Growing a Pipeline to Improve the Lives of Children and Families Through Innovative Research, Service, and Training

November 10, 2023

Information

Yale Child Study Center Annual Associates Meeting
November 8, 2023

Visit the YCSC website to learn more about the annual meeting and view the supplemental posters, mini-talks, and publications. Please also consider submitting feedback about this year's event.

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00:05And welcome everyone.
00:06Thanks so much for joining us.
00:08For those of you who are new to our
00:10annual Associates meeting, welcome.
00:12So glad you're here. I'm Linda Mays.
00:15I'm the Director of the Child
00:17Studies Center and just very grateful
00:19for you joining us via ZOOM.
00:22We look forward to when we will
00:24do this event again in person,
00:26hopefully next year.
00:28But again, we're just grateful
00:29for your taking the time.
00:31This has been a remarkable year
00:33for the Child Study Center with
00:35so much clinical activity.
00:37There's so many children in need,
00:38a remarkable year for our research,
00:41new grants, new discoveries.
00:43And we're always very enriched H July
00:47to have our new fellows come and
00:50join us for our educational mission.
00:53This year we're trying another format,
00:56format that we hope works well
00:59for you where you have a chance
01:01to introduce you to many members
01:04of our faculty and our fellows.
01:06We'd also encourage you and we'll give
01:08you links that we have a number of
01:10posters and talks that are online if
01:13you want to learn more about the center.
01:16But the format comes out of this out of
01:19a story and that is over the last few weeks,
01:23indeed even months.
01:26And the opportunity is,
01:28I've spoken with pediatricians and gone
01:31around to various meetings to meet with
01:34families and hear pediatricians and
01:37other other mental health folks talk
01:40about the impact that coming to the
01:43child Study Center has made on them,
01:46where they're coming for a research study,
01:50participating in research study
01:51and having the experience of giving
01:54back or coming for clinical care.
01:57And sometimes those stories have
02:00stretched over a decade or so,
02:03an individual or a family looking back at
02:07the impact 20 years before coming to us,
02:11coming to give us the opportunity
02:14and the honor to help them on the
02:17impact that has made over time.
02:20And it struck a number of us that we're
02:22always very grateful to hear that,
02:24and we're very grateful to hear
02:26how we've made an impact.
02:28But we want to actually be able to tell
02:31everyone that's been involved with us,
02:33in whatever way you've been involved with us.
02:35How you've made an impact on our community
02:39and this department and the many,
02:41many ways that you shape careers,
02:44That you shape careers by your support,
02:48your financial support,
02:50by your colleagueship,
02:51by the ideas you give us,
02:53by the networks that you help us make.
02:56And we hope this afternoon that you'll
02:58be able to hear a number of those
03:00nodal points where an individual,
03:02wherever they are in their career,
03:05has actually made a transition because of
03:09being a contribution from our associates,
03:11from a mentor,
03:13from an individual.
03:15We are all part of a community and we
03:18are all part as we need to support one
03:21another in this difficult but at the
03:24same time remarkably rewarding work in
03:26child and adolescent behavioral health.
03:29So listen to our gratitude this afternoon to
03:32you and to the stories that we will tell you.
03:37We'll look forward to also having discussion.
03:39We're going to divide up into four panels,
03:41as you may have seen in the agenda,
03:44And so we'll have time for
03:46discussion and questions.
03:46And indeed, besides telling you our stories,
03:49which is a tremendous amount of fun,
03:51being able to engage with you
03:53and ask your your questions,
03:54your your concerns is also
03:57extraordinarily rewarding for us.
03:58So please, you can send them in the chat,
04:01you can raise your virtual hand,
04:03you can just speak up,
04:06but that's our format.
04:07And then at the end of the panels,
04:09we'll have four panels.
04:11We'll have a brief break in the
04:13middle and then at the end,
04:14we invite you to join any breakout room with
04:17each of the panelists as you as you like.
04:19We hope you will, we will be available to
04:22move you from breakout room to breakout room.
04:25But but that again is the format.
04:28So with that,
04:30I think we'll turn to our first panel.
04:33And Krista,
04:34you're still admitting folks in, right?
04:37Great.
04:37OK,
04:38Thank you.
04:39And so our first panel is a panel
04:42where we're really you'll hear from a
04:44number of our clinical
04:45faculty and clinical fellows.
04:47And let me just tell you
04:49who you hear from panel.
04:51You'll hear from Doctor Aarti Basilopoulos,
04:55who is an assistant professor and
04:58pediatric health psychologist
04:59and also the Yale Site Director
05:02for our Comfort Ability program,
05:04which is about chronic pain.
05:07You'll hear from Carrie Epstein,
05:09Assistant Clinical Professor and
05:10also Co Director of the Yale Center
05:13for Traumatic Stress and Recovery.
05:15The next speaker will be Carla Marin.
05:18Dr. Carla Marin,
05:19who is an assistant professor and
05:21Licensed psychologist as well as
05:23the in the Yale Child Studies Center
05:25Anxiety and Mood Disorder program.
05:27And then Amanda Calhoun.
05:28Dr.
05:29Calhoun is our Chief resident in Child
05:32Psychiatry in the SOLNIT Integrated Program.
05:36So let me turn our panel or turn
05:38it over to our panelists.
05:40And Aarti,
05:41may I turn to you?
05:44Yes, absolutely. Hi, everyone.
05:46I'm so grateful to be starting us off today.
05:49My name is Aarti, just like Linda mentioned,
05:52and I'm a pediatric health psychologist,
05:54which really means that I focus on the
05:56intersection of health and behavior,
05:59really on how we can adjust
06:00to medical conditions,
06:01but also how behavior can really impact
06:04physical change in physical health.
06:06My interest in this started in grad school,
06:09but really blossomed into two specific
06:11areas while I was in residency.
06:14While I was at Hopkins,
06:15I was exposed to paediatric Chronic
06:18pain and Paediatric Functional
06:20Neurologic Symptom Disorder,
06:22or FNSD for short.
06:23These two conditions are quite different,
06:26but their impact on kids,
06:28teens and their families are profound.
06:31I I can talk about stats or numbers,
06:34but I would love instead today
06:36to talk about two such kids,
06:38one in each of those categories,
06:40with each of those conditions and kind of
06:43their experience and then our work together.
06:46So for one, there's a 17 year old young
06:49man who had chronic daily migraine.
06:52He was in the 11th grade at an
06:55incredibly competitive boarding school,
06:58previously very high achieving.
07:00He missed a good chunk of his 10th
07:02grade year because of his migraines
07:04and he unfortunately was starting
07:06off his junior year in the same way.
07:08So when I met him in fall of his junior year,
07:12he'd been missing a lot of school.
07:13He'd been going home because of
07:15his headaches and migraines.
07:17His school staff weren't sure what to do.
07:19His parents were at a loss and it felt
07:22like all the things he'd worked for
07:24were kind of falling apart around him.
07:26And we move over to a 13 year
07:29old girl with FNSD.
07:30She was lovely and vibrant,
07:33was involved in karate and loved teaching
07:36the younger kids in in her karate class.
07:40But she developed FNSD and her
07:43specific type of FNSD were these
07:45episodes that looked like they were
07:47seizures but they weren't epileptic.
07:50So everything in her body was safe.
07:52Her imaging her lab work was good and
07:55clean and nothing dangerous was going on,
07:57but these episodes were so challenging,
08:00her school didn't again know what
08:02to do and so she was home for
08:05about two months before I met her.
08:07Her mom had been told by an outside
08:09hospital that she will need to
08:11quit her job or have some sort of
08:13family medical leave because her
08:14daughter will never be the same.
08:18I had the pleasure of working with both
08:20of those teenagers and their families,
08:22and their life completely shifted.
08:25They allowed me to join with them.
08:27He the 17 year old completed
08:29high school and actually,
08:31about a year after our work together,
08:32his mom sent me a lovely e-mail
08:35with his college essay that
08:37explained that unexpectedly,
08:39his psychologist helped him understand
08:41how to manage his migraines.
08:43The young girl was able
08:45to finish middle school,
08:46start high school and jump
08:48right back into karate and
08:50doing all the things that are much
08:53cooler than than I am or that
08:55I can understand their lives.
08:57Kind of fell off the track for
09:00a bit but were able to go right
09:03back on and be fulfilling.
09:05I don't think that them falling off
09:08course or misinformation by anyone at
09:10any other hospital system was intentional.
09:13These things are complex and
09:16access to conferences,
09:18access to colleagues and collaborators is
09:20really the way that we remain up to date.
09:24I have been fortunate through
09:25faculty development funds to be able
09:27to attend conferences where I am
09:30on leadership committees for FNSC
09:31and for disseminating information
09:33that is based in science.
09:34I have been able to meet with
09:37colleagues at other hospitals and
09:39medical systems that implement the
09:41same pain workshop that I direct here.
09:44I was able to earn a pilot internal
09:48grant to kind of improve my research
09:52skills and then apply for an NIH funded
09:56grant on pediatric FND with colleagues.
09:59That ended up becoming the first
10:01and only pediatric FND study funded
10:03to date by the NIH.
10:05And these are all such exciting
10:07and wonderful things that I would
10:08not have been able to do and would
10:10not be able to have the reach that
10:12I have because of the support of
10:14those internally and externally.
10:16So thank you and I I am so excited to
10:19continue to provide these families and
10:22join with them in order to improve their,
10:24their lives and their kids lives.
10:27With that,
10:28I passed it along to Carrie for
10:30the fantastic work that she does.
10:32Thank
10:32you so much.
10:35I'm Carrie Epstein. As I said, I'm.
10:37I'm the Co director of the Yale
10:39Center for Traumatic Stress and
10:40Recovery at the Child Study Center.
10:42It was a wonderful story to follow up.
10:45I'd like to tell you the story
10:47of the power of partnership.
10:49So way back at the start
10:50of my career in the 1980s,
10:52I was working as a psychotherapist in the
10:55first paediatric AIDS clinic in the country.
10:58And back then,
10:59pediatric AIDS was really terrifying.
11:01It was stigmatizing and all
11:03too often it was fatal.
11:04And there were days when I felt really lost,
11:07not sure how or even if I
11:10could help my patients.
11:11And one of my patients was 8 year old Johnny
11:14who was really wise beyond his years.
11:16And when I asked him about his
11:18experience of being a child with AIDS,
11:20you know, he told me, you know,
11:22people look like right through me,
11:24like I don't exist,
11:25and they turn the other way
11:26when they see me coming.
11:28And in that moment,
11:29as I listened,
11:29it was the first time I think
11:31that I realized that I began
11:33to understand my own feelings.
11:34Working with children who are
11:36really suffering sometimes made
11:38me feel helpless and hopeless,
11:40and sometimes they felt tempted
11:42to protect myself from those
11:44feelings by turning away.
11:46And Johnny's insight really showed
11:48me that I had to fundamentally change
11:51my perspective and instead focus
11:53my professional energy on finding
11:56ways to decrease the isolation
11:58and suffering of traumatized
12:00children like Johnny and develop
12:02therapeutic approaches to help
12:04them heal and recover and overtime,
12:06that's just what I did.
12:07So Fast forward to about 14 years
12:09ago when I joined the trauma
12:12team at the Child Study Center.
12:14We've developed a ground breaking
12:16mental health treatment,
12:17a therapy called the Child and Family
12:20Traumatic Stress Intervention or CF TSI.
12:22Our bottle focuses on helping
12:24children communicate more effectively
12:26with their caregivers about their
12:28trauma reactions,
12:29teaching them coping strategies
12:30to decrease those reactions and
12:32really helping them recover.
12:34From the outset,
12:35we were committed to research
12:36because we wanted to be absolutely
12:38sure that our intervention worked.
12:40We wanted to know that CFTSI was
12:43effective in reducing children's
12:45symptoms after traumatic experience
12:46and interrupting PTSD from developing.
12:49And that's exactly what we found.
12:51Our model is brief, 5 to 8 sessions.
12:54It's powerful and effective.
12:56It works. So there we were.
12:58We had an important,
12:59effective way to help children
13:01who undergone trauma,
13:02but the only way we had to get it out
13:04there in the world was by word of mouth.
13:06We knew how to research,
13:08we knew how to develop a treatment method,
13:10but we still didn't have the
13:12skill set to connect with a much
13:14broader number of child therapists.
13:16And then something very
13:17critically important happened.
13:18I It was introduced to a woman named Nancy,
13:21and she started peppering me
13:23with questions about my work.
13:24She wasn't an expert in the field,
13:26but she was deeply interested.
13:28You know, how did the treatment work?
13:29What did the evidence tell us?
13:31You know, how is it playing out with kids,
13:33participate in the treatment?
13:34And toward the end of our conversation,
13:37Nancy told me that she had an idea for how
13:39to unlock the potential of our treatment
13:41model by getting it out to a vastly
13:43greater number of children and families.
13:45And a few days later, Nancy introduced
13:47me to a woman named Teresa Huizar.
13:50Teresa is an internationally
13:52recognized expert in child abuse,
13:54and she's the CEO of a professional
13:57membership organization that includes a
13:59network of 1000 centers that provide services
14:02to children impacted by trauma and abuse.
14:05So what that means is that if
14:07Teresa supports an approach to
14:08therapy for traumatized children,
14:10thousands of people learn about it.
14:12And because of Nancy,
14:14Teresa really understood the
14:15importance of our work.
14:17So once Teresa connected with us,
14:19the demand for trainings in our
14:21treatment ramped up dramatically
14:23and our reach and influence in the
14:25United States became so strong and
14:27so vibrant that request for training
14:28now come from all over the world.
14:31The connection that Nancy made
14:33for us changed my career and the
14:35trajectory of our treatment approach.
14:37And it's meant that thousands and thousands
14:39of children have been given the help
14:41they need after experiencing a trauma.
14:43And I want to mention one last thing today,
14:45which is that an associate and a recent
14:47donor and partner to our work shared
14:49with us that he had gone through his
14:52own significant traumatic experience.
14:53And that in addition he's the
14:56child of Holocaust survivors.
14:57And he told us that seeing the impact of
15:00his parents inability to address their
15:02trauma inspired him to address his own.
15:05And at the time,
15:06I think he couldn't have fully
15:08known that his description of his
15:11personal and family experience it
15:13really so movingly and so deeply
15:16articulates the mission of our work.
15:18And as I'm talking about
15:19the power of partnerships,
15:20I think I'd be remiss if I didn't
15:22mention some of our partnerships that
15:23have been so meaningful to our work,
15:25including the Harris Foundation
15:27and the Israel Foundation.
15:29With supports of many partners in the
15:31extended child study center community,
15:34we've had the opportunity to turn toward
15:36rather than away from the children and
15:38families who we're all concerned about.
15:40And as we've learned more,
15:42we've also grown more effective in
15:44our efforts to develop effective
15:46treatment approaches that help children
15:48recover from the impact of trauma
15:50that could otherwise last a lifetime.
15:53So it's really in my mind,
15:54it's the power of partnership that
15:56brought us where we are today.
15:58And it's the power of partnership that
16:01will take us through the next phase
16:03of our work as we work to bring CF
16:05TSI to additional and new communities
16:08not only across the United States,
16:10really been around the world.
16:11So this is the work that I'm
16:13passionate about and
16:14I'm so grateful to our partners
16:15for supporting this work.
16:17And I really want to thank you for letting
16:19me share this story with you today.
16:22And now you'll be hearing
16:23from Doctor Carla Marron,
16:24who's assistant professor and
16:26licensed psychologist and in the
16:28Anxiety and Mood Disorders Program.
16:32Thank you, Carrie. Good afternoon, everyone.
16:35Yes, I'm Carla Marine,
16:37an assistant professor.
16:38We're in the Anxiety and Mood
16:40Disorders program where I provide
16:42clinical services and where
16:44I'm also engaged in research.
16:47Before I tell you about why
16:49I do the work that I do,
16:50I would like to briefly share a personal
16:54story about a very close family member.
16:56She is 12 years old,
16:59first generation Hispanic immigrant
17:01whose parents do not speak any English.
17:04So a school trip was planned to
17:06visit the Vizcaya Gardens in Miami,
17:09which are really beautiful.
17:10I don't know if any of you have visited,
17:13but she was petrified to go on
17:17the school trip and after weeks
17:19of really trying to work up the
17:22courage to speak to her teacher,
17:25she finally approaches her and simply
17:28expresses that she's feeling very sad,
17:31does not want to go on the school trip now.
17:34She also shared with me that she
17:37didn't want to go because there
17:39would be too many kids that she
17:41didn't know and she would be really
17:44uncomfortable with this anyway.
17:46Her teacher told her you'll be all right
17:49and so she went because she's compliant,
17:53but she also hated it.
17:55She was riddled with so much anxiety
17:58following that school trip that she
18:01started to experience pretty significant
18:04stomach aches on most school days.
18:08Again,
18:08this 12 year old girl tells her teacher
18:12a few months later that she was lonely,
18:16but again her teacher did not
18:19recognize the signs and told her why
18:23don't you try making some friends?
18:26Well guess what?
18:27This 12 year old girl is my 41 year
18:31old sister and 20 years passed before
18:34she received adequate care for her
18:37debilitating anxiety and depression.
18:40And you know,
18:41although it has been decades since
18:43this incident and we have made
18:45significant strides in helping to
18:47identify and refer children with anxiety
18:50and other mental health concerns,
18:52what strikes me now as a clinician
18:54and as well as many of my other
18:57colleagues that I speak to,
18:59the clinician and researcher,
19:01is that we continue to see
19:03similar stories in 2023,
19:04that is children not being referred or
19:07being able to access mental health services,
19:11particularly children from
19:13minority backgrounds.
19:15So yes, this is partly what drives my work.
19:19I have and feel privileged to be
19:22surrounded by so many talented
19:24colleagues who similarly share this passion.
19:28And most recently I was honored
19:31to receive the Viola Bernard Award
19:33to pilot a digital intervention
19:35that incorporates science based
19:37tools to teach parents how to help
19:41their child with anxiety.
19:43And what excites me about those this
19:45work is that it is specifically
19:48designed for Hispanic mothers of
19:51children with anxiety disorders.
19:53I am really excited about the project
19:56because it will allow me and our team
19:58to focus our work on learning how we
20:01can improve access to mental health
20:03care to so many children who need it.
20:06In fact, there's been,
20:07you know,
20:08papers showing that Hispanic children
20:11are particularly at risk for anxiety,
20:13which, by the way, is the most
20:16common mental health, the most
20:18prevalent mental health concern.
20:23I'm also really excited to start
20:25this project because it will give
20:28participants a voice in shaping
20:30the intervention to ensure that it
20:33is being delivered in a culturally
20:35sensitive way and that it really,
20:37you know, speaks to families.
20:40And so, of course,
20:42we hope that this initial pilot
20:44work study will lay the groundwork
20:46for our larger project where again,
20:48we can learn how not only to
20:51improve these treatments that
20:52we know work really well,
20:54but how to best disseminate them to
20:57reach as many families as possible.
21:00So thank you very much for your time.
21:04And now I think I'll pass it
21:07along to Doctor Amanda Calhoun.
21:12Thank you so much.
21:14I'm going to start us out with a quote.
21:17When we speak, we are afraid our
21:20words will not be heard or welcomed.
21:22But when we are silent,
21:24we are still afraid.
21:26So it is better to speak Audrey Lord.
21:30Growing up as a black
21:31girl in a predominantly white school,
21:33I remember being aware of
21:35racism as early as kindergarten.
21:37I remember realizing that my brown
21:39skin and dark coily hair were not
21:41the American standard of beauty.
21:43As I grew older,
21:44I watched family members receive poor
21:46care in the emergency department.
21:48I was embarrassed to go places
21:50because I was regularly assumed
21:51to be the mother of my 4 year old
21:54sister when I was only 13 years old.
21:57I remember years ago when my
21:59little sister's best friend came
22:01home from kindergarten in tears.
22:03Her white classmates said that her
22:05skin was too dark to play with them.
22:09A few years
22:09ago, I cried on my way to work in the
22:12hospital after I talked to my parents.
22:14My older brother,
22:15who suffers from severe autism,
22:17had been thrown on the ground at
22:19the Science Center in my hometown.
22:21Even though his paraprofessional
22:23had screamed at the security guard that
22:25he was autistic and not harming anyone,
22:28the security guard did not listen.
22:30My brother was handcuffed so roughly
22:33that it left bruises on his wrists.
22:36These painful interactions impact the mental
22:39health of black children and families
22:42in profound ways that now I am studying.
22:45I have the words now for some of these
22:49experiences like adultification,
22:50the assumption that black girls are
22:53less innocent and require less emotional
22:55support than white girls like massage noir,
22:58the mistreatment of black women and
23:00girls that is distinct from the racism
23:03black men experience and the sexism
23:05that non black women experience.
23:07I know now that my black families
23:10experience of poor care in the emergency
23:12department was not just anecdotal,
23:14it is documented.
23:15I know now that experiences of anti
23:18black racism are tied to suicidality and
23:21black youth suicide rates are increasing
23:23faster than any other racial ethnic group.
23:26And I know now that individuals with autism,
23:30especially black individuals with autism,
23:33are more likely to be harmed
23:35and killed by law enforcement.
23:38Yet the mental health effects
23:40of anti black racism,
23:42despite its demonstrable impact
23:43on health and well-being,
23:45remain understudied,
23:46especially in the field of child
23:49psychiatric research.
23:50Research centering adverse mental health.
23:52The outcomes of black children
23:54usually cites poverty or lack of
23:57access to care without considering
23:58the independent impact of racism,
24:01even when economic resources are not lacking.
24:05When I received the 2022 Pilot
24:07Research Award for Yale Child Study
24:10Center trainees for my study proposal
24:12entitled The Mental Health Sequella
24:15of Anti Black Racism in Children,
24:17it honestly affected my entire
24:19career trajectory.
24:20I proposed my study as the basis for
24:23a dissertation and I'm now pursuing
24:25APHD at the Yale Graduate School of
24:27Arts and Sciences and Doctor Linda
24:29Mays as my senior thesis advisor.
24:32And I cannot emphasize
24:33enough how powerful and important
24:35it is for me as a trainee to have
24:38the chair of my department serve as
24:40such a strong mentor and advocate.
24:43Because of how much support
24:44I received from my research,
24:45I was able to put forth a
24:47competitive application and receive
24:49the NIH Law Repayment Award.
24:50But this is just the beginning.
24:52My research will lay the groundwork
24:54for a whole line of investigations
24:57examining the effects of anti
24:59black racism in children and
25:01developing innovative interventions.
25:03This year I was also awarded the Viola
25:05Bernard HealthEquity Fellowship and
25:06will be using this funding to hold a
25:08Black Youth Clinical Case Conference
25:10series at the Yale Child Study Center.
25:12The clinical case conferences will
25:14be held monthly from January to
25:16June and will lay the groundwork
25:18for a new Black Culture and Identity
25:20console and Liaison team which we
25:22plan to present in fall of 2024.
25:24The conversations generated by these
25:26case conferences and the work of this
25:28console team will be transformative
25:30for the mental health field.
25:32As a current Yale child psychiatry fellow
25:35and member of the Yale College class of 2011,
25:39one of the reasons why I chose and
25:41continue to choose Yale is because
25:43it is an academic institution that
25:45truly wants to produce leaders.
25:47Yale pushes us to ask difficult questions,
25:50think critically,
25:51and produce creative ideas.
25:53And the Yale Child Studies Center
25:54not only wants to produce leaders
25:56in research and science,
25:58but the department also wants to
26:00produce clinician leaders who are
26:03committed to making the world a better
26:06place for children and for families.
26:08My researchers that are twined
26:10with my clinical work.
26:11But at the end of the day,
26:12this work isn't for me.
26:14It's for the kindergartner,
26:16like my sister's friend who becomes
26:18sad and withdrawn for weeks after
26:20their classmates exclude her
26:22from play based on skin color.
26:23It's for my 10 year old patient
26:25who developed suicidal thoughts
26:27after her neighbors told her that
26:29dark brown skin was ugly.
26:30It's for my high schooler patient
26:32who attempted suicide because of
26:34racist ostracism from peers and
26:37excessive punishment from teachers in
26:39a predominantly white prep school.
26:41I'm so thankful to be supported by
26:43the Yale Child Study Center and
26:44to speak with you all here today.
26:46My work is thought provoking and innovative,
26:49but it is also urgent and life saving.
26:53Thank you Fernando.
26:55Thank you everyone.
26:57We're now open for questions,
27:00questions from our audience. I
27:06think one question that has come in
27:08just to get us started is we all know
27:11that there's a certainly a tremendous
27:14increase in mental health needs.
27:16And I wondered if the question is,
27:19would the panelists comment on
27:20various ways and your efforts,
27:23we're trying to address those or you are
27:25trying to address those increase in needs.
27:30Anyone want to start that
27:36Gary, please.
27:40Thank you, Linda.
27:42So you know there is really a a very
27:45pretty serious child mental health
27:47crisis going on higher acuity wait list.
27:50I think that there's no easy solution,
27:53but the good news is we have
27:55ways to start to address it.
27:56I think one way we have to address
27:58the wait list that unfortunately
28:00characterize the mental health crisis.
28:02This is the great news about our child and
28:05family traumatic stress intervention being
28:07brief and powerful that because it's brief,
28:10because it's a powerful and effective it can
28:13help reduce the need for longer term therapy.
28:15It can help alleviate long wait
28:18lists and increase access and allow
28:20programs to serve more children.
28:22And so that can be really helpful.
28:24And in order to do this,
28:25we need to equip clinicians to build
28:27the skill to to do the work and we
28:29can get them there, for example,
28:30by training them in our model.
28:32And so the good news is,
28:34is that we found even when we're training
28:36clinicians are new to the field or have
28:38been around alone for quite a while,
28:40they're both highly effective in it.
28:41So that's,
28:42it's one of the ways that our
28:44work is hoping to address that.
28:49Thank you. Anyone, anyone else?
28:53Yeah, I would jump
28:54in. You know, I think I really appreciate
28:57the context of of talking about increasing
28:59mental health needs and the black,
29:01you know, the youth suicide crisis
29:03and the youth mental health crisis.
29:05But I also think it's important
29:07to note that for black youth,
29:09they've been in crisis for 20 years.
29:11So this isn't new for black youth
29:13and actually you know, suicide rates
29:16have been increasing and I think,
29:18you know, we'll actually look
29:19at data from 2019 to 2020,
29:21it was found that actually
29:23white and Asian children,
29:25their suicide rates remain the
29:27same or declined and black and
29:29Latin a Latin X children,
29:30their suicide rates continue to increase.
29:32So I think it's really important
29:34when we're thinking about this,
29:36you know, youth mental health crisis.
29:38We need to really think about different
29:40minoritized groups and really make
29:42sure that the things that we're doing,
29:44the interventions that we're doing
29:46are not just tailored to A1 size
29:48fits all model and certainly not
29:50just tailored for white children,
29:51but tailored for the specific needs of
29:54minoritized groups and populations,
29:56which I think is one of the things
29:58that the Yale Child Studies Center
29:59obviously is trying to do it to do
30:01with all this here and thinking about,
30:03you know, OK.
30:04So some interventions may work
30:05for all kids or most kids,
30:07but we may may need targeted.
30:08We definitely need targeted interventions,
30:11as Doctor Marin mentioned,
30:12for different groups.
30:14And I think what that looks like
30:15is we're bringing in experts
30:16from those groups that are,
30:17we have here the Child Study
30:19Center to pilot those programs.
30:21And so I think it's a really
30:23important question.
30:23And I think I'm so glad that, you know,
30:25the youth mental health crisis is out there.
30:27It's out there in the media.
30:28But it's also important to
30:30recognize that for some groups,
30:31specifically black children,
30:32this isn't new.
30:33Thank
30:35you, Tom.
30:44Obviously there's a great need
30:47by children and families and
30:49they're great providers called
30:50the Yale Child Study Center.
30:52How did the two get together?
30:56It's a great question, Tom and I
30:58may I may I be sure you're asking
31:01how do we improve access, right.
31:06How do we improve access to US
31:07and access for services generally?
31:16Anyone want to take that?
31:19I can kind of start us
31:20off. Oh, sorry, no,
31:21no, go ahead. Go ahead, already you're good.
31:24So one way kind of in particularly
31:25in my work in pediatric psychology IT,
31:28it decreases kind of one of the stops.
31:30So I am integrating A
31:31variety of medical clinics.
31:32So kind of when they present for
31:35their neurology clinic appointment,
31:37it's not just that they're seeing
31:38their neurology provider but also
31:40myself as a multidisciplinary clinic.
31:42And so kind of being able to get that
31:45comprehensive view as a one stop shop
31:47really decreases barriers from kind of
31:49scheduling and waiting and getting in
31:51and instead getting something there
31:53and now where the families are and
31:56really meeting them where they're at,
31:57which has been wonderful.
32:01So embedding, embedding where
32:02families come, that's one way, Carla.
32:06Yeah. So I I just wanted to add that I
32:09I think another way is to leverage the
32:11digital tools that we have currently
32:14available to us even just like now right
32:16being on Zoom and I know that we're
32:19providing telehealth services to many
32:21families who are not able to either
32:24you know have transportation here.
32:26But again you know trying to think about
32:31or excuse me going beyond sort of Zoom
32:34or Intellotherapy and thinking about
32:36developing other types of digital tools
32:39that again allow a greater reach and
32:41and tools that are again science based,
32:43you know that we know provide relief to
32:47so many of these children and families.
32:50So I again you know it's my hope
32:52of course and the work that I'm
32:54involved in that hopefully you know
32:57we'll we'll we'll see this.
32:59But I mean again that's just some some
33:01other thought that I wanted to offer
33:05anyone else. Carrie,
33:11you're muted Carrie, I
33:13think it's such an important question.
33:14I I think building on what my
33:18colleagues just spoke about,
33:19I think that there are a few ways we've
33:20been also trying to accomplish this.
33:22One is that our our,
33:25our trauma center actually goes does
33:28outreach to families in communities.
33:31I'm going into folks homes to touch
33:33base with families to connect with them
33:36and to make the bridge into from the
33:39actual community and bridging into our
33:42the the services that we can offer.
33:44That's one thing we do,
33:44and there's more to say about that.
33:46The the telehealth piece, we actually,
33:49through the pandemic really had to look
33:51at and we did a study about whether we
33:53could do our treatment model via telehealth.
33:55And the great news is that the study shows
33:57that we have literally the same outcomes,
33:59maybe a little bit better through telehealth.
34:02Look at that.
34:03And I think that's about
34:04having less stressors maybe,
34:06but coming in.
34:06And then the final thing I really
34:09think about is also looking about
34:11really challenging oneself to look at.
34:13And I, Amanda,
34:14I was thinking about what you said
34:16is that it is our treatment model
34:18working for different families,
34:19communities,
34:19people from different backgrounds,
34:21and we've been looking at that.
34:23We want to continue to looking at that,
34:25to really challenge ourselves
34:25to how do we need to adjust,
34:27adapt and tweak models and learn from
34:30colleagues with expertise to know
34:31that a treatment is going to resonate
34:33with all the families we work with.
34:38And I would just add,
34:39you know, sort of like I was saying
34:40and what Yale is renowned for,
34:42we need to get creative. You know,
34:44when people think about child psychiatrists,
34:46they're thinking about,
34:47you know, someone in a office
34:49and maybe it's boring to them.
34:51And these are kids, you know,
34:52we need to engage them.
34:53And so, you know, most kids will
34:55never see a child psychiatrist.
34:56And we need to think about, you know,
34:58how are we going to reach kids?
34:59And, you know,
34:59I don't want to put him on the spot,
35:01but I'm going to put him on the spot.
35:02Doctor Comer is here.
35:04And I think thinking about,
35:05you know, how are we reaching
35:07out to schools and you know,
35:08his amazing work that is looked at,
35:10what are the experiences that kids,
35:12the positive experiences
35:13that kids are not getting,
35:15you know, that they need to get?
35:17And how do we partner with teachers,
35:19you know, schools, community workers,
35:22you know, pediatricians as we already do,
35:25But all these touch points that kids
35:28are interacting with to reach them.
35:30And then once we reach them,
35:32are we doing things that are
35:34causing them to fall out of care?
35:35I mean, frankly,
35:36I've talked to a lot of my kids
35:37and I've said, you know, why?
35:39You know, when I say my kids,
35:41I mean my patients,
35:41I call them my kids.
35:42But
35:43I say, you know, why don't you like therapy?
35:45Why don't you go to therapy?
35:46And they've told me they've had a lot
35:48of racist experiences in therapy.
35:49And so I think we need to name that.
35:51And it's going to be very
35:54important that children, you know,
35:55of minoritized backgrounds are feeling
35:57comfortable in the therapeutic
35:58spaces because we bring them in,
36:00we tell them about child psychiatry,
36:02and they have a poor experience.
36:03They're probably not going to come back.
36:05And so thinking about all those things
36:07and being able to interrogate ourselves
36:09and our own procedures and our own
36:11policies and our own behaviors in the
36:13therapeutic space will be important.
36:26Doctor Comer,
36:29you're on mute, Tim.
36:32Yeah. No, I can only
36:35agree that it is terribly important to
36:38get to the all the people that children
36:41come in contact with who support
36:43their development and functioning.
36:45But it's very, very hard because in
36:49ways just the education alone feel
36:56the the basic problem is that the the
36:59field itself has not paid attention
37:02to development and mental health.
37:05And so you're working with educators
37:07who mean well, who want to do well,
37:10but they have not had the experience.
37:12So our they have not had the
37:14focus on child development and
37:16functioning and mental health.
37:18And so we're trying to look at how
37:23you can get that kind of preparation,
37:25that kind of introduction even at the
37:28at the pre service level and then make
37:32it possible for mental health people
37:35to work at the pre service level to
37:38help those people who are going to
37:42be working with children think child
37:44development and functioning before they
37:47even have their basic training and
37:50and development in their discipline.
37:53But it's hard.
37:54It's very hard.
37:55But I I think we have to keep
37:57doing it because I don't see any
37:59other way because they'll never
38:01be enough psychiatrists,
38:03psychologists
38:06to to provide the kind of
38:09support we need for the mental
38:11health problems we have today.
38:14But agree that it's very important.
38:16Thank you. Before I turn to Doctor Landeros,
38:19I just want to say too that several
38:22of you mentioned pediatricians and
38:24one of the things we're also doing
38:27is trying is training pediatricians
38:29and frontline behavioral healthcare.
38:31We're becoming a training site
38:34so that we can at least help our
38:37pediatric colleagues have some skills
38:38that they very much are asking for.
38:41Doctor Linderos,
38:44I just wanted to highlight within
38:47the the Mood Disorders Clinic,
38:52all of the different researchers
38:53within the Child Study Center
38:54that are engaged in research
38:58pursuing this have at.
39:00We've actually come together.
39:02We've created a working
39:05group where we've put,
39:06made ourselves available to the
39:09schools within Connecticut.
39:12And slowly but surely we're
39:13getting a lot of traction.
39:14And we're having
39:16experts in the field,
39:18us go into the schools and talk
39:20to the teachers and
39:21ask them what it is that
39:23they need and how it is that we can help
39:25them. Not only in an effort to help
39:28the recruitment so that people can
39:30come to us and help us answer all of
39:34these questions that we all have, but
39:37because we are part
39:38of the community and
39:40you know this
39:41is, this is part of what
39:42we need to do. And So
39:45what we do
39:45for example is that we've got imaging studies
39:48looking at the brain when
39:50someone is depressed. We have
39:53experimental treatments that have
39:55been shown to be useful in adults
39:58like ketamine or ischetamine.
40:00And through our partnership with big
40:03Pharma and through other foundations,
40:06we've been able to find and
40:09get evidence based. Result
40:13to show if it works
40:14or if it doesn't work in kids.
40:17Long story short, our RO one looking at
40:19ketamine for treatment resistant
40:21depression and one of the really nice
40:23things about being a child study center
40:25is that we've been able to capture and
40:29recruit a wide variety of participants
40:33of all ethnic backgrounds of all groups.
40:37And so I think that's one of
40:39the privileges of working here.
40:40And I'll throw it back to you, Linda.
40:42Thank you so much. Andy, any other questions?
40:49Let's move on to our second panel.
40:56And let me just introduce the second panel.
40:59In our second panel,
41:00we turn to our researchers.
41:02Three of our researchers on Doctor
41:05Kasha Habarska is the BD Professor,
41:08Child Psychiatry,
41:09Pediatrics and Statistics in Data Science.
41:12She's also the Director of the
41:15Toddler Developmental Disabilities
41:16Clinic and the Social and Affective
41:19Neuroscience of Autism Program.
41:21Doctor Tom Fernandez is Associate
41:23Professor and Vice Chair for
41:24Research for the Department and Co
41:27Director of the Tick and OCD Program,
41:29and Doctor Alan Gerber is a postdoctoral
41:32fellow in the Mcpartland Lab and the
41:35Developmental Disabilities Clinic.
41:36So I believe, Kasha,
41:37may I turn to you first?
41:41Yes, thank you.
41:42Thank you very much, Linda,
41:44for the introduction.
41:45It's a great pleasure to be here.
41:48And when Tom Allen and I were
41:52discussing this panel, we were one,
41:55we were we were thinking about, you know,
41:57what are the themes that are really
41:59important for our clinical research work.
42:00And we touch upon 2 mentorship and the
42:06inspiration that we get from our patients,
42:10inspiration that helps us define
42:12what we do and how we do it in
42:14in our in our path to discovery.
42:19I work with children with autism,
42:23babies, toddlers,
42:24and in our practice we see many
42:28toddlers with unusual characteristics
42:31that do not fit the very neat
42:35diagnostic criteria and categories.
42:38And today I would like to tell you
42:40about a new line of research which was
42:43inspired by a little girl who as an
42:47infant developed some unusual behavior,
42:49unusual motor behavior,
42:51which we call motor stereotypies.
42:54So you might ask yourself what
42:57on earth are motor stereotypies?
42:59Well,
42:59they are rhythmic and repetitive movements.
43:02They can involve hands, body or head.
43:06And you know we typically see
43:09them in autism and and in various
43:13neurological conditions.
43:15But as we are learning now we they're
43:18also often present in children who
43:21are otherwise developing typically.
43:24And I would like to take this
43:27opportunity and and show you a
43:29video and and I would like to do
43:31it for for two reasons why I'd
43:33like you to you to understand the
43:34mother stereotypes a little better.
43:36But also this video was shared
43:39by a family who of a girl who is
43:42affected by these mother stereotypes.
43:44And the family is very invested
43:48in sharing their experiences,
43:55invested in disseminating knowledge
43:58about mother stereotypes and raising
44:01awareness among professionals and and
44:04hopefully in the future increasing
44:07both understanding of this phenomenon
44:09but also understanding improving
44:11clinical care for these kids.
44:15And I would like to make sure that I can.
44:18I'm doing it right, but here we go.
44:21All right. Can you see that?
44:24So this is, this is a beautiful
44:25little girl and he's about,
44:27she's about six months old and she
44:31started doing these little things
44:34which kind of look cute, but actually
44:37they're they're stereotype movements.
44:38They are accompanied by a lot of motor
44:41activity and they were happening many,
44:43many times during the day which
44:45make parents think that perhaps
44:47their little girl has seizures.
44:49She was seen by a neurologist
44:53and seizures were ruled out.
44:54And then when she was a little older and her
44:58mother skills became more a little better,
45:01she was doing a lot of these
45:03kind of I'm calling them happy,
45:05happy hands,
45:07happy feet movements.
45:09They kind of look cute,
45:11but if they are repeated many,
45:13many times during the day and they
45:14do not appear to be functional,
45:16this is when begin we begin to
45:19worry and this is when we met her.
45:21She was about 18 months old.
45:23These movements continue and
45:25and and are accompanied by some
45:28additional modern movement.
45:32These kind of movements emerge very early,
45:34emerge in infancy, continue
45:37throughout childhood into adulthood.
45:39Tom Fernandez, who is going to
45:41speak after me is doing some very
45:43interesting work trying to understand
45:45how what the adult outcomes may
45:47look like in some of the children.
45:49This kind of movements may be
45:52mild or could be very severe,
45:54in some cases leading to self injury.
45:59It is not clear.
46:00Despite the fact that they
46:01are so behaviorally obvious.
46:03It is not clear what causes them
46:06and whether the mother stereotypies
46:08we see in children and autism and
46:11in children who are otherwise seem
46:12to be developing typically and
46:15really sharing the same mechanisms
46:17and and we don't know how to how
46:20to treat them and when to treat
46:23them and whether we really need
46:25to treat them in some cases.
46:27Importantly there are no clinics that
46:31specialize in in care of children
46:34with modern stereotypes to my best
46:37knowledge there there is one or
46:39the worst one which was which is
46:41about to close at at Johns Hopkins.
46:44So the families who are because children
46:47are affected by mother's stereotypies
46:49really have to rely on on on care,
46:52on rather fragmented care and often
46:57receive quite conflicted opinions
47:00about what it is and what whether
47:03the children should or should not be
47:05treated and if So what in what way.
47:09So I'm. I'm really happy to tell you that
47:15that we've partner with several our our
47:18colleagues here at the Child Study Center
47:21and at the Department of Paediatrics.
47:24What Tom and I are working very closely
47:27on this project and we have established
47:29a new line of research that's focused
47:32specifically on motor stereotypes and
47:35we're investigating investigating them
47:38in the context of other early onset
47:42complex neurodevelopmental disorders.
47:45We call our program CONDI or complex
47:48for new neurodevelopmental conditions
47:51program And we've been in operation
47:54from spring and and we've been,
47:58we've we have created a several
48:01course within this program.
48:02One of them involves clinical phenotyping
48:05or clinical assessment for these children.
48:08And if you're interested in hearing
48:10a little bit more about patient
48:12care within this context,
48:13I would strongly encourage you to
48:15take a look at one of the videos
48:18that was produced by my colleague Dr.
48:22Mariana Torres Miso.
48:25We also are trying to understand the
48:28underlying pathology and behind these
48:31behaviors using integrated approaches.
48:34We are developing research
48:37paradigms that involve imaging,
48:40genetics,
48:42eye tracking studies and also
48:45physiological studies which might
48:47help us map out the underlying
48:50processes and help us understand a
48:52little bit that better this very,
48:55very complex phenomena.
48:57We are also doing something
48:59that we call data mining,
49:02which means that we are basically and
49:06analyzing large databases which will
49:09help us understand these these complex
49:12phenomena from some different perspectives.
49:15Now you know these,
49:18these,
49:18this kind of work represents to
49:21some extent A paradigm shift in what
49:23we typically do in developmental
49:25psychopathology.
49:26Typically we focus on a single
49:28disorder and we study children
49:31with that particular disorder.
49:33In this case we are taking
49:35a transdiagnostic approach.
49:36We are actually interested in
49:38children with variety of diagnosis who
49:41experience a modern stereotypes and
49:43try to understand what's what what,
49:46what kind of underlying processes
49:50do these children share.
49:52You know,
49:52we we can be inspired by our patients.
49:57We can have tremendous expertise.
50:01But we wouldn't be able to do any
50:05of this exciting, innovative,
50:06high risk work without a tremendous
50:11support of of our associates.
50:13And I wanted to extend my deepest
50:17and more sincere thanks to
50:21to our supporters to the Virginia and
50:26Leonard Marks Foundation and and more
50:30specifically our our friends Jennifer and
50:33Bud Gruenberg for supporting this work.
50:36I also wanted to mention to you that
50:39this kind of this kind of programs,
50:42these these kind of research and
50:46clinical environments and rich research
50:48and clinical environments create a
50:50tremendous opportunities for fostering
50:53the next generation of of researchers.
50:57And I would just like to flag a couple of
51:01several presentations that you can take
51:04a look at in that are included in in our
51:09offline collection by two very talented
51:15trainees who are who just graduated
51:18from college and spent two years with
51:21us on getting ready for graduate career.
51:25We have Emily and and Kat and also
51:28I would like to highlight two young
51:32researchers Anjuna Vernetti and
51:34and Sarah Sanchez Alonso who are
51:37developing a new lines of research
51:40utilizing some of the exciting new
51:43technology involving live eye tracking
51:46and F news technology. No. Since
51:50we're also talking about
51:52mentors, I would like to just since
51:55many of you know Fred very well,
51:57I would like to acknowledge
52:00him and see if he just retired.
52:04And and thanks for all the knowledge
52:07and entertainment that we had together.
52:10And and Fred would say, you know,
52:13there's never a dull moment.
52:15So thank you very much for your
52:18attention and answer questions. We'll
52:20move over. We'll move to Tom now.
52:22Thank you so much. Tom,
52:27thank you. Just going to
52:28share my screen. Yes, please.
52:32OK. Hi, everyone.
52:33So I'm Tom Fernandez, associate
52:36professor in Child Study Center and Vice
52:38chair of research for the department.
52:40I am also a Co director.
52:42Oh, excuse me one second. Yep.
52:46Co Director of our Tourette's Syndrome
52:48and OCD program in the child Study Center.
52:52We have a great team.
52:53You'll see them on the screen here.
52:56Co Director, Michael Block,
52:57I just want to highlight and there are two
53:01mentors that who passed the baton to us,
53:03the former Co directors,
53:05Jim Blackman and Bob King.
53:07We really have a great team of
53:09clinicians and mentors in the in
53:11the program and we are a Tourette's
53:14Syndrome Center of Excellence
53:16acknowledged by the tourist Association.
53:18And you know in addition to
53:20the clinical work,
53:21I also do genetics research and have
53:26a neuropsychiatric genetics lab.
53:28And we do a lot of sequencing of DNA,
53:32of children that come through our
53:34clinic and others with the goal of
53:37trying to discover risk genes for
53:39these disorders and discovering the
53:41risk genes so that we can understand
53:44the biology and that with the hope
53:46that these will lead us toward
53:47new treatments and interventions.
53:51And I really love what I do.
53:53I mean, I think the only complaint
53:54that I would have is that there's
53:56just not enough hours in the day to
53:58do all the things that, you know,
54:00I think that we should be doing.
54:04And for me, there's really, you know,
54:06there's really nothing better than
54:07working on science that's going to teach
54:09us about these conditions with the goal
54:12of bringing them back to our patients.
54:13And this is what we call
54:15translational science.
54:16But here's what's so frustrating
54:17for me and I and I know for the
54:19families that we are trying to help
54:21and that is this statistic, 17 years,
54:24there's a 17 year gap between
54:27scientific discovery and getting them
54:29translated into clinical practice.
54:32And when I started out training,
54:34I was very skeptical of this number.
54:36This number has been floated
54:37around for a long time,
54:38but it just so happens that I'm about
54:4017 years out of graduating medical
54:43school and I can say that this,
54:46this absolutely is, if not precise,
54:48it's it's around there way
54:51too long and so one.
54:53So, So what do we do?
54:55I mean, this is really,
54:56in my mind,
54:57not acceptable.
54:58One thing is clear is we really need
55:01to have a deep bench of clinician
55:03scientists to do the innovative and
55:06translatable work that really needs
55:08to be done and make the difference.
55:10And one of my roles at Child
55:12Study Center is to advise Dr.
55:15Mason,
55:15the department on how we
55:17can grow new research,
55:19how we can do our part to grow the
55:21number of clinician scientists in
55:23pediatric and behavioral mental health.
55:25And I often think back to my journey
55:27and think about how I arrived at this
55:30great opportunity that I that I have now.
55:32And I think I'd like to share it
55:34with you very quickly because I think
55:36there's a few pivotal moments that
55:38taught me what I think we need to
55:41do in this field if we want to make
55:45some progress to closing this gap.
55:47And so soon after graduating college,
55:51I was trying to figure out
55:53what to do with my life,
55:54like most college graduates and
55:57applied for a fellowship at the NIH.
56:00And I was astounded that I was selected,
56:03not really knowing much
56:04about the health field.
56:06And I had the privilege of being mentored.
56:08And this was a kind of a random pair up
56:11with a remarkable clinician scientist,
56:13Doctor Judith Rapoport.
56:15And Dr.
56:16Rapoport was among the first to
56:18delve into complexities of early
56:21onset psychiatric disorders.
56:22And I remember on my arrival
56:24for my first day on the job,
56:26As for research assistant well
56:28#1 being extremely nervous.
56:30But on my desk she left me a copy of
56:33a book that she recently published
56:35called The Boy Who Couldn't Stop Washing.
56:38This went on to become a best seller
56:41and really was a Seminole worker
56:43responsible for bringing widespread
56:45attention to obsessive compulsive
56:47disorder at a time when it was not
56:50widely understood or discussed.
56:51And I remember reading it and
56:54even just recently rereading it
56:56and being drawn into these vivid
56:59personal accounts of individuals,
57:01children,
57:01families with OCD and realizing
57:03that talking to patients
57:05and families and understanding their
57:08perspective is really a prerequisite and
57:11essential in order to know what research to
57:14prioritize and how to approach treatments.
57:16I also remember being amazed by the
57:19observation that she writes in her book,
57:22and this is 30 plus years ago now,
57:25that 20% or more patients have a close
57:28relative with the same problems,
57:30and some argue that this could be because of
57:33children copying behaviors of their parents.
57:36But for obsessive compulsive disorder
57:38and this is a disorder in which so
57:40much of the symptoms are kept private,
57:42this was unlikely to explain it all.
57:44So I, you know, remember that being a focus
57:47of my discussions with Doctor Rappaport,
57:49I also told her that I was really
57:52interested in maybe studying this,
57:54you know, and we studied genetics of OCD.
57:57She walked me down the hallway and
57:59introduced me to her friend Francis,
58:00who happened to be Francis Collins,
58:02who is the head of the Human Genome
58:04Research Institute at the time, who said,
58:06why don't you come sit in on my course?
58:08I'm teaching a course to
58:10undergraduates at Georgetown.
58:12Be willing to, you know,
58:14be happy to have you.
58:15And I said great and and really
58:18was astounded by, you know,
58:20and at that time we hadn't even had
58:22had a draft of the human genome yet,
58:24but really astounded by the,
58:25the promise of potential to
58:27apply this in psychiatry.
58:28And so with the knowledge
58:30I gained in this course,
58:31it actually led to my first paper,
58:33you know, before medical school.
58:34And this was looking at,
58:36and this is, you know,
58:37nowadays, you know,
58:38really it would not be accepted
58:39as a paper because we have much
58:41higher standards for genetics.
58:44But looking at things in childhood,
58:46onsite schizophrenia,
58:47Looking at Maple lipoprotein ileals.
58:50So almost done.
58:52Bringing Fast forward to being
58:55admitted to medical school.
58:57Doctor Andreas Martin.
58:58I don't know if you remember
58:59or not Doctor Martin,
59:00but you know you all remember it.
59:02But I don't know if Doctor Martin
59:04remembers that he was the first to
59:06introduce me to my primary mentor,
59:09Doctor Matthews State,
59:10because I had shared my interest
59:13in psychiatry and genetics.
59:15Doctor State was really my foremost mentor,
59:17teaching me everything about genetics and
59:20the sharing his excitement for the field.
59:22He's also a collision scientist and Doctor
59:25State introduced me to Herb Allison,
59:29one of our associates.
59:31Unfortunately,
59:32he he passed away about 10 years ago,
59:34but he was very interested in advancing
59:38this field and provided very generous
59:41funding that allowed me to start up
59:44some of the first DNA sequencing
59:47studies in obsessive compulsive disorder,
59:49also in ADHD,
59:51anxiety and motor stereotomies.
59:54So now what?
59:54So it's been 17 actually 18 years
59:57since I've committed to becoming a
59:59physician scientist and psychiatry,
01:00:01believe it or not,
01:00:02we're we are almost there I think
01:00:04you know for using genetics.
01:00:06I think there are techniques now
01:00:09that we can be using and some
01:00:12tests that we can use in order to
01:00:14inform risk. And So what do we do?
01:00:18I said we need a deep bench of clinician
01:00:21scientists that can continue this progress,
01:00:23multidisciplinary scientists.
01:00:24And one of the things that we can do
01:00:28and we have been doing here at Child
01:00:30Study is to award early career funding.
01:00:32And these are to spark or ignite
01:00:34these new ideas that are innovative
01:00:36but have really great potential
01:00:38to lead to continued progress.
01:00:40And thanks to some of our families,
01:00:43really you made this possible,
01:00:46associated families,
01:00:46you made this possible for us to
01:00:49continue to give out awards for
01:00:51early career trainings in psychiatry.
01:00:53So I'm very hopeful for the future.
01:00:55I'm very excited about this work.
01:00:56And I really thank you all
01:00:57for making this possible.
01:00:59Thanks.
01:01:08Thank you, Tom. And turn to Doctor Gerber.
01:01:21Can everyone see my slides? Yes.
01:01:27OK. Hi, everyone.
01:01:29So my name is Alan Gerber.
01:01:31I'm a child psychologist.
01:01:33And I'm also a postdoctoral
01:01:35fellow in the Mcpartland lab
01:01:37at the Yale Child Study Center.
01:01:39Today I'm going to speak with you
01:01:41about my research on understanding
01:01:43loneliness and autistic youth.
01:01:45So I'll start with a story.
01:01:47When I was a grad student,
01:01:48it was during the beginning
01:01:50of the COVID-19 pandemic,
01:01:52and like many of us,
01:01:53I was feeling kind of lonely,
01:01:55a bit stuck in my apartment at the time.
01:01:59I reached out to friends and
01:02:01family sometimes people I hadn't
01:02:03spoken with in quite some time.
01:02:05Everyone was using Zoom
01:02:06and WhatsApp at the time,
01:02:08and and Zoom was quite new.
01:02:10And this experience really got me
01:02:12thinking about how was the pandemic
01:02:15impacting the autistic individuals
01:02:16and their families that I worked with.
01:02:22So it was around that time that as a whole,
01:02:24we were really starting to recognize
01:02:27loneliness as this major public health issue.
01:02:30But for many of the clients
01:02:31that I was working with,
01:02:32social isolation and loneliness
01:02:34were already a common concern.
01:02:37Now, despite this,
01:02:38the experience of loneliness and autistic
01:02:41youth remains pretty poorly understood.
01:02:44And so these experiences that I had
01:02:46both clinically and in the research
01:02:49world led to my dissertation project,
01:02:51which was focused on following
01:02:53autistic youth and their families
01:02:56throughout the pandemic.
01:02:57And I was able to do this at
01:02:59the time because of a generous
01:03:01seed grant from a donor.
01:03:03And
01:03:06one of the things that that really
01:03:08surprised me was I found a striking
01:03:11amount of variability in loneliness.
01:03:13So what do I mean by that?
01:03:15Well, many autistic youth were
01:03:17reporting high levels of loneliness,
01:03:19sort of as we expected.
01:03:21But also many weren't.
01:03:22In fact, many reported that they felt less
01:03:25lonely over the course of the pandemic.
01:03:28And so it's likely that for these youth,
01:03:31there were some beneficial
01:03:32aspects to the pandemic,
01:03:34including options for remote schooling
01:03:36and an increase in family time.
01:03:39And for me,
01:03:40this really sparked a career interest
01:03:42in understanding the experience
01:03:44of loneliness and autistic youth.
01:03:46The goal of my research is really
01:03:48to identify which of these youth
01:03:49are likely to feel lonely so we can
01:03:52develop preventative treatments.
01:03:56So right now I'm in the
01:03:57second year of a postdoctoral
01:03:58fellowship in the Mcpartland lab,
01:04:00and I recently received, as you saw
01:04:03with Doctor Fernandez's presentation,
01:04:05a donor funded pilot research award
01:04:08for Yale Child Study Center trainees
01:04:10to continue some of this work.
01:04:13And so we're now actually working
01:04:14on the study in the lab that uses a
01:04:17novel combination of methods to better
01:04:19understand the experience of loneliness.
01:04:21And my hope is that these results can
01:04:24be used to identify markers of risk
01:04:27for loneliness in autistic youth.
01:04:29So I'll tell you a little bit about
01:04:30the study, kind of a bird's eye view.
01:04:33The first aim is to capture the
01:04:35experience of loneliness and
01:04:37autistic adolescence as it unfolds.
01:04:39And so to do this,
01:04:40we ask teens to tell us about their
01:04:42feelings in the moment using real time
01:04:44reporting through their smartphone,
01:04:46Which as we know, if you have teens,
01:04:48they're always on.
01:04:49This novel approach allows us to get a
01:04:52more in depth and naturalistic picture
01:04:54of loneliness in their daily lives.
01:05:01So the second aim of the study is
01:05:03to examine whether some of these
01:05:05daily experiences of loneliness can
01:05:07be can be predicted using markers
01:05:09of brain functioning measured by
01:05:12electroencephalography or EEG.
01:05:14And here I've been really lucky
01:05:15to have Doctor Mcpartland as a as
01:05:17a mentor for this project who's
01:05:19a nationally recognized expert in
01:05:21autism biomarker research and who
01:05:23you'll hear from later this afternoon.
01:05:26Through the support from this
01:05:28donor funded pilot research award,
01:05:29I am able to receive specialized
01:05:31training in EEG data collection and analysis.
01:05:34It's really been very critical and
01:05:36vital for my own career development.
01:05:40Overall, I just want to thank funders
01:05:43who have had such a profound impact
01:05:45on my career trajectory by providing
01:05:48me with this funding for my research,
01:05:50but also the ability to gain
01:05:52really unique training experiences.
01:05:54So in the future,
01:05:55I'm planning on building on this
01:05:57work by applying for an NIMH career
01:05:59development award and that will
01:06:01ultimately help me transition into
01:06:03an independent research career.
01:06:05I'm also really looking forward
01:06:07to giving back to trainees in
01:06:09the same way that I was afforded
01:06:12some of these opportunities.
01:06:14So I just want to thank everyone
01:06:16for listening and appreciate the
01:06:18support and acknowledge the support
01:06:21from funders as well as my lab.
01:06:23And I'm going to turn it over for questions.
01:06:26Thank you very much.
01:06:27Thanks so much. So we're
01:06:30open now for questions.
01:06:35Any questions from the audience?
01:06:40One question submitted was do we know
01:06:43why children engage in stereotypic
01:06:46movements and what function do they serve?
01:06:50Does anybody want to take that one?
01:06:56Well, I, I, I can take this on.
01:06:57And it's it's an important
01:06:59question because this is
01:07:04it, will it. It tells us a little bit
01:07:07about why children continue doing it.
01:07:09So there's certain situations where
01:07:11children are more likely to engage
01:07:14in modern studies, and they involve
01:07:18sometimes children are excited,
01:07:20sometimes children are a little
01:07:23uncertain about what what's what's
01:07:25happening and a little stressed,
01:07:27and sometimes they're bored.
01:07:30Based on these observations,
01:07:33researchers have proposed that
01:07:36perhaps stereotypes have some
01:07:39regulatory functions and they can
01:07:42help children either increase or
01:07:45decrease physiological arousal,
01:07:47bringing them to more optimal states.
01:07:51What's interesting is this is pretty
01:07:54pretty straightforward hypothesis and and
01:07:57it has been advanced maybe 20-30 years ago.
01:08:02However,
01:08:02there are almost no studies
01:08:06that evaluated this empirically.
01:08:09There may be couple of studies that
01:08:11that were conducted on on one or two
01:08:14children in conclusive results and
01:08:15and but the question is tremendously
01:08:17important because if these therapies
01:08:18have a functional significance for
01:08:21for for our children we need to
01:08:23understand what it what it is because
01:08:25when we intervene or when we decrease
01:08:28their frequency we might actually
01:08:30take away very effective ways for
01:08:32them to to to regulate their arousal.
01:08:34So good question and I wish
01:08:36we had a better answer.
01:08:37This is one of the reasons where
01:08:40where why part of our experimental
01:08:42paradigms include measurements of
01:08:45physiological arousal to to to
01:08:47actually understand whether this is
01:08:50these contingencies are really true.
01:08:52Tasha,
01:08:54Tom, do you have any thoughts?
01:08:59Yeah, I think I think
01:09:00we'd be glad to talk about
01:09:01it in a breakout room.
01:09:02I think that is a really interesting
01:09:05question and it serves a purpose
01:09:07but not one that you know the
01:09:09kids can always tell us about
01:09:11and they can they can interfere.
01:09:12So that's the reason why we need
01:09:14to pay attention and they can,
01:09:16I think we're learning Kaja,
01:09:18with some of your work that they
01:09:20can predict a longer term outcomes
01:09:22and so we can use them as a maybe a
01:09:24predictor and then a way to to keep
01:09:26more track on some of these kids.
01:09:31Alan, it's You're engaging
01:09:33in such a important issue,
01:09:35especially given the Surgeon
01:09:37Generals calling it out.
01:09:39Do you have a sense,
01:09:42do you have a sense more broadly
01:09:45of why there's such an epidemic
01:09:47of loneliness in the country?
01:09:53This is a really interesting question
01:09:56and I do also want to speak to it why
01:09:58people are are have I think there's
01:10:00been a lot of loneliness and now we're
01:10:03really starting to see it with a pandemic
01:10:06where people are really starting to
01:10:07call it out and pay attention to it.
01:10:08But it's it's been there for quite
01:10:11some time and loneliness has
01:10:13really negative consequences.
01:10:15So it's associated with poor mental health,
01:10:19poor physical health,
01:10:21increase in suicidality.
01:10:22So a number of these things are,
01:10:24if we can reach it at an early time point,
01:10:27we can really make a difference.
01:10:29I think in terms of an increase,
01:10:32the pandemic really brought it out,
01:10:34but I I actually think it's been there
01:10:37for quite some time and only now we're
01:10:39starting to see this as a major issue.
01:10:42So hopefully that will draw
01:10:43attention to keep it there though,
01:10:46It's like so many things, isn't it?
01:10:48The pandemic didn't 'cause it,
01:10:49but shone a light on it.
01:10:54Other questions from from the audience,
01:11:02I'm just scanning for hands up
01:11:04or speak out or in the chat.
01:11:14Well, thanks so much to our panelists.
01:11:16We have built in a a break right now.
01:11:19So please, Krista will put up a
01:11:22screen that gives you a chance
01:11:25to scan in where the posters
01:11:27and the recorded talks are,
01:11:30as Kasha was mentioning.
01:11:32So here we have a question from Jason.
01:11:34So Alan, it's for you.
01:11:37Are there specific aspects of the
01:11:39COVID Online experience that you expect
01:11:42will become tools going forward?
01:11:45Yeah, this is a great question and
01:11:47I I won't be offended if anyone
01:11:49would like to take a break now,
01:11:51but it this is something we're
01:11:53thinking about quite a bit.
01:11:54Remote schooling in particular is a
01:11:57really important piece of this experience
01:11:59and there's a great paper on how it
01:12:01impacts kids with social anxiety as well.
01:12:04The ability to have some more control
01:12:07over your environment and the sort
01:12:09of unwritten curriculum are real
01:12:11challenges for neuro diverse students.
01:12:13And the pandemic has really gotten
01:12:15us to think a little bit about
01:12:18how we can be flexible with some
01:12:21of those things and you know,
01:12:23use those tools going forward.
01:12:25The other thing we think a lot about is
01:12:27digital social communication, right?
01:12:29If any of you have teens,
01:12:32you know that your kids most,
01:12:34perhaps most of their interactions
01:12:35is coming online, is coming through,
01:12:37you know, in an online setting.
01:12:40And so how do we make sure to keep those
01:12:44environments safe, but also helpful?
01:12:46Because for many autistic individuals,
01:12:48and I, I don't want to speak for them,
01:12:49but from what I've heard in
01:12:51my interactions with clients,
01:12:52it's actually quite beneficial
01:12:55and more comfortable.
01:12:57And at the same time,
01:12:58it can be harder because it can be
01:13:00harder to read body language through
01:13:02a text conversation, for example.
01:13:03And for people who are having
01:13:06challenges with that,
01:13:07that can add to your challenges.
01:13:08So it's really an interesting balance.
01:13:10I think if we offer the tools
01:13:17in a balanced way, in a flexible way,
01:13:20giving people choices for what works
01:13:21best for them, I think that's the
01:13:23way moving forward. But I think
01:13:25it's a great opportunity for research.
01:13:29You're muted, Linda. I'm
01:13:33sorry, Tom, You have your hand up.
01:13:37Fred Volkmar to me was sort of Mr.
01:13:39Autism, not just to me,
01:13:41it's the old Charles Sonny,
01:13:42but to the world.
01:13:45And she also was a neighbor.
01:13:46And Martha's Vineyard,
01:13:48terrific human being.
01:13:50Is he going to have any contact
01:13:52going forward that you're aware
01:13:54of with the Child Study Center?
01:13:56Oh, yes, no. Fred is very much a member
01:13:58of our emeritus faculty and very much so.
01:14:01Tom, we don't, we don't let people retire.
01:14:04Actually, we they just may move to
01:14:07a different title, but they stay.
01:14:09So no, thanks for asking about that.
01:14:13And Carl, thank you for putting
01:14:16the publication link in the chat.
01:14:18Appreciate that.
01:14:20So we'll move to break and you can
01:14:23stay online because we're coming
01:14:25back to the very same place.
01:14:26Keep your cameras on or off.
01:14:29Krista will put up links where
01:14:30you can go see the posters in the
01:14:33presentations or at least find
01:14:34the web page and look forward to
01:14:39seeing you back at 3:30.
01:14:41Thanks so much.
01:15:09everyone. So I hope you had a good break.
01:15:14I'm very glad for us to come to our
01:15:17third panel and on our third panel we'll
01:15:20have an opportunity to hear again from
01:15:22a number of our clinical colleagues.
01:15:24And let me let me just tell you
01:15:28about introduce the third panel.
01:15:30Starting us off will be Amy Myers
01:15:32who is the Assistant Clinical
01:15:35Professor and a Senior Consultant to
01:15:38our family based recovery program.
01:15:41Victoria Staub,
01:15:42I'm Assistant Clinical Professor
01:15:44and Co Director of the ICAPS
01:15:47Model Development and Operations,
01:15:49Doctor Maggie Stokel,
01:15:50an Assistant Professor and
01:15:52Associate Director of our Pediatric
01:15:54Psychology program and Director
01:15:56of the GI Psychology Service.
01:15:58And then Dr.
01:15:59Tara Thompson Felix who is a Clinical
01:16:01child Psychiatry Fellow and doing her
01:16:04research with Doctor Karen O'Donnell.
01:16:07So, Amy,
01:16:07may I turn it to you?
01:16:10Yes, Thank you for the introduction
01:16:12and the opportunity to speak today.
01:16:16I myself was supported by a
01:16:18helper when I was a child.
01:16:20She was steady and calm and to me
01:16:23possessed some kind of magic that could
01:16:26translate my feelings and experiences
01:16:29into words understood by adults.
01:16:31So this helped me to grow up knowing
01:16:34that I would become a helper too.
01:16:37I'm the 1st in my family to go to
01:16:40college and one of few in my entire
01:16:43extended family across generations
01:16:45to turn to obtain a Master's degree.
01:16:48I stopped correcting my 83 year
01:16:50old mother when she tells me
01:16:53and tells other people when she
01:16:55introduces me that I'm a doctor.
01:16:57The last time I corrected her, she said,
01:16:59well, you're a doctor in my mind,
01:17:01so really forcing me to
01:17:03embrace her pride in me.
01:17:06I'm really fortunate to have introduced
01:17:09a new possibility to my family's
01:17:12intergenerational experience in that way.
01:17:15So not as a doctor,
01:17:16but as a clinical social worker,
01:17:19I've been faculty at the Child Study
01:17:21Center in the Family Based Recovery
01:17:23Model for more than 14 years.
01:17:26In Family Based Recovery, or FBR.
01:17:29We treat families who experience
01:17:31challenges across generations,
01:17:33including trauma,
01:17:35parental addiction and family separation.
01:17:39Our hope is to inter interrupt some
01:17:42of these intergenerational experiences
01:17:44and to introduce new possibilities
01:17:47for recovery and to keep families
01:17:49together rather than to separate them.
01:17:52And understanding that substance use
01:17:54is often part of the constellation
01:17:56of concerns when young children
01:17:58are separated from their families.
01:18:00FBR combines substance use treatment
01:18:03with home visiting and dyadic
01:18:07parent child therapy.
01:18:09Attending to the relationship
01:18:11between the parent and the child
01:18:13with simultaneous treatment to
01:18:15the parent is the main Ave.
01:18:18For this intergenerational impact
01:18:20that we hope to have.
01:18:22FBR provides long term and intensive
01:18:25treatment which in this world of of
01:18:29adult substance use treatment can
01:18:31feel like a luxury to be able to
01:18:34work with families for up to a year.
01:18:37This is work that I truly love and I'm
01:18:39often seeking ways to to learn more
01:18:41and to expand what I know in the field.
01:18:45And so I applied for and received a
01:18:47Faculty Development Fund to support
01:18:50me in obtaining a professional
01:18:52endorsement from the Connecticut
01:18:54Association of Infant Mental Health.
01:18:56This is an internationally recognized
01:18:59credential that communicates specialization
01:19:01and family work for families during
01:19:04infancy and early childhood.
01:19:06And as John Dolby said,
01:19:08if a community values its children,
01:19:11it must truly chop cherish its parents.
01:19:16What better way to initiate new family
01:19:18cycles and to focus on babies and infancy?
01:19:22The babies, the newest members of the family,
01:19:24and some might say the most
01:19:26infused with hope.
01:19:28In FBR,
01:19:28we witnessed that infants and young
01:19:30children are the powerful motivators
01:19:32for recovery for their parents,
01:19:34as well as motivators for parents
01:19:37who often hope to create a different
01:19:39experience for their children
01:19:41than the one that they had.
01:19:43The professional endorsement that
01:19:45the Faculty Fund supported me to
01:19:47obtain an infant mental health has
01:19:50allowed me to deepen my practice of
01:19:52centering the baby or centering the
01:19:54child in the family and the family work
01:19:56to maximize the possibility of this
01:19:58intergenerational recovery and healing.
01:20:01The Infant Mental Health Endorsement
01:20:03has also supported my learning of
01:20:05reflective practice and understanding
01:20:07the impact that this work has on
01:20:09all of us as the providers aiding
01:20:11in my goal to provide reflective
01:20:14consultation to other professionals
01:20:15in this work and understanding that
01:20:18when parents are identified as
01:20:20having substance use disorders and.
01:20:22When there is sometimes substance
01:20:24use during pregnancy or in
01:20:27utero exposure to substances,
01:20:29there is often a weight and a
01:20:32tremendous heaviness to the families
01:20:34in these to these families,
01:20:36and often also to the providers
01:20:38who are journeying alongside them.
01:20:42We hope that in our
01:20:42treatment and FBR, we are counteracting
01:20:44that stigma with treatment deeply
01:20:46rooted and safe and accepting treatment
01:20:49relationships very much supported by
01:20:51the infant mental health approach.
01:20:55Additionally, as a black woman and
01:20:57descendant of capable people without formal
01:20:59or institutional knowledge and education,
01:21:02it's been important for me to validate
01:21:04that there are many ways of knowing.
01:21:06In addition to traditional
01:21:09medical or educational models,
01:21:11Faculty Development Fund has also
01:21:14given me access dedicated learning,
01:21:16holistic models of healing trauma
01:21:19from experts in the field of what
01:21:22is called indigoggy or Indigenous
01:21:24ways of knowing and being.
01:21:25This learning is truly opening my
01:21:28understanding of the strength and
01:21:30teachings that come from generations
01:21:31before the present and from teachers
01:21:34who may not have always been valued due
01:21:36to their lack of formalized education,
01:21:39much like the early teachers in my life
01:21:41and much like the early teachers and the
01:21:42lives of the families that we work with.
01:21:47As we can see, continued professional
01:21:48learning comes from multiple pathways and
01:21:51that we learn from the time spent from
01:21:53being with and listening to families,
01:21:55from our colleagues in the mutual
01:21:58relationships between research and practice,
01:22:00and also formerly as students in classrooms,
01:22:04which can be costly to access.
01:22:07The cost can be a disincentive for many
01:22:10pursuing the the learning or furthering
01:22:12education and philanthropy can and has and
01:22:15does play a crucial role in this access.
01:22:17And for me coming in the amount of funds
01:22:20of sometimes just a few $100 to be able
01:22:24to access that continued learning and
01:22:27philanthropy for continued community,
01:22:29for continued learning communicates and
01:22:31investing in faculty in this way is a
01:22:34valued action at the Child Study Center,
01:22:36which I truly appreciate.
01:22:39I look forward to hearing the stories from
01:22:41the rest of my colleagues in this panel.
01:22:42And we'll now pass this on to Victoria Staub.
01:22:47Thank you for your time.
01:22:49Thank you, Amy.
01:22:53So my name is Victoria Staub and I'm a
01:22:57licensed clinical social worker and I'm
01:22:59one of the directors of the ICAPS Network.
01:23:03And for those of you who don't know,
01:23:05ICAPS is a intensive home based model for
01:23:09really children and adolescents who are in
01:23:13crisis and often their families are as well.
01:23:16Often times what we're dealing with are
01:23:19the long term impacts of complex trauma.
01:23:21Most of the kids in our program have
01:23:25multiple diagnosis and most of them
01:23:29are endorsing at least one history
01:23:31of a traumatic experience.
01:23:35And so when I was trying to kind of
01:23:38come up with a through line to to
01:23:40like tell you how I came to be here,
01:23:45really the first thought I had was
01:23:47for as long as I can remember I've
01:23:51experienced myself and my gender as non
01:23:54binary as third gender or androgynous.
01:23:57And I think that this experience really
01:24:03drew me to outsiders.
01:24:05And so flash forward to
01:24:07my undergraduate years.
01:24:09I spent a lot of time working
01:24:11in harm reduction and working
01:24:13with injection drug users and people who
01:24:18really, it turns out we're in
01:24:21an incredible amount of pain.
01:24:22And this was the pattern over and over again.
01:24:26Many different life backgrounds,
01:24:28but lots of pain and lots of pain
01:24:30in their childhood and in their
01:24:32relationships with their families.
01:24:35And so again kind
01:24:37of flash forward to my
01:24:39master's program. I'm finishing
01:24:41and I don't know what I want to do,
01:24:42but I find a fellowship at the
01:24:44Yale Child Study Center offered
01:24:47with an intensive home
01:24:48based program that really
01:24:51is meeting people literally where
01:24:53they are at in their homes,
01:24:56in their communities,
01:24:57meeting their family members.
01:24:59And so I stayed on after my fellowship
01:25:04obviously and spent the next decade
01:25:07really being mentored by Gene Adnapose,
01:25:11Joe Woolston, Arietta Slade.
01:25:14And out of this,
01:25:16out of these mentorships,
01:25:17developed a clinical tool and
01:25:21developed a clinical measure and
01:25:25have really worked to improve the
01:25:28program based on the data that we've
01:25:30been able to collect over the years.
01:25:33And so this is a database
01:25:34of about 20,000
01:25:35kids at this point,
01:25:38about 2000 kids
01:25:39a year are seen by ICAPS. So
01:25:44last year when we found out that
01:25:46the state was not really going to
01:25:48be able to continue to fund our
01:25:50database that's very, very old.
01:25:53It was only through a generous donation that
01:25:58we were able to
01:25:59kind of develop a new database and
01:26:04continue to collect this data that I
01:26:05just think is so important on this
01:26:08population that I think would not otherwise
01:26:12be able to be be so represented, right.
01:26:18So yeah, that's really how
01:26:20you know in, in my clinical
01:26:22career I'd I think is very
01:26:23impacted by this as well because
01:26:26all of our publications are
01:26:27days based in this database and
01:26:31we hope to continue to be
01:26:33able to improve
01:26:34the program. You know,
01:26:36without quality assurance and
01:26:37quality improvement, we wouldn't
01:26:38be able to know if we're doing
01:26:40what we say we're trying to do
01:26:47and if we're actually
01:26:48making improvements.
01:26:49So thank you very much for
01:26:52your time and I will send this
01:26:54over to Maggie, my colleague.
01:26:58Thank you Victoria.
01:26:59And Amy, it's really an honor
01:27:01to be here with everyone and
01:27:02just hear everyone's stories.
01:27:05So I'm a pediatric psychologist.
01:27:06I specialize in working with
01:27:08with youth who have a variety
01:27:10of chronic health conditions.
01:27:11But I I have a specialty in in GI
01:27:14so identify it as a GI psychologist
01:27:16and that's the kind of clinical
01:27:18work that I do here at Yale and
01:27:21in in thinking through where to
01:27:23start my story for the sake of
01:27:26time I'll start during senior year
01:27:28about senior year of college a
01:27:30month before graduation as a 22
01:27:32year old just having that moment
01:27:34of of paralysis and not really
01:27:36sure what I was going to do next.
01:27:39I had been on a pretty traditional
01:27:41academic path in in college and worked
01:27:44in a developmental psychology lab,
01:27:45so had all these plans to
01:27:48continue on that that linear path.
01:27:50After after I graduated and
01:27:53just starting in in May,
01:27:56I I had had this pull to clinical
01:27:58work even though I hadn't had
01:28:00much you know traditional exposure
01:28:02to it just felt myself wondering
01:28:04if I should explore whether that
01:28:05was the path for me.
01:28:06So after graduation I decided to
01:28:09veer paths from my original plans
01:28:12and paused on their their research
01:28:15and took took a job as a teacher
01:28:17down in North Carolina as a a
01:28:19teacher in a school for for kids
01:28:21with mental health conditions and
01:28:22learning challenges that made it
01:28:24really challenging for them to
01:28:26participate in really in mainstream
01:28:27society and in mainstream schooling.
01:28:31And that sort of the the thread
01:28:32through my career has been that I
01:28:34really enjoy working with kids teens
01:28:36and young adults who who don't fit
01:28:38into the boxes that we create in
01:28:40healthcare or in school systems.
01:28:42And that that teaching experience
01:28:44it was it's the hardest job I've
01:28:45I've had in my life.
01:28:46I learned so much in the time that
01:28:48I was there and it really it made
01:28:50me feel a true investment in that
01:28:51kind of population.
01:28:52So I I quickly knew that I,
01:28:54I,
01:28:55I wanted to continue this path as
01:28:57a clinical psychologist and then
01:28:59over time specialized further
01:29:01into pediatric psychology.
01:29:03And part of being a pediatric
01:29:04psychologist that I really love is
01:29:06working as part of an interdisciplinary team.
01:29:08So working with people in all
01:29:09different specialties so that
01:29:11we can help these kids who don't
01:29:13necessarily fit in these boxes that
01:29:16we create in our healthcare system.
01:29:18So I I trained for my residency
01:29:20on the West Coast in Oregon,
01:29:21and when it came time to
01:29:23considering a fellowship,
01:29:24I was really fascinated by
01:29:26the gut brain connection.
01:29:27And the the field of GI psychology was
01:29:30a relatively new field in Pediatrics
01:29:32at the time and there were very few
01:29:35formalized training programs for it.
01:29:38And I happened to be at the
01:29:39right place at the right time.
01:29:40And that the hospital that I
01:29:43was completing my residency for
01:29:46received a really generous donation
01:29:48from a donor who was really invested
01:29:51in addressing the mental health
01:29:52needs of of kids with GI conditions.
01:29:54Because GI conditions tend to be
01:29:56these invisible problems that kids
01:29:58have that are embarrassing to talk
01:29:59about and and keep them out of school
01:30:01and in in their day-to-day life.
01:30:03So because of the the generosity of
01:30:05that donor, I was able to have this
01:30:08really specialized training experience
01:30:10which which led me on the the career
01:30:12that I I've pursued until now.
01:30:14So I I stayed on the West Coast for
01:30:17a while and then came to Gale almost
01:30:20three years ago and had the privilege of
01:30:22partnering with my GI colleagues here.
01:30:25And because of the the, you know,
01:30:28support of our child Study Center
01:30:30faculty and and the associates,
01:30:32we have been able to really build some
01:30:35exciting programming that we're we're really,
01:30:38we're really proud of to help these
01:30:40kids in in our GI section who may
01:30:43not have very clear places to go.
01:30:45So that the specific clinical innovations
01:30:47I wanted to share today are two
01:30:49interdisciplinary clinics that we've
01:30:51started recently that are targeted to
01:30:52treat kids who have what are called
01:30:54disorders of gut brain interaction.
01:30:56So these are conditions that the
01:30:58traditional medical testing is normal.
01:31:00You know that these these conditions are
01:31:03impairing kids who have abdominal pain,
01:31:05nausea,
01:31:05all of the GI symptoms that can
01:31:07make it really hard to function.
01:31:09And they've been told by many previous
01:31:11providers that we don't know what's wrong.
01:31:12We're not sure what this is.
01:31:14We don't know where to send you.
01:31:16So we've developed some interdisciplinary
01:31:18programs to to treat this very population.
01:31:20The 1st is called our GIR Fib program.
01:31:23It's meant to treat kids who have these
01:31:25kinds of gut brain access problems,
01:31:27who through those those GI issues
01:31:30develop significant feeding challenges.
01:31:32So we we help get them on their feet and
01:31:35and get them back to their life in many ways.
01:31:38So that that clinic is staffed
01:31:41by GI attending AGI psychologist
01:31:42and AGI dietitian and we treat,
01:31:44we treat the patients together in
01:31:47the room together and then hopefully
01:31:48kind of get them back to to eating
01:31:51adaptively and get back to life.
01:31:53The second clinic is that I wanted to
01:31:55highlight is called our pelvic pain program.
01:31:58And this is an interdisciplinary
01:32:00program across 3 disciplines actually
01:32:03with GI psychology,
01:32:04our GI attending and adolescent
01:32:06gynecology because we we noticed
01:32:07that we were sharing a lot of the
01:32:09same patients and they they all
01:32:11didn't seem to have a very clear
01:32:13home in the medical system.
01:32:14So we're this is the first of its kind
01:32:17in the nation in terms of this kind of
01:32:20collaboration with with these disciplines.
01:32:22Our hope is that through the
01:32:24clinical work we can not only
01:32:25help the patients that we treat,
01:32:27but but also develop a new
01:32:30classification diagnostically for
01:32:31for kids who have these types of
01:32:33conditions. It's a hope that we will be able
01:32:38to help more outside of the walls of Yale.
01:32:41So more to come in the breakout rooms.
01:32:42I'm happy to chat more about that,
01:32:44but I just wanted to express my
01:32:46gratitude to all the associates
01:32:48for your support and gratitude
01:32:49to all of my colleagues here.
01:32:50I feel really lucky to have all of you.
01:32:53So I'll turn it on to over to to Tara,
01:32:56our clinical fellow in
01:32:57the Child Study Center.
01:33:00Thank you so
01:33:00much, Maggie. So good afternoon, everyone.
01:33:03My name is Tara Thompson Felix and I'm
01:33:06a child and adolescent psychiatrist
01:33:07here in the Child Study Center and also
01:33:10a third year PhD student at the Yale
01:33:12Graduate School working with Kieran
01:33:14O'Donnell here at the Child Study Center.
01:33:16So I took a a very non traditional route
01:33:19to combine my clinical and research
01:33:21interests in perinatal psychiatry.
01:33:23But in retrospect I feel like things
01:33:26happen just the way they were supposed to.
01:33:28So I'm also a first year or first
01:33:31generation college student and
01:33:33the first doctor in my family.
01:33:35My parents came to the US in the
01:33:38early 80s from Jamaica seeking a lot
01:33:41of opportunities for our family,
01:33:42like many other families.
01:33:44And very early on,
01:33:46I learned the importance of networking
01:33:48and finding financial opportunities to
01:33:51create the future I wanted for myself.
01:33:53And so I also have a college story,
01:33:55you know, during my senior year.
01:33:57So while I was in college, you know,
01:33:59I worked in the MDPHD department
01:34:01at Rutgers in New Jersey,
01:34:03and I learned about all of the
01:34:05ways that we can integrate clinical
01:34:07care and the research.
01:34:08I also learned about the the gap between,
01:34:11you know,
01:34:12the translational research
01:34:13that we're all interested in.
01:34:15And I just found that very exciting and
01:34:17wanted to explore more opportunities.
01:34:20So when I came back home in Connecticut,
01:34:22I reached out to a world renowned scientist
01:34:25here in the Child Study Center, Dr.
01:34:27Elena Gregoranco,
01:34:28and I volunteered throughout the
01:34:30summer to learn more about genetics,
01:34:33epigenetics and how that relates
01:34:36to child psychiatric disorders.
01:34:38And during my senior year,
01:34:40I was awarded a small travel grant
01:34:42to travel from New Jersey back to
01:34:45Connecticut to complete my research
01:34:47project with Doctor Gregor Enko.
01:34:49And this grant helped me to
01:34:51develop my project.
01:34:52It also helped me to develop important
01:34:54research skills and to meet more
01:34:57mentors here at the Child Study Center.
01:34:59And importantly,
01:35:00it also helped me to secure additional
01:35:03funds to stay at the Child Study
01:35:05Center for an additional two
01:35:07years after I graduated college.
01:35:09And so this was a pivotal experience
01:35:11for me because it encouraged me
01:35:13to think outside of the box and
01:35:15to use the resources I have,
01:35:17no matter how small they might seem.
01:35:20So after my research experience
01:35:21at the Child Study Center,
01:35:23I went to medical school and
01:35:26completed adult residency training,
01:35:28and I developed a strong clinical and
01:35:30research interest in perinatal psychiatry,
01:35:33more specifically wanting to improve
01:35:34maternal health so that we can
01:35:36improve child health outcomes.
01:35:38And my passion for this topic took
01:35:41a whole new meaning when I became
01:35:44a mother myself during residency
01:35:46with two little ones.
01:35:47And I wanted to pursue my fellowship
01:35:50in a program where I knew I would
01:35:52feel supported not only as a
01:35:55scientist or a physician,
01:35:56but also as a mother and to have a community.
01:35:59And so coming back to the
01:36:01old Child Study Center
01:36:02was a very easy choice for me.
01:36:04But at that point, you know,
01:36:06I I knew I wanted to continue my research,
01:36:09but I wasn't sure how I would be
01:36:11able to do it after fellowship,
01:36:12you know, as I also had to think
01:36:15about paying my medical school debt
01:36:17and also having child care costs.
01:36:19And so during my child fellowship, you know,
01:36:22I was very grateful to receive a pilot
01:36:25award supported by our generous donors.
01:36:27And with this award,
01:36:28I was able to delve a little deeper
01:36:30into the research I wanted to do.
01:36:32So I was able to do some clinical work,
01:36:34you know, with moms and their infants,
01:36:36but I was also able to do some
01:36:40translational work and look at
01:36:41more basic science side of things,
01:36:43answering the similar question,
01:36:45you know, how do in utero
01:36:48exposures impact the fetal brain?
01:36:51And with the pilot award,
01:36:53I was able to investigate
01:36:55a new way of signaling,
01:36:56which are tiny little cellular packages
01:36:58called extracellular vesicles.
01:37:00And we learned that the fetal brain secrets,
01:37:03these vesicles,
01:37:05and they're really important in
01:37:07US understanding the communication
01:37:09between a mom and their baby.
01:37:12And so with the data I generated
01:37:14from this award,
01:37:15I was also able to attract more funding
01:37:18from the NIH to pay back a substantial
01:37:21amount of my medical school loans,
01:37:24which was a big stressor for me,
01:37:26but a huge relief for me and my family.
01:37:29So I was able to get additional
01:37:32funding and continue to
01:37:34pursue my PhD and think about,
01:37:36you know,
01:37:36in the future other ways that we
01:37:38can do translational work here
01:37:40at the Child Study Center.
01:37:41So in sharing my story,
01:37:43I wanted to highlight how these
01:37:45donations might seem small,
01:37:47but they can have a huge impact
01:37:49for early career investigators
01:37:51like myself and my colleagues.
01:37:53So I want to thank you for your time
01:37:55and for having me on the panel today.
01:37:56Well,
01:37:58thank you so much.
01:38:01We're open now for questions.
01:38:04Any questions for everyone in the audience
01:38:24hands up
01:38:28this will be AI Hope it's a continuation.
01:38:32Actually the question that Tom Israel
01:38:35asked early with the number of children
01:38:38needing mental health services and
01:38:42there's fewer of us than than of them.
01:38:46Can you think of ways, continued ways
01:38:49that we can better engage and better
01:38:56ensure that we're getting
01:38:57those services out there?
01:39:01Anybody want to start
01:39:03Amy, I I can just say that
01:39:05I know that something that
01:39:06Family Based Recovery does along with
01:39:09other models of the child Study Center
01:39:11and including Icaps is thinking about
01:39:14ways to to bring services to the family.
01:39:17That there can be many barriers to families,
01:39:21families accessing services in the community.
01:39:23And I think in particular where
01:39:25there's substance use involved,
01:39:27the stigma that's often attached to that
01:39:30can be a barrier to parents accessing
01:39:33treatment treatment or or going to community
01:39:37providers for accessing treatment.
01:39:39And so thinking about home based work
01:39:43and ways to to support that often
01:39:45funding for home based work because
01:39:47some of the services may or may not
01:39:49be available can be challenging.
01:39:51And so I think ways to expand if possible
01:39:54bringing some of those two families is,
01:39:56is one of the things that I feel
01:39:58like it's really important.
01:40:03Yeah, I'll just second that because
01:40:05I think one of the things about.
01:40:09Home based programs is that
01:40:11we have to deal with a lot of
01:40:14politics and it it's really nice
01:40:20when there there's you can
01:40:21kind of make improvements and
01:40:23you can you know you you don't
01:40:25have to deal with so many layers.
01:40:28I think that's really one of the the
01:40:30benefits of, yeah, generous. Tony,
01:40:36any questions from the audience?
01:40:41Maggie, can you see the
01:40:44question GI psychology asking
01:40:48for a little more about that.
01:40:53Do you see it in the chat?
01:40:54Sorry, Yeah, I'm just reading the question.
01:40:59So do the children with the
01:41:02enteric neurobiological conditions
01:41:03have concurrent mucosal?
01:41:04So my quick answer to that is yes.
01:41:06I think our our general approach
01:41:08to the treatment of disorders
01:41:10of gut brain interaction is,
01:41:12is that we we really make it clear
01:41:16to families that it's not an either
01:41:18or it's not either the gut in the
01:41:20entire nervous system or the brain.
01:41:22You know a lot of the families that
01:41:24come to us have received messages like
01:41:26these aren't these symptoms aren't real.
01:41:28These, these,
01:41:29these symptoms are all in in
01:41:30your brain or related to some of
01:41:32the things in the questions this
01:41:33they they might think this is all
01:41:35related to the food we're eating.
01:41:36This is all related to the gut microbiome.
01:41:39And what what we really focus on in
01:41:42every visit with the families we work
01:41:44in is that it's it's not an either or
01:41:46all of these disorders of gut brain
01:41:47interaction are are multifactorial.
01:41:48You know similar to a lot of
01:41:51the complex mental health
01:41:52conditions that that we all treat.
01:41:54I think it probably relates a
01:41:56lot to what with the work that
01:41:57you do in ICAPS Victoria.
01:41:59So I think that's that's our
01:42:00first really mission in in our
01:42:02our interdisciplinary clinics is
01:42:04is helping families to understand
01:42:06that it's not just one factor that
01:42:08leads to all these conditions.
01:42:10So in terms of how
01:42:13things are interpreted and processed by kids,
01:42:15I think we sometimes surprise kids and
01:42:18and parents with our descriptions of what
01:42:20disorders of gut brain interaction are.
01:42:22Because I think sometimes they have
01:42:24been so stigmatized with previous
01:42:26providers that they come in thinking
01:42:28that when they're seeing the GI
01:42:30psychologist that I'm going to give them
01:42:32traditional mental health treatment and
01:42:33and if if we treat your depression,
01:42:36if we treat your anxiety that the GI,
01:42:38the GI problems will go away.
01:42:39And it's not actually not just
01:42:41about that which is kind of shocking
01:42:42for families to to hear.
01:42:44The my role is actually to use cognitive
01:42:47behavioral therapy tools to treat the
01:42:49GI symptoms directly so we can use GI
01:42:52informed cognitive behavioral therapy
01:42:54to turn the volume down on the GI tract.
01:42:57So we we, it's never just one conversation.
01:43:01We, you know,
01:43:02we make sure that we have that kind
01:43:03of conversation every,
01:43:04every clinic visit.
01:43:05So I hope that answered your questions.
01:43:09Maggie, there's a question above Michael
01:43:11Raven wanting to know a little bit more
01:43:14about what this field we see it above.
01:43:17Yes. OK,
01:43:23yes, it is a
01:43:25a a new, a new field. I often get
01:43:28that question of I've never heard
01:43:29those two words used together.
01:43:33It's unique in in the ways that I
01:43:36just described is that I I don't
01:43:39treat traditional mental health
01:43:40conditions like I treat GI conditions.
01:43:42Of course we treat depression and
01:43:44anxiety and and trauma along the way,
01:43:46but my job is to actually treat
01:43:48the GI symptoms themselves.
01:43:50And I think the special challenges that
01:43:53come with this kind of work are that
01:43:55we we are immediately hit with stigma.
01:43:58And unfortunately because it's a newer field,
01:44:02really well-intentioned providers
01:44:04that may see these families before
01:44:06may unintentionally send the wrong
01:44:08kind of messaging to to families about
01:44:11what the what the conditions are.
01:44:13So we sometimes have to do a lot
01:44:15of relationship building and kind
01:44:17of undoing of some of the messages
01:44:20that that that have been received.
01:44:23But I I see those challenges as
01:44:24the exciting part of the work.
01:44:26I think it was what really fascinated
01:44:28me by it when I was finishing my
01:44:30residency because the the field is
01:44:32constantly changing in really cool ways.
01:44:34We're learning more about the the
01:44:36gut microbiome and we're learning
01:44:38more about the kinds of therapies
01:44:39that we can do to treat these kids.
01:44:41So I feel really lucky to be a part of this,
01:44:44this small and growing community and
01:44:47I feel really grateful to be able to
01:44:49be appreciated for that here at Yale
01:44:51because it is such a unique specialty.
01:44:56Any other questions from the audience?
01:45:01Yes,
01:45:03it's a little
01:45:04off topic, but when I heard ICAPS,
01:45:06it reminded me of your close working
01:45:09relationship in the past anyway with
01:45:11the New Haven Police Department and I
01:45:14didn't know where that was currently.
01:45:18I think that's
01:45:20Kerry's program, correct? Do you want to
01:45:23take that one?
01:45:25And I'm so sorry. Could you repeat
01:45:27the question? I heard the police,
01:45:29the state of the relationship with
01:45:31the New Haven Police Department,
01:45:33working relationship.
01:45:35No, I'm speaking for my team.
01:45:37I'm not sure if any of them are on.
01:45:39I know Kristen Hamm was
01:45:41on at a certain point.
01:45:42Yes, we have an ongoing,
01:45:43I think it's almost a 40 year
01:45:45relationship with the New Haven
01:45:47Police Department where we
01:45:49collaboratively cross train
01:45:51each other and really work on
01:45:54improving trauma informed policing,
01:45:56going out together on ride alongs
01:45:59and responding and and going to
01:46:01the homes and engaging families
01:46:03where children have been impacted
01:46:05by recent traumatic events.
01:46:07And that is one thing that our
01:46:09program is doing that has been just
01:46:10so key in terms of community engagement.
01:46:12I would say
01:46:14it's over 20 years ago,
01:46:16but my daughter was on a Harris
01:46:19Fellowship and was on a ride
01:46:21along with somewhat late at night
01:46:24and she called my wife and said,
01:46:26I don't know if I should tell you this,
01:46:27but I forgot my bulletproof
01:46:30vest and my wife said you
01:46:31shouldn't be telling me this.
01:46:35Unfortunately, she is OK
01:46:38yes. And it was that wonderful
01:46:42clip of a police officer whose
01:46:45life was saved because of his
01:46:47relationship with the community.
01:46:49And here's his big,
01:46:51tough old detective pulling his eyes
01:46:54out because of the relationship that
01:46:56had been established between the
01:46:59Child Study Center in New Haven.
01:47:00Please. Yeah.
01:47:03Thank you, Tom is
01:47:05the shout out to my team,
01:47:06who does that amazing work.
01:47:09Thank you, Karen.
01:47:10So thanks to our panelists.
01:47:12And we'll move to our final panel.
01:47:14We move back to our research colleagues.
01:47:19So our first speaker will
01:47:20be Doctor Flora Vacarino,
01:47:21who is the Harris Professor and Director
01:47:24of the Program for Neurodevelopment
01:47:26and Regeneration as well as Laboratory
01:47:29of Development on Neurobiology.
01:47:31Dr. Jamie Mcpartland will be next.
01:47:33Also Harris Professor and Director of
01:47:36the Yale Developmental Disabilities
01:47:38Clinic and the Yale Center Co Director in
01:47:40the Yale Center for Brain and Mind Health.
01:47:43Doctor Ellie Leibowitz,
01:47:44an Associate Professor and Co Director
01:47:46of the Anxiety and Mood Disorders
01:47:49Program and Doctor Emily Olson,
01:47:51an assistant professor in the Center.
01:47:53So, Flora, may I turn to you first?
01:47:57Good afternoon.
01:47:59It's truly an honor to be speaking with
01:48:03you as I've done sometimes in the past.
01:48:07So I'd like to start with a personal story.
01:48:10I'm a physician trained in neurology
01:48:13in Italy and in psychiatry here,
01:48:16actually here at Yale that early on
01:48:20entered the field of neurobiology
01:48:23or developmental biology because
01:48:26I really wanted to help patients.
01:48:29And I was aware how little we knew
01:48:33about brain, how brain develops,
01:48:35how brain functions,
01:48:36how the different portion of this incredible
01:48:39machine get put together very early on.
01:48:44And indeed,
01:48:44I did learn that this happens sometimes very,
01:48:47very early.
01:48:48Some of the fundamental decision that
01:48:50govern how many cells we have and
01:48:54what kind of neurons would grow and
01:48:56how do we respond to things like the
01:48:58environment and all the challenges
01:49:00and injuries that we have in life.
01:49:03So, So I I was eager to answer these
01:49:09questions and when I started working,
01:49:11I was a young faculty member in the 90s.
01:49:15At that time, you know,
01:49:18it has been very difficult to
01:49:19study the human brain.
01:49:21So what I was doing,
01:49:22I was mostly dealing with mice and
01:49:25I was doing a lot of genetics,
01:49:27doing working on the genetics
01:49:29of mammalian development,
01:49:31using mouse as a model.
01:49:33And that's been great,
01:49:35but it was deeply unsatisfactory
01:49:38because of course we all know
01:49:40how different is the brain of a
01:49:43human from the brain of a mouse.
01:49:45As a matter of fact,
01:49:46from the brain brain of almost
01:49:48any other animal,
01:49:48except perhaps some primates
01:49:50that are more similar to us.
01:49:51We have so many more cells.
01:49:53It's so much more complex.
01:49:54It's incredible.
01:49:55And and there's been no model so
01:49:59far to really study this except
01:50:03about let me share my screen.
01:50:08In 2007,
01:50:11about 15 years into my working
01:50:15mouse development,
01:50:18somebody called Shinya Yamanaka
01:50:20in Japan discovered something
01:50:23incredible that you can take a human
01:50:25cell and it can be any cell and
01:50:28develop that into a pluripotent cell
01:50:30which is a cell that can give rise
01:50:32to almost any cells in the body.
01:50:34And so you can take these cells
01:50:36and they're basically in vitro.
01:50:38They become immortal and then
01:50:40you can take them back and sorry
01:50:43and develop them into something
01:50:46that's similar to a mini brain.
01:50:48So you can did give them
01:50:51instructions that tells them,
01:50:53OK, now you become a brain.
01:50:54We call this brain organoids.
01:50:56But basically they recapitulates what
01:51:00normal cells do during development to
01:51:03generate from a pretty potent cell,
01:51:06a neuron,
01:51:07a particular kind of neurons
01:51:09of a specific brain region.
01:51:12So this was kind of incredible because
01:51:15this says when they can be brought
01:51:18back to recapitulate brain development,
01:51:21they do so in a personal way.
01:51:24They maintain the personal genetic
01:51:26background of that person.
01:51:27And so that immediately I understood
01:51:30that that gave us the occasion to
01:51:33really study brain development in a
01:51:35particular person retrospectively.
01:51:39So I was very eager to enter this field,
01:51:41but I had all these mice and and I
01:51:46really didn't know how to embrace it.
01:51:49And so at that time there was a
01:51:51family of donors, the Aronstein
01:51:53family who really, really helped us,
01:51:56me in particular to recruit somebody new,
01:52:00change my, my lab gradually into
01:52:04developing this type of research.
01:52:08So over the years,
01:52:09we in collaboration with many
01:52:11clinician at the Child Studies Center,
01:52:14the some of whom you already
01:52:15heard of Doctor Chavaska Dr.
01:52:17Mcpartland who will speak after me,
01:52:20We recruited patients and we developed
01:52:23these lines and now we're at the point
01:52:27that 10 years later we have about
01:52:291000 lines from over 150 individual
01:52:32from many developmental disorders
01:52:35particularly autism into that syndrome.
01:52:38And So what we do and so this was thinking
01:52:44really a particular set of donors,
01:52:47this family that really helped us
01:52:49in a in a time where pretty much we
01:52:53didn't have any other resource and just
01:52:56give you an example of what we do.
01:53:00So right now we recruit patients.
01:53:03We have these lines.
01:53:05And then here is a study where
01:53:07we compared families of patients
01:53:09with autism and we compared the
01:53:11program with autism with the father.
01:53:13In this model of invitro brain development,
01:53:16we just published this paper.
01:53:18We demonstrated that children with autism,
01:53:21when they are modeled this way,
01:53:25actually develop a slight imbalance
01:53:27between excitatory and inhibitory neurons.
01:53:30But this imbalance remarkably is
01:53:32different in every individual.
01:53:33So we're not all the same.
01:53:35Patients are not all the same.
01:53:38People that are so-called have typical
01:53:40trajectory are not all the same.
01:53:42We do this,
01:53:43the brain develops in slightly
01:53:45different way in each individual.
01:53:46This is a remarkably powerful notion
01:53:49that we're learning using this modeling.
01:53:53And this is just an example.
01:53:54We do a lot of genomics.
01:53:56We analyze every single cells.
01:53:59This is a typical organoid,
01:54:01each dot is a cell.
01:54:02We characterize them in different
01:54:04type of neurons or real cells and
01:54:07we and we reach sets and conclusion.
01:54:10We can also look at their electrical
01:54:12activity.
01:54:13You see here these neurons are
01:54:15firing in a dish and we can study
01:54:18the rate of their firing,
01:54:20how fast they fire, do they fire less,
01:54:22do they fire more?
01:54:24So where are we going with this?
01:54:27So the the basic notion I want to
01:54:30impress in you is that studying the
01:54:33individual and this is gives that the
01:54:36possibility of studying the individual,
01:54:38the actual biology of that individual,
01:54:40the actual biology of brain
01:54:42development of that individual.
01:54:43Such a powerful notion.
01:54:46And they're telling US1 size doesn't fit all.
01:54:49We're all different.
01:54:50And maybe there are some extreme trajectories
01:54:53that are more different than others.
01:54:55And then they lead to some disease.
01:54:57But we're all different.
01:54:59Where are we going with this?
01:55:01We want to study autism in female.
01:55:04We've shown that.
01:55:04I've shown that in males we
01:55:06have these imbalances between
01:55:07excitatory and inhibitory neurons.
01:55:09This could be implication.
01:55:10They could have implication for treatments.
01:55:13We need to remind ourselves that these
01:55:15things potentially could be corrected,
01:55:17but we need to be aware of how
01:55:20different people are and the
01:55:22treatments may need to be personalized.
01:55:24And we can then develop this model
01:55:27further in view of treatment
01:55:30and we can look at large scale
01:55:32studies potentially in the future
01:55:33to look at this phenotype across
01:55:35a large number of individuals.
01:55:38And so I wanted to finish by
01:55:42acknowledging my lab, my collaborator,
01:55:45the clinicians who have helped in our
01:55:48studies to recruit all these people,
01:55:50our Funding Agency and especially
01:55:52the Aranstein family who gave
01:55:54us the chance to be here to get
01:55:57to this point and to continue
01:56:00this incredible trajectory.
01:56:01Thank you.
01:56:06Thank you for. May we turn to Jamie.
01:56:10Sure. Thanks so much, Linda.
01:56:12And and Laura, thanks for queuing me up.
01:56:15I'm going to expand on the idea that Laura
01:56:18put forward that one size doesn't fit all
01:56:21her or we can talk about it as heterogeneity.
01:56:24And as many of you know,
01:56:25I my focus primarily is autism.
01:56:28And really the idea that one size doesn't fit
01:56:30all is actually what brought me to autism.
01:56:33One summer during college I was I was very,
01:56:37very certain that I was going to be a lawyer.
01:56:40And I spent a summer working as an assistant
01:56:43teacher at a school on Long Island for
01:56:45children with development disabilities.
01:56:47And this was my first contact
01:56:49with autistic children.
01:56:50And I came to the classroom that first day,
01:56:52and I met Tessa, and I met Bradley,
01:56:55and Bradley came up to me and talked
01:56:57to me and read to me from his favorite
01:56:59book and told me probably more than I
01:57:01actually wanted to know about that book.
01:57:04And Tessa said nothing to me.
01:57:07She didn't look at me.
01:57:08She sat in the corner by herself,
01:57:10and she played with the fringe on the carpet.
01:57:13And I didn't understand what
01:57:16they They both had autism.
01:57:18They were both in the same classroom.
01:57:21What did this mean?
01:57:22What did it mean about the brain
01:57:26that that the same kinds of kids who
01:57:28have such different strengths could
01:57:30have some common vulnerabilities?
01:57:32And what does it mean about psychology and
01:57:35psychiatry that we don't have better labels,
01:57:37that we call these really,
01:57:38really different kids autism?
01:57:40And I changed gears and that's what I did,
01:57:43is try to figure out what's happening here
01:57:46and how we can individuate the differences,
01:57:49the strengths,
01:57:50the weaknesses of these kids
01:57:52in meaningful ways.
01:57:53I,
01:57:53again,
01:57:54clinically as a graduate student
01:57:56trying to understand the diagnostic
01:57:59classifications that we use.
01:58:01And maybe if I really,
01:58:02really dug in there,
01:58:04the answer would be there and it wasn't.
01:58:08And I thought, well,
01:58:10maybe if I dig into the brain,
01:58:13maybe the things that I can't
01:58:15see with my own eyes,
01:58:16the things that are hidden
01:58:17inside the cranium,
01:58:18are the things that are going to
01:58:20help me understand what are the
01:58:21meaningful differences and how to help.
01:58:23And what I can't tell you
01:58:25whether they're there or not,
01:58:26but I can tell you that for the
01:58:28past 20 years, I continue to look.
01:58:30And that's what I've done since
01:58:32I came to Yale, now 20 years ago,
01:58:35almost 2004.
01:58:36And you know, on this day,
01:58:39talking to the associates,
01:58:40I feel like my career is a bit of a
01:58:43case study in how you can be impactful.
01:58:46When I came here,
01:58:46my job was to be in a clinic and to
01:58:49be working with kids with autism
01:58:51and get from the associates gave
01:58:53me some time to study and to write
01:58:55grants and to try to start a lab.
01:58:57And then when I had a lab support
01:59:00from the associates,
01:59:01let me do things like
01:59:03send print a poster
01:59:04so that I could be a part of an
01:59:07academic conference or or take a lab
01:59:09a colleague out for coffee so that
01:59:11we could talk about a new project.
01:59:13As my lab grew and as my the
01:59:16trajectory of my career changed,
01:59:19the associates have made have
01:59:21remained just as important.
01:59:23In 2015, I received the the biggest grant
01:59:27the NIH has ever given to study autism.
01:59:31But as bizarre as it sounds,
01:59:32this gigantic grant didn't include money
01:59:36for an EEG system to actually do the work.
01:59:39The associates came through
01:59:41and let this study happen.
01:59:43When I had the idea that maybe some of
01:59:45the things that we've learned in this
01:59:48study could be termed not just as kind
01:59:50of descriptors of how to understand
01:59:52autism but as treatment targets,
01:59:55it was an associate who helped
01:59:57me buy a machine so that I can
02:00:00now directly stimulate parts of
02:00:02the brain to ramp up the parts.
02:00:04That we think are under active.
02:00:06So really it's been critical at every
02:00:08stage and now I find myself at a part
02:00:11of the career where I've come full
02:00:12circle a little bit and now I have
02:00:15the opportunity to help some of the
02:00:17people that are that are in my lab.
02:00:19You heard from Allen.
02:00:20Others that are other postdocs
02:00:21or junior colleagues have ideas
02:00:23that need to be launched.
02:00:25And one of the the truths about
02:00:28science is that we can't launch our
02:00:31boldest ideas with conventional
02:00:33funding mechanisms that are too risky.
02:00:35And most funding mechanisms are risk averse.
02:00:38So what people what supporters like
02:00:40you all do is let us support those
02:00:42kinds of ideas to launch today.
02:00:44The kinds of things that we're
02:00:46trying to launch a Bolt.
02:00:47We're trying to understand how
02:00:49social media and the idea that
02:00:51someone thumbs up or thumbs down,
02:00:53every single thing you do,
02:00:55how that affects autistic people
02:00:58with social disabilities.
02:00:59We're trying to figure out ways.
02:01:00You know,
02:01:01we we've learned so much about how
02:01:03the autistic brain responds to social
02:01:05information, but most of what we do in a lab,
02:01:08if we have new kinds of equipment,
02:01:10could we actually do it when people
02:01:11are engaging with one another in real life?
02:01:13We think so.
02:01:14That's what we're trying to do.
02:01:15So thank you.
02:01:17It's been a partnership.
02:01:19Many of you associates are people
02:01:21that I consider friends,
02:01:23colleagues.
02:01:23I was thinking some of you are
02:01:26even co-authors,
02:01:27some of you have been mentors to me
02:01:29and I thank you for your partnership.
02:01:31And really today I'm still trying
02:01:34to do a better job than we did,
02:01:38you know more than 20 years ago
02:01:39for Tessa and Bradley.
02:01:40So thanks for your partnership in that.
02:01:42I'm going
02:01:45to turn to Ellie.
02:01:49Hi, I'm Ellie Liebowitz.
02:01:51I'm in the Anxiety program. And about
02:01:5615 years ago, I was living in Israel
02:02:00actually, and working primarily as a
02:02:04clinician in my own practice and in
02:02:07Israel's largest Children's Hospital.
02:02:10But I knew that I wanted my clinical work to
02:02:15inform a career in research on child anxiety,
02:02:20and my boss at the hospital gave
02:02:22me a contact the lead at the Child
02:02:24Study Center and suggested, hey,
02:02:26maybe reach out, share your interest,
02:02:28see if there's an opportunity there.
02:02:31So I sent an e-mail and about 5 minutes
02:02:35later I woke up my wife to say hey.
02:02:39They replied to my e-mail and the e-mail
02:02:43back said there might be something.
02:02:47And that led to a very rapid whirlwind.
02:02:50A couple of weeks and within
02:02:53a month our family,
02:02:54including two little boys at
02:02:56the time and two dogs,
02:02:58had moved to New Haven to start
02:03:02working as the quote anxiety postdoc.
02:03:06Now that was only possible because
02:03:10of a person's generosity and
02:03:14commitment to building a world
02:03:17leading anxiety program because they
02:03:20cared enough about mental health,
02:03:22about children's development,
02:03:24and we're willing to take concrete
02:03:27action and steps to make a difference.
02:03:30And now we have a thriving anxiety
02:03:34program that has already made a
02:03:36very real impact on the field,
02:03:39including developing to the
02:03:41fastest growing new treatment
02:03:43for child anxiety in 30 years.
02:03:48When people ask me about
02:03:50my personal trajectory,
02:03:52I tend to emphasize being
02:03:55fortunate in three ways.
02:03:583 forms of generosity that I
02:04:01have been able to benefit from.
02:04:05Generosity of philanthropy.
02:04:07Generosity of mentorship and
02:04:10generosity of collaboration.
02:04:13And I try to pay these things
02:04:15back as much as I can today,
02:04:17because I know very well that without
02:04:19all three of those forms of generosity,
02:04:23I would never be able to accomplish anything.
02:04:27You know, when I sent that e-mail years ago,
02:04:30I had a lot of ideas about things that I
02:04:33thought needed to change in our field.
02:04:36My clinical work was showing me that
02:04:39the one size approach to treating
02:04:42anxiety just didn't make sense.
02:04:44For example,
02:04:45I would often have to turn away
02:04:49families who were seeking treatment
02:04:51because their anxious child wasn't
02:04:53motivated or was unwilling or
02:04:55unable to collaborate with the very
02:04:57demanding challenges that are part
02:04:59of cognitive behavioral therapy,
02:05:01which has been for a long time the
02:05:04frontline treatment for anxiety.
02:05:05But my frustration about not being able
02:05:08to help those families kept growing.
02:05:10You know, parents would say to me,
02:05:12of course, they're too anxious for
02:05:14what you're asking them to do.
02:05:17They're anxious.
02:05:18That's the whole point.
02:05:19They have anxiety.
02:05:20That's why we came.
02:05:21And I knew from my work with
02:05:24other problems like aggression,
02:05:26defiance,
02:05:27disruptive behaviors.
02:05:28I knew from those fields that
02:05:31parent work can be just as
02:05:34sometimes even more effective
02:05:35than treating a child directly.
02:05:38And I also saw how deeply
02:05:40parents were getting entangled
02:05:42in their children's anxiety
02:05:44symptoms through the process of
02:05:47accommodating the child's anxiety.
02:05:52And when I went to do a review of
02:05:54the literature of the research on
02:05:57accommodation of child anxiety,
02:05:58which I learned about through
02:06:00the field of research in OCD,
02:06:02and I was seeing in my clinical work,
02:06:03I went to do like,
02:06:05what does the literature say about this?
02:06:07Well, that literature review
02:06:08proved to be very,
02:06:10very short because there were
02:06:12exactly 0 studies of that.
02:06:15And so I had a lot of ideas for new research,
02:06:19directions for different
02:06:21biological mechanisms,
02:06:22for new treatment to help more families.
02:06:26But ideas are actually not the
02:06:30scarcest resource in our field.
02:06:33There are a lot of good ideas out there,
02:06:37but none of them really mean anything without
02:06:40the opportunity to actually implement them.
02:06:44For me,
02:06:45it would not have come to anything
02:06:47without the opportunity to be here
02:06:49benefiting from the generosity of donors,
02:06:52of mentors,
02:06:53of collaborators working with
02:06:55collaborators like Flora and the
02:06:58really mind boggling science that she
02:07:01just described a few minutes ago.
02:07:03Collaborations with Flora LED us to
02:07:06identify novel biomarkers that have
02:07:09never been studied before in human beings,
02:07:12and that may help to unravel some mysteries
02:07:14that have been around for a really long time.
02:07:18Like how does stress and adversity in
02:07:22childhood lead to anxiety disorders later?
02:07:27What are the actual molecular
02:07:29pathways linking those things,
02:07:30and can we intervene to change them?
02:07:33Or working with brilliant
02:07:36geneticists like Tom Fernandez,
02:07:38like Emily Olson,
02:07:42has led to groundbreaking genetic
02:07:45discoveries that can take us one step
02:07:48closer to being able to say more than just.
02:07:53Yes, genetic plays a role,
02:07:56but we don't really understand how,
02:07:59which has kind of been my answer to a lot
02:08:02of the genetics questions for way too long.
02:08:05And working with mentors
02:08:07like Wendy Silverman,
02:08:09who directs the Anxiety Program,
02:08:10like Jim Lackman, like Bob King.
02:08:12Like so many others.
02:08:15The mentors who believed in me supported
02:08:17me and have been a role model to me.
02:08:22Without all of those things,
02:08:23it would not be possible.
02:08:26Now, I guess, in a sense,
02:08:28I guess my message is that if you
02:08:31can be generous in any of these ways,
02:08:34do it not just for our center,
02:08:37our department,
02:08:38but for every sphere in your life.
02:08:40Maybe there is somebody that you
02:08:42can mentor. Maybe there
02:08:45is a new collaboration that you
02:08:47can form that can prove to be more
02:08:49than just the sum of its parts,
02:08:51as so many collaborations really do,
02:08:54And maybe you can support financially the
02:08:57outcomes that you want to see in the world.
02:09:00We have a lot more things to do.
02:09:03I have more ideas, more directions,
02:09:07more potential discoveries in mind today
02:09:10than I did back when I sent that e-mail.
02:09:13And with enough support,
02:09:15with enough mentorship,
02:09:16with enough collaboration,
02:09:18I hope that some of these ideas
02:09:21will become reality as well.
02:09:23So thank you.
02:09:26Well, and, Emily, may I turn to you.
02:09:32Thank you. And these are hard
02:09:36acts to follow for sure.
02:09:38So my name is Emily Olson,
02:09:40and I'm a child psychiatrist
02:09:42and a genetics researcher,
02:09:43and I started on faculty here at the Yale
02:09:45Child Study Center just over a year ago.
02:09:48And before that I did my clinical
02:09:50and research training here as well.
02:09:52So I don't have quite as long
02:09:53a career to draw upon as my
02:09:56other colleagues in this panel.
02:09:58But even in this time,
02:10:00I do feel that donations have
02:10:02really made a big difference,
02:10:04not only in my career,
02:10:05but also, importantly,
02:10:07in the science that I've been able to pursue.
02:10:11And just as an example,
02:10:12the first grant that I ever
02:10:14received at the Child Study
02:10:15Center was about six years ago,
02:10:17when I was fortunate to receive
02:10:19one of those Child Study Center
02:10:21pilot grants that we've heard
02:10:23kind of come up a few times,
02:10:25which were only made possible
02:10:26by donations to the center.
02:10:28And this pilot grant allowed me
02:10:30to start a new research study
02:10:33focused on trichotillomanium.
02:10:35Now,
02:10:36trichotillomania is a condition
02:10:37you might not always hear about,
02:10:39but it's relatively common,
02:10:41affecting about 1% of the population,
02:10:44usually onsets around puberty,
02:10:46and it's characterized by
02:10:48pulling out of one's own hair.
02:10:52And it causes kind of significant
02:10:54distress because it causes bald
02:10:56spots and so impairment in
02:10:58school and at home and sometimes
02:11:01medical complications as well.
02:11:03And these kids who have trichotillomania
02:11:06are also have high rates later on of
02:11:10developing anxiety and depression.
02:11:12So I became interested in this condition
02:11:14because of a few patients I was
02:11:17seeing clinically and because of my mentors.
02:11:20And I was really struck because
02:11:22there are no first line treatments,
02:11:25there are no FDA approved medications.
02:11:27And then as someone who has a PhD in
02:11:30genetics, when I went to the literature,
02:11:32we know so little about the
02:11:35biology of this condition.
02:11:37So with this,
02:11:38you know,
02:11:39$10,000 pilot grant that I received
02:11:41kind of as a second year resident,
02:11:43it allowed me to start collecting
02:11:45families who were impacted by this
02:11:47position and generate important
02:11:49kind of preliminary data showing the
02:11:52role of specific genetic factors.
02:11:54And this preliminary data really has
02:11:56motivated kind of a whole line of research.
02:11:58So it's fortunately led to more
02:12:01donations to additional grants.
02:12:03And then last year I got an NIH
02:12:06grant that allowed me really to
02:12:09transition from being a trainee
02:12:11to becoming a faculty member.
02:12:14And I should say that this is the
02:12:15only NIH grant currently funded
02:12:17on trichotillomania.
02:12:18I'm hoping it won't remain that way
02:12:20for long and that as we do more research,
02:12:22more people will get excited in
02:12:24the field and we'll be able to
02:12:27learn more about this condition.
02:12:29So now as a faculty member,
02:12:31you know,
02:12:32I continue to see and treat patients
02:12:34who have trichotillomania as well
02:12:36as you know related conditions,
02:12:38things like OCD, ticks, ADHD and anxiety.
02:12:43And you know in our outpatient clinic.
02:12:46And I also kind of continue to do
02:12:49research really trying to better
02:12:51understand the genetics of these
02:12:53conditions with the hope that you know,
02:12:54as we learn more about the
02:12:57underlying biology that that will
02:12:58inform our treatment of these kids.
02:13:03And specifically right now
02:13:03a lot of the work I'm doing,
02:13:05I'm really interested in how we can
02:13:07take these new discoveries in genetics
02:13:09because they are coming slowly as
02:13:12Tom kind of discussed early on,
02:13:14but they're coming and how we can
02:13:16actually use them to inform early
02:13:18intervention and treatment because I
02:13:20think that's really the goal is how
02:13:22can we make this information useful.
02:13:24And as a new faculty member now
02:13:26I'm also in the process of kind
02:13:28of starting my own laboratory.
02:13:30And I'm finding, you know,
02:13:32in addition to kind of the two main
02:13:34joys in my career that I've had of
02:13:36kind of working individually with
02:13:37families and doing this genetics research.
02:13:39I'm also realizing that I also love
02:13:41being a mentor and that getting trainees
02:13:44really excited about the field.
02:13:46It's been really fun. So.
02:13:49So right now a lot of my thoughts and
02:13:51and Jamie kind of mentioned this as well,
02:13:53but a lot of my thoughts are
02:13:55now around kind of how to secure
02:13:58funding and donations so that,
02:13:59you know,
02:14:00other people can pursue kind of
02:14:03these important research questions
02:14:05as well and work in our center.
02:14:07And so that we can all kind of continue to,
02:14:10you know,
02:14:10help these kids who continue
02:14:12to suffer despite kind of our
02:14:14available interventions right now.
02:14:15So with that, thank you for the time.
02:14:19I think I was actually the
02:14:21last talk but of the day,
02:14:23but so thank you everyone
02:14:24for sticking around.
02:14:25Thank you
02:14:26so much, Emily.
02:14:28We have time for questions.
02:14:29And Ellie, there is a question
02:14:31in the chat directed to you.
02:14:35Can you see it?
02:14:36Oh, I I do see it.
02:14:39The question is around increased
02:14:44anti-Semitism on college campuses
02:14:46and rallies and social media.
02:14:49And how can we help young people,
02:14:52teens and young adults coping
02:14:54with anxiety in that context?
02:14:59And I will say that this is a a topic it's
02:15:03hard for me to speak about dispassionately,
02:15:07in in part because the horrific events of,
02:15:10you know, the past month have affected
02:15:13me very deeply on a very personal level.
02:15:16So it's not a topic that's easy for me to
02:15:19talk about in a in a dispassionate way,
02:15:20but I also think it's a really important,
02:15:23it's a really important topic.
02:15:26How can we help young people to cope?
02:15:28I think first of all it it
02:15:31doesn't need to be said.
02:15:33I think it it's important to first
02:15:34of all just ensure physical safety.
02:15:36And, you know, I would check in with with,
02:15:40you know, the person in your life that
02:15:42you're concerned about or thinking about,
02:15:44are they actually safe?
02:15:46Are they taking steps to ensure
02:15:48that they're safe?
02:15:48Things, you know,
02:15:50like staying,
02:15:50trying to like just stay away from
02:15:53situations that might actually
02:15:55be physically dangerous to them.
02:15:58Check in about how they are coping.
02:16:00How are you feeling those check
02:16:03insurance aside from just,
02:16:04you know,
02:16:05like you hearing that they're doing
02:16:07OK or actually are an important
02:16:09source of support when somebody
02:16:11just shows you like OK,
02:16:12I'm concerned for you,
02:16:13especially when you may find
02:16:15yourself in an environment where
02:16:17you feel more isolated or more
02:16:19targeted or things like that.
02:16:20I think,
02:16:21you know,
02:16:21having somebody reach out and just
02:16:23ask are you OK and express care
02:16:26is really is really important.
02:16:27You can ask questions like are there
02:16:28things you don't feel like you can say,
02:16:30are there places you don't
02:16:32feel like you can go?
02:16:33And things like things like that.
02:16:36I think especially for teenagers,
02:16:37it is also really important to just
02:16:40help to make some distinctions right?
02:16:43Like not
02:16:47and not everybody who expresses even say,
02:16:50an anti-Semitic trope is necessarily
02:16:53a deeply hostile anti-Semitic person.
02:16:55There are a lot of things that
02:16:57become ingrained in our culture,
02:16:58just like biases and implicit biases
02:17:00and things that can can apply to many
02:17:03other minorities and many fields.
02:17:04These things can happen in
02:17:06this context as as well.
02:17:08I would encourage them to seek out healthier,
02:17:12convert healthy conversations.
02:17:13It's important to know when you're in
02:17:15an interaction with another person,
02:17:17are we actually having a constructive
02:17:19conversation even if we disagree?
02:17:21A constructive conversation where your goal
02:17:23is to try to understand another perspective,
02:17:26try to understand the other side.
02:17:27Or are we having more of a combative,
02:17:32you know, hostile kind of inter interaction?
02:17:38I would help them to remember,
02:17:39again, these are things that are
02:17:40harder when you're a teenager.
02:17:41Remember like you as an individual,
02:17:43you are not the Jewish people,
02:17:45you are not the state of Israel.
02:17:47You are a a person and sometimes
02:17:50that can get a little bit,
02:17:53a little bit lost.
02:17:54And by the way, I think,
02:17:56I mean the question is very good
02:17:58and and and very important.
02:18:00It is also important
02:18:02to remember it's that
02:18:03this these events affect
02:18:07not only Jewish people,
02:18:08they also affect Palestinian people.
02:18:10I feel a lot of what we're are
02:18:12what I am saying can actually go
02:18:14very much for somebody who may
02:18:16feel themselves isolated on the,
02:18:19you know, so-called other side of this
02:18:21particular of this particular divide.
02:18:23I would encourage people to try to be
02:18:26like more of a learner and less of an
02:18:28expert in a lot of their interactions.
02:18:30So those are some off the cover kind of,
02:18:33you know, suggestions for for this.
02:18:39But really I think just showing care and
02:18:42staying physically safe are probably the
02:18:43two like top bullets for for me.
02:18:47Thank you, Ellie.
02:18:48Tom, you had your hand up.
02:18:53How does one
02:18:54breakdown when one wants to study anxiety?
02:18:58Seems to me, if you know children,
02:18:59you know anxiety.
02:19:01And as we've heard today,
02:19:04some people are experts and
02:19:05spend their careers studying
02:19:07something I never heard of before,
02:19:08which is GI psychology and
02:19:11then others study loneliness.
02:19:14How do you, when you try to
02:19:16organize what you're going to study,
02:19:17there's so many different silos and
02:19:21the silos is so deep you can't get
02:19:25to the bottom of all the silos.
02:19:26So how do how do you sort
02:19:28through that then that dilemma?
02:19:36Who would like to start with that?
02:19:40Well, one one way would
02:19:41be to for forget a little bit about
02:19:44diagnostic categories that are now a bit
02:19:49stereotyped. And they keep changing,
02:19:52sometimes for reasons that are
02:19:54not entirely clear, and and go
02:19:56back to the most fundamental
02:20:00reactions of the human brain.
02:20:03And and and try to draw parallels
02:20:05between what we call phenotypes that
02:20:09is any manifestation behavioral or
02:20:13physical or motor manifestation like
02:20:15stereotypies that we were talking
02:20:17about this morning and the brain,
02:20:21the brain in this incredible
02:20:25multifunctional manifestation at any
02:20:27level and and by by drawing those
02:20:30linkages we can then probably understand
02:20:32how certain disorders because disorders
02:20:35are just a collection of this like
02:20:37disorders are are not silos themselves.
02:20:39You have a little bit of autism
02:20:41in Tourette's.
02:20:42You have a little bit of
02:20:43Tourette's in autism or in anxiety.
02:20:45With stereotypic behavior is
02:20:47common to many disorders.
02:20:48Anxiety is common to many disorders.
02:20:50So how do we understand that
02:20:52we have to go to the basics.
02:20:54That's my feeling.
02:20:55Not an easy thing.
02:20:59Anyone else,
02:21:00I feel like, I mean,
02:21:02I'm just checking, I'm not on mute.
02:21:05I feel like in a sense almost like
02:21:07the answers that you might get from
02:21:09the group are and the heterogeneity
02:21:10in answers that you might get from
02:21:12the group are almost like a little
02:21:13bit of an answer in in themselves.
02:21:15In the sense that
02:21:18you you also follow your passion a little
02:21:21bit like what actually sparks your,
02:21:23you know, interest For me,
02:21:26I like my clinical work to actually
02:21:30drive the questions that I'm most
02:21:32focused on in in studying Like for me
02:21:35those are where the the best questions
02:21:37that I come come up with and also like
02:21:39thoughts on how to try to address them.
02:21:42They come very much from my clinical work,
02:21:44but that's not because the correct
02:21:45way to get to those questions is
02:21:47to like start from clinical work.
02:21:49It's because that's the way
02:21:50I'm wired and it it, you know,
02:21:52kind of makes sense for, for, for me.
02:21:54And then you might have another person
02:21:56who really has like another approach.
02:21:58But I don't at least I can say for myself,
02:22:01I think it's probably true broadly.
02:22:03I mean you don't really set out
02:22:04to solve the field of anxiety.
02:22:06You set out to do something right.
02:22:08Like you have a,
02:22:09you have an idea or a question or you know,
02:22:13I think I'm more,
02:22:14I'm more somewhat more narrowly focused,
02:22:16maybe a little bit more humble kind of goal.
02:22:18And then it takes you,
02:22:20you know to the next to the next thing.
02:22:23Emily, there's a question in the
02:22:26chat you is there evidence for
02:22:29genetic basis of trichotillomania?
02:22:30Yeah. So there is evidence,
02:22:34some of it so kind of,
02:22:36you know, decades ago,
02:22:37there have been for decades,
02:22:38there have been family studies
02:22:40kind of looking at how these,
02:22:41how trichotillomania runs in families.
02:22:43Actually Bob King did did some of
02:22:46that work at the Child Study Center
02:22:48and there were a few twin studies
02:22:51as well kind of showing kind of
02:22:54the the role of genetic factors,
02:22:56inheritable factors as well.
02:22:58But I think what was harder
02:23:00for scientists until recently
02:23:01was kind of to find what are
02:23:04specific genetic risk factors.
02:23:06So not just that these run in families
02:23:08and that there's a genetic basis,
02:23:12but that's kind of what
02:23:13we're hoping to do here.
02:23:15And so the work I'm doing is actually
02:23:17the first kind of genome wide approach
02:23:19looking at trichotillomania and kind of
02:23:22building out for some of the successes
02:23:25of what we've done in other childhood
02:23:28psychiatric conditions to try and find
02:23:30those specific genetic risk factors.
02:23:32Because when you think about,
02:23:34you know, treatment,
02:23:35identifying drugable targets and
02:23:38really understanding the biology,
02:23:40the neuro circuitry,
02:23:41you need to understand what those specific
02:23:44genetic factors are that are involved.
02:23:47So and I guess that kind of
02:23:49leads in to the next question
02:23:51I see in the chat from Larry.
02:23:54And I don't know if I'm the
02:23:56best person to answer this,
02:23:57but I will take a stab of
02:24:00everyone who spoke today.
02:24:02So
02:24:03you know I think
02:24:05in some fields I think the
02:24:07genetics really is getting there.
02:24:10So I think in and we have
02:24:12some experts in autism,
02:24:13so I will let them speak more.
02:24:15But in the field of autism now you know
02:24:18they've done these genetic studies
02:24:20looking at thousands of families and
02:24:23they've actually found these high
02:24:24confidence what we think of as high
02:24:27confidence risk genetic factors.
02:24:28And you can identify these in
02:24:31over kind of 10% of individuals.
02:24:33It's depending on the type
02:24:34of cohort you look at,
02:24:35but it's a pretty significant
02:24:37proportion of kids that you can find
02:24:40kind of a specific genetic risk
02:24:42factor that you know is associated.
02:24:44And
02:24:45you know, I think for families,
02:24:49you know, knowing why their child
02:24:51has a the condition can be really
02:24:53helpful depends on the family,
02:24:55right, understanding kind of what
02:24:58recurrence risk is for other children.
02:25:02And some of these genetic
02:25:03factors are associated with
02:25:05medical comorbidities as well.
02:25:06So things like cardiac
02:25:07conditions and things like that.
02:25:09So I think there are kind of
02:25:12implications and right now,
02:25:14you know the, I feel like the
02:25:17guidelines are rapidly shifting.
02:25:19Currently it's recommended by the
02:25:22Society of Genetic Counselors that a
02:25:26diagnosis of autism you should get a
02:25:29kind of do Fragile X testing and get
02:25:31a microarray to look for these kind
02:25:34of large insertions and deletions.
02:25:36But I I think as more and
02:25:37more risk genes are found,
02:25:39it will be DNA sequencing, right.
02:25:42And that's really where
02:25:43the field isn't moving.
02:25:45And you know,
02:25:46I think autism is really ahead
02:25:49of kind of other disorders.
02:25:50But I think we are going to find
02:25:53genetic risk factors and thinking
02:25:55about and whether and whether we
02:25:57start doing it as clinicians or not,
02:25:59people are going to bring our
02:26:01genetic results and to us.
02:26:02And so we have to think about what to
02:26:05do with that and how we can do it to
02:26:07help use the information to help families.
02:26:10So I think there's a lot of potential there,
02:26:11but I think we have to be thoughtful
02:26:14and doing the research to find out
02:26:16how it can actually help patients
02:26:18is really important as well.
02:26:20But if others want to add on
02:26:22to those thoughts, please,
02:26:24please do share.
02:26:25Thank you
02:26:27something very much, much,
02:26:29much less sophisticated.
02:26:31You know, Emily,
02:26:32what you talked about is like
02:26:33insightful and about best practices,
02:26:35but in even a more simple way.
02:26:36And I think one of you maybe
02:26:38Ellie said this, you know,
02:26:40being a clinician inspires our science.
02:26:42It helps us ask the questions that are
02:26:44going to be important to the families
02:26:45and the people who are affected by it.
02:26:47And with that in mind,
02:26:48I also think, you know,
02:26:49aside from knowing you know,
02:26:53which which gene might potentially
02:26:55be involved in this kid,
02:26:57as a scientist,
02:26:58I think I'm going to do a better job helping
02:27:00the parents understand what happened,
02:27:02what's happening with their kid
02:27:04and answering their questions.
02:27:05And so I just think the,
02:27:07the model that we all apply
02:27:08where we're both clinicians and
02:27:10scientists just lets us do both.
02:27:12We're both had so much better.
02:27:14Thank you, Jamie.
02:27:16Well, thanks to everyone and thanks
02:27:17to all of you for staying with us.
02:27:20And we're still very open to questions
02:27:22if you want to send them to us.
02:27:25I know, I know there's already
02:27:26a few questions that have been
02:27:28going to the individual panelists,
02:27:30which is great.
02:27:31Please do check out the posters
02:27:34and the talks that are online.
02:27:36Thank you again for all of your time.
02:27:37We really, really appreciate your attention
02:27:39and we look forward to your feedback.
02:27:42And please join into breakout rooms.
02:27:44We hope you had good discussions.