How neglect shapes the brain

Scientific evidence to support early intervention for neglected children continues to strengthen

How neglect shapes the brain
A child's early social environment can affect how its brain adapts to future stress. [Image credit: Paul Goyette ]

It’s the year 2000 in Bucharest, Romania. Carrying computers, audio amplifiers and electroencephalography (EEG) equipment, University of Maryland neuroscientist Nathan Fox sets up a makeshift lab inside a children’s orphanage. Today, his team will measure the electrical charges inside the orphaned children’s brains and compare them to those of children with foster parents. Fox is one of several neuroscientists from the Bucharest Early Intervention Project (BEIP)  an American research program tracking the health of 136 orphan children over a period of twelve years. The BEIP will publish its 12-year follow-up data this spring.

“What we found that day was very traumatic,” Fox tells me. “No matter how much we turned up the amplifiers on our equipment, the signal that was coming out of the brains of the kids in institutions were very small compared to typically developing children of the same age living in the community.”

The cause was not physical abuse in any conventional form. It wasn’t cuts, bruises or a blow to the head. Rather, it was the absence of consistent stimulation and response, kindness and warmth. In short, the cause was neglect.

A recent working paper by the Harvard Center on the Developing Child shows that Fox’s findings were just the start of a solid body of evidence for how neglect shapes a child’s developing brain. “Neglect” is defined as a caregiver’s lack of attention to a child’s physical, social and emotional needs. “The newest idea is that neglect has this lasting and permanent impact on the brain,” says Phil Fisher, a University of Oregon neuroscientist who studies American foster care. Fisher says science is becoming increasingly precise about what parts of the brain neglect can affect — the two main areas being, cortisol production and physical changes to the prefrontal cortex (the area of the brain that influences cognitive decision-making).

Neglect’s behavioral impact ranges from delayed language learning to poor problem solving to dysfunctional social behavior. But to understand how the experience of neglect — which is more like a permanent cavity than a bruise — can shape the brain, the story starts with the formation of neural patterns in infants.

Wiring the brain for a life of response

A baby’s brain begins to create connections between brain cells during its first year of life. When a baby repeatedly uses these connections — called synapses — they repeatedly strengthen the circuit, laying down grooves like those of a well-worn train track. According to neuroscientist Judy Cameron, at the University of Pittsburgh, if a child doesn’t use these circuits repeatedly the connections are likely to get pruned and wither away.

“Failing to encourage children to do specific things like talk, reason, read or think through problems will affect the development of brain circuits underlying those areas,” Cameron explains. “And if a child is neglected and they don’t have caring adults encouraging them to do these things, they won’t use those circuits over and over.”

Children must strengthen the reasoning, reading and learning circuits during particularly sensitive periods of brain development when pruning occurs heavily. Studies show these critical windows of time differ for the areas of brain development: for vision, visual stimulation is especially crucial from infancy to five years; for problem-solving, cognitive stimulation (like games and reading) is important until 12. And for social behavior, the Bucharest Early Intervention Project found that a warm social environment is especially important from infancy to two years. The BEIP found that children taken out of institutions and placed in good foster care before two years formed healthy attachments and good social development compared to those who stayed in an orphanage longer.

For neurobiologist Megan Gunnar, wiring the infant brain for close social interaction is crucial for thriving in society. At the University of Minnesota, Gunnar studies the biological importance of relationships.  “We have evolved for our brains to develop in the context of relationships,” says Gunnar, explaining that it’s written in our biology to expect responsive interactions from a caregiver as infants. Gunnar calls this back-and-forth, ‘serve-and-return’ interaction “grips” for the baby’s brain to hold onto. When a baby reaches out to an adult, its brain organizes the adult’s response and reads the response as a signal — it is much like a returned throw in a game of catch.

“All the nerves, pathways made in producing that response were confirmed,” says Gunnar. “They were successful. Successful patterns of action repeated over and over bring food to those parts of the brain that help create the brain. You’re building the brain and that happens in the context of relationships.” As a child gets older, says Gunnar, such patterns allow the brain to better handle life’s stresses.

How do researchers try to measure neglect?

According to Phil Fisher, the strongest evidence for the impact of neglect comes from measuring electrical signals in the brain and cortisol production.

When Nathan Fox measured the Bucharest children’s brain signals, he attached sensors to their scalps and amplified the signals to observe them clearly. “It’s as if the brain’s dimmer switch had been turned down, and the amount of energy coming out of the children’s brain was extraordinarily small,” Fox says of the institutionalized children. A 2012 study led by Margaret Sheridan at the Boston Children’s Hospital found this was because the neglected children’s brains were not developing enough white matter, or myelin tract.

White matter covers and connects neurons and their axons. The substance speeds up the electrical signals between neurons, strengthening communication in the brain. An MRI conducted on the Bucharest children at eight years old revealed significantly less white matter development in institutionalized children compared to those in foster care. “That has significant consequences in terms of their ability to solve complex cognitive problems, as well as their executive functions,” says Fox.

But research shows neglect also impacts cortisol levels in the body. At the University of Delaware’s Infant Caregiver Lab, Mary Dozier found that neglected children produced less cortisol throughout the day as measured by saliva samples compared to children living in loving foster homes.

“Cortisol is a hormone of energy—it’s made by the body to give the body energy so if you’re stressed, you make energy to deal with the stress,” Nathan Fox explains.  A typically developing child will produce high levels of cortisol in the morning that tapers off throughout the day. But neglected children show low levels in the morning and a flat rate throughout the day—an abnormal pattern of production that puts children at risk of not being able to activate stress responses in the body during stressful situations. “We looked to see whether we could change the flatter slope of cortisol for kids living under high-risk conditions,” says Dozier. “And we found after an early intervention, children show a steeper slope and a higher morning value.”

Early interventions like Dozier’s are designed to mediate the impact of neglect for children in high-risk environments while the children are still young. Dozier developed the Attachment and Biobehavioral Catch-Up (ABC) Intervention , a ten session parenting program carried out in the homes of neglectful parents. It aims to help parents become less frightening and more nurturing for their children. Dozier currently implements the intervention throughout the country, reaching about 300 foster children, and 200 children adopted internationally.

Is it ever too late?

As for the Bucharest Early Intervention Project, Fox says there is a good ending to the story. “We followed the children who were taken out of institutions, and their brain activity got larger and larger, until about eight, when we found they were now indistinguishable from community children in terms of their EEG signals,” says Fox. “They looked just like normal, healthy, happy kids.” Yet Fox and other researchers emphasize that despite this turnaround, timing matters.

“It’s never too late to help neglected children, but it will require tremendous effort and energy,” neuroscientist Charles Nelson — and Fox’s colleague in the BEIP — says. “Would I say, based on my work in Romania, people shouldn’t adopt a ten-year old? My answer is no. But just be prepared that child will have a range of developmental problems, and it will require a lot of resources. That child may never look like a perfectly normal child. But you will improve that child’s life.”

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  1. I know that neglect to stop child abuse… incest at that, does some god awful negative effects to not only your psychological functions but also your autonomic and somatic system functions as well

    toni vossen, July 12, 2014 at 12:14 am
  2. I am the parent of a child that we adopted from a Bulgarian orphanage in 1997. She was 7 at the time we adopted her but she was the size of a 4 year old. She spoke Bulgarian but it was more like “twin speak.” We soon found out that she was very developmentally delayed and she suffered from PTSD. We tried everything we could to help her but as she got older her violent outbursts got worse and she was hospitalized several times. Today she lives in housing managed by the Department of Developmental Disabilities in NJ. She has been on 24/7 line of sight for almost 2 years because she self injures. She attends a day program for DD adults that have violent tendencies. She can not take care of herself because she functions at a first grade level. If it was just that she was delayed I think we would have seen a more positive outcome for her but the result of so much neglect for so long took it’s toll on her. I shudder to think what the outcome would have been had we not adopted her.

    Maureen Baeck, July 27, 2014 at 9:37 am
  3. It has been broadly known for many yrs that children who have spent more than a couple of yrs in these overseas institutions ( Russia, Romania, etc) have serious disabilities. This may be the first time someone has attached electrodes to measure their brain waves, but the phenomena is not new. They have been tied in their cribs, or onto a chair, for hours & hours, just to keep them under control. No love, no attention, no stimulation.

    Rena Fowler, July 30, 2014 at 6:59 pm
  4. Interesting…seems like DCF in America could do a SIMPLE EEG on all adoptable children, to measure their brain activity…that would social workers more info on selecting appropriate families. My daughter would have benefitted (looking back) tremendously on having been an ONLY child, so she could get a TON of attention (i.e. neural ‘input’). Now she’s 7 1/2, and I truly worry about her behaviors…mostly a result of extreme neglect :(

    cmill, August 1, 2014 at 4:20 pm
  5. “Two forms of “neglect” will be considered below: extreme multi-sensory
    neglect in childhood and a more subtle, insidious decrease in our opportunities to elaborate our socio-emotional potential caused by the sociocultural changes in how we choose to live. The sensory deprivation neglect results in obvious alterations in neurobiology and function while the second form has an almost invisible toxic impact on the developing child – and ultimately, society…Healthy development of the neural systems which allow optimal social and emotional functioning depends upon attentive, nurturing caregiving in infancy and opportunities to form and maintain a diversity of relationships with other children and adults throughout childhood. In our modern world, we are more mobile, compartmentalized and and socially-disconnected. The true costs of our lifestyle choices may be difficult to see; yet an understanding of neurodevelopment suggests that the modern world’s socio-emotional milieu is not sufficient for most children to express their true potential for forming and maintaining healthy relationships” http://theunlimitedchild.co.za/wp-content/uploads/2011/08/mindbrain-information.pdf

    Anue Nue, October 28, 2014 at 1:21 am
  6. I was raised in 6 foster homes and finally an orphanage and have always suffered from extremely severe anxiety. Now at at 72 I look back at my life like it was a constant struggle, or a race if you will. I never had coping mechanisms or good relationships. It leaves you with phobias. I am phobic about going to anyone’s home, perhaps because I wanted one so bad. But not venturing out there leaves you isolated and alone with broken relationships all around you. It’s scary. I believe I am a good person that has paid a huge price for other peoples failure to take responsibility. I am still paying today. I am using meditation and living in the present to help. The cycle of life can be brutal to abandoned and neglected children. When people ask me how I survived I always answer the same way. “miraculously”,

    Sharon Gonzales, January 11, 2015 at 11:15 pm
  7. Can this be reversed in adults. I know the brain can be retrained, anyone out there have any feed back. I need it

    Donna, January 17, 2015 at 7:45 pm
  8. I’m asking myself the same question. I realized recently that I grew up without enough smiling from my parents and people around generally (I mean genuine smile directed at me – not just seeing people smile). My mother was depressed and distant a lot (she was physically abused by her mother throughout her childhood) and my father, when he was at home, was visibly uncomfortable holding us and playing with us (he grew up in a large rural family in the first years after WW2 in Poland). Sometimes it seems to me like 2/3 of Polish society suffers from neglect carried over through generations. It might be similar in all the countries of the former Soviet bloc.

    Marek, January 30, 2015 at 1:28 am
  9. @Marek while I’m not 100% sure and can’t give a professional response, I can definitely sympathize with your experience and I’ll suggest you try visiting or taking an extended holiday in a country like Philippines. Where smiling is second nature. I never thought to Australia until 26, but felt my emotional development took a huge leap after visiting, it was a feeling of relief, for lack of a better word. Emotional relief, to visit a place that had everything I missed growing up, given freely on a daily basis.

    Joey Williams, August 1, 2015 at 9:31 am
  10. Never left Australia until 26** sorry.

    Joey Williams, August 1, 2015 at 9:32 am
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