Neglect - Passive Abuse

 

In the last Newsletter we discussed the damage that occurs when a child is exposed to extreme levels of stress.  Of course, this stress is generated by conditions in the environment often, but not always the reaction to abuse.  Neglect could be considered to be the inverse of these conditions.  It is a condition where the environment fails to provide the stimulus that is needed to form the neural connections that build the cognitive structure that determines our sense of self!

 

Appropriate stimulus is essential in early childhood when the brain is primed to develop foundation networks and there is an abundance of neural material to create the behavioural schemas to navigate the environment.  It is a process of trialling behaviours that will address the needs we have to survive in homeostatic equilibrium.  Over this period of exploration one solution will take primacy.  With progressive use of the neural pathway that facilitates that behaviour will reinforce it creating a memory.  This process is referred to as long term potential (LTP) and is characterised by the popular declaration ‘neurons that fire together are wired together’!  These will eventually become the long-term memories that drive our behavioural choices.

 

The conditions that support this process are at their greatest in early childhood with the abundance of neurons available and the presence of myaline, critical to the strengthening of pathways.  It is also the time when the brain is particularly sensitive to the environment.  One feature of this process is what is described as ‘windows of opportunity’ when areas of the brain are particularly enriched to support specific undertakings.  A powerful example of this process is in establishing the ability to interpret visual stimulation, that is learning to see. 

 

If a child is born with cataracts they are unable to receive visual stimulation, there is nothing to evaluate.  It is in about the first eight months the conditions to learn to see are augmented that is, there is abundance of myaline present.  If the cataracts are removed in time the ability to see will be in place.  However if not, then that child will not be able to correctly interpret their visual environment.  This phenomena illustrates the dual types of impairment that are the consequence of neglect.

 

The first is the necessity of a stimulus to generate the need to create neural pathways, hence memory and resultant behaviours.  The example of the presence of cataracts illustrates just one of the significant processes that require stimulus in early childhood.  In broad sequential terms these periods start with sensory development as illustrated above and the same is required for the interpretation of other receptor inputs such as sound.  The next is the acquisition of language.  All parents rejoice at their child’s first word and it is miraculous how they quickly learn, not only put those words into language. 

 

The next is social and emotional development.  This starts with attachment where the stimulus provided by the primary caregiver, usually the mother will determine the child’s ability to attach with others.  Attachment theory provides a powerful illustration of how different stimulus results in different properties of the child’s ability to bond with others.  In general, there are four types of attachment very briefly described below:

• Secure – where the child feels comfortable and protected in the presence of their caregiver.  They grow to feel they have someone on whom to rely.
• Anxious-Ambivalent – this is the result of inconsistent parenting; the child is unable to depend on the support being there.  This results in fear of rejection of abandonment and these children will be described as ‘clinging’.
• Disorganise – This develops as a result of consistent failure of the caregiver to respond when the child is in distress.  This has an impact on their ability to regulate their emotions.
• Avoidant – this is a result of parenting by strict and emotionally distant parents who do not comfort their child when distressed.  These children become extremely independent and often are uncomfortable in intimate relationships.

 

Each of these types are a result of the social, environmental stimulus that was present at the time the child was ready to develop attachment behaviours.  The same process of relating with others continues with the ability to connect with peers, affiliation is the next stage.  This occurs at playgroup, or preschool, anywhere they mix with children of their own age.

 

One stage that has been identified but, to my knowledge not examined for the same neural and myaline conditions of early childhood is the emergence of the teenage brain, the time when the frontal lobes, in particular are being developed.  In contemporary culture teenagers spend inordinate amounts of time on electronic devices immersed in social media or the various gaming platforms.  The focus on this particular environment may well develop very sophisticated accommodating networks.  I wonder what stimulus is not being catered for?  At a school level, while we develop an authoritarian focus on numeracy and literacy (the dreaded NAPLAN regime), what are we neglecting to provide the stimulus for a healthy development of self?

 

In summary, the first behavioural casualty from neglect is the absence of stimulus.  This is a different issue than the presence of inappropriate stimulus which is a separate cause of dysfunctional behaviour.  In this latter case the pathways will be developed and strengthened; the brain does not make ‘principled’ judgements it just provides for the presenting environment.

 

The second casualty is a result of the brain’s drive for efficiency.  We have discussed the development of dominant neural pathways which were formed through trial and error.  What we must understand that during these trials there are many efforts that did not provide a satisfactory behaviour and were discarded.  This residue of neglected neural connections create an inefficiency in the processing of behaviour and along with those neurons not used they are discarded; this is a process referred to as pruning.  The issue is, once this neural material is removed any attempts to re-address the issues arising from an environmental stimulus are much more difficult to construct.  This is why students who have built a powerful collection of behaviours that work in their early childhood environment struggle if the adult environment they now experience contrasts.  It is very difficult for these students to learn new ‘appropriate’ behaviours!

 

In summary, the behavioural outcomes from neglect is a child who is at risk of cognitive delay, high levels of aggression and anxiety and social isolation.  For students, and there are many who suffer neglect along with the damage that comes from direct abuse, attempts to help them alter their behaviour is an immense challenge.

 

The following is an extreme example of the damage done through acute neglect and abuse.

The MRI on the right is of a child rescued from the Romanian orphanage after the fall of the USSR.  These children suffered the permanent damage to their brains: 

• Amygdala is increased in size.
• Hippocampus reported to be reduced by 12%.
• Prefrontal lobes are 20% smaller and have lesions on the surface.
• Cerebellum is reduced in size

All of these are the result of the actions of adults on these children.  They are not at fault!

 

I hope these recent Newsletters help you understand the enormous challenge you face when dealing with these children and more importantly the real disability resulting from the absence of appropriate stimulus and the neural material lost through pruning.