CHAPTER
2
Impact
of Abuse and Neglect on Child Development
For
some children, the effects of abuse, neglect, and witnessing
violence can be buffered by close personal relationships
they form with trusted adults. Social supports can even
help them recover from such traumatic events, particularly
when current attachments to safety figures outweigh the
terrors of the past, according to trauma researcher Dr.
Bessel van der Kolk.[39]
For
too many children, however, these experiences result in
scars that, if not indelible, are exceedingly difficult
to erase. This is particularly true when abuse, neglect,
or trauma from violence occurs by age three.[40] Experts
say that traumatic early experiences can cause a normal
child to become developmentally delayed or develop serious
emotional problems. Research has established that early
childhood trauma has a profound impact on the emotional,
behavioral, cognitive, social, and physical functioning
of children.[41]
A 1995
Baylor University study found that children who were rarely
touched or spoken to and who were not allowed to explore
and experiment with toys developed brains that were 20 to
30 percent smaller than normal for children their age.[42]
The study conducted by Dr. Bruce Perry also found that,
"multiply abused infants and toddlers often experience developmental
delays across a broad spectrum, including cognitive, language,
motor, and socialization skills."[43]
In
a sample of sexually abused children,[44] victimized children
were found to display the following symptoms and behaviors:
- 61% exhibited anxiety symptoms
- 41% depressive symptoms
- 31% regressive behaviors
- 36% inappropriate sexual behaviors
Other
symptoms, such as eating disorders, have also been found
to relate to child physical and/or sexual abuse.[45] In
addition, maltreated children have been found to develop
a variety of psychiatric conditions, including Attention
Deficit and Hyperactive Disorder (ADHD), Oppositional Defiant
Disorder, Conduct Disorder, Separation Anxiety/Overanxious,
Phobias, and Posttraumatic Stress Disorder (PTSD).[46]
Impact
of Abuse and Neglect on Early Brain Development
The
human brain is not fully developed at birth and represents
only 25 percent of its approximate weight at adulthood.
It depends upon individual experiences to guide its growth
and development. Experiences and sensory inputs organize
the brain's patterns of communication between neurons and
determine how we think, feel, and behave.[47]
As the
brain develops, it begins to organize and eliminate unnecessary,
rarely used neural connections.[48] Connections that are
used repeatedly during the early years of a child's life
become the life-long foundation of the brain's organization
and function.[49] By three years old, a child's brain has
reached approximately 90 percent of its full potential.
To reach this optimal stage, the brain requires good health
and nutrition, as well as a great deal of stimulation and
support.[50]
Thus,
a loving, secure, stimulating environment fosters healthy
development, while a continually neglectful, physically
or emotionally abusive environment can create significant,
long-term harm.[51] The quality of a child's earliest experiences,
including the quality of infant and toddler childcare, plays
a crucial role in the overall development of the brain.[52]
Early
trauma alters the development of the brain. Failure to properly
nourish a child, inflicting physical pain and injury or
simply ignoring the emotional needs of a small child can
cause trauma. Damage can be significantly more detrimental
than other diseases that affect the brain and can often
be corrected through drugs or surgery. Influencing the way
the brain functions in repeatedly harmful ways can result
in permanent and irreversible injury.[53,54]
The
neural connections established during the early years of
life respond to certain patterns. Traumatic experiences,
for example, when a child endures physical or sexual abuse,
or witnesses violence, can increase the production of cortisol,
a brain hormone that can lead to a destruction of neurons
and a reduction in synapse formation, thus altering brain
function. Chemical levels in the brain and blood play a
role in determining how a person will respond to challenges
in the environment. When a child lives in constant fear
or has experienced trauma, they live in a state of chronic
stress. Research has found that children with chronically
high levels of cortisol demonstrate more cognitive, motor,
and social delays than other children.[55]
Serotonin
and noradrenaline also play significant roles in brain function.
Serotonin modulates emotions, including aggression, while
noradrenaline regulates responses to fear and anger. Under
normal circumstances, these hormones work harmoniously.
However, traumatic events and/or chronic stresses can alter
levels of these hormones, resulting in a variety of emotional,
behavioral, and cognitive problems.
Children
who are physically abused in early life develop brains that
are highly attuned to aggression and danger. It has been
found that, "early, frequent, and intense stress tunes the
brain to set stress regulation mechanisms at high levels."[56]
As a result, the child often lives life in a perpetual state
of fear. A child of this type may behave more aggressively
to environmental stress and may have difficulty controlling
his or her aggressive actions.
Similar
to adult veterans of war, children exposed to trauma may
experience symptoms of Posttraumatic Stress Disorder (PTSD).
PTSD is a syndrome that occurs in response to a highly distressing
event. After the occurrence of a traumatic event, the child
frequently re-experiences the event through nightmares or
intrusive thoughts. As a result of the stress on the child,
symptoms such as jumpiness, sleep disturbance, and poor
concentration undermine his or her stability.
Immediate
and Long Term Behavioral Effects of Abuse and Neglect
Several
immediate responses to child abuse trauma have been identified
in children. Many show difficulty remaining calm when faced
with emotional challenges, and develop what are termed "arousal
disorders." Others have the tendency to overreact or freeze
in uncomfortable situations. Children may also experience
attention difficulties that make it hard to focus on and
complete tasks.[57] Other physiological responses include
increased heart rate, temperature, and blood pressure. Many
children also continuously scan their environment for danger
and over-interpret the actions of others.[58]
Traumatic
experiences in childhood increase the risk of developing
future psychiatric symptoms in adolescence and adulthood.[59]
Depending on the frequency, nature, severity, and pattern
of traumatic experiences, at least half of all exposed children
are at risk of developing considerable neuropsychiatric
conditions.[60] Most researchers agree that the difficulties
of abused and neglected children intensify over time, particularly
when abuse is longstanding and no formal intervention occurs.[61]
Some
of the long-term problems experienced by children who have
been traumatized include difficulties forming and maintaining
stable relationships with others, as well as problems meeting
their own personal needs. Affected brain development, especially
at an early age, can have long-term effects on cognition,
the regulation of emotions, and social interactions. Problems
that abused and neglected children face as they grow into
adulthood can include:
- Increased prevalence of drug or alcohol dependence
- Increased rate of status offenses - running away, truancy
- Delinquent behavior and adult criminal behavior
- Growing up to repeat abusive and neglectful parenting
behaviors
- Lost future earnings
- Recurring health problems - physical and mental
The
"Adverse Childhood Experiences Study" described in Chapter
1 has also documented the link between abuse in childhood
and risk factors for adult disease. The U.S. Centers for
Disease Control and Prevention, joined by other leading
health researchers, confirm: there is a significant graded
relationship between the extent of exposure to emotional,
physical, sexual abuse and household dysfunction during
childhood and multiple risk factors for the leading causes
of deaths in adults -including, ischemic heart disease,
cancer, chronic lung disease and liver disease.[62]
A study
completed in 1983, following up on 97 boys who in 1943 had
been abused and neglected, found that 45 percent had become
criminals, alcoholics, mentally ill, or had died before
the age of 35.[63] According to researcher Widom, being
abused and neglected as a child can increase the likelihood
of arrest as a juvenile by 53 percent, and arrest as an
adult for violent crime by 38 percent.[64]
Most
tragically, if the cycle of violence is not interrupted,
child abuse and family violence can be perpetuated for generations.
Parents that abuse their own children, and the victims and
perpetrators of other forms of domestic violence, are frequently
survivors of maltreatment in their own childhoods.[65]
Trauma
and Learning
Maltreated
children have greater behavioral problems and perform significantly
worse in school, according to a study by Dr. van der Kolk:
- 30% of abused children have some form of language or
cognitive disability;
- 50% or more have difficulty in school, including poor
attendance and misconduct;
- 22% or more have a learning disorder;
- 25% require special education services at some time.[66]
Significant
differences in academic performance are also found between
maltreated and non-maltreated groups of children.[67] The
constant threats experienced by an abused child can result
in the child being fearful and over-vigilant, even in situations
that present no risks. Concentrating on the emotional and
physical cues of other people, including teachers, the abused
child may have difficulty taking in academic information
and may fail to develop appropriate problem-solving and
language skills. In one study, the cortex, or thinking part
of the brain, was 20 percent smaller on average in abused
children than in those children who had not been victimized.[68]
Resiliency
and Early Intervention
Resiliency
can be defined as "strength under adversity." It is the
capacity to withstand the effects of adverse conditions.
According to childhood trauma expert Mark Katz, PhD, "There
is a myth that children are resilient. If anything, we now
know that children are more vulnerable to trauma than adults."
The
brain's agility provides potential for positive experiences
to lessen the damage of trauma.[69] These protective influences
can be found in families, communities and schools, but too
often they are lacking.[70] For example, it is not uncommon
to hear of children who are berated or punished in school
for poor concentration and aggressive behavior that are
themselves the results of previous trauma and violence.
In such instances, the school fails to be a supportive environment
and a protective influence, and becomes yet another traumatizing
influence on already vulnerable children.
It is
important to note that resiliency decreases, as children
get older. Increased exposure to risk and the severity of
risk also decreases resiliency. This demonstrates the critical
need for early intervention in the lives of abused or neglected
children in order to minimize these damaging effects.
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I: Incidence and Impact of Abuse and Neglect on Children:
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