By Bruce Hershfield, MD
[Fall 2007; Vol. 34, No. 1; Pg 6]
Q:
“Please tell us about the Agnes Purcell McGavin Award that the APA gave you in
San Diego.”
A:
“The award is for “distinguished career service”. It is a lifetime
achievement award. The areas that were highlighted included my textbook,
published in 1995 “Developmental Neuropsychiatry”. It is a single-authored
two-volume textbook that is the culmination of 25 years and more of working with
children and adolescents with developmental disabilities.
I wanted to write it a textbook from a developmental perspective. I
wanted to explain how understanding neurogenetic disorders that involved brain
function could help us better understand how brain systems emerge and perhaps
help us also understand the neurological basis of obsessive compulsive disorder,
compulsive self-injury, and other types of behaviors.
I
also received the award because of my activities in residency education, as
President of the Society of Professors of Child & Adolescent Psychiatry,
which is the organization that represents the various academic divisions in
child & adolescent psychiatry, as President of the Maryland Regional Council
of Child and Adolescent Psychiatry,
and my involvement with the American College of Neuropsychopharmacology
and the Society for Neuroscience.”
Q:
“You’ve been working in neurodevelopment for quite some time.”
A.:
“Since 1976. When I
finished my residency in Adult & Child Psychiatry, I was made Director of
Psychiatry at the Kennedy Krieger Institute. Later I directed the Division of
Child Psychiatry at Hopkins for four years and combined the Kennedy Krieger
program and the Hopkins program into one program in Child and Adolescent
Psychiatry. After Joe
Coyle followed me as the Division Director in 1982, I continued to direct the
training program in Child and Adolescent Psychiatry, During that time I
basically had two hats. One was to direct the training program. (We had NIMH
funding training most of those years.) The other hat was to direct the
developmental neuropsychiatry program, as we started to call it, at Kennedy
Krieger. Eventually, it seemed to me that there was not enough emphasis within
Psychiatry on neurodevelopment. I was granted a Sabbatical to write a textbook,
which I hoped would emphasize a developmental approach and eventually lead to a
subspecialty area within Psychiatry.”
Q:
“Is that the way it turned out?”
A:
“There isn’t a subspecialty “per se”, but it is considered to be a area
of special focus within Psychiatry and reviewers suggested that my textbook
could pave the way for an eventual specialty area.
The developmental pediatricians were seeing these many of children at the
time the book was written, but they weren’t emphasizing their behavioral and
emotional needs. Surprisingly Developmental Neuropsychiatry was chosen
“Medical Book of the Year” out of 2500 books in 76 medical specialties in
the year of its publication.
When I received the book of the year citation I was told that the
decision was made because of my focus on a new specialty area within
Psychiatry.”
Q:
“Are you communicating with colleagues in the field and are there other
indications that it is becoming a new specialty?”
A:
“I think that is happening incrementally as with the greater focus on clinical
neuroscience in psychiatry and ongoing efforts to understand the neurobiology in
of different types of psychiatric
disorders in children. I
focused on neurodevelopmental and neurogenetic disorders, but other
investigators are now looking at brain function in bipolar disorder and OCD and
other conditions.
My
NIH funded research has focused on brain mechanisms in Lesch-Nyhan syndrome.
That‘s a rare genetic disorder, but practically everyone knows it
because of the characteristic severe compulsive self-injury.
We did the first PET scans to try to understand the role of the dopamine
and the serotonin systems in self-injurious behavior. Since then, in looking at
those mechanisms, I’ve been interested as well in self-injury in eating
disorders and particularly in bulimia nervosa.
The
outcome of continued focus on neurodevelopment is that having done the book on
developmental neuropsychiatry, I wrote another book, published in 2006, that’s
called “Intellectual Disability”.
The reason I wrote it was that it had become increasingly clear that
“mental retardation” was a stigmatizing term.
By writing a textbook, I’d hoped to focus attention on a new name,
which is increasingly being adopted “intellectual disability”. In 2007 the
American Association on Mental Retardation changed its name to the American
Association of Intellectual & Developmental Disabilities.
So I think that we’re moving forward and that this is will be the
accepted diagnostic term in DSM-V.”
To
Be Continued in Next Edition