CHILD MIND INSTITUTE
Dr. Harold Koplewicz and The Child Mind Institute Host Symposium on Psychology Research
By Sybil Maimin
More than 15 million children and teens in this country have diagnosable psychiatric disorders. About 50 percent of them do not get help. The Child Mind Institute, founded by Dr. Harold S. Koplewicz and Brooke Garber Neidich, is determined to transform the diagnosis and treatment of childhood psychiatric and learning disorders to family-focused approaches based on the latest clinical studies and scientific research. Committed to healthy brain development, the Institute hosted a scientific symposium recently and presented its 2011 Distinguished Scientist Awards to Dr. Jerome Kagan, the Daniel and Amy Starch Professor of Psychology Emeritus at Harvard, and Dr. Judith L. Rapoport, founder and chief of the Child Psychiatry Branch at the National Institute of Mental Health (NIMH). Celebrated as “giants” in their fields, the two doctors have produced major findings that have changed the way children’s psychiatric disorders are understood and treated.
A developmental psychologist, Kagan has shown that temperament is influenced by the interaction of genetics and environment, not just environment alone, as previously believed. A mix of family history, culture and biology shape personality. He notes that environment “determines what we worry about;” before there were schools, attention deficit hyperactivity disorder (ADHD) was not recognized. He saw the influence of biology during field work in a small indigenous village in Guatemala in 1970 where local children showed many of the same traits and exhibited similar developmental milestones in their early years as New York City youngsters. Dr. Kagan has written a book, “The Temperamental Thread: How Genes, Culture, Time and Luck Make Us Who We Are” (2010), that compares personality to a fabric woven with threads from the many aspects of our being, from both nature and nurture.
Rapoport and her clinic investigate the neurobiology and treatment of psychiatric disorders in children, including childhood-onset schizophrenia, ADHD, and obsessive-compulsive disorder. Early in her career, she decided to enter research, where she could design and conduct studies. One of her first clinical papers, produced during a fellowship at Karolinska Hospital in Stockholm, Sweden, concerned American women who came to Sweden for easy-to-obtain abortions. It was “interesting” and she realized, “I wanted the immediacy.” She has spent most of her career at NIMH, conducting “so many fascinating studies.”
One trial raises “a serious issue,” she said. In a study of ADHD children and drugs, she included non-ADHD children to participate as placebos. All the children took the stimulants and all were affected. The non-ADHD participants improved their studies with better focus, reaction time, and use of vocabulary. She noted that college students sometimes take drugs such as Ritalin to enhance performance on exams. The use of drugs by adults as well as children is increasing, she said, because the effect on performance has been noticed. Rapoport has done important work on OCD, showing that the behavior is not psychological but a brain functioning disorder that can be controlled with drugs and behavior therapy. Half of the people with OCD are under age 15. The most common manifestations are obsessions with cleanliness and with punctuality. “It is important to distinguish between a disorder and a habit,” she cautions. Her book “The Boy Who Couldn’t Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder” (1998) was the first on the subject for general readers.
Initially, both doctors were discouraged from specializing in child psychology research. Kagan was told it was “soft” and of no value because a child is simply shaped by environment. Rapoport considers her choice lucky because becoming a child psychiatrist was rare when she started, with few people interested in doing research. Much has changed, and Koplewicz asked where the field is going. Today, development is driven by technology, explained Kagan. He hopes to see work in deep brain stimulation, brain imaging and complex analysis, and specificity in circuits. He would like methods to measure emotions that he believes would lead to important gains in the study of the brain. The development of new pharmacological treatments has stalled, he reports. Progress in understanding and treating childhood psychiatric disorders has been impressive since Kagan and Rapoport began their careers and their findings offer a solid foundation for future work.#
