“I Can’t Think” - How Abuse & Neglect Changes a Child
Every year thousands of New Zealand children are exposed to violence and abuse. This can take a number of forms; it can be physical, emotional, psychological or sexual, and it can be directly against the child or witnessed by him or her. To a large extent it will go undetected.
Trauma, neglect and under-stimulation do not allow the brain to develop in a normal, orderly way. The time parameters governing brain development mean that by the age of three a child who has been neglected or abused may have developed a brain structure with patterns which may be difficult, or in some cases almost impossible to change. This can result in lifelong learning difficulties and emotional and social problems, leading variously to difficulty in relationships, mental health problems, juvenile offending, alcohol abuse and at the extreme end, suicide.
Here, we will examine just how the brain works when it is under threat.
How the Brain Works Under Threat
Our bodies and minds respond to perceived threats in an automatic and preprogrammed way. When faced with danger the body releases stress hormones such as cortisol and adrenaline. These hormones are designed to help the body respond quickly to the threat by preparing for ‘fight or flight’, that is, to confront the threat or escape from it.
This stress response automatically moves us from a state of calm to a state of fear to prepare us for ‘fight or flight’. Breathing quickens, blood pressure goes up, hearts beat faster and muscles prepare for action. We become very alert and watchful. The brain shuts down functions that are not immediately needed, including access to the cerebral cortex - the part of the brain we need for rational thought. We respond without thinking.
The body generally relaxes when the threat is over; however, where there is constant or repetitive fear, the hormones remain on alert.
The Threatened Child
Repeated chaos, threat or trauma in the early years over-stimulates that part of the brain which responds to threats - the fight or flight response. The brain begins to develop permanent neural pathways attuned to the stress reaction. This results in changes to physical, emotional, behavioural, learning and social functioning. Their heart rate and blood pressure becomes higher than those of other children, reduced access to the cerebral cortex means that these children may not think rationally and are less able to listen or be reasoned with, and they tend to act impulsively.
Constant feelings of fear begin to colour the way the child perceives the world. He or she begins to see danger in all aspects of life, and in school or in play with other children; for example, the child remains sensitized to the possibility of threat.
Over time these children adapt to their traumatic environment as a means of increasing their survival. They adapt by using a hyperarousal response (flight or fight) or they will use a dissociative response (freeze and surrender). Some use a combination of these responses. These are survival strategies that help them when they sense danger, but they do not help if the environment changes.
The act of learning requires a state of calm. In order to learn efficiently the child needs to be able to access the parts of the brain which will allow rational thought and logic. A child in a persistent state of trauma-induced arousal will rarely achieve this state, and whilst he or she may sit in the classroom they will rarely learn, absorb or process information effectively.
In the event of reintroduced threats or triggers, whether real or perceived and no matter how slight, the stress response in these children is again activated. Denied access to the parts of the brain such as the cerebral cortex, the response in these children is again activated. Denied access to the parts of the brain such as the cerebral cortex, the child will focus on nonverbal skills such as the tone of voice, body posture and facial expressions. He or she may suddenly feel fear, confusion, or the need to lash out, and is likely to become impulsive, reactive and aggressive. He or she may not even be aware of what has sparked the response or the feelings of threat, and is certainly most unlikely to be able to reflect on the consequences of his or her behaviour.
By the age of three, children who have experienced repeated trauma may have already developed brain patterns with connections that are difficult to change. The effects of this early abuse can extend into adolescence and adulthood, even if the child experiences a positive change in circumstances.
In very young children signs of trauma can include:
• unusual fears
• repetitive play in which the child re-enacts traumatic situations without coming to a solution
• regressive behaviour
School aged children may demonstrate different patterns of behaviour. They may appear to act up in class presenting as:
• aggressive
• learning disabled
• hyperactive
• destructive.
Others may exhibit symptoms of detachment. These children can be overlooked as being in need of special attention by teachers and health professionals as their behaviour may allow them to go unnoticed. These children may appear:
• dreamy
• compliant
• inattentive
• withdrawn
The forms of adaptation can differ with gender and age. Boys and older children often display symptoms of hyperarousal whereas girls and preschool children are more likely to become withdrawn and aloof.
If not dealt with the problems can continue to grow. Children who are emotionally empty and unattached are more likely to take up high-risk behaviours in early adolescence. These can include early heavy smoking, unprotected sex, an addiction to drugs and alcohol, glue sniffing and self-mutilation. Their behaviour may become:
• aggressive
• sexualized
• abusive
• violent
There is a strong association between trauma and antisocial or criminal behaviour. These early experiences of abuse can also lead to an increased risk of social isolation, failure at work, dependency, psychological, psychiatric, psychosomatic disorders and the end results of stress and high risk behaviours, such as liver, lung and heart disease, HIV and cancer.
Cycle of Abuse
If a pregnant mother is subjected to violence or abuse - physical, emotional or verbal - her brain will release high levels of stress hormones into her body. These hormones are now known to affect the developing brain of the foetus. Such babies at birth are aroused, difficult to settle and over-react to any stimulus. Those who are abused are more likely to abuse their own children and pass on the damage.
The Neglected Child
In young children, neglect can be as traumatic as abuse.
The majority of early brain development is achieved through the interaction of the child with others, such as parents or caregivers. Neglect deprives the child of the interaction needed to nurture the brain cells and trigger the neural pathways. If the child lacks appropriate stimulation his or her brain may fail to develop properly.
Children who don’t play much or are rarely touched have brains 20% - 30% smaller than others their age.
Neglect can inhibit the child’s potential to learn and participate in a normal life. Problems associated with neglect can include:
• Difficulties forming relationships
• Developmental delays
• Intellectual retardation
• Verbal delays
• Social delays
The ability to feel remorse, empathy and sympathy are experience-based responses. If the child does not receive consistent touch, care, love and affection by the child’s second birthday the part of the brain enabling the child to bond may not be able to develop fully. The child may experience ongoing emotional problems and have difficulty bonding as an adult.
This disconnection from others has also been associated with seemingly senseless acts of violence where the person shows no remorse.
Conclusions
Ongoing abuse or neglect alters brain development in children. This leads to learning problems and social and emotional difficulties. Intensive, well-designed, timely intervention can improve the quality of life of children at risk. The earlier the intervention the better the outcome.