Large-scale brain organization during facial emotion processing as a function of early life trauma among adolescent girls

Adverse childhood experiences, brain efficiency, and the development of pain symptoms in youth

BACKGROUND

Adverse childhood experiences (ACEs) are often reported by youths with chronic pain, and both ACEs and chronic pain disrupt how information is processed. However, it is unknown whether changes to shared neural networks underlie the relationship between ACEs and the development of pain symptoms. This study explored the relationships between ACEs, brain efficiency, and pain symptomology in youth.

METHODS

A community sample of youths aged 14-18 years underwent MRIs, answered trauma and pain questionnaires, and underwent pain sensory testing, twice, 3 months apart (Nbaseline = 44; Nfollow-up = 42). Sensory testing determined thresholds for mechanical and thermal stimuli. Global and local network efficiencies were evaluated using graph theory. Generalized estimating equations were applied to examine whether brain efficiency moderated the relationships between ACEs, pain intensity, and pain sensitivity (i.e., mechanical detection, heat pain, and temperature change thresholds).

RESULTS

There was a significant interaction between ACEs and global brain efficiency in association with pain intensity (β = -0.31, p = 0.02) and heat pain (β = -0.29, p = 0.004). Lower global brain efficiency exacerbated the relationship between ACEs and pain intensity (θX → Y|W = -1.16 = 0.37, p = 0.05), and heat pain sensitivity (θX → Y|W = -1.30 = 0.44, p = 0.05). Higher global brain efficiency ameliorated the relationship between ACEs and pain intensity (θX → Y|W = 1.75 = -0.53, p = 0.05).

CONCLUSIONS

The relationship between ACEs and pain symptomology was comparable to chronic pain phenotypes (i.e., higher pain intensity and pain thresholds) and may vary as a function of brain efficiency in youth. This stresses the importance of assessing for pain symptoms in trauma-exposed youth, as earlier identification and intervention are critical in preventing the chronification of pain.

SIGNIFICANCE

This article explores the relationship between ACEs, pain symptomology, and brain efficiency in youth. ACEs may affect how the brain processes information, including pain. Youths with lower brain efficiencies that were exposed to more ACEs have pain symptomology comparable to youths with chronic pain. Understanding this relationship is important for the earlier identification of pain symptoms, particularly in vulnerable populations such as youths exposed to trauma, and is critical for preventing the chronification of pain.

Neural differentiation of emotional faces as a function of interpersonal violence among adolescent girls

Interpersonal violence (IV) is associated with altered neural threat processing and risk for psychiatric disorder. Representational similarity analysis (RSA) is a multivariate approach examining the extent to which differences between stimuli correspond to differences in multivoxel activation patterns to these stimuli within each ROI. Using RSA, we examine overlap in neural patterns between threat and neutral faces in youth with IV. Participants were female adolescents aged 11-17 who had a history of IV exposure (n = 77) or no history of IV, psychiatric diagnoses, nor psychiatric medications (n = 37). Participants completed a facial emotion processing task during fMRI. Linear mixed models indicated that increasing hippocampal differentiation of fear and neutral faces was associated with increasing IV severity. Increased neural differentiation of these facial stimuli in the left and right hippocampus was associated with increasing physical abuse severity. Increased differentiation by the dACC correlated with increasing physical assault severity. RSA for most ROIs were not significantly associated with univariate activity, except for a positive association between amygdala RSA and activity to fear faces. Differences in statistically significant ROIs for physical assault and physical abuse may highlight distinct effects of trauma type on encoding of threat vs. neutral faces. Null associations between RSA and univariate activation in most ROIs suggest unique contributions of RSA for understanding IV compared to traditional activation. Implications include understanding mechanisms of risk in IV and trauma-specific treatment selection. Future work should replicate these findings in longitudinal studies and identify sensitive periods for neural alterations in RSA.

Lifespan adversities affect neural correlates of behavioral inhibition in adults

Introduction

Growing evidence suggests that adverse experiences have long-term effects on executive functioning and underlying neural circuits. Previous work has identified functional abnormalities during inhibitory control in frontal brain regions in individuals exposed to adversities. However, these findings were mostly limited to specific adversity types such as maltreatment and prenatal substance abuse.

Methods

We used data from a longitudinal birth cohort study (n = 121, 70 females) to investigate the association between adversities and brain responses during inhibitory control. At the age of 33 years, all participants completed a stop-signal task during fMRI and an Adult Self-Report scale. We collected seven prenatal and postnatal adversity measures across development and performed a principal component analysis to capture common variations across those adversities, which resulted in a three-factor solution. Multiple regression analysis was performed to identify links between adversities and brain responses during inhibitory control using the identified adversity factors to show the common effect and single adversity measures to show the specific contribution of each adversity. To find neural correlates of current psychopathology during inhibitory control, we performed additional regression analyses using Adult Self-Report subscales.

Results

The first adversity factor reflecting prenatal maternal smoking and postnatal psychosocial adversities was related to higher activation during inhibitory control in bilateral inferior frontal gyri, insula, anterior cingulate cortex, and middle temporal gyri. Similar results were found for the specific contribution of the adversities linked to the first adversity factor. In contrast, we did not identify any significant association between brain responses during inhibitory control and the second adversity factor reflecting prenatal maternal stress and obstetric risk or the third adversity factor reflecting lower maternal sensitivity. Higher current depressive symptoms were associated with higher activation in the bilateral insula and anterior cingulate cortex during inhibitory control.

Conclusion

Our findings extended previous work and showed that early adverse experiences have a long-term effect on the neural circuitry of inhibitory control in adulthood. Furthermore, the overlap between neural correlates of adversity and depressive symptomatology suggests that adverse experiences might increase vulnerability via neural alterations, which needs to be investigated by future longitudinal research.

The influence of childhood emotional neglect on emotional face processing in young adults

Childhood emotional neglect (CEN) refers to a failure to meet the basic emotional needs of a child, which can seriously impact interpersonal communication and psychological health in young adults. Emotional face processing is critical in interpersonal communication; however, whether CEN affects this processing in young adults has not been investigated. Therefore, the current study aimed to explore the effects of CEN on emotional face processing in young adults. Using the Child Trauma Questionnaire, an online survey was conducted with 5010 students from four universities in Tianjin, China. After online interviews and diagnosis by professional doctors, we obtained 20 participants with CEN (CEN group) and 20 without CEN (control group). None of the participants had any mental diseases. A 2 × 4 mixed design was used to investigate the differences in accuracy and response time when identifying the valence of the emotional faces. Compared to the control group, the CEN group identified the valence of all emotional faces more slowly, but there was no significant difference between the two groups in terms of accuracy. CEN caused delayed emotional face processing in young adults, which may be related to unresponsive, unavailable, and limited emotional interaction patterns between parents and their children.

Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment

Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.

Test-retest reliability of fMRI during an emotion processing task: Investigating the impact of analytical approaches on ICC values

Test-retest reliability of fMRI is often assessed using the intraclass correlation coefficient (ICC), a numerical representation of reliability. Reports of low reliability at the individual level may be attributed to analytical approaches and inherent bias/error in the measures used to calculate ICC. It is unclear whether low reliability at the individual level is related to methodological decisions or if fMRI is inherently unreliable. The purpose of this study was to investigate methodological considerations when calculating ICC to improve understanding of fMRI reliability. fMRI data were collected from adolescent females (N=23) at pre- and post-cognitive behavioral therapy. Participants completed an emotion processing task during fMRI. We calculated ICC values using contrasts and β coefficients separately from voxelwise and network (ICA) analyses of the task-based fMRI data. For both voxelwise analysis and ICA, ICC values were higher when calculated using β coefficients. This work provides support for the use of β coefficients over contrasts when assessing reliability of fMRI, and the use of contrasts may underlie low reliability estimates reported in the existing literature. Continued research in this area is warranted to establish fMRI as a reliable measure to draw conclusions and utilize fMRI in clinical settings.

Childhood trauma history is linked to abnormal brain metabolism of non-medicated adult patients with major depressive disorder

OBJECTIVES

Childhood trauma is a risk factor that may lead to persistent brain metabolic abnormalities, predisposing individuals to major depressive disorder (MDD). To better elucidate the pathogenesis of MDD, we investigated the neurometabolic changes in unmedicated MDD patients who had experienced childhood trauma (CT).

METHODS

In this study, 37 unmedicated MDD patients with CT, 35 unmedicated MDD patients without CT, and 30 healthy control participants underwent high-resolution proton magnetic resonance spectroscopy (¹H-MRS) examination. Bilateral metabolic ratios of N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr in the prefrontal white matter (PWM), anterior cingulate cortex (ACC), putamen, and cerebellum were obtained.

RESULTS

MDD patients showed neurometabolic changes in the cortico-striato-cerebellar (CSC) circuit. Furthermore, MDD patients showed significantly lower NAA/Cr and higher Cho/Cr ratio in the bilateral ACC and putamen, and higher NAA/Cr and lower Cho/Cr ratio in the cerebellum. Childhood trauma reduced the Cho/Cr ratio in the left ACC, which played an important role in longer and more episodes of depression.

CONCLUSION

Early childhood trauma has a long-lasting impact on the metabolism of adult MDD patients, leading to abnormal choline metabolism of the left ACC. Abnormal biochemical metabolism in the CSC circuit may be an underlying pathophysiology of MDD.

LIMITATION

As this is a small cross-sectional study, the impact of childhood trauma on the different stages of depression has not been observed.

Experience-dependent associations between distinct subtypes of childhood trauma and brain function and architecture

Background

Childhood trauma can alter brain-development trajectories and lead to a greater risk of psychopathology developing in adulthood. For this reason, understanding experience-dependent brain abnormalities associated with different trauma subtypes is crucial for identifying developmental processes disrupted by unfavorable early environments and for proposing early intervention measures to reduce trauma's negative effects.

Methods

This study used multimodal magnetic resonance imaging (MRI) to explore the neural correlates of distinct subtypes of childhood trauma. We recruited a large community sample of young adults (mean age, 24.1, SD 1.9 years) who completed a Childhood Trauma Questionnaire, were given behavioral scores, and underwent multimodal MRI. To quantify brain changes, we used functional connectivity density (FCD) mapping based on whole brain analysis, regions of interest (ROI) analysis, and morphological measurements. Experience-dependent brain abnormalities were identified by multivariable linear regression.

Results

We found that diverse brain regions in the FCD mapping were significantly related to 4 trauma subtypes and belonged to different cognitive components used for various behaviors. Experience-related influences on functional circuits and brain morphology were observed in extensive regions, including the sensorimotor, cingulum, accumbens, insula, and frontal-parietal areas, as well as in regions within the default mode network.

Conclusions

Identifying specific regions or systems may be a valid strategy for understanding the pathogenesis and development process of psychiatric disorders in people with different traumatic experiences and may facilitate better-targeted intervention strategies for maltreated children.

Longitudinal hippocampal circuit change differentiates persistence and remission of pediatric posttraumatic stress disorder

BACKGROUND

Previous studies have identified functional brain abnormalities in pediatric posttraumatic stress disorder (pPTSD) suggesting altered frontoparietal-subcortical function during emotion processing. However, little is known about how the brain functionally changes over time in recovery versus the persistence of pPTSD.

METHODS

This longitudinal study recruited 23 youth with PTSD and 28 typically developing (TD) youth (ages: 8.07-17.99). Within the PTSD group, nine remitted by the 1-year follow-up (Remit) while the remaining 14 persisted (PTSD). At each visit, youth completed an emotional processing task in which they viewed threat and neutral images during functional magnetic resonance imaging (fMRI). Voxelwise activation analyses using linear mixed-effects regression were conducted using a group (TD, Remit, PTSD) by time (baseline, follow-up) by valence (threat, neutral) design. Based on activation findings, a subsequent analysis of hippocampal functional connectivity was performed using a similar model.

RESULTS

PTSD youth showed significantly increasing hippocampal activation to threatening images compared to TD youth, while the Remit group showed more similar patterns to TD youth. Subsequent hippocampal functional connectivity analyses reveal the Remit group showed increasing functional connectivity between the hippocampus and visual cortex (V4) while viewing threat stimuli.

CONCLUSIONS

These findings represent one of the first preliminary reports of functional brain substrates of persistence and remission in pPTSD. Notably, increased hippocampal activation to threat and decreased connectivity in the hippocampal-V4 network over time may contribute to persistence in pPTSD. These findings suggest potential biomarkers that could be utilized to advance the treatment of pediatric PTSD.

Functional imaging correlates of childhood trauma: A qualitative review of past research and emerging trends

Childhood trauma exposure is common and is associated with poor clinical outcomes in adolescence along with mental health and sociodemographic challenges in adulthood. While many strategies exist to investigate the biological imprint of childhood trauma exposure, functional neuroimaging is a robust and growing technology for non-invasive studies of brain activity following traumatic experience and the relationship of childhood trauma exposure with psychopathology, cognition, and behavior. In this review, we discuss three popular approaches for discerning functional neural correlates to early life trauma, including regional activation, bivariate functional connectivity, and network-based connectivity. The breadth of research in each method is discussed, followed by important limitations and considerations for future research. We close by considering emerging trends in functional neuroimaging research of childhood trauma, including the use of complex decision-making tasks to mimic clinically-relevant behaviors, data-driven techniques such as multivariate pattern analysis and whole-brain network topology, and the applications of real-time neurofeedback for treatment of trauma-related mental disorders. We aim for this review to provide a framework for understanding the relationship between atypical neural functioning and adverse outcomes following childhood trauma exposure, with a focus on improving consistency in research methods and translatability of research findings for clinical settings.

Feasibility of Using Child Maltreatment Measurement Instruments in the Primary Care Setting: A Systematic Review

PROBLEM

Child maltreatment is a devastating epidemic affecting millions of children and adolescents in the United States (U.S.) every year. Primary care providers (PCPs) encounter these victims but need resources to aid in the recognition of maltreatment. The purpose of this review is to evaluate child maltreatment measurement instruments and determine feasibility of use by U.S. PCPs.

ELIGIBILITY CRITERIA

A systematic search was conducted in the PubMed, CINAHL, and PsycInfo databases from 2014 until 2020. Eligibility criteria included articles conducted in the U.S., with use of a child maltreatment measurement instrument, and subjects less than 18 years old. Eligible articles were reference searched to find the original studies for each instrument and were included if they were published in a peer-reviewed paper, could be located, and addressed the development or validation of the instrument.

SAMPLE

Of the 3816 articles, 111 used a child maltreatment measurement instrument. Sixteen of the 27 identified instruments were evaluated for feasibility using a quality rating with criteria including psychometrics, construct measurement, administration, availability, and cost.

RESULTS

Six instruments were recommended for use by PCPs.

CONCLUSIONS

This is the first review evaluating the use of child maltreatment measurement instruments by PCPs and it highlights the combination of psychometric evaluation and other pertinent feasibility criteria to recommend several instruments for use by PCPs.

IMPLICATIONS

Use of these instruments by PCPs may serve to identify children and families who are at risk for or suffering from maltreatment.

Gray matter volume correlates of adolescent posttraumatic stress disorder: A comparison of manual intervention and automated segmentation in FreeSurfer

Exposure to early life trauma is common and confers risk for psychological disorders in adolescence, including posttraumatic stress disorder (PTSD). Trauma exposure and PTSD are also consistently linked to alterations in gray matter volume (GMV). Despite the quantity of structural neuroimaging research in trauma-exposed populations, little consensus exists amongst research groups on best practices for image processing method and manual editing procedures. The purpose of this report is to evaluate the utility of manual editing of magnetic resonance (MR) images for detecting PTSD-related group differences in GMV. Here, T1-weighted MR images from adolescent girls aged 11-17 were obtained and analyzed. Two datasets were created from the FreeSurfer reconall pipeline, one of which was manually edited by trained research assistants. Gray matter regions of interest were selected and total volume estimates were entered into linear mixed effects models with method (manual edits or automated) as a within-subjects factor and group dummy-coded with PTSD as the reference group. Consistent with prior literature, individuals with PTSD demonstrated reduced GMV of the amygdala compared to trauma-exposed and non-trauma exposed controls, independent of editing method. Our results demonstrate that amygdala GMV reductions in PTSD are robust to certain methodological choices and do not suggest a benefit to the time-intensive manual editing pipeline in FreeSurfer for quantifying PTSD-related GMV.

Dysregulated functional brain connectivity in response to acute social-evaluative stress in adolescents with PTSD symptoms

Background: Posttraumatic stress disorder (PTSD) is associated with dysregulated neural, cortisol, and cardiac stress reactivity and recovery. This understanding is predominantly based on studies in adults applying emotional-cognitive and trauma-related stimuli inducing negative emotions or perceived threat. Despite large numbers of adolescents with PTSD, few studies are available on neurobiological stress reactivity in this population. Moreover, no previous studies investigated neural reactivity to social-evaluative stress. Objective: To investigate functional brain connectivity, cortisol and cardiac reactivity to acute social-evaluative stress, and additional cortisol measures in trauma-exposed adolescents with and without high PTSD symptoms. Method: A speech preparation task to induce acute social-evaluative stress elicited by anticipatory threat, was used in a subsample of the Amsterdam Born Child and their Development (ABCD) birth cohort, consisting of trauma-exposed adolescents with (n = 20) and without (n = 29) high PTSD symptoms. Psychophysiological interaction analyses were performed to assess group differences in functional connectivity of the hippocampus, mPFC and amygdala during social-evaluative stress and recovery, measured by fMRI. Additionally, perceived stress, heart rate and cortisol stress reactivity and recovery, cortisol awakening response and day curve were compared. Results: The stressor evoked significant changes in heart rate and perceived stress, but not cortisol. The PTSD symptom and control groups differed in functional connectivity between the hippocampus and cerebellum, middle and inferior frontal gyrus, and the mPFC and inferior frontal gyrus during social-evaluative stress versus baseline. Mostly, the same patterns were found during recovery versus baseline. We observed no significant group differences in amygdala connectivity, and cortisol and cardiac measures. Conclusions: Our findings suggest threat processing in response to social-evaluative stress is disrupted in adolescents with PTSD symptoms. Our findings are mainly but not entirely in line with findings in adults with PTSD, which denotes the importance to investigate adolescents with PTSD as a separate population.

Early Adversity and Emotion Processing From Faces: A Meta-analysis on Behavioral and Neurophysiological Responses

BACKGROUND

Although the link between early adversity (EA) and later-life psychiatric disorders is well established, it has yet to be elucidated whether EA is related to distortions in the processing of different facial expressions. We conducted a meta-analysis to investigate whether exposure to EA relates to distortions in responses to different facial emotions at three levels: 1) event-related potentials of the P100 and N170, 2) amygdala functional magnetic resonance imaging responses, and 3) accuracy rate or reaction time in behavioral data.

METHODS

The systematic literature search (PubMed and Web of Science) up to April 2020 resulted in 29 behavioral studies (n = 8555), 32 functional magnetic resonance imaging studies (n = 2771), and 3 electroencephalography studies (n = 197) for random-effect meta-analyses.

RESULTS

EA was related to heightened bilateral amygdala reactivity to sad faces (but not other facial emotions). Exposure to EA was related to faster reaction time but a normal accuracy rate in response to angry and sad faces. In response to fearful and happy faces, EA was related to a lower accuracy rate only in individuals with recent EA exposure. This effect was more pronounced in individuals with exposure to EA before (vs. after) the age of 3 years. These findings were independent of psychiatric diagnoses. Because of the low number of eligible electroencephalography studies, no conclusions could be reached regarding the effect of EA on the event-related potentials.

CONCLUSIONS

EA relates to alterations in behavioral and neurophysiological processing of facial emotions. Our study stresses the importance of assessing age at exposure and time since EA because these factors mediate some EA-related perturbations.

Effects of childhood trauma experience and COMT Val158Met polymorphism on brain connectivity in a multimodal MRI study

Childhood adversity may act as a stressor to produce a cascade of neurobiological effects that irreversibly alter neural development, setting the stage for developing psychopathology in adulthood. The catechol-O-methyltransferase (COMT) Val158Met polymorphism has received much attention as a candidate gene associated with environmental adversity, modifying risk for psychopathology. In this study, we aim to see how gene × brain × environment models give a more integrative understanding of brain modifications that contribute to predicting psychopathology related to childhood adversity. A large nonclinical sample of young adults completed Childhood Trauma Questionnaire (CTQ), behavioral scores, multimodal magnetic resonance imaging (MRI) scans, and genotyping. We utilized graph-based connectivity analysis in morphometric similarity mapping and resting-state functional MRI to investigate brain alterations. Relationships among COMT genotypes, CTQ score, imaging phenotypes, and behavioral scores were identified by multiple regression and mediation effect analysis. Significant main effect of CTQ score was found in anatomic connectivity of orbitofrontal cortex that was an outstanding mediator supporting the relationship between CTQ score and anxiety/harm-avoiding personality. We also noted the main effect of childhood trauma on reorganization of functional connectivity within the language network. Additionally, we found genotype × CTQ score interactions on functional connectivity of the right frontoparietal network as well as anatomic connectivity of motor and limbic regions. Our data demonstrate childhood adversity and COMT genotypes are associated with abnormal brain connectivity, structurally and functionally. Early identification of individuals at risk, assessment of brain abnormality, and cognitive interventions may help to prevent or limit negative outcomes.

Alterations in fear extinction neural circuitry and fear-related behavior linked to trauma exposure in children

Exposure to childhood trauma is extremely common (>60 %) and is a leading risk factor for fear-based disorders, including anxiety and posttraumatic stress disorder. These disorders are characterized by deficits in fear extinction and dysfunction in underlying neural circuitry. Given the strong and pervasive link between childhood trauma and the development of psychopathology, fear extinction may be a key mechanism. The present study tests the impact of childhood trauma exposure on fear extinction and underlying neural circuitry. Children (N = 44, 45 % trauma-exposed; 6-11 yrs) completed a novel two-day virtual reality fear extinction experiment. On day one, participants underwent fear conditioning and extinction. Twenty-four hours later, participants completed a test of extinction recall during fMRI. Conditioned fear was measured throughout the experiment using skin conductance and fear-related behavior, and activation in fear-related brain regions was estimated during recall. There were no group differences in conditioned fear during fear conditioning or extinction learning. During extinction recall, however, trauma-exposed children kept more distance from both the previously extinguished and the safety cue, suggesting poor differentiation between threat and safety cues. Trauma-exposed youth also failed to approach the previously extinguished cue over the course of extinction recall. The effects on fear-related behavior during extinction recall were accompanied by higher activation to the previously extinguished cue in fear-relevant brain regions, including the dorsal anterior cingulate cortex and anterior insula, in trauma-exposed relative to control children. Alterations in fear-related brain regions and fear-related behavior may be a core mechanism through which childhood trauma confers heightened vulnerability to psychopathology.

Effects of childhood trauma experience and BDNF Val66Met polymorphism on brain plasticity relate to emotion regulation

Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism may modulate the link between childhood trauma experience and psychopathology by altering trophic signaling on neuroplasticity. However, few multimodal magnetic resonance imaging (MRI) researches have investigated this gene-environment interaction on both structural and functional plasticity, thereby advancing knowledge about the etiology, prevention, and customized therapeutic directions of mental disease in individuals with childhood trauma experience. We recruited a large non-clinical sample of young adults that completed Childhood Trauma Questionnaire (CTQ), behavioral scores, multimodal MRI scans, and genotyping. Morphometric similarity network (MSN) and independent component analysis were adopted to quantify brain structural and functional changes. Gene-environment-brain-behavior relationships were identified by multiple regression and mediation effect analysis. CTQ score was positively associated with depression and anxiety scores. We found interactions on MSN in sensorimotor, temporal, and orbitofrontal cortex. For intra-network connectivity, significant interaction was noted in clusters within sensorimotor network. For inter-network connectivity, connectivity between dorsal attention network and salience network showed an interactive effect. For mean connectivity strength of each network, we found a main effect of CTQ score on self-reference network that was an outstanding mediator supporting the relationship between CTQ score and anxiety. Our findings demonstrate that childhood trauma and the BDNF Val66Met polymorphism are associated with brain plasticity involving emotion regulation, structurally and functionally, which may contribute to understanding psychotic mechanisms and predicting differential susceptibility. Imaging genetics may be useful as biomarkers to provide early assessment and guide cognitive interventions to avoid or decrease the risk of developing psychopathology.

MRI Insights Into Adolescent Neurocircuitry-A Vision for the Future

Adolescence is the time of onset of many psychiatric disorders. Half of pediatric patients present with comorbid psychiatric disorders that complicate both their medical and psychiatric care. Currently, diagnosis and treatment decisions are based on symptoms. The field urgently needs brain-based diagnosis and personalized care. Neuroimaging can shed light on how aberrations in brain circuits might underlie psychiatric disorders and their development in adolescents. In this perspective article, we summarize recent MRI literature that provides insights into development of psychiatric disorders in adolescents. We specifically focus on studies of brain structural and functional connectivity. Ninety-six included studies demonstrate the potential of MRI to assess psychiatrically relevant constructs, diagnose psychiatric disorders, predict their development or predict response to treatment. Limitations of the included studies are discussed, and recommendations for future research are offered. We also present a vision for the role that neuroimaging may play in pediatrics and primary care in the future: a routine neuropsychological and neuropsychiatric imaging (NPPI) protocol for adolescent patients, which would include a 30-min brain scan, a quality control and safety read of the scan, followed by computer-based calculation of the structural and functional brain network metrics that can be compared to the normative data by the pediatrician. We also perform a cost-benefit analysis to support this vision and provide a roadmap of the steps required for this vision to be implemented.

Altered large-scale functional brain organization in posttraumatic stress disorder: A comprehensive review of univariate and network-level neurocircuitry models of PTSD

Classical neural circuitry models of posttraumatic stress disorder (PTSD) are largely derived from univariate activation studies and implicate the fronto-limbic circuit as a main neural correlate of PTSD symptoms. Though well-supported by human neuroimaging literature, these models are limited in their ability to explain the widely distributed neural and behavioral deficits in PTSD. Emerging interest in the application of large-scale network methods to functional neuroimaging provides a new opportunity to overcome such limitations and conceptualize the neural circuitry of PTSD in the context of network patterns. This review aims to evaluate both the classical neural circuitry model and a new, network-based model of PTSD neural circuitry using a breadth of functional brain organization research in subjects with PTSD. Taken together, this literature suggests global patterns of reduced functional connectivity (FC) in PTSD groups as well as altered FC targets that reside disproportionately in canonical functional networks, especially the default mode network. This provides evidence for an integrative model that includes elements of both the classical models and network-based models to characterize the neural circuitry of PTSD.

Biotypes of functional brain engagement during emotion processing differentiate heterogeneity in internalizing symptoms and interpersonal violence histories among adolescent girls

Youth exposed to early life interpersonal violence (IPV) demonstrate heterogeneous clinical symptoms. Studies based on univariate methods suggest that neurocircuitry related to emotion processing explains heterogeneity in internalizing symptoms. Here, we use a multivariate, data-driven method of identifying distinct functional brain activation profiles (i.e., "biotypes") and test whether these biotypes differentiate internalizing symptoms among IPV-exposed youth. 114 adolescent girls (n = 38 with no IPV exposure or psychopathology; n = 76 with IPV exposure and heterogeneous internalizing symptoms), aged 11-17, completed an emotion processing task during fMRI. To identify distinct biotypes of brain engagement profiles, data-driven clustering analysis was applied to patterns of voxel activation, constrained within a mask of distributed regions implicated in emotion processing. Resulting biotypes (BT1-3) were compared on measures of IPV exposure and internalizing symptoms, as well as symptom reduction during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) among a subset of participants (n = 21). Cluster analyses identified three biotypes, differentiated by engagement of medial prefrontal, anterior insula, hippocampus, parietal, and ventral visual cortex during emotion processing. BT1 exhibited low levels of IPV exposure and internalizing symptoms. BT2 exhibited elevated levels of IPV, except sexual assault, and demonstrated moderate severity across internalizing symptom domains. BT3 exhibited elevated severity across all IPV and internalizing symptom domains. Greater symptom reduction during TF-CBT was associated with increased pre-to post-treatment changes in similarity with BT1. These results demonstrate distinct profiles of emotion processing neurocircuitry that differentiate heterogeneity in internalizing symptoms in IPV-exposed adolescent girls.

Commentary: Paediatric post-traumatic stress disorder from a neurodevelopmental network perspective: reflections on Weems et al. (2019)

Paediatric post-traumatic stress disorder (PTSD) is an incredibly heterogeneous and syndromic disorder that likely has a myriad of underlying neurobiological mechanisms at play. The disorder is even more complicated in youth, given that the expression of illness interacts with ongoing developmental processes. In their review in this issue, Weems and colleagues call for broader network-based approaches for studying the development and expression of PTSD in youth. In this commentary, I highlight some of the important knowledge gaps raised by Weems et al. and propose ways in which future studies may leverage network-based approaches for eventual translation into clinical care. Key concepts include the use of network-based approaches for understanding the emergence and maintenance of PTSD symptom architecture over development, identification of resilient and vulnerable patterns of symptom and brain network architecture following trauma, and consideration of how divergence between biological (e.g. brain) and chronological may inform our understanding of resilient and vulnerable patterns over development. Importantly, advancing and translating this work to clinical care will require larger, prospective studies assessing youth as early in development as possible, and integrating information across multiple research groups and sites.

Annual Research Review: Pediatric posttraumatic stress disorder from a neurodevelopmental network perspective

BACKGROUND

Experiencing traumatic stress is common and may lead to posttraumatic stress disorder (PTSD) in a number of children and adolescents. Research using advanced imaging techniques is beginning to elucidate some of the neurobiological correlates of the traumatic stress response in youth.

METHODS

This paper summarizes the emerging network perspective of PTSD symptoms and reviews brain imaging research emphasizing structural and functional connectivity studies that employ magnetic resonance imaging techniques in pediatric samples.

RESULTS

Differences in structural connections and distributed functional networks such as the salience, default mode, and central executive networks are associated with traumatic and severe early life stress. The role of development has been relatively underappreciated in extant studies though there is evidence that critical brain regions as well as the structural and functional networks implicated undergo significant change in childhood and these typical developmental differences may be affected by traumatic stress.

CONCLUSIONS

Future research will benefit from adopting a truly developmental approach that considers children's growth as a meaningful effect (rather than simply a covariate) interacting with traumatic stress to predict disruptions in the anatomical, functional, and connective aspects of brain systems thought to underlie the network of PTSD symptoms. Linking symptom networks with neurodevelopmental network models may be a promising avenue for future work.

Differential Roles of the Salience Network During Prediction Error Encoding and Facial Emotion Processing Among Female Adolescent Assault Victims

BACKGROUND

Early-life assaultive violence exposure is a potent risk factor for posttraumatic stress disorder (PTSD) and other mood and anxiety disorders. Neurocircuitry models posit that increased risk is mediated by heightened emotion processing in a salience network including the dorsal anterior cingulate cortex, anterior insula, and amygdala. However, the processes of reinforcement learning (RL) also engage the salience network and are implicated in responses to early-life trauma and PTSD. To define their relative roles in response to early-life trauma and PTSD symptoms, the current study compared engagement of the salience network during emotion processing and RL as a function of early-life assault exposure.

METHODS

Adolescent girls (n = 30 girls who had previously been physically or sexually assaulted; n = 30 healthy girls for comparison) 11 to 17 years of age completed two types of tasks during functional magnetic resonance imaging: a facial emotion processing task and an RL task using either social or nonsocial stimuli. Independent component analysis was used to identify a salience network and characterize its engagement in response to emotion processing and prediction error encoding during the RL tasks.

RESULTS

Assault was related to greater reactivity of the salience network during emotion processing. By contrast, we found lesser encoding of negative prediction errors in the salience network, particularly during the social RL task, in girls who had been assaulted. The dysfunction of salience network activity during emotion processing and prediction error encoding was not associated with PTSD symptoms.

CONCLUSIONS

These results suggest that hyper- versus hypoactivity of the salience network among trauma-exposed youths depends on the cognitive-affective domain.