Tag Archive for: behavioral health

Wooden blocks spelling out the word Autism

Training model improves autism knowledge among early childhood educators

Wooden blocks spelling out the word Autism

With 13 million children under age 5 attending an early childhood education program in the United States, early childhood education providers are well positioned to identify early developmental concerns such as autism.

A study published in the Journal of Research in Childhood Education showed that a novel autism training program among early education providers was feasible and well-received. The program, facilitated by specialists at Children’s National Hospital and community agencies, also successfully improved the providers’ knowledge of autism and how to navigate resources to support children with autism.

What it means

Specialists at Children’s National hypothesized that with appropriate training delivered by specialists, providers at community agencies could also train early childhood education care providers to recognize autism in young children and help families access resources to support them.

With 13 million children under age 5 attending an early childhood education program in the United States, early childhood education providers are well positioned to identify early developmental concerns such as autism and support access to early intervention services. Increased knowledge of autism and resource navigation can help ensure quick and equitable access to care.

What’s been the hold-up in the field?

Early childhood education providers themselves have identified several barriers to their support of children with an increased likelihood of autism. These include:

  • Limited knowledge about autism
  • Hesitancy among providers to discuss developmental concerns with families
  • Limitations in knowing how best to engage parents in the diagnostic referral process

Moving the field forward

The study findings demonstrate a successful model that depends on and expands community-based partnerships between hospital specialists and child-serving community agencies. The findings also demonstrate that the program’s train-the-trainer model provides a sustainable approach that increases autism knowledge and improves resource navigation.

While the training was well-received and succeeded in meeting study goals, participants noted that some barriers still exist, and a system for continued training would be needed to maintain the program’s efficacy.

What is exciting about this work?

“It was exciting to co-develop this research with our community partners, who helped ensure that the work is relevant and timely,” says study lead author Serene Habayeb, PhD, a psychologist at Children’s National. “It has been wonderful to see the work sustained by community partners.”

As just one example, DC Public School’s Early Stages evaluation center is now providing regular training workshops with the materials developed through the project.

Children’s National leads the way

This is just one example of the many impactful behavioral health initiatives led by Children’s National. Partnerships created as part of this training program effort were leveraged to expand the reach of other hospital initiatives that aim to increase access to autism-related knowledge. This includes the work of ECHO (Extension of Community Health Outcomes) Autism, a program at Children’s National hosted through the Center for Autism Spectrum  (CASD). ECHO Autism at Children’s National offers an innovative tele-mentoring model that creates virtual learning communities between multidisciplinary autism specialists and community professionals, including early childhood education providers. The early childhood education-focused ECHO at Children’s National has been highly successful, as shown by high attendance at training sessions and participant-reported gains in autism-related knowledge. The program’s success reflects both the need and interest of community professionals to improve care for children with autism or related developmental needs.

As a result of  the identification of ongoing challenges and needs, a city-wide collaborative, the DC Autism Collaborative (DC-AC), was formed in 2020.  More than 90 members from more than 45 different organizations regularly participate in the DC-AC. These members continue working toward increasing early and equitable access to high-quality autism care for all children.

A number of hospital teams are represented in the DC-AC collaborative, including CASD, the Divisions of Psychology and Behavioral Health, Neurodevelopmental Pediatrics, Primary Care, as well as the Community Mental Health CORE (Collaboration, Outreach, Research and Equity). The Community Mental Health CORE leads infrastructure building activities, develops enabling services to connect families to high quality care and launches innovative models to deliver direct services, all anchored in the mission of promoting equal access to health care for all children and families in Washington, D.C.

Read the study, Expanding Autism Knowledge and Access in Early Childhood Education Community-Based Settings, in the Journal of Research in Childhood Education.

Additional authors from Children’s National include: Amanda Hastings, PsyD, Anne Inge, PhD, Olivia Soutullo, PhD, Renee Williams, CHES, MSHEP, Melissa Long, MD, Leandra Godoy, PhD

Leandra Godoy, PhD

Honor bestowed on Leandra Godoy, PhD

Leandra Godoy, PhDChildren’s National Hospital named Leandra Godoy, PhD, as the A. James & Alice B. Clark Distinguished Professor of Early Childhood Intervention and Advocacy.

Dr. Godoy is a clinical psychologist and the co-director of the Early Childhood Behavioral Health Program and the Community Mental Health Collaboration, Outreach, Research and Equity (CORE) team.

 The big picture

Dr. Godoy joins a distinguished group of Children’s National physicians and scientists who hold an endowed chair. Children’s National is grateful to generous donors who have altogether funded 51 professorships.

Professorships support groundbreaking work on behalf of children and their families. They foster discoveries and innovations in pediatric medicine. These appointments carry prestige and honor that reflect the recipient’s achievements and the donor’s commitment to advancing and sustaining knowledge.

Why it matters

Dr. Godoy leads teams that care for young children from birth to age six. Innovation plays a key role in advancing care. Her research aims to improve access to optimal mental healthcare for children and families.

“Funding from this professorship will give my team the flexibility to respond to specific behavioral health needs,” Dr. Godoy says. “These resources will fuel strategic investments so we can help kids get the best start in life.”

Moving the field forward

The A. James & Alice B. Clark Foundation established this professorship as part of its historic investments in the Clark Parent & Child Network. Founded in 2020, the network aims to create the best possible health outcomes for parents, infants and young children.

“The Clark Foundation’s enduring vision and generosity will enable Dr. Godoy and future holders of this professorship to launch bold new initiatives that meet the health needs of young children in the Washington, D.C., region,” says Elizabeth Wells, MD, MHS, executive vice president, chief clinical officer and physician-in-chief.

Dr. Godoy’s work has fueled improvements in care, including reducing wait times for autism evaluations in primary care clinics. She also fosters online support groups for parents of children with behavioral health challenges and leads several citywide initiatives, such as the DC Autism Collaborative.

little girl using asthma inhaler

Exploring how maternal depression shapes pediatric asthma care

little girl using asthma inhaler

A new Children’s National study shows that maternal depression can make managing childhood asthma more difficult.

Asthma affects more than 4 million children in the United States and remains the most common chronic childhood condition. A new study from Children’s National Hospital highlights an overlooked factor in childhood asthma care: a mother’s mental health. Researchers in the Center for Health Outcomes Research & Delivery Science found that maternal depression can make daily asthma management – like tracking medications or spotting flare-ups – more difficult. Through interviews with 12 mothers whose children receive care at IMPACT DC, Children’s National’s community-based asthma program, the study captures how depression shapes caregiving in their own words.

Why it matters

Asthma management depends on consistent, attentive care. When depression drains a caregiver’s energy or focus, even small lapses can lead to more emergency visits, missed school days and worse health outcomes. In this study, mothers also noticed how their mood affected their children emotionally. When a mother was stressed or withdrawn, her child often felt anxious, sometimes enough to trigger an asthma attack. The connection between mental health and asthma was clear on both sides.

More than half of the mothers had clinically significant depressive symptoms and nearly all had experienced those symptoms for over a year. Four mothers also had asthma themselves and almost every child in the study had uncontrolled asthma, underscoring the complexity of care in these families. Together, these numbers paint a picture of how common and intertwined maternal and child health challenges can be.

The big picture

Many mothers described slipping into what they called “super mom mode”, pushing through depression to care for their kids while ignoring their own needs. Several mothers said the pressure to “stay strong” left them feeling guilty or ashamed when they could not do everything perfectly. Even when mothers received treatment, most found it inconsistent or incomplete. Some were taking antidepressant medication, others attended therapy but many still had moderate or severe symptoms. Limited access, long waits and therapist turnover were common barriers.

Children’s National researchers say these findings reinforce that pediatric health cannot be separated from caregiver wellbeing. Integrating behavioral health into pediatric asthma care could change that. Social workers and behavioral health specialists can help mothers manage depressive symptoms, strengthen coping skills and connect to resources, all within the same clinic visit that treats the child’s asthma.

What’s next

Building on this study, Children’s National is testing a brief, evidence-based depression treatment delivered in the IMPACT DC Asthma Clinic. The new clinical trial uses implementation science to determine how integrated care can improve outcomes for both mothers and children.

“By treating maternal depression alongside asthma, we can address the whole family’s needs,” said Rachel Margolis, PhD, LCSW, social work researcher at Children’s National and senior author of the study. “When mothers receive mental health support, children breathe easier. Integrating behavioral health into community-based asthma programs offers a path toward better control, fewer emergencies and greater equity in care.”

Read the full study, “Exploring Black Mothers’ Lived Experiences of Depression and the Relationship to Their Child’s Asthma: A Qualitative Study” in the Journal of Evidence-Based Social Work.

woman meditating on a couch

Results from first-of-its-kind mental health intervention for adults with CHD

woman meditating on a couch

Mindfulness-based interventions have been widely recognized for their effectiveness in managing stress, anxiety and depression, so the team set out to specifically design the virtual EMBRACE program for adults with CHD. It’s the first of its kind for this population.

A first-of-its-kind virtual, real-time group psychosocial intervention successfully demonstrated the promise of mindfulness interventions to address mental health challenges in adults with congenital heart disease (CHD).

The findings from a small pilot study of the Exploring Mind-Body Resilience and Coping/Cognitive Exercises (EMBRACE) program were published in the journal Pediatric Cardiology.

What this means

The study included 31 participants ranging in age from 22 to 74 years old. Collectively the group had a variety of heart conditions involving 47 heart surgeries, seven pacemakers and one implantable cardioverter defibrillator.

Participants showed meaningful improvements after the EMBRACE intervention in anxiety, depression, resilience and mindfulness scores. Also, satisfaction surveys showed that 97% found the program effective. These improvements lasted through a three-month follow-up period.

“What I gained the most from this study was learning that my emotions/feelings did not have to control my life,” says study participant Tabatha Doherty. “The program taught techniques that focused on keeping your mind in the present and not getting caught up in those feelings.”

Additionally, people who participated reported several positive qualitative outcomes, including better community connections and improved focus on self-care and self-management.

“It was impactful to be in a cohort with other patients where we could talk, share stories, offer support, and work towards a common, yet individual, goal of being able to manage daily and CHD-related stressors,” Doherty continued. “It is very rare that CHD patients have the opportunity to interact with each other, but even more rare to have an opportunity to cooperate towards a common goal.”

Why it matters

The authors write that the lifetime prevalence of anxiety and depression in adults with congenital heart disease are significantly higher than the general population – occurring in up to 30 to 50% of adults with CHD versus only 7 to 10% in the general population.

Mindfulness-based interventions have been widely recognized for their effectiveness in managing stress, anxiety and depression, so the team set out to specifically design the virtual EMBRACE program for adults with CHD. It’s the first of its kind for this population.

The study sought to improve mental health, resilience and coping skills for people with CHD while demonstrating feasibility for a large number of people.

“The most comforting aspect was the acknowledgement and validation of the mental health struggles I’ve had my entire life,” Doherty says. “The statistics they shared were not surprising, but more proof/recognition of the CHD patient’s silent struggles.”

What’s next

The program will be adjusted based on feedback from the pilot cohort and further studies will be undertaken to gauge sustainability and long-term benefits.

The work was made possible through a grant from the Adult Congenital Heart Association (ACHA) with generous support from the Meil Family Foundation.

“ACHA is proud to support groundbreaking research initiatives though our Research Program that began in 2019,” says Mark Roeder, president and CEO of ACHA. “Vicki Freedenberg, PhD, RN was awarded the Meil Family Foundation Research Award for Neurocognitive Studies in 2022. This first-of-its-kind mindfulness-based program for adults with CHD demonstrated meaningful improvements in anxiety, depression, resilience, and self-care – highlighting the critical role of mental health interventions in the CHD population.”

Roeder continued, “The EMBRACE study not only addresses the physical realities of living with CHD but also elevates the importance of mental and emotional well-being, something that ACHA will also continue to promote through our educational programming.”

Before publication in Pediatric Cardiology, the data from EMBRACE was presented as a poster at the American College of Cardiology ACC.24 meeting. Additionally, program and study co-author Rachel Steury, NP, was awarded Best Allied Health Research for this work at the International Society of ACHD in June 2024.

Read EMBRACE Study: Outcomes of a Randomized, Mindfulness-Based Intervention for Adults with Congenital Heart Disease in Pediatric Cardiology.

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Justine Larson, MD

Expanding access to pediatric mental health care: Q&A with Justine Larson, MD

Justine Larson, MD

In this interview, Dr. Larson shares her journey into pediatric psychiatry, her passion for increasing access to mental health care and her goals for advancing services at Children’s National.

Justine Larson, MD, recently joined Children’s National Hospital as the new associate chief of Psychiatry and Behavioral Sciences. A board-certified psychiatrist specializing in child and adolescent mental health, Dr. Larson has extensive experience in clinical practice, research and policy development. Her work focuses on improving systems of care, integrating behavioral health and expanding mental health services for vulnerable populations.

In this interview, Dr. Larson shares her journey into pediatric psychiatry, her passion for increasing access to mental health care and her goals for advancing services at Children’s National.

Q: Why did you choose Children’s National?

A: I chose Children’s National because I see an incredible opportunity to provide high-quality behavioral healthcare to children, especially in the DMV. A big part of my career and passion revolves around increasing access to care for underserved children. Children’s National offers a platform where I can make a significant impact, especially given its potential to create a broad footprint in this crucial area — that was the primary reason behind my decision.

Q: How did you decide to pursue a career in pediatric psychiatry?

A: I initially thought I would pursue OB/GYN because I was drawn to the field’s focus on women’s advocacy, but I realized I wanted to develop deep, long-term relationships with my patients. Psychiatry allowed me to do that, as it offers a unique combination of sociocultural, philosophical, psychological and biological variables, variables that interact in ways I find fascinating.

Additionally, my connection to children’s health was solidified years ago when my son, now 16, was hospitalized at Children’s National for 10 days as an infant. He had RSV and was in the ICU, and I’ve always felt that Children National saved his life. That positive association with the hospital played a role in my decision as well.

Q: What are some of your goals while serving as associate chief of psychiatry at Children’s?

A: One of my primary goals is to explore and implement alternative models of care that can help more children access mental health services. With the nationwide shortage of mental health providers, particularly pediatric psychiatrists and therapists, it’s crucial to think outside the box. I’m particularly interested in developing care models that provide services in pediatric settings or schools. Increasing access to care is at the core of my focus and interest as I work toward making these services more available to those in need.

Q: How do you spend your free time when you aren’t at the hospital or with patients?

A: Outside of work, I spend a lot of time with my family. I have three children — an 18-year-old, a 16-year-old and a 7-year-old — and a Great Pyrenees dog. My son, the one who was hospitalized as a baby, is really passionate about music. He plays guitar and piano, and I love supporting him by attending his shows and encouraging his musical journey. My oldest son is passionate about the outdoors and dreams of becoming a park ranger, so he often drags the family on hiking and camping trips, which I thoroughly enjoy. My littlest one loves nature and reading. My husband is a health economist, but we try not to talk shop too much!

teens hiking in the woods

Mindfulness-based interventions boost teens with Type 1 diabetes

teens hiking in the woodsA team of experts at Children’s National Hospital, using the input of teens with Type 1 diabetes from our Children’s National clinics, adapted a six-week virtual group diabetes education program and mindfulness-based intervention. In their new study published in Journal of Pediatric Psychology, the team described how the intervention might work to support teens with Type 1 diabetes experiencing anxiety or depression.

The findings showed that both the mindfulness-based intervention and the diabetes education program were successfully implemented and valued by the participating teens. While the study was limited in scope, focusing primarily on assessing the programs’ acceptance and perceived value among adolescents, preliminary results suggest participation in the programs may also contribute to improvements in mood, diabetes-related distress and glycemic control.

Eleanor Mackey, Ph.D., psychologist and author of the study, shared more about the learnings.

Q: What’s been the hold-up in the field?

A: Many adolescents with Type 1 diabetes experience symptoms of anxiety and depression, yet it can be hard to access care to relieve some of these symptoms. Group-based, brief virtual care may be a way to provide more access to necessary support. Testing whether such programs are desired and useful by teens and their families, and whether they show promise for improving symptoms of depression and anxiety, is an important step in addressing this gap in care.

Q: How does this work move the field forward?

A: This study helped us to use the input of the teens we hope to serve to create and adapt programs that they were enthusiastic about and test them to see if they were helpful. We used these findings to obtain a second grant from the National Institutes of Health to do a larger scale study to see whether these programs help with depression, anxiety, eating, stress and diabetes management.

Q: What’s the goal and how will this work benefit patients?

A: Our ultimate goal is to create easy to access programs which help improve anxiety, depression and diabetes management in teens with Type 1 diabetes. We are trying to ensure that these programs are feasible and accessible and could be translated into our clinics if they prove to be beneficial. We hope to improve the ways we identify teens experiencing anxiety and depression and provide them the option for this brief group-based care in our clinics.

Q: What did you find that excites you and what’s next?

A: We were very excited to find that teens were interested in enrolling in these programs and found them useful. We were also excited to see that our very preliminary data indicates that mindfulness-based interventions may improve depression and even possibly glycemic control.

Children’s National is the first institution that we know of to use teen feedback to adapt a mindfulness-based intervention specific to teens with Type 1 diabetes. Our team is now preparing to embark on a five-year project in collaboration with the Barbara Davis Center in Colorado to evaluate the effectiveness of these programs with a larger group of teens.

Additional authors from Children’s National include: Katherine Patterson Kelly, Ph.D., R.N.; Randi Streisand, Professor, Ph.D., CDCES; and Jack Vagadori.

Maureen Lyon, Ph.D.

Pilot program improves well-being of families during advanced care planning


Children with life-limiting rare diseases and their caregivers face tremendous stress and anxiety about the heart-breaking decisions before them. A new intervention – designed at Children’s National Hospital to support the palliative needs of these families – improved their spiritual and emotional well-being, according to new research published in the journal, Pediatrics.

Called FACE Rare (FAmily CEntered Pediatric Advance Care Planning Intervention for Rare Diseases), the counseling tools were found to be safe, effective and increased feelings of peace among families in this underserved population.

“Seventy-four percent of the families in that intervention group reported feelings of sadness, yet 100% reported our pilot intervention was a worthwhile experience,” said Maureen Lyon, Ph.D., a clinical psychologist and principal investigator at the Center for Translational Research at Children’s National. “If you’re talking about the possibility that the worst thing in the world would happen to you – that your child might die, and what you would want for them – the families found that our intervention helped. They had a place to process their feelings and consider what would be important to their child.”

The big picture

A rare disease is defined as any condition affecting fewer than 200,000 people in the United States. In pediatrics, these diseases often require constant caregiving and require families to face the cruel reality that the diagnosis may be life-limiting. In such cases, clinical teams often decide that conversations about advanced care planning (ACP) are needed.

The pilot-phase, randomized trial enrolled patients from Children’s National between 2021 and 2023. Research nurses underwent two days of training to be certified in the new intervention. Families assigned to the new approach received three, weekly 60-minute sessions and were evaluated using evidence-based assessment tools, including the Carer Support Needs Assessment Tool/Action Plan and the Next Steps: Respecting Choices Pediatric ACP Conversation. Measures of anxiety and spiritualization were tracked, and families returned after three months for follow-up.

Patients had a range of diagnoses that put tremendous strain on the caregivers, including complex digestive disorders, white-matter diseases and rare forms of epilepsy. Yet the caregivers expressed similar challenges: having time for themselves during the day, knowing what to expect in the future for their child’s care, and managing financial, legal and work issues.

What we found

Reinforcing the need to improve engagement and support for these families, the investigative team found that those who received the FACE Rare intervention reported higher levels of spiritual meaning and peace than those who received “treatment as usual.” All families living below the poverty line reported greater anxiety, and noteworthy to the team, black caregivers were less likely to report caregiver distress than non-black caregivers.

Dr. Lyon said future research needs to understand better how families respond to the challenges of rare diseases and unique social determinants of health that can change the approach to care.

“In some cultures, and families, having strong feelings is discouraged,” Dr. Lyon said. “We want to give families and caregivers space to have these emotions and think about what would be important for their child, if the worst were to happen. They appreciated that they participated in the program and had the space to consider these difficult questions.”

Read the full study, “Advance Care Planning for Children with Rare Diseases: A Pilot RCT,” in Pediatrics.

Adelaide Robb

Changing the game in pediatric psychopharmacology

Adelaide Robb

“I realized adequate treatment in youth can prevent many of the harmful outcomes in adults who were never treated properly for their symptoms,” says Adelaide Robb, M.D.

Over three decades ago, Adelaide Robb, M.D., sat in her office with a clear goal in mind: follow a career in adult psychiatry. Her patients displayed all sorts of symptoms: generalized anxiety, depression, bipolar disorder, autism, schizophrenia.

“In the early 1990s, my patients would tell me other doctors didn’t believe in their children having bipolar disorder,” she says.

These adult patients had been sick for 5, 10 and even 15 years but had not been diagnosed or treated properly. Eventually, they started bringing their children with them, who also had similar symptoms.

“I realized adequate treatment in youth can prevent many of the harmful outcomes in adults who were never treated properly for their symptoms,” Dr. Robb says.

She soon came to another realization: there was a massive gap in the health care world – pediatric psychopharmacology. She felt the need to bridge this gap and help children, motivating her to change the course of her career. Since joining Children’s National Hospital in 1994, she’s been an unstoppable force in the pediatric psychopharmacology world, quickly changing the rules of the game.

The big picture

Pediatricians in the United States continue to grapple with a mental health crisis that was exacerbated by the COVID-19 pandemic and declared a national emergency in 2021.

Mental health plays a key role in a child’s mental, emotional and behavioral well-being. It affects the way they think, feel and act while also impacting how they handle stress, relate to their peers and make choices.

According to the Centers for Disease Control and Prevention, attention deficit hyperactivity disorder (ADHD), anxiety, behavior problems and depression are the most commonly diagnosed mental health disorders in children. While available treatments vary, over the years, data has proven how medications can play a role in improving most mental health conditions.

Children’s National leads the way

For decades, Dr. Robb has led research focused on pediatric psychopharmacology with more than 80 clinical trials. Children’s National is one of only a few sites nationwide to participate in federally funded mental health clinical trials. Major trials she has led include:

  • Lexapro for major depression in youth
  • Prozac for obsessive compulsive disorder
  • Abilify for pediatric bipolar and schizophrenia
  • Latuda for pediatric bipolar depression
  • Concerta for ADHD

Dr. Robb also co-chaired the American Academy of Child and Adolescent Psychiatry’s Pediatric Psychopharmacology Initiative Committee for more than 8 years. She has also been active for more than 15 years in the American Academy of Pediatrics Committee on drugs (pharmacology).

“Since its inception in the ‘90s, pediatric psychopharmacology has changed in two major ways: First, we started to do regular testing of new medications in children and not just adults. Second, there’s been congressional and FDA mandates for testing of all medications that can be used in kids,” says Dr. Robb. “It’s no longer a guessing game – we have an evidence-based approach to children with mental illness using psychopharmacology.”

Currently, Dr. Robb is the principal investigator on several open clinical trials at Children’s National, including a study that compares the effectiveness of treating a parent with ADHD medication plus behavioral parent training (BPT) versus BPT alone on their child’s ADHD related symptoms.

Moving the field forward

Earlier this year, Dr. Robb moderated a panel on mental health and precision genomics which touched on what we know about depression, anxiety and other disorders and the future of pediatric behavioral health care.

“The goal is to give people with depression and other mental health illnesses the opportunity to go to school and function, whether they have depression, ADHD or any other disorder. This can make a huge difference in someone’s life,” Dr. Robb says.

Children’s National is uniquely positioned with a dedicated pharmacokinetic clinical team – which has greatly aided its ADHD and Learning Differences Program and most recent Addictions Program.

“We changed how ADHD was treated because our patients had early access to new trialed drugs,” says Dr. Robb. “This makes a big difference and gives children the opportunity to have better control of their symptoms so they’re paying attention and learning in school.”

Read more about our advances in Behavioral Health.

children sitting at the kitchen counter

New intervention program can help children with food allergies

children sitting at the kitchen counter

Kids with food allergies can experience stress related to daily food allergy management.

Adolescence is a challenging developmental period associated with risky food allergy behaviors. Kids with food allergies can experience stress related to daily food allergy management. In fact, some kids report that they have anxiety about allergic reactions and get bullied for their allergies.

The big picture

In a new study published in the Annals of Allergy, Asthma and Immunology, a team of experts developed the Food Allergy Mastery Program (FAM), a six-session telehealth program led by a counselor that promotes food allergy self-management and adjustment for youth ages 10-14 years.

“We then conducted focus groups with families in our food allergy clinic to get their opinions on the program, made changes and conducted a pilot study with additional food allergy families,” said Linda Herbert, Ph.D., director of Psychology Research and Clinical Services for Allergy and Immunology and psychologist at Children’s National Hospital and author of the study. “When we compared kids’ food allergy knowledge, self-efficacy and social support before and after completing the FAM Program, we saw improvements in food allergy knowledge, greater self-efficacy and more social support after the program.”

What’s been the hold-up in the field?

To date, there are no behavioral interventions that promote food allergy self-management and adjustment for youth. However, Herbert said such an intervention is critically needed because adolescence is a higher-risk period for allergic reactions.

“Adolescents are typically diagnosed when they are young and may not have sufficient food allergy knowledge about how to engage in food allergy self-management,” Herbert said.

They also spend an increasingly greater amount of time with peers, so they are more responsible for their food allergy, she added.

What’s exciting about the findings?

Youth who completed all six sessions rated the FAM Program as relevant and enjoyable on the post-program evaluation. They also reported having better knowledge related to allergen avoidance, allergic reaction symptom recognition and allergic reaction treatment.

“The FAM Program is a promising intervention for youth with food allergies,” the authors wrote.

What’s next?

From here, the team is conducting a large-scale randomized clinical trial to fully evaluate the FAM Program’s impact on kids funded by the National Institute of Allergy and Infectious Diseases. This trial is evaluating the impact of the FAM Program on primary outcomes of interest, such as food allergy knowledge, skills, behavior and psychosocial functioning, and distal outcomes of interest, such as healthcare utilization.

girl looking at her phone

TikTok could be causing rising cases of tic-like behaviors

girl looking at her phone

Many teenagers who viewed a high number of Tourette syndrome TikTok videos during the COVID-19 pandemic started portraying similar tic-like behaviors.

The impact of social media on children is once again front and center. During the pandemic, experts noticed the increase in functional tic-like disorders and suggested an association with the rise in popularity of social media videos on TikTok. Many teenagers who viewed a high number of Tourette syndrome (TS) TikTok videos during the COVID-19 pandemic portrayed similar tic-like behaviors.

In a new study published in Pediatric Neurology, experts analyzed the 100 most-viewed videos under #tourettes on the media platform. The authors found the symptoms  portrayed as TS on viewed TikTok videos are an inaccurate representation of TS and are more consistent with functional tic-like behaviors.

“Tourette syndrome symptoms portrayals on highly-viewed TikTok videos are predominantly not representative or typical of Tourette syndrome,” says Alonso Zea Vera, M.D., neurologist at Children’s National Hospital and lead author of the study.

“Although many videos are aimed at increasing Tourette syndrome awareness, I worry that some features of these videos can result in confusion and further stigmatization,” Dr. Zea Vera says. “A common cause of stigmatization in Tourette syndrome is the exaggeration of coprolalia (cursing tics) in the media. We found that many videos portrayed this (often used for a comedic effect) despite being a relatively rare symptom in Tourette syndrome.”

There have been recent discussions about the accuracy of current social media videos of TS. This study highlights the importance of mentioning the source of the medical information and providing guidance. Children’s National has one of the largest movement disorders teams in the U.S. that is trained to differentiate TS from functional tic-like disorders.

“This differentiation can be challenging but important since the treatment is different,” Dr. Zea Vera adds. “Both of these conditions can be very impairing for patients.”

You can read the full study ‘The phenomenology of tics and tic-like behavior in TikTok” here.

Randi Streisand

Randi Streisand, Ph.D., appointed Chief of Psychology and Behavioral Health at Children’s National Health System

Randi Streisand

Children’s National Health System announces that Randi Streisand, Ph.D., will become the chief of Psychology and Behavioral Health within the Center for Neuroscience and Behavioral Medicine. Dr. Streisand is a behavioral scientist, child health researcher and certified diabetes educator. She is a tenured professor of Psychology and Behavioral Health, and Pediatrics at The George Washington University School of Medicine and Health Sciences, and serves as the director of Psychology Research for Children’s National Health System.

“Dr. Streisand’s acceptance of this leadership position will play an integral role in our approach to improve research methods and providing comprehensive approaches to psychological treatments” says Roger J. Packer, M.D., senior vice president of the Center for Neuroscience and Behavioral Medicine.

As chief, Dr. Streisand will lead our team of nationally recognized educators, research leaders and specialists who are experts in the care of children and teens with emotional and behavioral disorders. She will also continue to lead an extensive research portfolio, focusing on parent-child adjustment to chronic disease, behavioral interventions to prevent and control disease and treatment complications and adherence to pediatric medical regimens.

Before joining the faculty at Children’s National in 2000, Dr. Streisand received her doctorate in clinical psychology from the University of Florida, completed her internship at Brown University and a fellowship at the Children’s Hospital of Philadelphia. She has written numerous publications in the areas of child health and serves on several grant review committees through Children’s National, NIH and the American Diabetes Association. At Children’s National, she is an active participant in the psychology training program, and mentors undergraduates, graduate students, interns, fellows and junior faculty members.

Maureen Monaghan

Using text messages and telemedicine to improve diabetes self-management

Maureen Monaghan

Maureen Monaghan, Ph.D., C.D.E., clinical psychologist and certified diabetes educator in the Childhood and Adolescent Diabetes Program at Children’s National Health System, awarded nearly $1.6 million grant from American Diabetes Association.

Adolescents and young adults ages 17-22 with Type 1 diabetes are at high risk for negative health outcomes. If fact, some studies show that less than 20 percent of patients in this population meet targets for glycemic control, and visits to the Emergency Department for acute complications like diabetic ketoacidosis peak around the same age.

The American Diabetes Association (ADA) awarded Maureen Monaghan, Ph.D., C.D.E., clinical psychologist and certified diabetes educator in the Childhood and Adolescent Diabetes Program at Children’s National Health System, nearly $1.6 million to evaluate an innovative behavioral intervention to improve patient-provider communication, teach and help patients maintain self-care and self-advocacy skills and ultimately prepare young adults for transition into adult diabetes care, limiting the negative adverse outcomes that are commonly seen in adulthood.

Dr. Monaghan is the first psychologist funded through the ADA’s Pathway to Stop Diabetes program, which awards six annual research grants designed to spur breakthroughs in fundamental diabetes science, technology, diabetes care and potential cures. Dr. Monaghan received the Accelerator Award, given to diabetes researchers early in their careers, which will assist her in leading a behavioral science project titled, “Improving Health Communication During the Transition from Pediatric to Adult Diabetes Care.”

“Behavior is such a key component in diabetes care, and it’s wonderful that the American Diabetes Association is invested in promoting healthy behaviors,” says Dr. Monaghan. “I’m excited to address psychosocial complications of diabetes and take a closer look at how supporting positive health behavior during adolescence and young adulthood can lead to a reduction in medical complications down the road.”

During the five year study, Dr. Monaghan will recruit patients ages 17-22 and follow their care at Children’s National through their first visit with an adult endocrinologist. Her team will assess participants’ ability to communicate with providers, including their willingness to disclose diabetes-related concerns, share potentially risky behaviors like drinking alcohol and take proactive steps to monitor and regularly review glucose data.

“The period of transition from pediatric to adult diabetes care represents a particularly risky time. Patients are going through major life changes, such as starting new jobs, attending college, moving out of their parents’ homes and ultimately managing care more independently,” says Dr. Monaghan. “Behavioral intervention can be effective at any age, but we are hopeful that we can substantially help youth during this time of transition when they are losing many of their safety nets.”

Study leaders will help participants download glucose device management tools onto their smartphones and explain how to upload information from patients’ diabetes devices into the system. Participants will then learn how to review the data and quickly spot issues for intervention or follow-up with their health care provider.

Patients also will participate in behavioral telemedicine visits from the convenience of their own homes, and receive text messages giving them reminders about self-care and educational information, such as “Going out with your friends tonight? Make sure you check your glucose level before you drive.”

At the study’s conclusion, Dr. Monaghan anticipates seeing improvements in psychosocial indicators, mood and transition readiness, as well as improved diabetes self-management and engagement in adult medicine.