Child Study Center Research Articles

Responding to Childhood Trauma: Developing and Learning from Collaborations Beyond the Consulting Room

ABSTRACT Whether within or outside of the psychoanalytic consulting room, when individuals or professional groups can recognize their limitations in addressing familiar challenges and have the opportunity to find partners to explore and understand the underlying sources of their distress, opportunities for new adaptive solutions emerge as well. Shared concerns about the challenges of violence exposure and childhood trauma formed the basis of what at first seemed an unlikely collaboration between psychoanalysts and other clinicians at the Yale Child Study Center and members of the New Haven Police Department. This paper will describe the development of the Child Development-Community Policing partnership and later, our engagement with policymakers. The story of how these collaborations emerged illustrates ways in which the application of the most basic psychoanalytic principles of listening, close observation, and collaborative learning led to the development of early intervention and clinical treatment that have helped to advance the field of childhood trauma. Mobilizing these collaborative efforts outside of the consultation room has, most importantly, led to a far greater number of traumatized children who no longer need to remain alone in the immediate aftermath of the traumatic realization of their worst nightmares.

Structural differences among children, adolescents, and adults with attention-deficit/hyperactivity disorder and abnormal Granger causality of the right pallidum and whole-brain.

Attention-deficit/hyperactivity disorder (ADHD) is a childhood mental health disorder that often persists to adulthood and is characterized by inattentive, hyperactive, or impulsive behaviors. This study investigated structural and effective connectivity differences through voxel-based morphometry (VBM) and Granger causality analysis (GCA) across child, adolescent, and adult ADHD patients. Structural and functional MRI data consisting of 35 children (8.64 ± 0.81 years), 40 adolescents (14.11 ± 1.83 years), and 39 adults (31.59 ± 10.13 years) was obtained from New York University Child Study Center for the ADHD-200 and UCLA dataset. Structural differences in the bilateral pallidum, bilateral thalamus, bilateral insula, superior temporal cortex, and the right cerebellum were observed among the three ADHD groups. The right pallidum was positively correlated with disease severity. The right pallidum as a seed precedes and granger causes the right middle occipital cortex, bilateral fusiform, left postcentral gyrus, left paracentral lobule, left amygdala, and right cerebellum. Also, the anterior cingulate cortex, prefrontal cortex, left cerebellum, left putamen, left caudate, bilateral superior temporal pole, middle cingulate cortex, right precentral gyrus, and the left supplementary motor area demonstrated causal effects on the seed region. In general, this study showed the structural differences and the effective connectivity of the right pallidum amongst the three ADHD age groups. Our work also highlights the evidence of the frontal-striatal-cerebellar circuits in ADHD and provides new insights into the effective connectivity of the right pallidum and the pathophysiology of ADHD. Our results further demonstrated that GCA could effectively explore the interregional causal relationship between abnormal regions in ADHD.

Rage

Rage Hollee McGinnis (bio) Survival (avoidance and fear), moved to rage (acknowledgement and seeing the truth of what is), returned me to centeredness. I write: Fires out.But the embersStill glow. I don’t knowWhich wayThis will go. The fireHas consumedAll that I had to give. I am now left tired.No energy.A vague senseof dread. Rage is an alright emotion,But it tires outToo quickly. I am left empty.What else instead? [End Page 141] Eyes wide openThat things willContinue to go this way. Until we areTruly able to sayto each other: “You are myBrothers and Sisters.I would NEVERTreat you this way.” You can haveYour likes and dislikes,Your good days and bad. But pleaseSTOP KILLINGBecause you are mad. Instead, turn that rageTowards the hurt that you carry,To a culture that also says“You are not good enough for any . . .” There within youis where to beginTo learn to grow love,accepting yourself,And then each other,as family and kin. —Hollee A. McGinnis, a.k.a. Lee Hwa Yeong March 17, 2021, Atlanta Massacre [End Page 142] Hollee McGinnis hollee mcginnis, MSW, PhD, is an assistant professor at Virginia Commonwealth University in the School of Social Work. She has over twenty-five years of community, policy, and research experience on the life course of orphaned and separated children in alternative care. Prior to her doctorate at Washington University in St. Louis, Dr. McGinnis was policy director at the Donaldson Adoption Institute. She received her master of science from Columbia University School of Social Work, and a post-master’s clinical fellowship at the Yale Child Study Center. Adopted from South Korea, in 1996 she founded Also-Known-As, Inc., a non-profit adult intercountry adoptee organization. Copyright © 2022 Frontiers Editorial Collective, Inc

Rethinking Essential Services in the Wake of the COVID-19 Health Crisis.

During the COVID-19 global pandemic, Cook Children’s Health Care System needed a way to ensure that all employees had a reliable childcare option. This advocacy note details how Child Study Center, an applied behavior analysis facility in North Texas, transitioned into Camp Cook, a free-of-charge childcare facility that operates weekdays from 6:00 a.m. to 8:00 p.m. Closing the doors on our billable services allowed us to open them to the essential health care workers who were fighting on the front lines against COVID-19. Here we describe the redeployment of employees across 3 departments in an effort to ease the burden of childcare within our local community.

Gender-based functional connectivity differences in brain networks in childhood

Background and objectiveUnderstanding the effect of gender differences on the brain can provide important information to characterize normal changes throughout life and to increase the likelihood of sex-specific approaches for neurological and psychiatric diseases. In this study, Functional Connectivity (FC), Amplitude of Low-Frequency Fluctuations (ALFF) and fractional ALFF (fALFF) analyzes will be compared between female and male brains between the ages of 7 and 18 years using resting state-functional magnetic resonance imaging (rs-fMRI). MethodsThe rs-fMRI data in this study has been provided by The New York University (NYU) Child Study Center of the publicly shared ADHD200 database. From the NYU dataset, 68 (34 females, 34 males) healthy subjects in the age range of 7–18 years were selected. The female group (mean age: 12.3271±3.1380) and male group (mean age: 11.8766±2.9697) consisted of right-handed, small head motion and similar IQ values. FC was obtained by seed voxel analysis and the effect of low-frequency fluctuations on gender was examined by ALFF and fALFF analyses. Two-sample t-test was used to compare female and male groups with the significance thresholds set to FDR-corrected p<0.05. ResultsIn the results of our study, both in the ALFF, fALFF analyses and the seed regions belonging to many network regions, higher FC rates were found in girls than boys. Our results show that the females’ language functions, visual functions such as object detection and recognition, working memory, executive functions, and episodic memory are more developed than males in this age range. In addition, as another result of our study, the seed regions are statistically stronger where the higher activation of female participants than male participants has concentrated in the left hemisphere. ConclusionsGender differences in brain networks should be taken into consideration when examining childhood cognitive and neuropsychiatric disorders and the results should also be evaluated according to gender. Evaluation of gender differences in childhood can increase the likelihood of early and definitive diagnosis and correct treatment for neurological diseases and can help doctors and scientists find new diagnostic tools to discover brain differences.

Award for Distinguished Contributions to Research in Public Policy: Sandra J. Bishop-Josef.

APA's Award for Distinguished Contributions to Research in Public Policy is given to a psychologist who has made a distinguished empirical and/or theoretical contribution to research in public policy, either through a single extraordinary achievement or a lifetime of work. Sandra J. Bishop-Josef is the 2019 recipient of this award. Bishop-Josef "has produced high-quality research and worked tirelessly to ensure that psychological knowledge is effectively disseminated to improve the lives of children, youth, and families. From her early work on Capitol Hill, through her tenure at the Yale University School of Medicine Child Study Center and The Edward Zigler Center in Child Development and Social Policy, and now as Director of Research at Council for a Strong America, she has both produced and presented important findings in ways that maximize their impact on public policy in numerous areas, with an emphasis on early childhood education and child maltreatment." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

4.9 INTEGRATED PEDIATRIC AND MENTAL HEALTH CARE FOR CHILD REFUGEES: DESCRIPTIVE ANALYSIS AND REFLECTIONS FROM CLINICAL EXPERIENCE

The world is witnessing one of the largest refugee crises in modern history, with around 25.4 million refugees worldwide. Connecticut carries the second highest number of refugees’ settlement in the United States, with a range of 375–897 families settled yearly. However, child refugees (CRs) do not receive enough mental health care. Yale Child Study Center (YCSC), in collaboration with Yale Pediatric Refugee Clinic (YPRC) and Integrated Refugee and Immigrant Services, established an integrated Pediatric and Mental Health Clinic for CRs newly arrived at New Haven, Connecticut. In this presentation, we will discuss our experience and provide descriptive analysis of the examined population.

The Development of Hiroshima International School

Jean Piaget is well known as a child and cognitive psychologist. He is less understood as the founder of the discipline of genetic epistemology, the scientific study of the genesis and development of human meaning-making. He is also a major proponent of constructivist learning and activity pedagogy. A major supporter of the first international school, the International School of Geneva (which later developed the International Baccalaureate), and an early director of both the world’s first child study center, the Jean-Jacques Rousseau Institute, and the International Bureau of Education (later a part of the United Nations Educational, Scientific, and Cultural Organization), Piaget was deeply committed to student self-government, collaborative, active learning, and peace education. In 1980 I became principal of the Hiroshima International School of peace and culture, and we used his seminal work, “The Right to Education in the Modern World,” based on Article 26 of the Universal Declaration of Human Rights, to create and sustain an authentic “international” school organization, curriculum, and pedagogical practice.

Disrupted Resting Frontal-Parietal Attention Network Topology Is Associated With a Clinical Measure in Children With Attention-Deficit/Hyperactivity Disorder.

Purpose: Although alterations in resting-state functional connectivity between brain regions have been reported in children with attention-deficit/hyperactivity disorder (ADHD), the spatial organization of these changes remains largely unknown. Here, we studied frontal–parietal attention network topology in children with ADHD, and related topology to a clinical measure of disease progression. Methods: Resting-state fMRI scans were obtained from New York University Child Study Center, including 119 children with ADHD (male n = 89; female n = 30) and 69 typically developing controls (male n = 33; female n = 36). We characterized frontal–parietal functional networks using standard graph analysis (clustering coefficient and shortest path length) and the construction of a minimum spanning tree, a novel approach that allows a unique and unbiased characterization of brain networks. Results: Clustering coefficient and path length in the frontal–parietal attention network were similar in children with ADHD and typically developing controls; however, diameter was greater and leaf number, tree hierarchy, and kappa were lower in children with ADHD, and were significantly correlated with ADHD symptom score. There were significant alterations in nodal eccentricity in children with ADHD, involving prefrontal and occipital cortex regions, which are compatible with the results of previous ADHD studies. Conclusions: Our results indicate the tendency to deviate from a more centralized organization (star-like topology) towards a more decentralized organization (line-like topology) in the frontal–parietal attention network of children with ADHD. This represents a more random network that is associated with impaired global efficiency and network decentralization. These changes appear to reflect clinically relevant phenomena and hold promise as markers of disease progression.

The Family Cycle: An Activity to Enhance Parents’ Mentalization in Children’s Mental Health Treatment

ABSTRACTThis article introduces the Family Cycle, a therapeutic activity informed by attachment theory, family systems theory, and current literature on reflective functioning. The Family Cycle helps clinicians and families create a narrative about a child’s psychopathology that considers complex trauma and/or adverse childhood experiences. It reframes observable dysfunctional phenomena as behavioral sequelae of more deeply rooted emotional loss. After the theoretical underpinnings of the Family Cycle are laid out, we describe the implementation of the Family Cycle within the context of an intensive home-based, family-focused intervention created at the Yale Child Study Center, the Intensive In-Home Child and Adolescent Psychiatric Service (IICAPS). The Family Cycle provides a teachable clinical framework to facilitate the treatment of families with complex, multigenerational trauma.

Pioneer of Education Reform to Present Distinguished Psychiatrist Lecture

Back to table of contents Next article Annual MeetingFull AccessPioneer of Education Reform to Present Distinguished Psychiatrist LectureMark MoranMark MoranSearch for more papers by this authorPublished Online:26 Feb 2019https://doi.org/10.1176/appi.pn.2019.3a38AbstractThe Comer Process is not a project or add-on, but rather an operating system—a way of managing, organizing, coordinating, and integrating programs and activities within a school around the principles of child development to foster an atmosphere of learning. “For years we have known that principles of child development are critical to everything that individuals, families, and communities need to thrive,” said psychiatrist James Comer, M.D., M.P.H., in an interview with Psychiatric News. “We know it, but we don’t teach it, and we don’t use those principles to create schools that promote healthy development.”James Comer, M.D., M.P.H., is a pioneer in educational reform who set out to integrate the principles of child and adolescent development with academic learning.Yale UniversityComer, possibly the most influential figure today in educational reform, will elaborate on his impatience for school reform in a Distinguished Psychiatrist Lecture at this year’s Annual Meeting in San Francisco, titled, “Why Are We Still Waiting? Resistance to Prevention and Promotion With Mental Health Issues.”Comer is the Maurice Falk Professor of Child Psychiatry at the Yale University Child Study Center. In 1968, he founded the Comer School Development Program (SDP), an innovative school reform initiative that integrates the principles of child and adolescent development with academic learning. The program has improved the educational environment in more than 1,000 schools throughout the country. In 2014 President Barack Obama appointed Comer to his Advisory Commission on Educational Excellence.The Comer SDP does not impose an intervention on a pilot school but rather relies on the stakeholders within the school—parents, children, teachers, and administration—to develop an organic model of change that facilitates student engagement, development, and learning.According to the website of the Yale Child Study Center, the Comer Process is not a project or add on, but rather an operating system—a way of managing, organizing, coordinating, and integrating programs and activities.“Three teams—the School Planning and Management Team (SPMT), the Student and Staff Support Team (SSST), and the Parent Team—work together to create a Comprehensive School Plan (CSP); to design and conduct staff development aligned with the goals of the Comprehensive School Plan; and to assess and modify the plan as necessary using a wide range of student- and school-level data to ensure that the school is continuously improving,” according to the website. “The teams are guided by three principles: decision making by consensus, no-fault problem solving, and collaboration. The process fosters positive school and classroom climate and creates optimal conditions for teaching and learning, and emphasizes the alignment of curriculum, instruction, and assessment.”In comments to Psychiatric News, Comer said that most schools focus only on the mechanical aspects of learning—memorize and regurgitate—while disregarding the social, emotional, and relational aspects of education.“The problem is that we have ignored the environment and the dynamics of child development,” he said. “What we have done [with SDP] is to focus on creating an environment that, to the extent possible, focuses not on what is wrong with kids, but what they need to function well in society.”When asked why there is such resistance to change, Comer replied: “The privileged don’t want to change, and that’s built into the system. It’s not a matter of taking from the privileged but creating a balance that works for most of the people most of the time.”Comer recalled that he started out training to be a generalist. But so many of the problems he saw afflicting patients lay outside the purview of standard clinical care—they were social and environmental in nature.This realization is what led him to psychiatry, then to child psychiatry, the Yale Child Study Center, and public health. Comer said he is pleased that APA is making that same realization about the social determinants of public health problems, as reflected in many of the sessions planned for this year’s Annual Meeting. ■“Why Are We Still Waiting: Resistance to Prevention and Promotion With Mental Health Issues” will be held Monday, May 20, from 3 p.m. to 4:30 p.m. ISSUES NewArchived

Mejora escolar, liderazgo y reforma sistémica: una retrospectiva (School improvement, leadership and systemic reform: a retrospective)

Mejora escolar, liderazgo y reforma sistémica: una retrospectiva (School improvement, leadership and systemic reform: a retrospective)

Media Talks: Communicating the Neuroscience Underpinnings of Popular Media Stories.

Media Talks: Communicating the Neuroscience Underpinnings of Popular Media Stories.

Family‐Based Recovery: An Innovative Collaboration between Community Mental Health Agencies and Child Protective Services to Treat Families Impacted by Parental Substance Use

To meet the needs of families who have very young children and are involved with child protective services due to substance use, the State of Connecticut Department of Children and Families, Yale Child Study Center and Johns Hopkins University created an innovative treatment model. This public–private collaboration required a paradigm shift for both child protective services staff and treatment providers. This brief description of the Family‐Based Recovery model highlights the family‐focused practice elements that allow children to remain safely at home with parents who are in treatment. Outcomes suggest that Family‐Based Recovery is a promising practice, and collaborations between child protective services and substance use treatment providers can yield positive results for families with young children.‘Highlights the family‐focused practice elements that allow children to remain safely at home with parents who are in treatment’Key Practitioner Messages Strong collaboration between child protective services and treatment providers can mitigate the risk of out‐of‐home placement for children impacted by parental substance use. In‐home treatment that provides concurrent psychotherapy, substance use treatment and parent–child dyadic therapy is an important part of the service array for families involved with child protective services.

Emerging Therapies: Communication, Consent, and Collaboration in Research-Based Treatment.

Emerging Therapies: Communication, Consent, and Collaboration in Research-Based Treatment.

Combining Aerobic Exercise and Speech Language Treatment for Aphasia Rehabilitation: A Case Study

Combining Aerobic Exercise and Speech Language Treatment for Aphasia Rehabilitation: A Case Study

The Implementation of Social Work Practice with Children in Indonesia

&#x0D; &#x0D; &#x0D; This study aimed at examining the implementation of social work practice with children in Indonesia. The research used qualitative method with a case study on nine informants who were Social Workers carrying out the task of handling children cases in the city of Bandung, Indonesia. The results showed that Social Workers had started to implement social work practice with children in handling 44 cases of children, but, according to social work practice standards with children as defined by NASW (2013) and based on pragmatic perspectives of social work with children according to Petr.CG 2004), it was not optimal. The implementation of social work practice with children was seen from aspects of practice: 1) building relationships with children should had been done with a consideration to the children’s ages; 2) assessment with children should had already used 'tools' assessment; 3) preparation of intervention plans was less involving children and families; 4) interventions was less responding to the needs of children and less applying behavior change techniques; and 5) the evaluation had not been implemented and supervised. Based on the research findings it is recommended for: 1) Training Center to provide training on the perspective of social work practice with children for Child Social Workers; and 2) Directorate of Child Welfare of the Ministry of Social Affairs to facilitate the implementation of supervision on child social work practice by supervisors; 3) Child Study Center to conduct further study on child social work practice based on clusters of child problems.&#x0D; &#x0D; &#x0D;

The Pirate’s Bed by N. Winstanley

Winstanley, Nicola. The Pirate’s Bed. Illustrated by Matt James. Tundra Books, 2015.Nicola Winstanley has produced a tale both whimsical and original in this picture book for children of kindergarten and primary school age. In brief, her story details the adventures of a seafaring bed that, by means of a shipwreck, escapes its obligations to a smelly footed pirate, washes ashore, and becomes the treasured hand-me-down of generations of landlubbers. Her story is strongly supported by Matt James’ boldly coloured, graphically descriptive, and humorous illustrations. There is an appealing, childlike quality to his various depictions: a bearded and gap-toothed pirate who sleeps with his teddy bear; waves that reach up with evil fingers to spill the pirates out of their ship; playful dolphins and a helpful gull who guide the bed through the waves. Observant children will notice, as well, that the bed is able to frown and smile as events unfold. The artist’s work would both engage and enrich the imaginations of most five-to-eight year olds. While Winstanley’s brevity of sentence length and simplicity of syntax are suited to the listening skills of most children in this age group, generally, only the older ones would have the reading skills necessary to handle such text as follows:“When the bed had lived on the ship, the nights had been full of the bright richness of the pirate’s life and imagination. Now nighttime was long and dark and empty….The bed floated, unencumbered, and wished for the weight of a sleeper” [p.20].Younger children would most fully appreciate the book in the context of a story hour or bedtime reading.Editor’s note: This book was also reviewed by students from the Child Study Centre’s Junior Kindergarten Program in the Faculty of Education at the University of Alberta in Vol 6, No 2 (2016) of the Deakin (http://dx.doi.org/10.20361/G2WP5H).Reviewer: Leslie AitkenRecommended: 3 out of 4 starsLeslie Aitken’s long career in librarianship involved selection of children’s literature for school, public, special, and university collections. She is a former Curriculum Librarian at the University of Alberta.

Sex differences in fear of pain: item-level analysis of the Fear of Pain Questionnaire III.

ObjectivesThis study aimed to investigate sex differences in fear of pain (FOP) measured by the Fear of Pain Questionnaire III (FPQ-III) in a nonclinical sample. The FPQ-III is a self-report inventory measuring FOP, with 30 items, divided into three subscales: Severe, Minor and Medical Pain.MethodsA total of 185 subjects participated (49.7% females) in this study. Sex differences on overall FOP, the subscales, and at item level were examined. One-way analysis of variance tested the association between sex and FOP, measured by overall FOP and the subscales. Ordinal regression analysis enabled item-level analysis of the FPQ-III and was conducted to explore further specificity of FOP in males compared to females.ResultsOverall FOP and fear of Severe Pain was significantly higher in females than in males, as measured by the FPQ-Total and the FPQ-Severe. Moreover, females were more likely to report higher FOP than males on 16 items (p<0.05). Further inspection revealed that females scored significantly higher than males on all items on the Severe Pain subscale. When controlling for multiple comparisons six items reached significance (p<0.001). Five of these items belonged to the subscale Severe Pain. When controlling for overall FOP one item, also from the Severe Pain subscale, reached significance (p<0.001).ConclusionThere are sex differences in severe FOP, with higher FOP in females compared to males. Potential explanations are sex differences in the 1) psychosocial mechanisms of fear and anxiety, and 2) emotional reactions to and interpretation of FPQ-III Severe Pain items.

Life, Death, and Mind-Body Medicine Across the Lifespan

Back to table of contents Next article EditorialFull AccessLife, Death, and Mind-Body Medicine Across the LifespanDavid Saunders, M.D.David SaundersSearch for more papers by this author, M.D.Published Online:10 Feb 2017https://doi.org/10.1176/appi.ajp-rj.2017.120201AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail On June 6, 2015, an African American man from the Bronx hanged himself in his bedroom while his mother rested quietly downstairs. He concocted a rope from strips of bed sheets, a technique honed during five previous suicide attempts as an inmate at Rikers Island, the adult penitentiary in New York City where he was detained for 3 years. Two of those years were spent in solitary confinement, where he tried to take his life several times.Wrongfully imprisoned at age 16, exonerated at 20, and dead at 22 by suicide, Kalief Browder's story is a tragedy of epic proportions.His death reverberates with the unifying theme of this issue of the Residents' Journal: the inextricable bond between mind and body in children and adolescents. In each article, the false dichotomy of mind and body is undermined in its own way, effacing the ersatz distinction between the physical and mental. The mind, as psychiatrists know, can suffer mightily from insults to the body. And our bodies, of course, are vulnerable to the torment of mental illness.But some minds and bodies are more vulnerable than others. Browder's case is so troublesome, in part, because a constellation of bodily and mental attributes and insults conspired to take his life too soon. Imprisoned as an adolescent at Rikers, he was one of the 6,000 minors detained in adult facilities that are inappropriate for youths and devastating to development (1). As an African American male, he was among the 1 in 3 black men that can expect to be incarcerated at some point in their lives, a rate six times higher than their white counterparts (2). As a body that was placed in “solitary confinement”—a euphemism for the barbaric practice of limiting social contact by isolating individuals in closed cells for 22 to 24 hours per day, for days to years on end—Browder endured the effects of a draconian method of cruel and unusual punishment. And of course, Browder suffered from mental illness. During and after his solitary confinement, he began to experience severe depression and debilitating paranoia; all of these factors ultimately culminated in his suicide. His race, age, isolation, and mental illness were all wielded against him to end his life too soon.“Mind-body medicine,” the subtext of this issue on child medical conditions and psychopathology, has become a moniker for the frivolous pursuit of happiness by the worried well. Browder's story reminds us, however, that mind and body are not yoked exclusively in privileged circles. Oppressed bodies beget oppressed minds, and vice versa.It is time we as psychiatrists take a closer look at the forces that colluded to end Browder's life, including the terrible ways in which the mistreatment of the body can produce disastrous and unconscionable effects on the mind.Dr. Saunders is a second-year resident at the Child Study Center, Yale University, New Haven, Conn., and Guest Editor for this issue of the Residents' Journal.