The longer a child spends experiencing things that are disrupting their ability to make friends, to have relationships with their family, to do well in school – those disruptions create their own problems that are then harder and harder to resolve. We are trying to work on developing tools that would be useful in that regard – short, accurate predictors – and starting to think about how we can work with public health systems to start to incorporate more of that kind of screening early on. We do a better job as a field, in schools and pediatricians’offices, for screening for signs and symptoms of autism, depression, and suicidality, but we very rarely ever screen for problematic early evidence of psychosis in the general community. From there, we're starting to think about how we could do better screening in the community for kids who are having these kinds of early experiences that might be problematic. In this work, we’re identifying factors like whether the experiences last over multiple years, whether they are distressing to the kids, and whether they are getting in the way of them being able to concentrate or do well at school. In my lab, we are really trying to understand when we should be concerned about these experiences and when wes hould not. So, is that disorder? Or is it that your brain and mental systems have adapted themselves to challenging situations, and then it's difficult to readapt? If you're in an abusive relationship with a caretaker, it's going to be protective for the brain to kind of tap itself down because it's really hard to be constantly in a high stress response situation. There are ways in which children cope with early adversity that likely change their brain development and the way they process things in the world. I'll take as an example early adversity or trauma. Some of these changes in the brain might actually be very adaptive in the moment. One complexity is that we know that there are a variety of environmental factors that can impact brain development and can put people at risk for being more likely to develop mental illness. That's very, very rare, but it can happen. I've seen experiences that I would consider to be problematic psychosis occurring with as young as six-and seven-year-old kids. When these experiences aren’t transient in the way that we would expect them to be, and when they start getting in the way of having the kinds of relationships that kids want to have, that's when we want to help them figure out how to either not have these experiences or change them in some way. But if you're talking to a 12-year-old who is interacting with someone in their mind who is mean and awful to them, and it's very distressing – that's not the same experience. For most kids, having an imaginary friend is a really positive thing, and we would never want to say that was problematic. There are many experiences that younger kids have that are typical and normative. In my lab and other labs at WashU, we’ve been looking into psychotic-like experiences younger and younger in life. fMRI image of a preteen brain while child performs a memory task from the Adolescent Brain and Cognitive Development Study, on which Barch is an investigator. How should the brain be working? There's a lot of typical variability amongst humans, and we definitely wouldn't want to say that everybody who has somewhat less typical perceptions or experiences has a mental illness or disorder. There's so much variability among humans that it is often difficult to say what is or what is not disorder. But I think that is, frankly, a too overly simplistic way of thinking about mental illness. The general perspective is that if our brains and our cognitive and emotional processes are all working as intended, we wouldn't develop things like depression or anxiety or schizophrenia. In large part, the field of mental health research tends to think of mental illness as a disorder. The disordered brain | Urban disorder at the turn of the century | The power of quantum disorder | The political use of disorder | Literary invention in the age of disorder Read expanded versions of the five essays recently featured in Ampersand magazine: From emerging mass cultures to quantum computing, five faculty members explore the meaning of disorder – and what we can gain by harnessing its beauty and power.
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