Substance use during pregnancy: the role of mindfulness in reducing stigma

Stigmatization is a significant healthcare barrier among individuals who utilize substances during pregnancy. Of the 3.6 million U.S. births each year, approximately 10% are affected by perinatal substance use, an estimate which is likely underestimated due to fear of stigma and prosecution. Of those experiencing perinatal substance use, less than 11% receive treatment, while maternal deaths due to overdose during the postpartum period have increased by 81% from 2017 to 2020. Societal perception of non-pregnant individuals experiencing substance use disorders recognizes the biological basis of addiction, whereas for pregnant individuals, societal perception slides into moral failing as the basis of addiction. Many recommendations and guidelines for decreasing substance use stigmatization among non-pregnant and pregnant individuals exist. We focus on the use of mindfulness in recognizing and addressing structural and social stigma within healthcare systems. Mindfulness has been extracted from its roots as an essential element of the Eightfold Path in Buddhism, which largely centers on living ethically to reduce suffering of self and others. By acknowledging the roots of mindfulness, providers can engage mindfully in practices that help identify one’s overarching personal values and encourage one to lead healthcare encounters compassion and willingness to support help-seeking community members who are experiencing suffering. A deeper awareness of mindfulness practices within the context of ethical conduct can support healthcare shifts away from criminalization toward more patient- and family-centered approaches

Cognitive Control in Adolescence: Neural Underpinnings and Relation to Self-Report Behaviors

Adolescence is commonly characterized by impulsivity, poor decision-making, and lack of foresight. However, the developmental neural underpinnings of these characteristics are not well established.To test the hypothesis that these adolescent behaviors are linked to under-developed proactive control mechanisms, the present study employed a hybrid block/event-related functional Magnetic Resonance Imaging (fMRI) Stroop paradigm combined with self-report questionnaires in a large sample of adolescents and adults, ranging in age from 14 to 25. Compared to adults, adolescents under-activated a set of brain regions implicated in proactive top-down control across task blocks comprised of difficult and easy trials. Moreover, the magnitude of lateral prefrontal activity in adolescents predicted self-report measures of impulse control, foresight, and resistance to peer pressure. Consistent with reactive compensatory mechanisms to reduced proactive control, older adolescents exhibited elevated transient activity in regions implicated in response-related interference resolution.Collectively, these results suggest that maturation of cognitive control may be partly mediated by earlier development of neural systems supporting reactive control and delayed development of systems supporting proactive control. Importantly, the development of these mechanisms is associated with cognitive control in real-life behaviors

Association Between Initial Age of Exposure to Childhood Abuse and Cognitive Control: Preliminary Evidence

Cognitive control, which relies on the protracted development of frontal‐parietal regions into adolescence, is a brain process that may be particularly vulnerable to the impact of childhood abuse. In this study, we used functional magnetic resonance imaging (fMRI) to examine associations between the age of onset of childhood abuse and alterations to the neural mechanisms supporting cognitive control in early adulthood, which have not been previously examined. During fMRI scanning, participants completed hybrid block/event‐related versions of a classic color‐word Stroop task as well as emotional Stroop tasks (threat and positive words). Participants were young adult women (N = 15; age range: 23–30 years) who had a history of childhood physical or sexual abuse that began prior to 13 years of age. Results indicated that earlier age of onset of childhood abuse was robustly associated with increased transient (i.e., event‐related) recruitment of medial cognitive control regions in the classic color‐word paradigm as well as with less suppression of medial frontal regions that are part of the default mode network, βs = −.16 to −.87. In comparison, increased activation in dorsolateral prefrontal regions was associated with earlier age of abuse onset under conditions of sustained (i.e., blocked) cognitive control in the emotional Stroop task for blocks of positive distracting words versus fixation, βs = −.50 to −.60. These results provide preliminary evidence that earlier age of exposure to childhood abuse impacts the functional activation of neural systems involved in cognitive control in adulthood

General and Emotion-specific Alterations to Cognitive Control in Women with a History of Childhood Abuse

Background Although limited, the literature suggests alterations in activation of cognitive control regions in adults and adolescents with a history of childhood abuse. The current study examined whether such alterations are increased in the face of emotionally-distracting as compared to emotionally neutral information, and whether such alterations occur in brain regions that exert cognitive control in a more top-down sustained manner or a more bottom-up transient manner. Methods Participants were young adult women (ages 23–30): one group with a history of childhood physical or sexual abuse (N = 15) and one with no trauma exposure (N = 17), as assessed through the Trauma History Questionnaire and a two-stage interview adapted from the National Crime Victims Survey. Participants underwent fMRI scanning while completing hybrid block/event-related versions of a classic color-word and an emotional Stroop paradigm (threat and positive words). This paradigm allowed us to examine both sustained (activation persisting across blocks) and transient (event-specific activation) aspects of cognitive control. Results Women with a history of childhood abuse demonstrated decreased recruitment of frontal-parietal regions involved in cognitive control and enhanced recruitment of a ventral attention surveillance network during blocks of both versions of the Stroop task. Additionally, they had less suppression of brain regions involved in self-referential processes for threat blocks, but greater suppression of these regions for positive blocks. Severity of avoidance symptoms was associated with sustained activation in lateral prefrontal regions, whereas hyperarousal/re-experiencing symptoms were associated with sustained activity in temporal regions. No differential effects were observed for transient control. Conclusions Results suggest exposure to childhood abuse is associated with blunted recruitment of brain regions supporting task-set maintenance but hypervigilance for task-irrelevant information, regardless of whether distractors are emotionally neutral or emotional. Exposure to childhood abuse is also associated with less suppression of default mode brain regions associated with self-referential processing in the face of irrelevant threat information, but heightened ability to suppress similar processing for irrelevant positive information

General and emotion-specific alterations to cognitive control in women with a history of childhood abuse

Background: Although limited, the literature suggests alterations in activation of cognitive control regions in adults and adolescents with a history of childhood abuse. The current study examined whether such alterations are increased in the face of emotionally-distracting as compared to emotionally neutral information, and whether such alterations occur in brain regions that exert cognitive control in a more top-down sustained manner or a more bottom-up transient manner. Methods: Participants were young adult women (ages 23–30): one group with a history of childhood physical or sexual abuse (N=15) and one with no trauma exposure (N=17), as assessed through the Trauma History Questionnaire and a two-stage interview adapted from the National Crime Victims Survey. Participants underwent fMRI scanning while completing hybrid block/event-related versions of a classic color-word and an emotional Stroop paradigm (threat and positive words). This paradigm allowed us to examine both sustained (activation persisting across blocks) and transient (event-specific activation) aspects of cognitive control. Results: Women with a history of childhood abuse demonstrated decreased recruitment of frontal-parietal regions involved in cognitive control and enhanced recruitment of a ventral attention surveillance network during blocks of both versions of the Stroop task. Additionally, they had less suppression of brain regions involved in self-referential processes for threat blocks, but greater suppression of these regions for positive blocks. Severity of avoidance symptoms was associated with sustained activation in lateral prefrontal regions, whereas hyperarousal/re-experiencing symptoms were associated with sustained activity in temporal regions. No differential effects were observed for transient control. Conclusions: Results suggest exposure to childhood abuse is associated with blunted recruitment of brain regions supporting task-set maintenance but hypervigilance for task-irrelevant information, regardless of whether distractors are emotionally neutral or emotional. Exposure to childhood abuse is also associated with less suppression of default mode brain regions associated with self-referential processing in the face of irrelevant threat information, but heightened ability to suppress similar processing for irrelevant positive information. Keywords: Childhood abuse, Maltreatment, Trauma, fMRI, Inhibition, Cognitive contro

Characterizing the impact of adversity, abuse, and neglect on adolescent amygdala resting-state functional connectivity

18 pagesCharacterizing typologies of childhood adversity may inform the development of risk profiles and corresponding interventions aimed at mitigating its lifelong consequences. A neurobiological grounding of these typologies requires systematic comparisons of neural structure and function among individuals with different exposure histories. Using seed-to-whole brain analyses, this study examined associations between childhood adversity and amygdala resting-state functional connectivity (rs-fc) in adolescents aged 11–19 years across three independent studies (N = 223; 127 adversity group) in both general and dimensional models of adversity (comparing abuse and neglect). In a general model, adversity was associated with altered amygdala rs-fc with clusters within the left anterior lateral prefrontal cortex. In a dimensional model, abuse was associated with altered amygdala rs-fc within the orbitofrontal cortex, dorsal precuneus, posterior cingulate cortex, and dorsal anterior cingulate cortex/anterior mid-cingulate cortex, as well as within the dorsal attention, visual, and somatomotor networks. Neglect was associated with altered amygdala rs-fc with the hippocampus, supplementary motor cortex, temporoparietal junction, and regions within the dorsal attention network. Both general and dimensional models revealed unique regions, potentially reflecting pathways by which distinct histories of adversity may influence adolescent behavior, cognition, and psychopathology

Stakeholder Perspectives on Advancing Understanding of Prenatal Opioid Exposure and Brain Development From the iOPEN Consortium of the Healthy Brain and Child Development Study.

Introduction: There is a dire need for research regarding the implications of opioid use during pregnancy on fetal and childhood development to better inform both medical practice and policy. The Healthy Brain and Child Development Study will examine brain and behavioral development from birth through the first decade of life. Due to large scope and anticipated complexity of this initiative, an 18-month planning phase was implemented across 28 sites across the nation. A core element of the Phase I initiative involved the development of Stakeholder Advisory Committees to inform the next phase of the initiative. Methods: Phase I stakeholder meetings were conducted at Oregon Health and Science University, New York University Langone Medical Center, the University of Pittsburgh, and the University of Vermont to better understand perspectives and inform upcoming research. Despite differences in the structure of the stakeholder meetings by site, the overarching goals for the meetings included establishing relationships, gathering input, and learning about research engagement. Documents from each meeting were reviewed for location, duration, attendees, common research themes, and pertinent suggestions for improving research approaches. Results: All stakeholders had high levels of interest in research for pregnant people with substance use disorders and agreed on research priorities including collaboration, connection, communication, and support. Different stakeholders offered unique perspectives on various aspects of study design and themes that emerged through meetings. Discussion: Overall, there was excitement about the research, especially the opportunity to include the voices of people with lived experience; collaboration between providers, peer support specialists, patients, and others; and excitement around contributing to research that could elucidate new and pertinent findings in the realm of addiction medicine and child development. Sites also found that there is mistrust between people with substance use disorder and the medical system, and this could be addressed by including people with lived experience on the research team, forming connections, communicating clearly, training the research team in implicit bias, and practicing trauma-informed care. In conclusion, these stakeholder meetings provided valuable information for structuring upcoming studies; however, researchers would have benefitted from more time and more opportunities for in-person connection