Mary Dozier University of Delaware

Transcription

1 Mary Dozier University of Delaware

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4 Increase risk to nearly every negative outcome imaginable But probabilistic, not deterministic Increases risk, doesn t cause bad outcomes We can intervene But why so problematic?

5 Infants and young children Biologically prepared to depend on parents

6 Temperature regulation Neuroendocrine regulation Protection from infection Protection from danger Contact comfort Security

7 Consequences

8 Especially vulnerable are developing brain systems that are dependent on environmental input HPA axis Amygdala Prefrontal cortex Plasticity

9 H - Hypothalamus P - Pituitary A Adrenal Cortisol an end product

10 Stress reactive function Body s mounting a stress response Diurnal function Organism functioning as diurnal (or nocturnal) creature

11 mg/dl

12 Log-transformed Cortisol Value (in ug/dl) Low-risk (n = 96) Foster (n = 184) Neglected (n = 155) Wake-up Bedtime Bernard et al., 2010, Archives Ped Adol Med

13 HPA axis Amygdala Experience of adversity leads to sensitized amygdala Prefrontal cortex

14 Children who experienced adversity showed heightened amygdala activity in response to fear faces Emotional Go-NoGo Task (Tottenham, 2012)

15 HPA axis Amygdala Prefrontal cortex Decision making, planning, impulse control Control over amygdala

16 Adversity can affect the brain and behavior But, interventions can reverse or change the trajectory

17 10- session intervention Targets key issues identified as problematic for children who have experienced early adversity Implemented in home

18 Targets of ABC Intervention Enhanced Parenting ABC Intervention In the Moment Comments Nurture Follow child s lead Avoid frightening behavior Behavioral regulation Biological regulation

19 Nurturance especially important for children who have experienced early adversity Difficult to organize attachment behaviors without nurturing parent

20 This child needs you even though she may not appear to need you

21 Responding to child s cues when child is not distressed Critical to help child develop self-regulation Regulation of behavior, emotions, physiology

22 Targets of intervention Enhanced Parenting ABC Intervention In the Moment Comments Nurture Follow child s lead Avoid frightening behavior Behavioral regulation Biological regulation

23 Targets of intervention Enhanced Parenting ABC Intervention In the Moment Comments Nurture Follow child s lead Avoid frightening behavior Attachment quality Early selfregulation

24 Randomly assigned children and parents to Attachment and Biobehavioral Catch-up (ABC) or to an alternate intervention (DEF) Focus here on outcomes for neglected/cps-involved sample Children birth-24 months at start of intervention

25 Control intervention focused on cognitive and motor development Structure same as for ABC 10 weekly sessions in home

26 Assessed in Strange Situation (Ainsworth et al., 1978) Parents CPS-involved N=120 Secure Insecure

27 Percent of Children with Secure vs. Insecure Attachmnent Classifications 100% 80% Insecure (48%) Insecure (67%) 60% 40% 20% Secure (52%) Secure (33%) 0% ABC ABC Intervention Group Control DEF Bernard, Dozier et al., Child Development, 2012

28 Assessed at wake-up and bedtime postintervention over 3 days N=120

29 Log-transformed Cortisol Value (in ug/dl) Low-risk (n = 96) Foster (n = 184) Neglected (n = 155) Wake-up Bedtime Bernard, Butzin-Dozier, Rittenhouse, & Dozier, 2010

30 Log-transformed Cortisol (in ug/dl) ABC -0.8 DEF AM PM Bernard, Dozier, et al., 2015, Development and Psychopathology

31 Log-transformed Cortisol Value (ug/dl) ABC DEF AM PM Bernard, Hostinar, & Dozier, 2015, JAMA - Peds

32 Being able to sit quietly in school key to success Doing what one is supposed to do Inhibiting urge to do what one wants to do

33 Put attractive toys in front of child Tell him or her not to play with them, instead play with crayons (boring in this context)

34 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 34% Touched ABC Lind, et al., in press, Infant Mental Health Journal 53% Touched DEF

35 Functional Magnetic Resonance Imaging (fmri) Child views fearful and neutral faces N=75 (25 ABC, 25 DEF, 25 low-risk) Valadez, Tottenham, Dozier

36 Relative to DEF children, ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham, Dozier

37 Attachment DNA Methylation (whole genome analyses Hoye and Roth) Emotion expression (2 years post-intervention) (Lind) Language development (2 years post-intervention) (Freedman) Cortisol production (3 years post-intervention) Executive functioning (3 years post-intervention) Inhibitory control (Lind) Set-shifting (Lewis-Morrarty) Security (9-years-old) (Zajac) ANS regulation (9-years-old) (Tabachnick) Brain activation (9-years-old) (Valadez & Tottenham)

38 Parent: Sensitivity (3 years post-intervention) Neural activity/erp (3 years post-intervention) (Bernard) fmri: Fusiform gyrus (Tottenham) Attachment script knowledge (Raby) Child: Attachment DNA Methylation (whole genome analyses Hoye and Roth) Emotion expression (2 years post-intervention) (Lind) Language development (2 years post-intervention) (Freedman) Cortisol production (3 years post-intervention) Executive functioning (3 years post-intervention) Inhibitory control (Lind) Set-shifting (Lewis-Morrarty) Security (9-years-old) (Zajac) ANS regulation (9-years-old) (Tabachnick) Brain activation (9-years-old) (Valadez & Tottenham)

39 Substance Abuse and Mental Health Services Administration (SAMSHA) National Registry of Evidence-Based Practices (NREPP) California Evidence-Based Clearinghouse for Child Welfare Health Resources and Services Administration (HRSA) Maternal, Infant, and Early Childhood Home Visiting Programs (MIECHV)

40 Delaware Hawaii Idaho Kansas Kentucky (n=1) Louisiana Maryland Michigan (n=2) Minnesota New York North Carolina Ohio (n=3) Oklahoma (n=4) Pennsylvania (n=3)

41 Mary Dozier Department of Psychological and Brain Sciences University of Delaware