Pediatric Developmental Disabilities (PDD) Clinic Fellowship
The goal of the fellowship in the Pediatric Developmental Disabilities (PDD) Clinic at Kennedy Krieger Institute and Johns Hopkins University School of Medicine is to enhance training for future psychologists in behavioral assessment and intervention for toddlers, children, and adolescents with diagnosed or suspected neurodevelopmental disorders who also have challenging behaviors. Fellows will receive training in behavioral assessment and intervention via didactic instruction and supervised and independent practice. Fellows will develop a broad array of relevant clinical skills which will prepare them to apply for jobs within the field of neurodevelopmental disorders.
Qualified candidates for the PDD fellowship program will have received their doctoral degrees in School, Counseling, or Clinical Psychology and have successfully completed an APA-accredited internship program.
Logistically, Fellows will have a full year of training in the Pediatric Developmental Disabilities Clinic. They will also have the option of participating in a minor rotation described below to further individualize their training specialization. Positions in each minor rotation are limited and will be determined by candidate interests, availability, and training background. One day per week will be devoted to activities in minor rotations.
Behavioral Psychology Department–Pediatric Developmental Disabilities Clinic
Throughout the year, Fellows will receive training in behavioral assessment and intervention. They will assume the role as primary therapists for their clients and families. Based on initial and ongoing assessment, they will develop function-based interventions to decrease problem behavior and increase appropriate replacement behavior. Throughout, family barriers to treatment are assessed, and methods to overcome obstacles are utilized.
Externalizing behavior challenges: Common target behaviors include tantrums, aggression, elopement, toileting skills deficits, and sleep concerns. Primary intervention is provided through behavioral parent training to implement interventions in the home and community.
Anxiety and internalizing behaviors: Comorbid internalizing disorders, occur frequently in our patient population (e.g., GAD, specific phobias, social anxiety, selective mutism, OCD, and cognitive inflexibility). Fellows will learn to use interventions, such as modified CBT, elements of the SPACE program (i.e., decreasing parental accommodation), and components of ACT when working with anxious youth and parents. Fellows will receive specialized training via didactics, workshop, and supervised experiences.
In treating children with both externalizing and internalizing disorders, traumatic histories may require additional attention. Fellows will receive didactic training in trauma-informed care.
Group skills therapy:
- Social skills and flexibility training. Fellows will also have opportunities to participate in group skills training utilizing curriculum such as Superheroes, PEERS, and Unstuck & On Target.
- Sports-based social skills: Our latest addition to social skills training has been to integrate social skills into an after-school soccer group.
- Spanish-speaking parent groups: Group training experiences also include behavioral parent training and support designed to meet the needs of families in which Spanish is their primary language.
Additional training activities: To prepare fellows as future supervisors, they will be able to participate in several activities. This will include: (1) didactic training via a workshop (live or via video), (2) shadowing supervisors, (3) providing direct individual supervision to Doctoral Interns in collaboration with a licensed psychologist, (4) providing feedback to interns to improve their supervisory skills.
Fellows will also engage in community outreach activities in which they will identify appropriate groups within the community, identify their training needs, and present interactive training to groups. These have included parent support groups for Autism and Down syndrome.
Fellows are provided with two hours/week of individual face-to-face supervision, and two hours/week of group supervision. Group supervision will include: topic presentations, formal and informal peer review, and presentations on the application of research to clinical work. Once a month fellows will participate in peer review with the Neurobehavioral Unit (specializing in treatment of severe behaviors). Fellows may also provide periodic consultation with schools and engage in interdisciplinary communications within and outside of the Institute (e.g., Developmental Pediatricians and Psychiatrists).
Fellows in the PDD clinic will have 17 patient contact hours per week with PDD clients. However, based on minor rotation training, appropriate reductions to patient contact expectations will be made.
Minor Rotation Options (1 day per week):
Assessment/Treatment of Feeding Disorders: Behavioral Psychology Department - Feeding Clinic (full year)
Fellows will receive training in the assessment and treatment of feeding disorders. Experiences will include addressing feeding challenges (e.g., increasing variety and volume of foods accepted, decreasing interfering mealtime behaviors, such gagging, and disruptive mealtime behaviors, transitioning from G-tube dependence to by mouth feedings). Fellows will conduct evaluations and diagnose feeding disorders. Evidence- based interventions are then developed and Fellows will train caregivers to implement behavioral strategies via onsite or video sessions.
Assessment: Executive Functioning Deficits and ADOS-2 Training (2 five-month rotations)
Executive Function Assessment (Neuropsychology Department): For a six-month rotation, Fellows participate in psychological evaluations through the Executive Function Clinic, which is housed within the Neuropsychology Department. Children seen in this clinic often have known or suspected developmental or medical conditions that can be associated with executive dysfunction. During the minor rotation, fellows spend every Wednesday in the Neuropsychology Department alternating between evaluation days and report writing days. Fellows present cases during rounds including the reason for referral/presenting problem, relevant background information, differential diagnostic considerations, and the proposed testing plan. Fellows participate in all aspects of the evaluation including interviews with patients and families, test administration and scoring, family feedback sessions, and report writing.
ADOS training (CARD- Center for Autism and Related Disorder) For the alternating six-month rotation, Fellows will receive training in conducting developmentally informed diagnostic interviews and administration of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In addition to administration and coding of the ADOS-2, Fellows will also engage in report writing and family feedback sessions. Training will also include participation in weekly seminar meetings and ADOS-2 calibration scoring. Because of time limitations of the minor rotation, Fellows will be encouraged to select concentrated training in one of the modules.
Minor rotation- Pediatric Interdisciplinary Clinic (full year)
Fellows will participate in two days of interdisciplinary experiences each month and will conduct behavioral evaluations with an emphasis on developmental functioning. Summaries will be presented during the Interdisciplinary Meetings with recommendations provided by the Fellow. The interdisciplinary team consists of Developmental Pediatrics, Psychiatry, Speech Pathology, Neuropsychology, Occupational Therapy, and Genetics. Each discipline will also be presenting findings and recommendations for care. Children who receive treatment in the Preschool Interdisciplinary Clinic are usually followed until they are 6 years of age.
Minor rotation: Clinical Outcomes Research (full year)
Fellows will assist in research projects to assess and improve treatment outcomes for our patients. For example, prior project has included assessing outcome equivalence between onsite and telehealth behavioral sessions. Data collection, management, and analysis may be utilized to support improvement initiatives within clinical programs. Fellows will gain experience in utilizing administrative and clinical data to assess factors impacting behavioral treatment for medium-to-large clinical populations. They may also utilize analytical methods for health services and comparative effectiveness research. There may be academic products stemming from these efforts in which fellows may be part of, depending on their contributions and degree of involvement.