My program of research focuses on the scientific understanding of the origins of, and treatment and assessment for, schizophrenia-spectrum (“spectrum”) disorders in children and young adults. I define my work into three overlapping themes including, 1) “premorbid” spectrum research, 2) “prodromal” research, and 3) clinical services research for young people with spectrum disorders.

Premorbid spectrum research:

My primary line of research examines the etiology of schizophrenia-spectrum disorders through a neurodevelopmental model of psychopathology.  The neurodevelopmental theory suggests that schizophrenia is a mental illness with biological origins that can in part be traced back to the prenatal period.  My research has helped develop this theory, empirically documenting signs and predictors of spectrum disorders in children at genetic risk for schizophrenia who eventually go on to develop these disorders in adulthood.  The majority of this research has focused on neurological dysfunction evident in childhood prior to symptom onset. My research has uncovered links between abnormalities evident in childhood such as neuromotor dysfunction, minor physical abnormalities, left-side preference, and ocular alignment deficits, and the future development of schizophrenia-spectrum disorders.  I have obtained an NIMH R03 to continue pursuit of these endeavors. I have also documented social predictors of spectrum disorders such as perspective taking and social interaction deficits among youth who eventually develop spectrum disorders.  Uncovering factors developing prenatally and early in life that correlate with psychopathology in adulthood not only demonstrates that the roots of schizophrenia-spectrum disorders are established before birth, but can also provide insight into timing and early causes.  From a clinical-research perspective, this work increases the ability to identify children at risk for developing severe psychopathology and may provide opportunities and leads for intervention prior to disorder onset.

Prodromal Research

Complementing my research on “premorbid” signs of psychosis is the understanding and predicting of the “prodrome” (sometimes referred to as the “clinical-at-risk state”).  The prodrome is the time just preceding psychotic symptom onset and is associated with attenuated spectrum symptoms.  My current pursuits in this area include, 1) development and testing of a measure of spectrum traits among children and adolescents, 2) testing the hypothesis that signs of neurological disruption previously documented in schizophrenia are similarly evident in the prodrome, 3) assessing the psychometric properties of measures designed to detect the prodrome, and 4) uncovering how community providers conceptualize and treat individuals in the prodrome.  Most recently, we have initiated a collaboration with the Hawaii Child and Adolescent Mental Health Division of the Department of Health (DOH) to offer wide-reaching screening for youth transitioning from adolescence to young adulthood. This project holds the promise of providing a wealth of scientific knowledge about the clinical at-risk stage of schizophrenia, while simultaneously addressing a system need that will improve the lives of those who participate.

Clinical Services Research

My third and related line of research investigates (and in some cases addresses) the specific needs of youth with spectrum disorders, as well as their families.  This work stems from an extension of the vulnerability-stress model as well as literature on expressed emotion, both suggesting that individuals prone to or with schizophrenia will respond positively to the reduction of stress and the acquisition of improved coping skills.  To establish the justification for this type of research, I have documented that youth in Hawaii with spectrum disorders have more mental health care needs and require more costly services than all other youth registered for public mental health services.  I have subsequently procured over $900,000 in funding from the DOH in Hawaii over the past five years to support the assessment and treatment of youth with spectrum disorders.  This work not only helps the individuals with whom we work, but also provides valuable research opportunities contributing to the understanding and treatment of this type of psychopathology. For instance, several graduate students and I published a manuscript detailing the success of a treatment protocol for a specific phobia in a youth with schizophrenia using a single-subject design. In collaboration with the state public mental health system, we have also recently documented usual care practices of community practitioners working with youth with spectrum disorders. Understanding that children and adolescents function in a system that extends beyond the individual level, we have a line of research investigating the experiences of caregivers of youth with these disorders. We have begun a systematic analysis of the challenges, burdens, and worries of caregivers of youth with spectrum disorders.  Related, we recently ran a pilot study testing the effects of our multi-family group for families of youth with spectrum disorders. Although I have only been in Maryland for a short time, this line of research is still a central focus for me and my team.  We are actively meeting and collaborating with a variety of people to continue and grow our clinical services research.