Thanks TexasPhysician and Merovinge for your input. In regards to the child abuse piece - what I am particularly interested in is integrated care models where child psychiatrists are involved with pediatricians in the community to help develop programs for abuse prevention. In my experience, there is a lot of child abuse, especially in young children, that stems more from ignorance, frustration, and lack of resources than malevolent intent. One of my main interests in this area is developing programs, especially for young parents, new parents, single parents, and parents that otherwise fall into higher risk categories (like low socioeconomic status) that help them be successful parents. For example, helping them to understand what is and is not reasonable to expect from children at which ages, how to deal with high stress moments like tantrums or incessant crying, and potentially doing workshops and guided parent-child interaction sessions in a therapeutic setting. I'm also interested in how to help increase comfort level of pediatricians on how to screen for and identify signs of potential abuse, and how that could be effectively integrated into well-child visits. Since many children tend to manifest physical distress (rather than expressing psychological distress) after experiencing abuse, I think having the pediatric training would be useful for all aspects of this. Also, you would have a better understanding of typical outpatient pediatric care and therefore potentially be better able to develop programs that work well in an integrated care model.
In regards to developmental disabilities - I think both the research and training is really fractured and different in terms of what you get in developmental peds versus what you get in child psychiatry. Having seen these patients be managed in both settings, the approach is often quite different. Dev peds often focuses exclusively in the medical domain, whereas child psych operates in the psychiatric domain. They both prescribe anti-psychotics, stimulants, and other heavy duty drugs, but the methods behind choosing medication type and dose varies a lot between the two specialties. The other pieces is that kids with DD (particularly autism) often have both psychiatric AND medical comorbidities, many of the young adult patients with autism that I've seen also have diabetes, and/or high cholesterol or HTN, there are often also chronic GI issues, etc. Triple board seems like a way to get training that allows you to truly be the go-to physician for that patient - you will be able to prescribe drugs that help manage depression, anxiety and irritability and help them manage their medical complaints like chronic constipation or diabetes. Ultimately, you could also help build bridges between the world of developmental pediatrics and child psychiatry, which I think is going to be hugely important for kids and adults with DD.
Someone also mentioned not knowing how a couple months in PICU would help someone be a better child psychiatrist - but given that several of the child abuse cases I saw originally presented in the PICU, I disagree. I think it is incredibly valuable to see child abuse from first presentation, to understand how abuse is first identified, how things like court cases proceed, and how difficult the whole process is for them. These children have already experienced a traumatic or multiple traumatic events, usually caused by someone that is supposed to be one of their primary sources of love, protection, and support. They then have to cope with feeling like they "caused" the investigation, potentially going into foster care, and also potentially having to testify in court. I think it really important for a child psychiatrist to have exposure to this process first-hand.
Likewise, I spent a month in the NICU during 4th year, and for me understanding the many medical complications that can occur during a stay in the NICU was really valuable in terms of understanding the later medical and developmental disabilities that can occur for preemies. People tend to view infants as these really simple beings with simple needs, but they are incredibly complex and are at a stage where the most important neurological development is occurring. Having someone with both pediatric and child psychiatry training help assist NICUs in creating therapeutic environments that cause the least amount of stress possible I think would be extremely valuable. Also, having someone with both peds and child psych training there to provide outpatient support as parents make the difficult transition from having their child in the NICU, potentially for several months, to bringing that child home, would also be very valuable.
