History of loss, abuse, grief accompanied by delays in brain development
Tuesday, August 23, 2016
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Barrett Whitener: Why do some young people get in trouble with the law over and over again? In the search for answers to this complex and far-reaching question, researchers funded by the National Institutes of Health found that youth who had been arrested multiple times all shared a history of numerous, extreme, adverse events. These events, such as the death of a parent or being abandoned or abused, were accompanied by profound feelings of grief, shock, or feeling emotionally numb. Young people with a history of the two—adverse events and the emotional reaction to them—had differences in the structure of their brains.
From the National Institutes of Health, I'm Barrett Whitener. This is "Research Developments," a podcast from the NIH's
Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NICHD.
The youth who took part in this study ranged from 16 to 18 years old. They all shared some past experiences. All of them had evidence of disruptive behavior before they were 10 years old; all had come to the attention of the criminal justice system; and they had all been arrested and incarcerated multiple times. The boys, largely from impoverished backgrounds, were Latino, African-American, or Caucasian. They were recruited to the study through the San Diego County Probation Department. The researchers conducted extensive interviews with the teens about their life histories. The youth later underwent magnetic resonance imaging scans of their brains.
With us today is the study's lead author, Dr. Amy Lansing of the Department of Psychiatry at the University of California in San Diego and the Department of Sociology at San Diego State University. Thanks very much for joining us, Dr. Lansing.
Amy Lansing: Thank you so much, Barrett. It's a pleasure to be here.
Mr. Whitener: Can you tell us a little bit about how you conducted the study? How did you find out about the kinds of events the boys experienced?
Dr. Lansing: This was part of a broader study where we had talked with adolescent boys and girls in order to better understand how their life events shaped their cognitive abilities, their emotions, and their behaviors. We had a lot of opportunity to meet with the youth and got to know them over time, as well as a number of different researchers having the opportunity to interview the youth.
So we had a significant amount of buy-in from the youth. In our consenting process, we spent a lot of time explaining to them a bit about what research is about in a general way, and also that it was important for us to understand them as they really are, not necessarily how probation viewed them, their parents viewed them, or how they expected us to view them—but rather, we wanted to get to know them as they really were. We found with an adolescent population that we had a significant amount of buy-in because of this sort of approach. So youth were very forthcoming in talking with us about their adversity experiences.
Mr. Whitener: Now, what you observed, the history of a strong reaction to adverse events—is that like the kind of post-traumatic stress reaction that is seen in combat veterans?
Dr. Lansing: Well, there is some overlap, but we were actually assessing their lifetime symptoms, not just their current symptoms or their symptoms at one point in time. And we were also looking at a broader cross-section of experiences than is typical in a post-traumatic stress disorder type of interview.
So, for example, with the current DSM-V diagnosis, a person has to have experienced death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence in order to qualify for a PTSD diagnosis. We actually took a really broad snapshot in understanding what was important in the youths' lives, what kind of experiences that they had, which were much more broadly defined. And that's why we use the term "adversity."
So, for example, our delinquent boys had on average at least nine events—on average, each youth did—of traumatic events, according to the DSM. But they also had a lot of placements outside of their home, for example—an average of over seven placements outside of their home, either in child welfare or delinquency settings, residential treatment facilities, and things of that nature. More than 83 percent had had separations from or death of a parent. And on average, the youth had experienced their first loss by at least age 5, with many of the youth experiencing around birth to 3 years old, having their first kind of experience with losing a parent or a significant caregiver in their lives.
So we weren't exclusively focusing just on traumatic events, but on a broader range of adversities that the youth had experienced, in addition to more traditional traumatic events, which would include things like physical abuse, sexual assault, and things of that nature.
Mr. Whitener: Speaking of that broader context, what do you think is the link between the history of adverse events, the strong emotional reaction to them that I mentioned earlier, and the repeated behavior problems that these young people show?
Dr. Lansing: Well, when youth grow up in conditions of chronic stress, adversity, and loss, their lives really are quite chaotic. A number of researchers talk about things like poly-victimization, multiple traumatic events. One that we favor as well is the idea of complex trauma, which is defined as those kind of severe, direct harm, interpersonal, repetitive, pervasive events during development that really disrupt attachment.
And so on the one hand, while these youth are very adaptive and resilient in these chronic stress environments, they also are constantly in this "fight, flight, or freeze" survival mode. And so there's this potentially shared clinical presentation between traumatized individuals and antisocial populations.
For example, you might see emotional or affective blunting that is due to trauma and adversity. But it could be interpreted as callous or unemotional characteristics. Similarly, trauma-related hyperarousal could be perceived exclusively as aggression. So there's all of this overlap in clinical presentation that also tend to overlap in terms of neuroanatomical correlates.
And what I mean by that is that if you look at the literature on maltreatment, and if you look at the literature on post-traumatic stress disorder, and you look at the literature, broadly speaking, on conduct disorder, oppositional disorder, psychopathy, antisocial behavior in youth and adults, you actually see similar regions of the brain impacted by, or at least correlated with, these kinds of behavioral patterns. So we think that in part, these experiences, these early experiences, do shape their behavior and their emotional presentation.
Mr. Whitener: I mentioned a minute ago that you found when a young person had a combination of adverse events plus a strong emotional reaction to them, they were more likely to have differences in particular brain areas. Could you tell us what the brain differences were between the subjects, or the delinquent youth, and the controls, the non-delinquent youth that were part of the study—and then also what those brain areas are?
Dr. Lansing: Certainly. So there were several neuroanatomical differences between the delinquent youth and controls, but they were largely in the left frontal regions of the brain. This is really important because these regions of the brain are linked to both verbal and executive cognitive abilities. Executive cognitive abilities are just higher-order problem-solving abilities, flexibility in thinking, set shifting, and things of that nature. And these are two area of cognitive functioning where we see the most impairment among delinquent youth.
So we see smaller left hippocampal volume among delinquent youth. And that's important, because the hippocampus is involved in verbal learning and memory. We saw less left
pars opercularis surface area between delinquents and control youth, and that's important because the
pars opercularis is important for language processing, production, and comprehension. And we also saw less left
superior marginal gyrus surface area between the delinquents and the controls. And this matters because the
supermarginal gyrus is involved in language perception and processing.
So taken together, these different areas of the brain are really involved in verbal and executive abilities. And so that difference between very well-matched controls and delinquent youth is important.
But one of the things that's particularly important here is that as we move from looking at differences between controls and delinquents, when we began to look at events and symptom responses to those events—those kind of adverse traumatic events—one of the big areas that we see involved in terms of adversity among delinquents is the
pars opercularis, which I just mentioned is involved in both language production and comprehension. And this is the area most significantly correlated with lifetime grief, adversity, and trauma symptoms.
lingual gyrus is also implicated among delinquents in terms of being a neuroanatomical correlate related to adversity, and that's an area that's specifically related to processing visually things like letters, identification and recognition of words, analysis of logical conditions, so like the order of events. And these are, again, areas that delinquent youth in particular have deficits cognitively that may be seen in everyday functional settings like school.
So taken together, these findings suggest there could be neurodevelopmental delays or disruptions related to this cumulative adversity. And that's consistent with other recent imaging findings related to poverty and parental education.
Mr. Whitener: Now, what is the connection between those deficits that you just mentioned and the increased likelihood that these young people would get in trouble with the law?
Dr. Lansing: Well, for one thing, difficulty behaviorally in school can lead to contact with the police. We know that there is a fair amount of "school-to-prison pipeline" that occurs. And individuals who are really disruptive, who are really struggling in school, are much more likely to be identified for their behavioral problems rather than exploration of underlying cognitive difficulties that may be contributing to their school performance, or their life circumstances, which may be contributing to how they perform at school. So it's definitely an issue, particularly within school settings.
These are also youth who are likely to become truant because they don't do well in school, and that truancy alone can get them in contact with the juvenile justice system or police.
Mr. Whitener: Is it possible to be sure that the changes you mentioned in the brain are due to the adverse events the boys experienced? How do they compare to other youth from impoverished backgrounds?
Dr. Lansing: Well, adversity events could be in part a proxy for a larger picture of potential prenatal events, maternal distress during pregnancy, and/or poverty. But one of the things we didn't talk about earlier is that we examined both the neuroanatomical correlates of event exposure, so how many different types of events did you experience, how many losses—not number of losses, but types of losses. So, for example, separation from a caregiver, moving from a home, physical abuse, and other kinds of trauma.
And what really matters are the symptoms, not just the exposure to event types. So again, that's not
severity of the events or number of events, but number of type of events that you're exposed to.
Mr. Whitener: Is it possible to say why a combination of adverse experiences followed by the deep grief and depression can affect brain development permanently?
Dr. Lansing: Well, in the present study we present data on grief and trauma symptoms, not depression. But we're also looking cross-sectionally at the data. And longitudinal data are needed to better understand how lasting these effects might be. However, given that we know that the frontal and prefrontal cortex is still developing into our 20s and 30s, and also that hippocampal neurogenesis occurs throughout the lifespan, there's reason for hope. So it's not too late. Even though these youth are older adolescents, they're still very much in the midst of development and may have a more protracted developmental period because of this background of adversity.
Mr. Whitener: That leads into my next question, which is what are the implications of your findings for helping these young people in their life course ahead of them?
Dr. Lansing: Well, the first thing I would say is grief matters. This is one of the few studies really looking specifically at the impact of grief and loss on the lives of these youth. And so it's an important consideration for really understanding what the needs are in the population. So it's not just about post-traumatic stress disorder. It's not even about just current symptoms. It's rather the impact of that cumulative adversity burden, which includes loss and grief.
I think the other implication is that it really does cost more to do nothing. By not addressing the problems that are driving their cognitive problems, their behavior, and their emotions, we really are creating a more problematic picture for these youth, where they are in and out of systems of care, whether these are juvenile justice systems, child welfare, residential treatment facilities; they are not receiving services that they really need early on in order to deal with the chronic stress and trauma that they're experiencing.
I think also that the focus on behaviors exclusively really misses the point of what's going on in these youths' lives. So it's really important that we work toward reducing disparities and assisting youngsters who are experiencing loss, stress, and trauma.
There are a number of ways that could be done, including trauma-sensitive schools that break that school-to-prison pipeline that I was talking about; awareness in our educators about the symptoms of grief and trauma and how to respond to that in ways that help the youth get the care that they need as quickly as possible.
Mr. Whitener: Well, thanks so much for taking the time today to talk about your very important research with us, and we look forward to seeing where it goes from here.
Dr. Lansing: Thank you so much, Barrett.
Mr. Whitener: I've been speaking with Dr. Amy Lansing of the Department of Psychiatry at the University of California in San Diego and the Department of Sociology at San Diego State University.