Profile Professor Valsamma Eapen

Professor Valsamma Eapen always knew she wanted to work with children. She also knew she wanted to study medicine in keeping with other family members. Becoming a paediatrician seemed the obvious career choice.

But in her internship year, working in a children’s oncology unit and then in the Emergency Department, Prof Eapen realised that the path she was on did not align with her dreams.

“I found working in both these environments, extremely stressful and emotionally difficult. I witnessed children coming into ED as highacuity patients and saw some take their last breaths. I realised that although I still wanted to work with children, I needed to go down a different pathway,” she explained.

The pathway she took led her down a new trajectory which would see her become one of Australia’s leading researchers and educators in child and adolescent psychiatry with a focus on Neurodevelopment, Autism, Attention Deficit Hyperactivity Disorder and Tourette Syndrome.

“I was fascinated with the brain and the mind/body connection so neuropsychiatry and neurodevelopment seemed like a good idea because it meant I could work with young children to make a difference rather than wait until conditions had set in which makes them difficult to change.

“If you intervene in the first 2000 days of a child’s life (from pregnancy to start of school) when the brain’s plasticity is the most malleable, then you have the most potential to change their life trajectory and that became the focus of my life’s work.”

Prof Eapen initially worked with Tourette patients because it combined all the facets of mind/brain/body connection that fascinated her.

“Tourette’s was the crystallisation of everything I was interested in: the brain and its involvement in involuntary movements such as tics and the mind overlay through behaviours such as obsessions, compulsions, and socially inappropriate actions associated with this lack of control, and of course the secondary psychological challenges due to stigma, bullying etc.”

Wanting to learn more about neurodevelopmental disorders, and Tourette’s in particular, Valsa moved to London where she completed her PhD at University of London via research at the UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, whilst undertaking her registrar training at the University College Hospital scheme and child psychiatry training at the Great Ormond Street Hospital scheme, London.

A trip across the seas

In 2008, Prof Eapen moved to Australia where her interest in neurodevelopmental disorders broadened to include an equity angle in the context of her clinical work in South West Sydney where Prof Eapen heads the Academic Unit of Child Psychiatry, South West Sydney Local Health District. It is in this space that she began to make significant impact, not only to the lives of children and their families, but also to the health system.

Changing the health landscape

Working in child mental health, Prof Eapen has seen first-hand the difficulties families face when confronted by what she describes as a fragmented health system.

“In South West Sydney, I came to a new realisation that it doesn’t matter what condition you have, it’s the social determinants of health that make or break your trajectory. That is, you can have the same diagnosis, but the social determinants will dictate what treatment you can access, who you can see and how your condition progresses,” explains Prof Eapen.

Of particular concern to Prof Eapen was that parents were not engaging in the critical child developmental checks because of these social determinants as well as the complex and disjointed system that many families struggle to navigate (e.g. GP, state, NGO, private).

“In our first NHMRC Grant we aimed to understand how well baby health checks are done, who accesses, where, and the outcomes. We had a cohort of 2000 babies born in Liverpool and Bankstown hospitals who we followed up at six, 12, and 18 months. What we knew clinically was confirmed about the very low uptake of the blue book* developmental checks with only around 30% engaging at 12 months and a further steep decline after that.

Prof Eapen’s qualitative work found that the divide between the state and federal system was a significant issue. She discovered that families weren’t taking their children to child and family health nurses for their child developmental checks due to a range of issues including lack of transport, language barriers, poor health literacy, and unique help seeking patterns of multicultural families, and often they were only visiting their local doctors when their child was sick. Critical developmental checks were not being undertaken by GPs as these checks formed part of the State’s child and family services and not the federal GP system.

Prof Eapen explains that while one- in-five Australian children have one or more developmental difficulties (e.g. speech delay, autism) when they start school, many are not identified early, thereby missing opportunities for early intervention.

Watch Me Grow

To bridge the gap between the different service systems and to overcome the poor awareness as well as the structural, financial, geographic barriers to service access, the Watch Me Grow program was developed with a view of ‘going to where the children go’ in order to empower parents to engage in the developmental monitoring of their children. Initially piloted in South Western Sydney, Watch Me Grow is now being scaled up across three sites covering multicultural (Fairfield, NSW), regional/rural/Aboriginal (Taree, NSW) and low socioeconomic (Wanneroo in WA) communities for early identification as well as a tiered care response based on needs.

(see article SPHERE Grants Spur Nationwide Health Initiatives on p 19 for more information about Watch Me Grow).

And that’s not all…

If she isn’t busy enough with Watch Me Grow, Prof Eapen is working on a range of other projects including continuing her work in Tourette’s and Autism.

“I’m doing a cannabis trial for people with Tourette’s who haven’t responded to conventional treatment and my team is also trialling a behavioural intervention group program for Tourette Syndrome as well as developing a novel intervention for functional tics.”

As Director of Early Years program of the Autism CRC (completed in 2022), the world’s first national, cooperative research effort focused on Autism across the lifespan, Prof Eapen had oversight of several national programs such as the Autism Subtyping program with sites across all the six states in Australia, the Australian Autism Biobank project, in addition to the development of the National Autism guideline.

“I’ve also developed a Quality of Life in Autism (QOLA) scale which is now being used by 98 teams across 32 countries and recently published a cross-cultural comparison paper across seven countries.”

As Professor and Chair of Infant, Child and Adolescent Psychiatry at UNSW Sydney, Prof Eapen teaches medical students and registrars and supervises honours/Masters/ PhD students and medical students, registrars and fellows for scholarly research projects. In this regard, she is the Australian faculty lead for the Child Psychiatry International Fulbright Medical students Mentorship program.

Prof Eapen is the Chair of the Bi-national Faculty of Child and Adolescent Psychiatry, The Royal Australian and New Zealand College of Psychiatrists (RANZCP), and in this role she led a pre-budget submission to NSW Government in 2021 that resulted in the biggest ever investment in child mental health of $109 million for establishing rapid response Safeguards teams across NSW.

She is also the Treasurer and President Elect, International Neuropsychiatry Association.

Where to next?

From a young age, Prof Eapen had a vision to work with children but her work has grown beyond that.

“My work continues around finding evidence to support a tiered model of care that is responsive, integrated, sustainable and equitable in which all children irrespective of their socioeconomic, cultural and linguistic or geographic backgrounds have access to early identification of child developmental and mental health needs in conjunction with early intervention that is not just early in illness but early in life.”

* The ‘blue book,’ as it is known, is provided to all babies born in NSW and serves as the child’s first health record journal.

• Prof Eapen has published over 350 peer reviewed journal articles including in prestigious journals (e.g. Nature Reviews, Nature Medicine, BMJ, Neuron, Cell, Lancet (Child and Adolescent Health), JAMA Pediatrics), 6 books, >50 book chapters, international resources, podcasts, print, radio, and TV engagements.

• Her book “Where There Is No Child Psychiatrist” is used internationally to upskill professionals in early identification and management of child mental health problems, particularly in developing countries.

• Prof Eapen is part of grants totalling >$40million and leads the field, 4th worldwide for scholarly output for the topic “Child Development/Early Intervention” and 1st in Australia for topic “Tourette/Tic Disorders.”