Precision medicine offers hope for child mental health treatment

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In her decades-long career devoted to child and youth mental health, Dr. Kathleen Pajer says she has never been as excited by the work as she is currently.

Pajer, a psychiatrist and senior researcher at CHEO, is referring to a new approach toward understanding and treating mental illness called precision child and youth mental health. PCYMH, as it is known, considers genetic, environmental and lifestyle factors to precisely tailor treatments to children and youth.

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That work could involve understanding how a patient’s gut biome affects the way they respond to eating disorder treatment, or how closely physical movement is related to a child’s mental wellbeing.

The goal is to better be able to pinpoint factors influencing mental health to more successfully treat children and youth for a variety of mental illnesses.

“In my entire career, I have never been more excited about the potential to transform child and youth mental health care than I am right now,” said Pajer, who directs CHEO’s PCYMH initiative.

“It is care that precisely tailors treatment to the mental health needs of each child or youth based on understanding their unique biology, psychology, lifestyle and environment,” she said. “It takes a much bigger understanding of that child or youth in order to give them the treatment that they specifically need.”

Rising interest in the field comes at a time when CHEO and other children’s hospitals are seeing growing numbers of patients with mental health disorders, including high rates of anxiety and eating disorders. Between 20 and 30 per cent of youth and children now meet the criteria for mental health disorders, said Pajer.

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This week, the CHEO Research Institute in collaboration with the uOttawa department of psychology, is hosting the first-of-its-kind international conference devoted to the growing field of precision child and youth mental health.

For Pajer, it is a game-changer.

“The old way of studying people was to say ‘What works for the average person?’” she noted. Now, researchers are finding ways to understand what works for smaller groups of patients who don’t necessarily respond to conventional treatments.

Up to 50 per cent of children and youth being treated for a mental illness do not respond to the first line of treatment, Pajer said. In some cases, several treatments are tried before something works and even then, she said, it might not work well.

“That is what we are trying to fix.”

Among research at the conference is a project by scientists from SickKids hospital in Toronto called Spit for Science. The study is asking 30,000 children and youth visiting the Ontario Science Centre (known as junior scientists) to complete questionnaires about behaviour and to play a computer game to understand cognition as well as physical health and well-being. The information collected includes participants’ postal codes and a DNA swab, to find out more information on possible environmental and genetic influences. The project aims to look at how genes work with the environment to impact mental and physical health.

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Pajer said the field is blossoming, in part, because of new understandings about genetics as well as technological advances that can provide precise information, enabling medication to be adjusted, for example, or allowing lifestyle changes to be prescribed to treat individual patients. Artificial intelligence, with its ability to look at data from hundreds of thousands of patients to find patterns, plays a key role in the field.

Scientists and health experts now understand biological and lifestyle factors play a bigger role in mental health disorders than previously thought.

Pajer said in the coming years she hopes she can collect a range of information about patients — including biological and lifestyle factors, working closely with researchers, before deciding on a treatment. That could include movement and the outdoors as a way to improve the mental wellbeing of patients.

People are already doing what is known as social prescribing, she said, which could include prescribing activity or lifestyle changes and measuring the impact. Research at CHEO has found that lack of movement is associated with every type of mental health disorder. Others found that bacteria in patients’ guts may affect whether they respond to treatment for eating disorders.

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There is a need to look at the whole person to understand what is going on, and to know that “one size does not fit all” when it comes to treatment, said Pajer.

She said the precision child and youth mental health approach “produces so much more hope” about finding research-based solutions that work for patients and their families.

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