Developmental & Rehabilitation Medicine

The division’s mission is to provide comprehensive and compassionate diagnosis and management for children with neurodevelopmental and behavioral problems that range from normative deviations to rare disorders; to educate health care professionals and trainees about these problems; to add to existing knowledge by researching relevant questions in the field; and to offer advocacy and influence public policy.

The Division of Developmental and Rehabilitation Medicine is composed of a diverse faculty of developmental-behavioral pediatricians, an integrative medicine (IM) pediatrician, and advanced practice registered nurses (APRN). Our clinical services occur in a number of settings – outpatient, inpatient, and in the community (e.g., schools, Connecticut Birth-toThree system, and other agencies). We provide direct consultation, optimal clinical care, and consultative services to schools and agencies across the state.

NEW CLINICAL STAFF

•Ana Garnecho, MD, joined the division in January 2020 to become the primary developmentalbehavioral pediatrician at the Norwalk Developmental

Center, a joint venture between Connecticut

Children’s and Norwalk Hospital, which is part of Nuvance Health™. Dr. Garnecho brought with her nearly a decade of clinical subspecialty experience as well as clinical site management skills. •Dana Eisenberg, APRN, joined the division in

January 2020. Her background is in early childhood education, with particular Montessori expertise.

NEW CLINICAL STAFF ROLES

•After a decade as division chief, Ann Milanese, MD, transferred that leadership role to Sarah Schlegel,

MD, in July 2020. •Dr. Garnecho assumed the role of Norwalk site director from Susan Dellert, MD. •Robert Keder, MD, became the division’s education director. He had been the division’s core faculty liaison for the residency program, but also managed formal division education opportunities at all training/learning levels (undergraduate, graduate, and continuing medical education). In addition, Dr. Keder has become one of the main “physician faces” at Connecticut Children’s during the pandemic, dedicating countless hours to pandemic-related marketing and communication efforts. He is also very engaged in legislative advocacy. •Thyde Dumont-Mathieu, MD, MPH, became the autism spectrum disorder (ASD) program director. She has worked to design a sustainable, efficient autism spectrum disorder evaluation algorithm within the division amidst pandemic turmoil. •Ana Verissimo, MD, became the integrative medicine director. She balances outpatient and inpatient integrative medicine consultation.

ONGOING CLINICAL PROGRAMS

•Dr. Keder continues as an embedded developmentalbehavioral pediatrician in two of Connecticut

Children’s primary care settings, serving the goal of enhancing collaboration and co-management with primary care providers as well as improving access to care for our highest risk patients and families. •The Transition to Adulthood with Developmental

Services Clinic, directed by Dr. Schlegel and serving patients 15 to 26 years of age and their families, celebrated two years of operation. Absolutely unique to Connecticut, only a few other similar programs exist in the United States. •For years, integrative medicine consultation provided by Dr. Verissimo has been an integral component of

Connecticut Children’s Nuss procedure protocol.

CLINICAL HIGHLIGHTS/ACCOMPLISHMENTS

•Following the abrupt Covid-19 pandemic “shutdown” in mid-March 2020, the division rapidly (within weeks) and efficiently converted from 100 percent clinic-based outpatient services to fully functioning, entirely-telemedicine service provision. At the height of pandemic disruption, only the integrative medicine inpatient consultation services had a brief hiatus; daily general pediatrics consultation to the Institute of Living inpatient child psychiatric unit has continued uninterrupted. •During spring/summer 2020, the division uncoupled with the Speech/Language Department for joint evaluations for autism spectrum disorders and developed a novel telemedicine-based autism spectrum disorder evaluation process. The Show Me Video Assessment for Telehealth was developed by Dr. Garnecho; Jennifer Twachtman-Bassett, MS, CCC-SLP, CCRP; and Dr. Dumont-Mathieu so the division could continue to conduct effective assessments of children between 18 months and 11 years of age who may have autism spectrum disorders. •Dr. Verissimo’s integrative medicine consultation has been incorporated into two clinical pathways: scoliosis and somatic symptom and related disorders.

ONGOING COMMUNITY-BASED CONSULTATION PROGRAMS

•For 20 years, Dr. Milanese has been medical advisor for many school districts all over Connecticut, this year renewing contracts with 13, including the

Connecticut Technical High School system. •Dr. Milanese has been the medical advisor for

Connecticut’s Early Intervention program, Birth-to-

Three, for nearly 20 years. • Dr. Milanese has been providing daily general pediatrics consultation to the Institute of Living inpatient child psychiatric unit since 1997. • Dr. Schlegel continues to direct the decade-old

School Consultation Service, conducting individual evaluations of medically and developmentally complex students within their school districts.

NEW COMMUNITY-BASED CONSULTATION PROGRAMS/ROLES

• Dr. Milanese acquired medical advisor contracts for two more Connecticut school districts. • Dr. Schlegel became the first medical director for

Cheshire Fitness Zone in October 2020. • Dr. Milanese was appointed by Connecticut Gov. Ned

Lamont to the Connecticut Interagency Birth-to-

Three Coordination Council.

EDUCATION HIGHLIGHTS/ACCOMPLISHMENTS

• Dr. Keder presented “The Curbside Consult Podcast:

All About ADHD [Attention-Deficit/Hyperactivity

Disorder]” and “Ask the Experts: Effects of Covid on

Child Development” in April 2020 and “Pediatricians in PJs: Management of Screen-Time Use in Children in the 2020s: A Toolkit for Pediatric Primary Care.” • Drs. Dumont-Mathieu and Garnecho co-presented

“Autism Assessments During the Covid-19

Pandemic” to Birth-to-Three in June 2020. • Dr. Dumont-Mathieu was interviewed on National

Public Radio’s “Where We Live” for an episode entitled “Teachable Moments: Discussing Racial Bias

With Our Children” in September 2020. • Due to the virtual modality in which it was provided this year, the Society for Developmental and

Behavioral Pediatrics (SDBP) Annual Meeting (October 2020) was attended by nearly the entire division. » At the SDBP Annual Meeting, Dr. Keder, who is a SDBP Advocacy Committee co-chair, presented two workshops (“Come Play With Us! Teaching the Art of Play for Developmental Promotion, Evaluation, and Community Engagement in the Face of a Pandemic” and “Advocacy in the Wake of a Pandemic: Finding Creative Opportunities in Crisis and Speaking Up for the Voiceless”), led a discussion session, and facilitated two professional networking activities. • In October 2020, Dr. Keder hosted a parent talk for the ASPEN Network entitled “Managing Screen Time in the 2020s: A Toolkit for Families with

Neurodiverse Children.” • Drs. Keder and Garnecho co-presented “Navigating

Autism in 2020: A Toolkit for Pediatric Primary Care” for the Andrulonis Child Mental Health Evening

Lecture Series in October 2020. • Dr. Verissimo co-presented “Sickle Cell Disease Self-

Management, Education, Coping, and Resilience:

Building a Toolbox Together” in the Division of

Hematology-Oncology in November 2020. • In February 2020, a peer-reviewed poster presentation entitled “Parent Perspectives:

Strategies to Promote Developmental Screening,

Referral to Early Intervention, and Service Provision

Across the Care Continuum” was presented at the

Maine Osteopathic Association Research Forum by medical student Joanna Sajdlowska (mentored by

Dr. Dumont-Mathieu), and in December 2020, Dr.

Dumont-Mathieu presented a poster from that same large dataset at the Administration for Children and

Families’ National Research Conference on Early

Childhood.

ONGOING RESEARCH

• Supported by research assistant Rosalie Lyons, BS, from the Division of Research, Dr. Dumont-Mathieu continues work on five research projects, two of which are grant-funded: » Bridging the Gap » Strategies to Promote Culturally Effective Screening, Referral and Service Provision in Primary Care Practices and Birth-to-Three Programs » Decision-Making Process and Experiences with Genetic Testing in Autism Spectrum Disorder: Pilot Study With a Clinically Derived, Diverse Sample of Participants (Co-I: Louisa Kalsner, MD, Division of Neurology) » Early Detection of Pervasion Developmental Disorders » Connecting the Dots: An RCT Relating Standardized ASD Screening, Intervention Access, and Long-Term Outcomes.

NEW RESEARCH

• Dr. Dumont-Mathieu was awarded a grant from the Connecticut Office of Early Childhood to begin

January 2021.

ACCOLADES

• Dr. Milanese was awarded “Outstanding Physician of the Year” from the Connecticut Children’s medical staff and was given the Department Citizenship

Award by Connecticut Children’s Physician-in-Chief

Juan Salazar, MD, MPH.

PUBLICATIONS

Dai YG, Porto KS, Skapek M, Barton ML, DumontMathieu T, Fein DA, et al. Comparison of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F) positive predictive value by race. J Autism Dev Disord. 2020 Mar 3;10.1007/s10803-020-044280. doi: 10.1007/s10803-020-04428-0. Epub ahead of print. Eigsti IM, Fein DA, Dumont-Mathieu T 3rd. [response] Questioning a previous autism spectrum disorder diagnosis: can you ‘lose’ the diagnosis? J Dev Behav Pediatr. 2020;41(6):499.

STAFF

Ann Milanese, MD, Division Chief (until June 30, 2020) Sarah Schlegel, MD, Division Chief (from July 1, 2020)

Susan Dellert, MD Thyde Dumont-Mathieu, MD, MPH Paul H. Dworkin, MD Ana Garnecho, MD Robert D. Keder, MD Ana Maria Verissimo, MD Dana Eisenberg, APRN Keith Ellis, APRN Mariel Zeccola-Swan, APRN Jennifer Twachtman-Bassett, MS, CCC-SLP, CCRP