Out of the dark

Gaze up at the night sky, and the seemingly infinite number of stars scattered across its vast canvas can leave you in awe. Remarkably, trillions of miles closer lies something even more intricate: the human brain.

These two wildly different systems—the universe and the brain—are the most complex known to humankind. While significant progress has been made in exploring a galaxy that stretches 100,000 light-years across, the three-pound mass tucked inside our heads has remained far more mysterious. Treatments for childhood brain conditions have long lagged behind those for diseases like cancer and heart disease. Yet, this organ is central to everything we are—regulating bodily functions, shaping our thoughts and defining our very essence.

The brain is both medicine’s greatest challenge and its final frontier. That’s why medical experts across BC Children’s Hospital are radically rethinking how they confront its varied conditions. Their ability to treat them is dramatically better than it was just years ago—and the future holds even greater promise. With each discovery, they’re moving closer to revealing the brain’s deepest secrets

UNCOVERING THE BIOLOGICAL ROOTS OF MENTAL HEALTH CONDITIONS

If a child breaks a bone or has a suspected heart condition, scans or tests can usually pinpoint the problem, leading to a treatment plan. Mental health conditions, however, are a different story.

“One of the most frustrating aspects of mental health care is that there isn’t a single biologically-based test to diagnose conditions,” said Dr. Tamara Vanderwal, a researcher and child psychiatrist at BC Children’s Hospital. “In this way, mental health care stands apart from every other field of medicine.”

Traditionally, doctors have relied on patient and family self-reports and their own clinical experiences to diagnose mental health conditions and choose treatments. This subjective approach leads to complicated and sometimes long trials of different treatments—leaving many children’s mental health needs unmet.

But change is on the horizon. Thanks to cutting-edge imaging technologies, funded by donors, medical experts can now observe the brain in action with unprecedented detail. This has allowed Dr. Vanderwal to develop a novel way to study mental health conditions: showing movies inside functional MRI scanners. Why movies? As she explains, they engage children’s brains, providing a dynamic way to see how the organ processes unfolding emotions, stories and sounds.

“Think of it like a cardiac stress test,” Dr. Vanderwal said. “Just as doctors assess heart function by making it work on a treadmill, we use movies to stimulate brain activity and observe the brain in action. We think this could help us see the biological changes in children’s brains that underlie mental health symptoms, potentially leading to more accurate diagnoses and better treatments.”

The team has recently launched a new collaborative study to examine what changes occur in the brains of female adolescents with depression when their symptoms improve. This alone is a big undertaking, but Dr. Vanderwal’s plans are even more ambitious. She envisions a future where brain scans could detect a child’s risk of developing a mental health condition—before symptoms strike.

“If we can identify high-risk children early, we could intervene with support or treatment and potentially alter their developmental path,” added Dr. Vanderwal. “This kind of work is still a ways off, but it’s within the realm of possibility.”

Meanwhile, Dr. Evelyn Stewart, Director of Research for Child and Adolescent Psychiatry and Congdon Family Hospital Chair in Child and Youth Mental Health Research at BC Children’s Hospital, is studying lab tests using saliva and cheek swab samples to measure the body’s state of inflammation—along with the “on” or “off” state of differing genes relevant to brain functioning—to gauge how mental health treatments are working. In a pilot study on pediatric obsessive-compulsive disorder, these biomarkers were tracked to assess biological change before and after cognitive behavioural therapy.

Along with helping to understand how this non-medication treatment approach works in the brain, this could identify which children are best served by this treatment. A larger follow-up study will soon explore changes of these and other biomarkers across OCD and a host of other mental health conditions following cognitive behavioural therapy.

Direct brain manipulation is another exciting advancement. One innovative approach is repetitive transcranial magnetic stimulation, or rTMS—which acts like a pacemaker for the brain. This technique uses strong magnets to target and stimulate specific brain circuits to treat mental health conditions with remarkable precision.

Experts at BC Children’s Hospital are preparing to begin studying the effects of rTMS. Because developing brains are more plastic—meaning they are naturally able to form new connections and even new structures more quickly—there’s already promising data revealing its potential for treating adolescents with depression who don’t respond to traditional approaches.

THE MIND AND BODY AS ONE

This groundbreaking work underscores an important realization in medicine: mental health and brain health are deeply interconnected. For years, a gap between neurology and psychiatry has persisted. Closing this divide can revolutionize the way brain-related conditions are treated. While environmental and social factors contribute to mental health, understanding its biological roots is equally crucial. It provides both certainty and precision, something that’s incredibly valuable when navigating the intricate and elusive nature of the brain.

“One of the barriers to progress is this idea that the mind is separate from the body,” explained Dr. Steven Miller, Head of the Department of Pediatrics at UBC and BC Children’s Hospital and Hudson Family Hospital Chair in Pediatric Medicine at BC Children’s Hospital. “Yet, our brains shape who we are. If we have a change in our mental health, cognition or even language or motor skills, there’s a change in the brain. If we can better understand those changes, we can develop better approaches to tackle some of the biggest health challenges facing kids.”

SHAPING THE FUTURE OF BRAIN HEALTH

The way forward in realizing this daring future will require an integrated approach. Given the brain’s complexity, it demands close collaboration among multiple medical specialties—psychiatrists, neurologists, neurosurgeons, psychologists, child life specialists and social workers—working alongside neuroscience researchers who are developing the best evidence to bring to kids’ bedsides.

This work is especially crucial for children, as the foundation for lifelong brain health is laid in the earliest years. Kids’ brains are remarkably malleable—capable of changing, growing and adapting in ways far greater than an adult’s. A well-timed intervention can have a ripple effect that lasts an entire lifetime. Fortunately, brilliant minds across our campus are making extraordinary leaps in unravelling this vast and intricate universe within us.