Child psychiatry 1

New methods for child psychiatric diagnosis and treatment outcome evaluation

Principal investigators

Dr M. Markus, Dr N. van Lang, Dr B. van Widenfelt, Prof.Dr R. Vermeiren

Aim and focus

The research program (nr 31401) focuses on two main areas:(1) Patient Selection and Assessment: Child Public Mental Health (CPMH) and Routine Outcome Monitoring (ROM) and (2) Neuro-imaging.

The main aim of the child psychiatry research program is to optimize the identification of children in need of psychiatric care, and to monitor the effect of intervention longitudinally. Identification and monitoring include using traditional diagnostic instruments (self report-questionnaires and interviews) as well as innovative ones, i.e. neurobiological markers. Although up to 7% of Dutch children have a severe child psychiatric disorder, only 3% receive treatment. In order to ascertain correct identification of children with disorders, it is essential to focus on non child psychiatric services, as most children will consult these services first. For this purpose, a qualitative and efficient system of diagnostic selection and follow-up (Routine Outcome Monitoring, ROM) is being developed, both for first line settings as well as for child psychiatric departments. ROM will not only be helpful for the purpose of identification, but also for measuring the effectiveness of interventions in daily practice.
Because psychological conditions related to psychiatric disorders may not always be visible or measurable by means of traditional instruments, innovative assessment methods must also be developed. One of these methods is neuro-imaging, which allows visualizing specific conditions that are otherwise difficult to assess. 

Position in international context

For the success of this research program intensive collaborations have been established, firstly within the LUMC, Department of Psychiatry (ROM, parent-child, neuro-imaging), PHEG (patient selection), Pediatrics (gender poli, ROM, neuro-imaging), neuro-radiology (neuro-imaging), and medical statistics (ROM).  Regionally, TNO is an important collaborator, as well as FSW (Leiden University). Contracts to work together academically with Rivierduinen’s child and youth department and the Center for Autism have also been established. In addition, there is a collaboration with the VUMC in the area of forensic child and adolescent psychiatry and with other Child and Adolescent Psychiatry Departments in the context of ROM and evaluating care. Internationally, we have several collaborations, including with the Institute for Psychiatry in London (Professor Goodman) and the University of Antwerp (Professor Deboutte). Together with Professor Grisso (U of Massachusetts) we have taken the initiative to set up an International Forensic Screening and Assessment Network for Adolescents (InForSANA), of which Curium-LUMC is the European coordinator.

Content / highlights / achievements

At present, a computerized system of ROM is being developed and piloted in collaboration with first line settings and child psychiatric departments. Also, a neuro-imaging research line has been established in collaboration with relevant LUMC departments and FSW.

Future themes

With the current ROM infrastructure we have been building as well as the expertise we are gaining in neuro-imaging techniques together with our collaborative partners, we have a basis for numerous future projects, grants and manuscripts. Result oriented remains an important focus in the next years. CWTS analyses are certainly important, but are not the only indicator of results and productivity. For a starting research group, the CWTS analyses is a somewhat limited indicator.  Not only because the number of publications still needs to be increased, but also because the basic infrastructure for carrying out excellent research still needs to be further developed. Both a systematic set up for selecting patients as well as for assessment (ROM) are essential conditions for a research program. Based on current studies and the planned dissertations associated with them one can expect that the result oriented focus of our department will go well. In the past year 3 dissertations were completed (one LUMC and two FSW). Currently, over 15 dissertations are in progress and several will be completed over the next years.

A number of grants have been received in the last years, of which most were made available through external sources. A grant for 300,000 euro was given by the Ministry of Justice for a diagnostic project in the juvenile justice system (JJI) through the JJI Teylingereind. To set up an academic workplace for forensic care of youth, two JJI’s have given grants for 100,000 euro the first year (2010) and 200,000 euro in 2011, and ZonMW has awarded us a grant of 1,034,000 euro. An additional grant of a similar amount was recently honored as well to match this amount (Min. Justice). Research using the ROM in juvenile justice is being advanced with these grants as well. For the carrying out of a neuro-imaging project in which a staff member of Rivierduinen is participating, a WOP Rivierduinen grant has been honored (135,000 euro). An imaging project in the forensic field has been given a grant by NWO (250.000). For the CPMH program, an amount of a million euro for an Academic workplace grant has been granted to TNO and partners, of which Curium-LUMC is a participating partner. In addition it remains the goal to use 4% of Curium-LUMC’s own budget for academic activities, so long as the budget allows for it. Though seeking grant funds from external sources remains an important focus, applying for direct grant funds is also a high priority. The department sees it as a goal to continue to ask NWO/ZonMW for more attention for practice oriented research with clinical populations using alternative designs.

Cohesion within LUMC

This research program has been developed in extensive collaboration with the departments of psychiatry, epidemiology and public health, medical statistics, neuroradiology and pediatrics.