Study & Comment- Suboptimal parenting impacts brain shape and function
This meta study & responsive comment confirm childhood neglect/abuse impacts brain shape and function, and that attachment is the primary issue. Lead authors Teicher and van der Kolk are both heavy weights in the science fields.
Teicher and Samson reviewed a great number of studies and found substantial evidence to confirm the belief that child maltreatment impacts the shape and function of numerous brain regions and/or the neural connections between the regions, including the amygdala (fear system), hippocampus (memory system), various parts of the prefrontal cortex (executive functions), corpus callosum (connecting left and right hemispheres), and several other regions. These effects on brain shape broadly impact brain functions which are important to conflict resolution professionals, such as emotional regulation, the perception of and response to perceived danger, social cognition (empathy, self-awareness), accurately perceiving thoughts and intentions of others, and over-focus on internal feelings. All of these issues impact human information processing.
Teicher and Samson came to several conclusions, including:
- Childhood abuse has repeatedly been found to be associated with alterations in brain structure and function. (Other studies have found neglect has more impact than abuse.) The magnitude of the neurobiological impact is related to the severity of exposure.
- The specific neurobiological effect is impacted by type of maltreatment. For example, caregiver neglect and attachment disruptions are associated with increased amygdala volume (increased fear sensitivity).
- Both the quantity of adverse childhood experiences and the age of exposure may be important.
- Gender is relevant. Maltreatment impacts neurobiological systems differently in boys and girls (how and in what ways is complex).
- The findings appear to reflect “neuroplastic adaptive responses”. That is, children’s brain shape and neural connections can be significantly (perhaps permanently) modified in order to adapt to the parental environment. Verbal abuse leads to alterations in the auditory cortex. Witnessing domestic violence alters the visual cortex. Sexual abuse alters the somatosensory cortex. Threatening stimuli enhances fear response. Response to emotional faces can be enhanced, and the approach involved with intimate interpersonal contact (face gazing) can be reduced.
- The reversibility of neurobiological changes is poorly understood. White matter abnormalities (neural wiring) may be more reversible than gray matter abnormalities (neural cells). Preliminary studies indicate mindfulness practice can improve cognitive deficits.
Noted trauma psychiatrist Bessel van der Kolk provided a commentary on the Teicher & Samson article. While giving them credit for decades of excellent research and a good research review, van der Kolk notes there is more to the story. Adverse childhood experiences are better thought of as childhood traumas, and these traumas impact and change the child’s nervous system. Since the nervous system is the foundation for how a human perceives the world, negatively-impacted children necessarily experience the world differently.
Van der Kolk provides a different perspective on the prevalence of abuse. Looking at quality studies in North America, Asia and Africa, at least 50% of all children have experiences that qualify as a trauma which impacts neural wiring, and which in turn impacts the child’s (and later the adult’s) ability to appraise risk and safety. He referenced the ACES study (Adverse Childhood Experiences, U.S. Center for Disease Control), which indicates only 30% of middle class Americans had no adverse childhood experience.
Van der Kolk also points out that current psychiatric diagnostic systems, such as the DSM and ICD, are ineffective at identifying the neglect and abuse (impacting trauma). This, he argues, leads to Teicher and Samson’s confusion about the relationship between trauma and abnormal brain structure. For him (and for ICCI), attachment theory and science provides a better insight into understanding the problem and solutions. The impact is not so much to psychopathology, but to the development of modified attachment behaviors. At the heart of the problem are parents who chronically misattune with their children’s needs. The solution is parenting with improved attunement.
“Clarifying the neuronal connections associated with mental illness is vitally important, but it is equally critical to recognize that those neuronal connections are, in large part, the result of early caregiving interactions that shape our minds and brains when we are young, and that continue to underpin the fundamental substance and meaning of our lives.” Bessel van der Kolk, at 269.
From ICCI’s perspective, and that of the advanced attachment theory detailed in the Dynamic Maturational Model of Attachment and Adaptation (DMM, developed by Dr. Patricia Crittenden), the problem may be described this way. Adverse childhood experiences are common and impact how a child’s attachment needs are met. Those needs are primarily protection from danger and the receipt of comfort (especially after exposure to danger). Adverse experiences, especially neglect of attachment needs, modify normative childhood attachment behaviors. When caregivers don’t meet attachment needs reasonably well, children develop self-protective strategies that help them meet their own needs, and those strategies in turn shape the physical structure of the brain (neuroplasticity). The strategies ensure survival within the parent-child relationship, but may be less functional in other relationships. Rather than seeing the problem as a mental health issue, secure vs. insecure, or functional vs. dysfunctional, we can see it as one in which the functioning of the nervous system, and a person’s information processing systems, become more complex in the face of adversity.
In terms of client counseling, negotiating and litigating, the heart of the matter is understanding and effectively addressing the complexities of how people perceive the world and how they behave as they seek to find protection from danger. Applying adult attachment theory to conflict management helps us see the underlying problems and the information processing patterns. The DMM provides us with a simple yet deeply robust model for being able to identify the information processing and self-protective patterns. The ICCM’s Conflict Model ports the DMM into a usable model for the legal world.
Please note: the full articles are available from Wiley.com until April 31, 2016, at:
Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect. Martin H. Teicher, and Jacqueline A. Samson. Journal of Child Psychology and Psychiatry, 57:3, pp 241-266 (2016).
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress-induced damage.
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016. Bessel van der Kolk. Journal of Child Psychology and Psychiatry, 57:3, pp 267-270 (2016).
Traumatic life experiences during childhood and adolescence are far more common than expected. The Centers for Disease Control and Prevention estimates that child maltreatment may be the most costly public health issue in the United States, Eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, serious drug abuse, and domestic violence by three quarters. It would also have a significantly positive effect on workplace performance, and vastly decrease the need for incarceration. The current practice of applying multiple distinct comorbid diagnoses to traumatized children prevents a comprehensive treatment approach. Approaching their problems from a framework of memories of discreet traumatic ignores the fact that the damage affects the brain’s neural circuitry and goes well beyond dealing with discrete painful events. Our great challenge is to learn to utilize the brain’s neuroplasticity to reorganize defective brain circuits.