[MUSIC PLAYING] This podcast is brought to you by the Association for Child and Adolescent Mental Health, ACAMH for short. You can find more podcasts and other resources on our website, www.acamh.org, and follow us on social media by searching, ACAMH. Hello. Welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I'm Jo Carlowe, a freelance journalist with a specialism in psychology Today, I'm interviewing Dr. Catharina Hartman, associate professor of psychiatric epidemiology at the Interdisciplinary Center of psychopathology and emotion regulation, the ICPE, at the University Medical Center, Groningen in Netherlands. Catharina's research team aims to advance the understanding of the onset and course of childhood onset psychiatric disorders. Catharina is also deputy editor-in-chief of JCPP Advances, one of the three journals produced by the Association for Child and Adolescent Mental Health. ACAMH also produces JCPP and the CAMH. If you're a fan about In Conversation series, please subscribe on your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Catharina, welcome. Nice to meet you. Can you start by introducing yourself? I'm an associate professor in Groningen, based in at University of Groningen University Medical Center Groningen. My work is obviously on child psychiatry, and what I do is mostly epidemiological work. That is large samples. Hopefully, if we can do that, longitudinal research if we can do that and to study associations between different psychiatric disorders, risk factors, protective factors between psychiatric disorders and somatic diseases. I also do sometimes other studies like for example, intensive measurements from diary studies. But that is more occasional. The main thing is epidemiological work. And Catharina, what prompted your interest in child and adolescent mental health? My background is psychology. I'm a psychologist from Oregon. And I started this, it was my second study, and I started this with the idea that I would be a clinician in the future. So of course, I failed that the first study, art school. I failed but I stopped it. I had really read up on the next study but also did volunteer work to see if I would like to be a clinician. So I worked with youth who ran away early from home and had to be placed in other families. And that suited me, it went fine. I thought, OK, this is the study I'm going to do. So that is the background in children and psychology, psychiatry. But then, when I started my studies, it turned out that I didn't like the clinical psychology one bit at all. This was about learning how to IQ tests and interviews and all kinds of skills, and it didn't keep my brain occupied at all. It was very practical. But the other thing which was unexpected is that I was very good actually among psychology students, I must say, in statistics and maths. And I loved that because it was a new area. And for me, and I hadn't envisioned this as part of psychology. But then, in fact, I loved it. And so that became my speciality. So yeah, away from the ideal of youth and mental health. But then this was a route into science and then, when I finished my master, the opportunity was there to do a PhD with all this knowledge about methods and statistics in child psychiatry. That fitted. That was an old interest on youth mental health with the new skills, and that yeah, that was the basis and it has remained with me. Catharina, you hypothesize that childhood psychiatric disorders accelerate the onset of other psychiatric and somatic disorders throughout the lifespan and across generations. Is this view widely supported through longitudinal research? My first answer is, yes. Yes, we have indications that this is the case, but there is a big part and that is also where I'm doing my research. That is way too little research on this. When you think of, for example, about the lifespan, obviously we have no studies that run from baby to old age. We don't have that thing. And if we have long-standing studies, psychiatry is generally not a topic in the early childhood years, which are way back. And so somatic conditions have been studied more. So this is just to show that this is the area where I'm working but I feel passionate about, and we are working on studies doing this and whether or not my hypothesis will be true or not, but this is the frontline say. So yes, there are indications and yes, every study will inform us on this. Your team uses data from longitudinal studies to explore the inter-play between genetics, behavioral, and environmental factors. Catharina, you authored or co-authored over 200 peer reviewed papers. Can you highlight some of the studies and findings that have had the greatest influence or that you feel are especially important? As an explanation, we say that had over 200 peer reviewed papers. It could also have been 300 because that is also true. But it is just a way of saying I am a scientist who is very actively contributing. It's certainly not the case that all those 200 or 300 have my personal signature there. Yes, I contributed to more than 200, 300 papers, and that is why we do it these days and we work in groups. So we try to work together and then every scientist has a small contribution. And the other comment I want to make that all papers are of course, small pieces of the big puzzle as to why some people are more vulnerable to develop mental health problems and others are not. And why some have a higher chance to have a beneficial course even though they have a mental disorder. But as others become sicker and sicker, that is the main question. So that, we are looking at. And this is bit by bit, by bit, by bit. So that said, when I think about important papers, my PhD time, for example, I was very much focusing on measurements of child psychiatric disorders and how we can differentiate with the best possible signs and symptoms between different child psychiatric disorders. That is still very important, even though that is more like 30 years ago. Measurement is almost everything. If we cannot assess syndromes, then yeah, you get messy results. Here are the cross-diagnostic theme, and that is actually-- I guess that will be important to emphasize. I was in the opportunity to already work on different disorders very early back then through this measurement thing because it's very good that you have the overview what is going on in other psychiatric disorders. And with measurements, if you have each group, one group is working on depression, the other is on anxiety, you will get overlapping measures. The anxiety group will develop a measure of anxiety that yeah, accidentally also have some depression symptoms in them and so on. So just as an example of the PhD time, very important to have good measures that differentiate the syndromes that we want to know all about it. My postdoc was on anxiety and depression very much. And there, again, the cross-diagnostic theme was very important. So we did studies on the transference from parents to children. The parents and child had anxiety disorders or mood disorders or major depression, bipolar disorder. We wrote a lot about the risk, the high risk of offspring, and also that this is not a one-to-one relation. So if your parents, one of your parents has depression, it can very well be the case that, for example, the child is more at risk for ADHD. Again, a theme that is still very much acknowledged has gained momentum also through genetics. The scientific community has also discovered how many genes are actually not specific for specific disorders. This is also a theme that's still going on and has my big interest. Maybe more recently, when I was an assistant professor, I started to work more on ADHD and autism spectrum disorders. These are under developmental disorders. So for example, for ADHD, we start to explore the social problems of ADHD that is not particularly a core criterion that there are social problems like, for example, peer, problems with peer relations, children who do not accept a kid who has been diagnosed who has ADHD, and we wrote a review on this. And this was also quite an influential paper because we are the first to look at these social of to get all this information together in a paper. From that, I also thought, I started to think a lot about the comorbidity with autism spectrum disorders, and we did quite some review papers on that as well. So that is more extreme, these are more extreme social problems, not understanding other people, for example, how that is a core characteristic of autism. And also there, there's a lot about the overlap between ADHD and autism spectrum disorder. So this was also quite influential, highly-cited papers. Still an important theme very much. Maybe, that is maybe my biggest passion right now. So at some point, we moved on towards the adult part. And if you look at this theme for the neurodevelopmental disorders, there is such a huge gap that are in knowledge. So as if ADHD or autism spectrum disorder would stop at age 18, which is obviously not the case. So my question there is also to have more knowledge, knowledge about adults if neurodevelopmental problems. Catharina, what are the barriers to translating research into practice? And how have you managed to be successful at this? I noticed that because very simple questions that have already been answered in science are often not known in practice. I think implementation of knowledge is really a different job, and I would not know how to do really, implementation. So for me, it is about knowledge. How can we get sound knowledge from our research and then indeed, let the world know about this? And so we are writing and of course, we have always been writing because that is more the general kind of stuff. But yeah, more recently, we are talking more, we are making videos or small movies, we do online courses. And actually, I'm learning a lot still there. So I mean, from the generation that simply wrote scientific publications. In my recent like, six or seven years, I've been involved in multiple European grants and consortia. And there, the dissemination and the co-creation more and more is obliged, and there is somebody there who gets all our knowledge out of our heads safe from the scientists who are not used so much or not as much as should be used to spread the news. So that is how I learn a lot and how I teach my group. But the interesting thing is actually that the young generation is actually very eager to spread the knowledge. So I also learned from the young generation. It's really interesting to hear about the intergenerational input. You have the experience and perhaps, the younger generation have the know how about dissemination of ideas. Catharina, can we turn to some of your recent work with the ADHD comorbidity project, CoCA? What is CoCA and its overall goal? The CoCA project stands for comorbid conditions of ADHD. And we know quite a lot about this, again, in childhood. Yeah. So childhood aggression is often comorbid, some early onset anxiety disorders, and I also mentioned already the autism spectrum problems. CoCA was about adults. So for the first time for me, I was able to start participating in a group of experts, adult ADHD. We wanted to know exactly how prevalence comorbidities are, psychiatric comorbidities mostly in CoCA but also obesity. And we wanted to know why. And so how come that these comorbidities are so frequent that we knew or suspected but from smaller samples. And we wanted to do this in a big way but also understand the mechanisms, and also treat and learn more about the genetics of comorbidity and so on and so forth. So CoCA is a multidisciplinary consortium that is very much appreciated by the EU, and that is the kind of grants that are provided that you learn to talk to other disciplines and then get the best out of this. And my role was the epidemiology part obviously. And so what we were able to do is to based on very large samples or so in the 30, 40,000, and that these are cohort samples or based on registries, and that is the whole population. For example in Sweden, Denmark, or based on claims data from insurance companies. Again, yeah, hundreds of thousands of people to really show how comorbid multiple psychiatric conditions are with ADHD. And in particular, also the adult onset psychiatric disorders. So the common adult disorders like depression, anxiety, substance use disorders, because that is actually then a translation from child psychiatry ADHD towards the lifespan, potentially meaning that ADHD, if you can treat ADHD properly, some of these comorbidities may be avoided. I'm just wondering, why is it important for researchers and clinicians who work in child and adolescent mental health, why is it important for them to also think then about prevalence in adults and kind of co-morbidity in adults? If ADHD can be treated, meaning that for a particular person, there are less failures. Failures at work, for example, or at school, starts already at school, of course, failures in social relations that might prevent onset of later comorbidity. So if you have this knowledge, I guess, as a clinician, you're more inclined to look very closely at how can be treated in the best possible way if you think this will go away with age 18. Yeah I imagine it completely increases motivation if you think you can change the trajectory. Yeah, that is the point. Yeah, obviously, that has not been shown to a very large extent. Maybe that is why the work is set to show this, that it helps to treat. But first, you need to make sure that the problem is known, and that is my work. Fantastic. Thank you. But Catharina, I want to turn to your role as deputy editor in chief of JCPP Advances, JCPP Advances offers innovative approaches to publication and research. What is the importance of open science and rapid publication for the research community? And in particular, for those working in child and adolescent mental health. Yeah, open science is obviously very important right now, but it is also a very broad term. So let me talk about some aspects of this in relation to JCPPA. So JCPPA has open access publications. So that is at least one part secured in the journal and is part of open science. Open science would also ideally, for example, have the raw data available so that people can access it here. That is a complication. We cannot demand it by the journal because there are obviously and rightly so all kinds of privacy regulations there. So not every raw data set can be put on the internet. But what we can encourage is that we share scripts for our findings. And scripts meaning statistical analytic scripts so that people can see exactly what decisions were made. Other examples are of pre-registration. So you want to do a study and you think it through from the very beginning towards the end including all the decisions and the primary outcome measures, the secondary. And that means that you cannot anymore even unconsciously fish in your data. And so as a researcher, when something beautiful comes up with finding, even if it was not planned to be your main interest, you might get overly enthusiastic about this and describe this as this was your aim all along, not even consciously. But yeah, it can also be a chance finding. And we know already very well that this gives strong biases in the literature. So pre-registration helps to stick to your protocol, and of course, you can write all about your new finding that was unexpected and not planned for. But then at least you are explicit in saying, so this was the post-hoc finding so that others know, OK, this needs still replication rather than, this was planned all along and we find it and this is solid evidence. So this is another aspect that we can encourage and actually JCPPA has banners for different parts that are currently seen as important assets of open science. So you can see for every paper that we publish, the extent to which different open science principles were followed. So that is an incentive so it doesn't go unnoticed. If you make these commitments as an individual scientist to work according to open science principles, then this banner shows you that you did. So that is an important thing to change potentially. Had to motivate people. So that was your question, actually. You said, OK, what is the importance of being able to get soon to the new knowledge? Which is also an open science principle. And here, I am not sure if we should adopt it in JCPPA, so let me explain this a bit as soon as possible, obviously. But we only publish after thorough peer review, and peer review obviously takes some time. We do that as fast as possible and that is our task also as editors. But if you would not do that, then everything will be published, whether it is trustworthy or not. And actually, that was one of the reasons I like, when I was asked to join as an deputy editor, I was thinking, yeah, OK, my main interest is in some knowledge. So let me make sure that with this new journal, we will not publish nonsense. So yeah, here is an open science principle that I think rightly so, JCPPA has not welcomed yet. So first peer review then the knowledge. Whereas, others make another choice. But for me, it's important because when you're not completely knowledgeable about all these science practices, you cannot make the difference between solid knowledge and simply something that was put on the internet without a solid base. The fun thing of JCPPA is that there are a lot of young editors, and we have this new start. So we are building together on the journal. We have no tradition, so we do not have to fight for things to change but rather, we can make it ourselves. It was also one of the incentives for me that I thought, OK, a new group of people sitting together doing this in the best possible way, that should be very important and also refreshing, Yeah. And I'm the older person, so I may sometimes be more conservative, but that is also not particularly bad. And we balance the decisions. What content is coming up in JCPP Advances that particularly excites you? So what can readers look forward to? Can I turn this around first? I'm pretty sure that listeners have not read the three issues that we have done within the year, and they can read them first before looking at the future. I'm saying because we have been able to get very good research papers in editorials, reviews, and that within the year. So yeah, I might want to advertise what we've already done. And please, read these papers from beginning to end, and you will have a pretty good idea of where the research field of child psychiatry and adolescent psychiatry is at this point. It's already a very good overview. But then for the future, there is a special issue on gender differences. So you might want to look out for that as well. What else is in the pipeline for you? Currently, next week, we will have the reviews back from one very large grant in the Netherlands. So this will be scary because we worked in a multidisciplinary group very long and hard on this grant, that means that I'm already very committed to the content. So I'm hoping we get positive reviews, and it is something that is very near now. And there is another European grant, and that will also come back in, I think two months. So what I hope is-- And again, multidisciplinary group, a big great group, so I'm hoping at least one of them, one of the two makes it. But that is potentially, hopefully future work. One is on depression and ADHD, one is on positive functioning and ADHD. So yeah, the benefits of having features that we count as ADHD. But I'm not sure if this will go, if this will fly, of course. Yeah. And then, currently, I'm working on a relatively new project on the development of ADHD starting in pregnancy. That is the road in masters studies. So this is a lot of work because we're doing a study right now but also very exciting. And we have also other recent grants on intellectual disability, which is a very much neglected area in child psychiatry. So also that has my strong interest right now. And obviously, yeah, there are the smaller day-to-day things. So very soon, I have to teach these students who will defend their thesis, and I have done an excellent job. So yeah, I'm also very happy about it that kind of stuff. Finally, Catharina, what is your take home message for those listening to our conversation? I think my take home message is that child psychiatry is a very, very important field. Knowledge is accumulating and accumulating, it is a rather recent field child psychiatry, but that also means that we have a lot to learn there, and it goes fast, really fast. My take is that most of the mental and part of the somatic conditions have their origin in childhood. And then potentially, this means also that the change with the largest impact can be in childhood. So please follow the science in child psychiatry. And then DCPA, of course, is a new outlet that tends to be very important in this. Brilliant. Catharina, thank you so much. And good luck with the outcome of your grant submissions. Yeah. Thank you. For more details on Dr. Catharina Hartman, please visit the ACAMH website, www.acamh.org and Twitter, @acamh. ACAMH is spelled, A-C-A-M-H, and don't forget to follow us on your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review, and do you share with friends and colleagues. 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