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Original Investigation |

The Effects of Poverty on Childhood Brain Development:  The Mediating Effect of Caregiving and Stressful Life Events

Joan Luby, MD1; Andy Belden, PhD1; Kelly Botteron, MD1,2; Natasha Marrus, MD, PhD1; Michael P. Harms, PhD1; Casey Babb, BA1; Tomoyuki Nishino, MS1; Deanna Barch, PhD1,2,3,4
[+] Author Affiliations
1Department of Psychiatry, Washington University School of Medicine in St Louis, Missouri
2Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, Missouri
3Department of Psychology, Washington University in St Louis, Missouri
4Program in Neuroscience, Washington University in St Louis, Missouri
JAMA Pediatr. 2013;167(12):1135-1142. doi:10.1001/jamapediatrics.2013.3139.
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Importance  The study provides novel data to inform the mechanisms by which poverty negatively impacts childhood brain development.

Objective  To investigate whether the income-to-needs ratio experienced in early childhood impacts brain development at school age and to explore the mediators of this effect.

Design, Setting, and Participants  This study was conducted at an academic research unit at the Washington University School of Medicine in St Louis. Data from a prospective longitudinal study of emotion development in preschool children who participated in neuroimaging at school age were used to investigate the effects of poverty on brain development. Children were assessed annually for 3 to 6 years prior to the time of a magnetic resonance imaging scan, during which they were evaluated on psychosocial, behavioral, and other developmental dimensions. Preschoolers included in the study were 3 to 6 years of age and were recruited from primary care and day care sites in the St Louis metropolitan area; they were annually assessed behaviorally for 5 to 10 years. Healthy preschoolers and those with clinical symptoms of depression participated in neuroimaging at school age/early adolescence.

Exposure  Household poverty as measured by the income-to-needs ratio.

Main Outcomes and Measures  Brain volumes of children’s white matter and cortical gray matter, as well as hippocampus and amygdala volumes, obtained using magnetic resonance imaging. Mediators of interest were caregiver support/hostility measured observationally during the preschool period and stressful life events measured prospectively.

Results  Poverty was associated with smaller white and cortical gray matter and hippocampal and amygdala volumes. The effects of poverty on hippocampal volume were mediated by caregiving support/hostility on the left and right, as well as stressful life events on the left.

Conclusions and Relevance  The finding that exposure to poverty in early childhood materially impacts brain development at school age further underscores the importance of attention to the well-established deleterious effects of poverty on child development. Findings that these effects on the hippocampus are mediated by caregiving and stressful life events suggest that attempts to enhance early caregiving should be a focused public health target for prevention and early intervention. Findings substantiate the behavioral literature on the negative effects of poverty on child development and provide new data confirming that effects extend to brain development. Mechanisms for these effects on the hippocampus are suggested to inform intervention.

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Figure 1.
Conceptual Model Testing Multiple Mediators of the Hypothesized Association Between Income-to-Needs Ratio and Variation in Brain Volume

aMeasured at baseline.bMeasured after baseline but before scan.cBetween baseline and time of scan.dTime of scan.

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Figure 2.
Caregivers’ Education, Supportive/Hostile Parenting, and Children’s Experiences of Stressful Life Events as Mediators of the Relation Between Income-to-Needs Ratio and Hippocampus Volumes

Values shown are standardized regression coefficients. The top model is for the left (L) hippocampus volume, while the model at the bottom represents the right (R) hippocampus volume. Both models include whole-brain volume and sex as covariates.aMeasured at baseline.bP < .001.cMeasured after baseline but before scan.dP < .01.eP < .05.fAfter adding parents’ education, supportive/hostile parenting, and children’s stressful life events to the model.gTime of scan.

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