Child Abuse and Neglect and the Brain—A Review

Abstract

Developmental psychology and the study of behaviour and emotion have tended to be considered in parallel to the study of neurobiological processes. This review explores the effects of child abuse and neglect on the brain, excluding nonaccidental injury that causes gross physical trauma to the brain. It commences with a background summary of the nature, context, and some deleterious effects of omission and commission within child maltreatment. There is no post-maltreatment syndrome, outcomes varying with many factors including nature, duration, and interpersonal context of the maltreatment as well as the nature of later intervention. There then follows a section on environmental influences on brain development, demonstrating the dependence of the orderly process of neurodevelopment on the child's environment. Ontogenesis, or the development of the self through self-determination, proceeds in the context of the nature-nurture interaction. As a prelude to reviewing the neurobiology of child abuse and neglect, the next section is concerned with bridging the mind and the brain. Here, neurobiological processes, including cellular, biochemical, and neurophysiological processes, are examined alongside their behavioural, cognitive, and emotional equivalents and vice versa. Child maltreatment is a potent source of stress and the stress response is therefore discussed in some detail. Evidence is outlined for the buffering effects of a secure attachment on the stress response. The section dealing with actual effects on the brain of child abuse and neglect discusses manifestations of the stress response including dysregulation of the hypothalamic-pituitary-adrenal axis, and parasympathetic and catecholamine responses. Recent evidence about reduction in brain volume following child abuse and neglect is also outlined. Some biochemical, functional, and structural changes in the brain that are not reflections of the stress response are observed following child maltreatment. The mechanisms bringing about these changes are less clearly understood and may well be related to early and more chronic abuse and neglect affecting the process of brain development. The behavioural and emotional concomitants of their neurobiological manifestations are discussed. The importance of early intervention and attention to the chronicity of environmental adversity may indicate the need for permanent alternative caregivers, in order to preserve the development of the most vulnerable children.

Overuse of institutional care for children in Europe: Table 1

“…However, difficulties with social behaviour and attachments may persist,20 leading to a greater chance of antisocial behaviour and mental health problems 5…”

Understanding emotional abuse

“…It compromises development of relationship-dependent areas of the brain, influences programming of neuroendocrine function,1 2 3 and has lifelong implications for physical and mental health, including major causes of mortality 4 5. It is relevant to children’s behaviour problems, substance abuse, aggression, criminality and intergenerational parenting problems 6 7 8 9 10 11 12 13…”

Child abuse and neglect: Role of dentist in detection and reporting

“…[7] Ill-treatment during the formative years disrupts the development of the cerebral cortex and limbic system contributing to a host of later cognitive, academic, psychological and relationship problems that may persist well into adulthood. [8] Outlining Other Risk Factors for Child Abuse • Drug or alcohol abuse history of parents or caregiver. • History of parents or caregiver poor mental health.…”