Child Abuse and Neglect and the Brain

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 non-accidental 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.

Keywords:

Attachment, brain development, child abuse, neglect, neurobiology, stress.

Abbreviations

ACTH	adrenocorticotropic hormone
ADHD	Attention Deficit Hyper- activity Disorder;
CRH	corticotropin-releasing hormone
CSF	cerebrospinal fluid
DBH	dopamine beta hydroxylase
ERPs	event-related potentials
HPA	hypothalamic-pituitary-adrenal
PTSD	post -traumatic stress disorder

Note

Requests for reprints to:
Danya Glaser, Department of Psycho- logical Medicine, Great Ormond Street Hospital for Children, London WCIN 3JH, U.K.
E-mail: dglaser@ich.ucl.ac.uk
With thanks to the author.

Acknowledgements

The untiring support and constructive criticism of Vivien Prior, and the tolerance of my family, are gratefully acknowledged.