Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth

Abstract

Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the longterm mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.

The Effect of a Mindfulness-Based Stress Intervention On Neurobiological and Symptom Measures in Adolescents With Early Life Stress: A Randomized Feasibility Study

“…A number of cognitive interventions have successfully reduced symptoms of depression, anxiety, and PTSD in youth exposed to ELS (46). However, many of these interventions are focused on specific diagnoses and/or symptom profiles.…”

“…While childhood and adolescence are stages of particular vulnerability to psychopathology (43), proximity to ELS exposure, increased plasticity, and ongoing development provide an opportunity for normalization in systems subservient to stress responses and emotion regulation as a result of intervention, as well as increased resilience (44,45). A number of psychological interventions (e.g., Cognitive-Behavioral Therapy [CBT], Trauma-Focused CBT, Prolonged Exposure Therapy, Cognitive Processing Therapy, Parent Child Interaction Therapy, Child-Parent Psychotherapy, and Emotion Regulation approaches) have been efficacious in reducing symptoms of depression, anxiety, or posttraumatic stress disorder (PTSD) in ELS-exposed youth (46). However, it remains unclear whether, and to what extent, interventions exert influence on the disrupted underlying neurobiological mechanisms involved in response to and regulation of stress.…”

“…Research involving both adults and youth shows that mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes (47)(48)(49)(50)(51). Moreover, recent data indicate that mindfulness practice may positively influence processes involved in regulation of stress responses in adults, including changes in expression of pro-inflammatory genes (52) and methylation of FKBP5 in adults with PTSD(53), immune and endocrine system markers (e.g., reduction in C-reactive protein and increased cortisol reactivity, respectively (54,55)), and activation in a distributed network of brain regions involved in interoception, self-referential processing, threat detection, and emotion regulation (46,(56)(57)(58). Therefore, mindfulness represents a potential regulatory intervention that may inhibit or reverse some of the deleterious long-term effects of ELS exposure.…”

Inaugural Editorial

“…In this first issue of Adversity and Resilience Science, we present three reviews, two empirical papers, and a commentary in addition to this editorial. Kirlic, Cohen, & Singh (2020) review interventions targeting behavioral and neurobiological effects of adversity on children and adolescents, applying basic neuroscience research on early life stress to improve the effectiveness of novel and scalable preventive interventions. Kirsch, Nemeroff, & Lippard (2020) discuss the relationship between early life adversity, neurobiological adaptations, and subsequent adolescent and adult substance use disorders, discussing the potential for improved prevention and treatment outcomes by identifying potential pathways involving genetic vulnerabilities associated with mood and anxiety disorders.…”

A series of realist evaluations of multi-component programmes with disengaged young people: What works, for whom, and in what contexts?

“…There are also a range of social and economic impacts including higher public health and criminal justice expenditure (Goldman-Mellor et al, 2016;Maguire, 2015). Given such consequences, the need to re-engage young people who are NEET 1 , as well as preventing young people becoming NEET, is considered a key government priority and a major public health concern (Kirlic et al, 2020;Public Health England, 2014).…”