Latent vulnerability Child maltreatment through the lens of neuroscience - PowerPoint Presentation

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Latent vulnerability

Child maltreatment through the lens of neuroscience

Friday 2nd December 2016

Eamon McCrory PhD DClinPsyDirector of Postgraduate Studies, Anna Freud National Centre for Children and FamiliesProfessor of Developmental Neuroscience & Psychopathology, UCL e.mccrory@ucl.ac.uk

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Mental Health Problems

May emerge many years later

More likely to be less responsive to traditional treatments

Problems more likely to be comorbid

Problems show greater severity

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Poor

outcome

Adversity

Resilient

outcome

Treatment

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Poor

outcome

Adversity

Resilient

outcome

Early Identification –

how do

we

identify those most at risk?

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Poor

outcome

Adversity

Resilient

outcome

Early Identification –

how do

we

identify those most at risk?

Pinpointing mechanisms –

how does adversity get under the skin?

?

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Early Identification –

how do

we

identify those most at risk?Pinpointing mechanisms – how does adversity get under the skin?Understanding resilience – what can we learn from resilient young people?

Poor

outcome

Adversity

Resilient

outcome

?

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The concept of

Latent Vulnerability

McCrory & Viding Development and Psychopathology, 2015

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The theory of Latent Vulnerability is an emerging framework for thinking about how early adversity can embed long term risk of mental health problems

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Adverse

environment

Response &

adaptation…

Low protective factors

High stressors

Risk genotypes

High protective factors

Low stressors

Resilient genotypes

High risk of disorder

Low risk of disorder

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Adolescence & Latent Vulnerability

Growing up in an early adverse environment will lead to ‘adaptations’ at multiple levels that may have a short term benefit but which may incur long term cots.

Alterations at the epigenetic level. How genes are regulated.

Alterations at the neurocognitive level in ‘representations’ (of self and other) as well as in basic and higher order ‘processes’ Both basic and higher order processes are altered in a range of disorders associated with maltreatment (e.g. anxiety, depression and conduct problems). Here I will focus on:Threat processingAutobiographical memoryHow might early adversity shape these domains in ways that may embed latent vulnerability?

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Genetic

/ Epigenetic

Neurobiological

Cognitive

Behavioural

Maltreatment

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Neurobiological

Cognitive

Behavioural

Maltreatment

Genetic

/ Epigenetic

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Psychiatric Vulnerability

?

?

?

What are the

neuro

-cognitive mechanisms that embed latent vulnerability following childhood adversity?

Adversity

?

Threat processing

Autobiographical Memory

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Pollak

&

Sinha

, 2002, Pollak et al., 20011. Altered threat processing

Children exposed to physical maltreatment have been

shown to have altered processing of angry faces:

able to more accurately identify angry facial expressions using sparse perceptual information than peers

devote more

attentional

resources to the processing of angry faces - interpreted as increased

hypervigilance

to threat

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Pollak et al., 2009

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Pollak et al., 2009: Cognition

% Image

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Pollak

&

Sinha

, 2002, Pollak et al., 2001, Kelly et al., 20151. Altered threat processing

Children exposed to physical maltreatment have been

shown to have altered processing of angry faces:

able to more accurately identify angry facial expressions using sparse perceptual information than peers

devote more

attentional

resources to the processing of angry faces - interpreted as increased hyper-vigilance to threat

In some contexts they show

avoidance

of threat cues – diverting attention away from threat cues that may be processed as aversive

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1. Altered threat processing

Kelly

et al., 2015

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Threat avoidance

Loser

Admired

FailureCabinet

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Threat avoidance

Children exposed to maltreatment show significant hypo-activation of a network potentially reflecting an

avoidant response to social rejection

cues The greater the degree of hypo-activation the greater the level of dissociation symptoms

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Understanding the neural basis of threat vigilance

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Dec 2011

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Dec 2011

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Dec 2011

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Increased right

amygdala

reactivity and increased bilateral

anterior insula reactivity to angry vs. calm faces in children exposed to family violence.

This may be a latent neural marker of latent vulnerability – the same neural signature is common in anxiety disordered populations (Etkin & Wager, 2007).

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Exposure to family violence may

‘recalibrate’ responsiveness of the anterior insula and amygdala in processing potential threat.

But is this a conscious process? In other words, is this hypervigilance to threat under higher order regulatory influence?

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McCrory et al., (2013)

British Journal of Psychiatry

, 202: 1-8

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SC

Thalamus

Amygdala

Cortex“high road”

“low road”

emotional

stimulus

emotional

response

LGN

Pulv

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Amygdala

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Is amygdala reactivity calibrated in response to environmental adversity?

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Wingen et al., (2011)

Amygdala

Anterior

insula

Children

Soldiers

McCrory et al., (2011)

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Amygdala activation

Age of onset of neglect (years)

Duration of abuse associated with amygdala response in children

r

2

=

0.57

McCrory et al., 2013

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Amygdala activation

Severity of abuse (CTQ score)

Severity of abuse associated with amygdala response in adults

r

2

=

0.37

Dannlowski

et al., 2013

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Collectively, these findings suggest that the responsiveness of the amygdala is calibrated and adapts to the degree of environmental threat

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Do higher levels of amygdala reactivity to threat predict future mental health problems?

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Amygdala reactivity BEFORE stress predicts future symptoms

Amygdala activation

before combat (T value)

Change in PTSD Symptoms

Admon

et al., 2009

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Swartz,

Knodt,

Radtke & Hariri (2015), Neuron, 85(3):505-11

Prior amygdala reactivity to threat cues predicts anxiety and depression symptoms in a cohort of health adults (n=340) following future life stressors over a 1 – 4 year period

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Is altered amygdala reactivity to threat implicated in disorders associated with maltreatment?

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Yes

- heightened amygdala reactivity has been reliably associated with:

DepressionAnxietyPTSDConduct Problems

Monk et al., 2008

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Therefore, increased threat-related amygdala reactivity following maltreatment represents one promising candidate mechanism characterizing latent vulnerability.

It may signal adaptive vigilance within adverse early environments. However, it may in the longer term be maladaptive in more typical social and educational settings.

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Psychiatric Vulnerability

Adversity

Social Environment

Increasing likelihood of interpersonal

conflict with peers

Reducing cognitive capacity available for more normative developmental tasks and social learning

Altered Threat Processing

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Threat processing

Autobiographical memory

Increased Latent Vulnerability

?

?

?

But there are other candidate neurocognitive systems that will likely index Latent Vulnerability…

?

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2. Autobiographical memory

Autobiographical memory is concerned with the recollection of personally experienced events and plays a central role in scaffolding our sense of self.Our autobiographical memory provides the ‘data’ that helps us simulate future events and negotiate them more effectively.Children who have experienced maltreatment tend to show a pattern of OVERGENERAL memory.

Overgeneral memory is associated with increased risk of depression and PTSD and may therefore represent another latent vulnerability mechanism

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Autobiographical Memory

These findings may reflect increased latent vulnerability to mental health problems and social difficulties in two ways:First, over-general memory may reduce the ability to draw on past experiences to effectively negotiate future stressors. This may be particular pertinent during adolescence as a young person needs to navigate novel and challenging new contexts with reduced care-giver

supportSecond

, decreased specificity and salience of positive relative to negative memories may increase the likelihood of a negative inferential style and a ruminative response style.

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Psychiatric Vulnerability

Adversity

Social Environment

Poorer social problem solving – greater peer problems

Increased negative ruminative style

Poorer ability to conceptualize the future self

Over-general

Autobiographical Memory

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Infancy…..……..Childhood…..…..…Adolescence…..…..…Adulthood

Healthy Unhealthy

Outcome

Maltreatment

Clinical Threshold

Latent

Vulnerabilities

Threat bias

Autobiographical memory

Emotion regulation

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Infancy…..……..Childhood…..…..…Adolescence…..…..…Adulthood

Healthy Unhealthy

Outcome

Maltreatment

Clinical Threshold

Life Stressors

AND

Developmental Challenge

Latent

Vulnerabilities

Threat bias

Autobiographical memory

Emotion regulation

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Infancy…..……..Childhood…..…..…Adolescence…..…..…Adulthood

Healthy Unhealthy

Outcome

Clinical Threshold

?

Maltreatment

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Summary & Implications

According to the theory of latent vulnerability early

adversity

calibrates epigenetic

and neurocognitive systems in ways that may reflect adaptation to early risk environments but carry long term costs for mental health.

We have seen that altered

threat processing (both patterns of avoidance and vigilance) as well as alterations in autobiographical memory processing may have direct effects on psychiatric vulnerability as well as indirect effects, via the environment.

We need to investigate whether changes in these systems represent markers of latent vulnerability that can help us in the development of a clinical screening tool that identifies those children at most high risk of later mental health problems.

We also need to understand whether targeting these neurocognitive systems – through social interventions – can help young people recalibrate

these systems in ways that ‘fit’ with their new environments. Understanding

this

process of recalibration will be key to developing our understanding as to how best to promote resilience

through early prevention efforts.

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Thank-you!