Schore Allan N
UCLA David Geffen School of Medicine.
Infant Ment Health J. 2017 Jan;38(1):15-52. doi: 10.1002/imhj.21616. Epub 2017 Jan 2.
Why are boys at risk? To address this question, I use the perspective of regulation theory to offer a model of the deeper psychoneurobiological mechanisms that underlie the vulnerability of the developing male. The central thesis of this work dictates that significant gender differences are seen between male and female social and emotional functions in the earliest stages of development, and that these result from not only differences in sex hormones and social experiences but also in rates of male and female brain maturation, specifically in the early developing right brain. I present interdisciplinary research which indicates that the stress-regulating circuits of the male brain mature more slowly than those of the female in the prenatal, perinatal, and postnatal critical periods, and that this differential structural maturation is reflected in normal gender differences in right-brain attachment functions. Due to this maturational delay, developing males also are more vulnerable over a longer period of time to stressors in the social environment (attachment trauma) and toxins in the physical environment (endocrine disruptors) that negatively impact right-brain development. In terms of differences in gender-related psychopathology, I describe the early developmental neuroendocrinological and neurobiological mechanisms that are involved in the increased vulnerability of males to autism, early onset schizophrenia, attention deficit hyperactivity disorder, and conduct disorders as well as the epigenetic mechanisms that can account for the recent widespread increase of these disorders in U.S. culture. I also offer a clinical formulation of early assessments of boys at risk, discuss the impact of early childcare on male psychopathogenesis, and end with a neurobiological model of optimal adult male socioemotional functions.
为什么男孩面临风险?为了解决这个问题,我运用调节理论的视角,提供一个关于发育中男性易感性背后更深层次心理神经生物学机制的模型。这项工作的核心论点是,在发育的最早阶段,男性和女性的社会及情感功能存在显著的性别差异,这些差异不仅源于性激素和社会经历的不同,还源于男性和女性大脑成熟的速度差异,特别是早期发育的右脑。我展示了跨学科研究,该研究表明,在产前、围产期和产后的关键时期,男性大脑的应激调节回路比女性成熟得更慢,这种结构成熟的差异反映在右脑依恋功能的正常性别差异中。由于这种成熟延迟,发育中的男性在更长的时间内也更容易受到社会环境中的应激源(依恋创伤)和物理环境中的毒素(内分泌干扰物)的影响,这些因素会对右脑发育产生负面影响。在与性别相关的精神病理学差异方面,我描述了早期发育的神经内分泌和神经生物学机制,这些机制与男性患自闭症、早发性精神分裂症、注意力缺陷多动障碍和品行障碍的易感性增加有关,以及可以解释这些疾病最近在美国文化中广泛增加的表观遗传机制。我还提供了对有风险男孩进行早期评估的临床方案,讨论了早期儿童保育对男性精神发病机制的影响,并以成年男性最佳社会情感功能的神经生物学模型作为结尾。