Plasticity of risky decision making among maltreated adolescents: Evidence from a randomized controlled trial

Early environmental influences on the orbito-frontal cortex function and its effects on behavior

Early-life adversity during pre- and early post-natal phases can impact brain development and lead to maladaptive changes in executive function related behaviors. This increases the risk for a range of psychopathologies and physical diseases. Importantly, exposure to adversities during these periods is also linked to alterations in the orbito-frontal cortex (OFC) which is a key player in these executive functions. The OFC thus appears to be a central node in this association between early life stress and disease risk. Gaining a clear, and detailed understanding of the association between early life stress, OFC function, and executive function, as well as the underlying mechanisms mediating this association is relevant to inform potential therapeutic interventions. In this paper, we begin by reviewing evidence linking early life adversities to 1) alterations in behaviors regulated by the OFC and 2) changes in OFC anatomy and function. We then present insights into the underlying mechanisms for these changes, stemming from early life adversity models, and highlight important future directions for this line of research.

The Reward Positivity Mediates the Association Between Adverse Childhood Experiences and Anhedonia in Young Adults With Drug-Naïve Major Depressive Disorder

BACKGROUND

Current clinical studies have indicated that major depressive disorder (MDD) concurrent with adverse childhood experiences (ACEs) is associated with greater anhedonia. However, little is known about whether the change in reward sensitivity among young individuals with MDD and ACEs is related to anhedonia.

METHODS

We evaluated anhedonia and ACEs in 86 patients with MDD (31 with no or 1 ACE and 55 with 2 or more ACEs) and 44 healthy control participants. Then, participants completed the Iowa Gambling Task during electroencephalography to measure the reward positivity (RewP) and its difference (ΔRewP; gains minus losses). Furthermore, we constructed a mediation model to assess whether aberrant ΔRewP mediated the relationship between ACEs and anhedonia.

RESULTS

Compared with healthy control participants and MDD patients with no or 1 ACE, MDD patients with 2 or more ACEs had the most severe symptoms of anhedonia and impaired decision making and showed significantly reduced reward sensitivity (most blunted ΔRewP). More importantly, ΔRewP mediated the relationship between ACEs and anhedonia in MDD.

CONCLUSIONS

We found that the ΔRewP partially mediated the association between ACEs and anhedonia in patients with MDD, which provides evidence for the neurobiological basis of abnormal changes in the reward system in MDD individuals with early adverse experiences.

Cognitive Outcomes of Children With Complex Trauma: A Systematic Review and Meta-Analyses of Longitudinal Studies

Longitudinal studies have shown that children with complex trauma (i.e., exposure to multiple or repeated traumatic events of an interpersonal nature) have poorer cognitive outcomes later in life than children without complex trauma. This association may be moderated by the timing of the trauma, which may explain, in part, some heterogeneity in the findings reported across previous investigations. The objective of the systematic review and meta-analyses was to compare the cognitive outcomes of children with complex trauma and controls and to explore whether the timing of trauma (i.e., its onset and recency) moderated this association. Electronic databases (APA PsycNET, Pubmed Central, ERIC, CINAHL, Embase) and gray literature were systematically searched. To be included, studies had to (1) have a longitudinal design, (2) comprise children with complex trauma and controls, and (3) include a cognitive assessment. Thirteen studies were identified. Meta-analyses were conducted to compare children with complex trauma and controls, while subgroup analyses and meta-regressions explored the impact of potential moderators. Children with complex trauma had poorer overall cognitive functioning than controls, and the timing of trauma (early onset and, to a greater extent, recency of trauma) moderated this association. Thus, findings suggest that children with complex trauma are at risk of cognitive difficulties quickly after trauma exposure. As such, systematic neuropsychological assessment and interventions supporting the optimal development of cognitive functioning among children with complex trauma should be investigated to determine whether prompt interventions lead to better cognitive functioning.

A Systematic Review of the Biological Correlates and Consequences of Childhood Maltreatment and Adverse Childhood Experiences

Childhood maltreatment (CM) and adverse childhood experiences (ACEs) are two primary forms of interpersonal victimization that have been associated with a host of deleterious health outcomes. Studies over the past decade have begun to use a range of biologically informed methods to better understand the role biology plays in the relationship between CM, ACEs, and later life outcomes. This line of research has shown that both forms of victimization occur at sensitive periods of development, which can increase the likelihood of "getting under the skin" and influence health and behavior across the life course. This review examines the current state of knowledge on this hypothesis. One hundred and ninety-nine studies are included in this systematic review based on criteria that they be written in English, use a biologically informed method, and be conducted on samples of humans. Results reveal that latent additive genetic influences, biological system functioning captured by biomarkers, polygenic risk scores, and neurobiological factors are commonly associated with exposure and response to CM and ACEs. The implication of these findings for the existing body of research on early life victimization and recommendations for future research and policy are discussed.

Self‐affirmation reduces uncertainty aversion for potential gains

Decisions about one's health are often accompanied by uncertain outcomes, which may be either positively or negatively valenced. The presence of this uncertainty, which can range along a continuum from risk to ambiguity (i.e., decisions in which the outcome probabilities are known or unknown), can be perceived as threatening, and individuals tend to be averse to uncertain outcomes, and will attempt to avoid uncertainty when possible. We proposed that one way to reduce uncertainty aversion could be to provide opportunities to affirm one's core values, or "self-affirmation." Prior research has suggested that self-affirmation promotes health behaviour by providing a buffer against potential threats to the self. However, the degree to which self-affirmation affects decision-making is still unclear. Across two studies, we tested the effects of a self-affirmation manipulation on risk (Study 1) and ambiguity (Study 2) preferences for both potential gains and losses. In both studies, we found that, compared to the non-affirmed group, affirmed individuals were more accepting of uncertainty when the decision involved potential gains, but not for potential losses. Further, for risky decisions, the increased acceptance of uncertainty came at the expense of making choices consistent with expected value, such that self-affirmed individuals made more disadvantageous choices than non-affirmed individuals. Our results suggest both benefits and costs of self-affirmation in the context of risky choice, an important finding given the many applications of self-affirmation in behavioral decision making contexts.

Impact of Early Life Stress on Reward Circuit Function and Regulation

Early life stress - including experience of child maltreatment, neglect, separation from or loss of a parent, and other forms of adversity - increases lifetime risk of mood, anxiety, and substance use disorders. A major component of this risk may be early life stress-induced alterations in motivation and reward processing, mediated by changes in the nucleus accumbens (NAc) and ventral tegmental area (VTA). Here, we review evidence of the impact of early life stress on reward circuit structure and function from human and animal models, with a focus on the NAc. We then connect these results to emerging theoretical models about the indirect and direct impacts of early life stress on reward circuit development. Through this review and synthesis, we aim to highlight open research questions and suggest avenues of future study in service of basic science, as well as applied insights. Understanding how early life stress alters reward circuit development, function, and motivated behaviors is a critical first step toward developing the ability to predict, prevent, and treat stress-related psychopathology spanning mood, anxiety, and substance use disorders.

Capitalizing on Neuroplasticity Across Development to Redirect Pathways from Juvenile Justice Involvement

Adolescence is an exquisitely sensitive period of development during which pathways branch toward success in school and prosocial pursuits or, conversely, toward behavior problems and involvement in high-risk activities and systems, such as juvenile justice (JJ). Adverse childhood experiences (ACEs) such as poverty, family dysfunction, and child maltreatment, have been strongly and repeatedly associated with JJ involvement. A significant body of research from neuroscience has established that ACEs can alter facets of neurodevelopment that undergird self-regulation throughout childhood and adolescence, thereby increasing susceptibility to behaviors that attract attention of the JJ system. Because the ability to intervene prior to system-entrenchment is crucial to disrupting an adverse developmental pathway, we look toward neuroscience to offer insights into how to do so more effectively. In this chapter, evidence is summarized that informs an understanding of how neurodevelopmental pathways may lead to JJ involvement. Because neurodevelopment is malleable in response to both detrimental and positive experiences, there is potential for well-targeted interventions to normalize brain and cognitive development, especially during sensitive periods of maturation. This discussion is followed by a proposed research agenda to determine how to exploit these critical windows of opportunity to divert youth from persistent antisocial behavior and JJ involvement. Lastly, a review of neuroscience findings regarding the ability of intervention to strengthen brain systems that modulate self-regulation is presented. This research has direct practical significance with potential to be translated into meaningful policy change.

Developmental trajectory classes in psychological dysregulation predict later decision-making competence

Adolescence and emerging adulthood are developmental periods associated with increased risk taking, including alcohol and substance use and antisocial behaviors. Typical psychological growth from adolescence into early adulthood reflects increases in traits related to psychological regulation (e.g., greater emotional stability and less impulsivity), which are typically considered protective factors against risk behaviors. However, individuals may vary greatly in their development of these characteristics. This study examines the degree to which heterogeneity in developmental trajectories of psychological regulation are associated with later performance on decision-making skills battery. In this study, psychological regulation was assessed at age 10-12, with follow-up assessments at 14, 16, and 19 years. At age 19, we administered the Youth Decision-Making Competence (DMC; Parker & Fischhoff, 2005) measure. Correlational analyses revealed that lower psychological regulation, as early as age 10, was associated with lower DMC scores. A latent class growth mixture model yielded three distinct developmental trajectory classes of psychological dysregulation: (a) a Moderate-Stable group, a modal class that demonstrated stable and average regulative tendencies throughout adolescence, (b) a Low-Decreasing group, which demonstrated greater self-regulation throughout childhood, and a (c) High-Increasing group, which demonstrated low self-regulative tendencies (higher dysregulation) at age 10 that became increasingly dysregulated throughout adolescence. Individuals in the High-Increasing group demonstrated lower DMC performance than those in the Moderate-Stable and Low-Decreasing groups. Our findings also reinforce past work that indicates considerable individual differences in intra-individual change across adolescence, and that early patterns of psychological dysregulation development can impact later decision-making tendencies.

Behavioral processes and risk for problem substance use in adolescents

This narrative review examines associations of delay discounting, response inhibition, sensation-seeking, and urgency with adolescent problem substance use. Each of these processes is linked to adult substance use disorders, is associated with conditions linked to increased risk for adolescent problem substance use, and predicts problem substance use. Notably, all processes are linked to early life adversity (ELA) exposure and most appear to help explain links between ELA exposure and problem substance use. These findings are consistent with a growing body of literature indicating ELA interferes with the development of neural circuits crucial to cognitive functioning and emotion regulation. Further, developmental trajectories of these processes generally align with maturational imbalance hypotheses of adolescent risk. Ongoing and pending large longitudinal studies may be essential for better understanding how ELA and other influences shapes these processes and the role of these processes in risk for problem substance use in adolescence and beyond. Finally it is possible that risk-related processes may be useful metrics in the context of implementing and evaluating strategies to prevent problem substance use in adolescence.

Hidden talents in harsh environments

Although early-life adversity can undermine healthy development, children growing up in harsh environments may develop intact, or even enhanced, skills for solving problems in high-adversity contexts (i.e., “hidden talents”). Here we situate the hidden talents model within a larger interdisciplinary framework. Summarizing theory and research on hidden talents, we propose that stress-adapted skills represent a form of adaptive intelligence that enables individuals to function within the constraints of harsh, unpredictable environments. We discuss the alignment of the hidden talents model with current knowledge about human brain development following early adversity; examine potential applications of this perspective to multiple sectors concerned with youth from harsh environments, including education, social services, and juvenile justice; and compare the hidden talents model with contemporary developmental resilience models. We conclude that the hidden talents approach offers exciting new directions for research on developmental adaptations to childhood adversity, with translational implications for leveraging stress-adapted skills to more effectively tailor education, jobs, and interventions to fit the needs and potentials of individuals from a diverse range of life circumstances. This approach affords a well-rounded view of people who live with adversity that avoids stigma and communicates a novel, distinctive, and strength-based message.

Early life adversity and increased delay discounting: Findings from the Family Health Patterns project

Increased discounting (devaluing) of delayed rewards is associated with nearly all types of substance use disorders (SUDs) and is also present in individuals with family histories of SUDs. Early life adversity (ELA) likely contributes to these findings as it is common in both individuals with SUDs and their children and is linked to increased delay discounting and other neurocognitive impairments in human and animal studies. Here we examined data from 1192 healthy young adults (average age 23.6 years old) with (SUDs+) and without (SUDs-) histories of SUDs and with (FH+) and without (FH-) family histories of SUDs. A 2-way ANOVA was conducted to examine the effects of SUDs (SUDs-, SUDs+) and FH (FH-, FH+) on delay discounting followed by an examination of the effects of adding ELA to the model. First, we replicated findings that SUDs+ and FH+ participants had increased rates of delay discounting. After taking ELA into account, the effect of SUDs and FH on delay discounting were both reduced but still significant. The association of ELA and delay discounting was similar in magnitude among both SUDs+ and SUDs- participants and FH+ and FH- participants; those with higher levels of ELA had increased delay discounting. Collectively, these findings indicate that increased ELA is closely associated with the increased delay discounting seen in SUDs+ and FH+ individuals and suggests ELA may be contributing to the increased delay discounting seen in these populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Applying a Cognitive Neuroscience Perspective to Disruptive Behavior Disorders: Implications for Schools

A cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.

Partner influences on young women's risky drug and sexual behavior

Background

Adolescent girls with a history of maltreatment are at heightened risk for health-risking behaviors, including unsafe sexual behaviors and drug use. However, few studies have examined the views of this population in regard to sexual partner choice, sexual behaviors, and decisions to use drugs with sexual partners.

Methods

We conducted 15 semistructured, open-ended qualitative interviews with young women ages 18–24 with a history of maltreatment and asked them to reflect on their experiences as adolescents. We used the constant comparison method to group the qualitative coded data into themes.

Results

Analysis of the interviews suggested that adolescent girls with maltreatment histories often report that they chose partners who are promotive of risky drug and sexual behavior. The interviews also provided insight into why this population is likely to use drugs with their partner and why they might be hesitant to talk about or practice safe sex with their partner.

Conclusion

The young women’s feedback highlighted five areas where adolescent girls with maltreatment histories could benefit: (a) provision of information about partner characteristics that are promotive of both risky behavior and those that are linked to healthy relationships, (b) provision of information about how one’s partner can influence one’s own drug use, (c) practice talking about safe sex with partners, (d) provision of information about safe sex practices and the risks associated with unsafe sex, and (e) provision of information about the risks associated with drug use and unsafe sexual behavior to adolescent boys.

Impulsivity as a mechanism linking child abuse and neglect with substance use in adolescence and adulthood

Emerging developmental perspectives suggest that adverse rearing environments promote neurocognitive adaptations that heighten impulsivity and increase vulnerability to risky behavior. Although studies document links between harsh rearing environments and impulsive behavior on substance use, the developmental hypothesis that impulsivity acts as mechanism linking adverse rearing environments to downstream substance use remains to be investigated. The present study investigated the role of impulsivity in linking child abuse and neglect with adult substance use using data from (a) a longitudinal sample of youth (Study 1, N = 9,421) and (b) a cross-sectional sample of adults (Study 2, N = 1,011). In Study 1, the links between child abuse and neglect and young adult smoking and marijuana use were mediated by increases in adolescent impulsivity. In Study 2, indirect links between child abuse and neglect and substance use were evidenced via delayed reward discounting and impulsivity traits. Among impulsivity subcomponents, robust indirect effects connecting childhood experiences to cigarette use emerged for negative urgency. Negative urgency, positive urgency, and sensation seeking mediated the effect of child abuse and neglect on cannabis and alcohol use. Results suggest that child abuse and neglect increases risk for substance use in part, due to effects on impulsivity. Individuals with adverse childhood experiences may benefit from substance use preventive intervention programs that target impulsive behaviors.

Out of harm's way: Secure versus insecure–disorganized attachment predicts less adolescent risk taking related to childhood poverty

Although some risk taking in adolescence is normative, evidence suggests that adolescents raised in conditions of socioeconomic disadvantage are disproportionately burdened with risk taking and its negative consequences. Using longitudinal data from the NICHD Study of Early Child Care and Youth Development, we investigated quality of the early caregiving environment as a potential prospective buffer against the long-term association between childhood poverty and adolescent risk taking. Multicategorical moderation model results indicated that if raised in poverty across age 1–54 months (average family income to needs ratio ≤ 1.02), relative to affluence (income to needs ratio ≥ 6.16), adolescents with histories of secure attachment to caregivers exhibited two times the number of risk behaviors at age 15, whereas adolescents with insecure–disorganized histories exhibited nearly five times the number of risk behaviors. Both early family economic hardship and history of insecure–disorganized attachment remained significant predictors of increased adolescent risk taking, alongside the interactive effect. Probing the interaction's region of significance revealed that history of secure (vs. insecure–disorganized) attachment is associated with protective reductions in risk taking below a family income to needs ratio of 2.24, or about 220% poverty level. Findings support a diathesis–stress model in which children with secure attachment histories are less deleteriously impacted by early socioeconomic adversity than their insecure–disorganized peers.

Rank among Peers during Game Competition Affects the Tendency to Make Risky Choices in Adolescent Males

It has been shown that adolescents take more risks when they are with peers than when they are alone, presumably because the presence of peers can be a social reward/punishment that can bias decision making. Competition is inherent in peer interactions, and recent work has demonstrated that winning/losing is an intrinsic social reward/punishment. Taken together, it can be hypothesized that competition amongst peers affects adolescents’ risky behavior. While there is much evidence that status amongst peers can relate to antisocial/aggressive behavior, it remains unclear whether risky behavior is affected. Moreover, the degree to which ‘temporary status,’ such as ranking in a short-term competitive game, affects behavior is uncertain, an important issue because adolescents might be sensitive to situations or factors which potentially destabilize existing hierarchies. In this experiment, these issues were directly explored in the classroom environment using smartphone technology and Wi-Fi setup. Male junior high school students (aged 14–15) performed a roulette game task on smartphones, playing either independently or against five classmates. In the latter case, the students’ current ranks within the group of six were constantly presented on smartphone screens. To dissociate the effects of the students’ reactions to ranks from their actual performances, unknown to the students, the ranks presented were actually predetermined so that about half of the students were continuously presented with high ranks whereas the other half were continuously presented with low ranks. We found that the students presented with low ranks made more risky plays than those not presented with ranks or those presented with high ranks. This result suggests that even temporary status significantly affects adolescents’ risky behavior, and also demonstrates the usefulness of smartphones in examining and manipulating peer interactions in classroom experiments.

Greater decision-making competence is associated with greater expected-value sensitivity, but not overall risk taking: an examination of concurrent validity

Decision-making competence reflects individual differences in the susceptibility to committing decision-making errors, measured using tasks common from behavioral decision research (e.g., framing effects, under/overconfidence, following decision rules). Prior research demonstrates that those with higher decision-making competence report lower incidence of health-risking and antisocial behaviors, but there has been less focus on intermediate processes that may impact real-world decisions, and, in particular, those implicated by normative models. Here we test the associations between measures of youth decision-making competence (Y-DMC) and one such process, the degree to which individuals make choices consistent with maximizing expected value (EV). Using a task involving hypothetical gambles, we find that greater EV sensitivity is associated with greater Y-DMC. Higher Y-DMC scores are associated with (a) choosing risky options when EV favors those options and (b) avoiding risky options when EV favors a certain option. This relationship is stronger for gambles that involved potential losses. The results suggest that Y-DMC captures decision processes consistent with standard normative evaluations of risky decisions.

Decision-making competence predicts domain-specific risk attitudes

Decision-making competence (DMC) reflects individual differences in rational responding across several classic behavioral decision-making tasks. Although it has been associated with real-world risk behavior, less is known about the degree to which DMC contributes to specific components of risk attitudes. Utilizing a psychological risk-return framework, we examined the associations between risk attitudes and DMC. Italian community residents (n = 804) completed an online DMC measure, using a subset of the original Adult-DMC battery. Participants also completed a self-reported risk attitude measure for three components of risk attitudes (risk-taking, risk perceptions, and expected benefits) across six risk domains. Overall, greater performance on the DMC component scales were inversely, albeit modestly, associated with risk-taking tendencies. Structural equation modeling results revealed that DMC was associated with lower perceived expected benefits for all domains. In contrast, its association with perceived risks was more domain-specific. These analyses also revealed stronger indirect effects for the DMC → expected benefits → risk-taking path than the DMC → perceived risk → risk-taking path, especially for behaviors that may be considered more maladaptive in nature. These results suggest that DMC performance differentially impacts specific components of risk attitudes, and may be more strongly related to the evaluation of expected value of a specific behavior.