Editor's Note: Whether physical or emotional, benign or malicious, neglect alters the developing brain's architecture and circuitry in profound ways that often lead to physical and behavioral problems throughout life. In Part 2 of our series on The Neglected Brain we explore how childhood neglect effects areas of the brain that govern emotions and impulse control. Read Part 1, Part 3 and Part 4.
If Danielle Goodwin had taken the Adverse Childhood Experiences Test as a teenager, she would have scored a perfect 10.
The ACES test was developed in 1998 by researchers from the Centers for Disease Control in Atlanta and Kaiser Permanente in San Diego who were trying to find out whether childhood stress led to health problems later in life. The test consists of 10 “yes or no” questions designed to screen for exposure to violence, sexual abuse and neglect: “Did a parent or other adult in the household often or very often … act in a way that made you afraid that you might be physically hurt? Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way? Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or your parents were too drunk or high to take care of you?”
Each “yes” response counts for one point. The higher the score, the greater the likelihood that the test taker will experience heart disease, obesity, depression, substance abuse or some other downstream health and behavioral problem.
The ACES test is a blunt instrument. It doesn't add any additional points for neglect if, say, the neglect involved not being protected from sexual abuse committed by your mother's boyfriends, which resulted in your pregnancy at age 14, which is what happened to Danielle Goodwin. Perhaps some trauma can't be quantified.
Neurology of neglect
Like too many children, Danielle was a victim of abuse and neglect. Both are considered forms of “child maltreatment.” Both are clearly negative experiences and both affect development, but only abuse qualifies as trauma. “Traumatic events involve significant threats to one’s physical integrity (in an acute way), like being assaulted, sexually abused or exposed to other forms of violence,” explains Dr. Kate McLaughlin, assistant professor of psychology at the University of Washington and a member of the landmark Bucharest Intervention Project, which studied the impact of neglect on children in Romanian orphanages. “We have solid evidence that neglect and trauma impact brain development in fundamentally different ways. They are not the same type of experience.”
Though this series touches on the impacts of many forms of childhood maltreatment, neglect is the focus. Its impacts, though less publicized, are just as detrimental.
Experienced early on, neglect can create changes in the brain that contribute to a cascade of unrelenting problems for teenagers and young adults. It impairs the brain’s natural wiring process, retarding communication among the brain’s many cells, and it switches the brain into a kind of permanent high-stress mode.
Neglect also changes several key regions of the brain. The most important is the prefrontal cortex. Located just behind the forehead, the prefrontal cortex is the site of so-called executive function, adult-level management skills such as planning for the future, impulse control and the ability to concentrate and distinguish right from wrong. Emerging research suggests that the "critical period" for development of the prefrontal cortex may extend into a person's 20s, and even beyond. While most teens and 20-somethings look like adults on the outside, their brains are still maturing.
The prefrontal cortex tends to be smaller in neglected children, and it is less well connected, from a communications standpoint, to other brain regions. These differences are associated with a higher incidence of Attention Deficit Hyperactivity Disorder, which affects about 1 in 5 neglected kids, compared to 1 in 20 children in the general population.
Unlike abuses such as rape, neglect is not classified as a trauma. But kids like Danielle who are neglected are far more likely to experience trauma, because they don’t have adults in their lives who can protect them.
Some differences between the consequences of neglect and abuse were noted decades ago in behavioral studies, including one landmark study published in the American Journal of Public Health back in 1996. The study followed nearly 1,200 people. More than half the subjects had been neglected, abused or both; 520 had not experienced either abuse or neglect. The study’s lead author, Dr. Cathy Spatz Widom, now a professor of psychology at the John Jay College of Criminal Justice in New York, showed that girls who had been either neglected or sexually abused had a much higher chance of becoming prostitutes as adults. Girls who had been only physically abused were less likely to enter the sex trade. More recently, neuroscientists have begun to uncover the specific changes in the brain that are likely playing a role in these behaviors.
The amygdala and stranger danger
For instance, many neglected kids and teens are starved for attention, a craving that creates exceptional vulnerability in a young person whose impulse control (think prefrontal cortex) is not fully developed. Any attention, even bad attention, is better than no attention at all. Neglected children show an alarming lack of caution around strangers, approaching and engaging them more readily than children raised by consistently attentive parents. Scientists believe that this reckless tendency, which can put neglected children and teens at high risk for sexual assault, has something to do with a portion of the midbrain, called the amygdala.
This small, almond-shaped bundle of neurons straddles the left and right hemispheres deep inside the brain’s temporal lobe. Its name comes from the Greek word for almond. The amygdala helps process emotional experiences, memory and trauma and is also believed to play a role in emotional bonding.
Using neuro-imaging technology, researchers studied the responsivity of the amygdala in neglected vs. non-neglected children. In one study, scientists at the University of California in Los Angeles tested 67 kids ranging in age from 4 to 17. Half of their child subjects had spent time in international orphanages and were later adopted. The other children — the control group — were raised in attentive homes. Parents of all the study subjects answered questionnaires about their child’s tendency to engage with unfamiliar people.
Researchers showed their young subjects photographs of faces, including the faces of strangers and of their own biological or adoptive mothers, while measuring the response of the amygdala. Children raised in healthy, nurturing environments showed a heightened response when looking at pictures of their mothers, whereas neglected kids had the same level of amygdala activity regardless.
The researchers also found that the age at which the child was adopted played a role. The older the child, the less likely he or she was able to differentiate between the photo of an adoptive mother and a stranger. "The stranger anxiety or wariness that young children typically show is a sign that they understand their parents are very special people who are their source of security," explained Dr. Nim Tottenham, associate professor of psychology at UCLA and the study's senior author. "That early emotional attachment serves as a bedrock for many of the developmental processes that follow."
In an earlier, 2000 study in the journal Developmental Psychology, researchers compared the responses of neglected and abused youth when they were shown photographs of various facial expressions. Both groups saw faces that exhibited a range of emotions, including angry, sad, fearful and neutral. Abused kids were more likely to see anger in neutral expressions; neglected kids were not as good at perceiving the difference between anger and other emotions, or at correctly identifying emotion of any kind.
The corpus callosum is another brain region affected by neglect. Connecting the left and right hemispheres, the corpus callosum enables coordination between the two sides of the brain. It represents the largest concentration of white matter in the brain, the material that facilitates transmission of signals.
A 2004 study published in the journal Biological Psychiatry confirmed a connection between childhood neglect and the size of this brain region. The corpus callosum in subjects who had been abused or neglected was 17 percent smaller than in control subjects who had not experienced either. Neglect, wrote the authors in the study's abstract, "was the strongest experiential factor and was associated with a 15%–18% reduction" in certain areas of the corpus callosum.
The corpus callosum is also shaped differently in females and males, appearing more bulbous in female brains and more tubular in male brains. Scientists can’t say exactly how, but they suspect that this discrepancy may help explain why neglect and other forms of maltreatment can affect boys and girls differently, with boys becoming more aggressive and girls succumbing to depression.
Rethinking our approach to troubled teens
With few exceptions, brain studies have focused on very young children or the elderly. Researching, even recognizing teenage neglect is more complicated. Teens no longer need someone to hold a bottle for them or get them dressed, but they still need somebody to put food in the refrigerator, offer advice, set limits and guidelines, provide a safe, secure home. Somebody to trust.
Recent research findings have significant implications for the way we, as a society, approach troubled teenagers. Our current understanding of the under-developed prefrontal cortex, for example, raises questions about the wisdom of trying and sentencing teenagers as adults, and about the way young prisoners are treated. Just this year, New York’s notorious Rykers Island prison finally stopped its practice of punishing teenage inmates by locking them in isolation chambers, a form of severe neglect.
The latest studies also argue for revisiting sexual consent laws, which vary from state to state. In Washington, a 16-year-old can legally consent to sex with a person of any age, regardless of how mismatched the two parties may be in their developmental process or how much unaddressed trauma may have created a needy, impulsive, lonely teenager whose “consent” is questionable at best.
For Danielle Goodwin, the special combination of neglect and abuse she experienced at home predisposed her to a deeply troubled adolescence. When she was 12, her mom started bringing Danielle along with her to bars. With make-up and a stuffed bra, Danielle was a plausible 18, the legal drinking age in Calgary, Alberta, where they were living at the time. Men would tell her mother how pretty Danielle was. "At the time I thought it was awesome," Danielle says. But that enthusiasm didn’t last.
When her home life worsened and went largely ignored by the adults around her, who either didn't know how to help or didn't care, Danielle ran away. At 15, and back in Seattle, she left her baby with her foster parents, and took to the streets. "I ended up numbing my feelings with drugs and running from life," she says. That was how she had seen the grownups in her life cope with problems. It was all she knew.
Danielle didn't go looking for trouble, but she was no stranger to it either, and soon enough, trouble found her again.
Tomorrow: First steps in Danielle Goodwin's long road back.
Read Part 1, Part 3 and Part 4.
Illustratons by Kate Thompson. Photos courtesy of Zuhair Ahmad/Flickr and Belzie/Flickr.
