NIMH Workshop on Child Maltreatment and Trauma: Integrating Biological, Cognitive, and Social Trajectories of Development
Meeting Summary: August 04, 2010 – August 05, 2010
National Institute of Mental Health (NIMH)
In August 2010, NIMH convened a multidisciplinary workshop to discuss the state of empirical knowledge about, and opportunities regarding, the psychological and biological consequences of maltreatment in children. Although the negative consequences of maltreatment are well documented, little is known about the biological mechanisms underlying the association between childhood maltreatment and later mental illness.
Over two days, discussants reviewed current scientific knowledge, highlighted critical challenges, and identified research gaps in our scientific understanding of the impact of maltreatment on biological, cognitive, and social trajectories of development. Invitees included basic neuroscientists, experts in developmental psychopathology, and interventionists. Primary discussion included how each person’s work could inform the others’ expertise, opportunities to develop collaborations, and ideas for how NIMH could optimize progress in these interrelated areas. A series of presentations and group discussions addressed four major topics of the workshop.
Topic 1: New Developments and Challenges in Child Maltreatment Research
The first session highlighted recent findings in order to identify the challenges of conducting integrative studies of child maltreatment. Examples of research with both humans and animal models were provided, demonstrating the potential range of stressors (e.g., physical abuse, violence exposure, psychosocial deprivation) and outcomes (e.g., mood/anxiety disorder, indiscriminant friendliness, gray matter volume) associated with maltreatment.
Workshop participants identified several methodological challenges. First, establishing consistent measurement across studies has been difficult because there are very different means of ascertaining samples (e.g., community, clinic), obtaining data (e.g., retrospective report, medical records), and defining maltreatment (e.g., physical/emotional abuse, exposure to family violence, neglect). Second, more dimensional approaches are needed, as current categorical models tend to provide only abuse vs. non-abuse comparisons and overlook the complex array of factors that affect a child’s experience. Third, there is a pressing need to examine the timing of stressors and parent-child communication, particularly as it relates to brain development, and to map timing similarities better between humans and animal models. Fourth, participants discussed the importance and challenge of measuring “hidden effects” on the brain, where a range of potentially targetable processes are long underway before the observable effects of maltreatment (e.g., depression, anxiety) are detected. Finally, participants emphasized the importance of examining both risk and resilience promoting factors.
Topic 2: Genetics of Maltreatment and Mental Health Outcomes
The second session considered the influence of genetics and gene/environment (GxE) interactions on children exposed to maltreatment. In particular, participants discussed how genetics can be used to predict who will develop specific outcomes, such as mental disorders, as a result of maltreatment, and what research questions are addressable currently. Two presentations focused on the complex roles specific genes, childhood maltreatment experience/stress, and hypothalamic-pituitary-adrenal (HPA) axis response play on the development of later adult psychopathology.
In the discussion, participants emphasized the difficulties in characterizing and measuring environmental influences in GxE studies, from the specific characteristics of abuse to the contributing influence of family structure and context. In addition, the complex role of development was discussed, whereby a continuous GxE interaction occurs over time that is difficult to account for in research studies. Third, in addition to considering the risk that genes may confer for psychiatric disorders, it is also important to consider how genes may promote resilience. Finally, participants discussed the challenges of conducting genetic studies of maltreatment while the field is undergoing a paradigm shift away from specific candidate gene and whole genome wide sequencing (GWAS) studies to large scale sequencing and discovery studies to identify highly penetrant, rare structural variants. New approaches will need to be considered to leverage these new techniques and approaches, as well as the new excitement over inquiries into how early development (<1 year of age) is driven by genetic variation.
Topic 3: Neurocircuitry, Cognition, and Behavioral Outcomes of Maltreatment
The third session examined the effect of child maltreatment on brain circuits and basic neurocognitive and behavioral functioning. Individual presentations focused on animal and human work to delineate these effects in human and animal models, including: age-dependent persistence of early fear memories in rats, behavioral alterations and serotonin functioning in maltreated rhesus monkeys, variations in brain structure and function in youth with PTSD; and long-term neurobiological correlates of childhood abuse in inner city African-American populations.
Discussion from this session centered on how maltreatment researchers can leverage new approaches and opportunities in neuroscience. Investigations of functional connectivity were seen as promising, with longitudinal investigations providing potential insight into the role maltreatment may play in disrupting the development of brain connectivity. The importance of timing was revisited, noting the need to focus on sensitive periods of development when the occurrence of abuse might be particularly significant, and those periods when the effects may be most noticed. In addition, participants discussed challenges related to the use of animal models to understand underlying circuitry and raised questions about how to ensure that models of “abuse” are valid representations of human phenomena.
Topic 4: Integrating Science, Intervention, and Prevention
The final session sought to integrate the varied questions raised by previous presentations and identify the most pressing needs and priorities for future research. In particular, questions related to the role of basic neuroscience in guiding new intervention/prevention development were considered. Specific presentations were provided on: cultural and linguistically appropriate treatment for children; racial disparities in child welfare and representation in research; and, specific approaches to integrating developmental, social, and neurobiological research with adults who have a history of childhood maltreatment.
During discussion, workshop participants emphasized the need for truly collaborative team science that incorporates approaches and perspectives of both basic scientists and interventionists. The establishment of collaborative relationships with imaging researchers was seen as particularly promising, with advances in studies of functional connectivity (e.g., resting state functional magnetic resonance imaging) providing potentially powerful new ways to understand underlying mechanisms. In addition, discussants highlighted the importance of better characterizing the full range of environmental variables and exposures experienced by maltreated children. Further, more powerful bioinformatics approaches are needed to integrate these varied data types, as well as produce additional information from shared datasets.
Participants emphasized the need to move beyond correlational studies and focus on the more difficult task of identifying causal mechanisms that underlie negative outcomes and those active in efficacious interventions. Steps to doing this include focusing on timing and development (e.g., sensitive periods) as well as including biological data collection into therapy research and provision. Finally, intervention researchers could help advance the field by focusing on neuroscience-guided advances (e.g., attention training) to develop efficacy trials of new interventions.
For More Information
For more information, please contact Christopher Sarampote, PhD, 301-443-1959, firstname.lastname@example.org.