My education and experience over the past decade has prepared me for a clinical research career examining brain function in psychiatric disorders using neuroimaging and neuropsychological research methods. I attended the University of Connecticut clinical psychology doctoral program. I was fortunate to work with several respected neuropsychologists over the course of my graduate education. I received neuropsychological training in private practice, inpatient rehabilitation, and medical school settings. I completed my clinical internship in adult neuropsychological assessment at the West Haven VA Medical Center. My graduate program had a strong emphasis on clinical research training. I was schooled in experimental design and statistical analysis, and I took advantage of opportunities to conduct and publish research applying neuropsychological assessment to childhood autism and memory disorders (Fein et al., 1999; Stevens et al., 2000a,b; Stevens et al., 2001a; see Biosketch for references). The opportunity to publish in several well-respected journals began my interest in a research career.
My research career began in earnest with a postdoctoral position at the Alcohol Research Center at the UConn School of Medicine. I began to examine how neurobiological factors associated with cognitive impairment contribute to psychopathology, particularly to antisocial disorders that are risk factors for substance disorder. I authored several papers examining the relationship of alcoholism risk to executive cognitive abilities in samples of children and adolescents with Conduct Disorder and adults with Antisocial Personality Disorder. This work showed low verbal abstraction ability in Conduct Disordered youth who later go on to develop Antisocial Personality Disorder (Stevens et al., 2001, Stevens et al., submitted). Other work examined the heritability of general intelligence and antisocial traits, finding evidence for separate intergenerational transmission (Stevens et al, submitted). I also examined cognitive ability in relation to early- vs. late-age of Conduct Disorder onset, discovering a new finding – that females with early onset had significantly lower executive-function ability as measured by neuropsychological tests (Stevens et al., submitted).
During this time, I gained skills in fMRI research methods. Although neuropsychological tests are clinically useful and sensitive to brain dysfunction, they often lack specificity and are unable to provide a precise picture of brain dysfunction. I saw the combination of neuropsychology and neuroimaging methods as an ideal way to explore the neurobiological basis of psychiatric illness. Applying fMRI to Conduct Disorder found significant differences in evoked brain response in anterior brain areas (Stevens et al., 2001b). Stimulus-locked time course analysis of brain activity in response to target stimuli showed later latency and greater amplitude of response in anterior cingulate and bilateral insulae. I supplemented experiential learning with fMRI seminars, neuroscience conference attendance, and fMRI workshops (i.e., Visiting Fellowship at MGH NMR center).
When I finished my postdoc at UConn, I was offered a research faculty position to continue my work. I expanded my research with neuroimaging of Conduct Disorder to encompass all disruptive behavior disorders in childhood. I was particularly interested that 1) there is strong evidence that these are distinct disorders, 2) behavioral overlap made them difficult to distinguish using conventional clinical assessment methods, and 3) neuroimaging data has not yet differentiated the disorders neurobiologically. This theme of using research to better understand and differentiate similar psychiatric disorders now is the core of my clinical research approach. I developed a clinic to evaluate ADHD in adolescents and adults, and began comparing cognitive dysfunction in ADHD and Conduct Disorder using neuropsychology and fMRI. Initial results suggest interesting differences in brain function between young adults diagnosed with ADHD versus those with Conduct Disorder, or who were co-morbid with both diagnoses (Kaplan & Stevens, 2001). My pilot work led to the successful application for private grant monies to use fMRI to study ADHD subtypes in adults and methylphendiate response.
I recently took a position at the Olin Neuropsychiatric Research Center (NRC) at Hartford Hospital/The Institute of Living. Among the reasons I took this position is that I can continue using fMRI to explore brain function in psychiatry. More importantly however, this position also provides the opportunity to develop expertise in electrophysiology and measurement of brain function using event-related potentials (ERPs). Moreover, it has allowed me to begin working with like-minded colleagues who shared my clinical research interests. In particular, my research mentor here has published several papers examining the personality construct of psychopathy in adults using ERPs and fMRI. The largest part of my initial effort over the next two years will be to expand this work into youthful populations – using ERP and FMRI to differentiate psychopathy in juveniles from patterns of brain function associated specifically with Conduct Disorder or ADHD. This position also provides me the means and support to consider other factors such as temperament and socialization, which are thought to contribute to antisocial disorders, in neurobiological models of antisocial disorder development. This work will serve as the basis for future treatment studies aimed at reducing the negative consequences these youthful behavior disorders have for adult functioning.