January 26, 2015

expert reaction to changes in brain white matter in children suffering neglect

A study published in JAMA Pediatrics has examined the structure of the brains of infants in care homes, and compared children who remained in institutions with those who were placed in foster care. The researchers report associations between neglect of those in care homes in early life and poor quality of development of various parts of the brain.

Dr Andrea Danese, Head of Stress & Development Lab and Senior Lecturer in Developmental Psychobiology and Psychiatry, King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, said:

“This study is consistent with previous research suggesting that adverse childhood experiences, such as abuse or neglect, influence brain development including white matter development. The study significantly adds to existing literature suggesting that interventions, such as foster care, may remediate some of the effects of adverse childhood experiences on brain development.

“The brain’s white matter is made up of layers of (glial) cells that wrap around neurons’ terminals (axons) and speed up the connection between different neurons and different brain areas. After birth and until young adult life, there is a linear increase in the amount of white matter, which contributes to progressive increase in the speed of cognitive performances.

“In the context of limited available resources, the researchers have randomly assigned children to foster care or treatment as usual. Because of the random assignment, children in the two treatment groups had similar background characteristics. In the past, this remarkable feature of the study has enabled researchers to study the role of foster care on cognitive and behavioural outcomes in these children, ruling out alternative explanations. However, only a fraction of the children originally enrolled have taken part in the current neuroimaging study. Therefore, it is less clear if the findings in the current paper could be accounted for by alternative mechanisms.

“Further research is needed to understand what are the specific cognitive or behavioural correlates of the white matter differences reported in this study. Nevertheless, similar white matter abnormalities have been previously described in young people with a wide range of psychiatric disorders and, thus, appear to be a good candidate mechanism through which adverse childhood experiences can influence mental health.

“Ultimately, the study reminds us that the brain of children is very plastic. Bad experiences can harm it. Yet, early interventions have the potential to at least partly remediate harm. This is inspiring news for the many dedicated mental health workers and a call to boost financial support to the strapped child and adolescent mental health services.”

‘Effect of Early Institutionalization and Foster Care on Long-term White Matter Development – A Randomized Clinical Trial’ by Bick et al. published in JAMA Pediatrics on Monday 26^th January. 

Declared interests

Dr Andrea Danese has been funded for research on child maltreatment by MRC, Wellcome Trust, NARSAD, and the U.S. National Institute of Health. He is author of several papers on the topic of child maltreatment and wrote a chapter on this topic in the forthcoming new edition of the mainstream Rutter’s Textbook of Child & Adolescent Psychiatry. He is Senior Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, where he directs the Stress & Development Lab. He is also Consultant Child & Adolescent Psychiatrist with the National & Specialist Child Traumatic Stress & Anxiety Clinic, South London and Maudsley NHS Foundation Trust.