A new study recently published in the American Journal of Psychiatry has found an association between child abuse and the reduction of gray matter in the brain that is responsible for information processing.
Child abuse, also referred to as child maltreatment, describes all forms of physical and emotional abuse, sexual abuse, neglect, negligence and any other exploitation that harms the health, development, dignity or survival of a child under the age of 18 years.
The World Health Organization (WHO) states that worldwide, around 20% of women and 5-10% of men report being sexually abused as children, while 23% of individuals report being physically abused during childhood.
Past research has established that child abuse can lead to alterations in brain structure. But the team involved in this latest study, including Joaquim Radua, a researcher at FIDMAG Sisters Hospitallers Foundation for Research and Teaching in Spain, says neuroimaging studies investigating the extent of these alterations have been “inconsistent.”
With this in mind, the researchers set out to see just how much child maltreatment influences brain structure.
The team analyzed the data of 12 studies that used voxel-based morphometry (VBM) – a neurorimaging method that assesses differences in brain anatomy between two groups of individuals.
The studies included 56 children or adolescents and 275 adults with a history of childhood abuse, as well as 56 children and 306 adults who had not been exposed to childhood maltreatment.
Using a 3D meta-analytical neuroimaging technique created by Radua – called “signed differential mapping” – the team was able to determine the volumes of gray matter in each individual.
They found that the individuals who had been exposed to childhood maltreatment had much smaller volumes of gray matter in certain brain areas, compared with those who had no history of child abuse.
Specifically, those who had a history of child abuse had reduced gray matter in their the right orbitofrontal/superior temporal gyrus, amygdala, the parahippocampal and middle temporal gyri and the left inferior frontal and post central gyri.
The team notes that the most consistent reduction of gray matter volume among those exposed to child abuse was in the ventrolateral prefrontal and limbic-temporal regions – areas linked to cognitive control.
Since these brain regions develop relatively late – after the child abuse may have occurred – the team says this may explain why some victims of child abuse typically have compromised cognitive control.
In addition, the team found that reductions in gray matter in the right orbitofrontal-temporal-limbic and left inferior frontal regions of those with a history of child abuse remained even among those who were unmedicated, “indicating that these abnormalities were not related to medication but to maltreatment,” says Radua.
Radua comments further:
“These findings show the serious consequences of adverse childhood environments on brain development. We hope the results of this study will help to reduce environmental risks during childhood and to develop treatments to stabilize these morphologic alterations.”
According to the American Academy of Pediatrics’ (AAP) position statement on child maltreatment, mental abuse in young children can be just as damaging as physical abuse. In fact, the AAP describes psychological and emotional maltreatment of children as “the most challenging and prevalent form of child abuse and neglect.”
Because psychological maltreatment interferes with a child’s developmental trajectory in similar ways to physical and sexual abuse, it can cause severe short- and long-term problems including attachment disorders, developmental and educational problems, socialization problems, disruptive behavior, substance abuse, and even future criminal behavior.
Spotlight on Child Abuse in the U.S.
Every year more than 3 million reports of child abuse are made in the United States involving more than 6 million children (a report can include multiple children). The United States has one of the worst records among industrialized nations, with an average of between four and seven child fatalities every day to child abuse and neglect. In 2012, nearly 1,600 children in the U.S. died as a result of child abuse or neglect.
The youngest children are the most vulnerable to maltreatment. Over 25 percent of abused children are under the age of three while over 45 percent of abused children are under the age of five. Of the approximately 1,600 child fatalities, 70 percent occurred among children younger than three years of age, and 45 percent were among children younger than one year of age.
Research has shown that there is a strong correlation between child abuse and domestic abuse. Recent national studies have shown that 50 percent of men who frequently assault their wives also frequently assault their children. According to research from the Women’s Rural Advocacy Programs, children in homes where domestic violence occurs are physically abused or seriously neglected at a rate 1500 percent higher than the national average in the general population.
It is estimated that between 45 percent and 70 percent of children who are exposed to domestic violence are also victims of abuse. Furthermore, in over 20 percent of the child fatalities that occurred in 2012, the child was exposed to domestic violence in the home.
Children who live with domestic violence face several risks: the risk of exposure to traumatic events, the risk of neglect, the risk of being directly abused, and the risk of losing one or both of their parents. All of these may lead to negative outcomes for children and may affect their well-being, safety, and stability. Childhood problems associated with exposure to domestic violence fall into three primary categories:
- Behavioral, social, and emotional problems. Higher levels of aggression, anger, hostility, oppositional behavior, and disobedience; fear, anxiety, withdrawal, and depression; poor peer, sibling, and social relationships; and low self-esteem.
- Cognitive and attitudinal problems. Lower cognitive functioning, poor school performance, lack of conflict resolution skills, limited problem solving skills, pro-violence attitudes, and belief in rigid gender stereotypes and male privilege.
- Long-term problems. Higher levels of adult depression and trauma symptoms and increased tolerance for and use of violence in adult relationships.
Stopping the Violence
The connections between child and spouse abuse indicate a strong need for coordination between child abuse and domestic abuse agencies and advocates. Some communities are working to develop relationships between child abuse and domestic abuse agencies. In particular, because of the correlation between domestic violence and child abuse, it is critical that agencies that work with abused children are trained to recognize signs of domestic violence and to respond appropriately.
Further, because of the correlation between spouse and child abuse, it is important that the laws governing child abuse and child custody do not have unintended effects on battered women. In the United States, for example, child abuse laws that determined custody according to the “best interests of the child” often held that a women was an unfit parent because she did not protect her child from abuse—even though she was also abused and may not have felt is was safe for her and her child to leave.
Another problem arose with laws that required certain people, such as teachers or social workers, to report signs of child abuse. Mandatory reporting without consideration of domestic violence issue may force the woman into a lose-lose situation; when confronted with the signs of abuse, she either reveals the abuser’s responsibility and runs the risk of retaliation, or refuses to do so and potentially loses custody of her children.
Some potential strategies to coordinate the response of child abuse and domestic violence agencies and advocates include joint training, the implementation of protocols that require each agency or group to consult with its counterpart, where appropriate, co-location of staff working on these issues, and establishment of collaborative projects.
Recent child trauma research programs in the United States have adopted a “dual victim treatment” approach. This approach is based on the premises that mother and child witnesses are dual victims of domestic abuse, and that strengthening the mother-child bond in dual victim cases helps minimize the harm experienced by children. Reports from programs that work to develop the relationship between the two victims through counseling have been dramatic: Not only did the children’s mental and emotional health improve significantly, but only one in forty-five women returned to her abuser.