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Child & Family Mental Health & Developmental Neuroscience

Woman Looks at Autism App with ToddlerChild & Family Mental Health & Developmental Neuroscience is dedicated to caring for children, young adults, families and couples as well as researching the issues affecting these populations. We collaborate closely with our patients and other providers in the community to comprehensively address pediatric mental health needs. The Duke Children’s Evaluation Center (DCEC) provides care and referral coordination for all pediatric patients seeking mental health services at Duke.

We are dedicated to supporting the well-being of children, adolescents, young adults and families. This commitment is reflected across our clinical, research and educational initiatives.

  • Clinical services including individual, family, and group therapy, medical consultation and medication management. The DCEC is the primary portal for new appointments.
  • Educational opportunities including graduate clinical training, postdoctoral trainingchild psychiatry fellowshipspsychology internships and residency rotations
  • Research in areas such as anxiety, attention-deficit hyperactivity disorder, autism spectrum disorders, developmental epidemiology, eating disorders, mood disorders, suicide prevention, substance use and trauma. 

Faculty include leaders in the field who conduct studies to better understand and treat developmental, behavioral and mental health concerns in children and adolescents. Pediatric mental health services at Duke are provided by faculty and clinical staff from across the department’s clinical and research programs. Evidence-based treatments ensure that our patients receive the most current and effective therapies available.

Duke Center for Autism & Brain Development

The Duke Center for Autism & Brain Development is dedicated to helping people with autism and related developmental disabilities reach their full potential, thereby allowing society to benefit from the talents and diversity that people with autism and other developmental disabilities offer. We are a group of dedicated clinicians and scientists who work in partnership with people with autism and related disabilities, families and the broader community to realize this goal.
 

Duke Center for Eating Disorders

Eating Disorder Research Laboratory

Researchers in the Eating Disorder Research Laboratory, led by Nancy Zucker, PhD, are interested in how individuals learn to detect and decipher the signals from their bodies (e.g., of hunger, of emotional experience) and use these signals to guide their behavior. We study individuals for whom this learning somehow goes awry: individuals struggling with eating disorders (e.g., anorexia nervosa, ARFID, selective eating, pediatric binge eating), those with chronic medical conditions that may disrupt or complicate this learning (e.g., pediatric gastrointestinal disorders or pediatric cancer) or neurodevelopmental disorders such as autism. 

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Center for Eating Disorders Community Website

Managing an eating disorder can seem all-consuming. Having to approach fearful situations multiple times a day, every day, can be hard to keep up with. Yet, navigating and mastering this challenging journey is a life transforming experience, one that may provide the foundation for a vital and fulfilling life.

We don’t want you to have to take this journey alone. Our goal is to help you through that journey step-by-step to ensure the journey is a little less lonely—and perhaps even a little goofy.

The goal of this website is to offer information and tools to individuals who are affected by an eating disorder and to their families. As we launch the site, we focus on those who seek information and tools for Avoidant Restrictive Food Intake Disorder (ARFID). In the future, we will expand the site to include information and tools for those who have Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and related disorders related to an individual’s disconnection from the experience of their body.

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Eating Disorder Treatments at Duke

The Duke Center for Eating Disorders provides comprehensive, individualized treatment for the entire spectrum of eating and body image issues across the lifespan beginning with toddler-aged children. Conditions we treat include:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder (including pediatric binge eating)
  • Avoidance Restrictive Food Intake Disorder (including selective eating)
  • Eating issues that result from a medical condition (such as pediatric cancer or issues of the gastrointestinal or endocrine system)
  • Body image dysphoria (individuals uncomfortable living in their bodies but lacking eating symptoms)
  • Eating issues associated with autism spectrum disorders

The treatment of eating disorders is greatly helped by the loving support of friends, partners and family. Whenever possible, our philosophy is to incorporate as many individuals as is appropriate or beneficial for a given individual. Our experience is that families come away stronger when they participate in our program. 

 

Individual and Family Therapies

When your first appointment is scheduled with one of our therapists, you will receive an extensive diagnostic interview, a brief (or long) neuropsychological battery depending on which you request, and some questionnaires to complete about your experience of your body. After gathering this information and consulting with our treatment team, we will then conduct a feedback session in which we indicate the level of treatment that is appropriate, the model of treatment, what you can expect about the length of treatment, and how you will be able to measure treatment progress.
 

Empirically Validated Treatments Implemented at the DCED

At the DCED, our therapists are trained in empirically validated treatments for the management of eating disorders.  While we recommend these based on the clinical presentation of an individual, often individuals come to us requesting a specific form of therapy. We offer a brief description here, but are happy to answer questions about the nature of these therapies.
  • Family Therapy of Adolescent Anorexia Nervosa or Bulimia Nervosa based on the Maudsley Method: This treatment emphasizes the importance of the family unit in the management of a child and adolescent eating disorder. In essence, we help parents to conduct the form of supportive meal support that occurs in a more intensive eating disorder program while working with the family on approaching challenging situations.
  • Acceptance and Commitment Therapy (ACT): Under the leadership of Rhonda Merwin, PhD, a certified ACT trainer, our therapists are trained to implement this acceptance-based cognitive behavior therapy that helps individuals to build a rich and value-guided life even in the presence of unwanted or aversive experience.
  • Dialectical Behavior Therapy (DBT): This advanced cognitive-behavioral therapy is based on a theoretical model in which an individual's history of invalidation leads to a pervasive distrust and fear of emotional experience that sometimes promotes extreme behaviors to regulate that experience. We work closely with Zachary Rosenthal, PhD, and the Cognitive & Dialectical Training Program to provide all the components of the DBT model.
  • Mindfulness-Based Cognitive Behavior Therapy: Under the leadership of Noga Zerubavel, PhD, this treatment combines advances in cognitive-behavioral treatment with mindfulness based approaches. In so doing, it helps an individual to become more aware and accepting of ongoing joyous and aversive experiences so that life becomes more vital from moment to moment.
  • Accelerated Experiential Dynamic Psychotherapy (AEDP): Under the leadership of Laura Weisberg, PhD, this treatment builds on what is known about physiological changes that occur with the experience of traumatic life events. By helping individuals to activate the restorative branch of their nervous system in the presence of aversive remembrances, the individual is taught to more fully experience the full range of emotions rather than being closed off due to past traumatic events.

 

Empirically Validated Treatments Developed at the DCED

We are also known as innovators of treatment development based on emerging knowledge about the developmental neuroscience of eating disorders under the leadership of center director, Nancy Zucker, PhD. Some examples of the therapies we have developed and tested and that individuals can have access to include:

  • Appetite awareness training for the treatment of pediatric binge eating
  • “VOLCRAVO” craving exposure for the treatment of pediatric obesity
  • Group parent training for the management of adolescent eating disorders
  • "Feeling and Body Investigators" for children with elevated somatic symptoms and abdominal pain
  • "Sensory Scientists" is our treatment for individuals with selective eating or ARFID

 

Selective Eating Disorder/Avoidant Restrictive Food Intake Disorder (ARFID)

Nationally recognized experts, we have decades of experience improving our patients’ health and eating habits. Our pioneering program for adult picky eaters has been featured in Time magazine and The Wall Street Journal. Research results and our program for children with selective eating have been featured by ABC, Nightline, NPR and NBC and more.

Parent Weekend Workshop is a two-day educational workshop for parents who want to better understand the dynamics of this eating disorder and how it affects their family. Parents leave with a "toolbox" to take home and are encouraged on how to communicate more effectively, practice even more patience and help their child become a "food scientist".   

Immersive Family Program is a five-day program for parents and their child who has selective eating. A lot takes place during the week:  individual sessions with a therapist for parents and children separately, a family session, educational lectures presented by Nancy Zucker, PhD, center director, daily group food therapy sessions, an appointment with both a medical doctor and an occupational therapist and several group sessions for parents as well as children.  

Duke Center for the Study of Suicide Prevention & Intervention

The Duke Center for the Study of Suicide Prevention & Intervention (CSSPI) represents a collaborative effort among several clinical research scientists at the Duke Child & Family Study Center to advance our understanding of the risk for suicidal behaviors and to reduce suicide attempts and suicide deaths. The CSSPI has three key missions: scientifically sound and innovative research, the study of evidence-based prevention and intervention, and education.
 
The CSSPI partners with local, state, and national community organizations and foundations, as well as academic institutions. Specifically, the faculty members affiliated with the CSSPI maintain active collaborations with several groups, including:

 

Faculty

Click on a faculty member’s name to view their profile, including their grants and publications.

 

Current Research & Studies

  • National Child Traumatic Stress Network (NCTSN) Center (SAMHSA U79SM080041): The UCLA-Duke Adolescent Suicide/Self Harm & Substance Abuse Prevention (ASAP) NCTSN Center serves as a resource for information related to suicidal/self-harm behaviors and substance use among trauma-exposed youths. Through the work of the ASAP Center, interventions for trauma-exposed youths with suicidal/self-harm behaviors or substance abuse are being adapted and disseminated. A particular focus is on youths seen in emergency/acute care settings and other settings where brief time-limited treatments are needed. The Center is working to develop and strengthen trauma informed care that integrates care for adolescent behavioral health within primary care, emergency, and other medical settings, as well as other mental health, school, and community settings. Through trainings and dissemination activities, the Center aims to serve diverse youths, across racial and ethnic groups, sexual identities and orientations, socioeconomic groups, and address needs of youths in military families. The Center goal is to support providers and service systems in addressing safety issues and substance misuse effectively, thereby enhancing the benefits of other treatments that specifically target post-traumatic stress disorders/reactions. The web site for the ASAP Center grant is https://www.asapnctsn.org/.  
  • Cognitive & Affective Mechanisms of Risk for Suicidal Thoughts & Behavior (NIMH R01-MH48762): In the context of a prospective (20 year), naturalistic, repeated assessment study of long-term psychological adjustment following adolescent psychiatric hospitalization, we are examining processes associated with risk, resilience, and developmental trajectories of suicidal thoughts and behavior. Consistent with NIMH strategic priorities, this study is examining mechanisms of risk across domains, including cognitive (decision-making), psychophysiological, and affective (automatic affective responses). This is one of the few longitudinal studies to follow individuals at risk for an extended period of time, through two developmental periods (adolescence and adulthood). 
  • The Garrett Lee Smith Memorial Suicide Prevention Cross-Site Evaluation (SAMHSA/CMHS Contract 280-03-1606): Via a contract from SAMHSA to ICF, a cross-site evaluation is being conducted of the state, tribal, and campus suicide prevention programs funded via the Garrett Lee Smith Memorial Act. Duke University is participating in this project as part of the cross-site evaluation team. In a recent finding from the cross-site evaluation, communities in which Garrett Lee Smith Suicide Prevention programs had been implemented were found to have reduced rates of suicide deaths and reduced population rates of suicide attempts when compared to communities without these suicide prevention programs.   
  • Integrated Electronic & Care Manager Support Intervention for Caregivers of Adolescents with Suicide Attempts (NIMH R34-MH112811): The CSSPI is collaborating with Wake Forest University School of Medicine in the development and initial testing of an intervention to support parents of youths who have had suicidal thoughts and behavior. Previous studies conducted by our group indicated that parents often feel as though they lack support and information for caring for their children who have been discharged from the hospital following suicide attempts. The new intervention will address these needs, and consist of regular contact with a care support manager and use of a mobile health application to provide information and support to parents.
  • Suicidal Adults with Alcohol or Drug Use Problems: A New Hospital Based Treatment (NIAAA R34-AA026016): The CSSPI is collaborating with the University of Rochester School of Medicine in the adaptation, refinement, and preliminary evaluation of the Attempted Suicide Short Intervention Program (ASSIP). The ASSIP intervention previously was found to be very effective in reducing suicide attempts in studies in Europe. In this study, the adapted version of ASSIP will be used with adults who both have been medically hospitalized following suicide attempts, and who have alcohol and/or drug use problems. 
 

Intervention

The faculty members associated with the CSSPI are involved with research focused on developing and adapting interventions for different populations of suicidal individuals. The CSSPI is not associated with a specific clinic, but clinical services are available through the Duke Child and Family Study Center. Services are available for children, adolescents, young adults and families seeking evidence-based assessment, diagnosis and treatment services for a range of psychological or adjustment difficulties, including suicide-related thoughts and behaviors and self-harm.
 
For more information, please contact the Referral Coordinator at 919-385-3232.

 

Clinical Education

The CSSPI is involved in the provision of training opportunities for individuals interested in suicide- or self-harm-related research. Mentored research experiences are available for graduate students, postdoctoral fellows and junior faculty. Opportunities also are available for clinical training in the assessment and treatment of suicide-related thoughts and behaviors. The CSSPI is involved in outreach and education in the community, including consultation with the schools, collaboration with the NC Chapter of the American Foundation for Suicide Prevention and the Duke Integrated Pediatric Mental Health initiative.
 
As part of the CSSPI, the UCLA-Duke ASAP Center for Trauma-Informed Suicide, Self-Harm, & Substance Abuse Prevention and Treatment (https://www.asapnctsn.org) through the National Child Traumatic Stress Network, provides community outreach including educational and mental health awareness talks, as well as training in brief interventions for youths and young adults at risk for suicidal and self-harm behaviors.

 

External Resources

Duke Center for Developmental Epidemiology

At the Center for Developmental Epidemiology, we're working to advance the understanding of the origins, course and prevention of mental illness across the course of life. Our longest-running study, the Great Smoky Mountains Study, is a longitudinal assessment of the development of psychiatric and substance abuse disorders and access to mental health care in a representative sample of 1,400 children and adolescents living in the southeastern United States. Other studies include the Duke Early Childhood Study and the Preschool Health & Well-being Study.
 

Duke Attention-Deficit Hyperactivity Disorder (ADHD) Program

The Duke Attention-Deficit Hyperactivity Disorder (ADHD) Program aims to integrate innovative and state-of-the-art research into comprehensive and compassionate clinical care for individuals across the lifespan who are affected by ADHD.
 

 

Child & Family Health Collaboration

We're committed to creating a unified continuum of care for our community's children and their families, as they grow from infancy to adulthood. The central goals of our Integrated Pediatric Mental Health (IPMH) initiative are to streamline access to care within the Duke system and to work closely with Duke and community partners to address systemic challenges, provide support and share information. Our vision is to help Durham become a national model for effective and collaborative pediatric mental health care.

Faculty and staff, along with collaborators, work to strengthen the capacity of Duke Health and the Durham community to provide comprehensive mental health care to our youngest community members. Our collaborations focus on improving children's mental health, reducing the need for intensive hospital-based care and improving school attendance and academic performance.

We are grateful to have strong relationships with other divisions and departments within Duke, to participate in local and state partnerships, and to collaborate closely with local non-profits, social service agencies and mental health providers.

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