Dr. Pajer is a Full Professor of Psychiatry, was Chair of the University of Ottawa Department of Psychiatry from 2017-2022 and Chief of the CHEO Psychiatry department from 2014-2022. Her research has produced over 80 peer-reviewed papers, mainly on two topics: 1) the biopsychosocial characterization of conduct disorder in adolescent girls and 2) improving the child and youth mental healthcare delivery system. The work has been funded over the years by the U.S. National Institutes of Health, the Canadian Institutes of Health Research, the Ontario Ministry of Health, and various non-federal funders.
Dr. Pajer’s current focus is on using precision health to transform child and youth mental healthcare delivery and research. She is the Medical Lead of the CHEO Precision Child and Youth Mental Health Initiative, a cross-institutional program with SickKids in Toronto.
Research Projects
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Impact of a publicly-funded pharmacare program on prescription stimulant use among children and youth: A population-based observational natural experiment.
27/10/2023
Prescription drug coverage is a less well-studied determinant of medication access among individuals with ADHD. In one US study, children without insurance were less likely to be prescribed stimulants than those with private or public insurance. Similarly, a separate US study found that most stimulant prescriptions were paid through commercial insurance, with copayments required for nearly two-thirds of prescriptions dispensed. Therefore, disparities in insurance status may be an important source of inequity in treatment for children and youth with ADHD, favouring individuals with private insurance and the financial resources to cover out-of-pocket costs. This assertion is supported by findings from research associating higher income with a greater likelihood of stimulant treatment and lower treatment rates in children with ADHD from low-income families despite being at least as likely to meet the diagnostic criteria for this condition as high-income children.
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Electronic health records identify timely trends in childhood mental health conditions.
14/09/2023
Our interdisciplinary team of experts in informatics and Child and Adolescent Psychiatry collaborated in assessing the utilization of available, aggregated, standardized EHR data in identifying and tracking the full diagnostic spectrum of MH disorders/symptoms and exposure to ACEs, over time, across multiple sites and identifying groups at risk by year and demographics. This study necessitated the development of an EHR-based pediatric MH condition typology that expanded on the Diagnostic and Statistical Manual of Mental Disorders (DSM) by including Intentional Self-Harm, Catatonia, Encephalopathies, Standalone Symptoms, Tic Disorders, added exposure to ACEs, and that took into account the 2015 U.S. healthcare transition to the International Classifications of Diseases (ICD-10) [13]. This involved assembling clinical codes representing single diagnoses and symptoms from the Systematized Nomenclature of Medical Clinical Terms (SNOMED CT) [14, 15] which were then cross-mapped to ICD-9 [16] and ICD-10 [17] and checked for omission, commissions and alignment with DSM-5 [18].
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Validating existing clinical cut-points for the parent-reported Strengths and Difficulties Questionnaire in a large sample of Canadian children and youth.
01/09/2023
This study validated the existing British SDQ cut-points in a large sample of Canadian children and youth and developed Canadian-specific cut-points using a distributional approach and receiver operating characteristic (ROC) curves. The Canadian-specific clinical cut-points (90th percentile) using the distributional approach demonstrated higher specificity than the ROC curve derived cut-points. For this reason, the distributional cut-points have better population-based utility. Both the existing British and the Canadian-specific clinical cut-points for the total difficulties score met the threshold for clinical utility to predict mental health diagnosis.
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Circadian cortisol secretion in adolescent girls with conduct disorder
07/11/2022
This study advanced our knowledge about girls with severe antisocial behavior, discovering that lower circadian cortisol secretion is present in girls with CD, but largely due to decreased volume of cortisol secretion between awakening and 30-minutes post-awakening time. Comorbid internalizing disorders were not associated with differences in circadian secretion of cortisol, compared to girls with only CD.
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A stochastic optimization approach for staff scheduling decisions at inpatient units
26/10/2022
In this paper, we propose an optimization scheme in order to schedule the operations of the orthopedic surgery division at Habib Bourguiba University Hospital. This type of planning could be performed for a general problem of scheduling “n” operations in “m” operating rooms and “b” recovery beds with the conditions that: m ⩽ b, longer operation takes longer recovery time and no wait as much as possible between the operating room and the recovery room.