John N. Constantino
Blanche F. Ittleson Professor of Psychiatry and Pediatrics
Director, William Greenleaf Eliot Division of Child & Adolescent Psychiatry
Associate Director of the Intellectual and Developmental Disability Research Center
Co-Director of the Center for Violence and Injury Prevention - George Warren Brown School of Social Work
Dr. John Constantino received a B.A. degree from Cornell University in 1984 followed by an M.D. degree from the Washington University School of Medicine in St. Louis, Missouri. It was after medical school, between 1988 and 1993 that Dr. Constantino joined the Albert Einstein College of Medicine to complete duel residencies in pediatrics and psychiatry, followed by an American Psychiatric Association-Mead Johnson Fellowship in Community Psychiatry. After leaving Einstein, John returned to St. Louis for a Postdoctoral Research Fellowship in Psychiatric Epidemiology at Washington University.
Today, Dr. Constantino is Blanche F. Ittleson Professor of Psychiatry & Pediatrics at Washington University, and he is also Director of the William Greenleaf Eliot Division of Child & Adolescent Psychiatry, Associate Director of the Intellectual and Developmental Disability Research Center, Co-Director of the Center for Violence and Injury Prevention and the Co-Director of the George Warren Brown School of Social Work. Dr. Constantino is also a member of the Scientific Advisory Committee for the Autism Genetic Resource Exchange (AGRE – a program of Autism Speaks) and since 2009 has been its chair. John recently received the Washington University School of Medicine Clinical Teacher of the Year Award and was a Gubernatorial Clinical Advisory Council appointee to the Mental Health Commission in the State of Missouri’ s Department of Mental Health.
Over the years, Dr. Constantino’s research has largely, though not exclusively, focused on the genetic epidemiology of social impairment in autistic individuals and its relationship to expression, the development of quantitative methods for measuring inherited phenotypic components of autistic syndromes, and the discovery of distinct patterns of subclinical autistic traits in the relatives of children with autism. His focus concerns understanding the multigenic influences involved in autism and in identifying possible compensatory factors on the X chromosome that appear to mute its expression and thus explain the higher incidence of autism in males, as opposed to females.
Last but not least, Dr. John Constantino has been a pioneer in the development of the most widely used, quickest, and yet reliable autism spectrum disorder (ASD) assessment tool currently available to teachers and non-psychologists – the SRS (or Social Responsiveness Scale). The SRS was the first of its kind, and John continues to work on modifying and improving it while continuing his quest to discover new genes associated with the conference of risk for autism and its related disorders. (391)
Q: Looking back at your career, what and/or who do you credit as being the greatest influence?
A: Looking back, it was absolutely my time at Einstein, working in the Children’s Evaluation and Rehabilitation Center (CERC) in the 1990s under Dr. Isabelle Rapin that had the greatest influence on my career. Being at Einstein during that time provided me with an excellent model of how to combine research and clinical care. (71)
Q: What do you think made your experience at Einstein so unique?
A: I think the most unique thing about being at Einstein at that time was being able to come in contact with so many excellent doctors and researchers. The degree and high level of “cross-pollination” between disciplines and departments, specifically neuroscience, psychiatry and pediatrics, was profound and provided an extremely rich and rewarding environment – one certainly like no other. In fact, it was this experience which made it clear that the application of quantitative approaches in the diagnosis and treatment of autism spectrum disorders was not only desirable but entirely possible! It was this experience [at Einstein] which influenced the thinking and served as the impetus for the creation of the Social Responsiveness Scale, or SRS. (125)
Q: Please say more about the SRS.
A:The SRS is an easy to use questionnaire that takes roughly 15 to 20 minutes for a teacher or clinician to administer and it appears to have close to a 70% correlation with scores on the ADI-R, which is at the moment, the gold standard in autism diagnoses. The SRS generates a number that reflects the degree of impairment, with 0 representing a very gregarious individual and 170, representing the upper most limit, indicating that an individual has extreme social deficits. Its strengths are that it is a rapid and a reliable quantitative method that can be used as the first step toward seeking diagnosis, thus hastening intervention and further care.
Over the years we have continued to look at SRS data, and have found that autistic individuals have similar impairments in each of the three critical domains important in autism assessment: social impairment, language impairment and repetitive behaviors. They all appear to be very tightly correlated, with the degree of impairment in one area reflected in another area with a corresponding degree of impairment in another. Further, our studies involving siblings of children with autism seem to indicate that mild impairments are highly heritable, and that the SRS, in particular, seems capable of detecting autism-related genetic loci using behavioral information, and that there are distinctive patterns of familial aggregation of sub clinical autistic traits in the relatives of children with autism. (232)
Indisputably, it was though Dr. Constantino’s experience while working under the tutelage of Dr. Isabelle Rapin in the Children’s Evaluation and Rehabilitation Center (CERC) at Einstein that the course for the rest of his career was set, leading to a life-long commitment to researching autism spectrum disorders and to providing care to those individuals affected by it, so in this way, the past continues to influence the present. That said, Dr. Constantino’s ties to Einstein continue as he maintains research collaborations with several of our IDDRC investigators and most recently, Dr. Brett Abrahams with whom he has published on the relationship between disruption in the Celf6 gene and in autism –related behaviors. Dr. John Constantino remains at the forefront of autism research, as he tirelessly advances the effort to identify the patterns and transmission mechanisms involved in the familial transmission of ASD, and through his work as Associate Director of Washington University’s IDDRC.(153)