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Child and Adolescent Psychiatry Research

Dr. Carolyn HowellMany psychiatric conditions have their beginnings early in life. Diagnosing and treating ill children and young people are very important for the quality of the lives ahead of them. Our ambitious goal of preventing mental illness requires the discovery of complex causes and the development of earlier and more effective intervention. These aspirations have ramifications for mental health as a whole.

Our researchers investigate a broad range of psychiatric illnesses with faculty and staff across three campuses in Baltimore.The Division's efforts are also statewide, national, and international with collaborations reaching across the US, Canada, the UK, Ethiopia, Nepal and beyond. Research is funded by NIMH, SAMHSA, the State of Maryland, with private foundations and individual donors also providing generous support.The methods and approaches of our current research are varied, from molecular analysis, to neuroimaging, behavioral intervention testing, and clinical drug trials. Dr. Susan CarnellLearn more about the specific research projects of each principal investigator linked below the following general topic area descriptions.

ADHD | Anxiety Disorders | Autism Spectrum Disorder | Behavioral Medicine | Childhood Trauma | Community Outreach | Emotion/Self Regulatory Processes | Mood Disorders | Neuro-Developmental Disorders |Obesity/Eating Disorders | OCD and Neuropsychiatric Disorders | Schizophrenia | Substance Use Disorders

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is the most common behavioral diagnosis in childhood. It incurs high medical costs and can contribute to poor academic achievement, adult mental illness, substance abuse, and criminal behavior. Building on the long-standing observation that children with ADHD often demonstrate difficulties with motor control, several of our studies are measuring gains in cognitive and behavioral control using mindful movement training, especially Tai Chi. Other studies are examining the inhibitory and reward mechanismsin the brains of prepubescent children with ADHD and others are comparing attention, learning, memory, reward response, self control and motor skills in children with and without ADHD. Other research has focused on the association between ADHD and possible associations with other dysregulated behaviors such as binge eating. We are also examining ADHD-related sex differences and changes in brain structure and function into adolescence.

Investigators: Dejan Budimirovic, M.D., Matthew Burkey, M.D., Susan Carnell, Ph.D., Susan dosReis, Ph.D., Robert Finding, M.D., MBA, Bradley Grant, D.O., Lisa Jacobson, Ph.D., Carmen Lopez-Arvizu, M.D., Mark Mahone, Ph.D.., Stewart Mostofsky, M.D., Rick Ostrander, Ed.D., Alison Pritchard, Ph.D., Shauna P. Reinblatt, M.D., Keri Rosch, Ph.D., Karen Seymour, Ph.D., Rebecca Vaurio, Ph.D., Benedetto Vitiello, M.D.


Anxiety Disorders

Anxiety disorders are the most prevalent psychiatric disorders in youth. They are associated with severe disability, and are considered gateway disorders-- as they predict adult psychiatric illnesses. In order to expand data on the long-term effectiveness and cost-effectiveness of systematic efforts to prevent anxiety, a number of our researchers are working on a long-range follow-up of a preventive intervention for anxiety disorders in high risk offspring of anxious parents. Others are using a modular cognitive-behavioral intervention (M-CBT) with children in the Baltimore City School system to reduce excessive anxiety and improve their educational outcomes. Still others are testing breathing-oriented treatment for panic disorder in adolescents.

Investigators: Dejan Budimirovic, M.D, Marco Grados, M.D., Courtney Keeton, Ph.D., Mark Riddle, M.D., Roma Vasa, M.D.


Autism Spectrum Disorders (ASD)

Autism spectrum disorders (ASDs) are a class of neuro-developmental disorders characterized by impairments in social functioning and communication. The term 'ASD' encompasses autism, pervasive developmental disorder not otherwise specified, and Asperger's syndrome. Our researchers are studying the neuropsychological, learning and communication processes in autism across the lifespan, with particular focus on very early diagnosis, psychosocial and pharmacological interventions to improve functioning. Others are looking into co-occurring conditions associated with ASD including ADHD, anxiety and Down syndrome. Genetic and metabolic disorders that appear with autistic features that may offer a window into the underlying mechanisms for the development of an ASD are being explored as well.

Investigators: Lynn Bowman, M.A.Dejan Budimirovic, M.D., Robert Finding, M.D., MBA, Melissa Goldberg, Ph.D., Rebecca Landa, Ph.D., Rajneesh Mahajan, M.D., Stewart Mostofsky, M.D., Na Young Ji, M.D., Jennifer Zarcone, Ph.D.


Behavioral Medicine and Co-Occurring Conditions in Medically Ill Youth

Psychiatric illnesses, in combination with other medical conditions, often present special clinical challenges and sometimes offer clues that can guide research. For example, our researchers are investigating the brain-behavior relationships in children affected by hearing loss in order to develop appropriate assessment tools for behavioral conditions. The combination of medical and behavioral treatments seem to be most effective way to achieve the best outcomes. In line with this area of researcher, faculty are evaluating co-occurring disorders as moderators of treatment outcome in clinically complex patients, the development of emotion regulation in youth with co-occurring conditions (traumatic brain injury, epilepsy and seizures) and behavioral approaches to improve compliance with medical procedures, pharmacological treatments and life-style changes.

Investigators: Adrianna Amari, Ph.D., Jessica Hankinson, Ph.D., Mark Mahone, Ph.D., Rick Ostrander, Ed.D., Carisa Perry-Parrish, Ph.D., Jonathan Pevsner, M.D., Jennifer Reesman, Ph.D., Jay Salpekar, M.D., Keith Slifer, Ph.D., Matthew Specht, Ph.D., Beth Slomine, Ph.D., Roma Vasa, M.D., Andrew Zabel, Ph.D.


Childhood Trauma

Research efforts in childhood trauma are broad –spanning from neurobiology to social policy. The focus on neurobiology derives from emerging findings on the long-term effects of early stress on brain development and overall health and well being. The focus on social policy comes from strong evidence on the impact of the social environment in moderating the effects of early adversity. Research efforts include studies of mental health assessment and treatment outcomes, brain imaging, and genetic and environmental factors (e.g., trauma, social supports) that promote risk and resilience. Children who have been exposed to abuse, neglect, or multiple caregivers have alterations in their stress-responsive neurobiological systems. Some of our researchers are studying trauma as a factor in discovering biomarker profiles for children with disruptive behavior disorder and anxiety disorder/OCD.

Investigators: Lynn Bowman, M.A., Matthew Burkey, M.D., Deborah Gross, DNSc, Robert Finding, M.D., MBA , Joan Kaufman, Ph.D., Leslie Miller, M.D., Carolina Vidal, M.D., Albert Zachik, M.D.


Community and Primary Care Outreach

Our clinicians strive to integrate mental health considerations into primary care pediatric settings, to reach ethnic and underserved communities with services, and to care for patients and their families throughout the hospital who are coping with acute and chronic medical conditions. Some of these clinicians are also doing health services research to find the best ways to reach out and to impact young lives including parenting programs, partnerships with social services agencies and children in foster care. On a larger scale, others are studying health resources and services, forensic psychiatry, behavioral health screening, public health benefits of a teen depression education program as well as suicide intervention and prevention approaches.

Investigators: Shannon Barnett, M.D., Lindsay Borden, Ph.D., Matthew Burkey, M.D., Mary Cwik, Ph.D., Emily Frosch, M.D., Deborah Gross, DNSc, Jessica Hankinson, Ph.D., Joyce Harrison, M.D., Justine Larson, M.D., Dora Logue, M.D., Rick Ostrander, Ed.D., Maryland Pao, M.D., Carisa Perry-Parrish, Ph.D., Rheanna Platt, M.D., Cynthia Salorio, M.D., Cynthia Ward, Psy.D., Holly Wilcox, Ph.D., Larry Wissow, M.D., Andrea Young, Ph.D.


Emotion Regulation and Self-Regulatory Processes

A central goal of parents and clinicians alike is the achievement and maintenance of children’s healthy development. Development of emotion regulation in youth is both a sign of and explanation for adaptive psychosocial functioning. Children’s abilities to identify, understand, and integrate emotional information while simultaneously managing their behavior in accord with interpersonal (i.e., social) and intrapersonal (i.e., personal) goals is the essence of emotion regulation. Emotion regulation processes may be adversely affected by the presence of psychopathology (e.g., ADHD, mood disorders).

Investigators: Carisa Perry-Parrish, Ph.D., Karen Seymour, Ph.D., Leslie Miller, M.D., Elizabeth Reynolds, Ph.D.


Mood Disorders

Mood disorders such as major depressive disorder (MDD) and bipolar disorder (BPD) are associated with many negative consequences including suicide, the second leading cause of death among children and adolescents aged 12–17 years. We are part of a large multi-site study called the Longitudinal Assessment of Manic Symptoms (LAMS3). This study examines the progression of mental disorders from childhood to early adulthood by following the progression of elevated symptoms of mania using neuroimaging and neurocognitive testing to ascertain which psychiatric symptoms in early childhood are predictors of developing bipolar disorder. We are also home to multiple clinical trials for new safe and effective medications for major depressive disorder and bipolar disorder in children and adolescents as well as longitudinal studies to evaluate safety of drug treatments currently in use.

Researchers are also studying the effect of Interpersonal Psychotherapy (IPT) on youth diagnosed with disruptive mood dysregulation disorder (DMDD) and severe mood dysregulation (SMD). Youth with DMDD have chronically irritable and angry mood with excessive reactivity, manifesting as outbursts. These youth are at risk for significant impairment in multiple areas of functioning (school, peers, home). Our researchers are studying IPT with the goal of improving mood symptoms as well as interpersonal interactions. Researchers are also developing culturally sensitive diagnostic tools for disruptive behavior disorder in global child mental health.

Investigators: Dejan Budimirovic, M.D, Robert Finding, M.D. MBA,  , Bradley Grant, D.O., Elizabeth Kastelic, M.D., Leslie Miller, M.D., Rick Ostrander, Ed.D., Carisa Perry-Parrish, Ph.D. Matthew Burkey, M.D., MPH


Neurodevelopmental Disorders

Research on neurodevelopmental disorders includes a broad range of areas that impact the health of children. Our research includes the search for earlier genetic diagnosis of the rare Fragile X syndrome, Rett syndrome, Down syndrome, X-linked intellectual disabilities, Smith-Lemli-Opitz syndrome and other disorders. Researchers are also examining how to better assess and successfully treat severe behavior disturbance such as self-injury, pica, and aggression. Also being studied are developmental disorders such as autism and intellectual disabilities and how youth with these conditions may be at risk for disruptive behavior disorder. Additionally, clinical trials of medication to safely and effectively treat genetic disorders and sleep disturbances are also taking place. Descriptions of other neurodevelopmental disorders are also found throughout the topics in these research highlights.

Investigators: Lynn Bowman, M.A., Dejan Budimirovic, M.D., Michael Caltado, Ph.D., Robert Finding, M.D., MBA, Louis Hagopian, Ph.D., James C. Harris, MD., John Huete, Ph.D., Julia O’Connor, Ph.D., Mark Mahone, Ph.D., Griffin Rooker, Ph.D., Wayne Silverman, Ph.D., Elaine Tierney, M.D., Lee Wachtel, M.D.


Obesity and Eating Disorders

Childhood obesity affects about a third of children and adolescents in the U.S. and confers a significant risk for current and future health impairment, and eating-related conditions such as loss of control eating and binge eating disorder. Obesity in early/mid-childhood is common and may reflect a distinct, high-risk, early-onset form. Using a mix of behavioral and neuroimaging methods, our researchers are exploring weight- and eating- associated differences in eating behavior, cognition, and brain structure and function in children and adolescents. They are also studying the relationship between eating behaviors and comorbid disorders such as anxiety and ADHD. Research examining behavioral mechanisms, such as impulsivity, that may contribute to disordered eating like binge eating behavior, is another area of interest.

Investigators: Susan Carnell, Ph.D., Shauna P. Reinblatt, M.D.


Obsessive-Compulsive and Neuropsychiatric Disorders

Tourette’s syndrome and tic disorders are neurobehavioral disorders affecting 1% to 3% of children and adolescents. However, our researchers have found a specific behavioral intervention, focused on sustained reductions in tic symptoms, to be just as effective as medical treatments, but without the side effects that often accompany pharmacological treatment. Johns Hopkins is designated as a Tourette’s Center of Excellence. Other research focuses on evaluating co-occurring disorders (ADHD, OCD and anxiety disorders) as moderators of treatment outcome as well as developing and evaluating clinical algorithms for combining available empirically supported treatments for clinically complex patients.

Other research focuses on the genetics of Obsessive Compulsive Disorder in children. Studies include the familial phenotype of obsessive-compulsive disorder in relation to tic disorders and autism traits in children and adolescents with Cornelia de Lange syndrome. The pharmacological treatment of pediatric OCD is also studied here.

Investigators: Marco Grados, M.D., MPH, Mark Riddle, Ph.D., Matt Specht, Ph.D.


Schizophrenia

Schizophrenia is a chronic and devastating illness that often bringing with it hallucinations and delusions as well as deficits in emotion, motivation and social and cognitive functions. It typically appears in late adolescence and early adulthood, but growing evidence suggests that primary risks for the disease emerge during earlier neurodevelopment. At the molecular level, we are studying the cells of adolescents and young adults to characterize biomarker changes over the early course of psychotic disease. We are also conducting multiple clinical trials to determine the safety and efficacy of a number of drugs to treat symptoms in adolescents with schizophrenia or a related psychiatric disorder.

Investigators: Dejan Budimirovic, M.D, Robert Finding, M.D., MBA, Carolyn Howell, M.D.


Substance Use Disorders

Substance use in youth poses significant clinical and public health problems for youth and their families. Developing areas of research include youth who are at high risk of substance abuse disorders (SUD), the influence of social stress on risk-taking behaviors in adolescents, and the identification of biomarkers that predict SUD in youth.

Investigators: Christopher Hammond, M.D., Michelle Horner, D.O., Elizabeth Reynolds, Ph.D., Geeta Subramaniam, M.D.


 
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