Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC...

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Mary Dozier University of Delaware

Transcript of Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC...

Page 1: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Mary Dozier University of Delaware

Page 2: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,
Page 3: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,
Page 4: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Increase risk to nearly every negative outcome imaginable

But probabilistic, not deterministic

▪ Increases risk, doesn’t cause bad outcomes

▪ We can intervene

But why so problematic?

Page 5: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Biologically prepared to depend on parents

Infants and young children

Page 6: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Temperature regulationNeuroendocrine regulationProtection from infectionProtection from danger Contact comfortSecurity

Page 7: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Consequences

Page 8: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Especially vulnerable are developing brain systems that are dependent on environmental input

▪ HPA axis▪ Amygdala ▪ Prefrontal cortex

Plasticity

Page 9: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

H - HypothalamusP - PituitaryA – Adrenal

Cortisol an end product

Page 10: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Stress reactive function

▪ Body’s mounting a stress response

Diurnal function

▪ Organism functioning as diurnal (or nocturnal) creature

Page 11: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

0

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Bernard et al., 2010, Archives Ped Adol Med

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Wake-up Bedtime

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Low-risk (n = 96)

Foster (n = 184)

Neglected (n = 155)

Page 13: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

▪ HPA axis

▪ Amygdala

▪ Experience of adversity leads to sensitized amygdala

▪ Prefrontal cortex

Page 14: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Children who experienced adversity showed heightened amygdala activity in response to fear faces

(Tottenham, 2012)

Emotional Go-NoGo Task

Page 15: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

▪ HPA axis

▪ Amygdala

▪ Prefrontal cortex▪ Decision making, planning, impulse control

▪ Control over amygdala

Page 16: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Adversity can affect the brain and behavior

But, interventions can reverse or change the trajectory

Page 17: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

10- session intervention

Targets key issues identified as problematic for children who have experienced early adversity

Implemented in home

Page 18: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

In the

Moment

Comments

Nurture

Follow

child’s lead

Avoid frightening

behavior

Behavioral

regulation

Biological

regulation

Enhanced

Parenting

ABC

Intervention

Targets of ABC Intervention

Page 19: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Nurturance especially important for children who have experienced early adversity

▪ Difficult to organize attachment behaviors without nurturing parent

Page 20: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

This child needs you even though she may not appear to need you

Page 21: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Responding to child’s cues when child is not distressed

Critical to help child develop self-regulation

▪ Regulation of behavior, emotions, physiology

Page 22: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

In the

Moment

Comments

Nurture

Follow

child’s lead

Avoid frightening

behavior

Behavioral

regulation

Biological

regulation

Enhanced

Parenting

ABC

Intervention

Targets of intervention

Page 23: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

In the

Moment

Comments

Nurture

Follow

child’s lead

Avoid frightening

behavior

Attachment

quality

Early self-

regulation

Enhanced

Parenting

ABC

Intervention

Targets of intervention

Page 24: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Randomly assigned children and parents to Attachment and Biobehavioral Catch-up (ABC) or to an alternate intervention (DEF)

Focus here on outcomes for neglected/CPS-involved sample

Children birth-24 months at start of intervention

Page 25: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Control intervention focused on cognitive and motor development

Structure same as for ABC10 weekly sessions in home

Page 26: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Assessed in Strange Situation (Ainsworth et al., 1978) Parents CPS-involved N=120

Secure Insecure

Page 27: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Bernard, Dozier et al., Child Development, 2012

0%

20%

40%

60%

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100%

ABC Control

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ild

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ach

mn

en

t C

lass

ific

ati

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Intervention GroupABC DEF

Secure

(52%)

Secure

(33%)

Insecure (48%) Insecure (67%)

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Assessed at wake-up and bedtime post-intervention over 3 days

N=120

Page 29: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Bernard, Butzin-Dozier, Rittenhouse, & Dozier, 2010

-1.3

-1.1

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Wake-up Bedtime

Lo

g-t

ran

sfo

rme

d C

ort

iso

l Va

lue

(in

ug

/dl)

Low-risk (n = 96)

Foster (n = 184)

Neglected (n = 155)

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AM PM

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ABC

DEF

Bernard, Dozier, et al., 2015, Development and Psychopathology

Page 31: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

-1.3

-1.2

-1.1

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AM PM

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ABC

DEF

Bernard, Hostinar, & Dozier, 2015, JAMA - Peds

Page 32: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

• Being able to sit quietly in school key to success

• Doing what one is supposed to do

• Inhibiting urge to do what one wants to do

Page 33: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Put attractive toys in front of child Tell him or her not to play with them, instead

play with crayons (boring in this context)

Page 34: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ABC DEF

34%Touched

53%Touched

Lind, et al., in press, Infant Mental Health Journal

Page 35: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Functional Magnetic Resonance Imaging (fMRI) Child views fearful and neutral faces

N=75 (25 ABC, 25 DEF, 25 low-risk)

Valadez, Tottenham, Dozier

Page 36: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Relative to DEF children , ABC children show greater activation of:

Medial Prefrontal Cortex Right insula

Valadez, Tottenham, Dozier

Page 37: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

▪ Attachment

▪ DNA Methylation (whole genome analyses Hoye and Roth)

▪ Emotion expression (2 years post-intervention) (Lind)

▪ Language development (2 years post-intervention) (Freedman)

▪ Cortisol production (3 years post-intervention)

▪ Executive functioning (3 years post-intervention) ▪ Inhibitory control (Lind)

▪ Set-shifting (Lewis-Morrarty)

▪ Security (9-years-old) (Zajac)

▪ ANS regulation (9-years-old) (Tabachnick)

▪ Brain activation (9-years-old) (Valadez & Tottenham)

Page 38: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Parent:▪ Sensitivity (3 years post-intervention)▪ Neural activity/ERP (3 years post-intervention) (Bernard)▪ fMRI: Fusiform gyrus (Tottenham)▪ Attachment script knowledge (Raby)

Child:▪ Attachment▪ DNA Methylation (whole genome analyses Hoye and Roth)▪ Emotion expression (2 years post-intervention) (Lind)▪ Language development (2 years post-intervention) (Freedman)▪ Cortisol production (3 years post-intervention)▪ Executive functioning (3 years post-intervention)

▪ Inhibitory control (Lind)▪ Set-shifting (Lewis-Morrarty)

▪ Security (9-years-old) (Zajac)▪ ANS regulation (9-years-old) (Tabachnick)▪ Brain activation (9-years-old) (Valadez & Tottenham)

Page 39: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Substance Abuse and Mental Health Services Administration (SAMSHA) National Registry of Evidence-Based Practices (NREPP)https://www.samhsa.gov/nrepp

California Evidence-Based Clearinghouse for Child Welfare http://www.cebc4cw.org

Health Resources and Services Administration (HRSA) Maternal, Infant, and Early Childhood Home Visiting Programs (MIECHV)https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview

Page 40: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Delaware Hawaii Idaho Kansas Kentucky (n=1) Louisiana Maryland Michigan (n=2) Minnesota New York North Carolina Ohio (n=3) Oklahoma (n=4) Pennsylvania (n=3)

Page 41: Mary Dozier University of Delaware...Valadez, Tottenham, Dozier Relative to DEF children , ABC children show greater activation of: Medial Prefrontal Cortex Right insula Valadez, Tottenham,

Mary DozierDepartment of Psychological and Brain Sciences

University of Delawarewww.abcintervention.org