Yale Bulletin and Calendar

April 4, 2008|Volume 36, Number 24















Ami Klin, shown here enjoying a playful moment with a young visitor to the Yale Child Study Center, is a world-renowned expert on developmental disorders and head of the Autism Program.

In Focus: Yale Child Study Center

Cutting-edge research is fueling new treatments
for children at this ‘one-of-a-kind place’

The waiting area is filled with brightly colored toys that attract the attention of the three boys darting around the room. The parents leaf through magazines and chat quietly with one another while keeping an eye on their children.

At first glance, this seems like a typical scene in a pediatrician’s office, but behind the waiting room doors, researchers and clinicians are utilizing state-of-the-art equipment and collaborating with scientists in vastly different fields, like computer science, to advance treatment on autism, a social disorder affecting one in 150 children.

Some of the parents in the waiting room regularly travel from as far away as China to have their children treated at the Yale Developmental Disabilities Clinic — just one of many programs of the Yale Child Study Center at the School of Medicine.

From autism to pervasive developmental disorders, Tourette syndrome and anxiety disorders, major advances have emerged at the center, which is directed by Dr. Fred R. Volkmar.

Started in 1911 by child development pioneer Dr. Arnold Gessell, the Yale Child Study Center is one of the world’s leading centers for child psychiatry and is internationally recognized for its multidisciplinary programs of clinical and basic research, professional education, clinical services and advocacy for children and families.

The center’s researchers and clinicians study child development; social, behavioral and emotional adjustment; and psychiatric disorders. Solving the problems unique to children and families requires a mix of research in diverse areas such as child psychology, psychiatry, genetics, endocrinology, pediatrics, neurobiology, epidemiology, nursing, education, social work, social policy and a host of other disciplines. The clinical faculty includes child and adolescent psychiatrists, psychologists, social workers, nurses, child therapists and other affiliated mental health professionals.

Volkmar, the center’s sixth director, has been charged with leading its commitment to being on the cutting edge of research and clinical care in all areas of child and family development and mental health. The center’s challenges are to continue excellence in clinical services, science and training, and to enhance child mental health worldwide, he says.

To help meet this challenge, in January 2008, the Child Study Center opened its satellite clinic, the Yale Academic Skills Clinic in Greenwich, Connecticut, to serve children and youth with learning differences in southwestern Connecticut and eastern New York. The clinic provides assistance to children and youth with diverse academic needs.

“The Yale Child Study Center is a one-of-a-kind place,” asserts Volkmar. “We have a large international network. We collaborate with more than 30 countries to engage in clinical services. People come here to be trained and we go to other countries to train. Our commitment to excellence in research and clinical care has no disciplinary or geographical boundaries. We are interested in impacting the world and that requires us to go to many other countries to train people and set up clinics.”

The following is a look at some of the center’s most renowned programs.

Autism research and treatment

The Yale Child Study Center is a world-renowned leader in the study and treatment of autism.

Led by Ami Klin, the center’s Autism Program is composed of an interdisciplinary group of clinicians and scholars dedicated to providing comprehensive clinical services to children with autism spectrum disorders and their families. The 50-year-old program — designated a National Institutes of Health Autism Center of Excellence — includes some of the pioneers in the field and is one of the leading autism programs in the world. In fact, Klin and Volkmar are two of the most internationally renowned experts in the field of autism; Asperger’s Syndrome, a form of higher-functioning autism; and other pervasive developmental disorders.

The Autism Program encompasses research, training, clinical and advocacy programs. Scientists there are studying everything from the definition and classification of autism, to neuropsychology, social cognition, early development, speech-language and communication, family and molecular genetics, parent-training and behavioral treatments. These researchers are collaborating with a number of scientific labs, and have joint programs with other departments at Yale School of Medicine and the Central Campus. Autism researchers also collaborate with major national research networks and scientific initiatives.

Recently a team led by Dr. Matthew State, the Cohen Associate Professor at the Yale Child Study Center and the Department of Genetics, has identified several autism-linked rare variants of the gene Contactin Associated Protein 2.

The research conducted through the Autism Program is translated into clinical practice at the Yale Developmental Disabilities Clinic, which provides a variety of ­diagnostic and intervention services for hundreds of children from around the world with autism and other developmental disorders.

The Autism Program also provides specialty clinical training to residents in psychiatry and pediatrics, as well as to pre- and postdoctoral fellows in clinical psychology, speech-language pathology and social work. Graduates of the program go on to lead clinical and research teams around the country and the world.

Autism Program faculty members have also published widely on the topic. “The Handbook of Autism and PDDs,” is the leading textbook in the field, and “Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment and Treatment,” edited by Katarzyna Chawarska, Klin and Volkmar, was recently released.

Dr. Fred Volkmar (left), who directs the Child Study Center, and Ami Klin, who leads the center's Autism Program, are among the Yale clinicians treating children from around the world.

Children and violence

Another innovative Child Study Center program that has garnered national and international acclaim is the Yale-New Haven Child Development Community Policing Program (CDCP), which trains police officers and the center’s clinicians to respond to children and families who have witnessed violence and other catastrophic, traumatic events.

Through the CDCP, police and clinicians learn about each other’s work in order to serve traumatized children more effectively. A 24-hour consultation service staffed by a team of mental health clinicians working with police officer colleagues respond immediately to the needs of traumatized children and families who have requested assistance from the scene of violent and other emergency events. Other intervention strategies and initiatives have been developed that are specifically designed to assist women, children and families caught up in the terror of domestic violence; those dealing with the aftermath of sudden death; and young people involved in perpetrating violent crime.

The Child Study Center team has developed both short- and long-term approaches to clinical care. Children and families referred from the on-call service, domestic violence initiative, and from Yale-New Haven Hospital’s children emergency department and sexual abuse clinic are seen in the Child Study Center Trauma Clinic.

As a result of CDCP’s success in working with children exposed to violence, the U.S. Department of Justice and the White House established the National Center for Children Exposed to Violence (NCCEV) at the Child Study Center in 1999. The NCCEV provides training and assistance to communities around the country that are seeking to address the problems of children and families exposed to violence and other catastrophic events. Steven Marans, the Harris Professor of Child Psychiatry, leads the CDCP, NCCEV and trauma programs at the Child Study Center.

Success in school

Renowned educator Dr. James P. Comer, the Maurice Falk Professor of Child Psychiatry at the Yale Child Study Center and associate dean at Yale School of Medicine, pioneered another of the center’s initiatives, the School Development Program (SDP), which is nearing 40 years of success.

Comer maintains that an education without a focus on test scores that promotes development of the whole child — psychologically, socially and environmentally — will prepare children for successful adult lives. In his book “Leave No Child Behind: Preparing Today’s Youth for Tomorrow’s World,” Comer writes: “A focus on higher test scores alone cannot produce the outcomes we want and need for our children or our nation. But good child and youth rearing and development can do so, and can simultaneously produce good test scores.”

Founded in 1968 in two underachieving New Haven public schools, the SDP has evolved into what many call the “godfather” of school reform. SDP is based on the premise that all youngsters — regardless of race, geography or cultural and economic background — can learn at high levels. The programs and services that fall under the SDP umbrella help schools ensure that students achieve their highest academic potential. The SDP model has been used in at least 1,000 schools.

Comer cites research showing that support for good development can prevent the high social, emotional and financial costs of problem behaviors, even among students from very difficult circumstances.

“We must do a better job of rearing all our children well in our formative institutions, in preparing them to meet adult responsibilities in this complex age,” Comer says. “Neither the farm nor the factory is available to save them as in past eras. Down the road we will pay the ultimate price — loss of our open and democratic society — unless we pay now to better prepare families, schools and other resources.

“We worry about the behavior of young people. They don’t participate in the political system and don’t live up to their potential,” says Comer. “We don’t give them an education that encourages them or prepares them to handle their adult tasks. When you create an environment that’s inviting and supportive of parents and where they will have a useful role, they will come and participate in their children’s education.”

Comer’s passion for creating an educational model that benefits all children stemmed from his own background. His family consisted of nine brothers and sisters who, despite low income, all went on to educational and professional success. Comer was planning to become a general practitioner of medicine when he went back to his hometown as an intern. Three of his best friends were going on a downhill course.

“One eventually died of alcoholism, one spent a good part of his life in jail, the other was in and out of mental institutions, yet they were as bright as anybody in my family and the predominantly white, middle upper-income school that we attended,” says Comer. “So the question for me was: What happened to them? And that led me away from that plan into public health, child psychiatry and eventually working in schools to prevent the kinds of outcomes that those young people had and to give them the same chance that I had.”

Comer says preparing teachers, administrators and parents in the skills that create a culture at home and at school that helps children grow in social, psycho-emotional, ethical, linguistic, intellectual and cognitive areas, will help solve some of the problems facing school systems. “If all of those adults could do that, we could turn it around and many of the social problems that we have today, the achievement gap that exists, we could be eliminated,” says Comer, who was awarded the 2007 Grawemeyer Award in Education.

Comer’s efforts, combined with those of the hundreds of other educators, researchers, clinicians, nurses and staff, has kept the needs of children and families at the forefront of the Child Study Center’s mission.

For further information about the Yale Child Study Center, visit its website at http://info.med.yale.edu/chldstdy.

— By Karen N. Peart


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