Behavioral Health Archives

In the news: Advancing Pediatric Bipolar Disorder Treatment: The Critical Role of Lithium

March 5, 2025

Adelaide Robb, MD, is the chief of Psychiatry and Behavioral Sciences at Children’s National Hospital and a leading expert in the treatment and research of pediatric bipolar disorder. As a psychopharmacologist, Dr. Robb frequently prescribes lithium to treat bipolar mania in children and adolescents. While she acknowledges that lithium requires a more nuanced approach compared to faster-acting anti-psychotics, its proven effectiveness — particularly in reducing suicide risk — makes it one of the most reliable treatments, as supported by federally funded trials.

“My philosophy is that everyone with bipolar disorder deserves a lithium trial,” says Dr. Robb. When discussing the use of lithium, it is vital that patients and families understand the nature of bipolar disorder and the importance of early intervention. Dr. Robb highlights that the onset of bipolar symptoms typically occurs 3-5 years before the development of comorbid substance use disorders, creating a critical window of opportunity. By managing bipolar symptoms early, we can potentially prevent self-medication through substance use.

“We know that lithium is effective for children 7 and up, and we know it reduces the risk of death by suicide,” she explains. “When death by suicide is our worst outcome, any opportunity we have to reduce that risk — or prevent it altogether — is an important choice to make.”

Dr. Robb recently appeared on the Neuroscience Education Institute (NEI) Podcast, where she joined Jeffery R. Strawn, MD, to discuss the key aspects of lithium treatment. The topics covered included the importance of carefully calibrated dosing, proactive side effect management, and the essential role of parental involvement in treatment decisions. Learn more about her thoughts on the NEI Podcast.

Children’s National Hospital to host 35th Annual Pediatric Neurology Update

February 24, 2025

The Divisions of Neurology and Neurosurgery at Children’s National Hospital are proud to host the 35^th Annual Pediatric Neurology Update course.

Chair Elizabeth Wells, MD; Co-Chairs, Marc DiSabella, DO, John Schreiber, MD, William D. Gaillard, MD, Robert Keating, MD

The course attracts a national audience and brings together neuroscience clinicians and pediatricians in the Washington, D.C. and Mid-Atlantic region.

Guest speakers include Annapurna Poduri, MD, MPH, Deputy Director for NINDS, Emily Freilich, MD, from the FDA and Conor Mallucci, MBBS, Chief of Neurosurgery at Alder Hays, England.

This year’s course highlights 3 major areas:

Updates in Epilepsy
Innovations in Vascular Neurosurgery and Neurointerventional Radiology
Addressing Mental and Behavioral Health in Neurological Conditions

We invite you to join us for presentations from experts in the field during this full-day, CME accredited event on April 10, 2025. This is a hybrid event that will be held virtually or in-person at the Children’s National Research & Innovation Campus.

For more information and to register, visit ChildrensNational.org/NeurologyUpdate.

Podcast: Hidden struggles: The reality of pediatric addiction

February 19, 2025

Navigating Pediatric Bipolar Disorder: Insights from the 2024 Parent’s Medication Guide

February 10, 2025

The 2024 Parent’s Medication Guide to Bipolar Disorder, published by the American Academy of Child and Adolescent Psychiatry, was designed to help families navigate the complex condition of pediatric bipolar disorder. The guide, co-authored by Adelaide Robb, MD, division chief of Psychiatry and Behavioral Sciences at Children’s National Hospital, is a collaborative effort with contributions from top experts in the field of child and adolescent psychiatry.

This guide is a valuable tool for families newly introduced to pediatric bipolar disorder. It covers medication options in terms of their effectiveness, common side effects and necessary monitoring. Beyond treatment details, the guide provides families with helpful resources, such as links to child and adolescent psychiatry organizations and bipolar support groups.

U.S. News & World Report voting

February 6, 2025

Children’s National is ranked one of the top 10 pediatric hospitals in the nation by U.S. News & World Report. Our faculty and staff are proud of the impact made on the lives of children and families in our community. Your participation in the U.S. News & World Report annual reputational survey validates the quality of care we provide and reflects the mutual respect and trust we share as healthcare professionals.

How to determine your voting eligibility

Voting for the U.S. News & World Report Best Children’s Hospitals rankings can be done only through Doximity.

To participate, physicians must:

Be board-certified and meet the eligibility criteria for the voting categories.
For child and adolescent psychologists, your account must be up to date with your specialty and subspecialty correctly marked.
Be a credential-verified member of Doximity (you must have an active and claimed Doximity profile).
Have all certifications and board documents currently up-to-date in your Doximity profile.

View the full eligibility criteria

How to claim your Doximity profile to vote

You have to claim your profile on Doximity.com to participate in the online survey. If you have not yet claimed your Doximity profile, go to Doximity.com, and click “Find My Profile.”
Once your profile has been claimed, you must confirm your email address and board certifications.
Verified Doximity members will receive an email inviting them to participate in the U.S. News survey.
For more information on how to claim your profile, visit Doximity.com

How to update and verify existing Doximity account information

Your Doximity profile must have up-to-date licenses, certifications and board documents.

Once you are logged in, your profile will automatically be in “Edit Mode.” You are able to add new items or edit existing information.
Update your Doximity profile and ensure your information is current.

Once registered, users wishing to participate in the online survey should:

Watch for an email from Doximity about the annual member survey.
Even if you don’t see the email, if you are a registered Doximity user, you can still vote by logging in to Doximity.com with your username and password during the voting period.
Once logged in, look for a U.S. News graphic or button on the homepage and click on it.
The survey asks users to name the hospitals that provide the best care in your respective specialty, without consideration to location or cost. Pediatric specialists will list 10 hospitals. The order in which you list the hospitals does not matter.

Please note: Children’s National Hospital is listed as “Children’s National Hospital Washington, DC” on the survey.

Visit Doximity’s FAQs if you have issues or questions about registration or claiming your profile.

How to cast your vote

In February 2025 when voting opens, all survey-eligible physicians will receive a notification on the Doximity app for Android or iOS. If you do not use the Doximity app, you will receive an email when voting opens.

Log in to your Doximity account at doximity.com or via the mobile app.
Click the Notifications icon or tap the “Submit your Nominations” button on the homepage. You can also search for “U.S. News Best Hospitals”
Select 10 hospitals in your respective specialty that you believe provide the best care in the United States.
Submit your vote

Having technical issues?

If you have difficulty registering with Doximity or completing the survey, please visit Doximity support for assistance.

Vote

The 2025 U.S. News & World Report Best Children’s Hospitals reputation voting will open in mid-February. Look for your Doximity notification to vote.

Cast your vote

Extended-release buprenorphine for treatment of adolescent opioid use disorder

February 5, 2025

A new case series published in the Journal of Addiction Medicine highlights the need for more studies of extended-release buprenorphine for treatment of opioid use disorder (OUD) in adolescents under 18 years old.

Why it matters

In recent years there has been an increase in adolescent OUD and adolescent opioid overdose deaths. Extended-release buprenorphine has been shown to be a safe and effective medication in adults but not offered to adolescents due to lack of safety data. Larger studies are needed to establish the safety and efficacy of extended-release buprenorphine for treatment in this population.

The big picture

In this case series, the researchers discuss six cases of patients younger than 18 years old with severe OUD who receive(d) treatment of extended-release buprenorphine at the Children’s National Hospital Addictions Program and Howard University Hospital. All patients reported a history of smoking fentanyl as their primary method of use.

Initial treatment began with sublingual buprenorphine-naloxone but then transitioned to extended-release buprenorphine. The authors stated, “Transition to extended-release buprenorphine was most frequently done due to patient nonadherence with a daily sublingual buprenorphine medication regimen, ongoing fentanyl use and concerns surrounding the difficulty with administration of the sublingual buprenorphine.”

How does this work move the field forward?

Extended-release buprenorphine is not an FDA approved intervention due to lack of safety data in patients younger than 18. Overall, little clinical research is being done in adolescents with OUD.

“Given the current overdose crisis among adolescents caused by fentanyl and the rising number of kids with OUD, more intervention options are needed,” says Sivabalaji Kaliamurthy, MD, director of the Addictions Program at Children’s National and lead author of the study. “We are hoping that this work will decrease provider hesitance to offer this intervention and will also provide data to help with insurance coverage.”

Children’s National leads the way

Dr. Kaliamurthy says, “The uniqueness of this work comes from our ability as a hospital to provide appropriate care for children struggling with severe addiction, navigating and overcoming significant barriers along the way that other programs have struggled to address. We are offering a treatment that is effective and the kids in treatment are doing well.”

You can read the full study The Use of Extended-Release Buprenorphine in the Treatment of Adolescent Opioid Use Disorder: A Case Series in the Journal of Addiction Medicine.

In the news: Advocacy and challenges in child psychiatry

January 30, 2025

Adelaide Robb, MD, chief of Psychiatry and Behavioral Sciences at Children’s National Hospital, chose to pursue child psychiatry after her work with the National Institutes of Health (NIH) in the bipolar disorders branch. There, she collaborated with families to collect DNA for research in exchange for ongoing psychiatric care. Through this experience, Dr. Robb discovered the significant delays children faced in receiving accurate Bipolar diagnoses and appropriate treatment.

“I thought about how hard it was for people to wait so many years to get an appropriate diagnosis. Parents had told me that psychiatrists in DC did not believe in pediatric bipolar disorder and I thought they were wrong, that our nation’s child psychiatrists knew better, but in fact the parents were correct.”

Dr. Robb recently joined the Washington Psychiatric Society (WPS) to talk about her pivotal career moments, the importance of advocacy work and the challenges facing the field of child psychiatry. Learn more about her thoughts on the WPS podcast.

Review: New insights into brain development and behavior

January 24, 2025

A recent review by researchers at Children’s National, published in Trends in Neurosciences, offers a new and in-depth understanding of how the amygdala is formed during fetal developmental.

The medial amygdala (MeA) is a central structure of the brain for regulation of social and emotional behaviors. Amygdala dysfunction is associated with a host of developmental conditions including autism spectrum disorders (ASD), post-traumatic stress disorder (PTSD) and the consequences of early life stress. To date, there has been a lack of comprehensive understanding of how the amygdala forms developmentally.

A recent review by researchers at Children’s National Hospital, published in Trends in Neurosciences, offers a new and in-depth understanding of how this complex structure is formed during fetal developmental and the role it plays in social behavior.

“This extensive review conveys the latest findings on how the amygdala is formed from development across preclinical models and humans,” says Joshua Corbin, PhD, interim director of the Center for Neuroscience Research at Children’s National and lead author of the review. “Past and present work in our lab has contributed critical knowledge of how this important structure forms from development and implications for human conditions.”

Moving the field forward

Malformation of the amygdala is a hallmark feature of disorders of social cognition such as ASD. Additionally, amygdala development is highly susceptible to early life stress and influences altered fear and anxiety responses in individuals who have been faced with early life stress.

“Despite our growing understanding of MeA development and its role in behavior, many critical questions remain. However, with cutting-edge tools like transcriptomic profiling, subcircuit-level circuit mapping, CRISPR mutagenesis and targeted gene delivery, we’re on the brink of uncovering different neurons in the amygdala form and shape social behaviors,” says Dr. Corbin.

Children’s National leads the way

Dr. Corbin’s team is among only a handful of groups in the world focused on understanding amygdala development. Investigators within the Center for Neuroscience Research at Children’s National have a shared goal of understanding the biological underpinnings of neurodevelopmental disorders.

You can read the full review published in Trends in Neurosciences.

Pioneering evidence-based treatments for substance addictions

January 21, 2025

“We really want to focus on intervening in an evidence-based manner in the primary care setting because that is where most of our patients are going to first access care outside of the emergency room,” says Dr. Kaliamurthy.

Increasing evidence-based treatment is a key component of the Addictions Program at Children’s National Hospital, created in 2022 and led by Sivabalaji Kaliamurthy, MD. In addition to evidence-based treatment and prevention efforts, the team also prioritizes engagement and education. The team collaborates with area pediatricians, who are often the first providers to identify substance use. Pediatric residents rotate with the program during their adolescent medicine blocks and child and adolescent psychiatry fellows have dedicated time with the Addictions Program to increase their knowledge and comfort in managing substance use and often co-occurring psychiatric disorders. “We really want to focus on intervening in an evidence-based manner in the primary care setting because that is where most of our patients are going to first access care outside of the emergency room,” says Dr. Kaliamurthy.

The challenge

The most common substances kids use or experiment with are alcohol, nicotine and cannabis. The team at Children’s National is focusing on the significant increase in potency of substances over the last decade. For example, cannabis potency is based on the amount of tetrahydrocannabinol (THC), and over the last 10 years, average potency in the plant product has gone from 2-5% THC to 20-25% THC. There are also higher potency products that can be vaped which contain upwards of 80% THC, which kids prefer due to ease in concealability. “It’s not the same drugs anymore that the parents’ generation might have used or experimented with when they were high schoolers, even though it’s still nicotine and cannabis, the potency has significantly changed,” says Dr. Kaliamurthy.

In addition to prevention tactics, the team at Children’s National is prioritizing the development of evidence-based treatment for patients in the Addictions Program. “Children need more tailored intervention that simply doesn’t have the same robust evidence basis that we have for adults. Right now, we are prioritizing implementing treatments that have been successful in limited research settings and studying how it translates into real world clinical settings for kids,” explains Dr. Kaliamurthy.

The challenge of treating cannabis use disorder and cannabis use disorder with co-occurring mental health conditions is that there are no effective FDA-approved medications for cannabis use disorder. Alcohol, opioids and nicotine all have many FDA-approved medication options for adults that can be used as part of a child’s treatment, off label. Dr. Kaliamurthy notes, “that is one of the directions that we will also be taking in the future — how we can effectively treat cannabis use and cannabis use co-occurring with very severe mental health conditions.”

What’s next?

Addressing community misinformation and the stigma surrounding substance use treatment has led to the development of several priority projects, including:

Increasing education and access to information for staff at Children’s National. Ensuring that if any clinician at Children’s National meets a child that is struggling, they know where to go for regional resources and what to do for next steps to get support and help for the patient. Dr. Kaliamurthy led a project to develop resources on an intranet site available to all staff.
Increasing access to care. Kaliamurthy is piloting a team of peer recovery support specialists. “We know that peers are people with lived experience who are in recovery, and they’ve been very effective in the adult world in really helping patients engage and connect with care.” This is a novel program launching with our youth in the emergency room.
Focusing on cannabis. With the increase in the number of kids coming to the hospital for cannabis-related reasons and the lack of effective treatments, we are going to be focusing on effectively treating cannabis use and cannabis use with co-occurring mental health conditions.

Textbook explores psychosocial impacts of kidney disease and provides valuable resources

January 8, 2025

The cover of Psychosocial Considerations in Pediatric Kidney Conditions edited by team of pediatric experts including Kaushalendra Amatya, Ph.D.

The first edition of the Psychosocial Considerations in Pediatric Kidney Conditions textbook, edited by a collective of pediatric experts including Kaushalendra Amatya, Ph.D., psychologist at Children’s National Hospital, is now available.

This textbook delves into the psychosocial effects of kidney disease and treatments for children. With chapters written by multidisciplinary experts – including psychologists, nephrologists, neuropsychologists, dietitians, pharmacists, nurses, social workers, child life specialists, as well as patients and families – this book provides a unique and comprehensive perspective of caring for patients with kidney diseases.

The book emphasizes the importance of a multidisciplinary treatment approach, one that incorporates psychosocial factors to ensure the holistic well-being of young patients. It covers a wide range of topics, from disease-specific issues like nutrition and dialysis to broader challenges, such as collaboration with schools, supporting families, advocacy and the transition from pediatric to adult healthcare.

Providing valuable insights into the complexities of managing pediatric kidney diseases, this textbook offers practical strategies for supporting patients throughout their journey, making it an invaluable resource for nephrologists, psychosocial providers, patients and families.

Psychosocial Considerations in Pediatric Kidney Conditions, 1st edition textbook can be purchased here.

Children’s National in the News: 2024

December 26, 2024

In 2024, Children’s National Hospital continued to make remarkable strides across diverse areas of pediatric medicine, from groundbreaking technological innovations to critical health advocacy. The following compilation showcases ten significant stories that demonstrate the breadth and depth of the hospital’s impact, as featured in major national news outlets including NBC Nightly News, CNN, The Washington Post, The New York Times, NPR, The Today Show, Healio, and POLITICO. Delve into our 2024 news highlights for more.

1. World’s smallest pacemaker gives new hope to babies with heart defects

Charles Berul, M.D., and a patient family talk about the pill-sized pacemaker that saved the life of Abby, an infant born with deadly heart defects. (NBC Nightly News)

2. ‘A $10 death trip’: Fentanyl is killing teens. Meet one fighting for his life

Sivabalaji Kaliamurthy, M.D., addiction psychiatrist and director of the Addictions Program, spoke to CNN about the impact of drug addiction on teen health and the lack of resources available to treat opioid use disorder. (CNN)

3. Health panel urges interventions for children and teens with high BMI

Susma Vaidya, M.D., M.P.H., associate medical director of the IDEAL Clinic, shared her concerns about childhood obesity treatment recommendations issued today by a leading panel of independent U.S. health experts. (The Washington Post)

4. An Rx for food? Doctor’s offices offer groceries to those in need

Shideh Majidi, M.D., M.S.C.S., and Emily Frymark, clinical dietitian, spoke about how the food pharmacy, created in partnership with the Capital Area Food Bank, benefits patients with diabetes and other chronic conditions. (The Washington Post)

5. First patient begins newly approved sickle cell gene therapy

Kendric Cromer, a 12-year-old boy being treated at Children’s National Hospital, became the first person in the world with sickle cell disease to begin a commercially approved gene therapy that may cure the condition. “This is a big effort,” says David Jacobsohn, M.D., ScM, M.B.A. (The New York Times)

6. ‘We created this problem’: A pediatric surgeon on how gun violence affects children

Mikael Petrosyan, M.D., associate chief of General and Thoracic Surgery, discusses the stress medical staff face when treating young victims of gun violence. (NPR)

7. 7th grade boy rings bell after final round of chemotherapy

Landon, an 11-year-old patient, rang the bell at Children’s National Hospital with family, friends, doctors and nurses cheering after finishing his final round of chemotherapy. (The Today Show)

8. Study: One in three adolescents experience ‘period poverty’

Monika Goyal, M.D., M.S.C.E., pediatric emergency medicine specialist and co-director of the Center for Translational Research, emphasized the need for awareness in addressing period poverty in teenagers and young adults. (Healio)

9. The AI assurance labs are coming

Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer, participates in a panel discussion covering AI data collection, associated risks, reliance and other topics related to artificial intelligence. (POLITICO)

10. First day of a ‘new life’ for a boy with sickle cell

Children’s National patient Kendric Cromer, 12, became one of the first children ever to be treated with a newly approved gene therapy that will free him from the sickle cell disease that has stolen his childhood. (The New York Times)

The best of 2024 from Innovation District

December 19, 2024

2024 marked another groundbreaking year for Children’s National Hospital, showcasing remarkable advances across the spectrum of pediatric medicine, research and healthcare innovation. From pioneering surgical procedures to breakthrough artificial intelligence applications, the institution continued to push the boundaries of what’s possible in children’s healthcare. Read on for our list of the most popular articles we published on Innovation District in 2024.

1. Prenatal COVID exposure associated with changes in newborn brain

A study led by researchers at Children’s National Hospital showed that babies born during the COVID-19 pandemic have differences in the size of certain structures in the brain, compared to infants born before the pandemic. The findings suggest that exposure to the coronavirus and being pregnant during the pandemic could play a role in shaping infant brain development.
(3 min. read)

2. Children’s National Hospital again ranked among the best in the nation by U.S. News & World Report

Children’s National Hospital was ranked as a top hospital in the nation by the U.S. News & World Report 2024-25 Best Children’s Hospitals annual rankings. This marks the eighth straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.
(2 min. read)

3. Children’s National performs first ever HIFU procedure on patient with cerebral palsy

In January 2023, a team of multidisciplinary doctors performed the first case in the world of using bilateral high intensity focused ultrasound (HIFU) pallidotomy on Jesus, a 22-year-old patient with dyskinetic cerebral palsy. The procedure is part of a clinical trial led by Chima Oluigbo, M.D., pediatric neurosurgeon at Children’s National Hospital.
(3 min. read)

4. Novel ultrasound device gets FDA breakthrough designation with Children’s National support

A novel ultrasound device developed by Bloom Standard received the Food and Drug Administration’s valued breakthrough device designation with the help of Children’s National Hospital. The device that enables autonomous, hands-free ultrasound scans to be performed anywhere, by any user.
(2 min. read)

5. First-of-its-kind pilot study on the impacts of Lyme disease in pregnancy and infant development

Understanding the effects of Lyme disease on the developing fetal brain is essential to ensure timely prenatal and postnatal treatments to protect the fetus and newborn. In response to this need, Children’s National Hospital is leading a pilot study to establish the groundwork needed for a larger study to determine the effect of in utero exposure to Lyme disease on pregnancy and early childhood neurodevelopmental outcomes.
(3 min. read)

6. Earliest hybrid HLHS heart surgery kids thrive 5 years later

Five years ago, Cayden was born 6 weeks early weighing less than four pounds and at risk of dying from her critical congenital heart disease. Today, she’s a happy five-year-old. Early diagnosis of her hypoplastic right ventricle, double inlet left ventricle and critical coarctation of the aorta allowed for the team at Children’s National Hospital to create a careful plan for safe delivery and to offer an innovative hybrid HLHS surgical approach at the hospital within 24 hours after she was born.
(1 min. read)

7. Wayne J. Franklin, M.D., F.A.C.C., named senior vice president of the Children’s National Heart Center

Children’s National Hospital appointed Wayne J. Franklin, M.D., F.A.C.C., as the new senior vice president (SVP) of the Children’s National Heart Center. In this role, Dr. Franklin oversees the full spectrum of heart care services including cardiac imaging and diagnostics, interventional cardiology, electrophysiology, cardiac anesthesia, cardiac surgery and cardiac intensive care.
(2 min. read)

8. Artificial – and accelerated – intelligence: endless applications to expand health equity

By pioneering artificial intelligence (AI) innovation programs at Children’s National Hospital, Marius George Linguraru, D.Phil., M.A., M.Sc., and the AI experts he leads are ensuring patients and families benefit from a coming wave of technological advances. The team is teaching AI to interpret complex data that could otherwise overwhelm clinicians.
(4 min. read)

9. Evidence review: Maternal mental conditions drive climbing death rate in U.S.

Painting a sobering picture, a research team led by Children’s National Hospital culled years of data demonstrating that maternal mental illness is an under-recognized contributor to the death of new mothers. They called for urgent action to address this public health crisis.
(3 min. read)

10. Nathan Kuppermann, M.D., M.P.H., named chief academic officer and chair of Pediatrics

Children’s National Hospital appointed Nathan Kuppermann, M.D., M.P.H., as its new executive vice president, chief academic officer and chair of Pediatrics. In this role, Dr. Kuppermann oversees research, education and innovation for the Children’s National Research Institute as well as academic and administrative leadership in the Department of Pediatrics at George Washington University School of Medicine & Health Services.
(2 min. read)

11. First global clinical trial achieves promising results for hypochondroplasia

Researchers from Children’s National Hospital presented findings from the first clinical trial of the medication vosoritide for children with hypochondroplasia – a rare genetic growth disorder. During the phase 2 trial, researchers found vosoritide increased the growth rate in children with hypochondroplasia, allowing them to grow on average an extra 1.8 cm per year.
(2 min. read)

12. Pioneering research center aims to revolutionize prenatal and neonatal health

Since its establishment in July 2023, the Center for Prenatal, Neonatal & Maternal Health Research at Children’s National Hospital has gained recognition through high-impact scientific publications, featuring noteworthy studies exploring the early phases of human development.
(3 min. read)

Children’s National again ranked among the best in the nation by U.S. News & World Report

October 8, 2024

Children’s National Hospital in Washington, D.C., was ranked as a top hospital in the nation by the U.S. News & World Report 2024-25 Best Children’s Hospitals annual rankings. This marks the eighth straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.

This year, U.S. News ended ordinal rankings on its Honor Roll. Instead of assigning a numerical rank from 1 to 10, all hospitals on the Honor Roll will be recognized as having attained the highest standards of care in the nation.

In addition, Children’s National tied for #1 pediatric hospital in the Mid-Atlantic region, which includes New York, New Jersey, Delaware, Pennsylvania, the District of Columbia, West Virginia and Virginia. It’s also best in the Mid-Atlantic in Neonatology.

For the fourteenth straight year, Children’s National ranked in 10 specialty services. New this year, U.S. News included behavioral health as a service line in the rankings. Since it’s the first year, there are no ordinal rankings for behavioral health, but the Children’s National program was named one of the top 50 programs in the country.

“In my first year here, I witnessed what makes Children’s National so special — our commitment to collaboration, empowering one another, and charting a bold path forward for pediatric care,” said Michelle Riley-Brown, MHA, FACHE, president and chief executive officer of Children’s National. “I’m proud U.S. News again recognized Children’s National as one of the top in the nation and the highest-ranked pediatric hospital in D.C., Maryland and Virginia. Together, we’ll continue to push the boundaries of care, research and innovation to make a difference for those who matter most — the kids.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

“For nearly two decades, U.S. News has published Best Children’s Hospitals to empower the parents and caregivers of children with complex medical needs,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals appearing on the U.S. News Honor Roll have a track record of delivering unparalleled specialized care.”

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

Neonatology (No. 2), led by Billie Lou Short, M.D.
Neurology and Neurosurgery (No. 5), led by William D. Gaillard, M.D., and Robert F. Keating, M.D.
Cancer (No. 5), led by Eugene Hwang, M.D.
Diabetes and Endocrinology (No. 7), led by Andrew Dauber, M.D., MMSc.
Gastroenterology and GI surgery (No. 8), led by Ian Leibowitz, M.D., Marc Levitt, M.D., Anthony Sandler, M.D., and Timothy Kane, M.D.
Nephrology (No. 8), led by Marva Moxey-Mims, M.D.
Orthopedics (No. 9), led by Matthew Oetgen, M.D., M.B.A.

The other four specialties ranked among the top 50 are Behavioral Health, Cardiology and Heart Surgery, Pulmonology and Lung Surgery, and Urology.

Audience members at the NIAID Conference

Breaking free of illness: Experts explore solutions for chronic pediatric disorders

September 23, 2024

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When new patients with chronic illnesses come to Roberta DeBiasi, M.D., M.S., division chief of Infectious Diseases, they are often drained of energy, far behind in school and fatigued by the lack of coordinated care among multiple specialists. She envisions a better way to care for these children: a data-driven, multidisciplinary clinic that can help diagnose and treat disorders facing chronically ill children.

In a keynote address, Dr. DeBiasi laid out her vision for improving care during the 7th annual symposium hosted by Children’s National Hospital and the National Institute of Allergy and Infectious Diseases (NIAID): “A new paradigm: Infection-associated chronic illnesses (IACI) affecting children.” Experts from across the country came together to discuss these IACIs, the importance of finding biomarkers to diagnose and monitor them, data-driven therapeutics to treat them, and the urgent need for protocols to guide physicians.

The patient benefit

A range of IACIs – including long COVID, Lyme disease, postural orthostatic tachycardia syndrome (POTS), dysautonomia and more – are stealing normal, active lifestyles from children. Dr. DeBiasi said patients need researchers who understand disease pathogenesis and have standardized disease classification to diagnose and treat these disorders. Because of the complexity of these cases, care delivery and coordination also need to change. Patients, she said, would best be served by beginning with a three-hour appointment in a multidisciplinary clinic with experts from behavioral health, rehabilitative medicine and other specialties.

“When one of these patients comes to us, we feel helpless as physicians,” Dr. DeBiasi said. “There’s no diagnostic, and we don’t know how to treat them…. It is, to me, very energizing that we’re going to be able to have a coordinated way to help these families. But to do that, we have to have standardized disease classification.”

Moving the field forward

In 2017, NIAID and Children’s National launched a clinical research partnership devoted to advancing the health of children with allergic, immunologic, auto-inflammatory and infectious diseases through collaborative research and education. The partnership — co-led by H. Clifford Lane, M.D., NIAID’s deputy director for Clinical Research and Special Projects, and Catherine Bollard, M.D., M.B.Ch.B., director of the Center for Cancer and Immunology Research at Children’s National — promotes the prevention, diagnosis, treatment and cure of these childhood diseases. Every year, the partnership organizes and funds a symposium to explore cutting-edge research and pressing issues in pediatric care.

At this year’s gathering, experts examined the specifics of various disorders, including Alexandra Yonts, M.D. She provided new data from the Children’s National Post-Covid Program and explained that patients “are clamoring” for help with symptom management.

“There have been virtually no randomized, controlled trials and very little evidence on any sort of aggressive treatments, or pharmaceutical management options, especially in the pediatric population,” Dr. Yonts said. “Upon recent attendance at some long COVID meetings, there is an expressed concern, especially among pediatric providers, about trying medications off-label in these long COVID patients.”

Miss the symposium? You can learn more about the science they explored in the symposium’s recording on topics including:

Potential overarching mechanisms of disease, including pathogen- and host-mediated factors.
Identifying potential biomarkers for chronic illnesses
Treatments and multidisciplinary approaches for patients with IACIs
Patient advocacy

Mindfulness-based interventions boost teens with Type 1 diabetes

September 17, 2024

A 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.

Molly Basch, Ph.D., and Eleanor Mackey, Ph.D., both psychologists and authors of the study, shared more about their 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.

Assessing psychosocial risk, patient readiness for sickle cell gene therapy

August 21, 2024

The CureSCi Patient Readiness and Resilience Working Group brought together behavioral health clinicians and scientists from across the U.S. with expertise in sickle cell disease to develop recommendations for assessing and promoting patient readiness for gene therapy.

Two gene therapies for sickle cell disease were recently approved by the U.S. Food and Drug Administration (FDA) and are now commercially available in the U.S. This marks a historic shift in the treatment of sickle cell disease (SCD) and represents a leap forward more broadly for the medical community, opening a range of exciting possibilities for the development of novel therapeutics for other diseases. However, these new therapies are not without medical and psychological risks; therefore, the Cure Sickle Cell Initiative (CureSCi) of the National Heart, Lung and Blood Institute (NHLBI) convened a Patient Readiness and Resilience Working Group to develop recommendations for the assessment of psychosocial readiness for gene therapy.

What’s been the hold-up in the field?

Clinicians have long recognized that psychological and social issues have the potential to affect treatment outcomes following disease-modifying or transformative treatments, such as hematopoietic stem cell transplants. The same concerns exist for gene therapies, but there has not been clear guidance about the best ways to evaluate patient readiness and psychosocial risk and resilience factors in these contexts.

How does this work move the field forward?

The CureSCi Patient Readiness and Resilience Working Group brought together behavioral health clinicians and scientists from across the U.S. with expertise in SCD, as well as caregivers and patients with the lived experience of having SCD, to develop recommendations for assessing and promoting patient readiness for gene therapy. The resulting consensus statement outlines clear and practical guidance for conducting pre-gene therapy patient readiness assessments.

“This is an exciting time for the sickle cell and medical communities,” says Steven Hardy, Ph.D., director of Behavioral Health Services in the Divisions of Hematology, Oncology and Blood and Marrow Transplantation at Children’s National Hospital and lead author on the consensus statement. “But it is also a time to exercise caution to ensure that, in the cloud of such enthusiasm, we do not lose sight of the complex ways that human psychology, relationships and biology interact to influence health.”

How will this work benefit patients?

This new guidance for evaluating psychosocial readiness will ensure that important issues — such as the degree to which patients have been informed of and understand key treatment details, are interested in and motivated to pursue treatment, and have considered how undergoing gene therapy will affect their activities, relationships and mental health — are considered and patients are provided the necessary supports.

“These recommendations offer a blueprint and a charge to institutions, payors and policymakers around the world to prioritize the psychosocial well-being of patients with SCD undergoing gene therapy,” says Dr. Hardy.

How is Children’s National leading in this space?

Children’s National has participated in gene therapy clinical trials and is the first institution globally to treat a patient with SCD with one of the new commercially available gene therapies. Dr. Hardy chaired the CureSCi Patient Readiness and Resilience Working Group that developed the consensus recommendations. Psychologists in the Divisions of Hematology, Oncology and Blood and Marrow Transplantation have adopted a standard protocol, informed by the consensus recommendations, for conducting pre-gene therapy assessments of patient readiness.

You can read the full consensus statement, Assessing Psychosocial Risk and Resilience to Support Readiness for Gene Therapy in Sickle Cell Disease: A Consensus Statement, in JAMA Network Open.

Unlocking access to mental health support for families battling food allergies: A global view

August 19, 2024

In a recent study published in the journal Allergy, Linda Herbert, Ph.D., found that most children with food allergies experienced food allergy-related psychological distress.

Pediatric food allergy is a global public health concern that affects 8 percent of children in the United States, with higher rates observed in younger children. While new treatments are being developed, psychological support for food allergy-related concerns is not frequently available. This often impacts patients’ and caregivers’ quality of life and overall psychosocial functioning.

The big picture

In a recent study published in the journal Allergy, Linda Herbert, Ph.D., director of Psychology Research and Clinical Services for the Division of Allergy and Immunology at Children’s National Hospital, found that most children with food allergies experienced food allergy-related psychological distress. “This is the first study to survey families affected by food allergy across multiple countries, in multiple languages,” said Dr. Herbert. “Doing so has given us a global understanding of the impact of food allergies on patients and caregivers and allowed us to compare food allergy experiences across countries.”

Dr. Herbert and a team of researchers assessed psychological distress related to food allergy and use of psychological services among adults with food allergy and caregivers of children with food allergy in over 20 countries, utilizing surveys in multiple languages. The team found that about 66 percent of adults with food allergy, 75 percent of caregivers, and 50 percent of children with food allergy experienced food allergy-related psychological distress, with the most common concern being anxiety about having an allergic reaction.

The patient benefit

“We hear from many families that want help coping with food allergy-related distress, and either do not know where to find mental health professionals with this expertise or experience a long wait when they do find one,” said Dr. Herbert. “They also experience difficulties financing mental health care or cannot utilize services due to time constraints. We are excited that this research will permit our team to create an online food allergy-related psychological support program that is accessible and applicable to many families around the world.”

Read the full study here.

In the News: Battling fentanyl addiction in pediatrics

August 16, 2024

“Intervening quite early in a developmentally proper manner within the pediatric health system can go a long way.”

In a recent video with CNN, Sivabalaji Kaliamurthy, M.D., director of our Addictions Program, and one of his patients struggling with a severe addiction to fentanyl, talk about this deadly opioid that has become a leading cause of overdose among young people in the U.S. Dr. Kaliamurthy talks about the critical shortage of addiction programs specifically designed for teens and sheds light on our program at Children’s National Hospital. The program is one of the only ones in the country working to address this urgent need with specialized support tailored to younger patients grappling with substance use disorders. Watch the video on CNN.

Bullying, Impact on Health, and Beyond book cover

The impact of bullying in children’s health

July 17, 2024

In “Bullying, Impact on Health, and Beyond,” Dr. Srabstein highlights bullying as a form of victimization, while advancing the notion of a spectrum of maltreatment.

In a review of at least 2,000 published studies on bullying and other forms of victimization, Jorge Srabstein, M.D., psychiatrist at Children’s National Hospital and author, raises awareness of diverse health risks linked with bullying, a complex psychosocial stressor that can affect individuals throughout their lives, transcending social, cultural and geographical boundaries. In “Bullying, Impact on Health, and Beyond,” Dr. Srabstein highlights bullying as a form of victimization, while advancing the notion of a spectrum of maltreatment. This book was published by Oxford University Press on May 17, 2024.

What is it

Through its 20 chapters, this text presents documented academic evidence about the current understanding of bullying and related forms of victimization. It explores their global prevalence, associations with health risks including morbidity, psychosocial challenges, and mortality, as well as clinical strategies for prevention, detection, intervention and treatment.

Why it matters

Additionally, this book underscores the concept and importance of poly-victimization and revictimization. It examines the prevalence of bullying and various forms of maltreatment across multiple settings including schools, homes, neighborhoods, workplaces, cyberspace, sports, dating relationships, tertiary education, military training and incidents of witnessing others being victimized.

The author’s decades of clinical and advocacy efforts to prevent, detect and treat the deleterious effects of bullying and other forms of victimization are reflected through all chapters with recommendations for future research, clinical and public policy strategies to target this problem.

You can order a copy here.

Pandemic stress in pregnant mothers may affect anxiety regions of babies’ brains

June 20, 2024

The research from Children’s National Hospital provides mounting evidence that children of the pandemic, even those far too young to understand it, need ongoing assessments of developmental or mental health support later in life.

A critical part of the brain linked to risks for anxiety later in life – the left amygdala – was significantly smaller by volume in babies of mothers who reported stress during the COVID-19 pandemic, according to a new manuscript published in JAMA Network Open.

The right hippocampus, which governs spatial, visual and verbal memories, and the white matter were also reduced in children whose mothers reported stress.

The research from Children’s National Hospital provides mounting evidence that children of the pandemic, even those far too young to understand it, need ongoing assessments of developmental or mental health support later in life.

“Looking ahead, we want to use this information – and studies with similar findings – to empower pregnant mothers to request support to mitigate their stress, especially in the event of another global health crisis,” said Nickie Andescavage, M.D., a neonatologist and principal investigator at the Center for Prenatal, Neonatal & Maternal Health Research. “We also want to make sure babies born during COVID-19 get the services that they need in life if they develop anxiety or other mental health disorders.”

The fine print

Researchers at the center used magnetic resonance imaging (MRI) to compare the brains of 103 babies born between 2014 and 2019 prior to the pandemic to 59 born between 2020 and 2022. Mothers who had COVID-19 or other complications in their pregnancies were excluded. The babies underwent MRI imaging while in utero and again soon after delivery.

The mothers were evaluated for stress and anxiety, using the Spielberger State-Train Anxiety Inventory and other evidence-based scoring measures. Pre-pandemic, 21% of mothers reported elevated symptoms of anxiety; in the pandemic cohort, that number jumped to nearly 62%.

Their babies’ brains were also changed, as regions widely understood to control emotion and anxiety displayed smaller volumes on MRI imaging. Given the global impact of the pandemic and universal reports of mental distress worldwide, the potential impact of these findings may impact an entire generation of children born during the pandemic. The team is just beginning to unravel the medical significance.

What’s next

Catherine Limperopoulos, Ph.D., director of the Center for Prenatal, Neonatal & Maternal Health Research, said understanding the impact of stress is vital in supporting the healthy development of young children. Current studies are underway at her center to tease apart the role of stress in prenatal development and examine its long-term impact on development, including cognition, behavior and mental health.

“We all know that being pregnant can be quite stressful, and there are certain times of collective stress that can provide us windows to understand how the body and mind manage it,” Dr. Limperopoulos said. “At our center, we care deeply about the health of mothers and babies, and our researchers plan to continue investigating the role of stress in development to continue building data to show that mental health must be a greater priority.”

This study – “Prenatal maternal psychological distress during the COVID-19 pandemic and newborn brain development” – was supported by the National Institutes of Health, the Intellectual and Developmental Disabilities Research Center, and the A. James & Alice B. Clark Foundation. You can read the full study in JAMA Network Open.