Faculty Profiles

Yuanli Liu
Heather Nelson
Stephen Buka
Barbara Burleigh
Eric Rimm
Karen Kuntz

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Stephen Buka is worried about his children. His concern is not for his own infant son, born last fall in perfect health, but for the emotionally disturbed adolescents he has worked with from rural Maine and the thousands of kids he has studied since the 1970s, when he became interested in developmental psychology. Even before they are born, "Buka's children" may be headed for a lifetime of trouble: Learning disabilities. Attention deficit disorder. Alcoholism. Drug abuse. Suicide.

Unlike physical illnesses, the behavioral problems that erode kids' social and emotional well-being often go unaddressed, Buka says, because "it's not clear who beyond the family is responsible for them." Issues like violence, depression, and substance abuse, which Buka says are often "low-severity but high-prevalence," tend to fall outside the purview of doctors' offices and the support net afforded by schools, social service organizations, and religious institutions. Yet Buka believes many of these problems are "for the most part preventable"--and that, in heading them off, "public health should take the lead."

The window through which Buka examines the root causes of what he calls these "new morbidities" are long-term, multi-generational investigations of families. Buka, who describes himself as "one of the world's only child psychologist-epidemiologists," directs studies that follow children from conception into adulthood, gathering data on everything from parents' infections during pregnancy, eating habits, and neighborhoods, to their offspring's health, preschool experiences, and school performance. "Divisions between cognitive ability, social development, and health outcomes are blurring," Buka says. "Fully understanding the origins of behavioral disorders requires study of the whole child within multiple contexts of influence." One study he now directs, The New England Family Study (NEFS), begun in 1959, enrolled 17,000 pregnant women from Boston and Providence, Rhode Island, and followed them and their babies for seven years. In 1982, Buka resurrected this project, tracking down the kids (now in their 40s) and enrolling their kids.

According to Buka, three generations' worth of information will help to transform the way society thinks about human behavior and the web of genetic, environmental, and social factors that shape it. What's unusual about the NEFS databank is that it includes blood and tissue samples--including DNA, lead levels, and infectious agents--from pregnant women and their offspring, which will permit researchers to examine genetic and biological features of the uterine environment, along with physical and behavioral traits of the grown child. "We can now ask, 'How do early social and biological influences interact with genetic factors to affect early development?'" Buka explains. "For example, with respect to children of depressed parents, we want to know why some grow up to become depressed themselves while others don't. With this study we can ask, 'What conditions, including genetic factors, influence these kids' risk?'"

Buka and his collaborators have only begun to sift through their data trove. Last fall, Buka published a study in the American Journal of Psychiatry of grown children born to mothers who smoked during pregnancy, which found that kids whose moms smoked at least one pack a day demonstrated twice the normal risk of lifelong nicotine dependency. "Something about smoking appears to affect nicotine receptors in the brain of the fetus," Buka speculates. Buka is also exploring possible prenatal triggers of schizophrenia, a devastating affliction that typically becomes manifest in late adolescence. Through the NEFS, Buka has found that a large percentage of patients with schizophrenia were exposed in utero to the herpes simplex virus. He has teamed with experts in neuroscience, infectious disease, and brain imaging in the quest to pinpoint a mechanism through which herpes and other viruses, along with genetic factors, might alter early fetal neurological development. Infectious agents could prove to be among the few potentially preventable risk factors for this largely incurable psychiatric disease.

"In our lifetimes, demographers project that almost half of the world's morbidity and loss of productive years will stem from psychiatric disorders," Buka notes. "Traditional departments of psychology, psychiatry, and social work, which focus largely on the individual patient, will be inadequate to address this change in the face of human suffering. We need to develop new theories, new research strategies, new academic and service institutions. That is one of the leading challenges for public health in the 21st century."

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Photo: Kent Dayton