Developmental impact of child neglect in early childhood

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Child neglect, often overlooked, is the most common form of child maltreatment. [1] Most perpetrators of child abuse and neglect are the parents themselves. A total of 79.4% of the perpetrators of abused and neglected children are the parents of the victims, and of those 79.4% parents, 61% exclusively neglect their children. [2] The physical, emotional, and cognitive developmental impacts from early childhood neglect can be detrimental, as the effects from the neglect can carry on into adulthood.

Contents

Childhood

Physical health development

Research has shown that by the time a child reaches the age of six, if they have experienced adverse childhood experiences (ACEs), such as neglect, their chances of having overall poor physical health increases by two-fold. [3] Exposure to ACEs, which exert effect by increasing an individual exposure to toxic stress during key periods of development, has also been linked to higher risks of chronic diseases, respiratory and heart disease, cancer and suicide. [4]

More specifically, improper prenatal care increases the risk of premature births and complications during delivery. This can include prenatal neglect, such as the fetal exposure to controlled substances which result in withdrawal symptoms or the presence of the substance in the newborn. [5] Fetal exposure to substances, especially those that can easily cross the placenta such as nicotine and cocaine, can affect the development of the fetus's nervous system and thus, have been linked to long-lasting effects on brain structure and function. [6] Further, maltreatment and neglect during infancy has been linked to a variety of physical development issues, including poor growth and insufficient brain and neuronal development. Medical neglect can lead to a number of long-term physical consequences such as permanent loss of hearing from ear infections, vision impairment from strabismus, and chronic respiratory issues from untreated pneumonia.

A common outcome of neglect is non-organic failure to thrive in infants and children. "Non-organic" simply means that the child's failure to thrive cannot be explained by an organic cause, such as an illness or deficiency. [7] The term "failure to thrive" refers to an abnormal pattern of weight gain or weight loss, or experiencing insufficient growth patterns in accordance with a child's age and developmental stage. [8] These conditions can arise when a child does not receive adequate nutrition or necessary medical attention required for proper physical growth and development. [9] Neglect can play a role in non-organic failure to thrive because children who experience neglect are often malnourished, not receiving proper nutrients, which hinders their physical growth and development. [10] The most common symptoms of non-organic failure to thrive are insufficient weight gain or growth in height, and these common symptoms can affect a child over their life course by setting them back in weight class and can hinder their overall growth. [10] Other symptoms of failure to thrive include symptoms such as iron deficiency or anemia, low insulin, dry or cracked skin, thin hair growth, pasty skin, and more. [11] In more extreme cases, non-organic failure to thrive can affect a child over their whole life course by actually damaging their cognitive development and immune system due to insufficient calorie intake or lack of medical attention, making the child much more likely to miss developmental milestones and much more prone to illness even later into adulthood. [10]

Cognitive development

Social and emotional development

A developing child requires proper nutrition, protection, and regulation for healthy attachment. About 80% of neglected children display attachment disorder symptoms and eventually form insecure attachments to their caregivers as a result of caregivers' unresponsive interactions. [12] This disturbed attachment to their primary caregiver alters future relationships with peers by becoming emotional and physically isolated from others reducing the likelihood of forming emotional connections. [13] Moreover, as a result of their past maltreatment, neglected children feel that forming intimate relationships with others loses their control in life and exposes them by increasing their vulnerability. [14] A number of aspects may create a neglectful environment; however, substance abuse in parents is a common example. With parents who are addicted to drugs, children's basic needs are not met when parents are attempting to obtain their drugs as well as when they take them. This can create a weak parent–child relationship that is more likely to result in insecure attachment relationships as well as poor parenting practices. [15] This example is one of many scenarios where neglect can affect a child's development, especially in how they form relationships with others.

Neglected children demonstrate lack of emotional regulation, understanding emotional expressions by others, and difficulty in distinguishing emotions. [16] When posed with problem-solving tasks, neglected children reacted with anger and frustration, and were less enthusiastic with completing a new task. [17] Neglected children often have distressing memories of their past to which they regulate their emotions by suppressing them. [14]

Academic development

Neuroimaging studies using magnetic resonance imaging have shown that the brain structure of a neglected child is significantly altered. The overall cerebral volume of the brain of a neglected child is significantly diminished, with a reduced midsagittal area of the corpus callosum, and the ventricular system is enlarged thereby resulting in decreased cognitive growth, development, and functioning. [18] [19] Further studies show that neglected children have poor cerebral hemisphere integration and underdevelopment of the orbitofrontal cortex region which affects the child’s social skills. [20]

Studies on academic progress in neglected children have indicated that these children may experience a drop in their academic performance. Children who have experienced neglect are more likely to have attention deficits and poorer academic achievements. [21] Further, neglect in early childhood can result in a rise in stress levels in the child. [22] Elevated stress levels from neglect can lead to a release of higher levels of cortisol causing damage to the hippocampus which can affects a child’s learning and memory. [23]

A study examining the motor, language, and cognitive development of neglected children showed that the scores from the Bayley Scales of Infant Development were significantly lower than non-maltreated children. [17] Neglected children displayed poor self-control and a lack of creativity in solving problems. [17] Standardized tests become a challenge for neglected children as they perform poorly on intellectual functioning and academic achievement. [17] Further, neglected children perform significantly poorer on IQ tests than non-maltreated children. [24]

Protective factors

Preclinical and clinical data show that long-term effects of early-life stress can be blunted by the availability of positive supports and subsequent caregiving experiences. [25] Clinical studies have shown that the availability of a caregiver, who is present and caring, is a factor that differentiates abused children with positive developmental outcomes versus those with negative outcomes. [25] Age of onset may be another factor dictating the severity of symptoms, with some studies reporting that abuse that takes place during earlier stages of childhood development is associated with negative outcomes later on in life. [26] Children who experience traumatic episodes early in life are at increased risk of developing major depressive disorder. [25] However that risk may be attenuated by the presence of a functional polymorphism in the promoter region of the serotonin transporter gene 5HTTLPR, which can manifest in two different types of alleles, the "short" subtype and the "long" subtype, carriers of the long/long allele subtype were resistant to developing depression in response to early life trauma. [27]

Biological mechanisms

Activation of the LHPA axis triggers the hypothalamus to secrete corticotrophin-releasing hormone (CRH); CRH stimulates the release of adrenocorticotrophic hormone (ACTH) by binding to CRH receptors in the anterior pituitary. ACTH in turn binds to G protein-coupled receptors in the adrenal cortex, especially in the zona fasciculata of the adrenal glands. Elevated central CRH and CRF occurs with the onset of trauma. While this CRF elevation persists into adulthood, initial elevations of ACTH and cortisol levels become attenuated with chronic exposure to elevated CRH (a.k.a. CRF). [28] High CRH in turn causes adaptive down-regulation of pituitary CRH and neural CRF receptors after trauma onset. The long-term consequence of early trauma experiences and elevated CRF resets the regulation of the LHPA axis so that ACTH and cortisol secretions are set at lower 24-hour levels during baseline and non-stressful conditions. Cross-sectional studies show that trauma in infant primates and very young or prepubertal children living in orphanages show low morning and daytime cortisol production, suggesting that prepubertal children may be more sensitive to negative feedback control mechanisms for cortisol output than older school-age children who show higher cortisol levels. [28]

Research involving humans has similarly demonstrated that negative life events can disrupt the body's regulation of oxytocin. Decreased levels of oxytocin have been found in women exposed to early maltreatment—a relationship that was shown to be especially strong when the form of maltreatment was emotional abuse. [28]

Long-term consequences

Adolescence & adulthood

Physical health development

Children who experience maltreatment may be at greater risk for chronic conditions such as cardiovascular problems (e.g. heart attack, hypertension), endocrine dysfunction (e.g. diabetes), neurologic and vision changes (stroke, migraines), pulmonary disease (emphysema, COPD, bronchitis), gastrointestinal issues (malnutrition) and joint and back issues. [28]

Socio-emotional development

Adults and adolescents who have been victims of childhood neglect may also be at higher risk for substance use disorders, carceral system involvement, and the perpetration of abusive or neglectful parenting than those who have not experienced early childhood abuse. [28]

Psychological development

Victims of childhood neglect are at increased risk of development of post-traumatic stress disorder (PTSD) which can lead to further adverse mental health outcomes (depression, suicidality, substance use, behavioral disorders, etc.). These mental health consequences of neglect may effect one's ability to engage with one's day to day obligations in a negative way. [28]

See also

Related Research Articles

Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary caregiving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.

Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".

A form of child abuse, child neglect is an act of caregivers that results in depriving a child of their basic needs, such as the failure to provide adequate supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established that there are necessary behaviours a caregiver must provide for a child to develop physically, socially, and emotionally. Causes of neglect may result from several parenting problems including mental disorders, unplanned pregnancy, substance use disorder, unemployment, over employment, domestic violence, and, in special cases, poverty.

<span class="mw-page-title-main">Child abuse</span> Maltreatment or neglect of a child

Child abuse is physical, sexual, emotional and/or psychological maltreatment or neglect of a child, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential wrongful harm to a child and can occur in a child's home, or in organizations, schools, or communities the child interacts with.

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Emotional dysregulation is characterized by an inability in flexibly responding to and managing emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.

Dyadic developmental psychotherapy is a psychotherapeutic treatment method for families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. It was originally developed by Arthur Becker-Weidman and Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers. Hughes cites attachment theory and particularly the work of John Bowlby as theoretical motivations for dyadic developmental psychotherapy.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.

<span class="mw-page-title-main">Daniel Schechter</span> American neuroscientist

Daniel S. Schechter is an American and Swiss psychiatrist known for his clinical work and research on intergenerational transmission or "communication" of violent trauma and related psychopathology involving parents and very young children. His published work in this area following the terrorist attacks on the World Trade Center in New York of September 11, 2001 led to a co-edited book entitled "September 11: Trauma and Human Bonds" (2003) and additional original articles with clinical psychologist Susan Coates that were translated into multiple languages and remain among the first accounts of 9/11 related loss and trauma described by mental health professionals who also experienced the attacks and their aftermath Schechter observed that separation anxiety among infants and young children who had either lost or feared loss of their caregivers triggered posttraumatic stress symptoms in the surviving caregivers. These observations validated his prior work on the adverse impact of family violence on the early parent-child relationship, formative social-emotional development and related attachment disturbances involving mutual dysregulation of emotion and arousal. This body of work on trauma and attachment has been cited by prominent authors in the attachment theory, psychological trauma, developmental psychobiology and neuroscience literatures

Trauma bonds are emotional bonds that arise from a cyclical pattern of abuse. A trauma bond occurs in an abusive relationship, wherein the victim forms an emotional bond with the perpetrator. The concept was developed by psychologists Donald Dutton and Susan Painter.

The effects of domestic violence on children have a tremendous impact on the well-being and developmental growth of children witnessing it. Children can be exposed to domestic violence in a multitude of ways and goes beyond witnessing or overhearing, although there is disagreement in how it should be measured. Children who are exposed to domestic violence in the home often believe that they are to blame, live in a constant state of fear, and are 15 times more likely to be victims of child abuse. Close observation during an interaction can alert providers to the need for further investigation and intervention, such as dysfunctions in the physical, behavioral, emotional, and social areas of life, and can aid in early intervention and assistance for child victims.

Early childhood is a critical period in a child's life that includes ages from conception to five years old. Psychological stress is an inevitable part of life. Human beings can experience stress from an early age. Although stress is a factor for the average human being, it can be a positive or negative molding aspect in a young child's life.

Patricia McKinsey Crittenden is an American psychologist known for her work in the development of attachment theory and science, her work in the field of developmental psychopathology, and for creation of the Dynamic-Maturational Model of Attachment and Adaptation (DMM).

<span class="mw-page-title-main">Dante Cicchetti</span> Psychologist known for developmental psychopathology research

Dante Cicchetti is a developmental psychologist and developmental psychopathology scientist specializing in high-risk and disenfranchised populations, including maltreated children and offspring of depressed parents. He holds a joint appointment in the Department of Psychiatry at the University of Minnesota Medical School and in the Institute of Child Development. He is the McKnight Presidential Endowed Chair and the William Harris Endowed Chair.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious illness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. The effects of this trauma can be experienced very differently depending on factors such as how long the trauma was, how severe and even the age of the child when it occurred. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.

Betrayal trauma is defined as a trauma perpetrated by someone with whom the victim is close to and reliant upon for support and survival. The concept originally introduced by Jennifer Freyd in 1994, betrayal trauma theory (BTT), addresses situations when people or institutions on which a person relies for protection, resources, and survival violate the trust or well-being of that person. BTT emphasizes the importance of betrayal as a core antecedent of dissociation implicitly aimed at preserving the relationship with the caregiver. BTT suggests that an individual, being dependent on another for support, will have a higher need to dissociate traumatic experiences from conscious awareness in order to preserve the relationship.

Out-of-home placements are an alternative form of care when children must be removed from their homes. Children who are placed out of the home differ in the types and severity of maltreatment experienced compared to children who remain in the home. One-half to two-thirds of youth have experienced a traumatic event leading to increased awareness and growing literature on the impact of trauma on youth. The most common reasons for out-of-home placements are due to physical or sexual abuse, violence, and neglect. Youth who are at risk in their own homes for abuse, neglect, or maltreatment, as well as youth with severe emotional and behavior issues, are placed out of the home with extended family and friends, foster care, or in residential facilities. Out-of-home placements aim to provide children with safety and stability. This temporary, safe environment allows youth to have their physical, mental, moral, and social needs met. However, these youth are in a vulnerable position for experiencing repeated abuse and neglect.

The influence of childhood trauma on the development of psychopathy in adulthood remains an active research question. According to Hervey M. Cleckley, a psychopathic person is someone who is able to imitate a normal functioning person, while masking or concealing their lack of internal personality structure. This results in an internal disorder with recurrent deliberate and detrimental conduct. Despite presenting themselves as serious, bright, and charming, psychopathic people are unable to experience true emotions. Robert Hare's two factor model and Christopher Patrick's triarchic model have both been developed to better understand psychopathy; however, whether the root cause is primarily environmental or primarily genetic is still in question.

References

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