Opinion: Brain imaging has promise to improve mental health treatment for kids. Here’s why.

Brain imaging in a child. (Jillian Lee Wiggins ) Wiggins is an associate professor of psychology at San Diego State University, and lives in Hillcrest. She will delve further into this topic at the TEDxSan Diego CommUNITY speaker series on Wednesday at the David & Dorothea Garfield Theatre in La Jolla. Speakers start at 7 p.m.

Right now, we are fighting for the future of our children’s mental health. The U.S. surgeon general has declared a youth mental health crisis, and this has only gotten worse with the pandemic. We have a huge barrier to solving this crisis, though. Typically, when parents bring their children to the doctor’s office for anxiety or depression, a psychologist or psychiatrist typically try, through trial and error, a laundry list of potential treatments until something works.

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This approach is really inefficient, and costly, and grinds down children and parents every time a treatment doesn’t work. And it’s not because the doctors are trying to be obtuse — they just can’t yet look under the hood, into the child’s brain, to see what is wrong and figure out which kids will need what treatment.

I am the director of San Diego State University’s Translational Emotion Neuroscience and Development (TEND) Lab . I am on the vanguard of a scientific movement to address this youth mental health crisis by leveraging brain imaging.

You might be familiar with a traditional MRI, where they take a static image of your brain, which can be compared to looking under the hood of the car while the car is off.

At the TEND lab, we use a special form of brain imaging, functional MRI, to look “under the hood” in a way that is completely beyond just a static image. When children come into our lab, they lie in the MRI and play specially designed video games that tap psychological processes like how they feel when they win or lose money, how they react to people being angry or happy with them, and what it’s like when they’re frustrated. In functional MRI, the images are dynamic, and we get to see the brain activation in response to these emotional events.

Through this work, we’re now able to look under the hood while the car is running to identify what kind of brain signatures predict which children will get better after established psychological treatments, and whether we discover the brain signatures that will help us predict, in advance, which children are just experiencing mild emotional problems that will pass and get better on their own. Once we know those brain mechanisms of the risk for mental health problems, we can target them for novel, innovative preventive interventions and new, personalized treatments.

One of the best, evidence-based treatments out there is called Trauma Focused Cognitive Behavioral Therapy, or TF-CBT. In TF-CBT, children talk through their experiences with a therapist and learn how to calm themselves and cope. Even though people on average get better after TF-CBT, for about a third of people, it doesn’t work. So, we had to find out what was different in the brains of children who did get better versus those who did not.

What we found is that the children who did not get better had something in common: the way their brains reacted to getting rewards and being denied a reward. Further, we found that children who ended up not getting better after trauma treatment had brains that reacted totally inappropriately to getting a reward and being denied a reward. They showed the opposite patterns of activation compared to children who ended up getting better. This indicates that some fundamental problems with how these children’s brains value and react to rewards might be preventing them from healing from their trauma.

As researchers, this is an exciting time. We are just beginning to peek under the hood to find out how the brain works, and we are now working on larger studies to make sure that we can replicate and expand our findings. Imagine a future where, instead of trying treatments until something works — a doctor will order a lab test based on an MRI of the child’s brain. And, from the results of that lab test, they will prescribe a personalized treatment for that child.

When scientists were studying electricity centuries ago, they could have never imagined that their work would lead to the cell phones, computers and technology that we have today. Similarly, I will probably never live to see the full impact of my work, but my team and I are building the road to a better mental health future for our children.

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