Risk And Resilience Following Childhood Maltreatment: A Longitudinal Investigation

Childhood maltreatment continues to represent a major societal problem in the UK. The NSPCC have shown that almost one in five adolescents report experiencing severe maltreatment. Of these, around 70% experienced maltreatment from their parent or guardian. We know from previous research that familial maltreatment - including physical, sexual, emotional abuse and neglect - can have a profound impact on a child's development. In particular, we know that exposure to maltreatment significantly increases a child's risk of later mental health problems, including anxiety and depression.

Over the last decade neuroscience has begun to shed light on why early adversity is associated with future problems. We and others have identified structural differences in specific parts of the brain that characterise children with maltreatment. However, there has been relatively little research using functional magnetic resonance imaging (fMRI), which investigates brain function. In the first fMRI study investigating the impact of physical abuse and domestic violence on children, we found that exposure to such adverse experiences were associated with greater activation in threat regions of the brain, including the amygdala, suggesting that these children may have become 'hypervigilant' to threat cues in their environment.

But there are many important questions we still need to answer. Do the 'neural markers' associated with maltreatment go away over time or do they persist? Are these neural markers associated with future symptoms of anxiety or depression? Do brain changes differ across boys and girls? And what do we know about resilience? We plan to answer these questions by carrying out the first longitudinal fMRI study comparing children exposed to maltreatment with their non-maltreated peers. We will verify that children have been exposed to maltreatment from social services records. All children will be seen when they are 12-14 years old and undergo psychological tests and a brain scan. We will then follow up the same children two years later when they are 14-16 years old, and repeat our set of measures and carry out a second scan. By following up the same children over time we can learn about how their brain function and structure changes, but we will also have the chance to see if brain differences early on predict future problems. This does not mean that we would use brain scans to test all children in the future; rather, identifying brain differences associated with maltreatment may help us understand why maltreated children are often vulnerable to psychological problems.

Our study will also use novel tasks to broaden our understanding of the impact of maltreatment. Future vulnerability to mental health problems may be associated with greater brain reactivity to threat in maltreated children. However, we know that poor memory of past personal events is also common in maltreated children and this may be another factor that contributes to their vulnerability to mental health problems. A key function of memory for past events for all of us is to help better solve problems in the future. We will therefore investigate whether behavioural and neural measures of personal memory are associated with future mental health. Finally, we know that maltreatment affects boys and girls differently, with girls more likely to develop symptoms of anxiety and depression. Why? Using brain imaging we will investigate the brain basis of these different patterns of vulnerability.

We hope that our research will contribute to a better understanding of the impact of maltreatment on children and help inform more effective forms of prevention and treatment.

We plan to build on our already successful impact strategy developed for our previous ESRC grant (see end of grant report; RES-061-25-0189). We will continue to work closely with a broad range of potential beneficiaries including:

Clinicians and practitioners including social workers, health visitors, psychiatrists, clinical psychologists and psychotherapists. In the short to medium term our research will help inform a clinical model of how maltreatment influences emotional brain systems and its link to increased vulnerability to psychological and behavioural problems. The PI and Co-I recently organised a conference attended by over 250 clinicians (October 2011 "Childhood Disorders: Neuroscience and Intervention") that paired presentations from both leading academics and expert practitioners. We will also organize a new conference "Maltreatment: Neuroscience and Intervention" aimed at practitioners to disseminate the project findings at the end of the project.

In the longer-term we hope that gains from this project will contribute to improved clinical assessment of emotional disturbance, better clinical guidelines in meeting the needs of children experiencing maltreatment (including systemic intervention), and more effective individual interventions with those children most at risk for long term psychiatric and antisocial problems following maltreatment. Short briefing downloadable documents will be created for clinicians and practitioners that will be uploaded onto our UCL Unit website (www.drru-research.org).

Children's charities including organisations such as the NSPCC and Anna Freud Centre. The PI works for NSPCC and has strong links with the Anna Freud Centre. We propose to establish a formal advisory board with a representative from children's charities chaired by the PI in order to consider how the findings of the proposed study are relevant to their work. This will include:

i. Continuing to support their case for intervention: many of these charities lobby government to increase provision for children in need, particular those who experience abuse.
ii. Providing additional evidence of the impact of maltreatment relevant to increasing public and media awareness of this societal problem
iii. Informing new policy initiatives
iv. Convening workshops and seminars within each organisation for frontline practitioners

Policy makers including the Department of Children, Schools and Families, The Department of Health, and the Department of Justice will have a direct interest in the focus of the current research. Findings from the study will be well placed to inform policy and government priorities in relation to interventions for children who have experienced or are at risk from maltreatment. We will organise a national policy day towards the end of the grant period specifically aimed at policy makers and influencers to leverage the policy implications of the findings.

Carers often find it a challenging experience to understand and manage their child's emotional and behavioural problems. A fuller understanding of the links between adversity and emotional development may help contextualise some of these difficulties, making them easier to manage. Previously the PI has collaborated in the production of a series of recorded CD materials for prospective adopted parents to help them understand the possible impact of adversity and trauma on psychological and neural development. ("Everything you always wanted to know about adoption but were afraid to ask"; www.adoptionuk.org). We will continue to contribute to new materials in this way to help parents and carers of children who have experienced maltreatment.