May 11, 2013

Early Neglect and Child Development

Early Neglect and Child Development: Randomized trail compares children in institutions with those in foster care Summarized by Arthur Becker-Weidman, PhD Severe neglect and institutional care cause significant difficulties in attachment, biology, cognitive functioning including executive and neuropsychological functions, and behavioral and emotional regulation. Studies of children in Romanian orphanages and other settings have demonstrated the pervasive and negative impact of such neglect on various domains of child development. Those of us who work with such children know the complexities of helping families with these children. Their difficulties may include disturbed patterns of attachment, sensory-integration dysfunction, various neuropsychological impairments, mental health issues, and problems with emotional and behavioral regulation. These children are extremely challenging to work with and their families need comprehensive and supportive treatments. The Bucharest study, led by Charles Nelson, III, Nathan Fox, and Charles Zeanah, Jr., is a randomized trial comparing the emotional and physical well being of institutionalized children with those place in foster homes. The study involved 136 children in orphanages in Romania. The average age was 22 month, ranging from 6 to 31 months of age. All children selected were free of neurological, genetic, and other birth defects based on a study-team pediatrician's examination. The children selected then has a series of baseline physical and psychological assessment. Half the children were randomly assigned to foster care while the other half remained in the institution. The children placed in foster care were placed in homes that had been recruited, trained, financed, and maintained by the study team. This would be considered high quality foster care. The study team also recruited a third group of typically developing children who lived with their birth families and who had never been institutionalized. The study went on for ten years. One important finding that has significance not only for institutionalized children, but for all children who experience maltreatment is that there sensitive periods during which environmental influences are particularly powerful. The study found that the average IQ of the institutionalized children, measured at thirty, forty, and fifty-two months was in the low to middle 70's while it was ten points higher for the children in foster care. In other words, after only between eight and thirty months longer in an insitutional setting, there was about a 12.5% drop in IQ. The average IQ for the group of children never institutionalized was 100; or about 20% than the children in foster care. Or, to put it differently, about two years in an institution is associated with a 30% lower IQ. The sensitive period seems to be the first two years. The study found that a child placed in a home before two years of age had a significantly larger gain in IQ than a child placed in foster care after two years of age. The study measured attachment and found that the institutionalized children displayed incompletely formed and aberrant relationships with care-givers. However children place in foster care, at 42 months of age (after an average of 20 months in foster care) displayed major improvements in making emotional attachments. About half the children in foster care demonstrated secure attachments while only eighteen percent of the child in institutions demonstrated secure attachments. Sixty-five percent of the children never placed in institutions displaced secure attachments. This seems to demonstrate the capacity of healing relationships to help remedy these significant early deficits. However, as with IQ, children placed in foster care before two years of age were more likely to form secure attachments when compared with children placed after two years of age. Foster care had a major influence on levels of anxiety and depression; reducing their incidence by half. The more secure the attachment between the child and foster parent, the greater probability that the child's symptoms would be reduced. The study examined brain activity using an EEG. They found that infants in institutions has significant reductions in alpha and heightened theta waves, which they stated reflect delayed brain maturation. When measured eight years later they found that children placed in foster care before two years of age showed no difference in EEG when compared with children never in an institution. Children who remained in the institution and those placed in foster care after two years of age showed EEG patterns reflecting delayed brain maturation. Institutionalized children had smaller brain volumes. Finally they examined telomeres, regions at the ends of chromosomes that provide protection from the stresses of cell division and which are shorter in people who have experienced extreme psychological distress than in those who have not experienced such stresses. Children who spent any time in an institution had shorter telomeres than those who had not. REFERENCES Almas, A., et. al., (2012). Effects of Early Intervention and the Moderating Effects of Brain Activity on Institutionalized Children's Social Skills at Age 8. Proceeding of the National Academy of Sciences, 109 (2), 17,228-17,231. Nelson, C., (2007). Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project. Science 318, 1937-1940. Scientific American (2013). How Adversity Affects Young Children, accessed May 11, 2013.

Apr 14, 2013

Attachment-Focused Family Therapy and Epigenetics

Attachment-Focused Psychotherapy & Epigenetics: What your grandparents past on. Arthur Becker-Weidman, PhD Center For Family Development Attachment-Focused Treatment Institute 716 810 0790 Is it possible for the experiences of your parents, grandparents, and great grandparents to have effects on you, your children, your grandchildren and beyond? The answer is yes! But how is that possible? Is it nature and genetics or is it psychology and nurture? Is it bad genetics and biology or bad parenting? Turns out it is both! This article will summarize what we know about epigenetics and the implications of that for Attachment-Focused Treatment. Your life experiences and those of your parents, grandparents, and great grandparents directly affect your genes and resulting behavior. A bit of biology now. Chromosomes are composed of genes which are composed of long strands of DNA. DNA is wound around spools (histones) and how tightly the spools are wound determines how the gene is expressed. If the DNA is wound tightly the gene will have little or no expression. If the DNA is wound more loosely, then the gene and associated proteins will be expressed in large quantities. When a methyl group or acetyl group becomes attached to the DNA that changes the activity of the gene. Attachment of a methyl group tightens to thread of DNA wrapping around the histone spool. This makes it harder for the gene to produce the protein it codes. When an acetyl group becomes attached to a gene the thread of DNA is more loosely wrapped around the histone spool resulting in greater gene expression. Diet, chemicals, and various experiences including childhood maltreatment, drug abuse, and severe stress can cause methyl groups to become attached to genes. These epigenetic changes can be passed down from parent to child and on to grand and great-grand children. Szyf & Meaney, two researchers at McGill in behavioral epigenetics, suggest that traumatic experiences in our past and ancestry leave molecular markers on our DNA. Szyf & Meany found that maternal care causes changes in DNA methylation. In a series of famous experiments using rats that were either highly attentive or highly in attentive, described in their 2004 article in Science, they found that in the hippocampus region (essential for the regulation of stress response), pups of inattentive mothers had highly methylated genes regulating the production of glucorticoid receptors, which regulate sensitivity to stress hormones. Pups of the conscientious mothers had un methylated genes for glucocorticoid receptors in the hippocampus. More methylation results in less transcription. So, the methylation of the genes in the pups of inattentive mothers reduced the number of glucocorticoid receptors from being transcribed in the pup's hippocampus. This means that those pups had an over-active stress response system and were generally more nervous and fearful. Whereas a nurturing environment can predispose a rodent to be calmer in adulthood and raise a nurturing family of its own, an adverse environment can have the opposite effect. There’s evidence that this effect, too, may involve epigenetic changes. Last year, researchers led by Tania Roth and J. David Sweatt of the University of Alabama, Birmingham, helped show this by building on earlier work showing that rat mothers denied access to the materials needed to make a proper nest become anxious and spend less time nurturing their young. Pups raised by these stressed-out rat moms exhibited increased methylation of the gene for BDNF, a neural growth factor, in the brain’s prefrontal cortex, they reported in the 1 May 2009 issue of Biological Psychiatry. In addition, this methylation pattern, which would tend to reduce the amount of BDNF produced, was passed on to the subsequent generation. (Miller, 2010) This suggests that Jews whose great-grandparents were in concentration camps, Chinese whose grandparents lived through the ravages of the Cultural Revolution, young immigrants from Africa whose parents survived brutal civil wars and genocidal massacres, and adults who grew up with alcoholic or abusive parents, all carry with them more than just memories…our experiences and those of our forebears are never gone, even if they have been forgotten. They become a part of us, a molecular residue on our genetic scaffolding. The DNA remains the same, but the psychological and behavioral tendencies are inherited. You might have inherited not just your grandparent's eye color and freckles, but also their predisposition toward depression caused by the neglect they suffered as infants and young children. On the other hand, if your parent or grandparent, who was born to a maltreating family, was adopted at an early age by a nurturing, supportive, and loving family, then they and you will be privy to an epigenetic boost; strengths and resiliencies are also passed on. Sackler Program for Epigenetics and Psychobiology at McGill University found that childhood abuse amongst suicide victims was associated with a distinct epigenetic mark on the DNA. The discovery represents a huge step forward for epigenetics—the study of how environmental factors change gene expression—and holds the promise of better understanding suicide and, perhaps, new treatments. team used a cohort of 36 brain samples. One third were from suicide subjects who were known to have been abused in childhood, one third from suicides with no known abuse in their childhoods, and one third from a control group. The researchers discovered that those suicides who had suffered abuse as children bore specific epigenetic methylation characteristics absent on specific DNA sites that were in the other two groups. Significantly, those marks were shown to influence the hypothalamic-pituitary-adrenal (HPA) function. The HPA axis is a critical feature of the stress response. It is managed by a set of genes expressed in the hippocampus, including one that was epigenetically marked by the experience of childhood abuse. Abnormal HPA activity in response to stress is in turn strongly linked to suicidal action. They found excess emthylation of the genes in the suicide brains' hippocampus, a region critical for memory acquisition and for the regulation of the stress response. In a landmark study, Szyf looked at the blood samples of forty men all born in 1958, who were either very poor or very rich at some point in their lives. Genes were more than twice as likely to show methylation changes based on family income during early childhood. Timing matters! Early experiences have more impact on the developing brain and on genetic expression than later experiences. Yu and colleagues (Yu, et. al., 2012) compared blood samples of 14 children raised in Russian orphanages with 14 other Russian children being raised by their birth parents. The research team found markedly greater methylation in the institutionalized children's genes, particularly those influential in neural communication, brain development, and brain functioning. " The findings suggest that patterns of differential methylation seen in nonhuman species with altered maternal care are also characteristic of children who experience early maternal separation," (p. 143). Elena Grigorenko at Yale, one of the study's authors stated, "Our study shows that the early stress of separation from a biological parent impacts long-term programming of genome function. This might explain why adopted children may be particularly vulnerable to harsh parenting in terms of their physical and menthal health. Parenting adopted children might require much more nurturing care to reverse these changes in genome regulation." One clear implication of this research is that the Attachment-Facilitating Parenting associated with Attachment-Focused Psychotherapy can be instrumental in de-methylating important genes and, therefore, "resetting" the stress response system to be within a more normal range. It is clear that harsh parenting methods, methods grounded in power and control, methods that are shaming, blaming, and critical only serve to reinforce negative expectations and the unresponsive stress-response system's reset mechanism. Parenting methods that are grounded in a focus on relationship and connections of an emotionally meaningful and joyful nature may reset the stress response system by its epigenetic effects.   The following three slides are from my Workshop: Learning & Survival Brain: Effects of Maltreatment on Development. REFERENCES Francis, R., (2011). Epigenetics. NY: Norton\ Meaney, M., Szyf, M., (2005). Environmental programming of stress responses through DNA methylation: Life at the interface between a dynamic environment and a fixe genome. Dialogues in Clinical Neuroscience, 7(2), pp. 103-123. Miller, G., (2010). The Seductive Allure of Behavioral Epigenetics. Science 329 (5987), pp. 24-27 DOI:10.1126/science.329.5987.24 Saey, T., (2013). From Great Grandma to You. Science News, 183(7), pp 18-21. Weaver, I., Cervoni, N., Champagne, F. Alessio, A., Shakti, S., Seclk, J., Sergiy, D., Szyf, M., & Meaney, M., (2004). Epigenetic programming by maternal behavior, Nature Neuroscience 7, 2004. DOI: 10.1038/NN1276. Yu, O., Lee, M., Koposov, R., Szyf, M., Dozier, M., Grigorenko, E., (2012). Differential patterns of whole-genome DNA methylation in institutionalized children and children raised by their biological parents. Developmental Psychopathology, 24(1), pp. 143-155. DOI: 10.1017/S0954579411000605

Nov 22, 2012

Interview at NYU Medical Center after I did Grand Rounds

Earlier this month I did Grand Rounds at the NYU Medical Center in New York City. Afterwards I was interviewed and you can view the interview at:

Jun 27, 2012

Attachment Focused Treatment Institute Growing

The Attachment Focused Treatment Institute's Certification is growing by leaps and bounds. We have quite a large group on the listserv. Of that group there are about 20 Certified Attachment-Focused Psychotherapists and Family Therapists and five certified Attachment-Focused Consultants. There are two Certified Attachment-Focused Organizations and three in process. The Institute, based at the Academy for Human Development, a University in Singapore, is the one of the few certification programs that is University based. The program certifies therapists who practice Attachment-Focused Treatments, such as Dyadic Developmental Psychotherapy.

Jun 23, 2012

New York City office now open

Dear colleagues, Our NYC office is now open and we've begun to see families there. We have a wonderful group of staff and affiliates. You can see our info at the division's website. best regards art

Apr 22, 2012

Attachment-Focused Treatment Institute

A collaboration between the Academy for Human Development's Graduate Counseling program (a University in Singapore) and the Center for Family Development. This Institute provides training and certification in Attachment-Focused Therapy, Attachment-Focused Family Therapy, and certification as an Attachment-Focused Professional (for residential treatment center milieu staff, teachers, therapeutic foster parents, occupational therapists, and others who wish to use attachment-facilitating methods in their work. In addition, the Institute providers certification for organizations (Group Homes, Foster Care agencies, Residential Treatment Centers, Wilderness Program, and Therapeutic Boarding Schools as a Certified Attachment-Focused Organization. See the Institute's Facebook page.

Apr 10, 2012

The Dyadic Developmental Psychotherapy Primer

The Dyadic Developmental Psychotherapy Primer is now out in print and Kindle at Amazon. This book describes the principles of Attachment-Focused Treatment, the components of treatment, and the differential use of those 14 components in the five phases of treatment. It is essential a treatment manual, with many clinical examples, describing the essential elements of attachment-focused family therapy.