Research on Child and Adolescent Mental Health

III. Infrastructure and Training
Problems and Progress
Mental health research is a broad and complex
field in which solutions to problems will likely
require the synthesis of knowledge across various
disciplines. Because an integrated knowledge base
is critical to advancing the etiologic
understanding of behavioral and emotional
disorders in children and adolescents—and hence
developing, implementing, and studying
interventions with children within their diverse
environments—interdisciplinary training must
become the norm. As delineated in the Institute of
Medicine (IOM) “Report on Bridging Disciplines in
the Brain, Behavioral, and Clinical Sciences”
(2000), many barriers to interdisciplinary research
exist. In the child mental health arena, salient
issues relate to the acute shortage of
developmentally oriented clinical investigators
with the interdisciplinary training to leverage
rapidly emerging knowledge in developmental
neuroscience, developmental psychology,
cognitive and behavioral neuroscience, genetics,
and other areas of basic science. One specific
challenge is to reduce the fragmentation of
knowledge across areas of child and adolescent
psychiatry, pediatrics, adolescent medicine,
developmental and behavioral pediatrics, pediatric
neurology, developmental and clinical psychology,
and developmental neuroscience. Most academic
settings are organized into discipline-specific
programs and provide little training in this
interdisciplinary perspective.
The insularity of academic disciplines has resulted
in a dearth of research training programs and
mentors that bridge the traditional boundaries of
the various scientific disciplines. Further, funding
for interdisciplinary research is hampered by the
conservative nature of grant review or study
sections. Investigators who attempt to test
innovative models or alternative paradigms are
frequently penalized. For example, study sections
are often unreceptive to investigations that seek
to combine electrophysiological, molecular, and
biochemical approaches with studies of
environmental or activity-dependent determinants
of brain and behavioral development.
The shortage of well-trained mental health
investigators focused on children and adolescents
has been recognized repeatedly (IOM, 1989;
NAMHC, 1990; UNOCCAP Oversight Board, 1998).
A major obstacle to expanding the pool of junior
scientists is the lack of sufficient financial support
for training. Traditional research training
mechanisms are underused, in part, because
training grants typically provide little or no
overhead support in the form of indirect costs for
faculty salaries. Also, in recent years, clinical
revenue for many academic health sciences
centers nationwide has declined. This decline,
combined with the rise of financial requirements
for faculty, further constrains resources to offset
faculty time devoted to training and mentoring.
These issues are especially challenging for those
interested in child mental health research because
(1) child research is more expensive owing to the
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