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Neurobehavioral Research


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​​Our Neurobehavioral research aims to improve assessments and interventions for children and adolescents with behavioral and mental health problems.

Projects focus on understanding how disrupted brain functioning can give rise to emotional and behavioral disorders. The ultimate goal is to provide new tools for assessment and the best treatment strategies. This work involves collaboration between Boys Town National Research Hospital and Boys Town Youth Care Services.

Neurobehavioral Research in Children

The Center for Neurobehavioral Research focuses on understanding how disrupted brain functioning can give rise to emotional and behavioral disorders. Our ultimate goal is to provide new tools for assessment and help in the design of treatments.

The Neurobehavioral Research Center is a collaboration between Boys Town National Research Hospital and Boys Town Youth Care Services to study and improve methods for intervening early in the lives of children with behavioral and mental health problems.

Boys Town's long history of providing effective treatment for children with a wide range of disorders and Boys Town National Research Hospital's successful history of research over the past 40 years, position the Center to become a state-of-the-art collaborative research effort that will offer evidence-based solutions for treatment to the larger mental health community.

The Need for Research

​​​​​Childhood behavioral and mental health problems, if left untreated, have profound implications for the individual as well as society. They confer considerable economic and personal costs.

However, there is hope.

The neurosciences have advanced our understanding of the pathology associated with behavioral and mental health problems in youth.

Our goal is to use and advance this knowledge to provide new, objective tools for assessment and help in the design of treatments.



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Trauma-Informed Care is Critical for Youth Needing Residential Services Care is Critical for Youth Needing Residential Services2019-08-26T05:00:00Z<p>​​​​​​​​Repeated exposure to trauma is extremely common for youth that end up in residential programs. Exposure to trauma changes these kids, <a href=""> even altering their brain development [1], </a>in ways that affect their responses to many aspects of their environment, including how they will respond to those people who are attempting to help them. In some cases, this means that attempts to treat kids unintentionally ends up traumatizing them further.</p><p>Boys Town, however, uses a trauma-informed car​e model that takes past trauma exposure into account in order to prevent the treatment from causing additional trauma. Additionally, Boys Town developed a screening instrument to identify possible symptoms youth may have related to past trauma [2]. Boys Town clinicians use this information to determine the supports and services youth need to help them heal. While this approach is widely accepted as the recommended approach for improving care in residential programs, research is also needed to support existing practices and to help us further improve how we take care of at-risk kids.</p><p>To help understand the benefits of our trauma-informed model, researchers at Boys Town, led by Patrick Tyler, Ph.D., recently conducted a study examining records for 1,096 youth from 9 to 18 years old who received Boys Town services. Their goals were to assess how trauma was associated with behavioral incidents, as well as the effects of trauma on psychological health at intake and when youth discharged from our program. [3]</p><p>Among the discoveries from their study, the researchers found that trauma symptoms were the best predictor of emotional problems and self-injury. Additionally, girls had higher rates of self-injurious behaviors than boys, whereas boys had higher rates of conduct problems at intake than girls in this study. Younger children also had higher rates of disruptive behavior compared to older children.</p><p>This study also showed that boys and girls who were grouped into either high or low trauma categories responded favorably to the trauma-informed program. Overall decreases were observed in disruptive and self-injurious incidents while in care, as well as conduct and emotional problems from intake to discharge for all of the groups. However, youth whom clinicians identified as having lower levels of trauma did have greater decreases in emotional problems.</p><p>A primary goal of Dr. Tyler’s team for this study was to determine how well the trauma-informed model has been working for youth that receive Boys Town services. Future studies will build on this by looking at best practices for incorporating trauma screening and assessment into the admission process in order to plan and provide the most effective care for our youth. Research is currently ongoing to identify strategies that can help youth with higher levels of trauma make even greater improvement.</p><h2>References<br></h2><ol><li>Blair K.S., Aloi J., Crum K., et. al. (2019) <em>Association of Different Types of Childhood Maltreatment With Emotional Responding and Response Control Among Youths</em> 2019 <strong>2</strong>(5). JAMA Netw Open.</li><li>Tyler, P.M., Mason, W.A., Chmelka, M.B., et. al. (2019) <em>Psychometrics of a Brief Trauma Symptom Screen for Youth in residential care</em> Journal of Traumatic Stress. doi: 10.1002/jts.22442. </li><li>Tyler P.M., Patwardan I., Ringle J.L., et. al., (2019) <em> <a href=""> Youth Needs at Intake into Trauma-Informed Group Homes ​and Response to Services: An Examination of Trauma Exposure, Symptoms, and Clinical Impression​</a>.</em> doi: 10.1002/ajcp.12364. Am J Community Psychol</li><ol></ol></ol>
Functional Brain Imaging Shows How Maltreatment Affects Brain Development Brain Imaging Shows How Maltreatment Affects Brain Development2019-06-20T05:00:00Z<p>Boys Town is recognized as a world leader in caring for kids in trouble, many of whom have been subjected to childhood trauma. Boys Town National Research Hospital is also home to research investigating the impacts of maltreatment on developing brains. Karina Blair, Ph.D. and her team at Boys Town Hospital recently published a paper titled, <em>Association of Different Types of Childhood Maltreatment</em><em> </em> <em>With</em><em> Emotional Responding and Response Control Among Youths</em> [1] that examines some of these issues. </p><p style="text-align:left;">Specifically, the authors looked at measures of brain function and behavior for 116 young people from 10–18 years of age who reported and rated their personal experiences with different types of abuse and neglect. The children and adolescents were either enrolled in Boys Town programs or from the surrounding community, and their families gave consent to the study with the option to withdraw at any time. The kids' brain activity was monitored while they performed a number counting task in the presence of distracting emotional images. This allowed Dr. Blair to determine the association of different forms of maltreatment on brain systems critical for task performance as well as emotional responding.  </p><p style="text-align:left;">The main findings of this study were the association of abuse, rather than neglect—at least, within this group of participants—with both difficulties with response control and heightened emotional responding.  Moreover, physical abuse was particularly associated with heightened threat responding. Sexual abuse was associated with a cascade of difficulties that were present even after the influence of other forms of maltreatment was statistically accounted for (Figure 1). </p> <img src="" alt="Brain MRI" /> <p> <strong>Figure 1. The anterior cingulate region of the brain is importantly involved in emotional processing and shows overly increased responding in kids who have suffered sexual abuse. </strong>The colored areas in this image show the regions showing greater responding in kids who have suffered sexual abuse relative to those who have not.  The “hotter" the color, the more overly responding the region. </p><p style="text-align:left;"> </p><p style="text-align:left;">These findings are important because we know these kids need help. They may find themselves in dangerous situations and sometimes legal trouble.  We need to understand exactly what problems they face. Understanding their brain level-difficulties are part of the picture.  Moreover, the findings of this work suggest that maltreatment may have different impacts according to the form of maltreatment.  Indeed, sexual abuse may be associated with particularly severe brain-level difficulties.  Potential findings such as these may become the basis for assessing treatment success at the level of the individual. For a much more detailed description of their findings <a href="" target="_blank"> <span style="text-decoration:underline;">see the article in JAMA Network Open</span></a> [1]. </p> <p>References </p><ol><li>Blair KS1, Aloi J2, Crum K3, Meffert, et. al. (2019) <em>Association of Different Types of Childhood Maltreatment </em> <em>With</em><em> Emotional Responding</em><em> </em> <em>and Response Control Among Youths</em>, 2019 <strong>2</strong>(5). JAMA Netw Open.  </li></ol>
Discussing the Neuroscience of Kids Facing Adult Justice System the Neuroscience of Kids Facing Adult Justice System2019-06-12T05:00:00Z<p>The adult criminal justice system is often charged with determining the appropriate response to young children who have done bad things. However, these young child offenders are often also victims of abuse, pre-natal drug exposure and neglect. Trauma may change the brain's response to stressful situations and alter the child's ability to control unwanted behaviors. Courts must weigh these circumstances when considering whether the child should be charged as an adult.</p><p>Boys Town researchers are working to understand typical brain development as well as how this may be altered by stress using behavioral assessment tools and functional neuroimaging. In addition, for more than 100 years, Boys Town has been helping at risk youth and their families to change outcomes for the better. This combined experience puts us in an ideal position to provide judges with information relevant to their decisions about what to do with kids who end up in their courtrooms.</p><p>In partnership with the National Courts and Science Institute, Boys Town recently hosted a Neuroscience and the Law Workshop. Led by James Blair, Ph.D., Susan and George Haddix Endowed Chair for Neurobehavioral Research at Boys Town National Research Hospital, the judges were given an overview of current science on brain development and childhood trauma. In addition, judges and Boys Town staff held round table discussions covering case examples and how current knowledge may be applicable to judicial decision making. The judges were given a tour of facilities and technologies they may hear about in cases, and what those technologies can and cannot tell us about developing brains and mental health.</p><p>Advocating for youth, including those who end up in the criminal justice system but might be better served by therapy and intervention, is part of Boys Town's mission to help at risk youth. We appreciate the participation of the judges and hope that this meeting will be a model for future workshops as new discoveries are made.</p><div class="embed-container"> <iframe src="" width="560" height="315" frameborder="0"></iframe> </div>​
Understanding Brain Responses of Alcohol and Cannabis Abuse Disorders in Adolescents Brain Responses of Alcohol and Cannabis Abuse Disorders in Adolescents2018-08-15T05:00:00Z<p>​​​Across the country, many adolescents struggle with alcohol and cannabis abuse. While the U.S. Department of Health and Human Services (HHS) notes that alcohol use among teens is decreasing, still 3 out of 5 high school students have reported having a drink within the past 30 days, and 23% of high school seniors have used marijuana within the last month. Brain-imaging work by scientists at <a href="">Boys Town Center for Neurobehavioral Research</a> indicate that abuse of alcohol and cannabis can have lasting negative effects on a child's or teen's brain development.</p><p>Executive attention and response control are critical for impulse control.  They rely on regions at the front of the brain like dorsolateral frontal cortex and dorsomedial frontal cortex.  A recent study at Boys Town National Research Hospital shows a difference in function in these regions among youth with alcohol and cannabis substance abuse disorders. This study published in <em>Neuroimage Clinical</em>, titled, "Adolescents show differential dysfunctions related to Alcohol and Cannabis Use Disorder severity in emotion and executive attention neuro-circuitries." Adolescents reporting more severe substance abuse disorder symptoms, particularly those associated with alcohol abuse, show problems using these brain areas during response control.  This likely leads to further difficulties.  If these regions are not working well, an individual is less likely to control his/her impulses and may be more likely to abuse substances in the future. Behavior also generally becomes more impulsive.</p><p>Joseph Aloi, Ph.D., a research student at the Boys Town Center for Neurobehavioral Research, led the study that investigated the brain's executive attention and response control systems in youth with varying levels of alcohol and cannabis use problems.  The study used an MRI machine to measure youths' brain responses during a type of response control task and then related this information to their levels of alcohol and cannabis problems. </p><p>The findings from the study are important for several reasons.  First, they show that substance abuse problems in adolescents are associated with demonstrable brain level-difficulties, which may require intervention to improve function.  Second, the findings reinforce the importance of considering a person's substance abuse history.  Brain-level difficulties associated with alcohol abuse disorder may require specific intervention strategies.  Third, the data suggests that we might assess substance abuse treatment success, not only by abstinence, but also whether these brain-level difficulties have been reduced.</p><p style="text-align:justify;">This work is a first step in our goal to improve the care of children with substance abuse. By better understanding how substance abuse affects brain function, Boys Town scientists can develop better interventions and treatments to help more children.  To follow the progress of this work, please see our website at <br></p><p><br></p>
Research Helps Target Behavioral Interventions for Aggressive Youth Helps Target Behavioral Interventions for Aggressive Youth2018-08-09T05:00:00Z<p>​​Across the county, many adolescents struggle with disruptive behavior ranging from aggression or rage toward others to outbursts in the classroom. These behaviors appear similar, but a recent brain-imaging study at Boys Town National Research Hospital suggests a youth's prior exposure to abuse or neglect may impact the way that youth emotionally responds to the pain of others. </p><p>"If you could not empathize with another's pain or distress, you would be less concerned by hurting another individual," said <a href="" data-ytta-id="-">James Blair, Ph.D.</a>, Susan and George Haddix Endowed Chair in Neurobehavioral Research at Boys Town National Research Hospital. "Empathy can act as a barrier against aggressive behavior."</p><p>The study, published in <em>Psychological Medicine</em>, is titled "Moderation of prior exposure to trauma on the inverse relationship between callous-unemotional traits and amygdala responses to fearful expressions: an exploratory study."</p> <p>Previous research by Blair showed many adolescents with disruptive behavior have problems expressing empathy and guilt, which means they have difficulty emotionally responding to the distress of others. This background led researchers at Boys Town Hospital to explore the relationship of past traumatic experiences, such as abuse and neglect, with emotional responses, such as empathy and guilt.<br></p><p> <a href="" data-ytta-id="-">Harma Meffert, Ph.D.</a>, scientist at the <a href="" data-ytta-id="-">Boys Town Center for Neurobehavioral Research</a>, led a study that investigated how the amygdala (brain region central to empathy) responds to distress in others in youth with varying levels of prior trauma. The study used an MRI machine to measure youths' brain responses to fearful expressions in others.  The youth also filled out a questionnaire and received a psychological interview on prior traumatic events (abuse and neglect).<br></p><p>The study indicated that not everyone showing the behavioral signs of reduced empathy/guilt also shows the brain signs of reduced empathy/guilt.  In particular, youth that are exposed to significant prior trauma do not show the brain signs of reduced empathy/guilt, despite similar behavioral signs of reduced empathy/guilt.<br> </p><p>The findings revealed results that may help map new behavioral interventions.  </p><ol><li>The data suggests that not all youth with disruptive disorder face the same difficulty – and therefore need different interventions.  </li><li>The data reinforced the importance of considering an individual's trauma history. As other work by this Boys Town research team is beginning to show, trauma has a very negative impact on brain development. </li><li>The data indicates that behavioral symptoms alone may not be sufficient to accurately guide treatment decisions. </li></ol><p style="text-align:justify;">Currently, all youth with problems in expressing empathy and guilt receive the same interventions. Mental health assessments mostly rely on observed behaviors and information the patient and their family share with the clinician. This makes it difficult to tell apart an individual who is aggressive because they are prone to rage and another individual who uses aggression, including anger outbursts, to achieve their goals.  </p><p style="text-align:justify;">The work by Boys Town Center for Neurobehavioral Research in Children is a first step in our goal to improve the care of children with emotional and behavioral problems by developing better assessments in order to find the best interventions for each child individually. <br></p>
Announcing First Endowed Research Chair at Boys Town National Research Hospital First Endowed Research Chair at Boys Town National Research Hospital2018-01-16T06:00:00Z<p>​Boys Town National Research Hospital has received a gift of $2 million to establish the Susan and George Haddix Endowed Chair for the Center of Neurobehavioral Research, to support and expand efforts to improve the lives of children with behavioral and mental health problems.</p><p>This is the first endowed research chair at Boys Town Hospital. It has been created as part of the organization's ongoing commitment to enhance translational pediatric neuroscience research – meaning discoveries found by researchers in the lab are directly applied to improve outcomes in behavioral healthcare. </p><p> "We are truly grateful for Susan and George's deep understanding and compassion toward helping children in need of behavioral and mental health care, and for their generous contribution that will help sustain neuroscience research at Boys Town Hospital for many years to come," said John Arch, Hospital Director and Executive Vice President of Health Care at Boys Town.  "I am pleased to announce Dr. James Blair will be appointed to the Susan and George Haddix Endowed Chair for Neurobehavioral Research."</p><p>Dr. Blair, Director of the Center for Neurobehavioral Research in Children, joined Boys Town Hospital in August 2016, after 12 years at the National Institute of Mental Health. He is internationally recognized for his contributions toward better understanding conduct disorders in children and adolescents by using brain imaging technology to study behavioral traits.</p><p>"I am honored to be appointed to this prestigious position and grateful that the need for this research is being recognized," said Blair. "Our work is just beginning. What we uncover today can be applied to new studies tomorrow, in hopes that one day we will know how to help all children who have behavioral and mental health problems."</p><p>Childhood behavioral and mental health problems, if left untreated, have profound implications for the individuals as well as society. The goal of the Center for Neurobehavioral Research is to understand what is physiologically happening in the brain of a troubled child so that the right interventions can be applied for that individual child. This research moves beyond mere observation of behaviors to developing scientific ways of diagnosing and treating problems like depression, anxiety, aggression and ADHD.</p><p>"I was excited to hear of the neuroscience research at Boys Town Hospital," said Susan Haddix. "To me, the real problem is that we expect a troubled child to function the same as a child without behavioral concerns. This research is going to look deeper into understanding why children are having these problems. Then, one at a time, we will know how to help each child and family, and in doing so, make a real change."</p><p>Susan has been actively working to help troubled children and adolescents in the Omaha community for more than 20 years. She has been a long-time volunteer with Child Saving Institute and currently serves on their Board of Directors. She also has been serving on the Nebraska Foster Care Review Board for 20 years and was recently appointed to serve on their newly formed Probation Review Board. This spring, Susan will join the Boys Town National Board of Trustees, serving on the national youth care committee.</p><p>George Haddix, Ph.D., has been a prominent leader in computer engineering and software, having served as CEO for PKWare Inc., Applied Communications, CSG Systems International and US West.</p><p>The new era of neurobehavioral research couples George's interest in science and technology with Susan's passion to help children and families.</p><p> "We're proud to help this new endeavor at Boys Town Hospital," said Haddix. "This research is ground-breaking and shows great promise that the emotional and behavioral problems that stem from childhood neglect and abuse don't have to be a lifetime diagnosis. We can make a difference and change the future for these vulnerable children."</p><p>As benefactors of the first endowed research chair at Boys Town Hospital, Susan and George Haddix hope to influence others to give. Ongoing support will help Boys Town Hospital continue to lead the charge in neurobehavioral research and improve the lives of children with behavioral and mental health disorders. </p>

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