Early Traumatic Stress Exposure: Neurodevelopmental Mechanisms of Clinical Risk

描述（由申请人提供）：在生命早期暴露于极端压力源被认为会通过创伤过程对神经发育的影响而大大增加儿童发育性精神病理的风险。本建议的目的是阐明一种特别常见和有害的早期创伤性应激形式的神经发育和临床后遗症，即家庭暴力暴露。正如临床和社区样本中广泛的外化和内化问题以及创伤后应激症状所表明的那样，父母间暴力和儿童定向暴力都与临床风险增加有相当大的经验联系。最近来自神经科学研究的证据，使用极端群体对比的小样本（例如，比较受虐待与未受虐待的儿童），为假设暴力暴露发挥其影响的候选神经发育机制提供了强有力的经验基础，包括反映对愤怒和威胁线索高度敏感的情绪认知处理的非典型模式。在这项基础工作的基础上，我们采用基于社区的抽样方法，扩大和扩展这项工作，涵盖家庭暴力暴露的全部范围，并在关键的幼儿期将测试应用于更广泛的人群。具体目标是：(1)用维度方法确定家庭暴力暴露的最佳尺度，这反映了儿童暴力暴露的严重程度和形式的变化（从规范到极端）；(2)检验暴力暴露程度与学龄前破坏性行为特定模式、焦虑和损害的关系；(3)检验非典型情绪处理特征是否介导暴露程度与精神病理症状和功能之间的联系，并确定这些模式是特定于暴力暴露还是压力的更普遍影响。我们利用了一个大的儿童样本（N=2,200）来确定最近资助的关于学龄前破坏性行为发育敏感特征的MAPS研究（R01MH082830, Wakschlag， PI）。从社会人口统计学分层的MAPS队列中，我们抽取了一个样本（N=300），丰富了家庭暴力暴露和非暴力家庭压力源，但在其他方面代表了整体分层。与MAPS研究的程序平行，我们将采用多信息、多方法、发育敏感的方法，在基线实验室访问和6个月的随访中评估学龄前破坏行为和焦虑。在第二次实验室访问中，家庭暴力暴露将通过深度访谈进行评估，学龄前儿童的情绪处理将通过神经认知任务（如情感点探针）进行评估。使用事件相关电位（ERPs）直接评估160名儿童在面部处理过程中的大脑反应模式。这种方法有望阐明创伤应激暴露在精神病理学出现中的作用，并为广泛适用的新型干预措施提供基础，这些干预措施可以减轻与早期创伤经历相关的精神障碍负担。

DESCRIPTION (provided by applicant): Exposure to extreme stressors in early life is thought to substantially increase the risk of developmental psychopathology in children through effects of trauma processes on neurodevelopment. The aim of this proposal is to elucidate the neurodevelopmental and clinical sequelae of one particularly common and pernicious form of early traumatic stress, i.e., family violence exposure. Both inter-parental violence and child- directed violence have considerable empirical linkage to increased clinical risk, as indicated by broad-band externalizing and internalizing problems and post-traumatic stress symptoms in clinical and community samples. Recent evidence from neuroscientific studies using small samples of extreme group contrasts (e.g., comparing maltreated vs. non-maltreated children) provides strong empirical grounding for postulating candidate neurodevelopmental mechanisms by which violence exposure exerts its effects, including atypical patterns of cognitive processing of emotion reflecting heightened sensitivity to anger and threat cues. Building on this foundational work, we employ a community-based sampling approach to amplify and extend this work along the full spectrum of family violence exposure and test applications to the broader population during the critical early childhood period. Specific aims are to: (1) identify the optimal scaling of family violence exposure with a dimensional approach, which reflects variations in severity and forms of child violence exposure (from normative to extreme); (2) test the relationship of extent of violence exposure to specific patterns of preschool disruptive behavior, anxiety, and impairment; and (3) test whether atypical emotion processing characteristics mediate the link between exposure extent and psychopathology symptoms and functioning over time and establish whether these patterns are specific to violence exposure or are a more general effect of stress. We capitalize on a large pediatric sample (N=2,200) to be ascertained for the recently funded MAPS study on developmentally-sensitive characterization of preschool disruptive behavior (R01MH082830, Wakschlag, PI). From the sociodemographically stratified MAPS cohort, we draw a sample (N=300) enriched for family violence exposure and non-violent family stressors, but otherwise representative of the overall stratification. Parallel to the procedures of the MAPS study, a multi-informant, multi-method, developmentally-sensitive approach will be employed to assess preschool disruptive behavior and anxiety in a baseline laboratory visit and 6-month follow-up. In a second laboratory visit, family violence exposure will be assessed via an in-depth interview and preschoolers' emotion processing will be assessed with neurocognitive tasks (e.g., affective dot probe). Patterns of brain reactivity will be directly assessed during face processing using event-related potentials (ERPs) for a subset of 160 children. This approach shows promise for elucidating the role of traumatic stress exposure in the emergence of psychopathology and for providing a basis for broadly-applicable, novel interventions that can reduce the burden of mental disorder associated with early traumatic experiences.