Barry M. Lester, PhD, Director

Dr. Lester is Professor of Psychiatry and Human Behavior, and Professor of Pediatrics at the Warren Alpert Medical School of Brown University and Director of the Brown Center for the Study of Children at Risk.

Dr. Lester's research is on the study of developmental processes in children at risk. This includes children at risk because of biological factors and children at risk due to social factors. Risk is broadly defined and includes cognitive and academic deficits, antisocial behavior, psychopathology and substance use onset. We have studied biological factors such as prematurity, intrauterine growth retardation, and prenatal exposure to alcohol, tobacco and illegal drugs (cocaine, marijuana, and methamphetamine). Social factors include poverty, home environment and parenting factors.

The study of the interplay between biological and social factors provides an understanding of the mechanisms that determine developmental outcome. We have used interdisciplinary longitudinal research designs starting in the fetal and infancy periods to study the unfolding of developmental processes in normal and at risk children through adolescence. We use both standardized tests and have developed our own neurodevelopmental measures to see how children react under mild stress. We also use cross-cultural designs to study "naturalistic" experiments in environmental and parenting conditions.

Translational research includes the study of treatment for behavioral disorders in infancy and early childhood and social policy research involving the judicial and child welfare systems. Dr. Lester is currently a member of the National Advisory Council on Drug Abuse at NIDA.

Barry_Lester@Brown.edu

Selected Publications

• Lester, B.M., LaGasse, L.L., & Seifer, R. Cocaine exposure and children: The meaning of subtle effects. Science (282), 633-634, 1998.
• Lester, B.M., Tronick, E.Z., LaGasse, L.L., Seifer, R., Bauer, C.R., Shankaran, S., Bada, H.S., Wright, L.L., Smeriglio, V.L., Liu, J., Finnegan, L.P., Maza, P.L. The Maternal Lifestyle Study: Effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Pediatrics, 110 (6), 1182-1192, 2002.
• Lester, B.M., Boukydis, C.F.Z., Garcia-Coll, C.T., Peucker, M., McGrath, M.M., Vohr, B.R., Brem, F., & Oh, W. Developmental outcome as a function of the goodness of fit between the infant's cry characteristics and the mother's perception of her infant's cry. Pediatrics, 95 (4), 516-521, 1995.

Linda LaGasse, PhD - Director, Research

Dr. LaGasse is an Associate Professor (Research) in the Department of Pediatrics and in the Department of Psychiatry and Human Behavior at The Warren Alpert Medical School of Brown University.

Dr. LaGasse has two primary research areas: (1) The effects of prenatal exposure to drugs of abuse on child development and (2) the effects of cognitive processes on directed reaching in high-risk children. She has been studying children who are part of the multi-site, NIH Maternal Lifestyle Study (MLS), a longitudinal study of 1000 children prenatally exposed to cocaine. The MLS children are now preadolescents and current work focuses on the etiology pf poor outcomes. One study examines predictors of obesity (MLS children exceed the national average for obesity), and a second study determines pathways to antisocial behavior and early substance use.

Dr. LaGasse is also studying children who are part of the multi-site NIH Infant Development, Environment, and Lifestyle Study (IDEAL), a longitudinal study of 400 children prenatally exposed to methamphetamine during pregnancy. Her current work in the IDEAL study utilizes acoustic analysis of infant cries to examine the effects of methamphetamine exposure on arousal and regulatory processes.

Dr. LaGasse's secondary research area merges cognition with kinematic analysis of directed reaches in high risk children. Kinematic analysis provides a high resolution description of reaching efficiency (e.g. number of movement units, acceleration). For infants with prenatal cocaine exposure, she uses a reaching-in-the dark paradigm to test their memory for sounding, unseen objects. For youth who were born premature, she uses a two-choice task to test for motor perturbations based on decision rules.

Additionally, as director of research, Dr. LaGasse is the scientific administrator for the MLS and IDEAL studies, which includes protocol development and implementation, oversight of site adherence to protocol, and oversight of the Neurobehavioral Data Center that conducts data reduction and analysis.

Linda_Lagasse@Brown.edu

Selected Publications

• LaGasse, L.L., Van Vorst, R.F., Brunner, S.M. & Zucker, M.S. Infants' Understanding of Auditory Events. Infant and Child Development, 1999 (8), 85-100.
• LaGasse L., Messinger D., Lester B., Seifer, R., Bauer, C., Shankaran, S., Bada, H., Wright, L., Smeriglio, V., Poole, K., Liu, E. Prenatal drug exposure & maternal & infant feeding behavior. Archives of Disease in Childhood, 2003 (88), F391-F399.
• LaGasse, L. L., Neal, A. R., Lester, B. M. Assessment of infant cry: Acoustic cry analysis and parental perception. Mental Retardation and Developmental Disabilities 2005 (11), 83-93.

Cynthia Miller-Loncar, PhD, - Director, Clinical Services

Dr. Miller-Loncar is an Assistant Professor (Research) in the Department of Pediatrics. As the director of clinical services, Dr. Miller-Loncar oversees the five clinical services provided by the Center, working within a multidisciplinary team of professionals dealing with a variety of children at risk for developmental issues, including preterm infants, children with drug-exposure histories, infants with regulatory disorders, and children birth to 5 years with a both developmental and behavioral difficulties. These clinical services have allowed Dr. Miller-Loncar to expand her skills as a licensed psychologist in the areas of neurodevelopmental assessment and behavioral interventions within the family system.

Dr. Miller-Loncar's major research interest is the impact of parenting behavior on child outcomes, with a focus on creating parenting interventions that enhance child development in at-risk populations. Populations of interest include preterm infants, infants with early regulatory problems, and children with drug-exposure histories. Additional research interests include the relation of psychobiology and social development in children with autism and the interrelation among infant colic, feeding difficulties and family functioning.

Cynthia_Loncar_PhD@Brown.edu

Selected Publications

• Miller-Loncar, C.L., Bigsby, R., High, P.C., Wallach, M., & Lester, B.M., (2004). Infant colic and feeding difficulties. Archives of Disease in Childhood, 89 (10), 908-912.
• Miller-Loncar, C.L., Lester, B.M., Seifer, R. et al. (2005). Predictors of motor development in children prenatally exposed to cocaine. Neurotoxicology and Teratology, 27 (2), 213-220.
• Landry, S.H., Miller-Loncar, C.L., Smith, K.E., & Swank, P.R. (2002). The role of early parenting in children's development of executive processes. Developmental Neuropsychology, 21 (1), 15-21.

Lynne Andreozzi Fontaine, Ph.D.

Dr. Andreozzi Fontaine is an Associate Professor in the Department of Psychology at the Community College of Rhode Island. Dr. Andreozzi Fontaine has been involved through research and clinical intervention in working with families affected by perinatal substance abuse. Dr. Andreozzi Fontaine's research involves study of the efficacy of the Vulnerable Infants Program of Rhode Island (VIP-RI). VIP-RI is a demonstration project designed to improve the community's ability to manage cases of drug-exposed children at risk for compromised development and to provide the earliest and best intervention for vulnerable infants.

Dr. Andreozzi Fontaine is also the coordinator of the NICU Network Neurobehavioral Scale (NNNS) Training Program. She utilizes the NNNS for clinical, research, and teaching purposes, specifically in consultation with newborn nurseries and through the Vulnerable Infants Program (VIP-RI). She is certified to train others on the proper administration, scoring, and interpretation of the NNNS. Her additional clinical work at the center encompasses the assessment of infants and young children, and behavioral consultation with area professionals and caregivers. Her current research interests include attachment and substance exposed infants.

LAndreozzi@wihri.org

Selected Publications

• Andreozzi, L., Flanagan, P., Seifer, R., Brunner, S., & Lester, B. Attachment classifications among 18-month-old children of adolescent mothers. Archives of Pediatrics and Adolescent Medicine. 2002, (156), 20-26.
• Lester, B., Andreozzi, L., & Appiah, L. Substance Use During Pregnancy: Time For Policy To Catch Up With Research. Harm Reduction Journal, 2004; 1:5.

Rosemarie Bigsby, Sc.D., OTR/L, BCP, FAOTA - Clinical Assistant Professor

Dr. Bigsby is a Clinical Assistant Professor in the Department of Pediatrics. Dr. Bigsby coordinates the Center's NICU services at Women & Infants Hospital. Her experience as a pediatric occupational therapist over three decades includes working in a variety of settings as clinician, supervisor and consultant. For the past 14 years, she has practiced in the NICU, in the combined roles of therapist, educator and researcher.

Dr. Bigsby was named a Fellow of the American Occupational Therapy Association (AOTA) in 1994, for her contributions to the practice of occupational therapy with infants and children. She is the author of a number of journal articles and book chapters and is co-author of the AOTA guidelines for NICU practice, as well as the Posture and Fine Motor Assessment of Infants (Psychological Corporation; 2000). Her research focuses on motor development, behavioral cues, physiologic regulation, and feeding in early infancy. She has been an invited speaker both nationally and internationally, and currently teaches several two-day multidisciplinary workshops per year on assessment and intervention in the NICU.

Rosemarie_Bigsby@Brown.edu

Selected Publications

• Miller-Loncar, C.L., Bigsby, R., High, P., Wallach, M., & Lester, B. (2005). Infant colic and feeding difficulties. Archives of Pediatrics & Adolescent Medicine (89), 908-912.
• DeSantis, A., Coster, W., Bigsby, R., & Lester, B. (2004). Colic and fussing in infancy and sensory processing at 3 - 8 years of age. Infant Mental Health, 25 (6), 522-539.
• Boukydis, C.F.Z., Bigsby, R., Lester, B.M. (2004). Clinical Uses of the NNNS. In: Lester, B.M. & Tronick, E.Z. (Eds), The NICU Network Neurobehavioral Scale (NNNS). Pediatrics, 113 (3), 679-689.

Pamela High, MS, MD, FAAP - Professor

Dr.High is a Clinical Professor in the Department of Pediatrics. She is Director of the Division of Developmental-Behavioral Pediatrics (DBP) in the Department of Pediatrics and serves as Program Director for fellowship and residency training in Developmental and Behavioral Pediatrics. In addition, she directs the Infant Cry, Behavior and Sleep Program at the Center and co-directs the Hasbro Partial Hospital Program.

Dr. High's interests are medical education in developmental and behavioral pediatrics with a focus on early childhood issues and interdisciplinary collaboration. She has organized pediatric grand rounds for the Department of Pediatrics at Rhode Island Hospital since 1995, and she currently chairs the Education Committee for the Society of Developmental and Behavioral Pediatrics where, for the past 7 years, she has organized an all-day workshop at the Society's Annual Meeting on teaching DBP to pediatric residents.

Dr. High is a member of the American Academy of Pediatrics Committee on Early Childhood, Adoption and Foster Care. She helped plan and moderate the first two DB-PREP courses to help prepare subspecialists to sit for the first boards in DBP offered in 2002 and 2004, and she chairs the planning committee of the upcoming DB-PREP scheduled for July 2006. In addition, Dr. High represents the Society for Developmental and Behavioral Pediatrics at the American Board of Pediatrics for recertification in Subspecialty Pediatrics and she is Book Review Editor for the Journal of Developmental and Behavioral Pediatrics.

Her clinical and research interests include infant behavioral issues such as colic, sleep problems and feeding problems, anticipatory guidance including literacy promotion in primary care, and the interrelationship of medical and psychological problems in childhood.

Pamela_High@Brown.edu

Selected Publications

• Miller-Loncar, C., Bigsby, R., High, P.C., Wallach, M. & Lester, B.M. Infant Colic and Feeding Difficulties, Archives of Diseases in Childhood. October 2004, 89 (10):908-912.
• Roesler, T.A., Rickerby, M.L., Nassau, J.H., High, P.C. Treating a high risk population: A collaboration of Child Psychiatry and Pediatrics. Medicine and Health – Rhode Island, 2002, (85) 265-268.
• High, P.C., LaGasse, L., Becker, S., Ahlgren, I., Gardner, A. Literacy Promotion in Primary Care Pediatrics: Can we make a difference? Pediatrics, 2000; 105 (4), 927-934.

Jing Liu, PhD – Assistant Professor

Dr. Liu is an Assistant Professor (Research) in the Department of Pediatrics. Dr. Liu's research is focused on the study of environmental risk factors on the developmental processes of children born with prenatal drug exposure. Such environmental risks include neighborhood risks such as violence and poverty, parenting psychopathology such as maternal depression, as well as the home environment such as inadequate provision of learning materials and parent-child interaction.

Dr. Liu is particularly interested in identifying and developing statistical methodologies that can parse the overall environmental effects into the effects of individual risks and evaluate how environmental risks and prenatal drug exposure interact with each other to affect developmental processes. Findings of research will provide valuable information for interventions. Dr. Liu also serves as the Center's biostatistician.

Jing_Liu_1@Brown.edu

Selected Publications

• Seifer, R., LaGasse, L.L., Lester, B.M., Bauer, C.R., Shankaran, S., Bada, H.S., Wright, L.L., Smeriglio, V.L., Liu, J. (2004). Attachment status in children prenatally exposed to cocaine and other substances. Child Development, (75), 850-868.
• Maxted, A.E., Dickstein, S., Miller-Loncar, C., High, P., Spritz, B., Liu, J., Lester, B.M. (2005). Infant colic and maternal depression. Infant Mental Health Journal, (26) 56-68.
• Coyle, M., Ferguson, A., LaGasse, L., Liu, J., Lester, B.M. (2005). Neurobehavioral effects of treatment for opiate withdrawal: A comparison of treatment strategies. Archive Dis Child Fetal Neonatal Ed, (90), F73-74.

Amy Salisbury, PhD - Assistant Professor

Dr. Salisbury is an Assistant Professor (Research) in the Department of Pediatrics. Her fetal studies program examines fetal and infant neurobehavioral development. Fetal neurobehavior is assessed to determine neurologic integrity and behavioral stability of the fetus at various points in development. Measurement of fetal neurobehavior is accomplished by monitoring and recording fetal heart rate, motor activity, behavioral state, and responsiveness to extra-uterine stimuli. Dr. Salisbury and her colleagues have developed an organized method of assessing fetal neurobehavior, called the Fetal Neurobehavior Coding System (FENS). The FENS was patterned after the NICU Network Neurobehavioral Scale (NNNS) for at-risk infants. The two methods are used across development for a cohesive assessment of neurobehavioral development.

Assessment of neurobehavior can be used for many purposes. In current research the FENS Is being used to study the effects of fetal exposure to antidepressant medications, maternal depression, and maternal smoking, as well as buprenorphine and methadone treatment of heroine addiction.

Dr. Salisbury's research focus uses prenatal and postnatal neurobehavioral data within a larger biopsychosocial framework. The main goal is to examine why and how children develop mental illness. This includes consideration of variables that contribute to resilience in those children that do not develop a psychiatric diagnosis. This approach requires measurement of the infant-parent system, including physiology, genetics, behavior, social communication, and the environment. Results from this work should contribute to better prevention and treatment options in child and family psychiatry.

Amy_Salisbury@Brown.edu

Selected Publications

• Salisbury, A., Duncan Fallone, M., Lester, B., Neurobehavioral Assessment From Fetus to Infant: The NICU Network Neurobehavioral Scale and the Fetal Neurobehavior Coding System. 2005, Mental Retardation Developmental Disabilities Research Review 11 (1), 14-20.
• Salisbury, A., Yanni, P., LaGasse, L., Lester, B., 2004. Maternal-Fetal Psychobiology: A Very Early Look at Emotional Development. In Emotional Development: Recent Research Advances, J. Nadel, D. Muir, (Eds). Oxford University Press.
• Salisbury, A., Law, K., LaGasse, L., Lester, B., Maternal-Fetal Attachment. 2003. JAMA 289 (13), 170.

Stephen J. Sheinkopf, PhD - Assistant Professor

Dr. Sheinkopf is an Assistant Professor (Research) in the Department of Psychiatry and Human Behavior. Dr. Sheinkopf is a clinical psychologist and is also a member of the Developmental Disabilities Program at Bradley Hospital and a faculty member of the Brown Brain Sciences Program. Dr. Sheinkopf has extensive clinical experience in the area of early childhood, with particular expertise in the area of early diagnosis and development of young children with autism and developmental disabilities.

His research interests include studies of young children with autism and the development of children with prenatal drug exposure, including investigations of joint attention and social communication behaviors in these populations, as well as studies using measures of psychophysiology, such as cardiorespiratory functioning and functional neuroimaging. Dr. Sheinkopf's teaching responsibilities are with pediatric residents, fellows and clinical psychology trainees.

Stephen_Sheinkopf@Brown.edu

Selected Publications

• Sheinkopf, S.J., Mundy, P., Oller, D.K., & Steffens, M. (2000) Vagal atypicalities of preverbal autistic children. Journal of Autism and Developmental Disorders, (30), 345-354.
• Sheinkopf, S.J., Mundy, P., Claussen, A.H., & Willoughby, J. (2004). Infant Joint Attention Skill and Preschool Behavioral Outcomes in At-Risk Children. Development and Psychopathology, (16), 273-291.
• Sheinkopf, S.J., Lester, B.M., Eliassen, J. C., Sanes, J.N., Hutchison, E. R., Seifer, R., et al. (2004). Functional MRI and prenatal cocaine exposure. Pediatric Research, 55 (4), 580A.
• Sheinkopf, S.J., Lester, B.M., LaGasse, L.L., Seifer, R., Bauer, C.R., Shankaran, S., Bada, H., Poole, K., Wright, L.L. (2006). Neonatal Irritability, Prenatal Substance Exposure, and Later Parenting Stress. Journal of Pediatric Psychology, (31), 27-40.

Mary C. Sullivan, PhD - Associate Professor

Dr. Sullivan is an Associate Professor in the College of Nursing at the University of Rhode Island. Dr. Sullivan's research is focused on the developmental trajectories of preterm infants and understanding the medical and environmental risk and protective processes that exacerbate or ameliorate the impact of cumulative risk on outcomes. Developmental outcomes include cognitive, academic, medical, neurological and socio-emotional domains.

The team has been following two cohorts of almost 400 children who were born prematurely in a series of studies begun in 1985. Two smaller studies include a feasibility study using Magnetic Resonance Imaging (MRI/fMRI), kinematics, and traditional visual motor tests to examine brain anatomy and neuroactivation differences in children with known motor deficits contrasted with full term children with no anatomical, volumetric or functional activation abnormalities. The research protocol is designed to acclimate children of a wide age range to the Magnetic Resonance system. The paradigm adjusted for complexity by using nearly identical visual motor and kinematic assessment in a pre-MR session that are repeated in the magnet in an expanded visual-spatial task.

In an effort toward research translation, Dr. Sullivan's team has presented a series of programs to disseminate knowledge and assessment approaches on preterm infants to Family Outreach Program (FOP) nurses. The FOP is a statewide pediatric maternal visiting program that identifies mothers and infants at risk during the hospital stay. Approximately 50% of the infants followed in home visits were born prematurely.

MCSullivan@uri.edu

Selected Publications

• Sullivan, M.C. & Hawes, K. Brain Anatomy & Visual Motor Integration in Preterm Children. (April 2005). Paper presented at the Eastern Nursing Research Society
• Sullivan, M.C. & McGrath, M.M. (2003). Perinatal morbidity, mild motor delay, and later school outcomes. Developmental Medicine & Child Neurology, 45: 104-112.
• McGrath, M.M. & Sullivan, M.C. (2003) Testing proximal and distal protective processes in preterm high risk children. Issues in Comprehensive Pediatric Nursing. 26: 59-76.

Jean Twomey, PhD – Assistant Professor

Dr. Twomey is an Assistant Professor (Research) in the Department of Psychiatry and Human Behavior. Dr. Twomey has been involved through research, program development and clinical intervention in working with families affected by perinatal substance abuse. She is affiliated with the Maternal Lifestyle Study (MLS) and IDEAL, longitudinal studies on the effects of prenatal substance exposure on child development. The Vulnerable Infants Program of Rhode Island (VIP-RI) was established to assist families affected by perinatal substance use and to promote permanency planning within the time frame mandated by the Adoption and Safe Families Act (ASFA).

An outgrowth of VIP-RI and their collaboration with the Family Treatment Drug Court (FTDC) is a project, directed by Dr. Twomey, to study the trajectories of parents and their children's developmental outcome over the course of the 18 months following graduation from FTDC. This will be a pioneering study on the relationship among FTDC, ASFA, and child protective services, and the first long-term follow-up of infant and parental outcomes following drug court involvement.

Dr. Twomey's involvement in the Center's clinical services includes providing therapy to young children and their families and to parents in the Infant Behavior, Cry and Sleep Program. Her clinical and research interests include the parenting abilities of substance using women, the role of partners in families affected by perinatal substance use, and parent-infant relationships.

Selected Publications

• Lester, B.M., Boukydis, C.F.Z., & Twomey, J.E. (1999). Maternal Substance Abuse and Child Outcome. In: C.H. Zeanah, Jr. (Ed.). Handbook of Infant Mental Health Second Edition. New York: Guilford Press, 161-175.
• Twomey, J.E., Soave, R., Gil, L., & Lester, B.M. (2005). Permanency planning and social service systems: A comparison of two families with prenatally substance exposed infants, Infant Mental Health Journal, (26), 250-267.

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