Tools

Center for Children with Special Needs

Research + Clinical Trials

On the leading edge

One of the reasons the CCSN has earned national recognition for its work is its robust research program that seeks to advance the prevention, identification, diagnosis and treatment of developmental-behavioral conditions in children.  Research projects include those addressing autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), child abuse and numerous other areas related to the well-being of children and families.

Current research includes:

  • Early intervention for children at risk for developing ADD/ODD (parent training groups located in pediatric practices).
  • Early identification of children with autistic spectrum disorder
  • Children’s understanding and response to stigma.
  • Effect of a neurofeedback program on children’s ability to maintain focus on tasks

Faculty of the Division of Developmental-Behavioral Pediatrics pursue teaching and research pursuits are directed at promoting understanding among parents, professionals and the community of the variations, problems and disorders in children’s development. The Division also works to promote optimal development and successful adaptation among children with disabilities and their families.


Attention Deficit Hyperactivity Disorder

Neurofeedback Attention Training and Cognitive Attention Training (Brain Gym) in Schools

In this project we worked with students at school using neurofeedback attention training and computer-based cognitive attention training (brain gym).   Students were randomly selected to receive either of the systems or to be placed on a waiting list.   Preliminary results suggest that neurofeedback is beneficial in helping children focus their attention. Grants have been submitted to the USDOE.  Poster and platform presentations have been given at multiple national level conferences.

PI:   Naomi Steiner MD.   Other investigators:   Ellen Perrin, MD.   Funding from USDOE.

  • Steiner, NJ, Sidhu, T, Rene, K, Tomasetti, K, Frenette, E, Brennan, RT. Development and testing of a direct observation code training protocol for elementary aged students with attention/deficit hyperactivity disorder. Educational Assessment, Evaluation and Accountability.2013; DOI 10.1007/s11092-013-9166-x
  • Steiner, NJ, Frenette EC, Hynes, C, Pisarik, E, Tomasetti, K, Perrin, EC. Feasibility of a neurofeedback intervention for children with an autism spectrum disorder and attention difficulties. (Submitted).
  • Steiner, NJ, Sidhu, TK, Pop, PG, Frenette , EC, Perrin, EC. Yoga in an urban school for children with emotional behavioral disorders: A feasibility study. Journal of Child and Family Studies. 2012; DOI 10.1007/s10826-012-9636-7
  • Noggle, JJ, Steiner, NJ, Minami T, Khalsa SS. Preliminary psychological benefits of yoga during physical education in a rural US high school: A group randomized, controlled trial. Journal of Developmental & Behavioral Pediatrics. April 2012.
  • Khalsa, SS, Schultz, LH, Cohen, D, Steiner, NJ, Cope, S. Evaluation of the mental health benefits of yoga in a secondary school: A preliminary randomized controlled trial. J Behav Health Serv Res. June 2011.
  • Steiner NJ, Sheldrick RC, Gotthelf D, Perrin EC. Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: A preliminary trial. Clinical Pediatrics, 2011; 50(7), 615-622.
  • Steiner, NJ, Pop P, Sidhu T, Perrin EC. School Yoga Instruction, APA Focus (Vol 47, 6, 2010).
  • Steiner, NJ, Frenette, EC, Rene, KM, Brennan, RT, & Perrin, EC. Randomized control trial of neurofeedback and cognitive attention training for attention deficit/hyperactivity disorder. Journal of Developmental and Behavioral Pediatrics. (Accepted for publication August 2013).
  • Steiner, NJ, Sheldrick, RC, Frenette, EC, Rene, KM, & Perrin, EC. Classroom behavior of participants with ADHD compared to peers: Influence of teaching format, grade level and treatment status. Journal of Applied School Psychology. (Submitted).
  • Steiner, NJ, Frenette, EC, Rene, KM, Brennan, RT, & Perrin, EC. RCT in schools shows maintained improvements in ADHD symptoms after neurofeedback training. (Submitted).

Improving Care for ADHD in Primary Care Practices

The developmental research plan in this application proposes to pilot test models to improve the identification and treatment of ADHD in 10 primary care clinics affiliated with 4 networks in San Diego County.

PI:   Laurel Leslie MD.   Funding though a K08award.

  • Leslie, L.K., Weckerly, J., Landsverk, J., Hough, R.L., Hurlburt, M.S., Wood, P.A,. Racial ethnic differences in use of psychotropic medication in high-risk children and adolescents. J Amer Acad Child Adol Psychiatry. 2003. 42: 1433-1442.
  • Leslie, L.K., Weckerly, J., Plemmons, D. , Landsverk, J., Eastman, S. Implementing the AAP ADHD diagnostic guidelines in primary care settings. Pediatrics . 2004, 114:129-140.
  • Leslie LK , Stallone KA, Weckerly J, McDaniel AL, Monn A. Implementing ADHD guidelines in primary care: Does one size fit all? Journal of Healthcare for the Poor and Underserved . 2006;17:302-327.
  • Leslie LK, Canino G, Landsverk J, Wood PA, Chavez L, Hough RL, Bauermeister JJ, Ramirez R. ADHD treatment patterns of youth served in public sectors in San Diego and Puerto Rico. Journal of Emotional and Behavioral Disorders. 2005;13: 224-236. 
  • Leslie LK, Aarons G, Haine R, Hough RA. Caregiver depression and medication use by youth with ADHD who receive services in the public sector. Psychiatric Services. 2007;58:131-134.
  • Leslie LK , Wolraich ML. ADHD service use patterns in youth. Ambulatory Pediatrics. 2007;7:107-120.

Parents’ Beliefs and Preferences Regarding Treatment of ADHD

We are coding interview transcripts to ascertain parents’ explanatory models and preferences about treating Attention Deficit Hyperactivity Disorder. Their explanatory models will help to explain their choices and adherence to medication regimens.

PI:  Laurel Leslie, MD.  Other investigators:  Catherine Davis, MD.   Funding through a K08 award to Laurel Leslie.

  • Leslie LK , Plemmons D, Monn AR, Palinkas LA. Investigating ADHD treatment trajectories: listening to families’ stories about medication use. Journal of Developmental & Behavioral Pediatrics . 2007;28:179-188.

Autism

Quality of Life among teenagers with autism spectrum disorders

Teenagers with autism or Asperger disorder respond to a series of questionnaires that assess their self-reported quality of life. Parents also rate their teen’s QoL. Primary analyses will assess retest reliability, concurrent and construct validity, and correlations between teens’ and parents’ responses in order to demonstrate whether teenagers with autism can provide reliable and valid reports of their own quality of life.   Funding is being sought. No publications yet.

PI:  Deborah Shipman, MD.  Other investigators:  Chris Sheldrick, PhD; Ellen Perrin, MD.


Autism Consortium

In collaboration with many institutions in the Boston area, we are studying various aspects of autism in children. The genetic basis for the condition is the first priority, with a second phase to understand the phenotypic variation among children with this spectrum of disorders to follow.  An article will be published in the New England Journal of Medicine shortly.

PI (at Floating Hospital): Karen J. Miller, MD and Laurie Demmer, MD. Other investigators : Ellen Perrin MD. Funding through the Autism Consortium

Genotyping and Phenotyping of Children with Autism

Project Goals:  To research the etiological factors in Autism

Investigators:  Karen J. Miller, MD

The Autism Consortium and Autism Genetic Resource Exchange:

  • Beth Israel Deaconess Medical Center
  • Boston Medical Center
  • Boston University
  • Boston University School of Medicine
  • Broad Institute
  • Children’s Hospital Boston
  • Harvard Medical School
  • Harvard University
  • Massachusetts Institute of Technology
  • Massachusetts General Hospital
  • Lurie Family Autism Center/LADDERS
  • McLean Hospital
  • Floating Hospital for Children at Tufts Medical Center
  • UMASS Medical School, Worcester
  • UMASS Memorial Health Care

Funding Sources:  Philanthropic support, 2008-2011


Additional Autism Projects

Ellen C. Perrin, MD

  • Evaluation of a Mentoring Program for Teenagers with Autism
    • Effects on self-reported quality of life, anxiety, and self-esteem following 6 months of mentoring by college student volunteers
    • Subcontract, Noonan Fund, 2011

Deborah Shipman, MD 

  • Quality of Life of Adolescents with Autism Spectrum Disorders (fellowship project)

 

Nicola Smith, MD 

  • Validation of an Abbreviated Screening Test for Autism in Primary Care (fellowship project)

Interventions Based in Primary Care Settings

Advanced Parenting Education in Pediatrics.

Parenting education provided in pediatric offices provides a mechanism for pediatricians to deliver a preventive intervention for children at risk for developing attention deficit disorder or oppositional defiant disorder.   We identify through systematic screening in pediatricians’ offices children who are at high risk of developing ADD or ODD, and invite them to join a 10 week parenting program. Parent and child outcomes are compared with a waitlist control condition. Funded by NIMH (5 years).   No publications yet.

PI:  Ellen C. Perrin, MD.  Other investigators: Chris Sheldrick, PhD.


Development of a Screening/Surveillance Instrument.

In this project we intend to develop an instrument that can be used by pediatricians to fulfill the mandated screening requirement introduced by MA Medicaid this winter. Parents of children between birth and 5 years old will complete this screening instrument prior to their child’s well child visit with their pediatrician, which is expected to identify a range of developmental and behavioral concerns. Funding from the Commonwealth Fund.  No publications yet.

PI: Ellen C. Perrin, MD.  Other investigators: Laurel Leslie, MD, Alice Carter, PhD, Chris Sheldrick PhD, Brandi Henson, PsyD.


Advanced Parenting Education in Pediatrics (APEP)

Project Goals:  To test the effectiveness of a model of behavioral screening and group parent training protocol in several pediatric practices in Eastern MA

Tufts Investigators:  Ellen C. Perrin, MD, R. Christopher Sheldrick, PhD, Brandi Henson, PsyD, Steven Cohen, Dr.P.H., Public Health

Community Partners:  Jannette McMenamy, PhD, Fitchburg State College, Alice Carter, PhD, UMass Boston, Pediatric practices in eastern MA, Federally-qualified health centers, Boston

Funding Sources:  NIMH Grant 2006-2011

Related Project:  Resiliency Training for Teen Parents: Evaluation of a School Based Program


Mental Health Care in Pediatric Practices

Project Goals:   To investigate mental health care attitudes and practices among primary care pediatricians

Tufts Investigators:  Ellen C. Perrin, MD, R. Christopher Sheldrick, PhD

Community Partners:  The Massachusetts Chapter of the American Academy of Pediatrics

Funding Sources:  Partial funding by the Massachusetts Chapter of the American Academy of Pediatrics, 2010-2011


Screen Early, Screen Accurately for Child Well-being (SESAW)

Project Goals:   A large, head-to-head comparative effectiveness trial of three sets of developmental-behavioral screening instruments for use in pediatricprimary care

Tufts Investigators:  Ellen C. Perrin, MD, R. Christopher Sheldrick, PhD

Study Staff:  Alice Carter, PhD, UMASS Boston

Funding Sources:  NIH R01 grant, 2013-2018


Developmental Disability Literacy Promotion Guide

Project goals:  To help parents read to children with Autism Spectrum Disorder, ADHD, Cerebral Palsy, hearing loss, intellectual disabilities, speech and language problems, and vision loss

Tufts Investigators:  Monica Ultmann, MD

Community Partners:  Reach out and Read, CVS Caremark’s All Kids Can Program

The guide is being piloted at 57 community hospitals and clinics in Kansas City, Cleveland, and Philadelphia

Funding Sources:  CVS pilot project funding 2011-2012, CVS Caremark grant application pending


Related Projects, Sheryl Levy, MD

 

  • Facilitating Co-located Collaborative Mental Health Care in Pediatrics (fellowship project)
  • Comparative Effectiveness of Developmental-Behavioral Screening Instruments in Pediatrics
    • Application to be resubmitted to NICHD March 2012
    • Comparative Effectiveness of Autism Screening Strategies
      • Application pending at Autism Speaks
      • Substance Abuse Prevention in Primary Care Pediatric Settings
        • Application in preparation for NIDA

Lesbian and Gay Health Issues

The Lives of Gay Fathers and their Children

Gay men who have joint or full custody of one or more children participate in interviews and complete questionnaires describing their decision to become fathers, their experience of fatherhood, the joys and challenges of parenting, the stigma they are their children have encountered, and their children‘s well-being. Funding is being sought. No publications yet.

PI: Ellen Perrin, MD. Other investigators: Chris Sheldrick PhD, Brandi Henson, PsyD, Erin Phelps, EdD, Ellen Pinderhughes PhD.


Development of Children in the Child Welfare System

Medication Use for Behavioral Problems Among Youth in Child Welfare

This two-year grant seeks to develop important preliminary work in preparation for a broader research agenda to improve care for youth in child welfare and child protection services. It uses data from the National Survey of Child and Adolescent Wellbeing (NSCAW), a national dataset on children in the child welfare system. Funding from the Charles Hood Foundation. No publications yet.

PI: Laurel Leslie.


Mind Body Interventions

Efficacy of Computer-based Attention Training in Schools (CATS)

Project Goals:   To test the feasibility and effectiveness of two computer-based treatments for children with ADHD administered in several public schools.

Tufts Investigators: Naomi Steiner, MD

Community Partners:  Boston Public Schools                

Funding Sources:  Noonan Fund grant, 2007, Federal DOE grant, 2009-2013

Related Pilot Projects:  Neurofeedback in children with high functioning Autism, a computer attention training 4 year follow up study


Yoga in Schools

Project Goals:   To evaluate the benefits of yoga training for children with emotional-behavioral disabilities in an urban school 

Tufts Investigators:  Naomi Steiner, MD, R. Christopher Sheldrick, PhD

Community Partners:  Boston Public Schools

Funding Sources:  Noonan Fund. 2008, Dept. of Education, 2009-11

Related Pilot Projects:   Relaxation/calm breathing sessions using biofeedback for children with high anxiety


Mental Health Care for Vulnerable Children and Youth

ADHD Care

Project Goals:   To investigate the identification and treatment of children with Attention Deficit Hyperactivity Disorder in primary care settings, including qualitative investigation examining differences in explanatory models regarding ADHD symptoms for families from diverse racial/ethnic groups and the impact of these models on help-seeking behaviors

Tufts Investigators:  Laurel Leslie, MD, MPH, Catherine C. Davis, MD

Community Partners include:  The American Academy of Pediatrics, The National Heart, Lung, and Blood Institute Working Group, The American Heart Association, Aligning Researchers and Communities for Health, Dept. of Cardiology, Children’s Hospital, Boston, Dept. of Pediatrics, Harvard Medical

Funding Sources:  NHLBI, 2009-2011 (Comparative Effectiveness of ECG Screening Prior to Starting Stimulant Medications), Tufts CTSI, 2011 (Practitioner Preferences and Practices in Prescribing Antipsychotics for ADHD), AHRQ, 2011-15 (Comparative Safety of Atypical Antipsychotics in High-Risk US Children with ADHD)


Mental Health Services for At-Risk Children and Youth

Project Goals:   To examine the impact of guidelines/policy on youth service use and outcomes, collaborative models of care across sectors, and incorporation of the child and family as active agents in care

Investigators:  Laurel Leslie, MD

Community Partners include:  Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, CA,             Child Welfare Mental Health Best Practices Group, The REACH Institute, New York, New York, The Caring for Children in Child Welfare Project, a collaboration between the Child and Adolescent Services Research Group at Children’s Hospital San Diego, the Department of Psychiatry at the University of Pittsburgh, the Columbus Children’s Hospital, the Services Effectiveness Research Program at Duke University, and the Research Triangle Institute (Research Triangle Park, NC).

Funding Sources:  W.T. Grant Foundation, 2010-12


Pyschotropic Medication Use in Children in Foster Care

Project Goals:   To examine state policies and practices in 47 states regarding the use of medication for treating behavioral and mental health problems in foster care children and adolescents ages 2 to 21 years

Tufts Investigators:  Laurel Leslie, MD, MPH, Center on Child and Family Outcomes, Institute for Clinical research and Health Policy Studies, Tufts Medical Center, Tufts CTSI

Community Partners:  US Dept. of Health and Human Services, Administration on Children, Youth, and Families, Institute for Community Health, Cambridge Health  Alliance, Children and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, Boys Town

Funding Sources:  W.T.Grant Foundation, 2011-13 (Fostering Use of Evidence in Child Welfare Policies Regarding Psychotropic Medications), Court Improvement Funds, 2010-2012 (Commonwealth of Massachusetts Working Group on Psychotropic Medication Use in Children in Foster Care), ACF, 2011-12 (Development of a Psychotropic Medication Guide for Adolescents in Foster Care), ACF, 2011-2012 (Consultation with Federal ACF Office on Developing Psychotropic Medication Oversight Systems in States)


Educational Evaluation

Development and Evaluation of Innovative Medical School Clerkship in Child Development

Project Goals:  To develop and asses a child development clerkship through a 6 week seminar series with guided observation and discussion

Investigators:  Karen C. Bresnahan, MD

Funding Sources:  Innovations in Education grant, 2011


Evaluation of Pediatric Training

Project Goals:  A comprehensive reassessment of general pediatric residency education

Investigators:  Laurel Leslie, MD

Community Partners:  University of Colorado, Denver School of Medicine, Department of Pediatrics, University of Vermont College of Medicine, Residency Review and Redesign in Pediatrics Committee

Funding Sources:  American Board of Pediatrics


Pediatric Residence Education and Children with Special Health Care Needs

Project Goals:  To describe what and how pediatric residents in MA are taught about children and youth with special health care needs and the medical home

Investigators:  Roula Choueiri, MD

Community Partners:  UMASS Memorial Children’s Center, UMASS Medical School, Division of General Pediatrics, Children’s Hospital Boston, Fallon Clinic, Worchester, MA, Department of Pediatrics, Baystate Children’s Hospital


Additional Projects

The Lives of Gay Fathers and their Children

Project goals:  To investigate the composition of families that include a gay father, and the fathers’ journeys to becoming dads, support networks, joys and difficulties.

Tufts Investigators:  Ellen C. Perrin, MD, Ellen Pinderhughes, PhD, Eliot-Pearson

Community Partners:  Josh Rosenberger, University of Indiana, Volunteer consultants who are gay fathers

Funding Sources:  Philanthropic support, Arcus Foundation, Gill Foundation


Bilingualism

Project goals:  To assist parents and pediatricians in understanding the way children learn multiple languages

Tufts Investigators:  Naomi Steiner, MD


ADHD and Executive Function Dysfunction Research

Tufts Investigators:  Karen J. Miller, MD


Follow-up of Extremely Low Gestational Age Newborns

Project goals:  Re-assessment of developmental and behavioral status at 10 years of age, conducted in three regional hubs (New England, North Carolina, and Michigan)

Tufts Investigators:  Ellen C. Perrin, MD, Brandi Henson, PsyD

Community Partners:  Children’s Hospital, Bay State Medical Center, Yale, UMass, Boston Medical Center, Networks of medical schools and hospitals in North Carolina and Michigan

Funding Sources:  Subcontract, RO1, 2011-2014