By their appearances, the three little girls
sitting quietly in molded plastic chairs in the
psychiatric clinic of Texas Children's Hospital in
Houston betray nothing of the mayhem they have
experienced. No one would know that the night before,
two armed men broke into their apartment in a drug-ravaged
part of the city. That the children were tied up and
the youngest, only 3, was threatened with a gun. Or
that the men shot the girls' teenage sister in the
head before leaving (she survived).
Yet however calm the girls' appearances, their
physiology tells a different story. Their hearts are
still racing at more than 100 beats per minute, their
blood pressure remains high and, inside their heads,
the biological chemicals of fear are changing their
brains. "People look at kids who seem so normal
after these experiences and say, `All they need is a
little love,' " says Bruce Perry, a child
psychiatrist at Children's Hospital and at Baylor
College of Medicine. But as Perry and other
researchers are finding, trauma, neglect and physical
and sexual abuse can have severe effects on a child's
developing brain.
Tangled chemistry. Once viewed as
genetically programmed, the brain is now known to be
plastic, an organ molded by both genes and experience
throughout life. A single traumatic experience can
alter an adult's brain: A horrifying battle, for
instance, may induce the flashbacks, depression and
hair-trigger response of post-traumatic stress
disorder (PTSD). And researchers are finding that
abuse and neglect early in life can have even more
devastating consequences, tangling both the chemistry
and the architecture of children's brains and leaving
them at risk for drug abuse, teen pregnancy and
psychiatric problems later in life.
Yet the brain's plasticity also holds out the
chance that positive experiences--psychotherapy,
mentoring, loving relationships--might ameliorate
some of the damage. Much remains unknown. But if
scientists can understand exactly how trauma harms
the brain, they may also learn much about healing
broken lives.
Trauma's toll on a child's brain begins with fear.
Faced with a threat, the body embarks on a cascade of
physiological reactions. Adrenalin surges, setting
the heart pounding and blood pressure soaring and
readying the muscles for action, a response called
"fight or flight." At the same time, a more
subtle set of changes, called the stress response,
releases the hormone cortisol, which also helps the
body respond to danger.
Increasing evidence suggests that in abused or
neglected children, this system somehow goes awry,
causing a harmful imbalance of cortisol in the brain.
In a study of children in Romanian orphanages, for
example, Megan Gunnar, a University of Minnesota
developmental psychobiologist, is finding that
cognitive and developmental delays correlate with
irregular cortisol levels.
Gunnar and others believe that excess cortisol
leads to damage in a brain region known as the
hippocampus, causing memory lapses, anxiety and an
inability to control emotional outbursts. Cortisol
and other brain chemicals also can alter brain
centers that regulate attention, affecting a child's
capacity to attend to words on the blackboard instead
of a jackhammer banging outside.
Many of the brain abnormalities seen in abused and
neglected children are localized in the brain's left
hemisphere, where language and logical thought are
processed. Martin Teicher, a psychiatrist at McLean
Hospital in Belmont, Mass., compared recordings of
brain electrical activity in abused and normal
children. His finding: In abused kids, the left
hemisphere has fewer nerve-cell connections between
different areas. The electrical traces also revealed
that tiny seizures, similar to those of epileptics,
crackled through various sectors of abused children's
brains. Children with the most abnormal recordings
were the most likely to be self-destructive or
aggressive.
Scanning for danger. Abused children also
show a variety of other disturbances in physiology,
thinking and behavior. Many have elevated resting
heart rates, temperature and blood pressure.
Hypervigilance is common. Abused kids continually
scan their surroundings for danger and overinterpret
the actions of others: An innocent playground bump
may be seen as a direct threat. And as many as half
of children from some violent neighborhoods show
symptoms of Attention Deficit Hyperactivity Disorder
(ADHD), compared with about 6 percent of the general
population.
"Children who are aroused [from fear] can't
take in cognitive information," says Perry.
"They're too busy watching the teacher for
threatening gestures, and not listening to what she's
saying." Such behavior makes sense, given the
constant threats in the child's world. His brain has
become exquisitely tuned to emotional and physical
cues from other people. At the same time, he may be
failing to develop problem solving and language
skills. Perry has found that in a group of neglected
children, the cortex, or thinking part of the brain,
is 20 percent smaller on average than in a
control group.
Studies now indicate that abused and neglected
children run a high risk of developing mental
illnesses. Since 1987, National Institute of Mental
Health child psychiatrist Frank Putnam has tracked 90
sexually abused girls, comparing them to a control
group who were not abused. The abused girls were more
likely to evidence depression and suicide attempts,
and many showed the beginnings of PTSD, including
anxiety attacks and abnormal levels of cortisol,
which are also seen in combat veterans. Putnam also
found a decline in the abused girls' IQ over time.
Saddest of all, the abused girls are rated by their
teachers as not very likable. "That's tragic,"
says Putnam, "because the one place where they
might find some support is at school."
Indeed, for some children, a loving adult can
serve as a powerful antidote to abuse and neglect.
Infants and young children normally learn from a
comforting caretaker how to soothe themselves,
thereby regulating their stress response and cortisol
levels. Researchers now believe loving relationships
also can help older children reset their response to
stress when it has been derailed by abuse. Says
Gunnar: "We don't know when the door to the
brain's plasticity closes."
Unfortunately, loving damaged children can be
tough. One minute they are hostile, the next
withdrawn. In class, they escape their feelings by
daydreaming. When the teacher confronts them, they
retreat even further. Then, says Perry, "the
teacher touches the kid. When you touch them, that's
incredibly threatening, and the child has a tantrum."
The growing understanding of what's going on in an
abused and neglected child's brain has begun to yield
new treatments. In addition to psychotherapy, Perry
gives some of his young patients clonidine, a drug
that helps check the fight-or-flight response.
Clonidine, and other drugs that interfere with the
release of cortisol, may decrease the chances a child
will go on to develop PTSD. Perry also hands out
devices that allow teachers and foster parents to
monitor a child's heart rate from a distance, so they
can refrain from making demands on him when he's
frightened.
For every child who finds help at a clinic like
Perry's, there are dozens who fall through the cracks.
Only a fraction of the millions of children who are
mistreated each year receive the kind of help that
can reverse the underlying physiological changes they
suffer. Ultimately, says McLean's Teicher, failing
these kids may be shortsighted. They are less likely
to live up to their economic potential, and more
likely to wind up in prison, on drugs or in
psychiatric units, he says. "The cost on society
of having a child who has gone through abuse is
enormous."