For kids who face trauma, good neighbors or teachers can save their longterm health

September 16, 2019

Science Daily/Brigham Young University

New research shows just how important positive childhood experiences are for our long-term health -- especially for those who experience significant adversity as a child.

Studies over the past 20 years have found a correlation between the number of adverse childhood events (such as death or divorce) and worse health outcomes later in life. A new study from professor Ali Crandall and other Brigham Young University coauthors discovered that positive childhood experiences -- like having good neighbors, regular meals or a caregiver you feel safe with -- have the potential to negate harmful health effects caused by adverse childhood experiences.

"If your child has experienced trauma and you're worried about the long-term impact it could have on them, these findings show that the positive experiences in childhood lead to better adult physical and mental health, no matter what they have faced," said Crandall, assistant professor of public health at BYU.

Specifically, the study found that even when an individual had four or more adverse childhood experiences (called ACEs), having a high number of advantageous childhood experiences (Counter-ACEs) lessened the negative effect of ACEs on adult health. This is significant because the landmark 1998 ACEs study concluded that having four or more ACEs in childhood greatly increases negative health outcomes, including higher BMI, smoking rates, depression and chronic health conditions.

BYU study participants reported the number of ACEs and Counter-ACEs they experienced in childhood. ACEs include abuse, abandonment, having a family member in jail, alcoholism, mental illness, addiction, divorce or death. The full list of Counter-ACEs includes having good friends and neighbors, beliefs that provide comfort, liking school, teachers who care, having a caregiver whom you feel safe with, opportunities to have fun, feeling comfortable with yourself and a predictable home routine like regular meals and bedtimes.

Accoring to the study findings, published recently in the journal Child Abuse & Neglect, nearly 75 percent of participants had at least one adverse childhood experience, while the average amount of ACEs was 2.67 per person. The average positive experience score was 8.15, with 39 percent of people having experienced all 10 of those Counter-ACEs.

Participants also reported their current health through a variety of physical measures -- like BMI, fruit and vegetable consumption, physical exercise, sleep difficulties and if they smoked daily -- as well as their cognitive and mental health through executive functioning abilities, perceived stress, depression, internal locus of control, gratitude, forgiveness of self and challenging situations and familial closeness. Interestingly, researchers also found that the absence of Counter-ACEs led to poor adult health regardless of the number of ACEs.

"As bad as ACEs may be, the absence of these positive childhood experiences and relationships may actually be more detrimental to lifelong health so we need more focus on increasing the positive," Crandall said.

While many of the adverse childhood experiences in this study are affected by a child's family situation, Crandall said that "other adults in a child's life that are not the parent, like extended family, teachers, neighbors, friends and youth leaders all help to increase the number of counter ACEs and boosts lifelong health."

Crandall believes that increasing counter-ACES in the home is the easiest place to start and is working to educate the community about how to do this in conjunction with United Way. BYU professors Brianna Magnusson, Len Novilla, Carl Hanson and Michael Barnes were coauthors on the study.

https://www.sciencedaily.com/releases/2019/09/190916144004.htm

Early-life challenges affect how children focus, face the day

June 5, 2019

Science Daily/University of Washington

Experiences such as poverty, residential instability, or parental divorce or substance abuse, can affect executive function and lead to changes in a child's brain chemistry, muting the effects of stress hormones, according to a new study.

Adversity early in life tends to affect a child's executive function skills -- their ability to focus, for example, or organize tasks.

Experiences such as poverty, residential instability, or parental divorce or substance abuse, also can lead to changes in a child's brain chemistry, muting the effects of stress hormones. These hormones rise to help us face challenges, stress or to simply "get up and go."

Together, these impacts to executive function and stress hormones create a snowball effect, adding to social and emotional challenges that can continue through childhood. A new University of Washington study examines how adversity can change the ways children develop.

"This study shows how adversity is affecting multiple systems inside a child," said the study's lead author, Liliana Lengua, a UW professor of psychology and director of the Center for Child and Family Well-Being. "The disruption of multiple systems of self-control, both intentional planning efforts and automatic stress-hormone responses, sets off a cascade of neurobiological effects that starts early and continues through childhood."

The study, published May 10 in Development and Psychopathology, evaluated 306 children at intervals over more than two years, starting when participants were around 3 years old, up to age 5 ½. Children were from a range of racial, ethnic and socioeconomic backgrounds, with 57% considered lower income or near poverty.

Income was a key marker for adversity. In addition, the children's mothers were surveyed about other risk factors that have been linked to poor health and behavior outcomes in children, including family transitions, residential instability, and negative life events such as abuse or the incarceration of a parent.

Against these data, Lengua's team tested children's executive function skills with a series of activities, and, through saliva samples, a stress-response hormone called diurnal cortisol.

The hormone that "helps us rise to a challenge," Lengua said, cortisol tends to follow a daily, or diurnal, pattern: It increases early in the morning, helping us to wake up. It is highest in the morning -- think of it as the energy to face the day -- and then starts to fall throughout the day. But the pattern is different among children and adults who face constant stress, Lengua said.

"What we see in individuals experiencing chronic adversity is that their morning levels are quite low and flat through the day, every day. When someone is faced with high levels of stress all the time, the cortisol response becomes immune, and the system stops responding. That means they're not having the cortisol levels they need to be alert and awake and emotionally ready to meet the challenges of the day," she said.

To assess executive function, researchers chose preschool-friendly activities that measured each child's ability to follow directions, pay attention and take actions contrary to impulse. For instance, in a game called "Head-Toes-Knees-Shoulders," children are told to do the opposite of what a researcher tells them to do -- if the researcher says, "touch your head," the child is supposed to touch their toes. In another activity, children interact with two puppets -- a monkey and a dragon -- but are supposed to follow only the instructions given by the monkey.

When children are better at following instructions in these and similar activities, they tend to have better social skills and manage their emotions when stressed. Children who did well on these tasks also tended to have more typical patterns of diurnal cortisol.

But children who were in families that had lower income and higher adversity tended to have both lower executive function and an atypical diurnal cortisol pattern. Each of those contributed to more behavior problems and lower social-emotional competence in children when they were about to start kindergarten.

The study shows that not only do low income and adversity affect children's adjustment, but they also impact these self-regulation systems that then add to children's adjustment problems. "Taken all together, it's like a snowball effect, with adverse effects adding together," Lengua said.

While past research has pointed to the effects of adversity on executive function, and to the specific relationship between cortisol and executive function, this new study shows the additive effects over time, Lengua said.

"Executive function is an indicator that shows the functioning of cognitive regulation. Cortisol is the neuroendocrine response, an automatic response, and the two consistently emerge as being related to each other and impacting behavior in children," she said.

The research could be used to inform parenting programs, early childhood and school-based interventions, Lengua said. Safe, stable environments and communities, and positive, nurturing parenting practices support child development, while a focus on relationships and healthy behaviors in preschool settings can support children of all backgrounds -- those with high as well as low adversity.

https://www.sciencedaily.com/releases/2019/06/190605171354.htm

Childhood adversity linked to early puberty, premature brain development and mental illness

Penn study details effects of poverty and trauma on youth brain and behavior

May 31, 2019

Science Daily/University of Pennsylvania School of Medicine

Growing up in poverty and experiencing traumatic events like a bad accident or sexual assault can impact brain development and behavior in children and young adults. Low socioeconomic status (L-SES) and the experience of traumatic stressful events (TSEs) were linked to accelerated puberty and brain maturation, abnormal brain development, and greater mental health disorders, such as depression, anxiety, and psychosis, according to a new study published this week in JAMA Psychiatry. The research was conducted by a team from Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia (CHOP) through the Lifespan Brain Institute (LiBI).

"The findings underscore the need to pay attention to the environment in which the child grows. Poverty and trauma have strong associations with behavior and brain development, and the effects are much more pervasive than previously believed," said the study's lead author Raquel E. Gur, MD, PhD, a professor of Psychiatry, Neurology, and Radiology at the Perelman School of Medicine at the University of Pennsylvania, and director of the Lifespan Brain Institute.

Parents and educators are split into opposing camps with regard to the question of how childhood adversity affects development into mature, healthy adulthood. Views differ from "spare the rod and spoil the child" to concerns that any stressful condition such as bullying will have a harmful and lasting effects. Psychologists and social scientists have documented lasting effects of growing up in poverty on cognitive functioning, and clinicians observed effects of childhood trauma on several disorders, though mostly in the context of post-traumatic stress disorders (PTSD). There are also anecdotal observations, supported by some research, that adversity accelerates maturation -- children become young adults faster, physically and mentally. Neuroscientists, who are aware of the complexity of changes that the brain must undergo as it transitions from childhood to young adulthood, suspected, and more recently documented that childhood adversity affects important measures of brain structure and function. But this study was the first to compare the effects of poverty (L-SES) to those who experienced TSEs in the same sample set.

The researchers analyzed data from the Philadelphia Neurodevelopmental Cohort, which included 9,498 participants aged 8 to 21 years for the study. The racially and economically diverse cohort includes data on SES, TSEs, neurocognitive performance, and in a subsample, multimodal neuroimaging taken via MRI.

The researchers found specific associations of SES and TSE with psychiatric symptoms, cognitive performance, and several brain structure abnormalities.

The findings revealed that poverty was associated with small elevation in severity of psychiatric symptoms, including mood/anxiety, phobias, externalizing behavior (oppositional-defiant, conduct disorder, ADHD), and psychosis, as compared to individuals who did not experience poverty. The magnitude of the effects of TSEs on psychiatric symptom severity was unexpectedly large. TSEs were mostly associated with PTSD, but here the authors found that even a single TSE was associated with a moderate increase in severity for all psychiatric symptoms analyzed, and two or more TSEs showed large effect sizes, especially in mood/anxiety and in psychosis. Additionally, these effects were larger in females than in males.

With neurocognitive functioning, the case was reversed; poverty was found to be associated with moderate to large cognitive deficits, especially in executive functioning -- abstraction and mental flexibility, attention, working memory -- and in complex reasoning. TSEs were found to have very subtle effects, with individuals who experienced two or more TSEs showing a mild deficit in complex cognition, but demonstrating slightly better memory performance.

Both poverty and TSEs were associated with abnormalities across measures of brain anatomy, physiology, and connectivity. Poverty associations were widespread, whereas TSEs were associated with more focused differences in the limbic and fronto-parietal regions of the brain, which processes emotions, memory, executive functions and complex reasoning.

The researchers also found evidence that adversity is associated with earlier onset of puberty. Both poverty and experiencing TSEs are associated with the child physically maturing at an earlier age. The researchers also found the same effects on the brain, with findings revealing that a higher proportion of children who experienced adversity had characteristics of adult brains. This affects development, as the careful layering of the structural and functional connectivity in the brain requires time, and early maturity could prevent the necessary honing of skills.

"Altogether our study shows no evidence to support the 'spare the rod' approach, to the contrary we have seen unexpectedly strong effects of TSEs on psychiatric symptoms and of poverty on neurocognitive functioning, and both are associated with brain abnormalities," Gur said. "The study suggests that it makes sense for parents and anyone involved in raising a child to try and shield or protect the child from exposure to adversity. And for those dealing with children who were already exposed to adversity -- as is sadly the case today with refugees around the world -- expect an increase in symptoms and consider cognitive remediation, a type of rehabilitation treatment which aims to improve attention, memory, and other cognitive functions."

"Traumas that happen to young children can have lifelong consequences," said the study's senior author Ruben C. Gur, PhD, a professor of Psychiatry, Radiology, and Neurology, and director of the Brain Behavior Laboratory. "Obviously it would be best if we could ameliorate poverty and prevent traumatic events from occurring. Short of that, the study calls for paying more attention to a child's socioeconomic background and to effects of trauma exposure. Parents and educators should become more aware of the special needs of children who are exposed to either adversity. Additionally, mental health professionals should be particularly on notice that traumatic events are associated not only with PTSD, but with elevations across domains including mood, anxiety, and psychosis."

https://www.sciencedaily.com/releases/2019/05/190531085404.htm

Adverse events during first years of life may have greatest effect on future mental health

May 1, 2019

Science Daily/Massachusetts General Hospital

A Massachusetts General Hospital (MGH) study has found evidence that children under 3 years old are most the vulnerable to the effects of adversity -- experiences including poverty, family and financial instability, and abuse -- on their epigenetic profiles, chemical tags that alter gene expression and may have consequences for future mental health. Their report appearing in the May 15 issue of Biological Psychiatry, which has been published online, finds that the timing of adverse experiences has more powerful effects than the number of such experiences or whether they took place recently.

"One of the major unanswered questions in child psychiatry has been 'How do the stressors children experience in the world make them more vulnerable to mental health problems in the future?'," says Erin Dunn, ScD, MPH, of the Psychiatric and Neurodevelopmental Genetics Unit in the MGH Center for Genomic Medicine, corresponding author of the report. "These findings suggest that the first three years of life may be an especially important period for shaping biological processes that ultimately give rise to mental health conditions. If these results are replicated, they imply that prioritizing policies and interventions to children who experienced adversity during those years may help reduce the long-term risk for problems like depression."

Studies conducted in both animals and humans have found that adverse experiences early in life can have lasting effects on epigenetics, the process by which chemical tags added to a DNA sequence control whether or not a gene is expressed. These studies reported differences in DNA methylation, which can either silence or enhance gene expression, between individuals who were and were not exposed to early-life stressors.

The current study was designed to test the hypothesis that there are sensitive periods during which adversity is associated with even greater changes in DNA methylation. The investigators also compared that model to an accumulation hypothesis, in which the effects of adversity increase with the number of events, and a recency hypothesis, that the effects of adversity are stronger when events happened more recently.

They gathered data from participants in the Avon Longitudinal Study of Parents and Children, a U.K.-based study that has been following a group of families since the early 1990s. Participating parents report regularly on many aspects of the health and life experiences of their children, who were enrolled in the study before they were born. The current investigation analyzed data from a subgroup of more than 1,000 randomly selected mother/child pairs from which DNA methylation profiles had been run for the children at birth and at age 7.

The children's exposure to adversity before the age of 7 was based on whether parents reported their child's repeated experience of seven stressors:

·     abuse by a parent or other caregiver,

·     abuse by anyone,

·     a mother's mental illness,

·     living in a single-adult household,

·     family instability,

·     family financial stress,

·     neighborhood disadvantage or poverty.

The investigators recorded the number of exposures to each adversity, whether or not they were experienced at specific developmental stages and how close they occurred to the age at which blood samples were taken for the second methylation profile.

The analysis identified 38 DNA methylation sites at which adverse experiences were associated with changes in methylation, most of which were associated with when the stressful experience had taken place. Adversity before the age of 3 had a significantly greater impact on methylation than did adversity at ages 3 to 5 or 5 to 7. Exposure to adversity was typically associated with increased methylation, which would reduce the expression of specific genes; and neighborhood disadvantage appeared to have the greatest impact, followed by family financial stress, sexual or physical abuse, and single-adult households.

Although early-childhood experiences had the greatest effects, adversity at older ages was not without an impact. And while the results provide the strongest evidence for the sensitive or "vulnerable" period model, they do not totally rule out any effect related to the accumulation or recency hypotheses. In fact, two of the sites at which methylation appeared to be changed by adversity were associated with either the number of adverse experiences or how recent they had been.

"These additive effects may work together with the timing of exposure, so it would be interesting to examine more complex mechanisms in future studies with larger groups of participants," says Dunn, an assistant professor of Psychology in the Harvard Medical School Department of Psychiatry. "Our results need to be replicated by other investigators, and we also need to determine whether these changes in DNA methylation patterns are associated with subsequent mental health problems. Only then will we be able to really understand the links between childhood adversity, DNA methylation and the risk of mental health problems; and that understanding could guide us to better ways of preventing those problems from developing."

https://www.sciencedaily.com/releases/2019/05/190501131347.htm

Early life stress and adolescent depression linked to impaired development of reward circuits

October 29, 2015

Science Daily/Elsevier

Early life stress is a major risk factor for later episodes of depression. In fact, adults who are abused or neglected as children are almost twice as likely to experience depression. Scientific research into this link has revealed that the increased risk following such childhood adversity is associated with sensitization of the brain circuits involved with processing threat and driving the stress response. More recently, research has begun to demonstrate that in parallel to this stress sensitization, there may also be diminished processing of reward in the brain and associated reductions in a person's ability to experience positive emotions.

Scientific research into this link has revealed that the increased risk following such childhood adversity is associated with sensitization of the brain circuits involved with processing threat and driving the stress response. More recently, research has begun to demonstrate that in parallel to this stress sensitization, there may also be diminished processing of reward in the brain and associated reductions in a person's ability to experience positive emotions.

Researchers at Duke University and the University of Texas Health Sciences Center at San Antonio looked specifically at this second phenomenon in a longitudinal neuroimaging study of adolescents, in order to better understand how early life stress contributes to depression.

They recruited 106 adolescents, between the ages of 11-15, who underwent an initial magnetic resonance imaging scan, along with measurements of mood and neglect. The study participants then had a second brain scan two years later.

The researchers focused on the ventral striatum, a deep brain region that is important for processing rewarding experiences as well as generating positive emotions, both of which are deficient in depression.

"Our analyses revealed that over a two-year window during early to mid-adolescence, there was an abnormal decrease in the response of the ventral striatum to reward only in adolescents who had been exposed to emotional neglect, a relatively common form of childhood adversity where parents are persistently emotionally unresponsive and unavailable to their children," explained first author Dr. Jamie Hanson.

"Importantly, we further showed that this decrease in ventral striatum activity predicted the emergence of depressive symptoms during this key developmental period," he added. "Our work is consistent with other recent studies finding deficient reward processing in depression, and further underscores the importance of considering such developmental pathways in efforts to protect individuals exposed to childhood adversity from later depression."

This study suggests that, in some people, early life stress compromises the capacity to experience enthusiasm or pleasure. In addition, the effect of early life stress may grow over time so that people who initially appear resilient may develop problems later in life.

"This insight is important because it suggests a neural pathway through which early life stress may contribute to depression," said Dr. John Krystal, Editor of Biological Psychiatry. "This pathway might be targeted by neural stimulation treatments. Further, it suggests that survivors of early life trauma and their families may benefit from learning about the possibility of consequences that might appear later in life. This preparation could help lead to early intervention."

http://www.sciencedaily.com/releases/2015/10/151029102524.htm