Abstract
Childhood maltreatment is associated with serious developmental consequences that may be different depending on the form of maltreatment. However, relatively little research has investigated this issue despite implications for understanding the development of psychiatric disorders after maltreatment. To determine the association of childhood maltreatment and potential differential associations of childhood abuse or neglect with neural responsiveness within regions of the brain implicated in emotional responding and response control. In this cross-sectional study, participants aged 10 to 18 years with varying levels of prior maltreatment as indexed by the Childhood Trauma Questionnaire (CTQ) were recruited from a residential care facility and the surrounding community. Blood oxygen level-dependent response data were analyzed via 2 analyses of covariance that examined 2 (sex) × 3 (task condition [view, congruent, incongruent]) × 3 (valence [negative, neutral, positive]) with Blom-transformed covariates: (1) total CTQ score; and (2) abuse and neglect subscores. Data were collected from April 1, 2016, to June 30, 2018. Data analyses occurred from June 10, 2018, to October 31, 2018. Blood oxygenation level-dependent signals in response to an Affective Stroop task were measured via functional magnetic resonance imaging. The sample included 116 youths (mean [SD] age, 15.0 [2.2] years; 70 [60.3%] male). Fifteen participants reported no prior maltreatment. The remaining 101 participants (87.1%) reported at least some prior maltreatment, and 55 (54.5%) reported significant maltreatment, ie, total CTQ scores were greater than the validated CTQ score threshold of 40. There were significant total CTQ score × task condition associations within the bilateral postcentral gyrus, left precentral gyrus, midcingulate cortex, middle temporal gyrus, and superior temporal gyrus (left postcentral gyrus: F = 11.73; partial η2 = 0.14; right postcentral and precentral gyrus: F = 9.81; partial η2 = 0.10; midcingulate cortex: F = 12.76; partial η2 = 0.12; middle temporal gyrus: F = 13.24; partial η2 = 0.10; superior temporal gyrus: F = 10.33; partial η2 = 0.11). In all examined regions of the brain, increased maltreatment was associated with decreased differential responsiveness to incongruent task trials compared with view trials (left postcentral gyrus: r = -0.34; 95% CI, -0.17 to -0.51; right postcentral and precentral gyrus: r = -0.31; 95% CI, -0.14 to -0.49; midcingulate cortex: r = -0.36; 95% CI, -0.18 to -0.53; middle temporal gyrus: r = -0.35; 95% CI, -0.17 to -0.52; superior temporal gyrus: r = -0.37; 95% CI, -0.20 to -0.55). These interactions were particularly associated with level of abuse rather than neglect. A second analysis of covariance revealed significant abuse × task condition (but not neglect × task) interactions within the midcingulate cortex (F = 13.96; partial η2 = 0.11), right postcentral gyrus and inferior parietal lobule (F = 15.21; partial η2 = 0.12), left postcentral and precentral gyri (F = 11.16; partial η2 = 0.12), and rostromedial frontal cortex (F = 10.36; partial η2 = 0.08)). In all examined regions of the brain, increased abuse was associated with decreased differential responsiveness to incongruent task trials compared with view trials (midcingulate cortex: partial r = -0.33; P < .001; right postcentral gyrus and inferior parietal lobule: partial r = -0.41; P < .001; left postcentral and precentral gyri: partial r = -0.40; P < .001; and rostromedial frontal cortex: partial r = -0.40; P < .001). These data document associations of different forms of childhood maltreatment with atypical neural response. This suggests that forms of maltreatment may differentially influence the development of psychiatric pathology.
Highlights
Key Points Question Are the amount and type of childhood maltreatment differentially associated with the responsiveness of regions of the brain implicated in emotional responding and response control?. In this cross-sectional study including 116 youths aged 10 to 18 years, the amount of childhood maltreatment was inversely associated with the responsiveness of regions of the brain involved in response control and positively associated with emotional responding
We hypothesized first that maltreatment would be positively associated with responsiveness to distracters and inversely associated with the responsiveness of regions of the brain involved in response control
On the basis of previous suggestions,[22] we hypothesized that abuse would be positively associated with responsiveness to distracters while neglect would be negatively associated with the responsiveness of regions of the brain involved in response control
Summary
Childhood maltreatment is associated with neurodevelopmental disruption,[1] psychopathology[2,3,4,5] (ie, heightened threat sensitivity6-9), heightened amygdala responsiveness,[10,11,12] and disrupted reinforcement-based decision making.[13,14,15] Maltreatment may be associated with executive dysfunction, there is some inconsistency in the findings.[16,17,18,19] Two studies examining response control reported increased responsiveness within the dorsal cingulate cortex and midcingulate cortex and precentral and postcentral gyri during response control in maltreated children and adolescents.[16,17] 2 other studies using similar tasks reported that a history of childhood maltreatment in women[18] and a history of exposure to childhood stress in adults[19] were associated with decreased responsiveness in the frontal or frontal-parietal regions of the brain. A 2016 study[20] reported a history of childhood maltreatment was associated with significantly reduced activation during sustained attention within regions of the brain in adults, including the left inferior cortex, dorsolateral prefrontal cortex, insula, and temporal cortex, compared with healthy controls. This inconsistency in the association of maltreatment with executive function might reflect differences in the forms of maltreatment experienced by participants. Different forms of childhood maltreatment may have distinct consequences for development (even if many individuals who have experienced maltreatment experienced multiple forms of maltreatment).[22,23,24,25,26,27] In particular, the literature suggests that threatening contexts (eg, physical abuse [PA] or sexual abuse [SA]) increase threat responsiveness while deprivation (eg, physical neglect [PN] or emotional neglect [EN]) disrupts aspects of learning, memory, and executive function.[22,26,27]
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