The relationship between changes in functional networks and cognitive changes and PTSD symptoms in maltreated children before and after TF-CBT.

Several studies have found that maltreated children show neuropsychological deficits in various cognitive domains such as memory and attention, language, visuospatial skills, emotional regulation, social cognition, and executive functioning. In terms of functional connectivity, abused children show an increased connectivity in the salience network (SN) as opposed to a decreased connectivity within the default (DMN) and executive networks (CEN). Children who suffer maltreatment may develop post-traumatic stress disorder (PTSD), which in turn, can increase psychological and cognitive sequelae. The present study examined the relation between resting state functional connectivity (RSFC), PTSD symptoms and neuropsychological profiles in abused children before and after following a psychological therapy named Trauma Focused Cognitive Behavioral therapy (TF-CBT). Resting state functional magnetic resonance imaging, neuropsychological (attention, memory and executive functions) and clinical evaluations were performed in 13 abused children with PTSD (mean age=8.77 years old, S.D.=1.83) recruited from a non-governmental shelter in Mexico and in a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender. Changes in PTSD symptoms correlated with changes in the left insula node. Additionally, significant correlations were identified between changes in the average connectivity of the DMN, intra-nodal connectivity of lateral parietal and medial prefrontal regions, and performance in attention and memory tasks.

Brain structural change associated with Cognitive Behavioral Therapy in maltreated children.

BACKGROUND: Severely maltreatment child is a harmful social factor that can disrupt normal neurodevelopment. Two commonly reported effects of maltreatment are post-traumatic stress disorder (PTSD) symptoms and brain structural and functional alteration. While Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is effectively used to reduce PTSD symptoms in maltreated children, yet, its impact on brain structural alterations has not been fully explored. This study investigated whether TF-CBT can attenuate alterations in brain structures associated with PTSD in middle childhood. METHODS: The study evaluated the longitudinal effects of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) on post-traumatic stress disorder (PTSD) symptoms and gray matter volume (GMV) in two groups of children under 12 years old: maltreated children (MC) and healthy non- maltreatmentd children (HC). Structural magnetic resonance images T1 were obtained before and after TF-CBT in the MC group, while the HC group was scanned twice within the same time interval. Voxel-based morphometry (VBM) was used to analyze GMV changes over time. RESULTS: After TF-CBT, maltreated children showed significantly reduced PTSD symptoms. Furthermore, a significant group-by-time interaction effect was observed in certain areas of the Left Temporal, Left Occipital, and bilateral Frontal Cortex, the Basal Ganglia and Cerebellum. These interaction effects were driven by a GMV decrease in the MC group compared to the HC group. GMV changes can be predicted with clinical improvement in the left Middle Temporal gyrus, left Precuneus, and Cerebellum. CONCLUSIONS: Our results suggest that TF-CBT intervention in very young maltreated children may have an effect on gray matter. This evidence demonstrates the importance of timely intervention when neuroplasticity mechanisms may be activated.

Can psychopathy be prevented? Clinical, neuroimaging, and genetic data: an exploratory study.

The aim of the study was to explore the relationship among brain functional activations elicited by an emotional paradigm, clinical scores (PTSD, anxiety, and depression), psychopathic traits, and genetic characteristics (5-HTTLPR) in a group of severely maltreated children compared to a healthy control group before and after the implementation of a Trauma Focused-Cognitive Behavioral Therapy. The final sample consisted of an experimental group of 14 maltreated children (mean age = 8.77 years old, S.D. = 1.83) recruited from a non-governmental shelter in Mexico City for children who had experienced child abuse and a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender and were assessed before and after the implementation of the aforementioned therapy by means of clinical scales and an emotional paradigm that elicited brain activations which were recorded through functional magnetic resonance imaging. Genotyping of the 5-HTTLPR polymorphism was made at first assessment. A region of interest analysis showed amygdala hyperactivation during exposure to fear and anger stimuli in the maltreated children before treatment. Following therapy, a decrease in brain activity as well as a decrease in clinical symptoms were also observed. 5-HTTLPR polymorphism did not show any effect on the severity of clinical symptoms in maltreated children. Trauma-Focused Behavioral Therapy may help reorganize the brain's processing of emotional stimuli. These observations reveal the importance of an early intervention when the mechanisms of neuroplasticity may be still recruited.