John Lavigne, PhD, Chief Psychologist at Children’s Memorial Hospital and Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine, is keenly aware of the psychological problems that young children may face, and the challenges that pediatricians can encounter in treating them. “The clinical work gives one a real sense of what needs to be done, and the gaps between the research literature and what practitioners can even do…Little by little, that’s become known as the process of translating research into practice.” Lavigne’s translation has involved using what he observes in his research to identify problems in his patients, develop better therapies and help practices improve their services. Conversely, his awareness of the types of problems that children present with leads to more questions to be addressed in the research setting.

 

An ongoing area of research is a condition known as Oppositional Defiant Disorder, or ODD. This term is used to describe children who are very difficult to manage, have severe temper tantrums, or won’t do what adults tell them to do. Almost all young children display some ODD-like behaviors, but some preschoolers take it to an extreme, either in terms of intensity or frequency. Lavigne and his co-investigators were able to show how common the problem is. They also discovered that young children with ODD don’t necessarily “grow out” of it, and that these children often develop other problems later, such as depression or anxiety.

 

But this raised more questions: Were depression and anxiety already there but masked by the ODD? Or did they result from conflicts these children had with their families or at school? Lavigne’s current ODD study attempts to delineate these pathways. In a sample of 797 children that is similar demographically to that of Cook County, his group began tracking study participants at age 4 to determine how stable the problems were and what psychosocial factors might contribute to secondary problems. Family conflict, maternal depression, interactional factors such as quality of support the mother provides during play activities, maternal warmth vs. hostility, the child’s attachment to the mother, and his temperament are all evaluated for their potential roles.

 

Since the 1980s, Lavigne has been collaborating with the Pediatric Practice Research Group (PPRG), a practice-based research network that is part of the Mary Ann & J. Milburn Smith Child Health Research Program at Children’s Memorial Research Center. The PPRG was founded by Drs. Katherine Kaufer Christoffel and Helen Binns (the current director), who were interested in doing research in the clinical setting. Not long after this, they and Lavigne began looking at ways to improve the psychological care that children receive in primary care. Since pediatricians see preschool children at a much higher rate than other age groups, they focused on this range. Out of this study came the careful evaluation and follow-up of 500 children, which allowed them to determine how stable psychiatric diagnoses are when made in young children. Eventually the group shifted its focus to developing effective interventions that could be easily applied in primary care. Dr. Lavigne thinks this type of research is possible only with the kind of infrastructure the PPRG has established.

 

Currently, Lavigne is investigating ways to help doctors improve their use of stimulant medications for children with Attention Deficit Disorder with Hyperactivity (ADHD). These medications are generally effective but are not being used in the optimal way in regular practice. He seeks to train pediatricians, using guidelines and best techniques, to optimize effectiveness. This type of research has an immediate impact on the way people practice medicine and is beneficial to the patient.