Larissa Del Piero

The UCLA study of Predictors of Cognitive Functioning Following Moderate/Severe Pediatric Traumatic Brain Injury

OBJECTIVES Following pediatric moderate-to-severe traumatic brain injury (msTBI), few predictors have been identified that can reliably identify which individuals are at risk for long-term cognitive difficulties. This study sought to determine the relative contribution of detailed descriptors of injury severity as well as demographic and psychosocial factors to long-term cognitive outcomes after pediatric msTBI. METHODS Participants included 8- to 19-year-olds, 46 with msTBI and 53 uninjured healthy controls (HC). Assessments were conducted in the post-acute and chronic stages of recovery. Medical record review provided details regarding acute injury severity. Parents also completed a measure of premorbid functioning and behavioral problems. The outcome of interest was four neurocognitive measures sensitive to msTBI combined to create an index of cognitive performance. RESULTS Results indicated that none of the detailed descriptors of acute injury severity predicted cognitive performance. Only the occurrence of injury, parental education, and premorbid academic competence predicted post-acute cognitive functioning. Long-term cognitive outcomes were best predicted by post-acute cognitive functioning. DISCUSSION The findings suggest that premorbid factors influence cognitive outcomes nearly as much as the occurrence of a msTBI. Furthermore, of youth with msTBI who initially recover to a level of moderate disability or better, a brief cognitive battery administered within several months after injury can best predict which individuals will experience poor long-term cognitive outcomes and require additional services.

Basic emotion processing and the adolescent brain: Task demands, analytic approaches, and trajectories of changes

Early neuroimaging studies suggested that adolescents show initial development in brain regions linked with emotional reactivity, but slower development in brain structures linked with emotion regulation. However, the increased sophistication of adolescent brain research has made this picture more complex. This review examines functional neuroimaging studies that test for differences in basic emotion processing (reactivity and regulation) between adolescents and either children or adults. We delineated different emotional processing demands across the experimental paradigms in the reviewed studies to synthesize the diverse results. The methods for assessing change (i.e., analytical approach) and cohort characteristics (e.g., age range) were also explored as potential factors influencing study results. Few unifying dimensions were found to successfully distill the results of the reviewed studies. However, this review highlights the potential impact of subtle methodological and analytic differences between studies, need for standardized and theory-driven experimental paradigms, and necessity of analytic approaches that are can adequately test the trajectories of developmental change that have recently been proposed. Recommendations for future research highlight connectivity analyses and non-linear developmental trajectories, which appear to be promising approaches for measuring change across adolescence. Recommendations are made for evaluating gender and biological markers of development beyond chronological age.

Neural correlates of adolescents' viewing of parents' and peers' emotions: Associations with risk-taking behavior and risky peer affiliations

Social reorientation from parents to same-age peers is normative in adolescence, but the neural correlates of youths’ socioemotional processing of parents and peers have not been explored. In the current study, 22 adolescents (average age 16.98) underwent neuroimaging (functional magnetic resonance imaging) while viewing and rating emotions shown in brief video clips featuring themselves, their parents, or an unfamiliar peer. Viewing self vs. other and parents vs. the peer activated regions in the medial prefrontal cortex, replicating prior findings that this area responds to self-relevant stimuli, including familiar and not just similar others. Viewing the peer compared with parents elicited activation in posterior ‘mentalizing’ structures, the precuneus, posterior cingulate cortex (PCC), bilateral posterior superior temporal sulcus and right temporoparietal junction, as well as the ventral striatum and bilateral amygdala and hippocampus. Relative activations in the PCC and precuneus to the peer vs. the parent were related both to reported risk-taking behavior and to affiliations with more risk-taking peers. The results suggest neural correlates of the adolescent social reorientation toward peers and away from parents that may be associated with adolescents’ real-life risk-taking behaviors and social relationships.

Longitudinal Associations Between Family Aggression, Externalizing Behavior, and the Structure and Function of the Amygdala

Using longitudinal data from 21 adolescents, we assessed family aggression (via mother, father, and youth report) in early adolescence, externalizing behavior in mid-adolescence, and magnetic resonance imaging (MRI) data in late adolescence. Amygdalae were manually traced, and used as seed regions for resting state analyses. Both family aggression and subsequent externalizing behavior predicted larger right amygdala volumes and stronger amygdala-frontolimbic/salience network connectivity and weaker amygdala-posterior cingulate connectivity. Externalizing behavior in mid-adolescence mediated associations between family aggression in early adolescence and resting state connectivity between the amygdala and the subgenual anterior cingulate cortex, medial prefrontal cortex, orbitofrontal cortex, and posterior cingulate cortex in late adolescence. Family adversity and adolescent behavior problems may share common neural correlates.

Associations between family adversity and brain volume in adolescence: manual vs. automated brain segmentation yields different results

Associations between brain structure and early adversity have been inconsistent in the literature. These inconsistencies may be partially due to methodological differences. Different methods of brain segmentation may produce different results, obscuring the relationship between early adversity and brain volume. Moreover, adolescence is a time of significant brain growth and certain brain areas have distinct rates of development, which may compromise the accuracy of automated segmentation approaches. In the current study, 23 adolescents participated in two waves of a longitudinal study. Family aggression was measured when the youths were 12 years old, and structural scans were acquired an average of 4 years later. Bilateral amygdalae and hippocampi were segmented using three different methods (manual tracing, FSL, and NeuroQuant). The segmentation estimates were compared, and linear regressions were run to assess the relationship between early family aggression exposure and all three volume segmentation estimates. Manual tracing results showed a positive relationship between family aggression and right amygdala volume, whereas FSL segmentation showed negative relationships between family aggression and both the left and right hippocampi. However, results indicate poor overlap between methods, and different associations were found between early family aggression exposure and brain volume depending on the segmentation method used.

Community violence exposure in early adolescence: Longitudinal associations with hippocampal and amygdala volume and resting state connectivity

Community violence exposure is a common stressor, known to compromise youth cognitive and emotional development. In a diverse, urban sample of 22 adolescents, participants reported on community violence exposure (witnessing a beating or illegal drug use, hearing gun shots, or other forms of community violence) in early adolescence (average age 12.99), and underwent a neuroimaging scan 3-5 years later (average age 16.92). Community violence exposure in early adolescence predicted smaller manually traced left and right hippocampal and amygdala volumes in a model controlling for age, gender, and concurrent community violence exposure, measured in late adolescence. Community violence continued to predict hippocampus (but not amygdala) volumes after we also controlled for family aggression exposure in early adolescence. Community violence exposure was also associated with stronger resting state connectivity between the right hippocampus (using the manually traced structure as a seed region) and bilateral frontotemporal regions including the superior temporal gyrus and insula. These resting state connectivity results held after controlling for concurrent community violence exposure, SES, and family aggression. Although this is the first study focusing on community violence in conjunction with brain structure and function, these results dovetail with other research linking childhood adversity with smaller subcortical volumes in adolescence and adulthood, and with altered frontolimbic resting state connectivity. Our findings suggest that even community-level exposure to neighborhood violence can have detectable neural correlates in adolescents.

Neural correlates of inhibitory spillover in adolescence: associations with internalizing symptoms

Abstract This study used an emotional go/no-go task to explore inhibitory spillover (how intentional cognitive inhibition ‘spills over’ to inhibit neural responses to affective stimuli) within 23 adolescents. Adolescents were shown emotional faces and asked to press a button depending on the gender of the face. When asked to inhibit with irrelevant affective stimuli present, adolescents recruited prefrontal cognitive control regions (rIFG, ACC) and ventral affective areas (insula, amygdala). In support of the inhibitory spillover hypothesis, increased activation of the rIFG and down-regulation of the amygdala occurred during negative, but not positive, inhibition trials compared with go trials. Functional connectivity analysis revealed coupling of the rIFG pars opercularis and ventral affective areas during negative no-go trials. Age was negatively associated with activation in frontal and temporal regions associated with inhibition and sensory integration. Internalizing symptoms were positively associated with increased bilateral IFG, ACC, putamen and pallidum. This is the first study to test the inhibitory spillover emotional go/no-go task within adolescents, who may have difficulties with inhibitory control, and to tie it to internalizing symptoms.