Developmental Disabilities and Kids with a History of Abuse

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Developmental Disabilities and Kids with a History of Abuse




Guest:  Dr. Eve Spratt – Pediatrics, MUSC

Host:  Dr. Linda Austin – Psychiatrist, MUSC


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Eve Spratt who is Associate Professor of Psychiatry in the Division of Child Psychiatry, and Pediatrics.  Dr. Spratt, let’s talk about the work you do in the most vulnerable of children.  Tell us about your clinical life here at MUSC.


Dr. Eve Spratt:  Well, I’ve been on faculty here for 16 years, and I’ve had the privilege of working with a lot of diverse populations.  I ran our consult service in the Children’s Hospital for ten years, and supervised residency; everything from minor adjustment to acute illness; severe, devastating situations, such as an individual becoming a quadriplegic because they dove into a pool, or a child losing their family because of a fire while still being in the ICU. 


I’ve worked with outpatient teams as well, and I still do that.  I work with our pediatric HIV team, our international adoption clinic, and our diabetes team.  I also work predominantly with the Division of Genetics and Developmental Pediatrics.  There, I’m seeing, with other individuals, kids that either have developmental disabilities or a history of abuse and neglect.  I follow a number of children that have that history.  I also work some with our international adoption team.  I was honored with a K award, a career development award, and have done research these last few years on kids with a history of neglect, as well as kids with a history of international adoption.


Dr. Linda Austin:  Now, what scientific questions are you exploring with your K award?


Dr. Eve Spratt:  What I’ve just been fascinated with is how experience impacts brain development.  I’ve been looking at both measures of behavior and cognitive development, but also looking at neurobiology.  I’m especially interested in looking at the primary stress systems.  I’ve looked at the hypothalamic pituitary adrenal axis.  I’ve looked at posterior pituitary hormones involved with attachment, at how that’s functioning in these children.


Dr. Linda Austin:  Dr. Spratt, the words hypothalamic, pituitary, adrenal axis, those are very big words that translate into the stress hormone axis, or the stress hormone system.  Explain that though, if you’re trying to explain that to a lay person.


Dr. Eve Spratt:  Well, one thing that I want to emphasize is that we all need cortisol, which is the end product.  It helps us mobilize resources.  It helps us metabolize things in the normal kind of way, and it’s essential to our functioning.


Dr. Linda Austin:  So cortisol is the stress hormone?


Dr. Eve Spratt:  It is the end product, right.  It’s the primary glucocorticoid of this system.  And part of what’ concerning is that if there are high levels of cortisol, and they’re sustained, they can have an impact on the brain.  In fact, there are multiple studies now that have shown that you can have, actually, smaller structures of the brain, like the hippocampus, which is involved in memory, related to these higher levels.  And there are some suggestive studies that there’s long-term impact of that in terms of cognitive results as well.  We also know that sustained high levels can lead to susceptibility for medical illness.  We have, probably, more literature in looking at the mental health disorders associated with some this dysfunction.  But I think it’s becoming clear that it’s really important to medical health as well.


Dr. Linda Austin:  And, what have you found?


Dr. Eve Spratt:  Well, very interestingly, some of what we have found echoes some of what’s been found in the animal research, which is, really, that first year of life is probably what’s more important than anything.  In terms of biologic alterations, we actually found the international adoption children, versus the U.S. neglect children, had much greater sensitivity to stress, as measured by salivary cortisol.  We also found that with the posterior pituitary hormones, looking at, specifically, changes in vasopressin and some of the catecholamines.


Dr. Linda Austin:  Why do you hypothesize that?  Have those children had more sustained neglect?


Dr. Eve Spratt:  I think that it’s that many of them had their physical needs met, but not their emotional needs.  They don’t know who their caretaker is going to be next shift.  It may be this random group of people that are kind of coming in and out of the orphanage to care for them, versus a child that always knows who to look to for comfort and having their needs met.


All of the families that were in the study are just wonderful.  They have stable homes now.  But especially those families that have adopted children through international adoption, they’ve wanted children, to nurture them, and really care for them.  And they have better behavioral outcomes than our U.S. neglect kids, yet they were the ones that had the biologic differences.  We had a small sample, but we still found statistically significant differences, which I think helps to give some insight about some of their potential cognitive and mental health issues.


Dr. Linda Austin:  So, is the implication, then, that these are very vulnerable children, and that vulnerability can be biologically measured?  But the heartening news, I gather, from what you’re saying, is that this can be mitigated in a loving, supportive, consistent family setting. 


Dr. Eve Spratt:  Absolutely.  I think what we’ve learned is that there’s this biologic vulnerability that still persists, but having the right interventions take place can sustain them in a way we want.


Dr. Linda Austin:  So, there appears to be, then, a window during the first year.  Obviously, children remain much more vulnerable than adults so thereafter.  How long have your follow-up studies been able to carry these children?


Dr. Eve Spratt:  We did initial assessments on these children, and then I’ve ended up following some of them clinically.  It was a way that I could weave together some of the clinical duties as well as the research.  I think some of those questions are yet to be answered, but I continue to see the benefits, of course, of a stable home.


Dr. Linda Austin:  I think the obvious question is:  the stress hormone acts as the hypothalamic pituitary adrenal axis is sensitized, what is the practical significance of that?  Why is that important?


Dr. Eve Spratt:  Sort of how that translates to me is, again, any time I see a child, I want to be able to understand their psychosocial and biologic vulnerabilities.  We know that genetics are certainly a biologic vulnerability.  So if we know they’ve got that in place, then we can put some strategies in to help to, hopefully, keep them from developing disorders; even teaching children at a young age about cognitive behavioral strategies, what to do when they’re a little bit anxious.  We know that they may be more likely to have something happen and respond than a child that doesn’t have a heightened stress response. 


Being able to teach the parents some simple strategies of ways they can respond, as Barry Brazelton would say, knowing the touchpoints for them.  You know, you can handle a situation and make it worse, or you can handle a situation so they can continue to grow and master the situation.


Dr. Linda Austin:  Is there anything to suggest that those children who are more sensitive have increased incidents of other health problems, such as eating-related disorders; overweight, that sort of thing?


Dr. Eve Spratt:  We did find some statistically significant differences in our study.  There was this trend for the U.S. neglect children to have a higher body mass index than the international adoption children, which had a lower body mass index, as compared to our healthy controls.  So that was an interesting observation. 


The adverse childhood events studies that have been done, that have come out of the CDC, would certainly indicate that there are long-term health effects associated with altered hypothalamic pituitary adrenal axis functioning.  We have lots of studies that look at child maltreatment, and you find much higher rates of maltreatment in those with cardiovascular disease, diabetes.  For women, it’s more than immunologic disorders, depressive disorders. 


Dr. Linda Austin:  Thanks so much.


Dr. Eve Spratt:  Sure.

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