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Charles Nelson III, The Effects of Early Life Adversity on Development: Implications for Understanding Trauma at the Border

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March 4, 2019

At the center of contemporary political debate are the record numbers of migrant families and children at the U.S.-Mexico border. As these parents and children flee the trauma of violence in their native countries, they are now experiencing the trauma of navigating an increasingly hostile immigration system. What can neuroscience tell us about the effects of these traumatic experiences on the brains of the children and adults? And how might the neuroscience of trauma and brain development affect legal cases? Can advances in mobile neuroimaging provide practitioners with real-time brain evidence of trauma? Does neuroscience have a larger role to play in shaping our nation’s immigration policies? This panel session brought together scientists and lawyers to start a dialogue on neuroscience, trauma, and justice.

This event was free and open to the public.

Part of the Project on Law and Applied Neuroscience, a collaboration between the Center for Law, Brain & Behavior at Massachusetts General Hospital and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

Learn more on the website: https://petrieflom.law.harvard.edu/events/details/trauma-at-the-border

Published in: Law
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Charles Nelson III, The Effects of Early Life Adversity on Development: Implications for Understanding Trauma at the Border

  1. 1. Image by Juliendn The Effects of Early Life Adversity on Development: Implications for Understanding Trauma at the Border Charles A. Nelson, Ph.D. Professor of Pediatrics and Neuroscience, Professor of Psychiatry in Psychology, Harvard Medical School Professor of Education, Harvard University Richard David Scott Chair in Pediatric Developmental Medicine Research Boston Children’s Hospital Trauma at the Border, Harvard Law School, 4 March 2019
  2. 2. Outline Summary of Brain Development The Role of Experience in Brain Development The Effects of Early Adversity – Neglect/parent-child separation
  3. 3. 15 ½ weeks 22 weeks 23 weeks ~25 weeks 27 weeks Full term brain Adult Age of viability Part I: Brain Development http://medstat.med.utah.edu
  4. 4. Summary of Brain Development Source: Thompson and Nelson (2001). Figure provided by Heckman (2013).
  5. 5. Part II: The Role of Experience in Brain Development
  6. 6. Factors that Shape Development Healthy experiences facilitate healthy brain development; by contrast…. Adverse experiences can negatively impact brain development.
  7. 7. …And timing matters – Adverse experiences may have different effects depending on the timing and duration of their exposure – If a child is exposed to adverse events during a critical period (when the brain is particularly responsive to experience – generally the first few years of life; see next slide) OR – If they move through a critical period without exposure to experiences they expect to occur (e.g., someone who talks to them, holds them when they cry, etc.), development can be derailed. – Thus, early experience matters
  8. 8. Motor / Language Higher Cognition Sensory Birth environment critical periodgenes behavior in utero adulthood Early Windows of Experience Shape Brain Function Hensch, T. K., & Bilimoria, P. M. (2012). Re-opening Windows: Manipulating Critical Periods for Brain Development. Cerebrum: The Dana Forum on Brain Science, 2012, 11.
  9. 9. A final point about experience Brain plasticity changes with age; in some domains change is possible throughout the life span (e.g., learning and memory), whereas in others, change is much more difficult (e.g., we don’t learn to see better). This is illustrated in the next slide
  10. 10. The ability to change the brain decreases over time Source: Levitt (2009) Birth 10 20 30 Physiological “Effort” Required to Enhance Neural Connections Normal Brain Plasticity Influenced by Experience Age (Years) 40 50 60 70
  11. 11. Summary Early experience matters Atypical experiences or lack of experiences (i.e., neglect) during critical periods matters a lot
  12. 12. Part III: Effects of Early Adversity Some can be healthy and adaptive Others can be “toxic” and negatively impact development
  13. 13. Psychosocial adversities Income Parental education Housing conditions Stressful life events Parenting behaviors Continuum of normal experiences
  14. 14. Severe psychosocial adversities Neglect (emotional and physical)Traumatic events Parental psychopathology (compromised caregiving)Maltreatment (physical, emotional, sexual)
  15. 15. Biological adversities Malnutrition (micro and macronutrient deficiencies) Environmental toxins (heavy metals, pollutants, toxins) Infection (systematic and enteric)
  16. 16. Developmental trajectory • Early setbacks compound social disadvantage • Biological change embedded in behavior Early childhood adversity Biological change Adult outcomes Genetic variants alter susceptibility to specific adversities (“gene x environment interaction”) • Depriving environments (e.g. poverty, low quality institutional care) • Adverse birth outcomes (e.g. prematurity, SGA, LBW, IUGR) • Malnutrition (including under- and overnutrition) • Infectious and noninfectious inflammation (e.g. maternal inflammation, environmental enteropathy, other infectious diseases, toxin exposure) • Psychosocial stressors (e.g. caregiver insensitivity, exposure to violence) Early environment disrupts normal biology: Sensitive period effects Adversity impacts key domains most when concurring with periods of rapid development Increased risk of: • Cognitive deficits (e.g. lower IQ, poorer short- term memory, semantic fluency, and executive function) • Mental & somatic illness Genetic endowment Berens, Jensen, & Nelson (2017), BMC Medicine, 15(135): 1-12 Epigenetic changes (e.g. DNA & histone modification causing altered gene expression; telomere shortening) Altered homeostatic systems (e.g. derangements in microbiome and metabolic, immune, and stress regulatory axes) Excess inflammation (e.g. due to stress response dysregulation during fetal or postnatal development, or environmental enteropathy) Neurodevelopmental disruption (e.g. due to aberrant or absent stimulation; disturbed hormonal or inflammatory environments) How to model the biological embedding of adversity
  17. 17. World-wide prevalence of early adversity • The Centers for Disease Control (US) estimates 1/3rd of the world’s children <18 years old experience physical or harsh punishment or abuse • The United Nations (UN) estimates that at least 133–275 million children globally witness violence between primary caregivers • 223 million children are victims of sex trafficking each year. • 59% of children in developing countries had been victims of physical, emotional, or sexual violence (excluding corporal punishment) in the preceding year. • Finally, if we consider caregiver mental health, depression represents the leading cause of disease-related disability globally per World Health Organization (WHO) estimates.
  18. 18. Effects of Early Adversity are Long Lasting • Increased risk of mental (e.g., anxiety and depression) and physical health (e.g., cardiovascular disease; diabetes) disorders • It is theoretically possible for effects to biologically cascade from one generation to the next (epigenetic effect) • The financial and human capital costs to society are enormous
  19. 19. What happens when children are neglected/fail to receive adequate caregiving? Why neglect is bad for the brain: – Brain expects input it doesn’t receive, so its wiring is altered – Particularly egregious if experiences expected to occur during a sensitive period fail to occur (e.g., patterned light, sound, caregiving)
  20. 20. Early Institutionalization - A model system for understanding profound neglect?
  21. 21. Children reared in institutions*… …are at dramatically increased risk for a variety of cognitive, social, and behavioral problems: • disturbances of social relatedness and attachment • externalizing behavior problems • inattention/hyperactivity • deficits in IQ and executive functions • syndrome that mimics autism • growth stunting (next slide) ….and these outcomes also apply to children who experience familial neglect – that is, they are not limited to children experiencing institutional care * There are currently 140 million orphans around the world, 8 million of whom are growing up in institutions
  22. 22. Institutionalized children lose ~1 month of linear growth for every ~1 month in an institution (pictures courtesy of Dana Johnson, MD, Ph.D) Effects of institutionalization on growth 17 year old girl 14 year old girl
  23. 23. High Level Summary of Behavioral Findings Through Age 16 Years Children in institutions: • Lower IQ • Reduced language function • Poorer attachment • Impairments in executive functions and peer relationships • High rates of psychopathology (particularly ADHD and acting out behavior in adolescence)
  24. 24. High Level Summary of Behavioral Findings Through Age 16 Years (con’t) Children in high quality foster care: • higher IQ • Better language • Better relationships • Lower rates of psychopathology • BUT….largest benefits experienced by those placed <2 years
  25. 25. Effects on brain and physiology EEG Stress physiology
  26. 26. EEG Activity at Baseline Marshall, Fox, et al (2004) J. of Cog Neuro IG NIG institutionalized children never institutionalized children
  27. 27. 2.44μV2 3.80μV2 CAUG NIG FCG < 24 FCG > 24 Does Brain Activity (EEG) Change as a function of intervention and timing? Age 8 Vanderwert et al (2010) PLoS One
  28. 28. Summary Children in institutional care displayed deficits in brain electrical activity compared to the children randomized to foster care intervention (FCG). Children who received the foster care intervention continued to show typical levels of brain activity through age 16. The age of placement into foster care is associated with better outcomes; specifically, foster care placement before 24 months results more robust improvements in brain activity. Marshall PJ, Fox NA, Bucharest Early Intervention Project Core Group (2004). A comparison of the electroencephalogram between institutionalized and community children in Romania. Journal of Cognitive Neuroscience, 16, 1327-1338. Marshall P, Reeb BC, Fox NA, BEIP Core Group (2008). Effects of early intervention on EEG power and coherence in previously institutionalized children in Romania. Development and Psychopathology. 20, 845-859. Vanderwert, R.E., Marshall, P.J., Nelson, C.A., Zeanah, C.H., & Fox, N.A. (2010). Timing of intervention affects brain electrical activity in children exposed to severe psychosocial neglect. PlosONE, , 5(7): 1-5. Vanderwert R+, Fox NA, Nelson CA, & Zeanah CH (2016). Normalization of EEG activity among previously institutionalized children placed into foster care: A 12-year follow-up of the Bucharest Early Intervention Project. Developmental Cognitive Neuroscience, 17: 68- 75.
  29. 29. Stress response
  30. 30. Trier Social Stress Test • Delivered a speech about what makes a good friend in front of two teachers they have never met before • Record various Physiological (e.g., heart Rate) and hormonal (e.g., cortisol) responses McLaughlin KA, Sheridan M+, Tibu F, Fox NA, Zeanah CH, & Nelson CA (2015). Proceedings of the National Academy of Sciences, 112 (8), 5637-5642
  31. 31. Cortisol reactivity 0 2 4 6 8 10 12 14 Cortisolnmol/L CAUG FCG NIG FCG vs CAUG t = 2.58, p = .010
  32. 32. 0 2 4 6 8 10 12 14 Cortisolnmol/L < 24 months > 24 months Timing of placement (FCG only)
  33. 33. Summary Children placed into foster care <2 years show normalized stress response; children placed >2 years show response similar to institutionalized children
  34. 34. Conclusions • The effects of early adversity (including neglect) can have far reaching consequences on brain, biological and psychological development • As a rule, the earlier in life the adversity begins, and the longer it lasts, the more profound the effects. • If we want to reduce the burden of “disease” (both physical and psychological) in adults, we should take steps to address children growing up in adverse circumstances
  35. 35. So how do we translate science to policy?
  36. 36. Implications beyond Romania: Parent-child separation at US-Mexican border
  37. 37. What about the assertion Margaret Sheridan and I made in the NY Times? https://www.nytimes.com/2018/05/30/opinion/how-to-turn- children-into-criminals.html
  38. 38. Children with High Callous Unemotional Traits Humphreys et al., 2015 Journal of the American Academy of Child and Adolescent Psychiatry Girls Boys
  39. 39. A View from Above In this light, there are powerful lessons here for the millions of children who have experienced maltreatment and forceful/prolonged separation from parents (for recent news reports see): PBS News Hour: What we learned from congressional hearing on family separations USA Today: Despite ban, separating migrant families at the border continues in some cases Vox: Hundreds of families are still being separated at the border PRI: Why is the US still separating migrant families at the border? HHS Official Says He Would Never Have Supported "Zero Tolerance" Family Separation Policy What Are the Long-Term Effects of Separating Immigrant Children from Their Parents? Google News Roundup on Sexual Abuse of Migrant Youth HHS docs show thousands of alleged incidents of sexual abuse against unaccompanied minors in custody * Detention center in Texas Romania Orphanage A little girl at the border being separated from mother
  40. 40. Bottom Line • Let’s learn from the science • Let’s inform policy makers, politicians, and clinicians about the short- and long-term effects of adversity, but in particular, that… • Early and prolonged adversity can have life-long effects on both psychological and physical development • Duration of time spent in adversity powerfully influences later development • Age of child when removed from adverse environment will influence the outcome • Forceful separation of children from parents elevates risk of adverse outcomes – for both children and parents
  41. 41. THE END charles_nelson@harvard.edu

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