Child Maltreatment on Brain Development : Practice and Policy, Part 2

by Child Welfare Information Gateway

(Page 5 of 5)

To be more effective in their roles, caregivers who serve abused and neglected children could benefit from training and support related to the effects of maltreatment on early brain development. Understanding some basic information about the neurobiology underlying many challenging behaviors may help caregivers shape their responses more effectively. But while a general understanding is helpful, foster parents and other caregivers need to know the history of their particular foster children's experiences in order to tailor their approaches. They may need to develop some special skills to cope with the children's special needs.

In general, children who have been abused or neglected need nurturance, stability, predictability, understanding, and support. They may need frequent, repeated experiences of these kinds to begin altering their view of the world from one that is uncaring or hostile to one that is caring and supportive. Until that view begins to take hold in the child's mind, the child may not be able to truly engage in a positive relationship. And the longer the child lived in the abusive or neglectful environment, the harder it will be to convince his brain that his world can change. But one thing we have learned from research is that environment does make a difference. Consistent nurturing from caregivers who receive training and support may offer the best hope for the children who need it most.

Intensive, Early Intervention

Intensive, early interventions are key to minimizing the long-term effects of early trauma on children's brain development. Two studies that have shown this impact include the following:

Craig Ramey of the University of Alabama at Birmingham reported that vulnerable children who received services from 4 months to 5 years old showed better cognitive development than those receiving services from age 5 to age 8; the difference was even more pronounced at age 12 than at age 8.

Rutter, et al. studied the development of children adopted from Romanian orphanages. When each child was 6 years old, the researchers assessed what proportion of the adopted children were functioning "normally." They found that 69 percent of the children adopted before the age of 6 months were functioning normally, 43 percent of the children adopted between the ages of 7 months and 2 years, and 22 percent of the children adopted between the ages of 2 years and 3½ years.

Indeed, many studies have shown the effectiveness of early intervention, but we now have a better understanding of why early intervention makes a difference. And taking a neuro-developmental approach in early intervention can decrease the "intensity and severity of the response to trauma [which] will decrease the probability of developing ... sensitized neural systems resulting in a persisting hyper-arousal or dissociative symptoms or both".

In order to heal a "damaged" or altered brain, interventions must activate those portions of the brain that have been altered. Because brain functioning is altered by repeated experiences that strengthen and sensitize neuronal pathways, interventions can not be constrained to weekly therapy appointments. Interventions must address the totality of the child's life, providing frequent, consistent "replacement" experiences so that the child's brain can begin to incorporate a new environment-one that is safe, predictable and nurturing.

Although early interventions show the most promise for significant recovery from abuse and neglect, later interventions are not futile. However, as children get older, recovery from lost or altered brain functioning may be slower and less complete than recovery attempted earlier in the children's lives. But some recovery is certainly possible; while a negative environment may contribute to deficits, a positive environment can contribute to growth.

Prevention

While early intervention with maltreated children can minimize the effects of abuse and neglect, it is equally or even more important to prevent problems before they start. "Clearly,... the costs (in human suffering, loss of potential, and real money) of trying to repair, remediate, or heal these children is far greater than the costs of preventing these problems by promoting healthy development of the brain during the first few years of life".

Prevention efforts can target the general population ("primary" or "universal" prevention), educating the public and changing policies to promote healthy brain development. For example, one prevention strategy might involve expanding education efforts that target women who may become pregnant about the effects of alcohol on the developing brain of the fetus. An example of a policy change might involve expanding family leave to allow more parents time off from work to care for and build an attachment to a newborn or adopted child.

Prevention efforts also can target children and families considered to be "at-risk" of developing problems before problems develop ("secondary" or "selected" prevention). By the time a child who has been abused or neglected comes to the attention of professionals, it is likely that some damage already has been done. Secondary prevention efforts must reach out to at-risk families before this point. There are many home visitation programs that provide services to at-risk families before and after the birth of a child-services that support children's healthy development-that have proven to be successful in preventing future problems.

Many researchers examining the effects of maltreatment on early brain development agree that this knowledge should be used to expand and strengthen prevention efforts. Without expanded prevention, our society will continue to fight an uphill battle to "repair" the damage that has been done to thousands of children who have been abused and neglected. Society can not continue to ignore the laws of biology; the more we learn about early brain development, the more responsibility we have to act on that knowledge.

About the Author

www.childwelfare.gov
Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.