Impact of developmental trauma on brain function and connectivity. Presented by Carl A. Armes, BS. & Robert Coben, Ph.D.

Transcription

1 Impact f develpmental trauma n brain functin and cnnectivity. Presented by Carl A. Armes, BS. & Rbert Cben, Ph.D.

2 Ace Study EEG Measures OUTLINE Previus Findings Results Methds Discussin

3 WHAT IS DEVELOPMENTAL TRAUMA? The Cmplex Trauma Taskfrce f the Natinal Child Traumatic Stress Netwrk [Van der Klk, B. A. (2005) Develpmental Trauma Disrder, Psychiatric Annals, 35(5): ] cined the term Develpmental Trauma Disrder because mst f the maltreated children did nt meet the criteria fr PTSD. PTSD als cannt capture the multiplicity f physical, emtinal, and sexual abuse. PTSD diagnsis des nt als encmpass the develpmental effects, such as self endangering behavirs, self-hatred, self-blame, chrnic feelings f ineffectiveness, and lss f bdy regulatin in areas f sleep, fd and self-care.

4 ADVERSE CHILDHOOD EXPERIENCES STUDY (ACE) [Anda, Rbert F., et al. "The enduring effects f abuse and related adverse experiences in childhd." Eurpean archives f psychiatry and clinical neurscience (2006): ] Study f linkage between epidemilgic and neurbilgical evidence f the effects f childhd trauma. Questins pertained t respndent s first 18 years f life. Assessed 8 adverse childhd experiences: abuse (emtinal, physical, r sexual); witnessing dmestic vilence; parental marital discrd; grwing up withmentally ill; substance abusing; r criminal husehld members.

5 3 TYPES OF ABUSES Text

6 ADVERSE CHILDHOOD EXPERIENCES STUDY (ACE) Infrmatin frm medical review f systems (ROS), the physical examinatin (PE), and the ACE Study questinnaire (ACEQ) used t define the healthrelated behavirs r prblem surces. Behavirs: mental health disturbances; smatic disturbances; substance abuse; impaired childhd memry; sexuality; and perceived stress, anger cntrl, and risk f intimate partner vilence.

7 ACE SCORING The number f ACEs (range: 0 8) was summed t create the ACE scres, with scres f 4 r mre included as ne categry ( 4). Analyses were cnducted treating the ACE scre as 4 dichtmus variables (yes r n fr scres f 4, 3, 2, and 1) with a scre f 0 (n ACEs) as the referent. At least 1 ACE reprted by 64% f respndents. As ACE scre increased, mean number f cmrbid utcmes increased.

8 Prevalence % 60 Relatinship f ACE Scre t the Prevalence f Mental Health Disturbances and Smatic Health Disturbances Panic Reactins Depressed Affect Anxiety Hallucinatins Sleep Disturbances Mental Health Disturbances Severe Obesity Multipe Smatic Symptms Smatic Disturbances ACE Scre

9 Prevalence % 40 Relatinship f ACE Scre t the Prevalence f Substance Abuse and Sexuality Smking Alchlism Illicit Drug Use Injected Drug Use Early Intercurse Prmiscuity ( 30 partners) Sexual Dissatisfactin Substance Abuse Sexuality ACE Scre

10 Prevalence % 40 Relatinship f ACE Scre t the Prevalence f Memry and Stress & Anger Memry Impairment High Level f Perceived Stress Difficulty Cntrlling Anger Risk f Intimate Partner Vilence Memry Stress & Anger ACE Scre

11 pic Verbal abuse: higher grey matter vlume (GMV) in auditry crtex and lwer integrity f left arcuate fasciculus. Diminished arcuate fasciculus integrity assciated with lwer verbal IQ and cmprehensin. Witness dmestic abuse: Lwer grey matter density in right lingual gyrus and reduced thickness in prtins f visual crtex. Witnessing dmestic vilence between years f age had cnsiderable effect n thickness and vlume. Sexual abuse: Lwer GMV in primary visual crtex and visual assciatin crtices directly crrelate with duratin f expsure befre age f 12 and assciated with deficit in visual memry.

12 pic Plasticity f the limbic system was fund t be altered. Structural cnnectivity was lwer fr maltreated subjects in the left anterir cingulate (emtins), as well as the tempral ple, and medial frntal gyrus (scial cgnitin and thery f mind). In cntrast structural cnnectivity was higher fr maltreated subjects in areas such as precuneus and anterir insula, which are linked t self-awareness.

13 Add figue 5 Re-experiencing severity crrelated psitively with right anterir insula activity (invlved in aspects f emtinal states) and negatively with rstral anterir cingulate crtex activity (which can inhibit the amygdala. Re-experiencing crrelated negatively with activatin f right inferir frntal crtex (IFC), a regin implicated in inhibitin f mvement and f emtinal experience. Avidance was negatively crrelated with activatin in three separate anterir cingulate crtex (ACC) clusters: left rstal ACC and SC, and bilateral drsal ACC. Dissciatin was negatively crrelated with activity in left superir tempral crtex, as well as right anterir insula and right IFC.

14 Add figue 5 15 adlescent inpatients age (mean age 10.7 years, male:female=7:8, 10 medicated) with a histry f intense physical r sexual abuse. The cntrl subjects were 15 healthy vlunteers (mean age 10.1 years, M:F=6:9). Abused children had greater average left hemisphere cherence than nrmal children, but als significantly greater left vs right cherence.

15 HYPOTHESIS Adults that experienced develpmental trauma will shw significantly different findings than thse that did nt have such a histry. Regins may include thse near the anterir cingulate, left frntal tempral and limbic regins and right psterir regins invlved in scial engagement and anxiety/fear. We therize that cnnectivity anmalies will be fund as well.

16 METHODS Study 1: 50 subjects underwent 19 channel EEG EC and EO. 34 experimental (hx f abuse) vs. 16 nrmal cntrls. Fr pst-hc analyses the exp grup was divided in abuse grups with 19 suffering emtinal abuse/neglect and 15 physical/sexual abuses. Study 2: 19 subjects underwent 64 channel EEG EC and EO. 12 experimental (hx f abuse) vs. 7 nrmal cntrls. Dependent measures included lg pwer, surce lcalized activatins, graph thery cnnectivity metrics.

17 ICA/EEGLAB Scientists and Jurnals Jurnal f Neurscience Methds Pls One Cmputatinal Intelligence and Neurscience NeurImage Cmputatinal Intelligence and Neurscience Frntiers in Neurscience Frntiers in Neural Circuits UCSD Swartz Center fr Cmputatinal Neurscience University f Oxfrd UCLA Semmel Neurscience Institute MGH/Harvard Medical Schl Gergetwwn University Medical Center University f Michigan Neurscience Department

18 Makeig, Sctt, et al. "Independent Cmpnent Analysis f Electrencephalgraphic Data." in Advances in Neural Infrmatin Prcessing Systems

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25 GRAPH THEORY

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27 GRAPH THEORY METRICS Clustering cefficient is a measure f the degree t which ndes in a graph tend t cluster tgether. Cluster cefficient f a nde is always between 0 and 1 Average path length- average number f steps alng the shrtest paths fr all pssible pairs f netwrk ndes Glbal efficiency- measure f hw efficiently a netwrk exchanges infrmatin Radius- minimum eccentricity (distance frm ne nde t anther) f any vertex. Diameter- maximum eccentricity f any vertex

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30 Left Superir Frntal Gyrus, BA6 Right SFG, BA6

31 Left Superir Frntal Gyrus, BA8 Right SFG, BA8

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34 Experimental v cntrl grup demgraphics N significant difference fr gender and handedness Age was significantly different (p.014). Mean age f grups was 31.7 years (sd 19.21) fr exp and (sd 1.36) fr cntrls Eyes clsed graph thery metrics N significant differences fr clustering cefficient, glbal efficiency and radius Significant differences seen fr path length (p.038) and diameter (p.011) Mean path length fr exp (sd 20.5) and cntrls (sd 5.23) Mean diameter fr exp (sd 48.34) and cntrls (sd 15.51)

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36 Eyes pen graph thery metrics N significant difference fr clustering cefficient Significant difference fr path length (p.002), glbal efficiency (p.01), radius (p.009) and diameter (p.002)

37 Cmparing abuse grups t cntrl grup. Physical/sexual, emtinal/neglect, and cntrls. N significant difference fr age, gender r medicatin usage Significant difference fr age between the grups (p.009) N significant difference fr age between the abuse grups Eyes clsed graph thery metrics N significant difference fr clustering cefficient, path length, glbal efficiency r radius Significant difference fr diameter (p.04) Diameter means physical/sexual abuse (sd 46.98), emtinal abuse/neglect (sd 51.23) and cntrls (sd 15.51) N difference in diameter cmparing abuse grups

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39 Eyes pen graph thery metrics N significant difference between the three grups fr clustering cefficient Significant differences fr path length (p.004), glbal efficiency (p.038), radius (p.009) and diameter (p.006) Pst hc tests f significance acrss the three grups shw that the abuse grups are different than the cntrl grup but n different frm each ther.

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42 Left Frntal Syb-Gral White Matter Left Frntal Precentral Gyrus White Matter Left Parietal Pstcentral Gyrus White Matter

43 Left Middle Tempral Gyrus White Matter Left Tempral Lbe Sub Gyral White Matter

44 Right Frntal Paracentral Lbule White Matter Right Parietal Precuneus White Matter Right Parietal Precuneus

45 Right Parietal Precuneus, BA 7 Right Occipital Cuneus White Matter

46 Right Middle Occipital Gyrus White Matter Right Cuneus White Matter Right Middle Occipital Gyrus, BA 18

47 Left Cerebrum, Frntal Lbe, Sub-Gyral, White Matter Left Cerebrum, Sub-lbar, Insula, White Matter Right Cerebrum, Parietal Lbe, Pstcentral Gyrus, White Matter Right Cerebrum, Tempral Lbe, Transverse Tempral Gyrus, Gray Matter

48 Left Cerebrum, Frntal Lbe, Sub-Gyral, White Matter Left Cerebrum, Limbic Lbe, Cingulate Gyrus, White Matter Left Cerebrum, Frntal Lbe, Inferir Frntal Gyrus, Gray Matter, Brdmann area 44 Left Cerebrum, Frntal Lbe, Inferir Frntal Gyrus, White Matter

49 Right Cerebrum, Parietal Lbe, Precuneus, White Matter Right Cerebrum, Parietal Lbe, Sub- Gyral, White Matter Right Cerebrum, Frntal Lbe, Middle Frntal Gyrus, Gray Matter, Brdmann area 6 Right Cerebrum, Frntal Lbe, Middle Frntal Gyrus, White Matter

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53 EEG/ICA capable f demnstrating differences and regins f interest Individuals that experienced abuse as children shw wide spread pwer anmalies as adults that include multiple frequencies (theta, alpha and beta 1) Diple lcalizatin suggests regins f interest that are likely critical t their challenges and cnsistent with ther frms f neurimaging These include midline frntal, medial - psterir left frntal/tempral (insula), precuneus, and right ccipital/parietal/tempral regins f the brain. The majrity f these include lcalizatins t white matter tracts that cnnect crtical t limbic regins f the brain. Extensive anmalies f cnnectivity suggesting that cmmunicatin between ndes, especially lng range cnnectivity is prblematic. At least in term f cnnectivity difficulties, abuse grups d nt differ. This is, whether yu experience physical, sexual r emtinal abuse yur brain pathways and their functining are altered similarly.

54 19 channel data is severely limited in it s ability t surce lcalize activity t deeper structures and white matter pathways Study 2 s lw sample size may limit sme f it s findings and generalizatin Mre data and types f analyses may help us find even mre interesting relatinships Implicatins fr interventin: Regins f interest may be pints f feedback Alpha and Beta 1 inhibitin Cnnectivity training may ffer further access t systems that seem critical t functining

55 REFERENCES 1. Anda, R. F., et al. (2006) The enduring effects f abuse and related adverse experiences in childhd: A cnvergence f evidence frm neurbilgy and epidemilgy. Eur Arch Psychiatry Clin Neursci. 256(3): di: /s Hpper, J. W., Frewen, P. A., Van der Klk, B. A., Lanius, R. A. (2007) Neural crrelates f reexperiencing, avidance, and dissciatin in ptsd: symptm dimensins and emtin dysregulatin in respnses t script-driven trauma imagery. Jurnal f Traumatic Stress. 20(5): It, Y., Teicher, M. H., Gld, C. A., Ackerman, E. (1998) Preliminary evidence fr aberrant crtical develpment in abused children: a quantitative eeg study. Jurnal f Neurpschiatry, 10(3): Teicher, M. H., Andersn, S. L., Plcari, A., Andersn, C. M., & Navalta, C. P. (2002). Develpmental neurbilgy f childhd stress and trauma. Psychiatric Clinics f Nrth America, 25, Teicher, M. H., Samsn, J.A., Andersn, C. M., & Ohashi, K. (2016). The effects f childhd maltreatment n brain structure, functin and cnnectivity. Nature Reviews Neurscience, di: /nrn Van der Klk, B. A. (2005) Develpmental Trauma Disrder, Psychiatric Annals, 35(5):

56 THANKS! Any questins? Yu can find us at: /IntegratedNeurscienceSe rvices/ Clleagues invlved in this prject: Iman Rezazadeh, PhD HRL Being Labs, UCLA Semmel Neurscience Institute Tarik Bel-Bahar, PhD University f Michigan Medical Schl/Neurscience Prgram Resurces: EEGLAB Multivariate Granger Causality Tlbx Causality Tlbx