Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry – the contribution of functional brain imaging

Abstract

Background: Childhood maltreatment is a potent predictor of poor mental health across the life span. We argue that there is a need to improve the understanding of the mechanisms that confer psychiatric vulnerability following maltreatment, if we are to progress from simply treating those with a manifest disorder, to developing effective preventative approaches that can help offset the likelihood that such disorders will emerge in the first place. Methods: We review extant functional neuroimaging studies of children and adolescents exposed to early neglect and/or maltreatment, including physical, sexual and emotional abuse across four neurocognitive domains: threat processing, reward processing, emotion regulation and executive control. Findings are discussed in the context of 'latent vulnerability', where alterations in neurocognitive function are considered to carry adaptive value in early adverse caregiving environments but confer long-term risk. Results: Studies on threat processing indicate heightened as well as depressed neural responsiveness in maltreated samples, particularly in the amygdala, thought to reflect threat hypervigilance and avoidance respectively. Studies on reward processing generally report blunted neural response to anticipation and receipt of rewards, particularly in the striatum, patterns associated with depressive symptomatology. Studies on emotion regulation report increased activation of the anterior cingulate cortex (ACC) during active emotion regulation, possibly reflecting greater effortful processing. Finally, studies of executive control report increased dorsal ACC activity during error monitoring and inhibition. Conclusions: An emerging body of work indicates that altered neurocognitive functioning following maltreatment: (a) is evident even in the absence of overt psychopathology; (b) is consistent with perturbations seen in individuals presenting with psychiatric disorder; (c) can predict future psychiatric symptomatology. These findings suggest that maltreatment leads to neurocognitive alterations that embed latent vulnerability to psychiatric disorder, establishing a compelling case for identifying those children at most risk and developing mechanistically informed models of preventative intervention. Such interventions should aim to offset the likelihood of any future psychiatric disorder.

HPA axis dysregulation in adult adoptees twenty years after severe institutional deprivation in childhood

“…Initial cognitive impairment had largely resolved by young adulthood (Sonuga-Barke et al, 2017). Interestingly, problems of anxiety and mood, most commonly associated with HPA axis dysregulation were absent in this group during childhood and early adolescence, but emerged very strongly in adulthood in a way that was consistent with a model of latent vulnerability (McCrory et al, 2017;SonugaBarke et al, 2017).…”

What next for adolescent forensic mental health research?

“…Those thought to have callous and unemotional traits are subject to specific study (Viding & McCrory, ). Identifying factors associated with offending behaviour should inform developing early intervention for those at risk by managing the risk factors (Lahey, Rathouz, Applegate, Tackett, & Waldman, ; Rhee et al, ) or pathways of pathogenesis (McCrory, Gerin, & Viding, ). We suggest an additional need to identify protective/resilience factors in those with identified risk factors who avoid offending behaviour; knowing what has protected some can inform early intervention and support for others.…”

Commentary: A challenge for a higher bar in research on childhood trauma – reflections on Danese (2020)

“…Although not routinely used in psychology or psychiatry research, this recommendation to use machine learning techniques may be particularly worthwhile for the field of child maltreatment, where there is little psychometric research on measures. In a paper for the Journal of Child Psychology and Psychiatry , McCrory, Gerin, and Viding () called attention to the measurement of emotional abuse using self‐report instruments. Using the Childhood Trauma Questionnaire (CTQ) to illustrate their points, they noted that more than half of over 2000 male adolescents met the threshold for ‘severe’ or ‘extreme’ emotional abuse (Mikaeili, Barahmand, & Abdi, ) and suggested that the CTQ was not able to differentiate between common experiences for many children that may be unkind or other experiences that may reflect a denigrating or humiliating pattern of treatment.…”

“…McCrory et al (2017) expressed another concern that the emotional abuse items 'potentially conflate depressive schemas capturing the expectation (rather than the reality) that others will hurt, abuse, humiliate, cheat, lie, manipulate or take advantage (van Vlierberghe, Braet, Bosmans, Rosseel, & Bogels, 2010) with actual experiences of emotional abuse' (page 351). McCrory et al (2017) argued that measurement of emotional abuse in particular warrants appropriate use of stringent thresholds, structured interviews and/or independent verification, and new research focusing on the psychometric properties of the emotional abuse.…”