Behavioral Medicine and Clinical Psychology

Significant Accomplishments

FIT Teens Helps Adolescents with Chronic Musculoskeletal Pain

The new Fibromyalgia Integrative Training program for Teens (FIT Teens) is one example of the collaborative team science that makes Cincinnati Children’s unique. Juvenile fibromyalgia (JFM) is a poorly understood chronic pain condition that occurs more commonly in teenage girls. Symptoms include persistent widespread musculoskeletal pain, fatigue and sleep difficulties. Medications offer limited symptom relief. Patients with JFM have a lot of trouble participating in school, sports and social activities. Susmita Kashikar-Zuck, PhD, recently completed the first multi-site clinical trial for JFM, in which cognitive-behavioral therapy (CBT), a psychological intervention, produced strong improvements in daily functioning and improved coping. Kashikar-Zuck is now working to enhance CBT by adding an exercise component to reduce JFM-related pain, which is often made worse with deconditioning. Physical exercise is challenging for JFM patients due to their fear of causing pain flare-ups. Indeed, in a partnership with Greg Myer, MD, Sports Medicine, the research team used highly sensitive 3-D motion analysis and dynamometry to find alterations in body biomechanics that might JFM patients more prone to injury and pain when they exercise. In a new study funded by the NIH, Kashikar-Zuck, Myer and collaborators in Rheumatology and Pain Management are conducting a pilot study to test specialized neuromuscular training for JFM patients to improve gait, posture, balance and core strength while minimizing delayed-onset muscle soreness and fatigue. The training will be integrated with established CBT techniques.

Early Career Project Leads to Clinical Trial in Epilepsy Medication Adherence

Avani Modi, PhD, a member of the Adherence and Self-Management Center, seamlessly transitioned from an Early Career Award (K23) to independent funding with her first NIH R01 award.  Modi’s research focuses on non-adherence to antiepileptic drugs in children newly diagnosed with epilepsy. Medication adherence is critical in this population because patients who demonstrate non-adherence are more likely to have continued seizures, declines in academic functioning and poor quality of life. Data from her K23 award, published in JAMA, demonstrated that 58 percent of newly diagnosed patients exhibited some level of non-adherence, which followed five distinct patterns. These novel findings have direct implications for developing targeted biobehavioral treatments. Modi’s new grant supports a randomized clinical trial of a novel adherence intervention process. The study uses electronic monitoring to track medication adherence, and enters patients only if adherence falls below 95 percent. The treatment is designed to address the barriers families frequently report regarding medication adherence. Active therapeutic components of the treatment include problem solving skills and tailoring through systematic practice of behavioral solutions to identified adherence barriers. This novel intervention not only addresses the immediate barrier, but teaches the family strategies they can employ as new barriers emerge.

Funding Renewed for Behavior and Nutrition Center

Our Center for Child Behavior and Nutrition Research and Training received its second renewal of NIH funding, which will provide support for continued research training opportunities for clinical fellows in behavioral medicine, nutrition science and pediatrics. Fellows participate on NIH-funded research teams and conduct mentored clinical research on a wide range of chronic conditions that share dietary modification as a core component to disease management.  These conditions include obesity, cystic fibrosis and diabetes, which often begin in childhood but may cause significant adult morbidity and reduced life expectancy. Further, these diseases typically require long-term and burdensome self-management, necessitating age-specific approaches to prevention and treatment. Investigators with combined expertise in behavioral, biomedical and nutrition science are critically needed given the lack of robust clinical investigation in how to achieve optimal nutritional management for youth with these disorders. The Center for Child Behavior and Nutrition Research and Training was established in 1999 and initially funded by the NIH under the directorship of Scott Powers, PhD. The renewal represents 15 years of investment by the NIDDK. The continued goals of this program are to ensure fellows gain clinical research skills critical to becoming academic leaders in this area, as evidenced by graduates who have obtained faculty appointments with successful independently funded research programs and/or leadership positions related to clinical and research training. This most recent award also is significant for succession leadership planning as Meg Zeller, PhD, assumed the role of Co-Director of the training program.