Source:

Luby
J
,
Belden
A
,
Botteron
K
, et al
.
The effect of poverty on childhood brain development; the mediating effect of caregiving and stressful life events
.
JAMA Pediatr.
2013
;
167
(
12
):
1135
1142
; doi:
https://doi.org/10.1001/jamapediatrics.2013.3139

Investigators from Washington University in St. Louis, MO conducted a study to determine if living in poverty during the preschool years impacts white matter, cortical gray matter, amygdala, and hippocampus development measured at school age. Participants included children enrolled in an ongoing 10-year longitudinal study on preschool depression who had been selected from St. Louis preschool and day care centers. After enrollment, assessments included parent and child psychiatric evaluations with measures of stressful and traumatic life events. Measures of parental hostility and support were determined based on observation of the parent-child interaction during a structured task. The income-to-needs ratio (family income/federal poverty level based on family size) was used as a proxy for poverty. Three-dimensional T1 weighted magnetic resonance imaging was performed on study participants when they were school-aged. The main study outcomes were cortical gray matter, white matter, hippocampal, and amygdala volumes. The effect of poverty on these brain volumes was assessed with regression analyses after adjusting for potential confounding variables, including age, sex, pubertal status, psychiatric disorder, and use of psychotropic medications. The mediating effects of parental education, stressful life events, and parental hostility/support were also assessed.

Data from 145 children were analyzed. The sample was 51% female and 32% white, with a mean age of 9.8 years. Approximately half of the parents (47%) had completed college and/or obtained a graduate degree. The income-to-needs ratio was a positive predictor of brain volume, accounting for a significant increase in variance of white matter volume (P = .005) and gray matter volume (P < .001). The income-to-needs ratio was also a positive predictor of left hippocampus volume (P = .02) but only approached significance for the right. The relationships between the income-to-needs ratio and white or gray cortical volumes were not mediated by caregiving behaviors, education, or life stress. However, stressful life events and caregiving behaviors (hostile vs supportive) were significantly associated with left hippocampus volumes, and caregiving behavior also mediated the right hippocampus volumes. There were no significant mediators identified for the amygdala volumes.

The authors conclude that exposure to poverty in early childhood is associated with decreased white matter, cortical gray matter, hippocampus, and amygdala volumes when measured in school age/ early adolescence. In addition, the selective impact of early stress and caregiver behaviors on the hippocampus provide a potential mechanism through which the effect of poverty on brain development is mediated, along with possible targets for intervention.

Dr Nalven has disclosed that her husband works for Therapeutics MD (pharmaceutical) in a therapeutic area unrelated to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

The literature provides many examples of how early adverse experiences and toxic stress negatively impact...

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