Child abuse and its effect on brain development

In our Infant Mental Health Course my friend Lynne found an article on Child Abuse and brain development for her assignment. I found it very eye opening and thought I would share. Hope you learn something.

Child abuse and its effect on brain development

The article is by Jenni Whitehead
I have worked with many children and adults who have experienced abuse in childhood and have come to be fascinated by the way that survivors manage to carry on leading often very successful lives despite traumatic experiences.

This is not to say that all survivors are successful in life and obviously some people suffer terrible ongoing issues related to their experience of abuse. However, when starting to talk about the effects of abuse I always want to start by challenging the myth that says that if you are abused the damage is permanent.

In this article I want to explore research on the effect that childhood abuse has on brain functioning. Some of the research suggests that abuse can bring about permanent physical changes in how an individual’s brain works. Nonetheless, by understanding some of the possible changes we may be able to develop ways of working that are more successful with, and for, survivors of abuse.

As an officer in charge of a girls’ hostel back in the 80s, I came to understand that most of the girls in our care had been subjected to abuse and at any one time it seemed that about 80% of them had been subjected to sexual abuse. There appeared to be a number of commonalties across the girls in terms of how:

they accommodated their experience of abuse
they managed their everyday lives
their learning was affected.

Later, as an older, more experienced, worker I worked with adult survivors and began to realise that for many of them things hadn’t changed that much. They were dealing with the issue of abuse in pretty much the same way as the girls I had worked with – they were just more skilled at it!

The following descriptions of commonalties are drawn from my own experience and as such are anecdotal descriptions of the way some survivors manage. I am not suggesting in any way that I have carried out research that would support the following descriptions but will give references to works that explore some of these issues in detail at the end of this article.



Accommodation

The term accommodation is used to describe how children come to manage their experience of abuse. One of the most common forms of accommodation is dissociation. In order to psychologically survive each actual event of abuse the child must develop a coping mechanism, and for many children the coping mechanism is ‘this is not happening’. In order for ‘this’ not to be happening the child focuses on something other than what is physically happening to their bodies. The child might focus on the curtains or their teddy or may invent a place inside their heads that they can go to, or may feign sleep. Repeating the coping mechanism reinforces it and once established as a coping mechanism the child is likely to use it whenever either abuse occurs or when something happens that reminds them of abusive events.

Example 1: Sex education may result in the sexual abuse survivor dropping straight into their coping mechanism. The teacher may actually see a change in the child’s demeanour; sometimes people describe this as the ‘shutters coming down’ The lesson goes on, but the child, while physically present, is mentally in the curtains, their teddy or in that place they have invented inside their heads.

Example 2: Children whom we know have been sexually abused sometimes present with poor bladder control. Now, it may be that they have a urinary tract infection, but it may also be that when their body sends them a message that they need to pee their coping mechanism kicks in, ‘want to pee – that’s genitals I don’t go down there.’

Many of the survivors I have worked with describe how in order to cut out any memory of abuse they cut out any memory of childhood – it’s simply too painful to look back.



Managing everyday lives

If you successfully cut out the past and establish a pattern of not looking back you in effect live only in the present and the immediate. Understanding this has helped me to understand why some children behave in ways that suggest that they do not recognise likely consequences of their actions. They appear to change their behaviour to suit the immediate situation.

Example: The child who has messed up in some way with a member of staff may sit down with them and draw up a new contract for future behaviour. While the contract is being drawn up the child is totally compliant, agreeing with all that is said and the member of staff is lured into that wonderful feeling of success. Five minutes later the child is off with someone up to some new unacceptable behaviour and the staff member is left feeling foolish to have believed that the child was willing to change!

If we understand that the child is functioning in the present perhaps we can come to understand that while they were with us, working on a new contract, they probably did mean everything they agreed to. They probably were being honest, but that was then, and when another person comes along and says ‘Lets do this now’, this is now, a new present, and they are just as likely to agree with the other person for that moment.

There is a major problem in managing your life by living in the present: if you can only go forward and never look back you stop yourself from using all the useful information and experiences that enable us to learn from the past.

In successfully cutting out the past the child cuts out useful learning as well.



Effect on learning

I have noticed in my work with survivors that here are certain aspects of learning that appear very difficult for them, particularly learning that builds on past learning. Many of the children and adults that I have worked with have had great difficulty with subjects that demand an understanding of sequence, maths for instance. In order to carry on moving forwards in understanding maths and more complex maths you have to sometimes go back to previous learning of the process of working things out.

Going back in order to go forward is a difficult process for some survivors. I hasten to add, however, that some children may use numbers as a way of escaping more difficult thoughts about their past and so develop a fascination with maths. I am using maths only as an example of the need to understand sequence as integral to some areas of learning.



So what has this to do with how the brain functions?

Recent research from a number of sources and from different professional groupings has shown evidence that early childhood affects physical changes in the way the brain functions. This has helped me to put yet another perspective on my understanding of how some survivors come to behave and think in the way that they do. I am hoping it will help you too.



How the brain develops

To start with we need a basic understanding of how different parts of the brain develop, their purpose and function. (Any biology teachers reading this? Please forgive my extremely basic explanation!)

It is generally now accepted that genetics predispose us to develop in certain ways, (nature), but that our interactions with our environment have a significant impact on how our predispositions will be expressed (nurture); these interactions organise our brain’s development and, therefore, shape the person we become (Shore, 1997).

Babies are born with almost all the neurons they will ever have. Neurons are brain cells, the raw material of the brain. The neurons present at birth are primarily what the new-born have to work with as they develop into children, adolescents and adults. During feotal development the neurons migrate to form the various parts of the brain. The main structure of the brain is in place at birth, but, much of the brain’s growth occurs in the first few years after birth.

The brain develops sequentially from the bottom up so the first areas of the brain to fully develop are the brainstem and the mid brain. These brain areas govern the bodily functions necessary for life and are referred to as ‘autonomic functions’. The limbic system and the cortex develop last. The limbic system regulates emotions and the cortex is involved in abstract thought.

Each region of the brain manages its functions through complex processes, often using chemical messengers to help transmit information to other parts of the brain and body (Perry, Pollard, Blakely, Baker & Viglante, 1995).

By the age of three the brain has reached almost 90% of its adult size (Perry 2000c). Growth in each area of the brain is dependent on receiving stimulation that causes activity in that region. This stimulation gives the foundation for learning.

The connections formed between neurons are called synapses and it is the synapses that organise the brain by creating pathways that govern everything we do from breathing and sleeping to thinking and feeling. At birth the synapses that are present are primarily those that govern bodily functions; almost all other functions are developed as babies grow through childhood into adulthood (Shore 1997).

Brain development and learning involves the strengthening of some synapses and discarding others and this process is highly dependent on stimulation and environment.

Synapses develop at an incredible rate during children’s early life. However, by adolescence about half of a person’s synapses have been discarded and those remaining will exist for the rest of the person’s life (Shore 1997).

The early overproduction of synapses is believed to be the result of evolution that has led the human brain to expect certain experiences. For instance, babies appear to be pre-wired to respond to the sound of the human voice. Early synapses need reinforcement if they are to be strengthened; if they are not strengthened through repetitive use the brain may discard them.

For example, all babies have the genetic predisposition to form strong attachments to their primary caregiver but if the caregiver is unresponsive, threatening or rejecting, and the attachment process is disrupted, the child’s ability to form healthy relationships during later life may be seriously impaired (Perry, 2001).

The research in this area does not suggest it is impossible to learn or relearn in later life but does suggest it is much harder.



Memories

Memory helps us to organise our learning. Repeated experiences strengthen the neuronal pathway, the pathway becomes sensitised and at some point it becomes a memory. In early life the child learns and, through repetition, remembers how to do certain things and the appropriate response to others in specific situations. This process is so efficient that eventually we do not have to keep thinking our way through the process – it happens automatically. The brain learns through reinforcement, repetition and the development of memories.



Early development

If a baby smiles and the caregiver smiles back the baby learns that smiling is a good way to interact. Alternatively, if a baby’s primary caregiver is always unresponsive to their crying the baby will learn that crying does not bring a response. A primary development task in the first year of life is described as ‘the development of trust’ and so the baby who is repeatedly ignored by the caregiver is likely to develop an impaired sense of trust in their world. This has a knock-on effect on later psychological development tasks.

Stress

The experience of moderate and predictable stress in childhood has not been found to be particularly harmful – in fact this low level of stress can help children to develop ways of coping with life in general. However, chronic stress sensitises neural pathways and overdevelops the regions of the brain that deal with anxiety and fear responses.

Children who are constantly under threat of abuse will need to focus their brain’s resources on survival and responding to threats in their environment. The chronic stimulation of fear responses hinders the stimulation of parts of the brain involved in more complex thought and this effects learning.

Cortisol is a hormone that helps the body prepare to cope with stress, and studies have shown that children who have been subjected to abuse have abnormal secretions of cortisol (Hart, Gunner, Cicchetti, 1995).

It is important to understand that the abused child’s reaction to stress is not abnormal: their brain development is often an adaptive response to their negative environment. However, it is maladaptive to other environments. If the brain’s main focus is survival it will be more difficult to develop healthy cognitive and social skills. Abused children often have great difficulty when presented with kindness, nurturing and stimulation: their brains may have underdeveloped pathways to adapt to this new world.

Repeated abuse and resulting stress may cause an affect on the neurochemical systems which can cause changes in: attention, impulse control, sleep patterns, and fine motor control (Perry 2000).

Studies have shown that child abuse affects the development of a number of regions of the brain:

the hippocampus – involved in cognition and memory
the subcortical and limbic systems – involved in emotions and abstract thought.

The results of these effects include:

extreme anxiety
depression
difficulty forming attachments and relationships.

Chronic activation of the neural pathways involved with fear responses can also create permanent ‘memories’ which shape the child’s perception of and response to their environment (Shore 1997).

If early childhood is experienced in a persistent state of hyper-arousal and hyper-vigilance, constantly anticipating threats or disassociation the child is likely to have difficulties with the very ordinary tasks of learning at school. In order to learn, to incorporate new information the child’s brain must be in a state of ‘attentive calm’, a state that the traumatised child may find difficult to achieve.

Along with that I'm going to give you 11 facts about child abuse...
In 2008, one out of every 601.4 children were victims of physical abuse, with parents of victims accounting for almost 80.1% of abusers.
2.34 children out of 100,000 die from injuries relating to their abuse, with 80.8% of deaths occurring in children under four years old.
For every incident of child abuse or neglect that gets reported, it’s estimated that two others go unreported.
Neglect is by far the most common form of child abuse, accounting for more than 78% of all cases.
Physical abuse accounts for 17.8% of documented child abuse cases each year.
A fourth of all girls and a sixth of boys are sexually abused by an adult before the age of 17.
8 out of 10 sexual abusers are someone in the family or someone the child knows.
Every month, at least 100 babies are born to drug-using mothers.
Of kids who have a parent who uses drugs, one in 13 is physically abused regularly.
Abused children are more likely to abuse alcohol and become addicted to drugs, and one third will later abuse their own children.
Of all prison inmates, 84% were abused as children.

When I look at those 11 facts you have it makes my heart hurt. I just wish that there was a way for us in the field to reach the at risk families more quickly so that the statics could go down. I wish that when you become pregnant in our country that there was a mandatory parenting course and follow up. I understand it's people's rights involved but if one child could be saved from abuse wouldn't a mandatory parenting course be worth it.