Translational Neuroscience: The Giant Leap in Preventive Health Care


BW: Describe your current research.

DF: Much of what we have done relates to the origins of negative behaviors, such as substance abuse. We are in the process of applying that basic information in studies of particular preventive interventions shown effective in rigorous research, with the idea of making them more effective or effective for more people. Levels of neurocognitive functioning [e.g., attention, planning, and memory] and emotion regulation may predict and explain the response to preventive interventions and changes in behavior. For example, we are working on a study in Baltimore in which two schools get an evidence-based prevention program in kindergarten through first grade, and two schools do not. We want to determine whether change in academic and behavioral outcomes is characterized by improvements in neurocognitive functions.

DE: Some interventions stop at a particular grade, but the children are followed for years and continue to show better outcomes than those who did not participate. We don’t understand what changes in the brain have occurred. Neuroimaging comparisons between responders and nonresponders would give us some valuable information. We are currently neuroimaging kids — now in their early 20s — who participated in an evidence-based intervention in first grade, and we are comparing those doing well with those who are not and also with those who didn’t get in the program. Neuroimaging can help us see whether there is a neurodevelopmental progression among those who respond well to a preventive intervention. Is the neurodevelopmental pathway altered or accelerated by the intervention? How many years of the intervention are needed to make a difference?

DF: Boosters are often needed in prevention, but some interventions (such as the Good Behavior Game) have long-term effects without further intervention (although further intervention is always beneficial). We have looked at how individuals’ stress response is altered after a preventive intervention. The brain-scanning work for the neurocognitive tasks used in our assessments has been done by others previously, so we know the underlying neuroanatomy of performance on these tasks. This will allow us to focus on predetermined regions when we map the effects of a preventive program onto the brain.

DE: In terms of what we expect to find in this study, some participants may have experienced abuse or other forms of adversity that have a negative impact on the brain, compromising intervention effects. It is possible that some individuals may be trained to recruit other areas of the brain to perform tasks in a compensatory manner, or could use the skills they have to strengthen others.

BW: You have suggested that another use of biological measures such as neuroimaging is to link them to behavioral tasks so that, ultimately, the biological measures no longer have to be used. Please explain that idea.

DF: Once researchers have information from brain scans and laboratory tasks that map tasks to particular areas of the brain, practitioners who work with kids can just administer the tasks, without requiring the costly neuroimaging. These tasks [e.g., ones that require attention or inhibition] would be much more sensitive than what is in use now, yet still inexpensive and noninvasive. They would give us a high level of information about the individual — for example, an indication of prefrontal-cortex functioning or connectivity between areas responsible for inhibitory control — and could be applied in clinical settings, communities and schools.

But the first step is to use neuroimaging to understand the neural signature of the tasks based on laboratory studies. This work is in very early stages. The tasks could then be used to better understand the origin of disorders and monitor changes over time during treatment. Some of the tasks have graduated levels of performance — they increase in complexity and difficulty — and can even be part of intervention because doing the tasks well works areas of the brain involved in important functions, such as inhibiting impulses.

One cautionary note, however, is that studies are showing that when tasks lack a real-world setting, they are not as effective at engaging the brain as actually playing in a real-world setting or perhaps in virtual-reality scenarios. Challenges, choices, and decisions seem to require a social context to be reflective of brain function in actual situations. So simulation tasks that better mimic real-world settings would seem to be more readily transferable than two-dimensional computer tasks. The importance of context fits with what we know about adolescents. They tend to do as well as adults on cognitive tasks when alone, but their performance often breaks down in the social context of having peers present.

BW: Talk about a collaborative, transdisciplinary effort in which your group is involved.

DF: We do some neurodevelopmental work as an extension of the Promise Neighborhood Research Consortium — an effort to provide comprehensive, evidence-based programs to high-poverty communities nationwide and to set policies that encourage their use. The Harlem Children’s Zone is a model for this work. That program has had 10 years of academic and community services and activities, including a lottery-based academy, to boost quality of life in this very low-income neighborhood and has shown remarkably positive outcomes. We are looking at whether this kind of large-scale initiative affects neurocognitive development, which theoretically would be evident earlier than change in academic and behavioral outcomes.

The Promise Neighborhood Research Consortium is [composed] of 30 top prevention scientists who are developing a conceptual model and infrastructure for implementing and evaluating the effects of evidence-based intervention programs and policies on child development and family and neighborhood functioning. It is transformative work. The cost per child for such a program is about $500 per year, but if that approach was embraced across the country, the money saved in arrests, psychopathology, drug abuse, and other problems would be in the billions.

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