Many of the youths who come to live at Boys Town are taking a cabinet full of prescription drugs.
For ADHD. Depression. Anxiety. Bipolar disorder and more. Sometimes all at once.
» More than 500,000 children in the United States are taking antipsychotic drugs, according to a 2009 report from the U.S. Food and Drug Administration.
» Children in the welfare system are much more likely to get psychiatric drugs.
The rate of prescription antipsychotic drug use among children in the general population in the United States is about 7 percent; for children on Medicaid, about 11 percent; and for children in the foster care system, as high as 20 percent in some states.
» Medications safe for use in adults have had unanticipated side effects in children. Stimulants, for instance, can affect growth. Some antipsychotics can cause extreme weight gain (up to 40 pounds) and diabetes in children.
» The brain continues to develop through adolescence, but few studies have been done to assess the impact of psychiatric drugs on a developing brain.
» Some children are over-prescribed, taking several drugs at a time, and some who should get drugs aren’t getting them.
Sources: Boys Town; Dr. Christopher Bellonci, associate professor in the Tufts University School of Medicine;
Reuters Health; the New York
Taking part in studies
If your child may be a good fit for the Boys Town brain research, contact the Center for Neurobehavioral Research at 402-498-1220.
The studies will include both healthy children and those with mental health problems.
Subjects will be compensated for their time and inconvenience.
The drugs, of course, are necessary in many cases.
The amount, the variety and the frequency may not be, say Boys Town doctors and youth care workers.
The question of whether psychiatric drugs are overused in troubled kids has been debated for years. That's one reason Boys Town has embarked on biological brain research it says is the first of its kind.
Using high-powered MRI technology, among other tools, doctors at the Boys Town National Research Hospital will examine the brains of children to study how well those drugs work and whether they may have unforeseen consequences. Some drugs, for instance, cause weight gain and diabetes in young patients.
The research also is aimed at determining whether alternatives such as behavioral and environmental treatments are as effective as drugs — or more so in some instances.
Ultimately, Boys Town officials hope to develop new ways to treat childhood mental disorders.
“As you work with really difficult kids, you realize that what you're doing doesn't work for everyone,” said the Rev. Steven Boes, Boys Town executive director. “That haunts you. This is designed to answer that.”
A recent study led by a Columbia University professor indicates that anti-psychotic drugs are prescribed to youths during nearly one in three visits to psychiatrists in the United States.
“There are some real issues around appropriate use,” said Dr. Christopher Bellonci, an associate professor of psychiatry at the Tufts University Medical School in Boston and a national expert on childhood mental health disorders.
He said it's especially a concern when medications are prescribed in lieu of therapy.
That gets to the point of what Boys Town hopes to accomplish, officials said.
“We want to understand what is appropriate use of medications,” said John Arch, executive vice president of health care and director of the Boys Town National Research Hospital.
Boys Town leaders say the research is a natural step for them. The research hospital long has studied childhood hearing problems. Branching out to brain research will allow Boys Town to help children at every level of care, from training parents to working with seriously traumatized youths at its residential treatment centers.
Boys Town also plans to share the research and the new treatments it may spawn far beyond Omaha.
The studies are taking place at the new Center for Neurobehavioral Research in the Boys Town National Research Hospital West, adjacent to its campus near 132nd and Pacific Streets. Researchers already have begun one study, another will begin soon and two more are awaiting approval from a national panel of researchers and ethicists.
Youths who participate will be volunteers from Boys Town and the wider community. A couple of hundred — healthy children and those with mental disorders — will participate in the four current studies.
Right now, researchers are using a standard clinical MRI. But the studies will become easier when a new fMRI — with functional magnetic resonance imaging — is in place next spring.
That new fMRI is central to the project because it has more power and better resolution than the existing machine, said Dr. Kayla Pope, a psychiatrist and the director of the center.
Much of the research will involve looking at the brain before and after a child engages in an activity or while a child is taking psychiatric drugs and after he or she has been taken off some or all of the drugs.
Researchers will look at the brains of children as they complete a computer activity designed to detect differences in brain activity in patients with anxiety, depression or other mental health problems. Pope said the scans will show changes in the amount of blood and oxygen that flow to a particular area of the brain, reflecting an increase or decrease of activity in that area.
The study will require subjects to react to different images while in the MRI — such as photographs or shapes that flash quickly on a computer screen they see through goggles.
The center also will examine the effectiveness of alternative treatments for mental disorders.
One such evaluation will involve a computer game designed to treat adolescent depression. Clinicians and researchers in New Zealand developed the game, called SPARX.
It looks like a commercial video game, with dark screens, comic-bookish players and a fantasy feel. It has seven levels that last a half-hour each, taking players on a journey to seven provinces and requiring them to complete quests that will restore the world's balance. Along the way, they have to defeat Gnats (Gloomy Negative Automatic Thoughts.) The challenges teach skills — conflict resolution, how to think positive thoughts — that might help someone who is depressed or anxious.
Players keep a journal so they can later refer to those skills.
Center researchers will ask youths diagnosed with depression to play the game to see if it normalizes their brain function. Subjects will get brain scans before and after they play.
For the most part, kids give the game high marks.
“One of the biggest criticisms is that there weren't enough explosions and it didn't go fast enough,” said Patrick Tyler, a Boys Town research clinician. “Beyond that, they loved it.”
If the evaluation of SPARX is successful, they'll use that model to develop games to treat PTSD and other disorders.
Another study planned for the coming year will test children in the MRI before and after they exercise. Boys Town teachers and others long have known that exercise calms troubled kids and eases behavior problems.
“But we don't know why,” Pope said. “We know something's happening. We want to demonstrate that activity changes something in the brain.”
The new center will collaborate with researchers from across the country. Currently, it is working with the National Institute of Mental Health, the University of Auckland in New Zealand and the University of Nebraska Medical Center.
The second phase of a capital campaign that built the new Residential Treatment Center West will begin shortly to raise money for the MRI project, along with other needs. Arch said about $3 million is needed. Part of that will go toward the initial studies.
Studies occurring now are in the pilot stages with a small number of subjects, Pope said.
The full-blown research will begin when the new MRI is in place. That's when Boys Town will begin to seek grants for the studies from the National Institute for Mental Health and other sources, Pope said.
Few studies have been done using an fMRI to biologically evaluate the impact of behavioral interventions on the brain, Pope said. The research is groundbreaking because the MRI can demonstrate that the brain is actually changing in response to an activity, providing evidence that a treatment works.
Bellonci, the Tufts professor, said research has been done on what a bipolar brain looks like, but not what it looks like after medication or behavioral therapy. He said the Boys Town work would be “almost like the next-generation study.”
He sees great potential in the research.
“We don't have good science to show what these medications are doing to the developing brain, and we're using a huge amount of this medication,” he said. “We see the potential of these medications but we may not see the unintended consequences down the line. This research could benefit the whole nation, if not the world.”
That point is not lost on Boes. Boys Town researchers will share their findings with other medical personnel and parents on the Internet.
That's consistent with the home's 96-year tradition.
Boys Town's founder, Father Edward Flanagan, did whatever it took to help children, Boes said.
“This research goes directly to the heart of the Boys Town mission,” added Arch. “We want to change the way America treats kids.”