Toddler Clinic
Faculty: Susan Hill, ARNP
This rotation provides a concentrated learning experience with young children. This clinic serves toddlers and preschoolers referred for a variety of initial concerns, including hyperactivity, aggression or developmental delays. The residents learn to administer developmental screening procedures, to assess temperament variations, and to complete a comprehensive assessment and treatment plan for children under the age of five years. The clinic has an initial evaluation component and a clinic for follow-up appointments.
A. This required rotation is in the first year of training, occurring at institution 1 and requires 10% of the resident’s time
B. Faculty consists of one advanced nurse practitioner from the Division of Child and Adolescent Psychiatry.
C. Residents see new and follow up patients for evaluation, diagnosis and treatment in the outpatient setting. The treatment plans can include parent training, play therapy, medication management, family therapy, or referral for more specific interventions, such as Parent Child Interaction Therapy.
D. This clinic has 41% females and 59% males, ranging from 2 to 5 years of age. About 66% are Caucasian, 30% African American and the remainder of Hispanic background. Patients come from various socioeconomic backgrounds. Diagnoses include ADHD (48%), mood disorders (4%), anxiety disorders (3%), adjustment disorders 11%), and pervasive developmental disorders (33%). Special emphasis is given to the assessment and understanding of aspects of their temperament, developmental stage, and relationship to their caregiver and how these related to their symptoms. Treatment modalities used parent education and training; family therapy; play therapy; nutritional supplementation, and medications.
E. On average, a resident conducts one new assessment per week and 2 to 4 follow-up patients.
F. All new and follow up patients are discussed with the faculty on an individual basis before any recommendations are made to the patient and family. Faculty is present throughout the visit.
G. Following are the goals and objectives for this rotation:
Goal: To provide outpatient care to toddlers and preschoolers with psychiatric disorders that is of high quality, with priority on safety and use of interventions with established effectiveness.
Objectives:
Knowledge:
- The resident will become familiar with the AACAP Practice Parameters for the Psychiatric Assessment of Infants and Toddlers.
- The resident will be able to list Chess and Thomas’ three clusters of temperament and the nine parameters by which they are measured.
- The resident will become familiar with the age criteria of DSM-IV-TR disorders which may apply to toddlers and preschoolers
- The resident will be able to list the Freudian psychosexual stages, the Eriksonian tasks, and Piaget’s cognitive stages of development in the toddler and preschool years.
- The resident will become familiar with the DC:0-3 (Zero to Three/National Center for Clinical Infant Programs, 1994) diagnostic classification system.
Skills: The resident shall be able to
- Demonstrate proficiency in conducting an initial psychiatric evaluation on children ranging in age from 2 years to 5 years to include the following components:
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A family interview to elicit the parental concerns and reasons for referral, a thorough pregnancy, birth, and developmental history, history and course of present concerns/ symptoms, history of child’s strengths and positive adjustments, a past medical history, a past psychiatric history, and a psychosocial history, including a thorough review of the family relational history (early bonding, parental perceptions and expectations f the child, exploration of each family of origin parenting styles, display of affection and discipline and parental early relationship histories).
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Assessment of parent-child interaction and play
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A standardized developmental assessment of the child using the Denver II screening tool
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An age appropriate mental status exam, which encompasses the emotional and developmental functioning of the child, and includes assessment of the Chess & Thomas nine traits of temperament (activity level, biological rhythms, approach/withdrawal, mood, intensity of reaction, sensitivity, adaptability, distractibility, persistence)
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Assessment of child in other settings (daycare, babysitter, pre-K, etc) through utilization of appropriate rating scales
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Diagnostic formulation including a synthesis of the biopsychosocial and cultural influences contributing to, maintaining, or ameliorating the toddler’s difficulties, and identification of the correct psychosocial stage of development (using the models of Freud, Erikson, and Piaget)
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- Develop a treatment plan which may include: outside consultations, diagnostic test, parent education, pharmacological management, and behavioral strategies to address the toddler’s problems
Attitudes: The resident shall demonstrate
- A non-judgmental attitude when interacting with children and their families.
- A compassionate and supportive attitude during interactions with children and their families.
- Interactions characterized by a professional and respectful manner with patients and their families.
