Based on years of research, the framework – called the Intergenerational and Cumulative Adverse and Resilient Experiences (ICARE) model – identifies 10 types of ACEs, as well as 10 protective and compensatory experiences (PACEs) that build resilience.

The ICARE model also recommends a wide set of interventions that address the many ways ACEs can harm children’s development. At the heart of the approach is supporting the protective factors that are already in place in families and helping families become stronger.

The ICARE model shows the pathway by which ACEs can disadvantage children’s future and harm the next generation.

Neurobiological and epigenetic impacts of ACEs

Prolonged activation of stress responses that are typically used in brief crisis-response situations results in biological and neurobiological changes that can become embedded in a child. The body’s immune system can be harmed, as well as the development of brain structures and functions. Epigenetic changes to DNA as a result of adversity – the methylation of certain genes that change how they function – embed the impact of ACEs, influencing how the child responds to stress later in life. Epigenetic changes are heritable, passed from mothers and fathers to their biological children.

The ICARE model shows the pathway by which ACEs can disadvantage children’s future and harm the next generation.

Developmental impacts of ACEs

The most significant developmental system in early childhood is attachment. Secure attachment evolves when an infant’s needs are consistently met, creating a safe and predictable place where caregivers can be trusted. Attachment also has a biological/neurobiological dimension, for example, with the action of the hormones dopamine and oxytocin. ACEs can disrupt attachment, which is associated with a wide range of behavioral, social, and emotional problems later in life.

ACEs can also damage cognitive development. Skills associated with executive function, such as working memory, inhibitory control, and focused attention, can be harmed in children who have experienced adversity. This can lead to problems with learning during education and training.

Intergenerational transmission

ACEs can disadvantage the next generation in two ways: Parents who have been adversely affected by ACEs in their own lives are more likely to struggle with parenting. And parents may pass to their children epigenetic changes that affect the child’s biological response to stress.

Strategies to mitigate the negative impacts of ACEs

The foundation of the strategic approach proposed by the ICARE model starts with assessing and mobilizing protective factors that already exist or could exist around the child. Researchers point to successful support programs in five categories:

1. Supporting parents and caregivers with their own psychological and emotional well-being
2. Supporting parents and caregivers with attachment and parenting skills
3. Supporting children directly, for example, by encouraging their participation in sports, hobbies, and friendships
4. Psychological therapies for children that address the past traumas
5. Play-based therapeutic activities for children and parents together

The authors of the framework explain that the ICARE model “suggests new opportunities to design and implement multilevel prevention and intervention programs across the various pathways by which adverse and protective experiences influence outcomes.”

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Experiences that build resilience strengthen children who face adversities.

Adversity, such as abuse, neglect, and poverty, damages children. But protective experiences can build resilience against adversity and promote positive development.

We identified 10 relationships and resources proven to counter the impact of adverse experiences. They have hidden magic that can transform an otherwise miserable childhood. Perhaps a child has been abused and has an alcoholic or depressed parent – or both. Down the street lives a grandmother who provides safe harbor. Maybe a caring teacher or an athletics coach takes the child under her wing. These are just a few of many protective antidotes that can diminish the toxicity of adverse experiences. They mean that a child’s outcomes may turn out to be much better than expected in the face of difficult circumstances.

This list of PACEs – Protective and Compensatory Experiences – is based on more than common sense. The impact of such experiences is often identifiable through changes to the brain and in behaviors. For example, experiments with mice graphically demonstrate what can happen when a PACE repairs some of the damage caused by bad early experiences.

PACEs and genetic changes

 A new mother mouse placed after the she gives birth in an unfamiliar environment with inadequate bedding typically becomes abusive to her pups. She may step on her young, and stop licking or grooming them because she is stressed. These pups grow up and act in a depressed manner, and are more likely to be harsh and fail to nurture their own pups. However, when the pups are fostered by non-stressed, nurturing mothers, over time, the epigenetic change driving their abusive behaviors can be reversed.

“When children experience multiple forms of adversity, the impacts are magnified. Multiple protective experiences may also have a cumulative effect.”

We do not yet have data for humans on the epigenetic impact of switching from an adverse to a protective experience. However, infants raised initially in Romanian orphanages who were later fostered in nurturing homes showed developmental benefits that likely mirrored the neurobiological improvements observed in mice.

Our colleague, David Bard, professor of pediatrics at the University of Oklahoma Health Sciences Center, has demonstrated how positive parenting practices in thousands of U.S. families have buffered children against the impacts of adversity. Activities such as reading to children; ensuring they have routines; and taking them to shops, museums, and playgrounds were associated with better learning in preschool and fewer behavioral problems at school than would otherwise have been expected.

Top 10 protective and compensatory experiences

From research evidence, we have assembled a list of the top 10 types of relationships and resources that provide the PACEs that bolster children against adversity. These are detailed more extensively in our new book, Adverse and Protective Childhood Experiences: A Developmental Perspective.

1. Receiving unconditional love: Not only do children need to be nurtured and loved, that love should feel unconditional. This does not mean that children never get in trouble or parents never get mad. The crucial point is that whatever a child does, the parent stays on the child’s side. As an infant, it means that when you cry, you get a response; your parents make eye contact with you and cherish you; and they sing, play, and talk with you. As a child, you can count on your parent’s eyes lighting up when you walk into the room; mom or dad always has your back. And when you grow older, it means that your parent sets limits and explains how things are done. There are many ways to express unconditional love.
2. Having a best friend: Close friendship offers protection from peer rejection, bullying, and victimization. This happens not just because a child has someone to talk to, but because it helps the child learn how to deal with conflict and grow a relationship over time. Children have a sense of being important and they have someone to go to.
3. Volunteering in the community: Volunteering helps children learn about the needs of others and gives them the opportunity to see a world outside their own. When they understand that helping is not done out of pity, it allows them to accept help from others when they need it.
4. Being part of a group: Being in a group gives children a sense of belonging outside the family. It allows children and teenagers to learn about themselves in different contexts, and provides opportunities for friendship and leadership. Taking part in school clubs and sports is linked to academic success, psychological well-being, and lower rates of substance abuse.
5. Having a mentor: Having an adult other than a parent who can be trusted and counted on for help and advice helps protect against psychological distress and academic difficulties, and reduces the incidence of high-risk activities. Even if children have exemplary parents, an adult outside the home can be an alternative role model to whom children can aspire and is a reminder that someone else loves them.
6. Living in a clean, safe home with enough food: These primary needs are crucial. Good, regular nutrition is important for brain development and protects against health problems; eating dinner regularly with your family reduces the risk of weight problems. Chaotic, unpredictable home environments are associated with harsh and inconsistent parenting. Children who live in unclean, cluttered homes have worse outcomes than those living in clean, organized homes.
7. Getting an education: Just like living in a clean, safe home, the opportunity to learn and be educated in an environment with boundaries and rules also protects children from risk. High-quality early childhood programs make a lasting difference to outcomes for children from low-income families.
8. Having a hobby: Whether it is playing an instrument, dancing, doing judo, reading, or playing chess, any recreational activity helps teach self-discipline and self-regulation, and can provide children and youth with a routine and a sense of mastery, competence, and self-esteem.
9. Engaging in physical activity: Being physically active helps children handle the physiological effects of stress on the body, and improves mood and mental health. In so doing, it reduces the likelihood that children will grab a bag of chips or lash out to relieve stress.
10. Having rules and routines: Security comes when children know what to expect and when caregivers enforce clear rules and limits. Children cannot parent themselves; they need high expectations, consistency, and parents’ involvement. In early childhood, this means that parents should establish and enforce bedtime and other routines, redirect children when they misbehave, and as children grow up, explain the effects of their behavior on others.

Photo: Anna Earl. Unsplash.

We know that when children experience multiple forms of adversity, the impacts are magnified. Likewise, multiple protective experiences may have a cumulative effect for children, though the power of this accumulation requires further study.

PACEs matter for all children

Adverse experiences can happen anywhere to anyone — the rich as well as the poor. All children should have access to experiences that bolster and protect them. Children from more well-to-do families who face adverse experiences, such as family break-up, mental illness, and substance abuse, are more likely to have compensatory experiences. These might be opportunities to participate in clubs, have tutors, go to drama classes, choose to play an instrument, and have teachers and coaches who really care about them.

“Down the street lives a grandmother who provides safe harbor. Maybe a caring teacher or athletics coach takes the child under her wing. These are just a few of many protective antidotes that can diminish the toxicity of adverse experiences.”

In contrast, children in families living in high-crime and high-poverty neighborhoods might lack access to protective experiences because their families have insufficient money or time. These children face a double jeopardy – more adversity and less compensatory protection. Their difficulties have increased in recent decades as many PACE resources, such as youth sports and activities, have become increasingly expensive.

The COVID-19 pandemic has emphasized how alone many parents are as they try to help their children gain access to PACEs. Parents have struggled to support their children’s learning at home, grappling with isolation; lack of routines; inadequate opportunities for exercise and hobbies; and in some cases, lack of enough food to keep children healthy.

The pandemic reminds us that promoting childhood development is about much more than preventing adversity. We need to think more about how to ensure that children have the good things in life so they are less likely to be hindered by what can go wrong.

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Research shows that parents’ legitimacy increases when they set rules based on morality and safety. Constructive practices are more effective than harsh ones.

As children move into their preteen years, they increasingly differentiate between rules and obey the ones they think are legitimate. One of the most promising ways to bolster parents’ legitimacy is to treat children fairly.

Negative Impacts of Punishment

Parents often try to make their children comply with rules through punishments, but in our study, parental practices of procedural justice predicted obedience more strongly than did punishments. Procedural justice practices include allowing children to give their side of the story, explaining to them why they are being reprimanded, and talking politely.

“Research shows that parents’ legitimacy increases when they are fair judges.”

The study assessed a diverse group of 697 Brazilian 11-, 12-, and 13-year-olds once a year for three years. Disciplinary practices were classified into constructive practices (e.g., removing privileges, reprimanding verbally, grounding) and harsh practices (e.g., threatening, physically punishing , yelling). Harsh practices actually increased disobedience, possibly because they diminished perceived parental legitimacy. In other words, when parents punished their children harshly, instead of promoting obedience, it made the parents look less credible.

Parents often try to make their children comply with rules through punishments

This study also allowed children to differentiate between issues. It is well established that, as children develop, they discriminate between domains over which parents have authority and grant more legitimacy to issues of safety and morality than to issues of convention or personal preference. In the study, the children were presented with 10 common household rules and asked if it was legitimate for their parents to have that rule. The issues with the highest legitimacy across all three years were substance use and truth telling. The issues that declined the most in legitimacy were media use, curfews, homework, and dating. And the strongest predictor of individual obedience was issue-specific legitimacy. Thus, children obeyed the rules over which they thought their parents had legitimate authority.

The study also asked about parents’ global legitimacy, in other words, whether youth thought their parents had the right to make the rules and whether they trusted their parents to make the right decisions. Youth’s evaluations of global legitimacy also strongly predicted their obedience.

“One of the most promising ways to bolster parents’ legitimacy is to treat children fairly.”

Prior research has established that authorities with high levels of procedural justice are typically legitimized. In other words, if your child thinks you are a fair judge, he or she may obey you because he or she sees you as a legitimate authority figure. However, harsh disciplinary strategies may backfire for the same reasons. Instead of eliciting a healthy fear, they may unintentionally undermine parental legitimacy.

So, for your children to obey you, based on this study, you should:

• Avoid harsh discipline because it tends to backfire in the long term.
• Emphasize procedural justice (hear youth’s perspective, be polite, provide explanation).
• Stick to issues of morality and safety – it may be a losing battle to enforce other rules.

Published on 31/01/2021

Updated on 05/02/2024

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Adverse childhood experiences include growing up in poverty; absence or death of a parent; violence; caregivers’ drug or alcohol addiction; physical or emotional neglect; peer victimization; or physical, psychological, and sexual abuse.

Based on the study, the researchers concluded that fathers should be involved in programs that support children with problems such as anxiety, anger, inattention, and sleep disturbance. Other studies have shown that parents with a reported history of prior maltreatment have the capacity for improving their parenting practices. Fathers should also receive direct support to address depression and negative parenting practices.

The study featured 118 fathers of 6- to 17-year-olds. All fathers were in stable, committed relationships with the mother of their children. Fathers completed a series of psychological questionnaires and evaluations of their own children. They were asked about their own childhood experiences, their assessment of their children’s mental health (inattention, sleep disturbance, depression, anger, anxiety), their own parenting practices, and their relationship with their children’s mother.

The correlations in this research do not imply causation, but they do correspond with earlier research, particularly on mothers. Mothers’ depression and negative parenting has been shown to explain the link between their own adverse childhood experiences and their children’s development – including communication, problem solving, motor skills at age 2, health, and hyperactivity. Many studies have confirmed that individuals who were maltreated in childhood are at risk of repeating these negative behaviors toward their own children.

Fathers’ symptoms of depression have also been linked to their children’s anxiety, depression, substance addiction (for up to 20 years), psychiatric disorders, lower academic performance, hyperactivity, social problems, and emotional difficulties. The global socioeconomic changes that have been occurring for the last 40 years suggest that the traditional mother-focused models of developmental influence are old fashioned. The presence and involvement of fathers in their children’s lives is strongly associated with their offspring’s social well-being, academic achievement, and behavioral adjustment. Moreover, longitudinal studies have confirmed that, in child development, fathers matter in ways similar to mothers.

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Research shows that hitting children of kindergarten age harms their literacy skills through eighth grade.

A detailed statistical analysis of data collected from over 21,000 children in the United States  sheds new light on how harsh parental physical discipline during the kindergarten years can lead to reduced literacy in the subsequent eight years. Literacy is important because reading is a foundation of learning: Children learn to read and they need to read to learn.

Children with parents who frequently use physical discipline when the children are of kindergarten age are more likely to exhibit externalizing behaviors (e.g., aggression, acting out) in first grade, and such behaviors are likely to interfere with subsequent literacy development through eighth grade. In other words, the link between harsh parenting and reduced literacy skills can be explained by the fact that children who are hit are more likely to behave disruptively at school, which impedes their learning to read.

Based on this finding, the authors make three recommendations.

• Researchers should investigate more closely how teachers respond to children who act out in class to see how this results in reduced learning on the part of the child.
• Teachers and others who support parents should inform them about the negative effects of harsh discipline on children’s socioemotional development and subsequent impairment of literacy skills. They should teach parents alternative forms of discipline, such as setting limits, providing reminders about rules, and explaining the consequences of behavior, all of which are correlated with prosocial behavior and empathy.
• Education policy makers and managers should ensure that educators target the whole child by addressing their socioemotional learning, too.

The data in this analysis were drawn from the Early Childhood Longitudinal Study – Kindergarten class of 1998-1999 (ECLS-K). The nationally representative cohort consisted of 21,260 children from 944 kindergarten programs in the United States. Children’s externalizing and internalizing were assessed by asking teachers to rate the children. Literacy skills were directly measured by assessing the children. Parental discipline was assessed via a questionnaire that asked parents about discipline, warmth, and emotional supportiveness.

The picture from earlier research

 Research has shown a correlation between harsh parenting and reduced language comprehension, reduced vocabulary, and poorer reading in children. But how this happens has been unclear.

Harsh parenting – for example, shouting, threatening, shaming, spanking, slapping, pushing, or hitting with an object – is clearly linked to impaired social and emotional development in children. This kind of parenting is also correlated with more aggression, hostility, and disruptive behavior on the part of children.

This kind of behavior in children is also linked to less optimal academic performance. The hypothesis with the strongest evidence to explain this is the adjustment erosion hypothesis; it holds that impulsivity, hostility, and other such behaviors disrupt learning. These behaviors can even lead to children being excluded completely from the classroom or school. An alternative hypothesis – that academic incompetence comes first and leads to disruptive behavior — is not backed as strongly by evidence, especially in the early school years. However, influences in both directions do seem to exist.

This new statistical analysis confirms these associations, going further than previous research to find a correlation between harsh parenting during the kindergarten years and decreased literacy skills eight years later.

In this study, children’s externalizing symptoms in first grade completely mediated the relation between parents’ physical discipline in kindergarten and the development of literacy between kindergarten and eighth grade. In addition, children’s externalizing symptoms in first grade partially mediated the relation between parents’ physical discipline in kindergarten and children’s eighth-grade literacy levels.

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Gender nonconforming youth are more likely to experience rejection and verbal, physical and sexual abuse from both parents and peers.

Gender nonconforming children, particularly boys, experience victimization. They are more likely to be rejected and verbally abused by their parents, and they suffer higher levels of both depression and PTSD. Men who identify as both gay and “effeminate” report more sexual abuse in childhood. This may be related to the general low value given to “feminine” behaviors and characteristics. Possibly as a result, boys are less likely to be gender nonconforming than girls. 

Gender identity and child development

Children learn gender labels when very young, at 18 to 21 months, shaped by parental behavior and expectations. For example, parents give girl and boy toddlers different toys, and they often expect boys to be better at crawling than girls. At two years, children can already feel atypical if they are not like others of their own gender.

Researchers at Yale and Harvard universities in the USA reviewed how victimization of gender nonconforming children influences their development. They present a “social cognitive” approach which proposes that gender identity develops through direct influences, such as verbal messages about how boys and girls should behave, and indirect influences, such as parents modelling gender specific behavior. A child is an interactive agent in this process of development. The process is influenced by culture: for example, non-Western or more religious men are likely to be less accepting of gender nonconforming individuals.

Two types of socialisation have been studied: in the home and among peers.  

Gender socialisation at home

At home, gender socialisation takes place through things like clothing, how parents praise their boys and girls and how parents use gender specific pronouns. Experimental studies have shown that adults interacting with infants introduced as a girl were more likely to give ‘feminine’ toys to the child, such as dolls and domestic items. If the infant is introduced as a boy, however, they are more likely to introduce ‘masculine’ toys, such as tools and cars, and they encourage more physical activity. Parents support things like exploration, rough-and-tumble play and dressing up differently in boys and girls, despite a lack of evidence that boys and girls are different in any domain typically associated with gender, such as crawling ability. 

Parents tend to associate gender nonconformity in children with homosexuality and often discourage gender nonconforming behavior. Discouragement of nonconformity in children as young as four years includes telling them to change their behavior, punishing or restricting their nonconforming activities and sending them to counseling. Such children are also at greater risk of physical, psychological and sexual abuse in the home, and of PTSD later in life.

These problems affect sexual and gender minority youth in particular—individuals who identify as lesbian, gay, bisexual, queer, or another orientation that is not heterosexual, as well as those who identify as transgender, agender, gender fluid, or another category that is not cisgender. Transgender youth are particularly exposed to negativity from their parents. 

Gender socialisation among peers

When young children play among peers, their play becomes more gendered. For example, girls are less likely to play with toy cars when they are not alone. Preschool and middle-school children are more likely to befriend same-sex children with similar levels of gender-typed behaviors. Peer popularity of children is strongly related to gender conformity across childhood: there are strong social rewards for conforming. 

The process of gender socialisation is visible in trends across childhood. Over time, children’s attitudes about the other gender become more similar to their friends’ attitudes. Children’s identification with their own gender grows; at the same time, peer harassment and victimization of nonconforming children increase. As a result, gender nonconforming behavior falls over the school years.

This process is linked to children’s cognitive development: they are increasingly able to make social comparisons between boys and girls, to develop a sense of self around gender and to imagine what others are thinking about them.  

Gender nonconforming youth are more likely to experience rejection and verbal, physical and sexual abuse from peers. They are more likely to experience low self-worth, but only when they do not feel accepted by their peers. If they do feel accepted, no increased risk of low self-worth is present.

Child development risks from negative responses to gender nonconforming children 

Gender nonconforming children are more likely to suffer depression and to have suicidal thoughts. They are also at greater risk of bullying others and becomingaggressive.  The authors of the review describe the process according to “minority stress theory”, which encompasses both actual discrimination and the internalized response to it on the part of the victim. Such responses may include internalized homophobia, chronic vigilance about rejection and concealment of sexual orientation. 

What can be done?

Family acceptance of gender nonconforming children is important. For example, a father’s acceptance of nonconforming behavior in his son protects the child from psychological distress. (No such link occurs between fathers and daughters.)

The researchers make recommendations to parents about how to support sexual and gender minority children – talking about gender nonconformity, respecting it, ensuring other family and community members do the same, finding adult role models, and welcoming the child’s friends. 

Action in schools to support gender nonconforming children is particularly important given the long span of strong peer influence on child development. Again, the researchers direct their recommendations to the particular case of sexual and gender minority children. They recommend that schools explicitly address sexual orientation and gender and negative reactions to gender nonconformity. Teachers need training, and gender nonconforming students need support groups. The topic should be on the school curriculum, they write, and sexual orientation should be an explicit part of anti-bullying strategies.

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Reminiscing has been described as “emotional socialisation”, nurturing a child’s emotional development. Parents sensitively reminiscing about earlier experiences with their children is part of early childhood emotional development.

Is maltreatment by parents associated with less quantity and quality of parent-child reminiscing on the child’ past, and, if so, is this a mechanism by which maltreatment leads to poorer early childhood emotional development?

Researchers who asked this question in a recent study found a pathway between maltreatment and emotional development. Specifically:

• Maltreatment predicts less sensitivity in reminiscing activity (less encouragement, more criticism); perhaps these parents are less able to reminisce about the past, or they are less sensitive to the child while reminiscing.
• Less sensitive reminiscing predicts less developed emotion regulation and less inhibitory control on the part of the child.

Reminiscing has been described as “emotional socialisation”, nurturing a child’s emotional development. Other research has shown that parents’ sensitively reminiscing about earlier experiences with their children plays a significant role in early childhood emotional development. Conversely, children of mothers who are unable to discuss past emotional experiences with their children in a sensitive way are more likely to display deficits in remembering their past lives, understanding emotions and regulating their emotions.

In this based experiment, the researchers worked with mothers only, acknowledging that later research should include fathers and others who are likely to reminisce with young children. The study, based in the USA, involved 111 maltreating mothers and 65 non-maltreating mothers of 3- to 6-year-old children, all from similar demographic backgrounds.

The researchers asked the mothers to reminisce with their children about four past emotional events – one in which the child was happy, then others in which the child was sad, angry and scared. The sessions were videotaped and coded against measures of how well the mother stayed focused on the task, how encouraging and non-critical the mother was towards her child, how engaged and interested the child remained, how the mother responded to negative emotions, how well the mother worked with the child jointly to construct stories, how well the stories matched the happy/sad/angry/scared themes, and how fluent and clear the stories were.

The researchers homed in on three specific components of early childhood emotional development to measure:

• ‘lability/negativity’ – things like wide mood swings and quickly becoming frustrated
• ‘emotion regulation’ – things like being empathetic towards others and responding positively to peers
• ‘inhibitory control’ – the ability to control attention and not react compulsively.

The first two were measured by asking the mothers to complete questionnaires. Inhibitory control was tested with the children by giving them a task that could challenge them – saying “day” when presented with pictures featuring the moon, and “night” when presented with pictures featuring the sun.

The researchers found a pathway to two of the early childhood emotional development outcomes, emotion regulation and inhibitory control; they did not find a pathway to child lability/negativity. However, children who experience maltreatment are more likely to show greater lability/negativity. So the correlation between maltreatment and poorer emotional development does not appear to be influenced by how well the mother is able to engage in reminiscing with the child. Alternatively, it may be a deficit in the research method, given that all forms of maltreatment were lumped into one, and the impacts of different levels/types of maltreatment on emotional development might be significant.

Of course, reminiscing with parents is not the only activity that supports early childhood emotional development. Interactive reading and conversation through free play, for example, are other ways to enhance child emotional development. Other research has shown some differences in outcomes between these types of parental engagement. Reminiscing activity has a stronger link with language and literacy than does reading books together, for example.

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Disentangling the neurological impacts of different adversities, such as child neglect and child abuse, shows biological pathways that underpin child development challenges.

Picture children who are having a hard time paying attention and are disrupting a classroom. What’s the best way to address their behavior and help them to concentrate? Is it mindfulness training, to help them calm them down and react less to everything going on around them? Or is it cognitive training to improve their capacity to problem solve, making it easier for them to stick with the learning process, rather than giving up and disrupting their peers? The choice may depend on whether they’ve experienced child neglect or abuse and the impact on their brain development.

Victims of child neglect, or children with few invested caregivers who talk to them and engage them in learning-oriented play, may have a brain that is underdeveloped in areas that support complex thinking. On the other hand, a child who has experienced abuse or violence could have very different biological issues. He or she has a brain that’s been shaped by threat—its biology has been primed to be hypervigilant and overreactive.

These very different biological histories may manifest as what can seem to be the identical problem—disruptive behavior. But if we understand the very different neurological pathways forged variously by child neglect or abuse, we can explain why the same behaviors need different approaches that are tailored to each child’s experiences and neurobiology.

Different treatments for abuse and child neglect

Mindfulness and emotional regulation training could help abused children reduce their emotional reactivity and function better. In contrast, for neglected or deprived children, the answer might be developmentally appropriate, scaffolded learning experiences designed to challenge them. This could even involve, for example, computerised training of their attention skills. Exercises could gradually provide more complex tasks and develop their capacity to think in increasingly difficult ways.

Understanding the neurological impacts of child neglect and abuse 

These scenarios show how neuroscience is providing vital insights into the biological mechanisms, shaped by early experiences, that set in place the pathways to psychological and processing problems. Research is demonstrating how different types of adversity impact brain development in distinct ways. We need to understand these neural mechanisms to develop better targeted, more discriminating and more successful interventions, each designed to address particular brain impacts caused by different kinds of early adversity.

“At least two types of childhood adversity – deprivation (child neglect) and child abuse (threat) – are distinctive in terms of their biological impacts on the human brain.”

Identifying these mechanisms can be challenging, because some children have experienced multiple adversities. However, it is important to disentangle discreet impacts on brain development so that we can design appropriate ways to address them.

Research is making clear that there are at least two types of childhood adversity – child neglect (deprivation) and child abuse (threat) – which have distinctive impacts on the human brain.

Evidence about brain impact of child neglect and deprivation

Deprivation involves an absence of expected inputs from a child’s environment, such as cognitive and social stimulation. It’s a core feature of child neglect and institutionalisation. It can also be found in children with constrained learning opportunities, such as those reared by parents with few opportunities to invest in their children’s development.

We know that animals raised with a lack of environmental stimulation typically experience dramatic increases in synaptic pruning, resulting in reduced cortical volume and thickness in their brains. These changes are accompanied by deficits in learning and memory. The same picture can be found when cognitive enrichment and social stimulation is low during early human development.

Photo: David Goehring. Creative Commons.

For example, our studies of children raised in Romanian orphanages, an extreme example of child neglect with severe deprivation of caregiver contact, found that they often had reduced volume and thickness throughout the brain’s cortex. In these orphanages, children were deprived of stimulation, and their young brains developed to become as efficient as possible for the environment they faced. Their brains were learning that they would not need rich synaptic connections for sensory experiences. Our hypothesis is that these synapses would have been “over-pruned”. In brain development, this is a tragic example of the “use it or lose it” principle.

Recent evidence has found similar patterns of brain development, albeit more circumscribed, in children raised in poor households. In such cases, because of a limited social safety net, parents may be working multiple jobs, so they can’t be present with their children and can’t afford high quality care. Thus, their children may also experience some form of child neglect. Other research has identified increased cortical thinning in children from poorer families.

These disruptions to healthy brain development, caused by a lack of cognitive stimulation, underpin reduced capacities to think and learn in such children.

Understanding impact of abuse, living under threat

In contrast, abuse encompasses experiences involving harm or threat of harm. Living with threat is a core feature of sexual abuse, physical abuse and exposure to community violence or war. The biological impact of being raised amid chronic threat is increasingly being documented. It biases the development of cortical and subcortical circuits towards early detection of other threats, and it can create hypervigilance. These biological changes alter emotional development in ways that facilitate the rapid identification of potential threats to the environment, a heightened emotional response to those threats, and a reduced ability to control this response.

“A focus on ‘cumulative risk’ from multiple adversities can fail to distinguish the type, timing or severity of different experiences.”

As a result, children who have experienced physical or sexual abuse are more alert to threatening stimuli. They are more likely to perceive neutral facial expressions as threatening. They also find it difficult to discriminate between threat and safety cues in learning situations. These differences in emotional reactivity and regulation lead to psychological problems such as depression, anxiety and anger-related disorders.

Danger of focus on ‘cumulative’ adversity 

These distinctions between child neglect/deprivation and child abuse/threat have been ignored in recent research focused on “cumulative risk”. Cumulative risk focuses on children experiencing multiple adversities. This approach rightly recognises a key reality—children exposed, for example, to poverty, deprivation and child neglect are also more likely to experience violence and abuse. The multiplicity of adversity is, in itself, dangerous to children. However, this cumulative approach, which is dominant in the field, can fail to distinguish the type, timing or severity of different experiences. It also throws little light on the different mechanisms by which children’s psychopathology is impacted and makes it harder to design interventions to address the psychological problems which result from adversity exposure.

Neglect in Romanian orphanages

Our research into the children raised in Romanian orphanages is pertinent. They suffered severe child neglect, deprived of both attachment and stimulation. We were able to show that exposure to institutionalization early in life caused clear reductions in IQ and cognitive function, and changed their neural structure.

Our work – comparing the brains of infants rescued early with those who remained institutionalised for longer – has also helped us understand how these losses may be recoverable. Children who moved into families before they were two years old were able to recover in some ways with regards to their stress responses and IQ. This was less true for their executive functioning and attention – recovering this capacity seems to require even earlier intervention. Some research suggests that children who were rescued before they were six months old were doing a lot better in terms of executive function.

Adolescence is an important intervention opportunity

Neuroscience is helping practitioners understand when—and in response to which experiences—the brain is more plastic, making it responsive to certain interventions. We know that the brain remains plastic throughout life, but much less so after infancy, and plasticity apparently declines with age. But current research suggests that there may be another opportunity for plasticity during adolescence.

Linda Wilbrecht at the University of California, Berkeley has shown that hormonal changes at this age increase brain plasticity. This finding offers the intriguing and hopeful possibility that interventions around adolescence – ensuring that children experience positive relationships with trusted caregivers – may offer a second major opportunity, beyond infancy, to recover from child neglect or abuse, making a great difference in children’s brain development and their lifetime prospects.

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Brain development in children is influenced by good experiences, counteracting early trauma’s impacts, suggests neuroscience.

We need to identify and provide sustained experiences that can reverse or moderate the biological impacts of adversity on the brain development of children.

For example, children exposed to adversity may learn to cope with stress by becoming hypervigilant to signs of threat. These adaptations may help them manage some aspects of their early lives, but the biological imprints can leave them vulnerable to behavioral pathologies and make them overreact to less extreme situations later in life.

At the moment, we don’t know which interventions can alter children’s brain development for the better after early adversity has harmed them. However, we do know that the human brain is plastic, particularly when very young, and therefore mutable in ways that can not only harm but also benefit children in the long run.

Shaping brain development in children

We are also beginning to understand the nature of what shapes children’s brains. Research tells us that harm is typically caused by chronic experiences of extreme adversity.

Findings from experiments with rat pups suggest the potential for interventions that can tackle these harms. These studies showed that abusive parenting altered the genetics underlying the pups’ stress response system, so that the young rats had difficulty switching off their stress responses. However, when the same rats were moved and placed with responsive, caring mothers, that epigenetic change was reversed.

“The human brain is plastic and therefore mutable, in ways that can not only harm but also benefit children in the long run.”

Our next step must be to discover much more about how the human brain responds in positive ways to good experiences. This could help us identify interventions that can reverse the biological impacts of childhood adversity.

Neuroscience has already given us insights into the biological mechanisms that underpin the behavioral traits that often follow trauma, abuse, and deprivation in childhood.

How adversity affects brain development in children

The neurobiology of children subjected to physical abuse shares much in common with that of children who have been raised in extreme poverty or neglected. This fact suggests that the brain and stress systems learn and adapt in general ways when children find themselves in environments that subject them to high levels of stress.

Neuroscience also tells us that minor perturbations in experiences do not typically result in biological changes in the brain that have a cascading impact. Children’s brains can deal with a lot, and it takes something extreme or enduring to alter biological development.

For example, some people wonder what it is about child poverty that effects brain development. Is it living in a noisy environment? Is it lack of shelter or warmth, poor healthcare, stressed parents, or poor schooling? It likely wouldn’t be a problem if a child had to deal with just one of these components and everything else was OK. The biological needle is much more likely to shift when very young children are dealing with all of these factors at once, over a large period of their young lives.

It’s important here to recognise that infants don’t understand the physics of how the world works, or how social communication and language operate. They have to figure it all out, and this process can shape the brain that they will use throughout life. So a child’s brain will adapt to regulate and cope with an atypical environment that confronts it, even if that adaptation proves costly in the way the child relates to the rest of the world later on in life.

Hypervigilant response to threat

For example, children who have been physically harmed by their caregivers may become hypervigilant to signs of threat. This immediate response might be helpful around a parent who repeatedly becomes suddenly and violently aggressive. Such alertness, monitoring imminent change, may give children more time, prompting them, for example, to leave a room and hide to prevent further injury.

However, hypervigilance can become a problem later on at school, where such children can get into trouble and be viewed as aggressive. They may overreact when they perceive other children or teachers to be angry with them. Such children may mistakenly think that other people are angry with them when, in fact, they are upset with something or someone else. They may also misread upset and other emotions as marks of impending aggression.

Genetic changes caused by experience

My own research points to aspects of biology that might be effective targets for intervention. For example, we found that children in chronically stressed environments showed a change in the genes that regulate how we process stress hormones. Their glucocorticoid receptor gene had a part that was turned off, so these children still had a normal stress response, but they had more difficulty shutting it down and calming themselves afterwards.

We have also done studies showing that children with very high levels of early exposure to stress struggle to update their thinking and behaviors when their environment changes.

“An intervention need not be a traditional form of psychotherapy, but could build on how the brain responds to change.”

In one study, children had to learn to pair pictures of different ordinary objects (like chairs or bottles) with rewards and punishments such as gaining or losing points. Children quickly learned which objects to choose in the game to earn the most points. But when we changed which objects were rewarded, we observed something important. Most children quickly updated their choices and started selecting the objects that were now rewarded, abandoning their previous choices. But children from high-stress backgrounds continued to stick with the options that they first learned, even though doing so was no longer adaptive.

This type of study may give us some neurological explanations underpinning why children from abusive home environments might continue to employ strategies that helped them navigate their atypical home environments even when they are no longer living with an abusive caregiver.

Distinguishing childhood from adult stress impacts

In another study, we measured the life circumstances of children who experienced extremely high levels of early life stress and those with typical levels of stress. We then followed the children until early adulthood. They returned to our lab as young adults, where we studied their brain activation and behavior as they made decisions.

This approach overcame a huge scientific problem concerning studies that ask adults to report their childhood experiences retrospectively. With these studies, it is often difficult to determine whether behavioral problems associated with stress reflect early childhood experiences, or current levels of stress. That’s because people with extremely stressful childhood circumstances often have chronically stressful lives.

In our study, early life stress was assessed prospectively, when the participants were children, thereby avoiding the potential biases associated with adult recall. Our study suggests that childhood stress exposure, more than current adult stress, accounts for brain differences in decision-making. It revealed that adults who experienced very high, chronic levels of stress exposure in their early childhoods had difficulty attending to and using signs of punishments and losses.

Stress leading to poor decision-making

Our really startling finding is that decreased brain responses to cues warning of negative outcomes were associated only with childhood stress exposure, not with current levels of stress in the participants’ adult lives.

Interestingly, these brain responses were also related to how often individual participants engaged in risky behaviors in their everyday lives. So this experiment uncovered a potential neurological explanation about how high stress in early childhood creates risk for a wide range of behavioral problems: altered brain activation seems to lead to poor judgment and decision-making.

Challenge for research and policy

It has become even clearer from my own research and that of colleagues that we need to do our best for children when they are young, because the impact of what happens in those years can be profound and long-lasting.

For older children who have had prolonged stressful lives, interventions really have to derive from the science of learning. Given what we know from neuroscience, an intervention need not be a traditional form of psychotherapy but could build upon one of the many aspects of how the brain responds to change. Researchers now must identify how to harness knowledge about the science of learning and translate these ideas into policies and practices that can improve the well-being of children who have been exposed to negative learning experiences.

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