Division of Developmental Medicine

• To prepare fellows for academic leadership careers by providing them with the requisite skills to become outstanding clinicians, innovative translational researchers, and inspiring teachers
• To provide fellows with a theoretical and practical framework for assessing challenges in child development, intellectual, and social functioning, and working with families to optimize children’s development within family and community settings
• To provide fellows with a fundamental body of knowledge from neuroscience to behavioral pediatrics, including aspects of neurophysiology, neuroradiology, psychopharmacology, and behavioral therapies

The Developmental-Behavioral Pediatrics Fellowship Program is a comprehensive three-year ACGME-accredited program that provides comprehensive clinical, didactic, and research training in Developmental-Behavioral Pediatrics and associated fields including genetics, metabolism, neurology, and psychiatry. The program is designed to provide outstanding clinical experiences coupled with mentored research opportunities tailored to each trainee’s chosen area of concentration. All trainees develop expertise in the diagnosis and treatment of developmental disorders including attention problems, autism spectrum disorders, language disorders, learning disabilities, and intellectual disability, along with elective areas of their choice. Read on for more details.

• Developmental-Behavioral Pediatrics Fellowship Program Brochure.
• Neurodevelopmental Disabilities Residency Training Program Brochure.

The DBP fellowship program begins with a primarily clinical first year, during which trainees learn about a range of developmental and behavioral pediatric conditions in both hospital and community settings. Fellows further refine their research project focus within the first year with support of a research mentor, and then spend two months at the beginning of their second year participating in an intensive research experience in the clinical research program at the Harvard T.H. Chan School of Public Health. Each fellow uses the final two years of the fellowship to develop an area of clinical expertise while conducting a mentored research project and gaining knowledge and skills in quality improvement.

Fellows develop their clinical skills as members of multidisciplinary assessment teams and as pediatric consultants in both hospital-based and community settings. Trainees work with their patients longitudinally in a weekly follow-up clinic as well as in specialty programs including the Autism Language Program and the ADHD Program. Elective experiences may include clinical rotations in the Adoption Program, Down Syndrome Program, Fragile X Clinic, Growth and Nutrition Clinic, Neurofibromatosis Program, Psychopharmacology Clinic, Sleep Clinic, and a variety of other clinical programs at Boston Children’s. All fellows also participate in the Advocating Success for Kids (ASK) Program, providing consultative DBP services in community health centers. Fellows also often act as developmental consultants for local school systems or private specialty schools with staff supervision.

DBP fellows participate in weekly research seminars comprised of didactic sessions, journal club, and skills training in research design, methods, and analysis. Each fellow will work directly with a research mentor to develop and implement a scholarly work project, and present their research quarterly to the division during Works in Progress sessions. Fellows may have an opportunity to pursue an MPH at the Harvard School of Public Health or pursue more intensive research experiences beginning the summer at the end of their first year of fellowship. Fellows progress toward completing their scholarly work, culminating in presentation at regional and national meetings and preparing a manuscript for publication by the third year of their training. Each fellow’s progress is monitored by the Scholarship Oversight Committee including two formal project presentations each year.

Research opportunities

Current research projects in the Developmental Medicine Center include a variety of topics encompassing topics and methods in basic science, translational, clinical and health services research.

Fellows participate in formal didactic sessions reviewing research design and basic statistical approaches. Fellows have access to methodologists and statisticians to assist in planning studies and analyses, and when appropriate, research assistants may be assigned to help them with aspects of their research. Research computers and standard statistical software are available for use by fellows in all the programs.

Examples of current research in the division include:

• Developmental screening in primary care
• Genetics of autism
• Effects of early institutionalization on child development
• Neurobehavioral research on infants at risk for autism and specific language impairment
• Electrophysiological, metabolic, and behavioral markers of infants at risk for autism
• Neural markers for the transition from risk for attention deficit/hyperactive disorders (ADHD) to stable diagnosis
• Evaluation of face processing in children with autism
• Neurocognitive outcomes of infants of diabetic mothers
• Linking music, language, and reading
• Catching dyslexia in pre-readers
• Office management of adolescent substance abuse
• Long-term outcomes of attention deficit/hyperactivity disorder
• Parent, provider, and teacher perspectives on quality of ADHD care
• Quality of life in children with ADHD
• Cross-cultural quality metrics for ADHD care

Recent Developmental-Behavioral fellows’ projects have included:

• Video game use and ADHD
• Factors impacting parental choice with respect to adoption of a child
• Implementation of an autism-specific screening tool in continuity clinic
• Predictors of receipt of an IEP for children with an autism diagnosis
• Use of complementary and alternative medicine and quality of life in children with cerebral palsy
• Effect of requiring parental consent on adolescent participation in substance abuse research
• Teachers’ perspectives on collaborating with parents and clinicians on caring for children with ADHD

Weekly seminars specifically geared to trainees in pediatrics and psychology address topics in developmental-behavioral pediatrics, behavioral neurology, child psychiatry, educational methodology for teaching, research methodology and professional development. Specific seminars in the Division address topics such as professional development, substance abuse, educational skills and advocacy. Optional additional coursework at the Harvard School of Public Health during the second and third year of training may provide fellows with preparation for research projects and culminates in a Master’s of Public Health. For those applicants who already have completed an MPH program, alternative research and educational experiences are available.

• Developmental Medicine Seminar: This comprehensive weekly seminar follows a rotating two year curriculum covering topics selected in accordance with the DBP content specifications for the board examination. The course covers developmental theories and normal development, attentional and learning disabilities, autism spectrum disorders, language disorders, cognitive impairment, toileting and sleep problems, basic principles of psychological and neurodevelopmental assessment, identifying pediatric mental health concerns, providing feedback to families, diagnostic coding and billing, and writing clinical reports. Additional topics include psychopharmacology, behavioral management, behavioral therapies for children with developmental disabilities, language and literacy, genetic syndromes, metabolic disorders, chronic illness, family functioning, cerebral palsy, spina bifida, sensory impairments, feeding problems, toxic exposures and outcomes, dental health, normal sexual behavior, sexual and physical abuse, substance use and abuse, special education law, and advocacy. The seminar includes one or two field trips per year where fellows visit community agencies, specialized schools, or other clinical programs.
• Principles of Behavioral Neurology for DBP: This weekly course covers topics such as development of the central nervous system; pediatric imaging of the central nervous system; key concepts in behavioral neurology; neuroscience for the clinician; and key diagnostic and therapeutic considerations in patients with epilepsy. It is taught by the Director of the Residency Training Program in Neurology.
• Principles of Psychiatry for DBP: This weekly psychiatry skills seminar provides fellows with technical supervision for acquiring clinical skills critical in DBP practice, such as diagnostic interviewing, generating differential diagnosis, and parent/child guidance training. The course also includes training in identification and treatment of psychiatric disorders including mood disorders, anxiety disorders, eating disorders, psychotic disorders, trauma, suicidality, character pathology, disruptive behavior and conduct disorders. Fellows learn about therapeutic modalities including play therapy, cognitive-behavioral therapy and psychopharmacology. It is taught by the previous director of the Psychiatry Residency Program.
• Substance Abuse Seminar: This quarterly seminar focuses on interdisciplinary discussions of substance abuse including epidemiology; screening, assessment and interventions; and outcomes. The interaction of genes and environment as well as contextual considerations in treatment are also discussed.
• Teaching Skills Seminar: This seminar provides an introduction to adult learning theory and guidance on specific skills development in lecture development and presentation, facilitation of case discussion, one-to-one clinical teaching, curriculum development, development of a teaching portfolio and evaluation techniques such as giving feedback to trainees. Faculty and professional development is provided as fellows are guided to maintain a teaching log and to develop a teaching portfolio compatible with the Clinician-Educator academic track at Harvard Medical School.
• Professional Development seminar: This seminar provides fellows with practical skills for managing professional careers especially in academics. Topics include professionalism, setting goals, time management, organizational skills, career-family balance, developing effective curriculum vitae, and job interviewing skills.
• Quality Improvement Curriculum: Beginning in the second year, fellows will become active participants in the Division’s robust Quality and Performance Program, which oversees all quality improvement activities. Fellows attend team leadership meetings and QI seminars, develop quality metrics for clinical outcomes and processes, review data for ongoing projects, and propose, implement, and present their own mentored QI project. Emphasis is on developing solid working knowledge of QI principles and strategies for rigorous and effective implementation.

Entry into the fellowship program is at the PL-4 level (fourth year post-M.D.) or later. Fellows receive a concurrent appointment of Clinical Fellow at Harvard Medical School as they participate in the teaching of medical students and house staff.

Applications and inquiries from physicians seeking training are always welcome. The Division is particularly interested in applications from highly qualified minority pediatricians. A visit to the Division and its programs will usually provide a comprehensive picture of the Division’s activities, clinical programs and an opportunity to meet with current fellows.

We participate in the DBP fellowship match. All applications should be submitted through the Electronic Residency Application Service (ERAS). For questions related to the match, please contact Rosetta Mojahed-Dacey via email or call 857-218-5642.

International candidates

International medical graduates may apply. However, our DBP fellowship is partially funded by the federal government, and stipends are generally limited to U.S. citizens or permanent residents. Due to limitations on faculty resources, we cannot accommodate observational experiences; all fellows must be fully licensed and credentialed so that they can participate in patient care. International fellowship applicants must have passed the ECFMG examination and have a valid, current certificate as a prerequisite to any other visa or license application. In addition, international applicants must be fluent in both written and spoken English. Inquiries regarding specific individual circumstances may be directed to Rosetta Mojahed-Dacey.

Inquiries can be made to:

Rosetta Mojahed-Dacey
Fellowship Coordinator, Division of Developmental Medicine
Email: Rosetta.Mojahed-Dacey@childrens.harvard.edu

Demetra Pappas, MD, MPH
Co-Training Director, Developmental-Behavioral Pediatrics Program, Division of Developmental Medicine
Email: Demetra.Pappas@childrens.harvard.edu

Boston Children’s Hospital
300 Longwood Ave., BCH3185
Boston, MA 02115
Office telephone: 857-218-5642