ADVERSITY How adversity can markedly affect the development of the brain. Describe and evaluate evidence based methods used to overcome these adverse effects.

Question 1

Structure for the section on the effects of adversity on the developing brain? 4 pts

Answer 1

1. Intro
2. HPA-axis
3. Corpus Callosum and other White Matter Tracts
4. Functional Brain Differences Associated with Maltreatment

Question 2

Structure for evidence based methods for overcoming the effects of adversity? 5 pts

Answer 2

1. Intro
2. Neglect
3. Physical abuse
4. Sexual Abuse
5. Foster care

Question 3

A substantial evidence base from the animal literature delineates long-term effects on HPA system functioning following disruption to [blank]

Answer 3

adequate maternal care

Question 4

A substantial evidence base from the animal literature delineates long-term effects on HPA system functioning following disruption to adequate maternal care; these effects …

Answer 4

persist into adulthood and are accompanied by stable behavioural changes

Question 5

There is accumulating evidence that early trauma, including physical, sexual and emotional abuse, is associated with increased risk of what?

Answer 5

psychopathology in adulthood including depression, PTSD, alcohol and substance abuse, and borderline personality disorder

Question 6

In view of the persuasive evidence from the human and animal literature of the link between stress and HPA functioning, there is a strong case that early stress may lead to … which in turn predisposes to…

Answer 6

an ongoing dysregulation of the HPA axis

to psychiatric vulnerability in later life

Question 7

there is a strong case that early stress may lead to an ongoing dysregulation of the HPA axis, which in turn predisposes to psychiatric vulnerability in later life (van Goozen & Fairchild, 2006). While there is consensus aroud this general principle…

Answer 7

the putative mechanisms of how the HPA axis might mediate the link between stress and psychopathology and the precise nature of any interaction remain less clear.

Question 8

The corpus callosum (CC) is … and controls…

Answer 8

the largest white matter structure in the brain

inter-hemispheric communication of a host of processes, including: arousal, emotion and higher cognitive abilities

Question 9

With the exception of one study (Mehta et al. 2009), decreases in CC volume have been reported in …

Answer 9

maltreated children and adolescents compared to non-maltreated peers (DeBellis et al. 2002)

Question 10

With the exception of one study, decreases in CC volume have been reported in maltreated children and adolescents compared to non-maltreated peers (DeBellis et al. 2002) - who conducted the study that was the exception?

Answer 10

(Mehta et al. 2009)

Question 11

With the exception of one study (Mehta et al. 2009), decreases in CC volumehave been reported in maltreated children and adolescents compared to non-maltreated peers (DeBellis et al. 2002). Furthermore, preliminary evidence suggests that these effects are characterized by what?

Answer 11

sex dependent differences

Question 12

In a recent DTI study, Eluvathingal and colleagues (2006) found what?

Answer 12

decreased fractional anisotropy values in the left uncinate fasciculus (which connects the OFC to the anterior temporal lobe, including the amygdala) in maltreated children compared to controls

Question 13

What is fractional anistropy?

Answer 13

(a measure that assesses white matter fibre tract direction and density)

Question 14

More recently, a DTI study in a non-clinical sample examined the effects of severe parental verbal abuse (e.g. ridicule, humiliation and disdain) on brain connectivity - who conducted it? What did they find?

Answer 14

three white matter tracts were reported to show reduced fractional anisotropy

Choi et al 2009

Question 15

More recently, a DTI study in a non-clinical sample examined the effects of severe parental verbal abuse (e.g. ridicule, humiliation and disdain) on brain connectivity; three white matter tracts were reported to show reduced fractional anisotropy (Choi et al., 2009). The authors hypothesised that these abnormalities may underlie what

Answer 15

some of the language and emotional difficulties seen in victims of childhood maltreatment.

Question 16

Only a few studies have investigated the possible functional correlates associated with maltreatment using X techniques

Answer 16

imaging

Question 17

In an fMRI study, Carrion and colleagues (2008) used a Go/No-Go task assessing what?

Answer 17

sustained attention and response inhibition, and compared the brain activity of young adolescents with post-traumatic stress symptoms (PTSS) secondary to maltreatment to that of age and gender matched healthy controls.

Question 18

What kind of study did Carrion and colleagues (2008) do?

Answer 18

fMRI

Question 19

What kind of tast did Carrion and colleagues (2008) use?

Answer 19

Go/No-Go task

Question 20

In an fMRI study, Carrion and colleagues (2008) used a Go/No-Go task assessing sustained attention and response inhibition, and compared the brain activity of young adolescents with post-traumatic stress symptoms (PTSS) secondary to maltreatment to that of age and gender matched healthy controls. What did they find?

Answer 20

The adolescents with PTSS showed relatively decreased activation of the left dorsolateral PFC, but increased activation in the mPFC and ACC.

Question 21

What did Chugani and colleagues 2001 do?

Answer 21

used PET in the awake resting state to investigate the brain activation associated with early global deprivation in pre-adolescent children adopted from Romanian orphanages where the children had experienced adverse early rearing environments

Question 22

Who used PET in the awake resting state to investigate the brain activation associated with early global deprivation in pre-adolescent children adopted from Romanian orphanages where the children had experienced adverse early rearing environments ?

Answer 22

Chugani and colleagues 2001

Question 23

Chugani and colleagues (2001) used PET in the awake resting state to investigate the brain activation associated with early global deprivation in pre-adolescent children adopted from Romanian orphanages where the children had experienced adverse early rearing environments (Chugani et al, 2001). What did they find?

Answer 23

Compared to adult and child control groups, the adopted children showed decreased metabolism in a network of areas implicated in stress regulation, including the OFC.

Question 24

In this section, we will briefly identify and discuss selected evidence-based intervention models which show promise within child abuse and neglect. These will be outlined under four classes of services for the following forms of adversity - what are they?

Answer 24

neglect
physical abuse
sexual abuse
foster care

Question 25

Although neglect comprises the majority of child welfare system cases, there is …

Answer 25

limited study of intervention models

Question 26

Of these, [blank] is among the more widely studied and the best supported.

Answer 26

Project 12-Ways/SafeCare model

Question 27

Project 12-Ways/SafeCare model is among the more widely studied and the best supported. The model uses X methods

Answer 27

behavioral

Question 28

Project 12-Ways/SafeCare model is among the more widely studied and the best supported. The model uses behavioral methods, and focuses on …

Answer 28

various targets in the ecology of multiproblem families entering the system for child neglect

Question 29

The pattern of evidence supporting the model is complex, and involves over X published studies, although..

Answer 29

60

few randomised controlled trials

Question 30

The Project 12-Ways model is currently being tested in…

Answer 30

a large-scale field trial

Question 31

Two models in particular show promise for physically abusive parents. - What are they?

Answer 31

Parent–Child Interaction Therapy (PCIT)

Kolko (1996) structured cognitive–behavioral treatment.

Question 32

What is PCIT?

Answer 32

a live-coached behavioral parent training intervention

Question 33

Parent–Child Interaction Therapy (PCIT) is a live-coached behavioral parent training intervention which has already met criteria as… Says who?

Answer 33

a well-supported, empirically validated treatment for early childhood behavior problems (Chambless & Ollendick, 2001).

Question 34

Recent randomized efficacy trial evidence also suggests that PCIT can significantly reduce r…ates of

Answer 34

future physically abusive behavior among abusive parents (Chaffin et al., 2004),

Question 35

What did Kolko (1996) do?

Answer 35

conducted a randomized trial, and found benefits for physically abusive parents and abused children using a structured cognitive–behavioral treatment.

Question 36

Who conducted a randomized trial, and found benefits for physically abusive parents and abused children using a structured cognitive–behavioral treatment.

Answer 36

Kolko 1996

Question 37

Although sexual abuse is not invariably traumatic, it is commonly associated with

Answer 37

the development of trauma symptoms

Question 38

Trauma-focused cognitive–behavioral therapy, using the principles of … has been evaluated in a series of randomized trials . Who did the research?

Answer 38

gradual exposure and cognitive restructuring

Cohen and Mannarino 1997

Question 39

Trauma-focused cognitive–behavioral therapy, using the principles of gradual exposure and cognitive restructuring has been evaluated in a series of randomized trials (Cohen & Mannarino, 1997) and has consistently been found to be what?

Answer 39

superior to competing approaches for treating the effects of sexul abuse

Question 40

TF-CBT meets criteria as what?

Answer 40

a well-supported treatment for sexually abused children with traumatic stress symptoms