Intervention, Resilience May Counter Poverty’s Impact on Brain Development

For decades, research has shown that children who grow up in poverty face numerous challenges regarding their brain development, according to Cynthia Rogers, M.D. But more evidence may be emerging that suggests the brain is also resilient, and prevention, interventions, and policy changes can make a significant difference in children’s lives.

Rogers spoke as part of the National Institute of Mental Health’s Innovation Speakers Series during the session “Addressing Social Determinants to Optimize Infant Brain Development.” She is a professor of psychiatry and pediatrics and associate director of the Center for the Study of Race, Ethnicity, and Equity at Washington University. She is also the co-director of the Washington University Neonatal Development Research (WUNDER) Lab.

Rogers pointed out that social determinants of health—such as economic instability, a child’s neighborhood and built environment, and inadequate access to quality health care—account for 75% of population health outcomes, according to the Robert Wood Johnson Foundation. “If we are interested in improving health, either through research or through clinical care, how can we do that if we are not addressing something that is responsible for three-quarters of the outcome?” she said. “It is really important that we embrace this as practitioners.”

Poverty, she said, is related to almost all social determinants, and along with family history, genetics, and prenatal and postnatal stressors, has a significant impact on the developing brain. Poverty’s impact on the developing brain is a burgeoning area of research, most of which has been focused on older children. But Rogers and her colleagues are conducting numerous studies investigating adverse exposures in the prenatal period, several of which she detailed during her talk.

For example, Rogers and her colleagues have been running the WUNDER study since 2007, investigating the impact of premature birth on brain development. They found that neighborhood poverty—as measured by the Area Deprivation Index—during the prenatal/perinatal period was related to brain connectivity at birth, which is associated with psychiatric outcomes. The findings were published in Developmental Cognitive Neuroscience.

But there is also evidence of resilience to these poverty-related brain changes, she said. “I think a lot of folks are concerned about stigmatizing children by saying that if you [live] in poverty, your brain changes,” she said. But she pointed to a recent study published in Nature Communications that used MRI data from more than 6,800 children aged 9 and 10 enrolled in the Adolescent Brain Cognitive Development (ABCD) study.

The study analyzed how activity in the frontoparietal networks (which control executive function and cognitive control) and default mode networks (which have more to do with emotions and internal regulation) relate to scores on cognitive tests. For children not living in poverty (defined as a family of four making more than $25,000 a year), they found the expected result: better performance on cognitive tests correlated with weaker coupling of these two networks of the brain. For children from households in poverty, however, the direction was reversed: Better performance on the tests was directionally related to stronger connectivity between the two networks.

“There are ways in which our brains develop optimally … so that we can still be successful [regardless of our environments],” she said. “We should be a little bit more circumspect about what some of the changes that we find [relating poverty to outcomes] mean until we can do more longitudinal studies. ... Could there be some compensatory changes in the brain of those who grow up in poverty that still enable them to have optimal outcomes?”

There is a great deal that can be done to combat the challenges children experience when born into and grow up in poverty, Rogers said, and evidence is growing that improving the environments to which children are exposed can optimize brain development. She presented preliminary findings from an ongoing study that also involves children enrolled in the ABCD study, evaluating how anti-poverty programs might mitigate some of the disparities in brain development. The findings show that, for children in states with more generous social welfare programs, the relationship between poverty and hippocampal volume in the brain was diminished, meaning that those children experienced more resilience in terms of their brain development, she said. “This points to the impact that improving economic stability could have,” she said.

Rogers concluded her talk by reiterating the continued need for additional studies that take into account the social determinants of mental health.

“We need more research that is focused on the neonatal period to really understand how the brain is evolving over time and also what the outcomes of these kids will be,” she said. ■