The Duke Center for Autism and Brain Development (DCABD) is part of the Duke University School of Medicine Department of Psychiatry and Behavioral Sciences and includes both research and clinical missions, some of which are supported by Duke University Hospital. We aim to model family-centered, collaborative care for our trainees, so that they may become competent, ethical, and compassionate providers.
We serve a wide range of patients, from infancy through young adulthood, from a diverse array of socioeconomic and ethnic/racial backgrounds. Families visit from across the Southeast and internationally. Trainees have backgrounds either in Psychiatry (e.g., medical students, child psychiatry residents and fellows) or Psychology (e.g., graduate practicum students in clinical and school psychology, predoctoral interns, postdoctoral fellows). Referrals to the DCABD generally come from primary care providers and medical specialists at Duke and in the community, local schools, or community agencies.
Interns and fellows have opportunities to blend experiences from both research and clinical areas. While our primary focus in assessment is evaluating for ASD and other developmental concerns, training experiences also include the consideration and evaluation of co-morbid disorders, such as Global Developmental Delay or Intellectual Disability (ID), Attention-Deficit/Hyperactivity Disorder (ADHD), and anxiety and mood disorders. DCABD clinicians and trainees conduct diagnostic evaluations, behavioral/cognitive-behavioral therapy, and outreach. Training in parent-coaching early intervention is also provided. Our interdisciplinary clinical team includes licensed psychologists, medical providers (e.g., psychiatrists, pediatricians, nurses), and social workers. Our team works closely with a wide range of subspecialty providers, including neurology, gastroenterology, and medical genetics, as well as with Duke primary care providers.
Trainees are part of a diagnostic evaluation team that includes individuals from across training levels. Roles are based on a developmental model - as team members learn new assessment measures, their responsibilities increase within the team. By the middle of the year, the intern leads the team under supervision from the postdoctoral fellow and supervising psychologist. This ‘umbrella supervision’ structure allows for the intern and fellow to assume increasing peer supervision responsibilities, preparing them for their roles as licensed psychologists. In addition to test administration, scoring, and interpretation, trainees also develop their skills in conducting a thorough developmental interview, thinking critically about the diagnostic criteria of ASD, differential diagnosis between other disorders, and consultation with schools and other medical providers (e.g., working with Duke Primary Care clinic to develop visual schedules for standard office visits). Weekly interdisciplinary case conference meetings provide the opportunity to present and seek feedback on challenging cases and topics in a group format.
Practicum students, interns, and fellows provide therapeutic services to individuals with ASD, including interventions focused on parent coaching, emotion regulation, social skills, parent-child interactions, and cognitive flexibility. As trainees are generally involved in both assessment and intervention experiences, the therapy caseload ranges from about 2-6 patients per week, with case assignments geared toward individual training goals.
Additionally, interns also spend time in other clinics, including the Duke ADHD Clinic and Psychosocial Treatment Clinic. Interns also participate in weekly didactics with fellow interns from other tracks, with a focus on using current literature to stay up-to-date on evaluation and therapy techniques. Interns also participate in a unique family therapy training rotation with psychiatry residents and other interns (Family Studies Clinic). Pairs of interns and residents conduct the therapy while the rest of the team and the supervisor observe behind the one-way mirror, allowing for live supervision and en vivo feedback for the trainee therapists. These experiences allow for breadth outside of the realm of ASD and ID, which shapes trainees into being well-rounded child mental health clinicians.
Postdoctoral fellows, in addition to taking on a more advanced leadership role in the training clinic, are likely to see more complex treatment cases. They may also spend time working on research projects, and gain additional experience in peer supervision. Previous psychology interns and postdoctoral fellows have gone on to hold faculty and other positions at Rush University Medical Center, University of Minnesota, Virginia Institute of Autism, Children’s Hospital of the King’s Daughters, Cone Health Medical Group, and Duke University Medical Center, University of North Carolina, to name a few.
With regard to research opportunities at DCABD, we are committed to comprehensive, cutting-edge research. Current studies include clinical trials evaluating the efficacy of cord blood in improving outcomes for children with ASD, and of medication in improving social functioning for individuals with ASD. Additionally, Duke was recently awarded funding as an NIH Autism Center of Excellence (ACE), and aims to improve screening, diagnosis, assessment, and treatment of children with ASD and/or ADHD.
Nicole Heilbron, PhD