Thursday, November 24, 2011

University of Minnesota Medical School, 1 Fellowship in Pediatric Neuropsychology

The Pediatric Neuropsychology unit of the Division of Behavioral Neuroscience provides a diagnostic service for children with complex learning and behavioral disorders, both neurological and neurodevelopmental in etiology. Children are referred by schools, clinics, practitioners in the community, and medical staff at this hospital. This unit serves the community, state, five-state area, and for specific disease entities, the entire country. The clinical orientation of the faculty is developmental.

Our approach to neuropsychology is to integrate knowledge from neuropsychological testing with data from neurological, imaging, neurophysiological, and laboratory studies to quantity functional deficits in the context of the central nervous system using a developmental framework. Clinical Service: Neuropsychological diagnostic services are provided for children with neurodevelopmental disorders such as attention deficit hyperactivity disorder, dyslexia, learning disabilities, developmental aphasia, autism, and intellectual disability, and for neurological disorders such as epilepsy, Tourette Syndrome and other movement disorders, head trauma, sequelae of infectious diseases such as meningitis and encephalitis, neurotoxic conditions, congenital disorders such as agenesis of the corpus callosum and hydrocephalus, degenerative, metabolic, and genetic disorders, CNS effects of cancer and its treatment, and migraine and tension headaches. Opportunities exist for fellows to participate in specialty clinics, including: craniofacial clinic, neonatal follow-up clinic, oncology long-term follow-up clinic, and selected others. Psychiatric disorders such as depression, anxiety, and conduct disturbances especially in children with possible attentional and learning difficulties, and somatoform disorders are also commonly seen. For a diagnostic evaluation, cases are scheduled for two half day visits in the Pediatric Neuropsychology clinic. A staffing is done between the two visits to discuss initial data and to plan for the second visit. Many of the cases are also seen by one of the faculty pediatric neurologists.

Our neuropsychology service is an integral member of our multidisciplinary autism center. Interested fellows can develop skills in assessing autism spectrum disorders through training in the administration of the Autism Diagnostic Observation Schedule and participation in weekly case conferences with a developmental/behavioral pediatrician, neuropsychologist, and behavioral psychologist. Goals of the Fellowship: Our mission is to train pediatric neuropsychologists both as practitioners and as scientists. Although the experience is clinically based, it is quite research and academically oriented. This is an expanding field with a rapidly growing knowledge base that is the direct result of advances in technology in imaging, measurement of behavior and cognition, neurophysiology, and genetics. However, the field of pediatric neuropsychology is especially difficult because children are dynamic developing organisms often with different disorders than adults, different effects of abnormal conditions, and with both an increased vulnerability and an increased capacity to recover from disease conditions.

Training scientist-practitioners in this field is especially difficult for these reasons, but rewarding in the long term benefits accrued to children from the scientific information and clinical interventions provided. Clinical experience with a wide range of neurodevelopmental and neurologic disorders and establishment of a research direction for the Fellow can only be attained in an intensive two year program that will enable mastery of this large knowledge base.

Responsibilities of the Fellow: In our clinical setting, the Fellow in pediatric neuropsychology is expected to learn to integrate and organize information about the patient including medical and neurological data, neuropsychological assessment, educational information, and interview and history. The focus is not only on cognitive, but on behavioral and emotional aspects of the child's functioning. Both environmental and biological factors are considered in the evaluation of the child in this setting. Thus the Fellow is expected not only to learn the techniques of neuropsychological assessment, but also must be able to assess the emotional and social development of the child through interview and personality assessment techniques, both objective and projective. The Fellow is supervised on every case by a faculty neuropsychologist. The first visit which often consists of an intelligence test and a few other preliminary measures, is most often carried out by a psychometrist. However, the Fellow always carries out the detailed aspects of the evaluation at the second visit. The Fellow, together with the faculty, will, at the end of the second visit, interpret results to the parents, write chart notes, and prepare the report. In addition to the collection of data and the formulation of the case, the Fellow is expected to follow through with individual patients until appropriate resources in the community are mobilized. Many patients with neurological and neurodevelopmental difficulties are monitored periodically, together with a pediatric neurologist and/or behavioral pediatrician especially those followed on medication or those with specific interventions which need regular reassessment. Because this is a tertiary care center, monitoring treatments of rare and complicated disorders including transplant, neurosurgery, and experimental medications is also carried out, often as part of a research protocol. We have close collaborations with physicians in neurology, psychiatry, genetics, endocrinology, infectious diseases, oncology, ophthalmology, and other departments. Also, we have a strong emphasis on providing consultation and information for educational planning. Meetings with school personnel and telephone consultation regarding placement and interventions are an important part of the diagnostic process. We often consult with state agencies and attorneys regarding school-related issues for children with neurological and neurodevelopmental disorders. Occasional consultations on the inpatient pediatric and child psychiatry services as well as the psychiatric day treatment program are also available to the Fellow.

Education: Opportunities to learn about brain-behavior relationships from a developmental standpoint are abundant in informal and formal communication. Pediatric, Neurology, and Psychiatry Grand Rounds are optional according to the interests of the Fellow. At a monthly Test Conference, critical reviews of the latest measurement techniques are presented by Fellows and Interns. A case conference at which the Fellow is expected to present his or her cases is held weekly. This is a planning conference during which differential diagnosis is discussed for each patient and a diagnostic plan constructed for patients who are coming for their second visit. The neuropsychology seminar includes didactic presentations by the neuropsychology faculty, outside speakers, and topical presentations by Fellows. There is also a weekly journal club/research seminar for Fellows oriented toward helping them stay current on scientific literature, develop critical research skills, write papers and grants, and present their preliminary work. The Center for Neurobehavioral Development and the Center for Personalized Prevention Research in Children’s Mental Health also offer multi-disciplinary colloquia on a monthly basis, which Fellows are encouraged to attend. Altogether, four hours per week of didactics are required for Fellows. Advanced Fellows will obtain experience supervising graduate students in a training practicum, and in teaching other Interns and Fellows in Pediatric Neuropsychology. Research: Current and ongoing research in our department is extensive and includes studies of children with metabolic neurodegenerative diseases, cerebral malaria, autism, attention-deficit hyperactivity disorder, conduct disorder, temper tantrums, diabetes, prematurity, leukemia, and brain tumors, as well as normally developing populations. Studies in many of these areas include structural and functional neuroimaging as well as specialized approaches such as MR spectroscopy and diffusion tensor imaging. Additional research methods include event related potentials, clinical and experimental neuropsychological techniques, autonomic assessments, assessment of maternal risk factors, and quality of life outcomes. We are intimately involved with the Center for Neurobehavioral Development, a collaborative clinical/research center including the Department of Pediatrics and the Institute of Child Development, as well as the Departments of Psychology, Psychiatry, Neuroscience, and Educational Psychology. This center offers abundant research opportunities. The Fellow is required to be actively engaged in research throughout the fellowship, either independently or as part of a larger protocol. The Fellow should expect to spend approximately one day a week working on this project.

Mentorship: The Fellow chooses a faculty member for primary mentorship, to monitor and facilitate involvement in clinical and research activities. Often Fellows will select a mentor based on shared research interests and have the opportunity to develop some aspect of a faculty member’s program of research for themselves. These arrangements may be made prior to starting the fellowship if it is a position funded by a specific research program that the Fellow wants to pursue. Requirements: Applicants are expected to have a Ph.D. or Psy.D. from an APA-approved program, preferably in clinical or school psychology, and to have completed an APA-approved internship. It is expected that the applicant will have internship level training in child and neuropsychological assessment. The current Fellow salary is $32,000 for the first year and $34,000 for the second year with a possible increase for academic year 2012-2013. Benefits include health insurance (a family plan is available for a fee), some life insurance, 20 working days of vacation per year, and a $500.00 a year conference stipend. Fellowship contracts are on a yearly basis, with the expectation that Fellows will stay for two years. The time period is from September l to August 31.

To apply, send a letter of professional goals, a current curriculum vitae, two neuropsychological report samples, and three letters of reference (preferably two clinical supervisors and one academic/research mentor). Application deadline is January 31, 2012. Application materials should be sent to: Richard Ziegler, Ph.D. Associate Professor of Pediatrics and Neurology Section Head for Pediatric Neuropsychology MMC 486 420 Delaware St, S.E. Minneapolis, MN 55455