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Anyone who’s undergone an MRI knows what an unpleasant, claustrophobic and noisy experience it can be. But Dr. Dan Dickstein, director of The Pediatric Mood, Imaging and Neurodevelopment Program at Bradley Hospital in Riverside, said kids can’t wait to get inside his machine.

“For a lot of the time they’re in there, they’re actually playing video games,” said Dr. Dickstein, who’s both a pediatrician and child psychologist. “Kids do this willingly and they enjoy it. They get copy of brain pictures; I think we’re single-handedly responsible for more kids doing brain imaging science fair projects.”

Behind all the fun, however, is serious business as the MRIs (magnetic resonance imaging) give doctors a peek into what these kids’ brains are doing while they’re processing game strategy. “Our particular interest is looking at how kids adapt, how they respond to changes,” said Dr. Dickstein, whose ongoing research on bipolar disorder could help pave the way toward improved treatment of the disability.

Specifically, his team has found that bipolar children and adolescents react dramatically different than healthy kids when things are changed up on them. In the game, participants — healthy and bipolar kids ages 7 to 17 take part — are shown a picture of a dog and a cat with the goal of figuring out which one earns the most points.

“Then without warning, the one that mostly gets you points switches; what used to get you punished, now gets you points. It’s a switch, but it’s not that big of a deal,” said Dr. Dickstein.

The results are a big deal, however. “Bipolar kids’ brains respond in the exact opposite (manner than healthy children). They have significant more brain activation when they hit that reversal — that switch — than do healthy kids. It’s almost as if they had never seen this idea before,” he said.

Interesting stuff, but what does it all mean? Dr. Dickstein said the findings will give clinicians, educators, therapists and others better tools to help bipolar kids deal with their disability in the future.

“It shows that that circuitry — how you respond to rewards and punishments — is fundamentally different in bipolar kids. Maybe we need specialized kinds of behavioral therapy to address this problem,” he said, adding that Bradley is hoping to secure a National Institutes of Health (NIH) grant that would help develop a brain-based treatment for bipolar disorder. “We’re going to see if we can re-train the brain through specialized computer games.”

Dr. Dickstein is part of a team of investigators at the Bradley Hasbro Children’s Research Center, which centralizes the efforts of Bradley (the nation’s first psychiatric hospital focusing exclusively on children and adolescents) and Hasbro Children’s Hospital, the two teaching hospitals of The Warren Alpert Medical School of Brown University. Researchers collaborate in the study of autism, bipolar disorder, sleep apnea, substance abuse, asthma and many other areas, with the goal of promoting a better understanding and treatment of these diseases and disorders.

Dr. Gregory Fritz, Bradley’s academic director, said what sets the research center apart from other such facilities around the country is its breadth.

“In this research center, the topics being studied and being funded by the NIH (the source of nearly all of the center’s grants) are not just typical psychiatric studies,” said Dr. Fritz, who’s also the research center’s director. “They also include other studies such as how to treat obese adolescence, what’s the psychophysiology of asthma, what happens to siblings of children who have chronic disabilities or illnesses, how do we prevent adolescents from getting infected from HIV? It’s very unusual for a child mental health hospital.”

Everyone at the center has a faculty appointment at Brown University, known nationally for its excellence in brain science — a source of much study at Bradley. Collaboration is key.

“We all have a particular area of research, but we share information. What one of us learns can be applied to what others are working on,” said Dr. Fritz.

National expert on sleep

Among the more notable Bradley researchers is Dr. Mary Carskadon, a national authority on sleep apnea. “She’s been working in the development of sleep and biological rhythms that govern our day-to-day lives and how they change,” he said. “All over the country select school districts are changing the times teenagers are going to school based on her findings.”

Dr. Carskadon’s research, which dates back to 1985, shows that circadian rhythms shift during adolescence and that teenagers are typically not alert for morning classes. She’s advocated for later start times for high school students, an issue that has been welcomed in some districts and a cause for controversy in others.

The research center has also “raised the bar” in studying the most effective forms of HIV prevention. “You can’t just read a safety pamphlet; they use very involved intensive family intervention,” said Dr. Fritz.

His own research centers around asthma. “We are looking at why minorities have more — and worse — asthma,” he said, adding that the research focuses on Latinos in particular.

Genetic explanation for autism?

Autism is another big focus of the center’s attention. “Today we’re working very hard to get Rhode island to be the model for autism research and treatment,” said Dr. Fritz.

Dr. Eric Morrow heads up the Developmental Disorders Genetics Research Program with the goal of identifying genes associated with autism and intellectual disability so that the disorders can be detected and diagnosed earlier and more accurately — and treated more effectively.

“Ten to 20 percent of autism (cases), we can find genetic markers that are likely part of the explanation,” said Dr. Morrow. While having a medical explanation for autism may not necessarily lead to a cure, the value of such knowledge cannot be underestimated, he added.

“It’s a little bit like if you have a cough and a fever and you go to the emergency room and they find you have some sort of lung infection,” he said, adding that depending on the infection, the patient would receive a specific type of antibiotic. “We’re working to develop those kinds of medical explanations for autism.”

The tests also can help doctors diagnose autism cases much earlier, he said. “One of the more hopeful things with autism is that early detection and intervention is very valuable. Families should have hope that symptoms will improve with early identification and active behavioral interventions,” said Dr. Morrow.

Not only should the research lead to better treatment, it has proven helpful to parents of autistic children who are searching for answers. An international health scare was set off in 1998 when a British doctor claimed a link between autism and the MMR vaccine — a shot against measles, mumps, and rubella. His research was later found to be fraudulent, but some parents still question why their children are in the autism spectrum.

“There’s no evidence that vaccine causes autism. Families are looking for an explanation,” said Dr. Morrow, adding that’s why having a biological explanation so valuable. “It helps them understand why their child is being affected this way. Families have told me they feel some sense of relief by having a genetic explanation.”

If genetic defects can be identified, is there a cure for autism? “You can always dream of a cure,” he said. “My own hope is that these biological predictors will help navigate treatment.”

Crunching the numbers

Dr. Brady Case leads Bradley’s Health Services Research Program. He focuses on identifying and remedying gaps in the care of young people who are struggling with impairing mental health and substance use disorders.

“It’s the field that’s interested in the public health impact of mental health treatment. For example, we have treatments, but how are they affecting the community and to what degree are they being used in the community?” said Dr. Case.

Although he also works independently, the Barrington resident collaborates with other doctors at Bradley, such as Dr. Dickstein with his bipolar research. One study, in fact, was prompted by the large number of youths being diagnosed with bipolar disorder in recent years — a 40-fold increase over the past decade, according to Dr. Dickstein.

Dr. Case looked at nationwide Medicaid data — children in low-income families who were diagnosed with bipolar disorder and prescribed medication — and asked, “Who got started on what drugs?”

Among his findings? “There are a bunch of things that predict which drug you get but race is a really important one, interestingly,” he said, adding that black children, for example, “don’t get lithium” but more often antipsychotics.

“Race is a big deal in psychiatry — bigger than you’d hope. A black kid is only about a quarter as likely as a white kid to get treated for their depression,” said Dr. Case.

The bipolar study also found that by the end of one year, only about 10 percent of the kids prescribed medications were still on them. The next step, he said, is to come up with a reason for these disparities.

One of Dr. Case’s first papers (2007) looked at how long kids typically stay at a hospital when they’re admitted for a psychiatric disorder. In 1990, the average stay was 12 days. By 2000, it had dropped to four and a half.

“Whether or not it was good or bad to get rid of the kids, it was happening,” he said. “What does a four-day stay mean for treatment of depression? An anti-depressant can’t work in four days — we know that. It raised questions: What the heck are we doing?”

Dr. Case asked the same question when pointing to a survey he took part in last year along with the National Institute of Mental Health — what he called the first-ever comprehensive survey of American youth intended on identifying the existing disorders as well as their possible causes.

Among the notable results: “About a third of the kids who have mental disorders in this country have received treatment by the time they’re 17. So, that means we’re missing about two-thirds of the kids — big gap,” he said.

That gap, he said, only proves “how marginal we are as a field in terms of reaching the kids we need to reach,” Dr. Case said. “I feel really proud of the work we do with the kids we have (at Bradley). The question is about those kids we don’t have, and I don’t know what to do about that. I have some ideas, but it’s a big deal. We have to get more community oriented and there needs to be more intervention.”

It’s another example of research at Bradley that could lead to a better course of treatment for unhealthy children and adolescents.

“If we want to help these kids, maybe one thing we have to do is understand why they’re not getting treatment — and then bump it up,” he said.

If you have a child ages 7 to 17 who would be interested in volunteering for the bipolar study — whether they have a psychiatric disorder or not — call 401/432-1600. Dr. Dickstein said there’s a particular need for healthy kids to participate. For more about Bradley Hospital, visit www.lifespan.org/bradley.