Abuse and Neglect: Effects of Maltreatment on Brain Development
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Effects of Maltreatment On Brian Development
Babies’ brains grow and develop as they interact with their environment and learn how to function within it. When babies’ cries bring food or comfort, they are strengthening the neuronal pathways that help them learn how to get their needs met, both physically and emotionally. But babies who do not get responses to their cries, and babies whose cries are met with abuse, learn different lessons. The neuronal pathways that are developed and strengthened under negative conditions prepare children to cope in that negative environment, and their ability to respond to nurturing and kindness may be impaired (Shonkoff & Phillips, 2000).
Brief periods of moderate, predictable stress are not problematic; in fact, they prepare a child to cope with the general world. The body’s survival actually depends upon the ability to mount a response to stress (Shonkoff & Phillips, 2000). Children learn to deal with moderate stress in the context of positive relationships with reliable adult caregivers. Greater amounts of stress may also be tolerable if a child has a reliable adult who can help to buffer the child. But prolonged, severe, or unpredictable stress—including abuse and neglect—during a child’s early years is problematic. In fact, the brain’s development can literally be altered by this type of toxic stress, resulting in negative impacts on the child’s physical, cognitive, emotional, and social growth.
The specific effects of maltreatment may depend on such factors as the age of the baby or child at the time of the abuse or neglect, whether the maltreatment was a one-time incident or chronic, the identity of the abuser (e.g., parent or other adult), whether the child had a dependable nurturing individual in his or her life, the type and severity of the abuse, the intervention, and how long the maltreatment lasted. The sections below give a brief description of abuse and neglect and are followed by descriptions of some of the consequences of maltreatment.
Abuse—Physical, Sexual, and Emotional
Abuse can refer to physical abuse, such as hitting, shaking, burning, or other forms of maltreatment that a parent or other caregiver might inflict. Sexual abuse is a subset of abuse that refers to any type of sexual behavior with a minor, while emotional abuse generally refers to any injury to a child’s psychological or emotional stability (Child Welfare Information Gateway, 2008). Chronic stress may also qualify as emotional abuse. In some States, alcohol or substance abuse or domestic violence that affects the unborn child is considered child abuse.
Physical abuse can cause direct damage to a baby’s or child’s developing brain. For instance, we now have extensive evidence of the damage that shaking a baby can cause. According to the National Center on Shaken Baby Syndrome (2009), shaking can destroy brain tissue and tear blood vessels. In the short-term, shaking can lead to seizures, loss of consciousness, or even death. In the long- term, shaking can damage the fragile brain so that a child develops a range of sensory impairments, as well as cognitive, learning, and behavioral disabilities. Babies and children who suffer abuse may also experience trauma that is unrelated to direct physical damage. Exposure to domestic violence, disaster, or other traumatic events can have long-lasting effects. An enormous body of research now exists that provides evidence for the long-term damage of physical, sexual, and emotional abuse on babies and children. We know that children who experience the stress of abuse will focus their brains’ resources on survival and responding to threats in their environment.
This chronic stimulation of the brain’s fear response means that the regions of the brain involved in this response are frequently activated (Perry, 2001a). Other regions of the brain, such as those involved in complex thought and abstract cognition, are less frequently activated, and the child becomes less competent at processing this type of information.
One way that early maltreatment experiences may alter a child’s ability to interact positively with others is by altering brain neurochemical balance. Research on children who suffered early emotional abuse or severe deprivation indicates that such maltreatment may permanently alter the brain’s ability to use serotonin, which helps produce feelings of well-being and emotional stability (Healy, 2004). Altered brain development in children who have been maltreated may be the result of their brains adapting to their negative environment. If a child lives in a threatening, chaotic world, the child’s brain may be hyperalert for danger because survival may depend on it. But if this environment persists, and the child’s brain is focused on developing and strengthening its strategies for survival, other strategies may not develop as fully. The result may be a child who has difficulty functioning when presented with a world of kindness, nurturing, and stimulation.
Neglect—Lack of Stimulation
While chronic abuse and neglect can result in sensitized fear response patterns, neglect alone also can result in other problems. Malnutrition is a classic example of neglect. Malnutrition, both before and during the first few years after birth, can result in stunted brain growth and slower passage of electrical signals in the brain (Shonkoff & Phillips, 2000). This is due, in part, to the negative effect of malnutrition on the myelination process in the developing brain (ZERO TO THREE, 2009). The most common form of malnutrition in the United States, iron deficiency, can affect the growing brain and result in cognitive and motor delays, anxiety, depression, social problems, and attention problems (Shonkoff & Phillips, 2000).
Although neglect often is thought of as a failure to meet a child’s physical needs for food, shelter, and safety, neglect also can be a failure to meet a child’s cognitive, emotional, or social needs. For children to master developmental tasks in these areas, they need opportunities, encouragement, and acknowledgment from their caregivers. If this stimulation is lacking during children’s early years, the weak neuronal pathways that had been developed in expectation of these experiences may wither and die, and the children may not achieve the usual developmental milestones.
For example, babies need to experience face-to-face baby talk and hear countless repetitions of sounds in order to build the brain circuitry that will enable them to start making sounds and eventually say words. If babies’ sounds are ignored repeatedly when they begin to babble at around 6 months, their language may be delayed. In fact, neglected children often do not show the rapid growth that normally occurs in language development at 18-24 months (Scannapieco, 2008). These types of delays may extend to all types of normal development for neglected children, including their cognitive-behavioral, socio-emotional, and physical development (Scannapieco, 2008).
Researchers use the term “global neglect” to refer to deprivations in more than one domain, i.e., language, touch, and interaction with others. Children who were adopted from Romanian orphanages in the early 1990s were often considered to be globally neglected; they had little contact with caregivers and little to no stimulation from their environment— little of anything required for healthy development. One study found that these children had significantly smaller brains than the norm, suggesting decreased brain growth (Perry, 2002).
“These images illustrate the negative impact of neglect on the developing brain. In the CT scan on the left is an image from a healthy 3-year-old with an average head size. The image on the right is from a 3-year-old suffer- ing from severe sensory-deprivation neglect. This child’s brain is significantly smaller than average and has abnor- mal development of cortex.” These images are from studies conducted by a team of researchers from the Child Trauma Academy (http://www.ChildTrauma.org) led by Bruce D. Perry, M.D., Ph.D. (Reprinted with permission.)
This type of severe, global neglect can have devastating consequences. The extreme lack of stimulation may result in fewer neuronal pathways available for learning. The lack of opportunity to form an attachment with a nurturing caregiver during infancy may mean that some of these children will always have difficulties forming meaningful relationships with others (Perry, 2001a). But these studies also found that time played a factor—children who were adopted as young infants have shown more recovery than children who were adopted as toddlers (Rutter, et al., 2000).
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