PROVIDENCE – Conversations, collaborations and potential new research findings continue to converge around strategies on how best to reduce toxic stress in Rhode Island, following the event held on Oct. 28 at Rhode Island College.

Liz Tobin-Tyler told ConvergenceRI she recently sat down with Blythe Berger, who directs the Center for Perinatal and Early Childhood Health at the R.I. Department of Health, to talk about shared strategies moving forward.

Tobin-Tyler, who had attended the Oct. 28 event, wears many hats; she is an adjunct professor of Law at Roger Williams University School of Law, a clinical assistant professor of Family Medicine at the Alpert Medical School at Brown University, and an assistant professor of Health Services, Policy and Practice at the Brown University School of Public Health. She also chairs the R.I. Alliance for Healthy Homes.

Kevin Bath, an assistant professor of Cognitive, Linguistic and Psychological Sciences at Brown University, one of the presenters at the Oct. 28 event where he had shared the latest findings of his neuroscience research on how toxic stress affects brain development, is now collaborating with the Rhode Island College School of Social Work in the creation of a toolkit on toxic stress. [See link to ConvergenceRI story below.]

The first visualization document, a work in progress, which details the different initiatives, interventions and research now underway to address toxic stress in Rhode Island, has been created by DataSparkRI, in collaboration with the R.I. Department of Health and ConvergenceRI. [See link below to ConvergenceRI story below.]

And, potential findings of new groundbreaking neuroscience research being conducted at Brown University, the focus of a three-year grant by the National Institutes of Health, promise to identify and measure key social and economic determinants and their impact on toxic stress in Rhode Island children.

“Stress of any kind is one of those variables gives us a window into the developing brain,” explained Dima Amso, an associate professor at Brown University, in a recent interview with ConvergenceRI. Because we know it affects the developing brain, she continued, her lab’s research is focused on “how we can understand brain development through the lens of environmental influences.” While both positive and negative influences help to shape the brain, she continued, “I'm happy to focus this conversation on stress.”

Amso directs the Developmental Cognitive Neuroscience Laboratory at Brown, which studies the cognitive developmental neuroscience of attention, memory and cognitive control. She told ConvergenceRI that the data analysis has begun on some very large data sets her lab has developed through the research.

The research has been exploring how changes in core brain processes are shaped by a child's environment. For example, the prefrontal cortex is involved in regulating one's behavior; it develops into adolescence and is known to be impacted by environmental experiences. “This long developmental course suggests that this ability could be particularly vulnerable to factors deriving from socioeconomic status,” Amso said.

Here then, is the in-depth interview by ConvergenceRI with Dima Amso, director of the Developmental Cognitive Neuroscience Laboratory at Brown.

ConvergenceRI: Tell me about your work on toxic stress. What are the kinds of research that you’re conducting, and why is it important?
AMSO: There are lots of reasons why people study things like stress.

Sometimes, people come at it from the perspective there’s this environmental issue, and we want to ameliorate it, because it has negative consequences on long-term outcomes.

That’s in part why we think that stress of any kind is important in early development.

The other sort of less interesting reason from a public health perspective is that toxic stress, and stress of any kind, is one of those variables that gives us a window into the developing brain.

Acute stress is a positive thing, but chronic stressors of any kind can be considered toxic for kids.

You can have one, huge terrible event, for example, maltreatment, or you can have a chronic stressor, for example, neglect – which may or may not be considered toxic, but when neglect becomes chronic, it can become really negative for the system.

Our lab is one where we study brain development. And, one window into brain development is to understand how it is influenced by genes and by the environment, and their interaction.

ConvergenceRI: Nature and nurture?

Basically, yes. You can understand how to do something powerful with your science by understanding stress, because you can work on prevention and intervention.

You can get a window into how brain changes happen as a function of environmental exposure such as toxic stressors. It’s a long-term investment in time and research, but when you’re done with it, you have really powerful tools.

ConvergenceRI: Can you describe the actual kinds of research that you are conducting in your lab?
AMSO: Primarily, my lab studies the development of memory, attention and control systems in development in children, in humans, from infancy to adulthood.

We use a variety of different tools. For example, we get behavioral data, we get eye-tracking data, especially in young infants. You can’t tell infants to press buttons and you can’t ask them questions. But you can monitor their eye movements with incredible precision, so that you can manipulate things in the physical environment, or on a screen, and look at their patterns of behavior through their eye movements.

We have functional imagining in two different varieties, one is appropriate for use in infants; it’s called near-infrared spectroscopy. It’s basically an infrared device that is non-invasive. It gives you information about what’s happening in cortex development early in young infancy.

We also use, in older kids, the standard magnetic resonant imaging.

We do all of these in concert. For example, when I use near-infrared spectroscopy, I have an eye-track on the babies.

When I use magnetic resonant imaging, I have an eye track or a button press on the kids.

ConvergenceRI: Are you looking at both genes and cortisol [a stress hormone] levels?
AMSO: We’ve done both. We are not looking at cortisol levels right now. We are looking at genetic markers for risk.

ConvergenceRI: Have you identified specific genetic markers for toxic stress?
AMSO: The way it works is a little bit different from that. It’s called a candidate gene approach… But first, let me tell you about one research project.

There’s a whole lot going on in the lab. Stress impacts attention, it impacts memory, what we call cognitive control, which is the ability to regulate behavior.

A couple of years back, I partnered with another faculty member here, David Badre, and he and I got a grant form the NIH to study the role of socio-economic status in brain development.

Now, in addition to just studying brain development, we can look at how all of our measures vary as a function of poverty in the state of Rhode Island.

There are many things that make up socio-economic status.

With this particular research, this grant that we’ve been running now for two and a half years, we have hundreds of data points.

It is not about: is it bad to be poor?

It’s about: what are the variables in these different home environments, be they parenting, be they opportunities for enrichment, be they reading, be they linguistic complexity, be they stress, be they maltreatment, be they adverse events.

[We want to determine:] What are the variables that are weighing in on differences in brain development?

ConvergenceRI: Is it similar the concept of looking at health, not as a function of health care delivery, but as function of health equity, with a focus on wellness and prevention?
AMSO: Let me clarify our thinking on this, because I think it’s a little bit unique.

There are so many variables that are different between a child who lives in a high socioeconomic status environment and a child who lives in a low socioeconomic status environment.

And let’s say, [for example], that one of these different variables is availability of books in the home, and another of those variables is stress.

Scientists may test these kids on a whole bunch of measures, and find that the kids from the different environments perform differently.

By those measures, the high socio-economic status kids may out-perform their age and sex-matched counterparts that are coming from a more impoverished background.

And, the gut instinct is to say: stress and not having enough books caused these difference. But here’s the problem.

There are a million other things different in these children's environments, and its complicated.

You can have toxic stress, because of a really stressful school environment, which people don’t think about very much, they think home environment is the most important thing; but in truth, actually, kids spend more time in school during the day.

So, you have a toxic environment in school; maybe there’s fear, maybe there’s bullying; when they come home they are buffered by their home environment.

That’s a completely different low socio-economic status child than from one who isn’t buffered by their home environment, or, the high socio-economic status child who has been bullied but doesn’t have the home as a buffer.

These are really complicated issues; that’s what we need to figure out, for intervention.

ConvergenceRI: How close are you to publication?
AMSO: We’re actually quite far along on this project. You have to collect a ton of data to do this work.

What we did was to collect a ton of lab-based data. Some brain imaging data, but we also collected extensive information about home environments and early life stress, and the variables, and the genetics.

We have hundreds of variables. We are actually working with a statistician in public health to create models of what seem to be the most important data points for things like cognitive control, for things like memory.

Once we’ve got that information [analyzed], it [will become] a window. Everything will predict outcomes – but which ones are what seem to be the driving forces?

ConvergenceRI: The recent conference held to develop a collaborative approach to strategies to reduce toxic stress in Rhode Island got everyone to the table and got them talking to each other. But it didn't necessarily change their approach or their model of intervention. Do you believe that your research will provide a more unified approach around intervention and prevention?

AMSO: That’s why we’re doing the science the way we have chosen to do the science. Our goal was not to say, [definitively] this is it, it’s lead, or it’s parenting.

It’s saying: I don’t know exactly what it is, but I have a strategy for pulling out some of the variables. We’re going to look at as many variables as we can; then we have a strategy for pulling out the variables that have [the most impact on brain development].

By using a big data approach, collecting as much information as possible, using bio stats, and identifying the variables, not just as differences between groups, but actually mattering for our brain activations, our patterns of IQ, and our patterns of task performance, that’s what I want to know.

We’re in a pause in data collection right now. We have so much data, and it’s being processed.

ConvergenceRI: That sounds like a brilliant new approach. Who is actually doing the big data analysis?
AMSO: We hired a post-doc who is now in a faculty position at Notheastern Universitybut continues to work on this -- an expert in taking huge data sets from public health and creating the modeling analysis. These are really complicated models.

ConvergenceRI: When do you think you’ll be able to publish and present some of your findings?
AMSO: Our first couple of papers looking at brain development and socio-economic effects have been published. We found socio-economic effects on brain development as early as four months, in infancy.

We didn’t come at this research to discover that, we planned to just collect as much data about our individuals as possible, and this was the thing that keep popping up.

ConvergenceRI: Socio-economic status exhibits itself as a factor in brain development as early as four months?
AMSO: Yes. We have one publication that shows when infants are looking at faces and clutter, that the ability to identify a social stimulus is one of the most important predictors, related to socio-demographic background.

The finding is not shocking. The more exposure you have on a daily basis to people and social stimulus, the more you’re likely to go in search of that. We already know that this is a huge determinant of social development. But we’re finding it really early in babies [related to brain development].

ConvergenceRI: How does your research tie into the work that Kevin Bath [Dima Amso’s husband, to be transparent] is doing related to the way the stress changes the way that neurotrophins in the brain develop, in that they speed up, rather than slow down?
AMSO: He’s seeing something that a lot of people in the field have started to see.

Scientists often work based on intuition, such as: toxic stress is bad, toxic stress impairs the system; it slows development down.

Actually, it turns out, sometimes, in order to deal with stress, the brain matures earlier in order to help get [the person] through the stressful moment.

Look at pre-term birth as an example. You might think that all the new inputs – visual experience, language experience – pre-term babies are getting much earlier than full-term babies would be a good thing.

If it were a good thing to get tons of experience before your brain was ready for it, these kids should be at an advantage.

But, the pre-term babies are getting that exposure before their brain is ready to receive it, and may be altering the timing of the system of brain development.

The same thing may be happening as a result of early life stress and forcing mature patterns [of brain growth] in, for example, the prefrontal cortex, because the kids have to regulate behavior in order to survive, it’s adaptive.

The brain system is getting these inputs before it is ready to receive them.

ConvergenceRI: Are there still conversations that need to happen, that are not happening, around toxic stress?
AMSO: In the case of brain development, when you talk about kids and stress, you can do that from the perspective of a psychiatrist, a psychologist, or a neuroscientist. But this is one of those cases where you really need to put all of the data together in a cohesive way.

This is what has to happen, because I don’t think the literature is broad enough in any one area yet.

We all use what we know, but I don’t think there is a one-size-fits-all approach for toxic stress.

There are no miracles.