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通过创伤过程对神经发育的影响大大增加了儿童发育性精神病理学的风险。这项建议的目的是阐明一种特别常见和有害的早期创伤应激形式的神经发育和临床后遗症，即，家庭暴力曝光。父母之间的暴力和针对儿童的暴力都与临床风险的增加有着相当大的经验联系，临床和社区样本中的宽带外化和内化问题以及创伤后应激症状表明了这一点。最近的证据来自神经科学研究，使用极端群体对比的小样本（例如，比较受虐待儿童与未受虐待儿童）为假定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。在这一基础工作的基础上，我们采用了以社区为基础的抽样方法，以扩大和扩大这项工作沿着家庭暴力暴露的全方位和测试应用程序，以更广泛的人口在关键的幼儿期。具体目标是：（1）采用反映儿童遭受暴力的严重程度和形式差异的多层面方法，确定家庭暴力风险的最佳尺度（2）检验暴力暴露程度与学前破坏性行为、焦虑和损伤的特定模式之间的关系;以及（3）测试非典型情绪处理特征是否介导暴露程度与精神病理学症状和功能之间的联系，并确定这些模式是否特定于暴力暴露，是压力的一种普遍效应。我们利用了一个大型的儿科样本（N=2,200），以确定最近资助的MAPS研究对学龄前破坏性行为的发育敏感性表征（R 01 MH 082830，Wakschlag，PI）。从社会人口分层的MAPS队列，我们画了一个样本（N=300）丰富的家庭暴力暴露和非暴力的家庭压力源，但在其他方面的整体分层的代表。与MAPS研究的程序平行，将采用多知情人、多方法、发育敏感性方法，在基线实验室访视和6个月随访中评估学龄前破坏性行为和焦虑。在第二次实验室访问中，将通过深入访谈评估家庭暴力暴露，并将通过神经认知任务（例如，情感点探针）。大脑的反应模式将直接评估面部处理过程中使用事件相关电位（ERP）的一个子集的160名儿童。这种方法显示出的承诺，阐明创伤应激反应暴露在精神病理学的出现中的作用，并提供了广泛适用的基础，新的干预措施，可以减少与早期创伤经历相关的精神障碍的负担。

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.