Adolescent Psychiatry; Child Psychiatry; Tourette Syndrome; Obsessive-Compulsive Disorder; Psychiatry; Tic Disorders; Global Health
MacMillan Center: Middle East Studies
Dr. Leckman is widely recognized as a master clinician with special skills in the evaluation and treatment of Tourette's syndrome (TS) and early onset obsessive-compulsive disorder (OCD). Since the early 1980s, he has seen and evaluated hundreds of individuals with these conditions. In 1999, he edited with Dr. Donald J. Cohen, Tourette's Syndrome: Tics, Obsessions, Compulsions - Developmental Psychopathology and Clinical Care, published by John Wiley & Sons. Given its success, this volume was re-issued in paperback in 2001. More recently, Dr. Leckman edited (along with Andres Martin, Lawrence Scahill and Dennis Charney) a 56-chapter volume, entitled, Pediatric Psychopharmacology: Principles and Practice published in October of 2002 by Oxford University Press. Dr. Leckman's specific research interests include the interaction of genes and environment in the pathogenesis of TS and OCD. His research on these disorders is well known and multifaceted from phenomenology and natural history, to neurobiology (neuroimaging, neuroendocrinology, neuroimmunology) to genetics, to risk factor research (perinatal factors are important), to treatment studies.
Specialized Terms: Child and adolescent psychiatry; Tourette's syndrome; Obsessive/compulsive disorder (OCD)
Extensive Research Description
James F. Leckman, M.D. is the Neison Harris Professor of Child Psychiatry, Psychiatry, Psychology and Pediatrics at Yale. He serves as the Director of Research for the Yale Child Study Center. Dr. Leckman is a well known child psychiatrist and patient-oriented clinical investigator. His peers have regularly selected him as one of the Best Doctors in America. Dr. Leckman is the author or co-author of over 300 original articles published in peer-reviewed journals, seven books, and 120 book chapters. In 2002, he was identified by American Society for Information, Science and Technology as a “Highly Cited Researcher” - one of the world's most cited authors in Psychology and Psychiatry – in the top half of the top one percent of all publishing researchers.
In 1999, he edited with Dr. Donald J. Cohen, Tourette's Syndrome: Tics, Obsessions, Compulsions - Developmental Psychopathology and Clinical Care, published by John Wiley&Sons. Given its success, this volume was re-issued in paper back in the fall of 2001. More recently, Dr. Leckman edited (along with Andres Martin, Lawrence Scahill and Dennis Charney) a 56-chapter volume, entitled, Pediatric Psychopharmacology: Principles and Practice published in October of 2002 by Oxford University Press. In November 2002, an invited review article on Tourette’s syndrome appeared in the prestigious medical journal The Lancet.
Dr. Leckman is widely recognized as a committed clinician with special skills in the evaluation and treatment of Tourette’s syndrome (TS) and early onset obsessive-compulsive disorder (OCD). Since the early 1980s, he has seen and evaluated hundreds of individuals with these conditions. Physicians, patients and families from across the country and around the world regularly seek his advice. He is frequently invited to address professional, parent and advocacy groups at local, regional, and national meetings as well as international meetings. For example during the past four years, he has presented to professional and/or family groups in London, Rotterdam, Berlin, Rome, Johannesburg, Istanbul, Beirut, Sharm El Sheikh, Tehran, Tel Aviv, Taipei, Tokyo, Mexico City, Lima, and Sao Paulo. He is also a fully trained psychoanalyst.
Interdisciplinary research program on TS & OCD
One of Dr. Leckman’s main research interests has been the interaction of genes and environment in the pathogenesis of TS and OCD. His research on these disorders is well known and multifaceted from phenomenology and natural history, to neurobiology (neuroimaging, neuroendocrinology, neuroimmunology) to genetics, to risk factor research (perinatal factors are important), to treatment studies.
2006 has been another productive year in the world of Tourette’s syndrome and OCD here at Yale. Headlining this year’s contributions are original articles appearing in Science and the Proceedings of the National Academy of Sciences. One of these reports identify for the first time variations in a gene SLITRK1 that confer vulnerability to develop Tourette’s syndrome. The other report is a study of donated postmortem brain tissue that documented dramatic changes in the cellular organization of individuals with severe, persistent, refractory Tourette’s syndrome. We are particularly pleased that several of the first authors of these reports are either currently Yale undergraduates (Diana Feygin), medical students (Jesse Abelson and Paul Kalanithi), or recent medical school graduates (Michael Bloch). This bodes well for the future of research in this area as we bring along the next generation of scientific leaders.
Current projects focus on the role of post infectious autoimmune processes that may play a role in the development and course of some forms of TS and OCD. We are also working collaboratively to understand more about the electrophysiology of TS and OCD. This work includes EEG and magnetoencephalographic studies as well as the use of repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS) to treat individuals with severe forms of these disorders.
Yale Program on Risk, Resilience and Recovery
With the support of Yale School of Medicine, the Institute for Research on Unlimited Love, and a group of private donors, Dr. Leckman partnering with Linda Mayes initiated a new research program that focuses on that special time in the lives of families – from the pregnancy through the first years of life. Under normal circumstances, this is a time of transformation - a time when families come into being and what new parents value changes forever, as well as a time when a new person begins their journey through life. Projects include a prospective longitudinal study of typically developing families. In additional behavioral assessments, brain imaging studies have been an important feature. Another core mission of the program is to facilitate synergism across existing programs of research within the Center and the University as well as with leading investigative teams nationally. These affiliated projects between together investigators at the Child Study Center, as well as those in Psychology, Psychiatry, Obstetrics and Gynecology, Epidemiology and Public Health, Laboratory Medicine, Diagnostic Radiology, and the School of Nursing. Some of the highlights of the last year included a second annual conference that was held in the spring of 2006, entitled: “Risk, Resilience and Recovery: The Formation of the Family and the Effects of Trauma and Recurrent Stress: From Animal Models to Model Programs and Social Policy.”
Drs. Leckman and Mayes also regularly teach an undergraduate seminar on Love and Attachment at Yale College that integrates the principles of evolutionary biology, ethology, and developmental neuroscience with the study of psychopathology.
ERICE (Empowerment and Resilience in Children Everywhere)
With the support of the Fondazione per lo Studio e la Ricera sull'Infanzia el'Adolescenza, Italian Government, the International Association for Child and Adolescent Psychiatry and Allied Disciplines, Dr. Leckman convened child mental health professionals from Israel, the West Bank and Gaza to discuss how best to improve the lives of children in this region of conflict. From the first meeting in Jerusalem in 2004, this group continues to meet both in the region and in Europe. The last meeting was in Rome in July 2006 where we heard the ongoing results from the first funded joint project that is jointly led by Ruth Feldman (Israel) and Iyad Hallaq (West Bank). Theirs is a remarkable project that extends from the Israeli settlements in Gaza to the Palestinian neighborhoods of Nablus. It focuses on the effects of witnessing combat and catastrophe by infants and their families. At the meeting we also developed guidelines for the next round of grant requests. They include: (1) the likelihood of a positive impact for Palestinian and Israeli children; (2) that it will be a joint project involving Israeli and Palestinian professionals; and (3) that it will be feasible and will be capacity building. Thus far, we have secured external funding from NARSAD and the United States-Israel Binational Science Foundation.
As part of his leadership of the research program at the Child Study Center, Dr. Leckman has directed for the past 23 years an institutional postdoctoral research training program at Yale. With seven postdoctoral positions awarded annually, this is one of the largest grants of this kind awarded by the NIMH. Several of the graduates of this program now occupy leadership positions in child psychiatric research nationally. Dr. Leckman has been selected on five occasions as the Outstanding Research Mentor by the American Academy of Child and Adolescent Psychiatrists.
For two years Dr. Leckman served as the Co-Chair of the National Psychiatry Training Council. The NPTC was appointed by Thomas Insel, MD, Director, the National Institute of Mental Health to implement the recommendations of an Institute of Medicine committee report entitled: Research Training in Psychiatry Residency: Strategies for Reform. This effort led to the inauguration of the Albert J. Solnit Integrated Child and Adult Psychiatry Research Pathway at Yale in 2004. With the support of Yale University School of Medicine, NIH, and a group of private donors the Solnit Integrated Research Training Program was initiated to increase the number of physician-scientists with clinical and research skills. Dr. Leckman leads this effort nationally and one other site is active at the University of Colorado where there are also six trainees enrolled.
In 2002, to honor the memory of Donald J. Cohen, The Kingenstein Third Generation Foundation and the John & Patricia Klingenstein Fund established the Donald J. Cohen Medical Student Fellowship program. Through early engagement with patients and their families, this program is designed to encourage medical students to become familiar with the special challenges associated with the care of children and adolescents with mental, behavioral and developmental disorders. Thus far, more that 80 Yale medical students have entered this program. Many are now envisioning careers in child psychiatry and a number are doing their thesis project with faculty at the Child Study Center. Based on the success of the Yale program the Board of the Klingenstein Third Generation Foundation has now funded five additional sites: Harvard, Johns Hopkins, Mt. Sinai, Stanford and the University of California at Davis. Here at Yale the other faculty involved in this effort include: Andres Martin, MD, MPH, and Samuel Ritvo, MD, along with a score of faculty mentors.
We are currently involved in a series of studies focused on tic disorders (Tourette's syndrome, TS) and early-onset obsessive-compulsive disorder (OCD). These include cross-sectional and longitudinal studies that focus on neuropsychological performance and clinical outcomes, genetics, the role of environmental factors (such as psychosocial stress and perinatal risk factors), neurobiology (brain imaging and post-mortem studies), immunobiology, as well as studies evaluating novel treatments, including repetitive transcranial magnetic stimulation (rTMS).
Recent Yale Medical Student Thesis projects have included:
1. Longitudinal studies of the early adult outcomes of children with TS and early onset OCD. We have found that certain clinical indices, certain neuropsychological findings, and certain brain imaging findings are predictive of future tic and OC symptom severity in early adulthood.
2. Cross-sectional neuroimaging and dense array EEG studies looking at the role of sensorimotor gating.
3. Behavioral interventions that require focused attention and fine motor control appear diminish tic frequency.
Recent NIH funded studies include:
1. A multisite prospective longitudinal study of children with PANDAS with a focus of specific immune mechanisms and the role of psychosocial stress.
2. RTMS treatment of adults and adolescents with severe TS.
3. We are also participating in a number of multisite genetics consortia.
Formative Childhood and Peace Building
Most recently, in partnership with colleagues at UNICEF and the Mother-Child Education Foundation based in Turkey, Dr. Leckman has begun to explore the question whether strengthening families and enhancing child development is a path to peace and violence prevention. Related efforts include the Early Childhood Peace Consortium that was launched (September 2013) in New York in at the United Nations and the 15th Ernst Strüngmann Forum that took place in Frankfurt, Germany in October 2013. The deliberations of 40 international experts from a broad range of scientific disciplines are summarized in volume entitled, Formative Childhoods: The Transformative Power of Children and Families, published by the Massachusetts Institute of Technology Press in 2014. More information is available at: http://childstudycenter.yale.edu/international/peace/index.aspx.
Thank goodness for Uncle Sam and the NIMH Intramural Program.
Leckman JF. Thank goodness for Uncle Sam and the NIMH Intramural Program. J Am Acad Child Adolesc Psychiatry 2011;50(9):851-3.
Oxytocin and Social Motivation.
Gordon I, Martin C, Feldman R, Leckman JF. Oxytocin and Social Motivation. Dev Cogn Neurosci. 2011; 1(4):471-493.
Coercive and disruptive behaviors in pediatric obsessive-compulsive disorder.
Lebowitz ER, Omer H, Leckman JF. Coercive and disruptive behaviors in pediatric obsessive-compulsive disorder. Depress Anxiety. 2011; 28(10):899-905.
Breastfeeding, Brain Activation to Own Infant Cry, and Maternal Sensitivity.
Kim P, Feldman R, Mayes, LC, Eicher V, Thompson N, Leckman JF, Swain JE. Breastfeeding, Brain Activation to Own Infant Cry, and Maternal Sensitivity. J Child Psychol Psychiatry 2011 Aug;52(8):907-15.
Variations in maternal behavior--oxytocin and reward pathways--peripheral measures matter?
Leckman JF. Variations in maternal behavior--oxytocin and reward pathways--peripheral measures matter?! Neuropsychopharmacology 2011; 36(13):2587-8
Developmental neuroscience comes of age.
Leckman JF, March JS. Developmental neuroscience comes of age. J Child Psychol Psychiatry. 2011 Apr;52(4):333-8.
Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: A prospective longitudinal study.
Leckman JF, King RA, Gilbert DL, Coffey BJ, Singer HS, Dure LS4th, Grantz H, Katsovich L, Lin H, Lombroso PJ, Kawikova I, Johnson DR, Kurlan RM, Kaplan EL. Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: A prospective longitudinal study. J Am Acad Child Adolesc Psychiatry 2011; 50(2):108-118.
Developmental transitions to psychopathology: from genomics and epigenomics to social policy.
Leckman JF, Yazgan MY. Developmental transitions to psychopathology: from genomics and epigenomics to social policy. J Child Psychol Psychiatry. 2010; 51(4):333 – 340.
Obsessive-Compulsive Disorder: A review of the diagnostic criteria and subtype and dimensional and specifiers for DSM-V.
Leckman JF, Denys D, Mataix-Cols D, Hollander E, Rauch SL, Saxena S, Miguel EC, Phillips KA, Stein DJ. Obsessive-Compulsive Disorder: A review of the diagnostic criteria and subtype and dimensional and specifiers for DSM-V. Depress Anxiety 2010; 27(6):507-27.
Differential brain activity during chronic motor tics and intentional movements of healthy controls.
Hampson M, Tokoglu F, King RA, Constable TR, Leckman JF. Differential brain activity during chronic motor tics and intentional movements of healthy controls. Biol Psychiatry 2009 Apr 1;65(7):594-9.
Neuropsychiatric disorders associated with streptococcal infection: A case-control study among privately insured children.
Leslie DL, Kozma L, Martin A, Landeros A, Katsovich L, King RA, Leckman JF. Neuropsychiatric disorders associated with streptococcal infection: A case-control study among privately insured children. J Am Acad Child Adolesc Psychiatry 2008; 47(10): 1166-1172.
Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder.
Lin H, Katsovich L, Ghebremichael M, Findley DB, Grantz H, Lombroso PJ, King RA, Zhang H, Leckman JF: Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder. J Child Psychol Psychiatry 2007; 48(2)157–166.
Decreased number of regulatory T cells suggests impaired immune tolerance in children with Tourette’s syndrome.
Kawikova I, Leckman JF, Kronig H, Katsovich L, Bessen D, Ghebremichael M, Bothwell ALM. Decreased number of regulatory T cells suggests impaired immune tolerance in children with Tourette’s syndrome. Biol Psychiatry 2007; 61(3):273-8.
A systematic review: Antipsychotic augmentation with treatment refractory Obsessive-compulsive disorder.
Bloch MH, Landeros-Weisenberger, A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: Antipsychotic augmentation with treatment refractory Obsessive-compulsive disorder. Mol Psychiatry 2006 Jul11(7):622-32.
Clinical predictors of future tic and OCD severity in children with Tourette syndrome
Bloch MH, Peterson BS, Scahill L, Otka J, Katsovich L, Zhang H, Leckman JF. Clinical predictors of future tic and OCD severity in children with Tourette syndrome Arch Pediatrics Adolesc Med 2006:160:65-69.
Tourette syndrome: A relentless drumbeat driven by misguided brain oscillations.
Leckman JF, Vaccarino FM, Kalanithi PSA, Rothenberger A. Tourette syndrome: A relentless drumbeat driven by misguided brain oscillations. J Child Psychol Psychiatry 2006; 47(6):537-50.
Basal ganglia volumes and future tic severity in children with Tourette syndrome.
Bloch MH, Leckman JF, Peterson BS: Basal ganglia volumes and future tic severity in children with Tourette syndrome. Neurology 2005 65(8):1253-8
Mutations in SLITRK1 are associated with Tourette syndrome
Abelson JF, Kwan KY, O'Roak BJ, Baek DY, Stillman AA, Morgan TM, Mathews CA, Pauls DL, Ra_in MR, Gunel M, Davis NR, Ercan-Sencicek AG, Guez DH, Spertus JA, Leckman JF, Dure LS, Kurlan R, Singer HS, Gilbert DL, Farhi A, Louvi A, Lifton RP, _estan N, State MW. Mutations in SLITRK1 are associated with Tourette syndrome, Science 2005 310(5746):317-20.
Altered parvalbumin-positive neuron distribution in basal ganglia of individuals with Tourette syndrome.
Kalanithi PAS, Zheng W, DiFiglia M, Grantz H, Saper CB, Schwartz ML, Leckman JF, Vaccarino FM: Altered parvalbumin-positive neuron distribution in basal ganglia of individuals with Tourette syndrome. Proc Natl Acad Sci USA 2005; 102(37):13307-12.
Leckman JF. Tourette’s syndrome. Lancet 2002; 360:1577-1586.
Tourette’s syndrome: When habit forming units form habits of their own?
Leckman JF, Riddle MA: Tourette’s syndrome: When habit forming units form habits of their own? Neuron 2000; 28(2):349-354.