Can you tell us about your research background and what drew you to the SBS Department and more specifically to Maternal and Child Health?
About 15 years ago, I began studying child development and in particular child psychiatric problems. Previously, I had conducted research on late-life depression and had managed the data collection of the Rotterdam Study. When they asked me to help set up a population-based birth cohort, Generation R in Rotterdam, I wondered if it was no problem that I knew little of child development. My mentor just replied that the study starts prenatally and I would have time to learn before the problems in infants and toddlers occurred. So I got the chance to make mistakes and implement unusual assessments. I view all child psychiatric problems as neurodevelopmental, thus we collected imaging data with ultrasound, even before the first child was born, and in neonates. Now Generation R has become the world’s largest preadolescent MRI imaging cohort. All child problems are rooted in the family, so we assessed attachment with the strange situation paradigm (fathers too) and mother-child interaction. All child psychiatric problems are social, thus we assessed friendship, peer interaction and bullying.
I teach that child psychiatry is particularly challenging, because not only are there no biomarkers, but one cannot easily interview a child, thus research relies on observation and reports from others. Teaching brought me to HSPH in 2015. It was fun to develop a course around selected disorders but really teach psychiatric epidemiological challenges, i.e., reverse causality or time trends. In the end, the course helped me, I got to know HSPH as an ambitious yet friendly environment.
What are the next objectives in your research, and do you see opportunities in connecting child psychiatric epidemiology with the Maternal and Child Health curriculum?
Child psychiatric disorders are the most common health problem of children in the Western World and the burden, like in adulthood, often exceeds that of physical diseases. Research and curriculum in MCH can best include a focus on child (and maternal) behavior. Also, the classical themes of MCH, the family and social environment of children, are critical to children’s psychiatric problems. Poverty, poor parenting, poor prenatal and infant nutrition, parental psychopathology are established risk factors for psychiatric problems, e.g. disruptive and withdrawn behavior, in children. Having said this, it is not my goal to transform MCH to a child psychiatric research line. MCH research has been crucial to understand the causes and consequences of infant mortality and preterm birth, environmental exposures or nutritional deficits, and has witnessed the development of many effective interventions. Yet, important questions remain. Why can we not deliver these interventions on a large scale? Why do these problems persist in disadvantaged groups?
Often, we know little about the long-term prognosis, for example, is there accelerated ageing in children born preterm? The challenge for a modern MCH is exactly this combination of health service, public health research with fundamental research. I aim to add specific data collections to clinical cohort or registry data collection. Think of observational data to address parenting more validly, neuroimaging of neonates with 3-D ultrasound, biological sampling or experience sampling to monitor sleep for example. It is the MCH approach accounting for family and environment that will eventually advance biological research such as of the microbiome in children.
Can you say more about the interplay between perceived negative behaviors and children’s home environments?
There is a long tradition in developmental science of studying the interplay between home environment and child problem behavior. What fascinates me is that so many aspects of the environment affect children. I can talk to any SBS researcher, whether about health literacy, discrimination, stress and trauma, social networks, or smoking, all these environmental risks are related to child problem behavior. Yet, most exposed children never develop problems and those that do likely grow out of it.
What also intrigues me is how children’s behavior shapes their environment and, importantly, physical health. I once taught students reversed causality in Psychiatry asking to exchange exposure and outcome, to review the background and design a study for the reversed question. These questions were equally relevant and we began asking how a child’s temperament influences parenting, emotions shape the brain structure, or behavior determines epigenetic, microbiotic or immune function changes. Recently, we showed how much more child anxiety and withdrawn behavior affect structural brain connectivity than the reverse. Thus if a child is shy, socially withdrawn or fearful this can shape brain structural development, like regular physical exercise or music lessons do. Anxiety is an understudied problem, it is very amenable to treatment but it can herald future psychiatric problems. I argue that anxiety and other emotional problems both determine and mediate environmental effects on brain development (but also on physical health). “Reverse causality” is common in most areas of behavioral research, my groups showed that Vitamin D insufficiency is more consequence than cause of depression, and ADHD determines epigenetic changes. Thus, I am excited that my first collaboration at SBS, with Laura Kubzansky, is on the relation of child assets to physical health.
Back to MCH, our goal is to lastingly improve the health of children. If we understand how maternal and child behavioral problems shape the environment, it will inform research and implementation, we may learn why some interventions do not work, and even why some physical diseases persist.
Lastly, how can our community get to know more about your research? Do you have any upcoming talks or seminars planned?
Students are very welcome to come by to my new office on the 6th floor, then I will be having an SBS-sponsored talk on Monday, March 19th at 1:00pm, titled “Early Adversity, Brain Development and Child Behavior Problems.” I will also be attending the remaining Maternal and Child Health seminars on Wednesdays throughout the Spring semester.
-Interview by Whitney Waddell
