Article published in the American Journal of Psychiatry 2017

Hi All, I have just read an article 'The origins of cognitive deficits in victimised children: Implications for neuroscientists and clinicians.' Danese, A. et al (2017) https://doi.org/10.1176/appi.ajp.2016.16030333

I wondered if anyone had come across it, and if they could share their wisdom/understanding of it with me? I am involved in both teaching and doing my own academic writing (Thesis) on Trauma Informed Care and I want to ensure that I give a balanced objective argument to the work.

 Many thanks in advance,

Colette

Original Post

strange question to put to us -- there aren't "any" (at least not many) academic heavyweights on this list. What's your supervisor think of it? Who's your supervisor? Is it Richie Poulton? I can appreciate the difficulty in asking him his opinion of the paper, since he co-authored it, but ...?

Despite Danese and his colleagues having extensive experience in this field, the paper you refer to doesn't seem to have covered the literature extensively. Aren't there more comprehensive papers written even more recently on this topic. After all, the literature in this field goes back a fair way now.

Is your interest only in the childhood effects of interpersonal trauma? Doesn't the literature show the cognitive (neuropsychological / neurological) effects continue to be felt for decades -- perhaps even over the whole course of someone's life -- even on into dementia and other "neurodevelopmental" and neurodegenerative disorders -- isn't that the sort of literature you need to survey if your focus is on "trauma informed care"?  What's so special about this particular article, especially since it seems to miss out some of the other important work?

How about putting the question to other researchers in the field -- you might like to ask Anne-Laura van Harmelen who did some research in the early 2010's to see if she's revised her earlier opinions about the causative effects of brain impairment being trauma-related -- she's likely to have a similar opinion as Danese since she's written recently with him, but then again ...

Certainly authors of other research beginning to look at an etiological role for childhood stress disturbing normal neurological development would tend not to agree with Danese.  I always think when critiquing papers one needs to ask from within what sociocultural milieu is the author writing and what influence might that have on the views they express, and here one would be asking primarily about that of Danese (and Poulton), and how is that also evident from their earlier writings,

Hi Paul, thanks for your response. It may seem like a strange question to put to ACE's Connections, but I wanted to gauge other peoples opinion of the article and not just from an academic perspective, although any opinions are gratefully received.

I'm not an academic, but I do happen to be completing a thesis and I know that I will have to evidence a compelling argument in regards to the impact of interpersonal trauma on neurodevelopment.

I was interested to read in this article that 'exposure to several types of victimisation was assessed repeatedly from age 3 in the Dunedin longitudinal study, and from age 5 in the UK based study'. From my reading the most vulnerable time in regards neurodevelopment is up to age 3. 

In the discussion part of the paper they state: 'We found cognitive deficits previously described in individuals with a history of childhood victimisation are largely explained by pre-existing cognitive vulnerabilities and nonspecific effects of socioeconomic disadvantage.'  

Anyways my academic supervisor is from Auckland University and not Ritchie Poulton. My particular interest in this study is that it is based on data from the largest longitudinal study of its kind in the world, and subsequently that gives it merit (I guess), and it also happens to be from the city in which I live and therefore holds a lot of kudos here. 

Also you make a really good point  in regards the sociocultural milieu the authors maybe writing from.

I am still learning and experiencing the differing view points, as well as  resistance in some quarters, and just trying to navigate through.

And thanks for your suggestions in regards to getting in touch with other researchers.

many thanks

Colette

Some answers are not found because the right questions aren't asked, not even in " the largest longitudinal study of its kind in the world" -- and that study will be no different. Certain assumptions were made when that study was being set up, and so the "answers" found will be limited by the constraints in practice devolving from those assumptions -- you just have to found out in what ways they are.

Similarly, ask yourself with respect to that study, what's so significant about it -- what are the real world implications of what was "found" and what was "said to be found" -- not always the same things. And in sociocultural terms -- what are the real world implications of the settings in which people try to implement what they see needs to be done. If in the US, the implications, for children, will be in terms of diagnoses -- and not all professionals' "diagnoses" will be accepted as grounds for IEPs; similarly for other types of "solutions" / treatments people may wish to see applied. In New Zealand, principally (solely?) diagnoses made by psychiatrists will be accepted as justifications for certain interventions. Academically, in New Zealand, especially in southern New Zealand as far as I know, there's a dearth of clinicians in universities able to promote biopsychosocial formulations to clinicians in training, with a resulting bias towards bio-bio-biological formulations -- the situation being quite different in England, with the British Psychological Society in particular, being much more prominent in "socially acceptable" diagnostic formulations. In the United States, one needs to only think briefly about the tortuous history of the diagnosis of Developmental Trauma Disorder to see the truth of the proposal that one needs to consider the sociocultural heritage of clinical researchers in understanding and comparing their contributions. Sometimes one can only become aware of these "biases" until one receives other articles (personal communications!) from the clinical researchers involved -- a good reason to not just accept single papers on face value. An example of the latter is relevant to "understanding" your quote of Danese et al -- which on the surface one would think says that the social environment in which childhood trauma occurs does not play a role in the affected child's suffering cognitive impairment. Yet in a paper written at about the same time "The hidden wounds of childhood trauma", by Andrea Danese & Anne-Laura van Harmelen, which says "Supporting the role of inflammation in mediating the association between childhood trauma and later disease, experimental research in rodents showed that administration of anti-inflammatory medications can buffer cognitive impairment  after  early  life  stress  (Brenhouse  & Andersen, 2011). However, more research is needed to  directly  test  mediation  processes  in  humans (Danese,2014). " (p. 2), so Danese' position might not be as clearcut as your quote suggests ?

Thankyou Paul for your enlightend and informed response. 

It is very much appreciated and has made me consider where I need to go next in my thinking and what will  furthur influence my thesis. In clinical practice, where I come from we have a long way to go...

Thanks Colette 

 

 

Colette.. I am one of those victims of childhood abuse both sexual and physical and guess I could add,, emotional. The implications of this abuse so affected my life as an adult and to this day have presented challenges that seemingly defy solutions.  Countless bouts of therapy and still leave wondering what has been gained.. Then, fortuitous or luck, began writing feelings and therapy, now ongoing, began to make some sense and thus progress/ A lingering and difficult question for any researcher is … brain damages and medications to begin the healing process??

Collette,    My childhood and subsequent events of the myriad types of abuse have and will provide the substance for a book; a chronicle of life within the horror that is abuse of the young child.. Facing all levels including sexual the child has no protection nor security within such a family..  If the research content of your work does not begin the understanding of longevity of issues; seriousness of abuse pain continuing into aging then the work is not complete.  I would love to hear the extent of your work and is this for the doctorate  degree..  ??/ Regards, Bob Brooks

Having a conversation with others is so vital to both the understanding and for lack of a better term, acceptance of what was a childhood horror and present the experience both as a gift and a road map...  Mostly I stumbled trying to make any sense of some of my behaviors and further got little or no understandings let alone acceptance.. One of the many tiny successes I find is the simple exploration of words on paper.. If any healing is to occur the words we used must be out there to flog; to embrace and to accept.. 

Colette, I'm glad you received several responses on your intriguing post.

Personally, the way I read the paper in question and, in particular, the conclusion "We found cognitive deficits previously described .... etc" is a thought-provoking reminder that it's helpful from time to time to question our assumptions and beliefs.  The idea  that childhood adversities and toxic stress "cause" cognitive and affective adaptations that can be measured in anatomy, physiology and behavior has not only intuitive appeal, but has considerable empirical evidence from animal and human research. In addition, there is mounting research suggesting mechanisms underlying such causal effect, such as gene x environment interactions, epigenetic changes, and chronic low-grade inflammation. Many of us, myself included, take this array of ideas and beliefs as scientific facts. Also, again myself included, many of us have an emotional or irrational stake at these ideas and beliefs being truthful.

So it seems disconcerting and even anxiety-provoking when a study comes along that makes us question those beliefs.  All in all and in the absence of multiple replications, I take Danese's work with a grain of salt. Meanwhile, I continue my research, clinical work and education believing that there is a complex, recursive web of cause-effect relationships among adverse environments, the developing brain, resilience-promoting resources and idiosyncratic vulnerabilities associated with long-lasting physiological and behavioral adaptations, many of which in time can be considered maladaptive. Without forgetting that this web of relationships is immersed in a "soup" of social and structural determinants of health.

Best of luck with your thesis!

Andres

If and a very large when the community of survivors like myself might have a place to go; to share; and be supported.. The feeling, and a powerful deterrent to "shut up" is the lack of others talking and sharing what was.. For nearly 4 years here in my community my efforts writing an article for the local newspaper the resulting group of survivors, men and women, came forth asking that they too need support. We  met weekly beginning in my home and later at a local church.. Abuse is so common and the reactions of the abused get "stuffed".. The stuffing of emotions portends behaviors that further deny the person self respect. 

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Karen Clemmer (ACEs Connection Staff)Daun Kauffman
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