Pediatric Psychopharmacology Clinical & Research Program: Research Activities
Our neuroimaging program uses a variety of technologies to get a comprehensive understanding of the brain systems underlying childhood psychiatric. We use Magnetic Resonance Imaging (MRI) to produce detailed pictures of the structure of the brain by using magnets and radio waves, as well as Functional MRI (fMRI), which uses a similar technology to produce images of changes in brain function while a person is doing a task. We measure the chemical makeup of different parts of the brain by using Magnetic Resonance Spectroscopy (MRS).
Finally, our program images the brain using Positron Emission Tomography (PET), which measures the flow of different substances (including drugs or oxygen) in the brain. We have several current ongoing studies that use these methods. These include a study of the brain in adults who were diagnosed with Attention-Deficit/Hyperactivity Disorder in childhood, and who have been participating in our program for up to 20 years.
We also have a set of studies of patients at “high risk” for developing psychiatric disorders. These patients either have family members with psychiatric disorders or score high on questionnaires assessing problems with thinking and emotion. Our high risk imaging studies currently include assessments of people at high risk for affective disorders including depression and bipolar disorder. Additional ongoing neuroimaging studies are investigating young adults with high-functioning autism, and the brain systems underlying problems with controlling emotions.
Animal Model Program
We are using rodent models of Attention-Deficit/Hyperactivity Disorder (ADHD) for understanding the mechanisms of action of stimulant medications and the effects of long-term stimulant treatment on brain structure and function at cellular, molecular and system levels. The animal models offer unprecedented insight into the mechanisms of drug action in the central nervous system and permit us to design and develop safe and highly efficacious novel treatments for ADHD and other neuropsychiatric conditions.
Cognition is a central issue that affects all individuals regardless of their psychiatric diagnosis. Understanding the cognitive processes of individuals can be helpful in making recommendations for their education, vocation, and types of therapeutic interventions. Our Cognition Program strives to find commonalities and differences in individuals from the different disorders we study. Our studies on executive functions (the part of the brain that assists with attention, impulsivity, planning and organization) have been especially fruitful and helped to elucidate the impact of cognition on functional outcomes.
By understanding the cognitive processes within a particular disorder, we begin to understand more about brain functioning, which may lead to better treatment interventions.
Attention-Deficit/Hyperactivity Disorder (ADHD) Research Program
Our Attention-Deficit/Hyperactivity Disorder (ADHD) Research Program conducts research on all aspects of the disorder with a focus on the clinical course, neurobiology and treatment across the lifecycle This includes long term follow up studies examining the course of the disorder as children mature into adulthood, as well as retrospective studies of adults examining the course of ADHD during their childhoods. A very important aspect of our work is conducting studies of comorbid (co-occurring) psychiatric and cognitive disorders, as well as conducting genetic and neuroimaging research on ADHD across the lifecycle.
We also investigate the safety and efficacy of new and old treatments for ADHD and its associated conditions. We have recently focused our efforts on gaining a further understanding of the understudied area of defects in emotional self-regulation, also known as emotional impulsivity. Our program publishes dozens of scientific articles on ADHD every year.
Cognitive-Behavioral Therapy (CBT) Program
Through our Cognitive-Behavioral Therapy (CBT) Program, we study the helpfulness of CBT for children, adolescents, and young adults with a range of severe psychiatric disorders, including anxiety disorders, bipolar disorder, and autism spectrum disorders. CBT works on reducing distressing emotions and unhelpful behaviors by changing some of the factors that underlie these feelings and behaviors. These factors include unhelpful thoughts and responses that may inadvertently reinforce these feelings and behaviors.
The goals of CBT are to teach new coping skills and provide opportunities, both in session and between sessions, to practice these skills. Skills typically taught in CBT include identifying and modifying negative patterns of thinking, developing problem-solving skills, mastering relaxation and deep breathing, learning to pair feared situations with calm feelings instead of anxious ones, improving social interactions, and improving parent-child interactions. While prior research supports the use of CBT with youth, our program researches whether CBT can be helpful for youth who have not typically been included in studies of this treatment, including preschoolers and adolescents transitioning to adulthood. We are studying new CBT interventions for young adults with bipolar disorder and young adults with autism spectrum disorders. We also examine how to improve the efficacy of existing CBT treatments for children and adolescents.
Pediatric Anxiety Program
Our Pediatric Anxiety Program researches the causes, treatment, and prevention of childhood Anxiety Disorders. One way to study the factors that contribute to the development of psychiatric disorders is to follow a sample of children at high risk for developing the disorder. Children of parents with Anxiety Disorders are known to be at higher than usual risk for developing Anxiety Disorders themselves, so following these children over time can give us clues to which factors affect the development of Anxiety Disorders.
Our research team has been following a group of children of parents with Panic Disorder from toddlerhood through adolescence, exploring which genetic, neurological, temperamental, behavioral, and familial factors place children at higher or lower risk. For example, we pioneered work demonstrating that “behavioral inhibition,” a tendency to be shy, quiet, and hesitant in new situations or with new people during the preschool years increases a child’s chance of developing social anxiety disorder later in childhood. We have also identified other early factors that predict higher risk of Anxiety Disorders and have learned that some anxiety disorders begin quite early in childhood and, if untreated, persist over time. In collaboration with investigators at Massachusetts General Hospital and McLean Hospital, we have also been exploring the genes, brain function, and brain chemistry associated with behavioral inhibition and Anxiety Disorders.
Studies have shown that Anxiety Disorders in children and adolescents can be treated with Cognitive-Behavioral Therapy (CBT). CBT works by teaching children and their families to change some of the factors that lead to anxiety, including unhelpful fear-provoking thoughts, unhelpful coping strategies (such as avoiding feared situations instead of practicing facing them), and consequences that may inadvertently reinforce the anxious feelings. The goals of CBT are to teach new coping skills and to help children practice these skills in situations that make them anxious. Until recently, CBT was used mainly with children over 8 years, however understanding the factors that put children at risk for anxiety has helped us find ways to treat anxiety early in childhood, before the Anxiety Disorders begin to contribute to serious difficulties functioning in school or with friends.
We developed a Cognitive-Behavioral intervention for children ages 4-7 years and their parents, and showed in a controlled research study that this intervention led to reduced Anxiety Disorders and improved coping, even in these very young children. We are currently exploring ways to use this intervention to help young children with Autism Spectrum Disorders who also suffer from Anxiety Disorders.
High Risk Program
Our High Risk Program studies factors that contribute to the development of psychiatric disorders in childhood and adolescence. One way to study these factors is to do repeated assessments over time of children known to be at high risk for the developing a disorder. Because of genetics, children of parents with psychiatric disorders are at higher risk than children in general to develop their parents’ disorders themselves.
We have conducted numerous federally-funded studies following children of parents with psychiatric disorders. These have included a study of children at risk for Panic Disorder, a study of children at risk for Major Depressive Disorder and Attention-Deficit/Hyperactivity Disorder, and most recently, an ongoing study of preschool-age children at risk for Bipolar Disorder.
Our team has also conducted a study of older children at risk for Bipolar Disorder. In each of these studies, we explore which temperamental, behavioral, and familial factors place children at higher or lower risk for developing psychiatric disorders or difficulties in school or social functioning. We found that “behavioral inhibition,” a tendency to be shy, quiet, and hesitant in new situations or with new people during the preschool years increases a child’s chance of developing Social Anxiety Disorder later in childhood. In addition, we have pioneered research which found that “behavioral disinhibition,” a tendency to be talkative, approach-oriented, and exploratory in new situations increases a child’s chance of developing Attention-Deficit/Hyperactivity Disorder, Disruptive Behavior Disorders, school difficulties, and the combination of Behavior and Mood Disorders.
We have also been studying the role of factors like emotional dysregulation and the ability to intentionally control attention and behaviors to predict later difficulties. We collect data on pregnancy complications, parent-child relationships, family environment, and secondary disorders in parents, in order to explore their influences on child outcome.
In collaboration with investigators at Massachusetts General Hospital, McLean Hospital, and Massachusetts Institute of Technology, we have also been exploring the genes, brain function, and brain chemistry associated with risk for Mood and Anxiety Disorders in children. We have found differences in the brain chemistry of unaffected children at risk for bipolar disorder, and are currently looking at differences in brain function in children at risk for anxiety disorders, as well as differences in processing emotion among children at risk for depression.