Youth mental health problems are among the most significant public health problems affecting a large part of the population. In addition, mental health problems are often comorbid present in youth affected with somatic illness. For example, children with inflammatory bowel disease more often experience distress and depressive symptoms. The unique position of the Department of Child and Adolescent Psychiatry/Psychology, located in the heart of the Erasmus University Medical Center - Sophia Children's Hospital facilitates the collaborations and aims of the ACE Development and Psychopathology.
The key strategy of the ACE Development and Psychopathology is to integrate and harmonize clinical and epidemiological research with the primary goal to improve the health of children.
The general aims of the ACE Development and Psychopathology are:
- To integrate neurobiological and psychological approaches in epidemiological research for better understanding of the developmental processes leading to psychopathology.
- To continue with a multidisciplinary approach to provide a seamless transfer of new findings derived from epidemiology and developmental neuroscience into child and adolescent psychiatry and psychology clinical settings.
- To advance our knowledge of risks and vulnerabilities that will inform the development of prevention and intervention strategies to reduce mental health problems in children and adolescents and ultimately in adults. Collaboration with the ACE Prevention is evident here.
- To disseminate knowledge on the development of psychopathology through a several masters in the domain of Child (Mental) Health and Development. The ACE Development and Psychopathology studies both general, high-risk and clinical populations and will generate knowledge for prevention, intervention and diagnostic purposes.
In line with the strategy, the short-term goals of the ACE are providing expert advice for clinical assessments, developing a minimal neurodevelopmental assessment battery that could be used in the whole Sophia children’s hospital and providing a platform in the ACE colloquia to discuss front and back-end harmonization protocols within and across ACEs. In addition, we have recently started a new multidisciplinary minor on Child and Adolescent Psychiatry for medical students, in which the ACE is represented by multiple departments. This has been very successful and we will continue providing this minor in the coming years.
With these general aims and short-term goals, we will contribute to the ultimate aim to strengthen the position of Erasmus MC – Sophia Children’s Hospital and Erasmus University as leading in the clinical care, education and multidisciplinary research of the development of psychopathology. Importantly, the network and aims of this ACE overlap with the future pillar Pediatric Brain Center as part of the Sophia program and can therefor play a fundamental role in its development.
The ACE Development and Psychopathology has two particularly strong historical roots for the study of the development of psychopathology.
- The first is the epidemiological approach which is extremely important for the study of the full variation of the phenotype in behavioral developmental processes.
- The second is the leading role in the development and implementation of standardized procedures for the assessment and treatment of child and adolescent psychopathology.
The ACE Development and Psychopathology has several additional assets.
- First, the collaboration with groups outside Erasmus MC but within the Erasmus University (Social Sciences) allows us to tap a particular expertise that can contribute from a different, perhaps less ‘medically-based’ perspective.
- Second, strong bonds with the public health domain and a large mental health care center (Yulius Mental Health Center) create a bridge between bench and bed. Access to non-academic, clinical settings is crucial for translating new findings into clinical practice.
- The third asset is the availability of unique epidemiological samples (the Generation R/Next Study, Tracking Adolescents' Individual Lives Survey (TRAILS), Interventions for Behavioral and Emotional Risk Reduction in Youth (I-Berry), The Flemish Study on Parenting, Personality and Development (FSPPD), the Zuid-Holland Study, the Mood and Resilience in Offspring (MARIO), BRain functions and Attentional processes in adolescent anorexia nerVosa: predictors of its diffErential course (BRAVE), Safety and Pharmacokinetics of Antipsychotics in Children with autism (SPACE), a large study in Europe on Optimising the transition from child to adult mental healthcare (MILESTONE), Onderzoeksprogramma Postpartum Psychose Erasmus MC, Rotterdam (OPPER), the Expertise center Erfelijke Neuro-Cognitieve Ontwikkelingsstoornissen Rotterdam Erasmus MC (ENCORE), and Systemic Hospital-based Assessment of Rotterdam's critically Ill children, their Neurodevelopment and Growth (SHARING) as well as pediatric patient samples such as children with congenital heart disease or craniofacial anomalies, and child psychiatric samples such as children with autism spectrum disorders).
Academic Center of Excellence
Research Activities
Longitudinal research in the general population with projects aimed at increasing our epidemiological and neuroscience knowledge. These projects are embedded in the Generation R Study, Generation R Next, Tracking Adolescents' Individual Lives Survey (TRAILS), Interventions for Behavioral and Emotional Risk Reduction in Youth (I-Berry), The Flemish Study on Parenting, Personality and Development (FSPPD), the Zuid-Holland Study, and Mood and Resilience in Offspring (MARIO). All studies are fundamental and epidemiological in nature and integrate biological and psychosocial approaches in a multidisciplinary way. For example, current and future studies investigating associations between a diversity of prenatal exposures (e.g. cannabis, nicotine, alcohol, antidepressant medications but also exposure to micronutrients and other medications) and later child neurodevelopmental outcomes. In these fundamental and epidemiological studies neurodevelopmental outcomes are behavior, emotions and cognition as well as child brain development measured using repeated neuroimaging. These studies will have implications for intervention and prevention.
Clinical studies in the ACE Development and Psychopathology involve children with autism, children with physical conditions (congenital heart conditions, gastro-intestinal conditions, children admitted to pediatric intensive care unit (PICU)), children with eating disorders, children with neurocognitive syndromes, and children with anxiety disorders. These studies have different study designs, including randomized controlled trials, observational studies and mechanistic studies; some are outcome studies (children with physical conditions, autism) and some investigate underlying biological mechanisms including genetics (psychiatric outpatient sample) and neuroimaging (eating disorders, children treated with extracorporeal membrane oxygenation (ECMO)). Similar to the longitudinal research in the general population, the clinical studies integrate both fundamental (neurodevelopmental and genetic aspects) and clinical approaches in a multidisciplinary way (psychiatry, neurogenetics, psychology, radiology), with the aim to improve patient care. For example, the IRIS study is a multidisciplinary study in a high-risk population of somatic ill patients with mental health problems using innovative techniques (experience sampling methods or ecological momentary assessment); and was initiated in the ACE Development and Psychopathology and involves 8 departments in the Erasmus MC.
Type of
Collaborations
The ACE Development and Psychopathology has many worldwide prosperous collaborations and networks. The process of ACE formation has stimulated the strengthening of existing collaborations and the creating of new external collaborations and brings a network of experts together. Collaborations with other top institutes include Harvard T.H. Chand School of Public Health, Montreal Neurological Institute, University of New Mexico, University of Vermont, University of Chicago, Imperial College London, University College of London, University of Sidney, Technische Universität Dresden, University of Oxford, University of Iowa, National Institute of Mental health (NIMH), National University of Singapore, University of Bristol, Instituto de SaludGlobal Barcelona and the University of Copenhagen. The ACE is involved in several research consortia that are focused on child development, including ACTION Aggression in Children: unraveling gene-environment interplay to inform Treatment and InterventioN strategies http://www.action-euproject.eu/, CAPICE Childhood and Adolescence Psychopathology: unravelling the complex etiology by a large Interdisciplinary Collaboration in Europe https://www.capice-project.eu/, DYNAHEALTH Understanding healthy and active ageing https://www.dynahealth.eu, EAGLE The EArly Genetics and Lifecourse Epidemiology Consortium https://www.wikigenes.org/e/art/e/348.html, and LifeCycle Optimizing early-life conditions to maximize the human developmental potential aross the full life cycle https://lifecycle-project.eu., and ENIGMA (Enhancing NeuroImaging Genetics Through Meta Analysis), http://enigma.ini.usc.edu
In addition, the ACE Development and Psychopathology has multidisciplinary research activities that require collaboration between researchers from diverse fields including psychiatry, psychology, radiology, bioinformatics. National collaborations with University of Amsterdam and Free University Amsterdam, Leiden University, Utrecht Medical Center, University of Groningen. Collaborations with international experts other top institutes include Harvard T.H. Chand School of Public Health, Montreal Neurological Institute, University of New Mexico, University of Vermont, University of Chicago, Imperial College London, University College of London, University of Sidney, Technische Universität Dresden, University of Oxford, University of Iowa, National Institute of Mental health (NIMH), National University of Singapore, University of Bristol and University of Copenhagen.
Finally, the ACE Development and Psychopathology is involved in many national and international networks, i.e., European Society for Child and Adolescent Psychiatry, American Association for Child and Adolescent Psychiatry, National Network of Pediatric Psychology, Knowledge center of Child and Adolescent Psychiatry, Knowledge center of Bipolar Disorders, Academic Workplaces in Rotterdam, Pediatric Psychology Network, and the Psychosocial group of the European Society Congenital Heart Disease.
Educational
Contributions
This ACE contributes to the following educational programs:
- Medical education: Bachelor program (normal development, child psychiatry Minor), Master program (child and adolescent psychopathology), co-schappen (child and adolescent psychiatry).
- Residency: the department of Child and Adolescent Psychiatry provides two-year residency training for a maximum of 5 residents in psychiatry who specialize in child and adolescent psychiatry. The department coordinates the educational program for the South-West of the Netherlands which entails a program for about 20 residents. Residents can do a 6-month research elective. The last visitation report was very positive about the residency program in child and adolescent psychiatry. All residents are Dutch.
- (Clinical) Psychology training: the department of Child and Adolescent Psychiatry provides a two-year post-master clinical training for psychologists in three programs (health care psychology (GZ)-opleiding), psychotherapy, clinical psychology. Part of the training involves research which is supervised by a psychologist in the ACE Development and Psychopathology. The last visitation was positively evaluated about the training provided. All psychology trainees are Dutch.
- Netherlands Institute for Health Sciences (NIHES): psychiatric epidemiology as part of MSc and PhD of the NIHES program. All PhD students within this ACE are involved in NIHES educational programs. NIHES was evaluated in 2013 by the Koninklijke Nederlandse Akademie van Wetenschappen (KNAW) International Review and Advisory Committee. With regard of the Department of Child and Adolescent Psychiatry the committee's evaluation was that the work of this department is considered to be of very good quality (overall score 4). The department is expected to make a significant contribution to research in this field due to availability of the neuroimaging component of the Generation R Study, which the department has led on. It has good connections with other departments involved in the NIHES, sharing PhD students and an endowed professor with the Department of Epidemiology. The relationship with the Department of Epidemiology and the Generation R Study is vital to the research in the department of Child and Adolescent Psychiatry. The department is the only child and adolescent psychiatry department in the Netherlands that combines clinical care, education and scientific research. According to the KNAW International Review and Advisory Committee, this creates an excellent opportunity for cross-fertilization between these fields.
- Graduate students to obtain doctoral degrees (see previous bullet: this ACE delivers about 6 PhDs per year. About 10-20% of the PhD students are international (Germany, United States, Iran, Ukraine, Malaysia, Brazil, USA, and Colombia).
Patient
Care Activities
The ACE Development and Psychopathology primarily focuses on assessment and diagnostic procedures, pediatric neuroimaging, genetics and (clinical) epidemiologic methodologies is an essential investment in numerous activities aimed at meeting research standards within patient care in the department of child and adolescent psychiatry, as well as a large number of clinical research projects.
The ACE Development and Psychopathology is not primarily focused on specific patient groups. but instead we have a clinical focus on a variety of patients. For example we treat patients with autism (Werkplaats autisme), patients with anxiety disorders, patients within ENCORE (ROBIJN labels 1, 2, 3, 6, and 7); we focus on pediatric psychology (children with congenital heart disease, inflammatory bowel syndrome), high-risk populations, infant mental health, (hereditary) neurocognitive developmental disorders, severe psychiatric disorders, hospital psychiatry, or patient care in general (involvement in a FP7 project on the transition to the adult healthcare system; involvement in a national, practice based, research data infrastructure for child and adolescent psychiatry (ZonMw project: "Towards a national, practice based, research data infrastructure for child and adolescent psychiatry" Projectnummer 91112020, and expertise on assessment and diagnosis in the Landelijk Kenniscentrum Kinder- en Jeugdpsychiatrie).
The department of Child and Adolescent psychiatry/psychology provides excellent academic care to children and adolescents with complex psychiatric disorders, often in combination with somatic illness. The clinical areas of focus are all integrated with the profiling topics (profileringsgebieden) of the Sophia Children's hospital.
Societal Relevance to Research, Education and Patient Care
- The ACE Development and Psychopathology has a leading role in the development and implementation of standardized procedures for the assessment and treatment of child and adolescent psychopathology. This comprises: a) the distribution of rating scales, scoring programs and manuals for the assessment of psychopathology in children throughout The Netherland and Belgium. Nearly every child mental health service uses these materials with yearly distribution of over 300.000 items a year b) the development of an autism diagnostic instrument (3Di) and training activities for the use of this instrument.
- The development and dissemination of treatment protocols: a) the distribution of a treatment protocol for anxiety disorders in children (about 1500 per year). This evidence-based VRIENDEN-protocol is used as prevention and treatment protocol against anxiety in children, by schools, prevention centers and mental health institutions, on a large nationwide scale b) training in an innovative autism intervention as part of the implementation activities of a collaborative trial with regional partners (Yulius).
- Involvement in the 'Zorgstandaard Autisme', development of the curriculum of the 'Autisme Expertise Centrum', applied research on the effectiveness on autism interventions in the school setting, train-the-trainers to non-medical staff in ASD behavioral interventions
- Editorial boards: Manon Hillegers (Editorial boards of International Journal of bipolar disorders, Frontiers in psychiatry; Program Committee member American Academy of Child and Adolescent Psychiatry); Neeltje van Haren (member of Editorial Boards of Psychological Medicine and Psychiatry Research-Neuroimaging, Associate Editor of Board of Frontiers in Neuropsychiatric Imaging and Stimulation); Tonya White (Editorial Board Journal of the American Academy of Child and Adolescent Psychiatry).
Viability of Research, Education and Patient Care
The ACE Development and Psychopathology connects researchers, teachers and clinicians across Erasmus MC (adult psychiatry, public health, pediatrics, radiology, genetics) as well as across Erasmus University, in particular the Social Sciences Faculty. For example, within the ACE several staff members have an official appointment with the Erasmus University Rotterdam with the department of Psychology, Education and Child Studies as well as the department of Child and Adolescent Psychiatry. Also, other members have dual appointments in combination with the department of Epidemiology. These collaborations are especially fruitful, because ACE activities and knowledge acquisition are concentrated which is essential for researchers across multiple groups, and thus viability of this ACE is formally ensured. Experts who work within the ACE Development and Psychopathology share a common theme 'child and adolescent psychopathology from a developmental perspective' but each domain of expertise is needed to ensure the continuing success of this ACE. Not only are different disciplines involved, the ACE network is also diverse in terms of the age range of experts, the international background of the experts and the number of experts within this ACE ensures stability and continuity.
Within the ACE Development and Psychopathology we are particularly ambitious in connecting with international groups through conferences (each PhD student will present on an international conference), collaborations (we actively interact nationally and internationally, which can be seen by a number of publications involving both PhD-students and external collaborators) and visits of PhDs or postdocs to other international top institutions (recently or currently University of Cambridge, Washington University). Further, a number of former (mostly international) PhD students manage to have a successful international career (US and Canada) or a career within this ACE but across departments (several former PhD students within the Generation R Behavior group have a position at Erasmus University Social Sciences).
Key and relevant publications of the last five years
- Tuomainen H, Schulze U, Warwick J, Paul M, Dieleman GC, Franić T, Madan J, Maras A, McNicholas F, Purper-Ouakil D, Santosh P, Signorini G, Street C, Tremmery S, Verhulst FC, Wolke D, Singh SP; MILESTONE consortium. Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology. BMC Psychiatry. 2018 Jun 4;18(1):167
- Blanken LM, Mous SE, Ghassabian A, Muetzel RL, Schoemaker NK, El Marroun H, van der Lugt A, Jaddoe VW, Hofman A, Verhulst FC, Tiemeier H, White T. Cortical morphology in 6- to 10-year old children with autistic traits: a population-based neuroimaging study. Am J Psychiatry. 2015 May
- Muetzel RL, Blanken LME, van der Ende J, El Marroun H, Shaw P, Sudre G, van der Lugt A, Jaddoe VWV, Verhulst FC, Tiemeier H, White T. Tracking Brain Development and Dimensional Psychiatric Symptoms in Children: A Longitudinal Population-Based Neuroimaging Study. Am J Psychiatry. 2018 Jan
- Guxens M, Lubczyńska MJ, Muetzel RL, Dalmau-Bueno A, Jaddoe VWV, Hoek G, van der Lugt A, Verhulst FC, White T, Brunekreef B, Tiemeier H, El Marroun H. Air Pollution Exposure During Fetal Life, Brain Morphology, and Cognitive Function in School-Age Children. Biol Psychiatry. 2018 Aug
- Jansen PR, Dremmen M, van den Berg A, Dekkers IA, Blanken LME, Muetzel RL, Bolhuis K, Mulder RM, Kocevska D, Jansen TA, de Wit MY, Neuteboom RF, Polderman TJC, Posthuma D, Jaddoe VWV, Verhulst FC, Tiemeier H, van der Lugt A, White TJH. Incidental Findings on Brain Imaging in the General Pediatric Population. N Engl J Med. 2017 Oct
- Legerstee JS and Utens EMWJ, Pioneering Research Into Specificity of Intergenerational Transmission of Interpretation Biases From Parents to Children: Challenges for the Future. J Am Acad Child Adolesc Psychiatry. 2018 Jul;57(7):454-456
- Abramovic L, Boks MPM, Vreeker A, Verkooijen S, van Bergen AH, Ophoff RA, Kahn RS, van Haren NEM. White matter disruptions in patients with bipolar disorder. Eur Neuropsychopharmacol. 2018 Jun;28(6):743-751
- Bowling AB, Tiemeier H, Jaddoe VWV, Barker ED, Jansen PW, ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations. Pediatr Obes. 2018 Sep;13(9):567-575
- Sonzogni M, Wallaard I, Santos SS, Kingma J, du Mee D, van Woerden GM, Elgersma Y. A behavioral test battery for mouse models of Angelman syndrome: a powerful tool for testing drugs and novel Ube3a mutants. Mol Autism. 2018
PhD theses of the last five years
- Jorieke Duvekot: The Many Faces of Autism: Implications for assessment and association with anxiety (2018)
- Kirsten Visser: Tackling Teenage: a randomized controlled trial to examine a psychosexual training program for adolescents with autism spectrum disorder (ASD) (2017)
- Rolieke Cents: Like mother like child? Intergenerational transmission of psychopathology: a focus on genes and parenting (2016)
- Ryan Muetzel: The connections within: pediatric population-based neuroimaging of brain development (2016)
- Laura Blanken: On the spectrum, the neurobiology of psychiatric symptoms in the general population (2016)
- Nathalie Saridjan: Of cortical and children: Hypothalamis-pituitary-adrenal (HPA) axis functioning and the development of preschoolers in the general population (2016)
- Lisette van der Knaap: Epigenetics and adverse health outcomes (2015)
- Sandra Thijssen: Neurobiological correlates of externalizing and prosocial behavior in school-age children (2015)
- Eirini Pappa: Genetics and Epigenetics of Children’s Behavior Problems (2015)
- Lisanne de Barse: I don’t want to eat that: epidemiological studies of eating problems in the family (2016)
- Tim Korevaar: Thyroid hormone availability during pregnancy and early life: determinanta, interpretation and consequences (2017)
- Andrea Wildeboer: Nice traits or nasty states: dispositional and situation correlates of prosocial and antisocial behavior in childhood (2017)
- Raisa Schiller: The Vulnerable Brain: neurodevelopment after neonatal critical illness