How child abuse and neglect damage the brain

By Josh Kendall, Globe Correspondent, 9/24/2002

For 7 -year-old Zachary Risotti, feeling safe and cared about is a new experience.

At 2, Zachary was taken to the emergency room because of a suspicious cigarette burn under his left eye. Six months later, he was back in the hospital with a burn on his right forearm. Suspecting abuse, the state Department of Social Services removed him from his home, but he bounced around three foster homes before he was finally adopted in July 2000.

By then, Zachary already bore psychological scars of child abuse. At 3, he had the communication skills typical of a toddler half his age. He avoided eye contact, fidgeted constantly and expressed his frustration by sitting in a corner and crying.

But intensive mental health and support services as well as a loving family have given Zachary a second lease on life. ''Today he's happy, very sociable and doing well in school,'' said his adoptive mother, Kathryn Risotti of Marlborough.

Until recently, mental health clinicians could only speculate on the ways that abuse and neglect damage a child's developing brain. But a series of ground-breaking studies in neuroscience conducted over the last decade are allowing researchers to pinpoint the actual changes in children's brains caused by traumatic experience.

These new neurobiological findings show that trauma - physical abuse, sexual abuse and neglect - dramatically affects both the structure and chemistry of the developing brain, thus causing the behavioral and learning problems that plague about three-quarters of the children mired in the child welfare system. But the good news is that these brain changes aren't necessarily permanent. In fact, timely interventions - as in the case of Zachary - can help rewire the brain and put psychological development back on track. As Department of Social Services Commissioner Harry Spence put it: ''Neuroscience has helped to clarify our mission. We must do more than just protect children after the brain damage has been done. We must also provide loving environments because they are fundamental to healing on a physiological level.''

Dr. Martin Teicher, an associate professor of psychiatry at Harvard and director of the Biopsychiatry Research Program at McLean Hospital in Belmont, has been at the forefront of this new line of research.

In one of the first major studies in the field published in The Journal of Neuropsychiatry and Clinical Neurosciences in 1993, Teicher linked abuse to brain wave abnormalities. Reviewing the records of 115 consecutive admissions to a child and adolescent psychiatric hospital, Teicher found brain wave abnormalities in 54 percent of patients with an abuse history, but in only 27 percent of nonabused patients. And 72 percent of the patients in the sample with a history of both physical and sexual abuse had these neurological abnormalities.

As a rule, Teicher said, the greater the severity of the abuse, the greater the impact on brain function. And the relationship of the perpetrator to the child also matters: ''Sex abuse by a family member is worse than abuse by a priest or a baby-sitter.''

Several studies now document that abuse damages key brain structures such as the cortex, which is associated with rational thinking, and the hippocampus, which helps process memories and emotions. Both brain regions are critical for learning.

In a study published in the same journal in 1998, Teicher and his colleagues used brain scans to compare 15 child victims of severe abuse with 15 healthy volunteers. The left cortex of the abused group was underdeveloped. Likewise, studies by Dr. Douglas Bremner of Yale and Dr. Murray Stein of the University of California at San Diego have found that the left hippocampus is smaller in abuse victims.

Abuse also damages the amygdala, an almond-shaped cluster of nuclei located in the brain's emotional control center that enables us to respond quickly to danger - say, to step out of the way of a swerving car. But repeated abuse causes the amygdala to signal danger even when there is no apparent threat.

Dr. Bruce Perry, a neuroscientist who heads the nonprofit research center, the Child Trauma Academy in Houston, said: ''A maladaptive amygdala makes an abused child recoil in fear at the drop of a hat.''

This negative impact on developing brain structures is associated with changes in brain chemistry. Overwhelming stress early in life also alters the production of both the stress-regulating hormone cortisol and key neurotransmitters such as epinephrine, dopamine and serotonin, the chemical messengers in the brain that affect mood and behavior.

These biochemical imbalances can have profound implications. For example, abuse typically lowers serotonin levels, leading to depression and impulsive aggression.

Dr. Bessel van der Kolk, the internationally known expert on psychological trauma who serves as Medical Director of the Trauma Center in Allston, is now studying how treatment can undo these neurobiological effects.

One of 12 treatment sites across the country recently selected to receive a grant under a new federal program called the Child Traumatic Stress Initiative, the Trauma Center educates schools and communities throughout northern New England on state-of-the-art treatment methods for traumatized children.

Van der Kolk said he is convinced that Prozac-type drugs, which affect the neurotransmitter serotonin, can often improve a child's functioning or quality of life. But he insisted that medication is only part of the answer. ''Positive experiences that contradict a traumatized child's negative expectations are critical to helping the brain to readjust itself. For example, just saying to a child that you are sorry the event happened changes brain chemistry.''

Dr. Alexandra Cook, who directs Children's Services at the Trauma Center, also stressed that interpersonal experiences such as psychotherapy can change neurobiology. For instance, Cook began treating a girl she calls ''Sally'' when she was 5, right after her father had been sent to jail for sexually abusing her and the family had relocated to Massachusetts. Sally was prone to temper tantrums, and she was crying for three hours a day.

''I hypothesized that the abuse, plus the stress of testifying at her father's trial and the move had led to a cascade of chemical changes in her brain and body,'' Cook said. ''Her amygdala couldn't stop firing.''

To stabilize Sally, Cook helped her find constructive ways to discharge her overwhelming emotions. So, when Sally would run laps around the table in her office, Cook did not discourage her. Cook then suggested that Sally try ''messy painting,'' an activity involving splattering water colors on paper. After about four months of weekly sessions, Sally was much calmer and could move from stabilization to memory processing, the next phase of therapy.

Cook said she believes that the therapy improved the circuitry in Sally's brain because she never saw such acute distress again.

Some animal studies do show that new experiences can actually regenerate brain cells, but the ''research on humans is not there yet,'' said Dr. Glenn Saxe, chairman of the Department of Child Psychiatry at the Boston University School of Medicine.

Unfortunately, traumatized children such as Zachary and Sally who receive specialized treatment services remain the exception rather than the rule. According to the US Department of Health and Human Services, a million children are abused each year, and researchers estimate that fewer than 10 percent are benefiting from appropriate interventions.

''There is a huge disconnect between what science says we should do and the services we are now providing for maltreated children,'' said Dr. Jack Shonkoff, dean of the Heller School at Brandeis University and a co-author of a comprehensive recent study published by the National Research Council and the Institute of Medicine called ''From Neurons to Neighborhoods: The Science of Early Childhood Development.''

Yet, the window for psychobiological change never slams shut. The new neuroscientific findings have upended the deterministic view that brain development is essentially over by age 3. Although the most rapid period of brain growth occurs during early childhood, the brain continues to change throughout adulthood. But the more time that elapses between the abuse and the onset of treatment, the more entrenched are the neurological abnormalities.

''The brains of adult survivors are fragmented and resemble a hard drive on a computer that has crashed,''

Strong Oak, codirector of the Survivors Project, a drop-in center for adults in Greenfield, who runs psychoeducational groups on overcoming the biological effects of trauma, said: ''The brains of adult survivors are fragmented and resemble a hard drive on a computer that has crashed.''

Topics: stress hormones