Toward a Developmental Model of Continuity and Change in PTSD Symptoms following Exposure to Traumatic and Adverse Experiences

Introduction to the Special Section: Developmental Perspectives on Trauma Exposure and Posttraumatic Stress

This article provides an introduction and overview of the current special section devoted to developmental perspectives on trauma exposure and posttraumatic stress reactions. Although there have been many revisions to the posttraumatic stress disorder (PTSD) diagnosis in the four decades that have ensued since its inclusion in our diagnostic systems, and many decades of empirical and clinical work investigating the differential effects of traumatic stress on children and adolescents, a truly developmental perspective is still lacking in the diagnosis. In a call to address this gap, this article outlines principles of developmental psychopathology as applied to the phenomenology of trauma and points to potential developmental transformations in the expression of posttraumatic stress across developmental epochs. The introduction then goes on to describe the valuable contributions to the literature represented by the six teams of contributing authors to this present special section, in which they discuss stability and change in posttraumatic symptom expression across development, the current state of validation research on the proposed diagnosis of Developmental Trauma Disorder, complex symptom arrays in children who have been complexly traumatized, distinctions between Complex PTSD and emerging personality pathology, developmental perspectives on prolonged grief, and developmental considerations for understanding the intersection between trauma and moral injury. It is hoped that this collection of articles will serve to stimulate new research and inform effective interventions for young persons affected by traumatic stress.

Towards assessing subcortical "deep brain" biomarkers of PTSD with functional near-infrared spectroscopy

Assessment of brain function with functional near-infrared spectroscopy (fNIRS) is limited to the outer regions of the cortex. Previously, we demonstrated the feasibility of inferring activity in subcortical "deep brain" regions using cortical functional magnetic resonance imaging (fMRI) and fNIRS activity in healthy adults. Access to subcortical regions subserving emotion and arousal using affordable and portable fNIRS is likely to be transformative for clinical diagnostic and treatment planning. Here, we validate the feasibility of inferring activity in subcortical regions that are central to the pathophysiology of posttraumatic stress disorder (PTSD; i.e. amygdala and hippocampus) using cortical fMRI and simulated fNIRS activity in a sample of adolescents diagnosed with PTSD (N = 20, mean age = 15.3 ± 1.9 years) and age-matched healthy controls (N = 20, mean age = 14.5 ± 2.0 years) as they performed a facial expression task. We tested different prediction models, including linear regression, a multilayer perceptron neural network, and a k-nearest neighbors model. Inference of subcortical fMRI activity with cortical fMRI showed high prediction performance for the amygdala (r > 0.91) and hippocampus (r > 0.95) in both groups. Using fNIRS simulated data, relatively high prediction performance for deep brain regions was maintained in healthy controls (r > 0.79), as well as in youths with PTSD (r > 0.75). The linear regression and neural network models provided the best predictions.

Functional near-infrared spectroscopy brain imaging predicts symptom severity in youth exposed to traumatic stress

Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with the potential to enable the assessment of posttraumatic stress disorder (PTSD) brain biomarkers in an affordable and portable manner. Consistent with biological models of PTSD, functional magnetic resonance imaging (fMRI) and fNIRS studies of adults with trauma exposure and PTSD symptoms suggest increased activation in the dorsolateral prefrontal cortex (dlPFC) and ventrolateral PFC (vlPFC) in response to negative emotion stimuli. We tested this theory with fNIRS assessment among youth exposed to traumatic stress and experiencing PTSD symptoms (PTSS). A portable fNIRS system collected hemodynamic responses from (N = 57) youth with PTSS when engaging in a classic emotion expression task that included fearful and neutral faces stimuli. The General Linear Model was applied to identify cortical activations associated with the facial stimuli. Subsequently, a prediction model was established via a Support Vector Regression to determine whether PTSS severity could be predicted based on fNIRS-derived cortical response measures and individual demographic information. Results were consistent with findings from adult fMRI and fNIRS studies of PTSS showing increased activation in the dlPFC and vlPFC in response to negative emotion stimuli. Subsequent prediction analysis revealed ten features (i.e., cortical responses from eight frontocortical fNIRS channels, age and sex) strongly correlated with PTSS severity (r = 0.65, p < .001). Our findings suggest the potential utility of fNIRS as a portable tool for the detection of putative PTSS brain biomarkers.

A Systematic Review of the Validity, Reliability, and Clinical Utility of Developmental Trauma Disorder (DTD) Symptom Criteria

Exposure to complex trauma is a prevalent and costly public health concern. Though not yet included in the formal diagnostic systems, developmental trauma disorder (DTD) was proposed to capture the consistent and predictable emotional, behavioral, and neurobiological sequelae observed in children exposed to complex trauma. This systematic review synthesizes and evaluates the existing empirical evidence for DTD as a reliable, valid, distinctive, and clinically useful construct. We identified 21 articles reporting on 17 non-overlapping samples that evaluated DTD symptom criteria using objective, empirical methods (e.g., factor analysis, associations with other diagnostic constructs, associations with trauma exposure type, clinician ratings of utility). Studies were largely supportive of the DTD construct and its clinical utility; however, it will be crucial for this work to be replicated in larger samples, by independent research groups, and with more rigorous methodological and analytic approaches before definitive conclusions can be drawn. Findings from this review, while preliminary, provide a promising empirical foundation for DTD and bring the field closer to improving diagnostic parsimony for children and adolescents affected by complex trauma.

Thought Problems and Aggression Over Time Among Youth in Foster Care

Background

Youth in foster care may demonstrate high levels of aggression and thought problems. There is a growing trend to consider mental health symptoms of youth involved with the foster care system from a developmental trauma perspective.

Objective

The aim of this study was to test if trauma, race, age, and gender predicted variability in thought problems and aggression for youth in foster care.

Method

The sample (n = 303) included youth in out-of-home placements with a mean age of 14 years, a diverse racial demographic, and almost an equal percentage of males and females. Participants were assessed over three waves using a series of multilevel growth curve models.

Results

Results indicated significant decreases in thought problems and aggression and youth with higher levels of trauma reported higher initial levels and swifter decreases of both thought problems and aggression over time.

Conclusions

While trauma was associated with aggression and thought problems, results found that youth demonstrated significant decreases in aggression and thought problems over time. A better understanding of the long-term effects of trauma on thought problems and aggression of youth in foster care is needed. While our findings suggest foster care may be protective in fostering resilience, additional research on the nature of potential positive effects of foster care on aggression and thought problems is suggested.