Between 1966, when abortion was outlawed in Romania, and 1989, when the revolution overthrew the communist government, many parents turned over children they couldn’t care for to state-run institutions. Children grew up in neglect, without the security of a dependable, comforting caregiver. Babies were left alone in cribs, rarely held. No one answered their cries, and eventually they’d stop crying entirely. There were no toys or books. Older children would rock back and forth and bang their heads.
In the now-famous Bucharest Early Intervention Project conducted between 2000 and 2005, scientists showed that, on average, brain, cognitive, and social development suffered in these institutionalized children, who experienced less physical contact and emotional support than children growing up in families.
The neglected children in Romanian orphanages and other maltreated children suffer what scientists call toxic stress. The stress system helps us confront threats, but repeated, prolonged activation in response to frequent or severe harmful experiences, like long-term neglect or abuse, can disrupt typical brain development, especially in emotion regulation networks, and overall health in some children. The prolonged release of hormones involved in the stress response, like cortisol, increases risk of cardiovascular disease, mental illness, cognitive problems, and other health issues.
According to a recent review of studies about early life adversity and development published in Psychological Bulletin, the wear and tear of threatening experiences might also lead to early puberty, faster cellular aging, and accelerated thinning of a prefrontal cortex area important for decision-making and social and emotional regulation. The damage of trauma extends well beyond the brain.
So are some children simply doomed to a future of poor physical and mental health? The Bucharest Early Intervention Project, despite its general findings that abused and neglected children could be worse off, also found that these outcomes weren’t always permanent. For the children placed in foster care after living in the orphanage, a relationship with a consistent, responsive caregiver can help children make up lost developmental ground. Today, scientists are taking advantage of the brain’s adaptive abilities to create interventions that mitigate or reverse these developmental injuries.
According to 2018 reports from child welfare agencies, about 678,000 U.S. children experienced neglect or abuse, with Black and Native American children overrepresented among child maltreatment cases. By age 16, over two-thirds of children experience at least one traumatic event, an event that threatened death, major injury, or sexual violence. Responsive caregivers are key to protecting and helping children recover from the resulting toxic stress.
Knowing this, Mary Dozier, a professor of psychology specializing in child development at the University of Delaware, created an intervention for infants and toddlers that targeted parents. Sometimes she’d hear foster parents report that their newly placed foster children appeared to be adjusting perfectly fine.
“And I thought that that’s impossible,” said Dozier. “What is happening here that we’re not seeing behaviorally?”
These foster parents reminded Dozier of early research with animals that showed that even when young monkeys who had been separated from their mothers stopped crying, their bodies betrayed their stress as high cortisol levels persisted. Even if a child appears calm, stress might be boiling beneath the surface. “They might be upset, but they’re not showing symptoms that draw parents in for support,” said Shannon Dorsey, a psychology professor at the University of Washington.
Dozier’s Attachment and Biobehavioral Catch-up (ABC) intervention teaches parents to be nurturing, even when the child doesn’t seem to need comfort. In 10 sessions, coaches guide caregivers to be more sensitive and responsive, or, as Dozier puts it, to follow the child’s lead.
For example, if a child falls, “the parent picks the child up and says ‘Are you okay?’ The parent does not say, ‘You are okay’ or ‘I told you not to stand on that,’” said Dozier.
After families with a history of neglect complete the ABC sessions, not only are parents more sensitive, but children show stronger emotional regulation skills, self-control, language development, and brain activation than children with similar experiences who don’t go through the intervention. When scientists tested saliva samples, they found that the ABC kids also showed healthier cortisol production throughout the day compared to children in similar family situations who didn’t go through ABC intervention. This cortisol effect persists even three years later.
ABC can help buffer young children from the effects of adversity, but a childhood full of stress necessitates other interventions, like trauma-focused cognitive behavior therapy (TF-CBT), in which clinicians work with children to overcome post-traumatic stress symptoms.
TF-CBT sessions tackle harmful thoughts, like self-blame, and unhelpful actions like avoiding talking about the trauma. “We’re focused on cognitions related to trauma exposure [and] behaviors that are related to trauma,” said Dorsey.
Like the ABC intervention, TF-CBT also involves the caregivers. “Improving the parent-child relationship, increasing their support, felt love—that makes a huge difference,” said Dorsey.
A study published in the Journal of Psychiatric Research last year showed that after treatment, children noticed improvements in their symptoms, and functional MRI scans showed that brain networks for processing emotions improved, too.
But there’s no one-size-fits-all approach, and Victor Carrion, a professor of child and adolescent psychiatry at Stanford University School of Medicine, decided to address this by developing cue-centered treatment (CCT). Through CCT, children and adolescents learn about the physical effects of stress, talk through their traumas and life experiences with a therapist, and develop new coping mechanisms to reduce PTSD symptoms.
Currently, Carrion and his team are analyzing data from a recently completed study investigating why TF-CBT and CCT may work better for some kids than others. They used functional near-infrared spectroscopy, a portable technique that allows scientists to track brain activity, to see if they could identify brain-related correlates that predict whether a child responds better to one treatment than the other.
“The neuroscientific changes happen before behavior changes,” said Carrion. The idea, Carrion hopes, is that eventually—after much more research—clinicians might be able to look for neuromarkers early in treatment that would show whether the child would benefit more from a different approach.
While each of these interventions can address the harms of traumatic experiences, they don’t address the underlying problems that predispose children to experiencing adversity. They don’t give parents the resources necessary to meet their children’s physical and emotional needs.
“Parenting intervention has to be part of a broader approach that does things like make sure parents have as much income support as possible,” said Brenda Jones Harden, a professor in the University of Maryland’s School of Social Work. “There’s a study now called Baby’s First Years—if you can just bring parents above the poverty level, can [children] have better outcomes?”
In Baby’s First Years, a team led by Kimberly Noble, professor of neuroscience and education at Columbia University, and Katherine Magnuson, professor of social work at the University of Wisconsin, Madison, is providing new mothers with $330 each month over three years to see if this extra income can have a ripple effect that supports brain development in young children.
The neuroscience data from studies like Baby’s First Years might convince policymakers who aren’t convinced by data from “soft” sciences like psychology of the need to provide families with more resources. Jones Harden has already seen changes she attributes to developmental neuroscience.
“We’ve got a national home visiting program. We’ve got early childhood support programs attached to pediatric clinics, attached to court systems,” she said. The brain science, she said, “has made a huge difference.”
Jackie Rocheleau is a freelance journalist and editor based in upstate New York. She writes about neuroscience, public health, and medicine. Follow her on Twitter at @JackieRocheleau.