Prevalence/Types of Child Abuse. The Effects of Child Abuse on Brain Development

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1 The Effects of Child Abuse on Brain Development R. Christopher Qualls, Ph.D. Professor; Emory & Henry College Consulting Psychologist; Mt. Rogers CSB Overview Prevalence & Types of Child Abuse Neurological deficits associated with abuse in general and specific types of abuse Characteristics of parents/caretakers who abuse Nature/importance of Reparative Environments for abused/neglected children Prevalence/Types of Child Abuse Exact prevalence of child abuse is difficult to obtain Different ways to examine the prevalence of child abuse: Removed from home, Reported Cases, and General Population surveillance studies. Founded cases by Child Protective Services - ~900,000 cases in 2006 (US Health & Human Services, 2008) However, in one study, only 32% of reported cases were founded; fewer still removed from home. Equal numbers of boys and girls across all types of neglect and abuse but Boys are more likely to be physically abused Girls are more likely to be sexually abused 1

2 Prevalence/Types of Child Abuse Types of Abuse in Founded Cases & Removed from home 64% neglect 9% physical abuse 3% sexual abuse 17% multiple types of abuse Types of Abuse in Cases Investigated 20% Neglect (failure to provide) & 30% Neglect (failure to supervise) 27% physical abuse 11% sexual abuse 20% multiple types of abuse Prevalence/Types of Child Abuse Incidence of Abuse within a General Population Sample 15% emotional neglect 10% physical neglect 11% emotional abuse 28% physical abuse 21% sexual abuse Prevalence/Types of Child Abuse Estimates of Abuse in the General Population of Children 16 per 1000 children are subjected each year to some form of abuse; 2.4 per 1000 are subjected to sexual abuse, about half of these involving genital penetration. A CDC 2009 telephone survey found that 17.2% of women reported child sexual abuse and 6.7% of men. Followed group of working class/lower middle class white children bg. at age 5 and intervals between 9 to 18. Found that 15.5% of women and 12.3% of men were physically abused. Within this same cohort, 5.9% of women and 1.1% of men were found to be sexually abused. 2

3 Child Abuse and Brain Development Now, converging evidence from neurobiology and epidemiology suggests that early life stress such as abuse and related adverse experiences cause enduring brain dysfunction that, in turn, affects health and quality of life throughout the lifespan (Anda et al., 2006; European Archives of Psychiatry & Clinical Science). Neurological Effects of Child Abuse Overt vs. Subtle Neurological Injuries Overt neurological injuries include hemiparesis, seizures, cortical blindness, and dysarthria. More subtle neurological injuries include cognitive deficits, social dysfunctions, and psychiatric disorders. Subtle injuries are much more common. Males are more susceptible to neurological damage from abuse than females. Neurological Effects Decreased/Altered Cognitive Development Decreased Head Circumference Decreased Neuronal Connectivity (synaptic connections) due to: Lack of stimulation Increased cortisol production (stress hormone) decreases connectivity Connections that are not used are lost. Connections that are not consistently used are slowed. 3

4 Neurological Effects Cognitive Functioning (cont.) Decreased Corpus Callosum Functioning- Corpus Callosum is responsible for communication between two hemispheres of the brain; Volume decreased by 17% in one of study of abused/neglected children; Delayed/decreased development of Prefrontal cortex leading to longer reaction times in decision-making, particularly inhibitory responses; Decreased Basal Ganglia function, which is associated with less receptivity to potential rewards; Some negative effects do not present themselves fully until adulthood. For example, there is substantial evidence of decreased hippocampal volume in adults subjected to child abuse- Hippocampus is responsible for the conversion of short-term memories into longterm memories (learning). Neurological Effects Decreased Emotional Regulation Controlled by many factors including regulation of neurotransmitters (e.g., norepinephrine) and hormones (e.g., Adrenocorticotropic Hormone - ACTH); Dysregulation of neurotransmitters are involved in psychiatric disorders such as ADHD (dopamine), depression (serotonin; norepinephrine), and anxiety (GABA); Increased Amygdala activation; possible alteration in volume; Dysregulation of hormones are involved in children becoming over or under responsive to stress in their environments (e.g., PTSD; easily frustrated; decreased impetus for attachment). Neurological Effects Decreased Emotional Regulation (cont.) Changes in Cortisol Production such that: Exposure to immediate, intense stressful situations are associated with frustrated/frightened responses (increased cortisol); Exposure to prolonged (chronic) stress associated with underresponsiveness to others, which results in decreased empathy for others (decreased cortisol); Inability to effectively regulate painful/stressful emotions associated with self-injurious behavior. 4

5 Neurological Effects Decreased Attachment Capacities 80-90% of abused infants show disorganized attachment behaviors; Attachment capacity/behavior influenced by Orbitofrontal region of right hemisphere interacting with the limbic system and requiring the presence of adequate amounts of vasopressin and oxytocin; Development of expectation of adequate care (storage of internal working model of attachment relationship ); Abuse/neglect associated with decreased empathy; Neglect/abuse associated with the development of Reactive Attachment Disorder to Dissociative Identity Disorder (DID). Neurological Effects of Specific Types of Abuse Physical Abuse Physically abused children are1.5x s as likely to develop a mood or anxiety disorder, 5x s more likely to develop an eating disorder, and 6x s more likely to develop Conduct Disorder. Effects of Harsh Physical Punishment (HPP) 14 to 19% reduction in gray matter volume in prefrontal brain regions in young adults. Young adults who experienced HPP had IQ scores which were 10 points lower (2/3 s of a Standard Deviation) than those who did not experience HPP in spite of no difference in number of years of higher education. Emotional Abuse Emotional abuse includes the following: patterns of belittling, blaming, threatening, frightening, discriminating against, or ridiculing; and other non-physical forms of rejection or hostile treatment; Childhood emotional abuse is associated with reduced hippocampal volume and higher levels of mental illness symptoms (subclinical psychotic & depressive symptoms) in adults; 14% increase in gray matter volume of the left superior temporal gyrus; may be associated with greater receptivity to negative emotions (difficulty disengaging); Decreased Corpus Callosum may be associated with decreased language abilities; Also, associated with a reduction in medial, pre-frontal lobe volume with this brain region thought to regulate cost-benefit analysis and control of emotional responses; Emotionally abused children are 3 times more likely to develop a mood or anxiety disorder. 5

6 Sexual Abuse Repeated episodes of childhood sexual abuse are associated with bilateral reductions in gray matter volume in the visual cortex, which may affect dreaming and other visual-related behaviors; Dysregulation of the Hypothalamic-Pituitary-Axis is associated with increased anxiousness in the short-term, but increased depression in the long-term (also related to decreased serotonin); Short-term effects of sexual abuse associated with hypersensitivity to stress, such that victims will overreact to stressors; Dysregulation of the Locus Coeruleus and the production of norepinephrine, which is associated with sleep dysregulation and increased anxiousness. Polyvictimization and Neurological Outcomes Most heavily abused children (top 5%) are 100 times more likely to have a psychiatric disorder in adolescence; Polyvictimization associated with decreased cognitive abilities including poorer memory, processing speed, concentration, and verbal skills; Adults with more than 6 adverse childhood events had a higher likelihood of dying 20 years earlier than those without such histories (Anda et al., 2009). Exposure to child abuse decreases the effectiveness of treatment for depression (1.5 x s more likely to not respond to treatment) and 2x s as likely to relapse as compared to nonabused children. Correlates of Families and Caregivers Who Abuse Children Domestic Violence Less educational achievement Greater presence of psychiatric illness including substance abuse Experienced adverse childhood events, particularly parental exposure to abuse or neglect in their own childhood Lower family income Higher utilization of physical punishments and a lower use of more positive disciple methods 6

7 Importance of Reparative Environments A reparative environment is one in which the child consistently experiences what was missing from their previous abusive/neglectful environment. Neurodevelopmental plasticity and normal developmental increases in the hippocampus may mask any effects of traumatic stress in maltreated children with PTSD (De Bellis et al., 2011). Nature of Reparative Environments Elements of a reparative environment include: Abundant Nurturing External cues/support/instruction related to appropriate emotional arousal Consistent structure including the appropriate mix of rewards (more is needed) and negative consequences Consistent exposure to positive peer models Consistent and often creative learning opportunities for intellectual development Nature of Reparative Environments Consideration of biological supports (e.g., medication) to promote appropriate brain functioning Utilization of other sources of external social support (e.g., religious groups) A close, positive relationship with even one adult significantly decreases the long-term effects of abuse 7