Every parent wonders what dreams await a child at birth. Sometimes the child exceeds beyond all expectations, but achingly, others get derailed.
In an ambitious long-term study of brain development and child health in the nation, researchers want to find out more about what sets that trajectory. The National Institutes of Health study is called ABCD, which stands for Adolescent Brain Cognitive Development, and is the largest study of this type in the nation.
The Medical University of South Carolina is one of 21 research sites across the country helping to recruit 11,500 children ages 9 to10. MUSC hopes to recruit about 300 children from the Tri-county area, with enrollment lasting through September 2018. The children are followed for 10 years into early adulthood.
Co-principal investigators at MUSC are Lindsay Squeglia, a clinical neuropsychologist and neuroimager, and Kevin Gray, a psychiatrist and director of MUSC Health’s Child and Adolescent Psychiatry Division, both in the Department of Psychiatry and Behavioral Sciences at MUSC.
Gray says the scale and the length of the study are unprecedented.
“These types of efforts have been done on smaller scales, which have been valuable, but nothing has had the power of this level of data before. We’re only beginning to understand adolescent brain development. We know it’s complex. We know that so much of what happens during adolescence predicts life achievement. We used to think brain development was done when you’re a kid. We now know that it lasts at least into the mid 20s.”
Data being collected include: a medical history, genetics through a saliva sample, and environmental impacts — such as exercise and diet, socio-economic factors, mental health, substance use, extracurricular activities, cognitive testing and brain imaging.
Squeglia says kids will get a free “picture” of their brain done by an MRI scan, which will be read by a neuroradiologist. “The imaging piece is important because we know the brain is still developing, and we’re trying to better understand that and the trajectory of growth over time and all the factors that might affect development,” she says.
“It’s such an important period in life for kids. They’re learning so much and starting to develop their social skills. We want to understand how to help kids have the healthiest brains possible.”
That’s right up Squeglia’s alley as one of her specialties is studying teens using structural and functional neuroimaging and neuropsychological testing. Gray credits her expertise in helping MUSC become a study site.
“It is a rare person who has the clinical background and imaging background and expertise with kids to pull this off. You need clinical but also research expertise,” he says, adding that MUSC also has expertise in pediatric brain imaging, mental health, addiction neurosciences and radiology.
The study is a game changer in how different disciplines are joining forces, Gray says.
“So you have geneticists, brain imagers, clinicians — you have all these different areas working together for a shared goal,” he says. “We’re ambitious, but we’re collaborative. We all have our own areas of interest, but we also want to be collaborative as part of this consortium, working with others to answer their questions. In some ways, it’s daunting because there are so many questions that can be answered by this.”
This study puts all the data in one place so researchers can look at interactions among a wide range of influences, such as the impact on brain development by social interactions, genetics or mental health, to name just a few variables.
“I’m a psychiatrist, so mental illness is one thing I think about. Schizophrenia affects about 1 percent of the population. Typical onset is in late adolescence or young adulthood. One percent of 11,500 is a sizeable number, so with this kind of power, we can get a better sense if there’s a different trajectory of brain development in those who go on to develop schizophrenia, bipolar disorder, or other mental illnesses.”
Squeglia says the research can help explore if there are biomarkers for high-risk behaviors: suicide, major medical illnesses and substance use. “We could look at predictors of high-risk behaviors and poor outcomes, and that would give us a window into when to intervene and how to do so,” she says.
Being part of this study also is important from an economic standpoint. The consortium grant will bring in an estimated $7 million over 10 years. There’s a benefit for families as well. The study requires an initial eight-hour evaluation for the child, who is compensated $100, and three hours for the parent, who is compensated $200 on the first visit.
Even more important is that the MUSC site will provide critical data from the South, Squeglia says. “We provide a different demographic than some of the other sites that are predominantly white, with a higher SES,” she says, explaining that socio-economic status is an important factor the study will take into account.
Gray agrees. “We get at the demographics of the South more. We recognize that in the richness of America, there’s a regional diversity across a number of factors. We felt it was really important for us to have a southern site.”
Since the study ties in environmental factors, it’s important to have the state represented in the sampling. “You think of some of the things we are known for,” he says. “We’re the belt buckle of the stroke belt in the South. Type II diabetes is very common here. It’s a complex interplay between genetics and the environment. Hopefully, this can shed more light on that interplay.”
Beyond that, there’s the fun factor.
Gray, whose daughter participated as a practice subject in the study to help the staff learn the protocol, says it’s a great way to let kids see science in action. Because researchers are studying not just the structure but also the brain’s functioning, the kids are asked to do fun tasks and play games while in the scanner. The MRI scanner just uses a magnet, so there’s no radiation exposure, he adds.
“It’s a fun way to get kids engaged in science. We’re getting a lot of data, but we’re also trying to make this a lot of fun. It’s great exposure for kids to see cool technology and the scientific process in action, and we hope this will provide science education to kids who otherwise might not really get exposed to it. Also, it’s a nice way for MUSC to interact with families and the community.”
This study moves away from the traditional way research is done, which is to wait for bad outcomes and search for ways to intervene. The new model provides data where researchers can better predict the bad outcomes and develop interventions before they occur and on the flip side, to enhance development in general.
“This will give us data to help inform preventions to optimize healthy developments for kids,” Gray says. “Kids are our most important resource, and we want to make them as healthy as we can.”