Annual Research Review: Pediatric posttraumatic stress disorder from a neurodevelopmental network perspective

Abstract

Background: Experiencing traumatic stress is common and may lead to posttraumatic stress disorder (PTSD) in a number of children and adolescents. Research using advanced imaging techniques is beginning to elucidate some of the neurobiological correlates of the traumatic stress response in youth. Methods: This paper summarizes the emerging network perspective of PTSD symptoms and reviews brain imaging research emphasizing structural and functional connectivity studies that employ magnetic resonance imaging techniques in pediatric samples. Results: Differences in structural connections and distributed functional networks such as the salience, default mode, and central executive networks are associated with traumatic and severe early life stress. The role of development has been relatively underappreciated in extant studies though there is evidence that critical brain regions as well as the structural and functional networks implicated undergo significant change in childhood and these typical developmental differences may be affected by traumatic stress. Conclusions: Future research will benefit from adopting a truly developmental approach that considers children's growth as a meaningful effect (rather than simply a covariate) interacting with traumatic stress to predict disruptions in the anatomical, functional, and connective aspects of brain systems thought to underlie the network of PTSD symptoms. Linking symptom networks with neurodevelopmental network models may be a promising avenue for future work.

Early Life Stress and Pediatric Posttraumatic Stress Disorder

“…Exposure to traumatic events is rather common in childhood and adolescence, and PTSD will occur in a significant portion of those exposed to adverse events [15]. Estimates of the incidence of PTSD in children vary by sample, different assessment methodologies, and different types of traumatic event [16]. Roughly two thirds (61.8%) of youth are exposed to trauma by 17 years of age, and approximately 5% of children and adolescents below 18 years of age meet lifetime criteria for PTSD [17,18].…”

Commentary on the Special Issue on Network Analysis: Assessment, Intervention, Theory, and the Nature of Reality: Actualizing the Potential of Network Perspectives on Posttraumatic Stress Disorder

“…For example, some symptom associations identified in network models are supported conceptually via theoretical connections to brain structures and functions related to memory, emotion, and executive function. More specifically, Weems, Russell, Neill, and McCurdy (2019) theorized that, similar to the cascade of symptoms that may evolve following trauma exposure and underscored by a developmentally informed network model of symptoms (Russell et al, 2017), there is a cascade of neurodevelopmental changes that occur following traumatic stress (Cisler, 2017;Weems et al, 2014;Weems, Klabunde, et al, 2015). Some of these changes in functional connections among brain regions map onto the associations found between symptoms in network models.…”

Post-Traumatic Stress Symptoms after Pediatric Injury: Relation to Pre-Frontal Limbic Circuitry

“…As emphasized by Weems and colleagues, 13 PTSS rarely has been examined within a neurodevelopmental network framework that examines potential moderators of associations between stress exposure, age, and neural outcomes. The present study used a neurodevelopmental framework and tested interactions of age with brain metrics on PTSS.…”

“…This gap in knowledge is particularly troubling because stress exposure may delay, accelerate, or prolong the normal trajectory of brain development. 13 The purpose of the present article is to investigate the impact of brain and body injury on pathways connecting subcortical and cortical stress system components and their relation to age at injury and dimensions of PTSS.…”