CHARM research explores kids' brain development for clues to better trauma treatments

Eight-year-old Hayes de Arellano sits patiently with electrodes hooked up to his scalp, looking like a space-age fighter pilot. A thick Harry Potter book near him, the youngster is curious about being part of a study to see how kids’ brains work and develop.

“Why do you need gel?” he asks.

Jesse Walker, a research coordinator at the Medical University of South Carolina who works with the National Crime Victims Research and Treatment Center (NCVRTC), explains the gel increases the signal going across his scalp for the electroencephalogram, or EEG, that measures his brain waves. “Each of these squares represents a place on your head. We need them all to turn green to make sure we have a good signal.”

Hayes nods, satisfied.

His mother, Cora Ezzell, waits in the lobby. She and her husband, Michael de Arellano, both are firm believers in research and like the opportunity to have their son see science in action. A psychologist, Ezzell also likes the purpose of the study, which is called CHARM, or Charleston Resiliency Monitoring Study.

“They are looking at how we help our kids be resilient. Building resilience is incredibly important,” she says.

The monetary part, where participants can receive up to $375, is a nice perk, but the main draw for her is how it will add to the data on children’s brain development and the impact of life stressors. “Parents want to protect our kids from what’s happening, but life is hard. You can’t protect them from everything.”

When life does go sideways, the goal is to help them get through it, she says. “They can grow through challenges. Bad things can happen, but they can be OK.”

That’s what the principal investigator of the trial, psychologist Carla Kmett Danielson, Ph.D., believes. The $3.5 million, five-year study, funded by the National Institute of Mental Health, looks at children in third, sixth and ninth grades and follows them over a two-year period. The goal is to recruit 360 children and use a comprehensive assessment, including functional magnetic resonance imaging, EEG and questionnaires, to examine specific neural, physiological and psychological processes that contribute to long-term stress management and resiliency.

Danielson, a professor with MUSC’s Department of Psychiatry and Behavioral Sciences, says the prospective study is designed to capture critical changes that occur through the transition to adulthood. While the study is for all kids, whether they’ve experienced trauma or not, the results will help scientists understand better what happens as kids’ brains develop and the impact trauma may have.

Working in MUSC’s NCVRTC division, she understands better than most the impacts of trauma on kids. “I’ve spent 15 plus years working — directly and indirectly — with thousands of people who have been impacted by child abuse and by other forms of interpersonal trauma. I have witnessed the problems that impact them, and I’d like to better connect the dots to the basic translational science piece to be better able to help them.”

This study incorporates multiple levels of measures, even monitoring levels of stress hormones, such as cortisol. It may shed light on why some kids are be more susceptible to life stressors and offer clues to future biomarkers, she says.

“We’re looking at stress on a continuum of stressful life experiences. Unfortunately, 70 percent of kids will experience some kind of traumatic event by the time they are 18. Fifty percent will experience some form of interpersonal trauma.”

Most people are surprised by that and underestimate how common it is, even health professionals, she says. “As a clinical scientist who specializes in child abuse, I’m interested in questions relating to the how, when, why. How do the experiences of maltreatment and other forms of interpersonal trauma contribute to the onset of mental health problems? When we understand that, it will help us better understand how to fine tune and improve their treatment and the prevention needs.”

More kids than not are resilient, even those who do experience trauma, she says.

“We’re talking about a subgroup who are susceptible, but it can lead to significant problems for them, which in turn impact their family and community.”

Danielson says child abuse leads to huge societal costs in the form of lost wages, physical and mental health problems and a range of other issues. For example, child maltreatment and other forms of interpersonal trauma are a significant risk factor for substance use problems, she says.

“By bending trajectories away from negative outcomes after a child experiences abuse, you’re potentially circumventing those types of outcomes and costs associated with them.”

This type of study is innovative in two ways, she says. One is the longitudinal imaging component within a pediatric population, which is rare, she says. By the time the study ends, researchers will have a more comprehensive understanding of areas of the developing brain related to threat-processing in children in third through 11^th grades.

The other distinguishing feature is moving beyond reliance on one type of measure, merging multiple gold standard methods to study these developmental issues in kids, such as saliva cortisol testing and neuroimaging. These are combined with other common methods of assessment, such as comprehensive interviewing. The study extends from the RDoC, or Research Domain Criteria, framework initiative at NIMH, which is viewed as a high priority area in mental health research, she says.

That’s a big draw for NCVRTC colleague and psychologist Casey Calhoun, Ph.D, who is a co-investigator. The study will provide more of the scientific basis of what’s happening in the developing brain, particularly for children undergoing trauma, which is a useful to inform the tools put in the hand of therapists, he says.

“Providing some psycho-education that is rooted in the neuroscience of what’s happening in their brains helps validate what they are going through. It presents it in a less stigmatized way. It’s not that you are broken. It’s not that you’re this person who is never going to be happy again. It’s this is what’s happening in your brain right now and these are the treatments that we can use to help get you back on track. This is how we get those systems to work properly again and regulate your stress reactions better.”

Calhoun says the study also is a great way to expose families to research and science. Families receive free brain scans of their children, and kids can get a picture of the EEG for their phones if they want to share it with their friends. “Kids really enjoy it. It’s just the exposure to the science — going in and getting pictures of the brain and being able to do the tasks. Kids like to answer questions.”

Though it’s not a treatment study, it potentially will greatly impact treatment development and refinement in the future. Enrollment started in July and will extend across a two year period, through approximately June of 2019.

Danielson says it’s fitting the grant came through this year. Through this study, kids can help other kids at risk have better futures while learning the latest cutting-edge research techniques.

“This is the 40^th anniversary of our NCVC division, and everyone in the division shares this passion to help these families. That’s the main driving force,” she says. “Seeing the kids get better. Not all of them — but a lot of them do, and it is incredibly rewarding. At the end of the day, we all share the same mission, which is to make the lives better of people who have experienced stress and trauma.”