Research Projects

​AMIS – Analyzing pathways from childhood maltreatment to internalizing symptoms & disorders in children and adolescents

Background: Effective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathological mechanisms leading from maltreatment to behavioral disorders. Although some studies have already identified individual risk factors, there is a lack of research on how psychosocial, neurobiological, and genetic factors interact to modulate risk of internalizing symptoms in childhood subsequent to maltreatment.

Objectives: We aim to delineate gender-specific pathways from trauma to disorder / resilience and to study endocrine, metabolomic, and genomic stress response patterns to maltreatment alongside cognitive-emotional / social factors and developmental outcome. Specifically, we seek to study the interplay of maltreatment characteristics, individual cognitive-emotional coping styles, social support, endocrinological response patterns and genetic vulnerability factors.

Work plan: We will assess 4 large child samples: 2 samples (n= 585 plus 310 matched controls) with internalizing symptoms will be checked for maltreatment and 2 samples (n=220) with substantiated maltreatment will be checked for internalizing symptoms. We will apply a multi-source strategy with multiple informants (parents, children, teachers, and child protective service reports) in order to assess maltreatment and psychopathological symptoms, multiple measurements of risk and protective factors and cutting-edge laboratory analyses of endocrine, steroid metabolomic and epigenetic factors. As first assessments in two samples are under way now as part of ongoing research, we will be able to collect first longitudinal data within the three year study period.

Consortium structure: Our consortium is comprised of leading academics in the field of child psychiatry, neurobiology, (epi-) genomics, psychoendocrinology, and heads of child protection services of two large German cities.
Practical consequences: To exploit our results, we will (a) detect early biopsychosocial markers, (b) condense these to screening measures, and (c) create an empirical basis for multisystem-oriented interventions in the wake of maltreatment.

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Presentations:

Keil, J., Andreas, A., White, L. O., Sierau, S., Michel, A., Klein, A. M., & von Klitzing, K. (2013). Analyzing pathways from childhood maltreatment to internalizing symptoms and disorders in children and adolescents (AMIS). Poster presented at the 16th European Conference on Developmental Psychology, Lausanne, Switzerland, September 3rd to 7th.

Trajectories of anxiety and depressive disorders from preschool age to middle childhood and associations with psychosocial and biological factors

Research team: M.A. Yvonne Otto, Dr. Annette Klein

Background: 6 - 8 percent of preschoolers (Haffner et al., 2002) and 10 - 14 percent of school-age children (BELLA-Study) suffer from anxiety or depressive symptoms. Despite their high prevalence, longitudinal studies of anxiety and depression during preschool and school-age remain scarce. To date, neither do we have sufficient knowledge as to whether early emotional symptoms predict future problems nor about precise trajectories. In the current study we assess a sample of children with emotional symptoms and children without such symptoms on a third data-collection point.

Aims of the study:

1. Delineate trajectories of emotional symptoms and anxiety disorders / depression.
2. Identify psychosocial, neurobiological, and genetic predictors for the course of emotional symptoms.
3. Analyze, how these factors interact and whether gender is a moderator.
4. To explore how behavioral and autonomic responses vary as a function of emotional symptoms and anxiety disorders.
   At the first measurement point, the sample consisted of preschool children, aged 4 to 6. At the second assessment, the children were about 7 years old. Currently, a third assessment (the children are now in the age of 8 to 9 years) is underway. At all three measurement points we assess emotional symptoms drawing on a multi-informant approach (parents, teachers, and children) as well as conducting a standardized diagnostic interview with one of the parents to assess psychopathology. Moreover, we investigate psychosocial factors, such as family environment, life events, peer relationships and social competences in detail. Additionally, we seek to assess behavioral and cardiovascular responses (e. g. heart-rate variability) on reaction to fictional social play situations with peers (Cyberball).

The prospective investigation of three assessment points during the key transition period from preschool to school age permits the identification of pathways of symptoms and disorders. Moreover, it enables us to draw conclusions about the etiopathological significance of biological, psychosocial and genetic risk and protective factors, thereby laying the foundation for enhancing preventive and therapeutic approaches.

Funding body: Deutsche Forschungsgemeinschaft (German Research Foundation)

Project period: 2009 - 2012, 2013 - 2016

​LIFE, Leipzig Interdisciplinary Research Cluster of Genetic Factors, Clinical phenotypes and Environment

LIFE works within the research complex of the faculty of medicine at the University of Leipzig. The study aims at investigating the variability of the origin and course of different diseases, e.g. depression, and acts on the assumption of the interplay of environment, life style, biological and genetic factors. In LIFE, community as well as disease samples are assessed longitudinally.

Within the research complex of LIFE the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics investigates the origin and course of emotional symptoms and affective disorders between childhood and early adulthood. We are interested in individual developmental courses of emotional symptoms between child- and adulthood and in the influence of psychosocial, neurobiological and genetic risk and protective factors on these developmental courses. Therefore, we built up a sample of 400 young patients (8 - 12 years) with psychopathological symptoms and a control sample of healthy children (N=400). Both samples will be assessed by means of a multi-informant, multi-method approach in 2-year follow-ups over 10 years.

Funding body: Freistaat Sachsen and the European Regional Development Fund (ERDF).

Study group: Dr. med. Mirko Döhnert, Dr. phil. Stephanie Stadelmann, Dr. phil. Andrea Michel, Dr. rer. med. Sonia Jaeger, Dipl.-Psych. Tina Matuschek, Dipl.-Psych. Madlen Grunewald, Jan Keil (M.A. Soziologie), Dr. phil. Annette Klein, Prof. Dr. Kai von Klitzing

In Cooperation with: Prof. Dr. Ulrich Hegerl, PD Dr. Peter Schönknecht, Prof. Dr. Wieland Kiess, Prof. Dr. Elmar Brähler

Coordination of the LIFE - Research Complex: Prof. Dr. Joachim Thiery, Prof. Dr. Markus Löffler

Project period (funded by LIFE): since 2010

​Brief Psychoanalytic Therapy for children with depressive disorders aged 4-8 years - Evaluation of effectiveness, applicability, and indicative factors in a Randomized Controlled Trial

Research team: Dipl.-Psych. Sarah Bergmann, Dr. phil. Annette Klein, Dr. phil. Lars White, Prof. Dr. Kai von Klitzing

Psychodynamic approaches to treat children and adolescents are frequently used in child and adolescent psychiatry. However, there are only few studies that systemically evaluate the effectiveness of psychodynamic psychotherapies during childhood and adolescence (Windaus, 2005). In the context of treating children and adolescence at the department of our clinic, we developed and manualized the concept of the Short-term Psychoanalytic Child Therapy (PaCT; English manual: Göttken & von Klitzing, 2014). This form of therapy is based on psychoanalytic principles. It combines a therapeutic approach that focusses on the inner world of the child (interpersonal relationships, internal representations) with a consequent inclusion of the parents into the therapeutic process. In a previous study (Göttken, White, Klein, & von Klitzing, 2014), PaCT has shown to be effective in the treatment of children with anxiety disorders.

After the therapy, over 66 percent of children did not show an anxiety disorder (according to DSM IV, assessed with a standardized interview) anymore while during the waiting period for none of the wait-list patients a remission of symptoms occurred. Furthermore, also parents and caregivers / teachers reported a reduction of symptoms immediately after the end of the therapy and 6 months later (follow-up assessment).

The aims of the current study is to systematically evaluate PaCT in the treatment of depressive disorders in children aged 4 to 8 years by using a randomized controlled design including a wait-list control condition. As our intense previous studies on depressive disorders in preschoolers and primary school children (e.g. Otto et al., 2014, von Klitzing et al., 2014) have detected a relevant proportion of children with clinical and subclinical symptoms of depression, we see an urgent need to treat such children with PaCT and evaluate its effectiveness in this context.

PaCT comprises 20 - 25 weekly psychotherapeutic sessions conducted in alternating settings (parent-child together, child and parent, individually). During these sessions, therapist, parent, and child seek to identify and modify the core conflictual theme underlying the relationship and symptoms. During individual sessions including free play the therapist helps the child to work through the child's central conflicts. Depending on the organization of the child's personality, the therapist also uses techniques that promote mentalization. Every fourth session, sessions with the parents take place.

The sample of the planned study will include n=64 children with clinical symptoms of depression and their parents. First, we want to evaluate the effectiveness of PaCT in a pre-post comparison including all 64 children. Second, we want to compare a group of N= 32 children who will immediately receive the treatment with PaCT to a group of N=32 children who will be treated after a waiting period (randomized wait-list control condition). We hypothesize that compared to the wait-list group, PaCT will lead to a stronger decrease in depressive symptoms and disorders (according to DSM V). We will assess children before and after the therapy and the waiting period, respectively, as well as six months after the end of the therapy. We will also analyze changes that are connected to the specific factors of PaCT, e.g. improvement of the child's mentalization or improvement of emotional availability in the parent-child interaction. Furthermore, we will investigate the effects of these aspects on the outcomes of the therapy.

Funding body: Heidehof Foundation GmbH, Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten in Deutschland e.V (VAKJP)

Project Period: 2017 - 2020

Evaluation of Parent-Infant-Toddler Psychotherapy via prevalence and intervention studies (SKKIPPI)

Principal Investigators: Prof. Dr. med. Kai von Klitzing/ Dr. med. Franziska Schlensog-Schuster
Participating Researchers: Mona K. Sprengeler, Psychologist M.A./ Mirijam-Griseldis Galeris, Psychologist M.sc.

The joint research project SKKIPPI realized by the IPU Berlin and its collaborators (Charité Berlin, UKL Leipzig) aims to evaluate the integrated psychotherapeutic-psychiatric care for parents and children during toddlerhood. The research project consists of an epidemiological study on the one hand and two randomized-controlled intervention studies on the other hand.
The purpose of the study is to measure the incidence of parent’s mental disorders occurring after birth of their child and regulation disorders of the infant or toddler. We further aim to assess the utilization of therapy as well as the need, knowledge and costs of partent-child psychotherapy to be able to evaluate the present overall care situation. Finally we intend to measure the efficacy of the Parent-Infant-Toddler Psychotherapy (ESKP) comparing day care unit, inpatient care as well as an ambulant setting with usual care therapy.
In consideration of health-economic aspects, efficacy will be measured by reduction of psychopathological symptoms, improvement of the parent-child relationship, organization and quality of attachment, emotional availability of the mother and the infant’s development.
Across Germany, 360 mother-child dyads take part in the study and are randomly assigned to one of the investigation groups. 120 of these families are scientifically accompanied by the Medical Faculty of the University Leipzig at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics of the University Clinic Leipzig.

Project duration: 2018 - 2021
Funding: Federal joint committee, innovation fund care research (Gemeinsamen Bundesausschuss Innovationsfond Versorgungsforschung)

For further information please see the project website or project flyer (in german).

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