Neural responses to social exclusion in adolescents: Effects of peer status

MASI, a Smartphone App to Improve Treatment Adherence Among South African Adolescents and Young Adults With HIV: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Adolescents and young adults with HIV repeatedly demonstrate low rates of antiretroviral therapy (ART) adherence as well as low rates of viral suppression. Digital health interventions are a promising way to engage adolescents and young adults with HIV to support ART adherence. However, few digital health interventions have been developed and tested with adolescents and young adults in countries like South Africa, where the HIV burden among adolescents and young adults is greatest. Masakhane Siphucule Impilo Yethu (MASI; Xhosa for "Let's empower each other and improve our health") is a comprehensive ART adherence-supporting app for South African adolescents and young adults with HIV. It was culturally adapted using the HealthMpowerment platform.

OBJECTIVE

The aim of this paper is to describe the protocol for a pilot randomized controlled trial examining the feasibility, acceptability, and preliminary efficacy of MASI on self-reported ART adherence and social support.

METHODS

We will enroll 50 adolescents and young adults with HIV ages 15-21 years. Participants will be recruited from public ART clinics linked to a large government-funded teaching hospital in Cape Town, South Africa. Participants will be randomized 1:1 into either the intervention arm receiving a full version of MASI or the control arm receiving an information-only version of the app (n=25 per arm). Participants will be asked to engage with MASI daily for 6 months. All participants will complete baseline and follow-up assessments at 3 and 6 months.

RESULTS

Study screening began in May 2022 and the first participant was enrolled on June 21, 2022. As of June 12, 2023, 81 participants have completed screeners, and 36 eligible participants have been enrolled in the pilot randomized controlled trial. Recruitment is anticipated to last through August 31, 2023, with study activities anticipated through February 29, 2024.

CONCLUSIONS

There is an urgent need for innovative interventions to improve ART adherence among adolescents and young adults in settings like South Africa. If found to be feasible and acceptable, MASI could be implemented with adolescents and young adults with HIV in other parts of the country.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04661878; https://clinicaltrials.gov/ct2/show/study/NCT04661878.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47137.

Exogenous testosterone administration is associated with differential neural response to unfamiliar peer's and own caregiver's voice in transgender adolescents

Changes in gonadal hormones during puberty are thought to potentiate adolescents' social re-orientation away from caregivers and towards peers. This study investigated the effect of testosterone on neural processing of emotional (vocal) stimuli by unfamiliar peers vs. parents, in transgender boys receiving exogenous testosterone as a gender-affirming hormone (GAH+) or not (GAH-). During fMRI, youth heard angry and happy vocal expressions spoken by their caregiver and an unfamiliar teenager. Youth also self-reported on closeness with friends and parents. Whole-brain analyses (controlling for age) revealed that GAH+ youth showed blunted neural response to caregivers' angry voices-and heightened response to unfamiliar teenage angry voices-in the anterior cingulate cortex. This pattern was reversed in GAH- youth, who also showed greater response to happy unfamiliar teenager vs. happy caregiver voices in this region. Blunted ACC response to angry caregiver voices-a pattern characteristic of GAH+ youth-was associated with greater relative closeness with friends over parents, which could index more "advanced" social re-orientation. Consistent with models of adolescent neurodevelopment, increases in testosterone during adolescence may shift the valuation of caregiver vs. peer emotional cues in a brain region associated with processing affective information.

The relationship between self-esteem and self-concept clarity is modulated by spontaneous activities of the dACC

Although it has been found that self-esteem and self-concept clarity are positively correlated, self-determination theory shows that the positive relationship might be lowered for individuals whose basic psychological needs are chronically thwarted. The exact neural mechanisms underlying the relationship between self-esteem and self-concept clarity are still not fully understood. The dorsal anterior cingulate cortex (dACC) plays an important role in monitoring basic psychological needs, considering that it is more active when some basic psychological needs are actually or potentially thwarted. To better understand the neural mechanisms underlying the relationship between self-esteem and self-concept clarity, we investigated the differences in the relationship between self-esteem and self-concept clarity among healthy adults with different levels of spontaneous activities of the dACC using rs-fMRI combined with amplitude of low-frequency fluctuation (ALFF). As expected, the results showed that the positive relationship between self-esteem and self-concept clarity was modulated by the ALFF value of the right dACC, which indicated that the positive relationship was significant when the ALLF value of the right dACC was lower, but the positive relationship was not significant when the ALFF value of the right dACC was higher. The modulating roles of right dACC might also reflect that the individuals with higher ALFF value of dACC might experience chronically thwarted relatedness of basic psychological needs, which means the more disturbed by thwarting relatedness information in individuals, the lower positive relationship emerged.

Understanding the Dynamics of the Developing Adolescent Brain Through Team Science

One of the major goals for research on adolescent development is to identify the optimal conditions for adolescents to grow up in a complex social world and to understand individual differences in these trajectories. Based on influential theoretical and empirical work in this field, achieving this goal requires a detailed understanding of the social context in which neural and behavioral development takes place, along with longitudinal measurements at multiple levels (e.g., genetic, hormonal, neural, behavioral). In this perspectives article, we highlight the promising role of team science in achieving this goal. To illustrate our point, we describe meso (peer relations) and micro (social learning) approaches to understand social development in adolescence as crucial aspects of adolescent mental health. Finally, we provide an overview of how our team has extended our collaborations beyond scientific partners to multiple societal partners for the purpose of informing and including policymakers, education and health professionals, as well as adolescents themselves when conducting and communicating research.

Neurobiological correlates of the social and emotional impact of peer victimization: A review

Peer victimization is very common during late childhood and adolescence. Despite the relatively reduced number of studies, the neurobiological underpinnings of the negative impact of peer victimization experiences have received increasing attention in recent years. The present selective review summarizes the most recent available evidence and provides a general overview of the impact of peer victimization experiences on social processing and decision-making at the neurobiological level, highlighting the most pressing areas requiring further research. Three key cognitive areas show a clear negative impact of peer victimization and bullying experiences: social valuation processing, reward and reinforcement learning and self-regulation processes. Victims show enhanced activation in key regions of the limbic system including the amygdala, rostral and dorsal anterior cingulate cortices, suggestive of enhanced sensitivity to social stimuli. They also show enhanced recruitment of lateral prefrontal regions crucially involved in cognitive and emotional regulation processes, and abnormal reward-related striatal function. The presence of psychopathology is a complex factor, increased as a consequence of peer victimization, but that also constitutes vulnerability to such experiences.

Ranking status differentially affects rejection sensitivity in adolescence: An event-related potential study

Adolescents are sensitive to peer rejection but this may be dependent on their status. This study examined the role of ranking status on rejection sensitivity in adolescence using an experimental bargaining design. To manipulate ranking status, participants between ages 9-22-years (final sample n = 102) performed a reaction time task with two peers to induce high and low status. Next, participants played an iterative Ultimatum Game as high or low status proposer with an opposite status responder. Rejection of fair offers was associated with larger Medial Frontal Negativity (MFN) compared to acceptance of fair offers. An interaction between age and status group revealed that after rejection of fair offers, mid-adolescents showed a larger MFN when having a low status and smaller MFN when having a high status, relative to children and adults. These findings suggest that the MFN reacts as a neural alarm system to social prediction errors, signaling a need for vigilance to deviations from the norm, which is influenced by ranking status especially during mid-adolescence.

Feeling left out or just surprised? Neural correlates of social exclusion and overinclusion in adolescence

Social belonging is an important human drive that influences mood and behavior. Neural responses to social exclusion are well-characterized, but the specificity of these responses to processing rejection-related affective distress is unknown. The present study compares neural responses to exclusion and overinclusion, a condition that similarly violates fairness expectations but does not involve rejection, with a focus on implications for models of dorsal anterior cingulate cortex (dACC) and anterior insula (AI) function. In an fMRI adaptation of the Cyberball paradigm with adolescents aged 11.1-17.7 years (N = 69), we employed parametric modulators to examine scaling of neural signal with cumulative exclusion and inclusion events, an approach that overcomes arbitrary definitions of condition onsets/offsets imposed on fluid, continuous gameplay. We identified positive scaling of dACC and posterior insula response with cumulative exclusion events, but these same regions exhibited trending signal decreases with cumulative inclusion events. Furthermore, areas within the dACC and insula also responded to context incongruency (throws to the participant in the exclusion run; throws between computer players in the overinclusion run). These findings caution against interpretations that responses in these regions uniquely reflect the affective distress of exclusion within social interaction paradigms. We further identified that the left ventrolateral PFC, rostromedial PFC, and left intraparietal sulcus responded similarly to cumulative exclusion and inclusion. These findings shed light on which neural regions exhibit patterns of differential sensitivity to exclusion or overinclusion, as well as those that are more broadly engaged by both types of social interaction.

The role of chronotype and reward processing in understanding social hierarchies in adolescence

INTRODUCTION

Circadian rhythms shift toward an evening preference during adolescence, a developmental period marked by greater focus on the social domain and salience of social hierarchies. The circadian system influences maturation of cognitive architecture responsible for motivation and reward, and observation of responses to reward cues has provided insights into neurocognitive processes that underpin adolescent social development. The objective was to investigate whether circadian phase of entrainment (chronotype) predicted both reward-related response inhibition and social status, and to explore whether mediator and moderator relationships existed between chronotype, reward processing, and social status outcomes.

METHODS

Participants were 75 adolescents aged 13-14 years old (41 females) who completed an eye tracking paradigm that involved an inhibitory control task (antisaccade task) within a nonsocial reward (Card Guessing Game) and a social reward (Cyberball Game) context. Chronotype was calculated from weekend midsleep and grouped into early, intermediate, and later terciles. Participants indicated subjective social status compared with peers in seven domains.

RESULTS

An intermediate and later chronotype predicted improved inhibitory control in the social versus nonsocial reward context. Chronotype also predicted higher perceived social status in two domains (powerful, troublemaker). Intermediate chronotypes reported higher "Powerful" status whereas later chronotypes were higher on "Troublemaker." Improved social reward-related performance predicted only the higher powerful scores and chronotype moderated this relationship. Improved inhibitory control to social reward predicted higher subjective social status in the intermediate and later chronotype group, an effect that was absent in the early group.

CONCLUSION

This behavioral study found evidence that changes toward a later phase of entrainment predicts social facilitation effects on inhibitory control and higher perceived power among peers. It is proposed here that circadian delayed phase in adolescence is linked to approach-related motivation, and the social facilitation effects could reflect a social cognitive capacity involved in the drive to achieve social rank.

Neurobiological Bases of Social Networks

A social network is a web that integrates multiple levels of interindividual social relationships and has direct associations with an individual’s health and well-being. Previous research has mainly focused on how brain and social network structures (structural properties) act on each other and on how the brain supports the spread of ideas and behaviors within social networks (functional properties). The structure of the social network is correlated with activity in the amygdala, which links decoding and interpreting social signals and social values. The structure also relies on the mentalizing network, which is central to an individual’s ability to infer the mental states of others. Network functional properties depend on multilayer brain-social networks, indicating that information transmission is supported by the default mode system, the valuation system, and the mentalizing system. From the perspective of neuroendocrinology, overwhelming evidence shows that variations in oxytocin, β-endorphin and dopamine receptor genes, including oxytocin receptor (OXTR), mu opioid receptor 1 (OPRM1) and dopamine receptor 2 (DRD2), predict an individual’s social network structure, whereas oxytocin also contributes to improved transmission of emotional and behavioral information from person to person. Overall, previous studies have comprehensively revealed the effects of the brain, endocrine system, and genes on social networks. Future studies are required to determine the effects of cognitive abilities, such as memory, on social networks, the characteristics and neural mechanism of social networks in mental illness and how social networks change over time through the use of longitudinal methods.

Exclusion Expected? Cardiac Slowing Upon Peer Exclusion Links Preschool Parent Representations to School-Age Peer Relationships

Attachment theory proposes that children's representations of interactions with caregivers guide information-processing about others, bridging interpersonal domains. In a longitudinal study (N = 165), preschoolers (M_age  = 5.19 years) completed the MacArthur Story Stem Battery to assess parent representations. At school-age (M_age  = 8.42 years), children played a virtual ballgame with peers who eventually excluded them to track event-related cardiac slowing, a physiological correlate of rejection, especially when unexpected. At both ages, parents and teachers reported on peer and emotional problems. During exclusion versus inclusion-related events, cardiac slowing was associated with greater positive parent representations and fewer emerging peer problems. Cardiac slowing served as a mediator between positive parent representations and peer problems, supporting a potential psychophysiological mechanism underlying the generalization of attachment-related representations to peer relationships.

Social exclusion reliably engages the default network: A meta-analysis of Cyberball

Social exclusion refers to the experience of being disregarded or rejected by others and has wide-ranging negative consequences for well-being and cognition. Cyberball, a game where a ball is virtually tossed between players, then leads to the exclusion of the research participant, is a common method used to examine the experience of social exclusion. The neural correlates of social exclusion remain a topic of debate, particularly with regards to the role of the dorsal anterior cingulate cortex (dACC) and the concept of social pain. Here we conducted a quantitative meta-analysis using activation likelihood estimation (ALE) to identify brain activity reliably engaged by social exclusion during Cyberball task performance (Studies = 53; total N = 1,817 participants). Results revealed consistent recruitment in ventral anterior cingulate and posterior cingulate cortex, inferior and superior frontal gyri, posterior insula, and occipital pole. No reliable activity was observed in dACC. Using a probabilistic atlas to define dACC, fewer than 15% of studies reported peak coordinates in dACC. Meta-analytic connectivity mapping suggests patterns of co-activation are consistent with the topography of the default network. Reverse inference for cognition associated with reliable Cyberball activity computed in Neurosynth revealed social exclusion to be associated with cognitive terms Social, Autobiographical, Mental States, and Theory of Mind. Taken together, these findings highlight the role of the default network in social exclusion and warns against interpretations of the dACC as a key region involved in the experience of social exclusion in humans.

Preference and popularity as distinct forms of status: A meta-analytic review of 20 years of research

INTRODUCTION

A systematic meta-analysis was conducted of the association between preference and popularity across childhood and adolescence. The role of development, sex, and region of the world were examined.

METHOD

The analysis was conducted on 135 samples including 136,014 participants. The samples were divided by age (upper grades primary school, k = 41; lower grades secondary school, k = 72; upper grades secondary school, k = 22) and region (North America, k = 54; Europe, k = 66; China, k = 10).

RESULTS

Across all samples, a moderate positive association between preference and popularity was found (r = 0.45). The association was significantly weaker in the upper grades of secondary school (r = 0.37) than in the lower grades of secondary school (r = 0.47) or the upper grades of primary school (r = 0.47). The association was weaker for girls (r = 0.26) than for boys (r = 0.38) in the upper grades of secondary school. The association was weaker in European samples (r = 0.41) than in those from North America (r = 0.50) and China (r = 0.57).

CONCLUSIONS

The results confirmed that preference and popularity are related but distinct dimensions of adolescent peer status. The association differed significantly by age, sex, and region of the world. Further research should examine additional factors that explain the variability in the association between preference and popularity.

Heightened neural sensitivity to social exclusion in boys with a history of low peer preference during primary school

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Low peer preference was linked to higher brain activation during early social exclusion experiences.

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Activation was found in an area implicated in emotion regulation and attentional control.

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Results suggest that low peer preferred boys become sensitive to social exclusion.

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Low peer preference seems to become embodied in children’s neurobiology.

Peer preference among classmates is a highly influential factor in children’s social development and not being preferred by peers has long-term consequences for children’s developmental outcomes. However, little is known about how a history of low peer preference during primary school is associated with neural responses to a new social exclusion experience in childhood. In this functional magnetic resonance imaging (fMRI) study, we examined self-reported social distress and neural responses to social exclusion using the Cyberball paradigm in primary school boys (M_age = 10.40 years) with a history of low (n = 27) versus high peer preference (n = 28). Boys were selected from a longitudinal classroom-based study in which children’s peer social preferences were assessed in three consecutive years prior to this study. Neuroimaging results showed that low peer preferred boys exhibited increased activation in the lateral prefrontal cortex during early social exclusion relative to later social exclusion experiences as compared to high peer preferred boys. Increased neural activity was not accompanied by higher self-reported levels of social distress during social exclusion in low versus high peer preferred children. Findings of this study may provide insight into the neural processes associated with real-life peer experiences in children attending primary school.

Future Directions in Peer Relations Research

Peer relationships among youth have been examined as predictors of mental health outcomes for at least fifty years, revealing dozens of discrete peer constructs that each are associated with adjustment in childhood, adolescence, and later in adulthood. Future research may benefit by examining a range of new outcomes and psychological processes that have been discussed recently in related literatures. This paper reviews recent research on interpersonal determinants of physical health outcomes, and opportunities for greater examination of 1) peer influence processes toward health risk behaviors; 2) neural correlates of peer adversity; 3) adverse peer experiences that may affect physiological markers of stress response; and 4) immune system markers of peer adversity. Additional future directions include the study of differences in the forms and functions of peer interactions within the digital age.

Heightened neural sensitivity to social exclusion in boys with a history of low peer preference during primary school

•

Low peer preference was linked to higher brain activation during social exclusion.

•

Activation was found in areas implicated in social cognition and emotion regulation.

•

Results suggest that low peer preferred boys become sensitive to social exclusion.

•

Low peer preference seems to become embodied in children’s neurobiology.

Peer preference among classmates is a highly influential factor in children’s social development and not being preferred by peers has long-term consequences for children’s developmental outcomes. However, little is known about how a history of low peer preference during primary school is associated with neural responses to a new social exclusion experience in childhood. In this functional magnetic resonance imaging (fMRI) study, we examined self-reported social distress and neural responses to social exclusion using the Cyberball paradigm in primary school boys (M_age = 10.40 years) with a history of low (n = 27) versus high peer preference (n = 28). Boys were selected from a longitudinal classroom-based study in which children’s peer social preferences were assessed in three consecutive years prior to this study. Neuroimaging results showed that low peer preferred boys exhibited increased activation in the bilateral dorsolateral prefrontal cortex and right supramarginal gyrus during social exclusion as compared to high peer preferred boys. Increased neural activity was not accompanied by higher self-reported levels of social distress during social exclusion in low versus high peer preferred boys. Findings of this study may provide insight into the neural processes associated with real-life peer experiences in children attending primary school.