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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.

American Academy of Child & Adolescent Psychiatry Meeting Logo

Children’s National at the American Academy of Child & Adolescent Psychiatry Meeting

Several experts from Children’s National Hospital will be sharing their knowledge at the upcoming American Academy of Child & Adolescent Psychiatry Meeting in New York City, October 23-28. Here’s a sample of what you can expect.

  • Mahdieh (Emmie) Bodaghi, M.D., a child and adolescent psychiatrist with expertise in telepsychiatry, will be on a clinical case conference panel about assessing and treating adolescents with comorbid catatonia. The presentation will feature a review of the current understanding of catatonia in the adolescent population and the assessment and management of catatonic features in bipolar disorder across inpatient and outpatient settings.
  • Jennifer Dorr, D.O., M.P.H., will be chairing a workshop on advocating purposefully, in which participants learn about the new advocacy toolkit developed by the AACAP Advocacy Committee. Laura Willing, M.D., will also be presenting in the workshop. Additionally, Dr. Dorr and Meghan Schott, D.O., will be presenters in a member services forum on effectively engaging in public discourse and advocacy.
  • Kriti Gandhi, M.D., Ayman Saleh, M.D., and Adelaide Robb, M.D., are presenting a poster on factors and implementations to decrease no-show rates for follow-up appointments at child psychiatry clinics.
  • Dr. Robb, who is division chief of Psychiatry and Behavioral Services at Children’s National, is also co-presenting in a sold out workshop and a clinical case conference. The workshop will look at various psychopharmacological decision-making strategies and allow participants to identify their personal strengths and areas for improvement by completing a self-assessment. The clinical case conference will discuss deprescribing — the process of reducing or withdrawing medications that pose higher risks than benefits — and include real-life examples of deprescribing to support young patients from diverse cultural backgrounds.
  • Priya Punnoose, M.D., and Dr. Schott will be presenting a clinical perspective on psychodynamic psychiatry in the inpatient setting.
  • Dr. Schott, who is medical director of Psychiatric Emergency Services at Children’s National, will be chairing a forum, that includes Dr. Robb, and is geared towards early and mid-career child and adolescent psychiatrists in academia who want to learn more about academic promotion. Dr. Schott will also be participating in two other forums — on personal finance and public advocacy — as well as chairing a discussion on the coming-of-age animated movie Luca and having conversations about life transitions with patients and their families.
  • Irene Chatoor, M.D., director of the Infant and Toddler Mental Health Program at Children’s National, will be chairing a clinical perspective on the diagnosis, treatment and follow-up of lack of interest in eating or food, as well as presenting her research during that time.
Date Time Presenter(s) Title
10/24/23 7:00 pm Meghan Schott, D.O. A Fish Out of Water: Reflections on Transitions and the “Other” in Luca
10/25/23 8:00 am Irene Chatoor, M.D. The Diagnosis, Treatment, and Follow-up of Avoidant/Restrictive Food Intake Disorder Subtype: Lack of Interest in Eating or Food
10/25/23 8:00 am Jennifer Dorr, D.O., M.P.H., and Laura Willing, M.D. How to Advocate Purposefully: Introducing AACAP’s Advocacy Toolkit
10/26/23 8:00 am Adelaide Robb, M.D. Helping You Know What You Don’t Know: A Self-Assessment Review of Psychopharmacology
10/26/23 1:30 pm Meghan Schott, D.O., and Adelaide Robb, M.D. Instructor to Professor: A Roadmap to Academic Promotion
10/27/23 8:00 am Adelaide Robb, M.D. Developmental Dynamics in De-prescribing for Children, Adolescents, and Transitional-Age Youth
10/27/23 1:30 pm Mahdieh (Emmie) Bodaghi, M.D. More Than Mania: Assessment and Treatment of Adolescents With Comorbid Catatonia Across Treatment Settings
10/27/23 n/a Kriti Gandhi, M.D., Ayman Saleh, M.D., and Adelaide Robb, M.D. Factors and Implementations to Decrease No-Show Rates for Follow-Up Appointments at the Child Psychiatry Clinic
10/27/23 n/a Priya Punnoose, M.D., and Meghan Schott, D.O. Psychodynamic Psychiatry in the Inpatient Setting

 

10/28/23 8:30 am Meghan Schott, D.O. From Residency Rags to Riches: A Physician’s Primer on Personal Finance, Paying Off Debt, and Preparing for the Future
10/28/23 1:00 pm Jennifer Dorr, D.O., M.P.H., and Meghan Schott, D.O. A Developmental Approach to the Child and Adolescent Psychiatry Advocate: Finding Your Stride and Making It Count
Pediatric Neurology Update Attendees

Pediatric neurologists get a primer on the state of ASD research and care

Pediatric Neurology Update Attendees

Neurologists who attended the 2019 Pediatric Neurology Update received a broad look at autism spectrum disorders, ranging from biology to clinical care and advocacy.

Autism spectrum disorders (ASD) took center stage for the afternoon sessions of the annual Pediatric Neurology Update in April. The meeting, hosted by the Center for Neuroscience and Behavioral Medicine at Children’s National Health System, brings together 150-plus pediatric neurologists each year to discuss critical research and clinical care of pediatric neurological conditions.

Led by the Center for Autism Spectrum Disorders Director Lauren Kenworthy, Ph.D., the afternoon’s slate of presentations sought to give broad perspective of the current state of ASD research and treatment best practices.

“We know that the brain is different in autism, but many times we continue to define autism by behavioral traits,” Dr. Kenworthy told the crowd in her introduction. “Sitting between the brain and behavior often is cognition – how do you understand your world and interpret it?”

The afternoon’s presentations were organized to provide the audience with a clear picture of many facets of ASD research and treatment. Highlights included:

  • Joshua Corbin, Ph.D., director of the Center for Neuroscience Research, offered “New Insights into the Neurobiologic Underpinnings of Autism,” which mapped out some of the biological mechanisms of autism.
  • Adelaide Robb, M.D., and Dr. Kenworthy presented current clinical care outlines, with Dr. Robb focusing on pharmacological therapies and Dr. Kenworthy sharing successful strategies to improve executive functioning and day to day task management for school-aged children.

Attendees also received a taste of two current “hot topics” in autism research and care:

  • Kevin Pelphrey, Ph.D., presented recent findings on “Gender Differences in Autism Spectrum Disorders: Girls with Autism” calling attention to the fact that the current diagnostic standards may not capture some female-associated phenotypes of ASD.
  • Julia Bascom of the Autistic Self Advocacy Network brought the autistic person’s point of view to the table via her presentation: “Autism: Society and Government Challenges and Solutions,” which focused on her organization’s efforts to improve inclusivity in advocacy and research, which she sums up as, “Nothing about us without us.”

The session concluded with a real-world focused “Autism-Friendly Hospital Roundtable,” of six panelists from the clinical, advocacy, community and technology fields, who are all involved in hands-on practices to improve medical experiences for autistic children and adults.

  • CASD’s Yetta Myrick talked about her work to engage families of autistic children in discussions of research and clinical care programs, including the start of CASD’s first-ever Stakeholder Advisory Board.
  • Julia Bascom talked about some of the less-often discussed challenges for many autistic people who seek medical services.
  • Kathleen Atmore, Psy.D., and Eileen Walters, MSN, RN, CPN, provided an overview of Beyond the Spectrum, the clinical service at Children’s National that coaches providers and families in techniques to reduce the stress of routine medical visits for patients with autism and other developmental disabilities.
  • Amy Kratchman, director of the LEND Family Collaboration at Children’s Hospital of Philadelphia, talked about some of the autism-friendly strategies underway at her institution.
  • Michael O’Neil, JD, MBA, founder and CEO of the GetWell Network, Inc., previewed how GetWell and Children’s National are partnering on a new tool that harnesses app technology to bring better information to autistic children and their families after a new autism diagnosis.
  • Vijay Ravindran, CEO and co-founder at Floreo, demonstrated how it might be possible to reduce stress and create a calm peaceful autism-friendly environment even in the busiest of waiting rooms, by allowing the patient to escape via virtual reality.

The roundtable showcased how Children’s National and other health care institutions are using evidence-based strategies to improve medical care experiences for autistic people and their families. Ideally any provider, including pediatric neurologists, who cares for people from the autism community, can incorporate any or all of these strategies as a way to meet the unique needs of this patient population.

The content was so timely and relevant to the audience that many attendees stayed past the official end of the meeting to continue discussing best practices with the panelists and each other.