Part of the Institute's mission is to carry out applied research projects in which psychological theory and research techniques are used to directly examine the effects of particular biological insults, interventions, or environmental conditions. These applied research projects address important social issues in regard to facilitating the development of children at-risk for cognitive, emotional, and/or social dysfunctions.
Development Effects of Prenatal Cocaine Exposure
The use of cocaine during pregnancy reached alarming proportions in the mid 1980's with the widespread availability of “crack” cocaine. Tens of thousands of fetuses in this country continue to be exposed to this drug of abuse every year. There are compelling data suggesting that cocaine affects the developing central nervous system, primarily pathways utilizing monoaminergic transmitters such as the prefrontal, orbitofrontal, and mesolimbic cortices. These brain regions are implicated in attention, inhibitory or effortful control requiring suppression of a dominant response in order to perform a subdominant one, making complex decisions requiring planning, and regulating emotional states. In addition to potential biological effects, children exposed to cocaine often are raised in chaotic, stressful high risk environments that might potentiate the impact of cocaine on developmental outcome.
Our study is designed to examine effects of prenatal exposure to cocaine on specific aspects of mental and emotional development. Children are being followed from birth through school age. A major aim is to separate the adverse effects of the chaotic, impoverished home environments in which many of these children are reared from any permanent brain damage caused by prenatal drug exposure. Another important area of inquiry is whether exposure to cocaine during gestation affects later behavioral and physiological responses to stress. Our findings so far suggest that the ability to calm following a stressful situation, be it withdrawal of a mother’s attention or a painful inoculation, is diminished in infants exposed to cocaine. However, it appears that problems emerge only if the infant was exposed to heavy cocaine use during gestation. Difficulty adapting to stressful situations may have wide ranging consequences for later emotional, social, and cognitive functioning. We are currently examining the mediating role of response to stress on outcomes during toddlerhood and early childhood. These findings will help pinpoint the most effective areas for intervention with this population of children.
Development in High-Risk Pediatric Populations
Preterm birth remains one of the most frequent complications of pregnancy in this country. The developmental morbidity associated with prematurity and co-occurring perinatal medical problems is a significant concern. One of the most significant medical risk factors is intraventricular hemorrhage (IVH), bleeding into the developing brain, as this is a complication that potentially affects the central nervous system directly.
A longitudinal study of the effects of intraventricular hemorrhage on development has followed small preterm infants from birth to three years of age. Other common medical complications of prematurity and the quality of children's home environments have been examined, in addition to intraventricular hemorrhages, as predictors of specific functional deficits. Neurological, mental, motor, language, and lateralized skills have been assessed at six age points. Analyses have indicated several major findings:
Communication, Brain Function, and Self-Awareness in Young Children with Autism Spectrum Disorders
The ability to communicate socially requires social cognition, which involves thinking and knowing about other people and their actions. The development of social cognition is an important aspect of mental health and successful mental functioning, leading to the development and maintenance of fulfilling relationships. Social cognition requires a sense of self, or self-awareness. It also requires the development of a theory of mind; that is, an understanding that one’s thoughts and feelings are not necessarily the thoughts and feelings of others.
We have found evidence that self-awareness related to language perception, in particular recognizing one’s own name, is indexed by different patterns of brain function in adults and children. Studies also indicate that subjects with ASD have abnormalities in brain structures related to processing emotional and social stimuli. Based upon these findings, we have begun a research program using fMRI with young children with ASD. The goal of the current project is to include a greater number of children and more behavioral measures of self-awareness. This project also will include other names, as well as “hello,” the child’s own name, and numbers in the fMRI condition. Results of the fMRI will be related to results of the behavioral measures and the severity of ASD, with particular emphasis on communicative skills.
We expect that the localization and degree of differentiation in brain function found in normal people when presented with one’s own name versus other names, words, or numbers will be present in some children diagnosed with ASD and absent in others. We predict that children with more severe ASD, especially those with impaired communication skills, will show less differentiation in brain function between hearing their own name and hearing other names, words, and numbers. We expect the degree of differentiation between one’s own name and numbers, for example, to be related to the severity of autistic symptoms. Finally, we expect this degree of differentiation and the severity of autistic symptoms to be related to behavioral measures of self-awareness.
Functional MRI in Autism: A Case Study
Social communication skills are impaired or absent in children with autism. In this study, we examined a case of a 4-year-old child with Autism Spectrum Disorder (ASD), evaluated her performance on standardized psychological tests of language and communication, and performed a functional MRI under sedation while she listened to auditory stimuli. Psychological testing at age 3 years had included the Differential Abilities Scales (DAS), the Test of Visual Motor Integration (VMI), the Vineland Adaptive Behavior Scales, and the Autism Diagnostic Observation Schedule (ADOS-G module 1). The child wore headphones and heard words repeatedly while fMRI data were collected. The words were presented as blocks in three separate runs. One run presented the word “hello”, the second run presented her name, and the third run presented random numbers ranging from one to fifteen.
The subject's high level of activity and inattention impacted the testing session; therefore, the results are a minimal estimate of her abilities. The general conceptual ability score on the DAS was below the first percentile, and her adaptive behavior composite on the Vineland was in the low range. She was unable to copy simple line drawings on the VMI. In ADOS testing, she showed poor eye contact and occasional echoing, and she failed to show shared enjoyment in interactions. However, she did give a responsive smile to social smiles, and although she did shift her gaze when she heard her name, she failed to make eye contact with the examiner who spoke her name.
Brain activation in response to words differed depending upon the word content. For the word “hello,” brain activity was found in the right inferior parietal lobe, left superior temporal gyrus, and right dorsolateral portion of superior frontal gyrus. When she was presented with her own name, brain activation was found in the right superior frontal lobe, specifically the orbital portion and the right dorsolateral region. The greatest activation occurred when numbers were presented, with reliable findings in the right medial portion of prefrontal gyrus; bilateral anterior cingulate; bilateral precuneus; and bilateral portions of frontal gyrus, including precentral, paracentral, and postcentral regions. Overall, brain activation was found in response to words spoken to a sedated child with autistic spectrum disorder. Brain activity was highest to numbers, with activation in portions of the frontal lobe, anterior cingulate, and precuneus.
Maltreated Children’s Emotions and Self-Beliefs
Increasingly, clinicians have become aware of the importance of shame and self-blame in the etiology of psychological difficulties in the presence of stressful or traumatic events. Interpersonal conflict, various forms of maltreatment, and other situations in which individuals might feel personal responsibility for the negative events of life, as well as their shame and self-blaming attributions, have been linked to a variety of problems, including depression, hostility, and post-traumatic stress symptoms. The Institute's research program in this area has focused specifically on children and how a child's gender and age impact on shame, self-blame, and emerging behavioral difficulties in response to sexual abuse and other forms of maltreatment, enuresis, and the presence of a sibling with disabilities.
Sexual Abuse and Shame
The experience of shame as a consequence of sexual abuse is a primary mechanism related to subsequent behavioral problems. Our work is directly concerned with attributions as they are related to self-evaluative emotions, especially those attributions made regarding the cause of abuse. We have been able to show relations between sexual abuse, shame, and adjustment in a longitudinal study of sexually abused children aged 8 to 15 years. We examined the relations of severity of sexual abuse, shame, and attribution to symptoms of depression, using risk and protective factors as covariates. Our findings indicate that within six months of the reported abuse, both severity of abuse and shame were related to depressive symptoms. However, by one year after report of the abusive incidents, only the amount of shame was related to depressive symptoms. More importantly, children whose shame stayed the same or increased showed increases in depression.
Maltreatment and Shame
We also have examined shame in relation to other forms of maltreatment, including physically abused and neglected children. The nature of parenting in maltreating families - severely physically punitive and/or psychologically aggressive and rejecting - is hypothesized to affect shame in children. The results of this study and more recent work indicate that maltreated children show less pride when they succeed and more shame when they fail relative to children from the same background who have not been maltreated. Among physically abused children, however, severe punitiveness appears to suppress shame and other emotions, especially in boys. Maltreated girls show more shame when they fail a task and less pride when they succeed compared to nonmaltreated girls. Boys, on the other hand, show a suppression of both shame and pride. These sex differences have important implications for behavioral therapy with these children since for girls maltreatment might result in depression, whereas for boys maltreatment might result in a suppression of emotion in general and, potentially, in an increase in aggression, since boys are not constrained by feelings of shame, guilt, or regret. Observations of these boys do indicate higher amounts of behaviors such as throwing or roughly pushing the test materials away, verbally aggressive statements and, occasionally, angry faces.