Poverty and the Brain: A Glimmer of Hope

January 10, 2017

CHW LogoMichel de Montaigne said “Poverty of goods is easily cured; poverty of the mind is irreparable.”  As it turns out, he was both too optimistic and too pessimistic at the same time.  On the one hand, despite the efforts of both liberal and conservative governments over the past 50 years, the poverty rate is essentially unchanged.  So much for the easy cure.

I have written before of the effects of poverty on the developing brainA new study suggests that a relatively simple intervention may sharply ameliorate those effects.  The Strong African American Families Program, started at the University of Georgia, offers parenting skills-building to rural African-American families, in a 7-week series of two-hour sessions.  Researchers conducted a randomized trial of this program versus a control program.  Youth who were enrolled in the program at ages 11-13 were followed up at age 25 with brain MRI.  Among control youth, there was a strong negative correlation between the number of years of living in poverty between the ages of 11 and 18 (a time of rapid brain development) and the size of key areas of the brain related to emotions and short-term memory.  The longer the exposure to poverty, the smaller the hippocampus and amygdala.  But among youth enrolled in the program, poverty had no such effect!  14 hours of training in supportive parenting appears to have essentially wiped out the harmful effects of deprivation on brain development.

This study doesn’t address the question about whether these changes are in turn associated with cognitive, emotional, or behavioral problems, and more importantly whether the intervention can prevent such problems.  But it provides tantalizing evidence that, if we don’t have the societal wherewithal to deal with poverty and disparities, we may at least be able to repair some of the damage.

Your Brain on $20,000 a year @ChildHealthUSA @AmerAcadPeds

September 11, 2015

CHW LogoAs part of the war on drugs, there were a series of public service announcements that showed an intact egg with the caption “This is your brain,” next to a fried egg captioned “This is your brain on drugs.”  I doubt it was any more effective than the ”Just Say No to Drugs” buttons people wore in the 80s (or the “Whip Inflation Now” buttons that people wore in the 70s, for that matter), though it did make for some great comedy fodder, like the breakfast platter captioned “This is your brain with a side order of bacon.”

In any case, there is growing evidence that poverty in early childhood is far more damaging to the brain than most things done to it later in life.  An article in the current issue of JAMA Pediatrics could be accompanied by a picture of a fried egg with the caption “This is your brain on less than $20,000 a year.”  Researchers examined data on a diverse group of almost 400 children enrolled in an NIH study of brain development.  These children had serial MRI images of the brain and standardized cognitive testing.  The study found that key regions of the brain were smaller – and cognitive scores lower – among children in families earning less than 150% of the federal poverty level ($36,375 per year for a family of 4).  These brain areas are known to undergo a long period of postnatal development in the early childhood years, and are linked to cognitive abilities that affect learning.  The gray matter volume in these brain regions was 3-4% less than normal among children in the <150% FPL group, with an even bigger gap (8-10% smaller volume) for children in homes earning less than 100% of the poverty level.  This is after accounting for differences in race and ethnicity, birthweight, and parent’s education level.

One strength of this study is that potential participants with high risk criteria known to affect brain development – e.g., risky pregnancy or newborn history, family psychiatric history, lead exposure, etc. – were screened out.  Many of these are more common among the poor, so they need to be accounted for in most studies of this type, but in this study there was more of an apples-to-apples comparison.   While this strengthens the conclusion that poverty causes arrested brain development, it likely underestimates the effect, since the stress of poverty might have an even more profound effect in the presence of some of these other risk factors.

The authors conclude that “households below 150% of the federal poverty level should be targeted for additional resources aimed at remediating early childhood environments.”  A key question then is what type of remediation?  There are other studies showing that both caregiver support style and stressful life events in early childhood – again, both associated with poverty – are associated with change in brain structure.  Classes or coaching to promote better parenting might be expected to help.  But the formidable stress of living in poverty can only be alleviated by, well, alleviating the poverty.

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