Neural and Cognitive Factors Influencing the Emergence of Psychopathology: Insights From the Bucharest Early Intervention Project

Prenatal maternal Inflammation, childhood cognition and adolescent depressive symptoms

BACKGROUND

Accumulating evidence indicates that higher prenatal maternal inflammation is associated with increased depression risk in adolescent and adult-aged offspring. Prenatal maternal inflammation (PNMI) may increase the likelihood for offspring to have lower cognitive performance, which, in turn, may heighten risk for depression onset. Therefore, this study explored the potential mediating role of childhood cognitive performance in the relationship between PNMI and adolescent depressive symptoms in offspring.

METHODS

Participants included 696 mother-offspring dyads from the Child Health and Development Studies (CHDS) cohort. Biomarkers of maternal inflammation [interleukin (IL)-6, IL-8, IL-1 receptor antagonist (IL-1RA) and soluble TNF receptor-II (sTNF-RII)] were assayed from first (T1) and second trimester (T2) sera. Childhood (ages 9-11) cognitive performance was assessed via standardized Peabody Picture Vocabulary Test (PPVT), a measure of receptive vocabulary correlated with general intelligence. Adolescent (ages 15-17) depressive symptoms were assessed via self-report.

RESULTS

There were no significant associations between T1 biomarkers and childhood PPVT or adolescent depressive symptoms. Higher T2 IL1-RA was directly associated with lower childhood PPVT (b = -0.21, SE = 0.08, t = -2.55, p = 0.01), but not with adolescent depressive symptoms. T2 IL-6 was not directly associated with childhood PPVT, but higher T2 IL-6 was directly associated at borderline significance with greater depressive symptoms in adolescence (b = 0.05, SE = 0.03, t = 1.96, p = 0.05). Lower childhood PPVT predicted significantly higher adolescent depressive symptoms (b = -0.07, SE = 0.02, t = -2.99, p < 0.01). There was a significant indirect effect of T2 IL-1RA on adolescent depressive symptoms via childhood PPVT (b = 0.03, 95 % CI = 0.002-0.03) indicating a partially mediated effect. No significant associations were found with T2 sTNF-RII nor IL-8.

CONCLUSIONS

Lower childhood cognitive performance, such as that indicated by a lower PPVT score, represents a potential mechanism through which prenatal maternal inflammation contributes to adolescent depression risk in offspring.

Fostering inclusion in EEG measures of pediatric brain activity

The past two decades have seen a rapid increase in neuroscientific evidence being used to characterize how contextual, structural, and societal factors shape cognition and school readiness. Measures of functional brain activity are increasingly viewed as markers of child development and biomarkers that could be employed to track the impact of interventions. While electroencephalography (EEG) provides a promising tool to understand educational inequities, traditional EEG data acquisition is commonly limited in some racial and ethnic groups due to hair types and styles. This ultimately constitutes unintentional systemic racism by disproportionately excluding participants from certain racial and ethnic groups from participation and representation in neuroscience research. Here, we provide a comprehensive review of how cultural considerations surrounding hair density, texture, and styling consistently skew samples to be less representative by disproportionately excluding Black and Latinx participants. We also provide recommendations and materials to promote best practices.

Neurodevelopmental vulnerability to psychosis: developmentally-based methods enable detection of early life inhibitory control deficits that predict psychotic-like experiences at the transition to adolescence

BACKGROUND

Inhibitory control develops in early childhood, and atypical development may be a measurable marker of risk for the later development of psychosis. Additionally, inhibitory control may be a target for intervention.

METHODS

Behavioral performance on a developmentally appropriate Go/No-Go task including a frustration manipulation completed by children ages 3-5 years (early childhood; n = 107) was examined in relation to psychotic-like experiences (PLEs; 'tween'; ages 9-12), internalizing symptoms, and externalizing symptoms self-reported at long-term follow-up (pre-adolescence; ages 8-11). ERP N200 amplitude for a subset of these children (n = 34) with electrophysiological data during the task was examined as an index of inhibitory control.

RESULTS

Children with lower accuracy on No-Go trials compared to Go trials in early childhood (F(1,101) = 3.976, p = 0.049), evidenced higher PLEs at the transition to adolescence 4-9 years later, reflecting a specific deficit in inhibitory control. No association was observed with internalizing or externalizing symptoms. Decreased accuracy during the frustration manipulation predicted higher internalizing, F(2,202) = 5.618, p = 0.004, and externalizing symptoms, F(2,202) = 4.663, p = 0.010. Smaller N200 amplitudes were observed on No-Go trials for those with higher PLEs, F(1,101) = 6.075, p = 0.020; no relationship was observed for internalizing or externalizing symptoms.

CONCLUSIONS

Long-term follow-up demonstrates for the first time a specific deficit in inhibitory control behaviorally and electrophysiology, for individuals who later report more PLEs. Decreases in task performance under frustration induction indicated risk for internalizing and externalizing symptoms. These findings suggest that pathophysiological mechanisms for psychosis are relevant and discriminable in early childhood, and further, suggest an identifiable and potentially modifiable target for early intervention.

Is there evidence of a causal link between childhood maltreatment and attention deficit/hyperactivity disorder? A systematic review of prospective longitudinal studies using the Bradford-Hill criteria

Background

Studies report an elevated risk of maltreatment in children with attention deficit/hyperactivity disorder (ADHD), and elevated levels of ADHD in people who suffered childhood maltreatment (CM). However, the direction(s) of causality between CM and ADHD remain unclear-does ADHD create a context for CM, does CM cause ADHD, or both?

Objective

This study systematically reviews and qualitatively synthesizes the research evidence relating to this question using Bradford-Hill criteria for establishing causality-strength, temporality, dose-response and plausibility.

Methods

We conducted a systematic review, following PRISMA guidelines, of prospective longitudinal studies examining both CM and ADHD. We then used Bradford-Hill criteria to assess the quality of evidence for a causal link between CM and ADHD.

Results

All 11 included studies demonstrated an association between CM and ADHD. Seven included evidence for temporality: five suggesting that CM precedes ADHD in the lifespan; two suggesting ADHD precedes CM. Four studies demonstrated a dose response relationship in which greater CM exposure was associated with elevated risk of ADHD. Studies presented a range of plausible mechanisms, including CM causing ADHD through biological programming, versus ADHD causing CM through parental stress.

Conclusions

The high quality prospective longitudinal studies reviewed confirm the association between ADHD and CM, but present conflicting evidence about the direction of causality and mechanisms underpinning this association. To better understand the complex interplay between CM and ADHD, more studies using new research designs will be required that can partition effects by type of CM and account for bidirectional effects and other complexities.

Effects of institutional rearing and foster care intervention on error monitoring and externalizing behaviors in adolescence

Children raised in institutions display deficits in error monitoring and increased psychopathology. Deficits in error monitoring might be a pathway for the emergence of psychopathology in previously institutionalized adolescents. Here we investigate the impact of early psychosocial deprivation and a foster care intervention on error monitoring and its association with internalizing and externalizing behavioral problems in adolescence A modified Flanker task assessed error monitoring in 16-year-old adolescents from the BEIP. The ERN and mid-frontal theta power were computed as indices of neural responses of error monitoring. Adolescents who experienced early institutional rearing and were subsequently placed into foster care showed comparable behavioral (RT, accuracy) and neural (ERN, theta power) measures of error monitoring to their never institutionalized peers; whereas adolescents who received care as usual showed both perturbed behavioral performance and neural responses. Longer duration of institutional care was associated with a reduction in mid-frontal theta power. The results further demonstrated a link between error monitoring as measured by ERN and mid-frontal theta and externalizing-ADHD behavioral problems in adolescents who continued receiving care as usual. The results highlight the long-term positive impact of early foster care placement and perturbations due to prolonged institutional care in neural responses of error monitoring.

The effects of early life adversity on children's mental health and cognitive functioning

Emerging evidence suggests that partially distinct mechanisms may underlie the association between different dimensions of early life adversity (ELA) and psychopathology in children and adolescents. While there is minimal evidence that different types of ELA are associated with specific psychopathology outcomes, there are partially unique cognitive and socioemotional consequences of specific dimensions of ELA that increase transdiagnostic risk of mental health problems across the internalizing and externalizing spectra. The current review provides an overview of recent findings examining the cognitive (e.g., language, executive function), socioemotional (e.g., attention bias, emotion regulation), and mental health correlates of ELA along the dimensions of threat/harshness, deprivation, and unpredictability. We underscore similarities and differences in the mechanisms connecting different dimensions of ELA to particular mental health outcomes, and identify gaps and future directions that may help to clarify inconsistencies in the literature. This review focuses on childhood and adolescence, periods of exquisite neurobiological change and sensitivity to the environment. The utility of dimensional models of ELA in better understanding the mechanistic pathways towards the expression of psychopathology is discussed, with the review supporting the value of such models in better understanding the developmental sequelae associated with ELA. Integration of dimensional models of ELA with existing models focused on psychiatric classification and biobehavioral mechanisms may advance our understanding of the etiology, phenomenology, and treatment of mental health difficulties in children and youth.

Negative urgency as a risk factor for hazardous alcohol use: Dual influences of cognitive control and reinforcement processing

Negative Urgency (NU) is a prominent risk factor for hazardous alcohol use. While research has helped elucidate how NU relates to neurobiological functioning with respect to alcohol use, no known work has contextualized such functioning within existing neurobiological theories in addiction. Therefore, we elucidated mechanisms contributing to the NU-hazardous alcohol use relationship by combining NU theories with neurobiological dual models of addiction, which posit addiction is related to cognitive control and reinforcement processing. Fifty-five undergraduates self-reported NU and hazardous alcohol use. We recorded EEG while participants performed a reinforced flanker task. We measured cognitive control using N2 activation time-locked to the incongruent flanker stimulus, and we measured reinforcement processing using the feedback-related negativity (FRN) time-locked to better-than-expected negative reinforcement feedback. We modeled hazardous drinking using hierarchical regression, with NU, N2, and FRN plus their interactions as predictors. The regression model significantly predicted hazardous alcohol use, and the three-way interaction (NU × N2 × FRN) significantly improved model fit. In the context of inefficient processing (i.e., larger N2s and FRNs), NU demonstrated a strong relationship with hazardous alcohol use. In the context of efficient processing (i.e., smaller N2s and FRNs), NU was unrelated to hazardous alcohol use. Control analyses ruled out the potential impact of other impulsivity subscales, individual differences in dimensional negative affect or anxiety, and use of substances other than alcohol, and post hoc specificity analyses showed that this effect was driven primarily by heavy drinking, rather than frequency of drinking. This analysis provides preliminary evidence that brain mechanisms of cognitive control and reinforcement processing influence the relationship between NU and hazardous alcohol use, and confirms a specific influence of negative reinforcement processing. Future clinical research could leverage these neurobiological moderators for substance misuse treatment.

Armed Conflict and Early Childhood Development in 12 Low- and Middle-Income Countries

OBJECTIVES

Despite 1 in 10 children being affected by armed conflicts, there is limited evidence on the effects of conflicts on early childhood development (ECD), an important Sustainable Development Goals indicator. We aimed to elucidate the relationship between exposure to conflicts and ECD.

METHODS

We conducted a multinational observational study using population-based data on 27 538 children 36 to 59 months old from Demographic and Health Surveys from 12 low- and middle-income countries merged with prospective data on conflicts from Uppsala Conflict Data Program. We estimated the association between 1 to 5 consecutive years of exposure to conflicts within 50 km and ECD after inverse probability of treatment weighting. Mediators of the relationship between conflicts and ECD were identified. We also estimated the association between conflicts and individual domains of ECD.

RESULTS

Exposure to conflicts was associated with a 5.9% decrease (95% confidence interval -7.5% to -4.3%) in the probability of a child being developmentally on track from the first year of exposure. This was compounded after the second year, with 5 consecutive years of exposure associated with a 10.4% decrease in the probability of a child being developmentally on track (95% confidence interval -13.7% to -7.2%). A lack of access to early childhood education was a significant mediator into the fifth year of exposure. Among individual ECD domains, socioemotional development was disproportionately impaired.

CONCLUSIONS

Exposure to nearby conflicts is associated with an increased probability of delayed ECD, especially with chronic exposure. Children in affected areas should be provided psychosocial support and early childhood education from an early stage.

The Error-Related Negativity Predicts Self-Control Failures in Daily Life

Adaptive behavior critically depends on performance monitoring (PM), the ability to monitor action outcomes and the need to adapt behavior. PM-related brain activity has been linked to guiding decisions about whether action adaptation is warranted. The present study examined whether PM-related brain activity in a flanker task, as measured by electroencephalography (EEG), was associated with adaptive behavior in daily life. Specifically, we were interested in the employment of self-control, operationalized as self-control failures (SCFs), and measured using ecological momentary assessment. Analyses were conducted using an adaptive elastic net regression to predict SCFs from EEG in a sample of 131 participants. The model was fit using within-subject averaged response-locked EEG activity at each electrode and time point within an epoch surrounding the response. We found that higher amplitudes of the error-related negativity (ERN) were related to fewer SCFs. This suggests that lower error-related activity may relate to lower recruitment of interventive self-control in daily life. Altered cognitive control processes, like PM, have been proposed as underlying mechanisms for various mental disorders. Understanding how alterations in PM relate to regulatory control might therefore aid in delineating how these alterations contribute to different psychopathologies.

Psychiatric outcomes following severe deprivation in early childhood: Follow-up of a randomized controlled trial at age 16

OBJECTIVE

Early psychosocial deprivation is associated with increased risk for psychopathology, yet few studies have examined outcomes in adolescents.

METHOD

At baseline (M age 22 months), 136 children from Bucharest, Romania, living in large institutions, were randomized into foster care (FCG) or to care as usual (CAUG). Caregivers completed psychiatric interviews regarding their children (52 FCG; 51 CAUG) at age 16 years (M = 16.67 years; SD = 0.78) to assess past year diagnoses and symptom counts. In addition, never-institutionalized community comparison children (n = 47) were included.

RESULTS

Ever-institutionalized children had higher rates of meeting criteria for any psychiatric disorder and higher symptom counts of internalizing, externalizing, attention-deficit/hyperactivity, and substance use disorders compared to never-institutionalized children (ps < .05). Using intent-to-treat analyses, we found that children in the CAUG had more than twice the rate of psychiatric disorders than children in the FCG (OR = 2.48, 95% CI [1.12, 5.48]). Furthermore, children in foster care who remained in their original placement did not significantly differ in their rates of psychiatric disorders compared to never-institutionalized children.

CONCLUSIONS

There are many ways children can be separated from parents, including placement into institutional care. The current findings indicate that such placements are associated with significant risks for psychopathology. Moreover, we provide causal evidence for the long-lasting positive effect of foster care in reducing the risk of psychopathology in adolescence, especially among those in stable placements. These results provide strong evidence that early and stable placements into quality foster care may mitigate risk for psychopathology following severe early psychosocial deprivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adolescent cognitive control and mediofrontal theta oscillations are disrupted by neglect: Associations with transdiagnostic risk for psychopathology in a randomized controlled trial

Children that have experienced psychosocial neglect display impairments in self-monitoring and controlling their behavior (cognitive control) and are at broad, transdiagnostic risk for psychopathology. However, the neural underpinnings of such effects remain unclear. Event-related mediofrontal theta oscillations reflect a neural process supporting cognitive control that may relate to transdiagnostic psychopathology risk. Recent work demonstrates reduced mediofrontal theta in rodent models of neglect; however, similar findings have not been reported in humans. Here, 136 children reared in Romanian institutions were randomly assigned to either a high-quality foster care intervention and placed with families or remained in institutions; 72 never-institutionalized children served as a comparison group. The intervention ended at 54 months; event-related mediofrontal theta and psychopathology were assessed at 12- and 16-year follow-up assessments. Institutional rearing (neglect) predicted reduced mediofrontal theta by age 16, which was linked to heightened transdiagnostic risk for psychopathology (P factor); no specific associations with internalizing/externalizing factors were present once transdiagnostic risk was accounted for. Earlier placement into foster care yielded greater mediofrontal activity by age 16. Moreover, foster care placement was associated with the developmental trajectory of mediofrontal theta across the adolescent period (ages 12–16), which was, in turn, associated with greater reductions in transdiagnostic risk across this same period. These data reflect the first experimental evidence that the development of mediofrontal theta is impacted by removal from situations of neglect in humans, and further characterizes the importance of studying developmental change in mediofrontal theta during the adolescent period.

Neural dynamics of executive function in cognitively able kindergarteners with autism spectrum disorders as predictors of concurrent academic achievement

Although electrophysiological (electroencephalography) measures of executive functions (e.g. error monitoring) have been used to predict academic achievement in typically developing children, work investigating a link between error monitoring and academic skills in children with autism spectrum disorder is limited. In this study, we employed traditional electrophysiological and advanced time-frequency methods, combined with principal component analyses, to extract neural activity related to error monitoring and tested their relations to academic achievement in cognitively able kindergarteners with autism spectrum disorder. In total, 35 cognitively able kindergarteners with autism spectrum disorder completed academic assessments and the child-friendly "Zoo Game" Go/No-go task at school entry. The Go/No-go task successfully elicited an error-related negativity and error positivity in children with autism spectrum disorder as young as 5 years at fronto-central and posterior electrode sites, respectively. We also observed increased response-related theta power during errors relative to correct trials at fronto-central sites. Both larger error positivity and theta power significantly predicted concurrent academic achievement after controlling for behavioral performance on the Zoo Game and intelligence quotient. These results suggest that the use of time-frequency electroencephalography analyses, combined with traditional event-related potential measures, may provide new opportunities to investigate neurobiological mechanisms of executive function and academic achievement in young children with autism spectrum disorder.

Animal Models and Their Contribution to Our Understanding of the Relationship Between Environments, Epigenetic Modifications, and Behavior

The use of non-human animals in research is a longstanding practice to help us understand and improve human biology and health. Animal models allow researchers, for example, to carefully manipulate environmental factors in order to understand how they contribute to development, behavior, and health. In the field of behavioral epigenetics such approaches have contributed novel findings of how the environment physically interacts with our genes, leading to changes in behavior and health. This review highlights some of this research, focused on prenatal immune challenges, environmental toxicants, diet, and early-life stress. In conjunction, we also discuss why animal models were integral to these discoveries and the translational relevance of these discoveries.

Maternal pre- and postnatal anxiety symptoms and infant attention disengagement from emotional faces

BACKGROUND

Biases in socio-emotional attention may be early markers of risk for self-regulation difficulties and mental illness. We examined the associations between maternal pre- and postnatal anxiety symptoms and infant attention patterns to faces, with particular focus on attentional biases to threat, across male and female infants.

METHODS

A general population, Caucasian sample of eight-month old infants (N = 362) were tested using eye-tracking and an attention disengagement (overlap) paradigm, with happy, fearful, neutral, and phase-scrambled faces and distractors. Maternal self-reported anxiety symptoms were assessed with the Symptom Checklist-90/anxiety subscale at five time points between gestational week 14 and 6 months postpartum.

RESULTS

Probability of disengagement was lowest for fearful faces in the whole sample. Maternal pre- but not postnatal anxiety symptoms associated with higher threat bias in infants, and the relation between maternal anxiety symptoms in early pregnancy and higher threat bias in infants remained significant after controlling for maternal postnatal symptoms. Maternal postnatal anxiety symptoms, in turn, associated with higher overall probability of disengagement from faces to distractors, but the effects varied by child sex.

LIMITATIONS

The small number of mothers suffering from very severe symptoms. No control for the comorbidity of depressive symptoms.

CONCLUSIONS

Maternal prenatal anxiety symptoms associate with infant's heightened attention bias for threat. Maternal postnatal anxiety symptoms, in turn, associate with infant's overall disengagement probability differently for boys and girls. Boys may show enhanced vigilance for distractors, except when viewing fearful faces, and girls enhanced vigilance for all socio-emotional stimuli. Long-term implications of these findings remain to be explored.

Impact of early institutionalization on attention mechanisms underlying the inhibition of a planned action

Institutional rearing is associated with deficits in executive functions, such as inhibitory control, and may contribute to later externalizing behavior problems. In the current study, we explored the impact of institutional rearing on attention in the context of inhibiting a planned action. As part of the Bucharest Early Intervention Project (BEIP), children were randomized to either remain in the institutions in which they lived (Care as Usual Group) or be placed into foster family homes (Foster Care Group). We also recruited age and gender matched never-institutionalized (NIG) children from the Bucharest community. We examined differences in behavioral and Event Related Potentials (ERPs) during a go-no-go task when children were 12 years old. Results revealed that the ever-institutionalized group (CAUG and FCG combined) showed slower reaction times, worse performance accuracy, larger P2 activation, and smaller (less negative) N2 activation than the NIG group. Results of a moderation analysis revealed that children who spent more time in institutions and had small N2s showed more externalizing symptoms. These results have implications for the design of treatment approaches for previously institutionalized children with externalizing behavior problems.