Pediatric Trauma

Teen BOT: Biosignatures of Trauma and moderating effects of additional lifetime adversity in adolescents

Joshua Roffman & Erin Dunn

Children who have been exposed to traumatic events have substantial risk for mental illnesses through adolescence and adulthood. However, not all children exposed to traumatic life events progress to mental illness, suggesting the importance of other predisposing elements. Understanding not only which additional elements influence  mental health outcomes in children exposed to trauma – but also when the brain is susceptible to their effects – may be critical to developing  protective interventions. This proposal seeks to identify inflection points, and underlying drivers, in clinical and neurodevelopmental trajectories among children exposed to trauma. We will canvas sensitive windows of brain development occurring before (prenatal/early life) and after (adolescence) traumatic childhood exposures. This work is enabled by the Adolescent Brain Cognitive Development (ABCD) Study, a large, ongoing, population-based neurodevelopmental cohort; as well as by a natural experiment design, which leverages the Covid-19 pandemic as an intervening, population-level stressor. We hypothesize that variance in pandemic-associated stress – which for children previously exposed to trauma may reflect a “second hit” – will stratify risk for emergent psychopathology through its effects on brain development trajectories. Further, we will use biospecimen-derived data from ABCD in an attempt to further stratify risk, based on environmental and genomics elements that shape early brain development. This approach will incorporate both measures of early-life adversity as encoded in shed (baby) teeth, and novel genetic markers of altered prenatal brain development that were recently described by our team. In concert with other studies being conducted by the Biology of Trauma Initiative, this work could lay the foundation for resiliency-focused studies and related interventions in high-risk youth.

Feasibility of establishing a trauma-informed pediatric interventions data core

Archana Basu, Makiko Watanabe & Dana Allswede

This two-year proposal aims to establish a data core at Massachusetts General Hospital

(MGH), Division of Child and Adolescent Psychiatry leveraging a) pediatric trauma focused psychotherapy expertise, b) hospital-based data (e.g., electronic medical records and Biobank data), and c) Biology of Trauma Initiative (BTI) consortium expertise in community based participatory research (CBPR) approaches and neuroscience expertise across the life course. Specifically, we will implement two group-based psychotherapy interventions for pediatric patients. Each of the interventions will integrate the principles trauma informed care (TIC), and utilize psychoeducation, behavior management skills, and relational approaches that strengthen parent-child relationships, each of which have been identified as core mechanisms of change to address children’s emotion dysregulation, a transdiagnostic risk factor for psychopathology. Establishing feasibility of the pediatric interventions and patient consent for integrating data from hospital-based sources, a range of pre- and post-intervention psychosocial and behavioral measures, and biological specimens for candidate biomarkers of risk for psychopathology, will allow the data core to serve as the basis for future intervention capacity building and quasi-experimental models to assess effectiveness of trauma-informed pediatric interventions for behavioral and biological outcomes.

A Pilot Study to Address Intergenerational Health Impacts of Childhood Trauma

Shakira Suglia

We propose to establish an integrated three module intervention, first addressing mothers’ adverse childhood experiences (ACEs), second supporting positive parent-child relationships and lastly promoting the adoption of healthy behaviors, thus holistically addressing the mental and physical health of mothers and babies. We propose to recruit a racially and ethnically diverse cohort of 100 mother-child pairs from the Atlanta metro area seeking postpartum care at the Emory-based Postpartum Metabolic Clinic, run by Co-I Dr. Chandrasekaran, for patients who experienced hypertension or diabetes during their recent pregnancy. We will recruit participants at their postpartum visit (~12 weeks following delivery) and randomly allocate them to our integrated intervention or a usual care model. The maternal ACE module will be based on Co-I Dr. Power’s CDC-funded work and consist of a conversation with trained intervention providers that will include an ACE screening and resilience-based conversation, tailored to the type(s) of ACEs revealed and what resources might be needed. This evidence-based ACEs screening and psycho-educational intervention can improve caregiver resilience and warmth and mitigate negative health outcomes on children associated with their caregiver’s ACEs. The parent-child relationship module will be based on the SafeCare Model, an evidence- based skills training program for caregivers of young children that promotes safe, stable and nurturing environments and encourages social and emotional well-being. Trained providers will work with caregivers to strengthen their skill in structuring daily activities for their children that are engaging and stimulating, increasing positive interactions and curtailing challenging behavior. The health behavior module will be based on the Healthy Homes/Healthy Families (HH/HF) to target diet and physical activity (PA), starting early in the postpartum period and continuing for six months. The HH/HF is a comprehensive intervention that changes behaviors not just at the individual level but also through changes in the home environment. Dr. Suglia is currently supported by the Georgia Diabetes Global Center to adapt the HH/HF intervention to postpartum women. We will follow mother-child pairs longitudinally for 6 months postpartum to assess the mental and physical health impact of the intervention on both mothers and children.