Understanding The Effects Of Maltreatment On Brain Development
ISSUE BRIEFApril 2015Understanding theEffects of Maltreatmenton Brain DevelopmentIn recent years, there has been a surgeof research into early brain development.Neuroimaging technologies, such as magneticresonance imaging (MRI), provide increasedinsight about how the brain develops and howearly experiences affect that development.WHAT’S INSIDEHow the brain developsEffects of maltreatmenton brain developmentImplications forpractice and policySummaryAdditional resourcesOne area that has been receiving increasingresearch attention involves the effects ofabuse and neglect on the developing brain,especially during infancy and early childhood.Much of this research is providing biologicalexplanations for what practitioners havelong been describing in psychological,emotional, and behavioral terms. Thereis now scientific evidence of altered brainfunctioning as a result of early abuse andneglect. This emerging body of knowledgehas many implications for the preventionand treatment of child abuse and neglect.Children’s Bureau/ACYF/ACF/HHS800.394.3366 Email: info@childwelfare.gov https://www.childwelfare.govReferences
https://www.childwelfare.govUnderstanding the Effects of Maltreatment on Brain DevelopmentThis issue brief provides basic information ontypical brain development and the potential effectsof abuse and neglect on that development. Theinformation is designed to help professionalsunderstand the emotional, mental, and behavioralimpact of early abuse and neglect in children whocome to the attention of the child welfare system.grow rapidly in the first 3 years of life (ZERO TOTHREE, 2012). (See Exhibit 1 for more information.)Exhibit 1 – Functions of Brain RegionsCortexHow the Brain DevelopsWhat we have learned about the process of braindevelopment helps us understand more about theroles both genetics and the environment play in ourdevelopment. It appears that genetics predispose us todevelop in certain ways, but our experiences, includingour interactions with other people, have a significantimpact on how our predispositions are expressed.In fact, research now shows that many capacitiesthought to be fixed at birth are actually dependent ona sequence of experiences combined with heredity.Both factors are essential for optimum developmentof the human brain (Shonkoff & Phillips, 2000).Early Brain DevelopmentThe raw material of the brain is the nerve cell, calledthe neuron. During fetal development, neurons arecreated and migrate to form the various parts of thebrain. As neurons migrate, they also differentiate, orspecialize, to govern specific functions in the bodyin response to chemical signals (Perry, 2002). Thisprocess of development occurs sequentially fromthe “bottom up,” that is, from areas of the braincontrolling the most primitive functions of the body(e.g., heart rate, breathing) to the most sophisticatedfunctions (e.g., complex thought) (Perry, 2000a).The first areas of the brain to fully develop are thebrainstem and midbrain; they govern the bodily functionsnecessary for life, called the autonomic functions.At birth, these lower portions of the nervous systemare very well developed, whereas the higher regions(the limbic system and cerebral cortex) are still ratherprimitive. Higher function brain regions involved inregulating emotions, language, and abstract thoughtLimbicMidbrainBrainstemBruce D. Perry, M.D., Ph.D.www.ChildTrauma.orgHigherAbstract ThoughtConcrete ThoughtAffiliationAttachmentSexual BehaviorEmotional ReactivityMotor RegulationArousalAppetite/SatietySleepBlood PressureHeart RateBody TemperatureLowerThe Growing Child’s BrainBrain development, or learning, is actually the processof creating, strengthening, and discarding connectionsamong the neurons; these connections are calledsynapses. Synapses organize the brain by formingpathways that connect the parts of the brain governingeverything we do—from breathing and sleeping tothinking and feeling. This is the essence of postnatalbrain development, because at birth, very few synapseshave been formed. The synapses present at birthare primarily those that govern our bodily functionssuch as heart rate, breathing, eating, and sleeping.The development of synapses occurs at an astoundingrate during a child’s early years in response to that child’sexperiences. At its peak, the cerebral cortex of a healthytoddler may create 2 million synapses per second (ZEROTO THREE, 2012). By the time children are 2 years old,their brains have approximately 100 trillion synapses,many more than they will ever need. Based on thechild’s experiences, some synapses are strengthenedand remain intact, but many are gradually discarded.This process of synapse elimination—or pruning—isa normal part of development (Shonkoff & Phillips,2000). By the time children reach adolescence, abouthalf of their synapses have been discarded, leaving thenumber they will have for most of the rest of their lives.This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare InformationGateway. This publication is available online at in-development.2
Understanding the Effects of Maltreatment on Brain DevelopmentAnother important process that takes place in thedeveloping brain is myelination. Myelin is the white fattytissue that forms a sheath to insulate mature brain cells,thus ensuring clear transmission of neurotransmittersacross synapses. Young children process informationslowly because their brain cells lack the myelinnecessary for fast, clear nerve impulse transmission(ZERO TO THREE, 2012). Like other neuronal growthprocesses, myelination begins in the primary motorand sensory areas (the brain stem and cortex) andgradually progresses to the higher-order regions thatcontrol thought, memories, and feelings. Also, like otherneuronal growth processes, a child’s experiences affectthe rate and growth of myelination, which continuesinto young adulthood (Shonkoff & Phillips, 2000).By 3 years of age, a baby’s brain has reached almost90 percent of its adult size. The growth in eachregion of the brain largely depends on receivingstimulation, which spurs activity in that region. Thisstimulation provides the foundation for learning.Adolescent Brain DevelopmentStudies using MRI techniques show that the braincontinues to grow and develop into young adulthood (atleast to the midtwenties). White matter, or brain tissue,volume has been shown to increase in adults as old as 32(Lebel & Beaulieu, 2011). Right before puberty, adolescentbrains experience a growth spurt that occurs mainly inthe frontal lobe, which is the area that governs planning,impulse control, and reasoning. During the teenageyears, the brain goes through a process of pruningsynapses—somewhat like the infant and toddler brain—and also sees an increase in white matter and changes toneurotransmitter systems (Konrad, Firk, & Uhlhaas, 2013).As the teenager grows into young adulthood, the braindevelops more myelin to insulate the nerve fibers andspeed neural processing, and this myelination occurs lastin the frontal lobe. MRI comparisons between the brainsof teenagers and the brains of young adults have shownthat most of the brain areas were the same—that is, theteenage brain had reached maturity in the areas thatgovern such abilities as speech and sensory capabilities.https://www.childwelfare.govThe major difference was the immaturity of the teenagebrain in the frontal lobe and in the myelination of thatarea (National Institute of Mental Health, 2001).Normal puberty and adolescence lead to thematuration of a physical body, but the brain lagsbehind in development, especially in the areas thatallow teenagers to reason and think logically. Mostteenagers act impulsively at times, using a lower areaof their brains—their “gut reaction”—because theirfrontal lobes are not yet mature. Impulsive behavior,poor decisions, and increased risk-taking are all partof the normal teenage experience. Another changethat happens during adolescence is the growth andtransformation of the limbic system, which is responsiblefor our emotions. Teenagers may rely on their moreprimitive limbic system in interpreting emotions andreacting since they lack the more mature cortex thatcan override the limbic response (Chamberlain, 2009).Plasticity—The Influence of EnvironmentResearchers use the term plasticity to describe the brain’sability to change in response to repeated stimulation.The extent of a brain’s plasticity is dependent on thestage of development and the particular brain systemor region affected (Perry, 2006). For instance, the lowerparts of the brain, which control basic functions suchas breathing and heart rate, are less flexible, or plastic,than the higher functioning cortex, which controlsthoughts and feelings. While cortex plasticity decreasesas a child gets older, some degree of plasticity remains.In fact, this brain plasticity is what allows us to keeplearning into adulthood and throughout our lives.The developing brain’s ongoing adaptations are theresult of both genetics and experience. Our brainsprepare us to expect certain experiences by formingthe pathways needed to respond to those experiences.For example, our brains are “wired” to respond to thesound of speech; when babies hear people speaking,the neural systems in their brains responsible for speechand language receive the necessary stimulation toorganize and function (Perry, 2006). The more babies areThis material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare InformationGateway. This publication is available online at in-development.3
https://www.childwelfare.govUnderstanding the Effects of Maltreatment on Brain Developmentexposed to people speaking, the stronger their relatedsynapses become. If the appropriate exposure doesnot happen, the pathways developed in anticipationmay be discarded. This is sometimes referred to as theconcept of “use it or lose it.” It is through these processesof creating, strengthening, and discarding synapsesthat our brains adapt to our unique environment.they were 24 months old (Smyke, Zeanah, Fox, Nelson,& Guthrie, 2010). This indicates that there is a sensitiveperiod for attachment, but it is likely that there is ageneral sensitive period rather than a true cut-off point forrecovery (Zeanah, Gunnar, McCall, Kreppner, & Fox, 2011).The ability to adapt to our environment is a part of normaldevelopment. Children growing up in cold climates,on rural farms, or in large sibling groups learn how tofunction in those environments. Regardless of the generalenvironment, though, all children need stimulationand nurturance for healthy development. If these arelacking (e.g., if a child’s caretakers are indifferent, hostile,depressed, or cognitively impaired), the child’s braindevelopment may be impaired. Because the brain adaptsto its environment, it will adapt to a negative environmentjust as readily as it will adapt to a positive one.While sensitive periods exist for development andlearning, we also know that the plasticity of the brainoften allows children to recover from missing certainexperiences. Both children and adults may be ableto make up for missed experiences later in life, butit is likely to be more difficult. This is especially trueif a young child was deprived of certain stimulation,which resulted in the pruning of synapses (neuronalconnections) relevant to that stimulation and the loss ofneuronal pathways. As children progress through eachdevelopmental stage, they will learn and master eachstep more easily if their brains have built an efficientnetwork of pathways to support optimal functioning.Sensitive PeriodsMemoriesResearchers believe that there are sensitive periodsfor development of certain capabilities. These refer towindows of time in the developmental process whencertain parts of the brain may be most susceptible toparticular experiences. Animal studies have shed lighton sensitive periods, showing, for example, that animalsthat are artificially blinded during the sensitive period fordeveloping vision may never develop the capability tosee, even if the blinding mechanism is later removed.The organizing framework for children’s developmentis based on the creation of memories. When repeatedexperiences strengthen a neuronal pathway, the pathwaybecomes encoded, and it eventually becomes a memory.Children learn to put one foot in front of the other towalk. They learn words to express themselves. And theylearn that a smile usually brings a smile in return. At somepoint, they no longer have to think much about theseprocesses—their brains manage these experienceswith little effort because the memories that have beencreated allow for a smooth, efficient flow of information.It is more difficult to study human sensitive periods, butwe know that, if certain synapses and neuronal pathwaysare not repeatedly activated, they may be discarded,and their capabilities may diminish. For example, infantshave a genetic predisposition to form strong attachmentsto their primary caregivers, but they may not be able toachieve strong attachments, or trusting, durable bondsif they are in a severely neglectful situation with littleone-on-one caregiver contact. Children from Romanianinstitutions who had been severely neglected had a muchbetter attachment response if they were placed in fostercare—and thus received more stable parenting—beforeThe creation of memories is part of our adaptation to ourenvironment. Our brains attempt to understand the worldaround us and fashion our interactions with that world in away that promotes our survival and, hopefully, our growth,but if the early environment is abusive or neglectful, ourbrains may create memories of these experiences thatadversely color our view of the world throughout our life.Babies are born with the capacity for implicit memory,which means that they can perceive their environmentThis material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare InformationGateway. This publication is available online at in-development.4
Understanding the Effects of Maltreatment on Brain Developmentand recall it in certain unconscious ways (Applegate& Shapiro, 2005). For instance, they recognize theirmother’s voice from an unconscious memory. Theseearly implicit memories may have a significant impacton a child’s subsequent attachment relationships.In contrast, explicit memory, which develops aroundage 2, refers to conscious memories and is tied tolanguage development. Explicit memory allows childrento talk about themselves in the past and future or indifferent places or circumstances through the processof conscious recollection (Applegate & Shapiro, 2005).Sometimes, children who have been abused or sufferedother trauma may not retain or be able to access explicitmemories of their experiences; however, they may retainimplicit memories of the physical or emotional sensations,and these implicit memories may produce flashbacks,nightmares, or other uncontrollable reactions (Applegate& Shapiro, 2005). This may be the case with very youngchildren or infants who suffer abuse or neglect.Responding to StressWe all experience different types of stress throughoutour lives. The type of stress and the timing of that stressdetermine whether and how there is an impact on thebrain. The National Scientific Council on the DevelopingChild (2014) outlines three classifications of stress: Positive stress is moderate, brief, and generally anormal part of life (e.g., entering a new child caresetting). Learning to adjust to this type of stress is anessential component of healthy development. Tolerable stress includes events that have thepotential to alter the developing brain negatively, butwhich occur infrequently and give the brain time torecover (e.g., the death of a loved one). Toxic stress includes strong, frequent, and prolongedactivation of the body’s stress response system (e.g.,chronic neglect).Healthy responses to typical life stressors (i.e., positiveand tolerable stress events) are very complex and mayhttps://www.childwelfare.govchange depending on individual and environmentalcharacteristics, such as genetics, the presence of asensitive and responsive caregiver, and past experiences.A healthy stress response involves a variety of hormoneand neurochemical systems throughout the body,including the sympathetic-adrenomedullary (SAM) system,which produces adrenaline, and the hypothalamicpituitary-adrenocortical (HPA) system, which producescortisol (National Council on the Developing Child, 2014).Increases in adrenaline help the body engage energystores and alter blood flow. Increases in cortisol also helpthe body engage energy stores and also can enhancecertain types of memory and activate immune responses.In a healthy stress response, the hormonal levels willreturn to normal after the stressful experience has passed.Effects of Maltreatment onBrain DevelopmentJust as positive experiences can assist with healthybrain development, children’s experiences with childmaltreatment or other forms of toxic stress, such asdomestic violence or disasters, can negatively affect braindevelopment. This includes changes to the structureand chemical activity of the brain (e.g., decreased sizeor connectivity in some parts of the brain) and in theemotional and behavioral functioning of the child (e.g.,over-sensitivity to stressful situations). For example,healthy brain development includes situations in whichbabies’ babbles, gestures, or cries bring reliable,appropriate reactions from their caregivers. Thesecaregiver-child interactions—sometimes referred toas “serve and return”—strengthen babies’ neuronalpathways regarding social interactions and how to gettheir needs met, both physically and emotionally. Ifchildren live in a chaotic or threatening world, one inwhich their caregivers respond with abuse or chronicallyprovide no response, their brains may become hyperalertfor danger or not fully develop. These neuronal pathwaysthat are developed and strengthened under negativeconditions prepare children to cope in that negativeenvironment, and their ability to respond to nurturing andkindness may be impaired (Shonkoff & Phillips, 2000).This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare InformationGateway. This publication is available online at in-development.5
Understanding the Effects of Maltreatment on Brain DevelopmentThe specific effects of maltreatment may dependon such factors as the age of the child at the timeof the maltreatment, whether the maltreatment wasa one-time incident or chronic, the identity of theabuser (e.g., parent or other adult), whether the childhad a dependable nurturing individual in his or herlife, the type and severity of the maltreatment, theintervention, how long the maltreatment lasted, andother individual and environmental characteristics.Effects of Maltreatment on BrainStructure and ActivityToxic stress, including child maltreatment, can havea variety of negative effects on children’s brains: Hippocampus: Adults who were maltreated mayhave reduced volume in the hippocampus, which iscentral to learning and memory (McCrory, De Brito, &Viding, 2010; Wilson, Hansen, & Li, 2011). Toxic stressalso can reduce the hippocampus’s capacity to bringcortisol levels back to normal after a stressful event hasoccurred (Shonkoff, 2012). Corpus callosum: Maltreated children andadolescents tend to have decreased volume in thecorpus callosum, which is the largest white matterstructure in the brain and is responsible for interhemispheric communication and other processes (e.g.,arousal, emotion, higher cognitive abilities) (McCrory,De Brito, & Viding, 2010; Wilson, Hansen, &
of the human brain (Shonkoff & Phillips, 2000). Early Brain Development. The raw material of the brain is the nerve cell, called the . neuron. During fetal development, neurons are created and migrate to form the various parts of the brain. As neurons migrate, they also differentiate, or specialize, to govern specific functions in the body
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in conjunction with related publications from the Regional Office: European report on preventing child maltreatment (3), Implementing child maltreatment prevention programmes: what the experts say (4), and Measuring and monitoring national prevalence of child maltreatment: a practical handbook (5).
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