The Biological Embedding of Child Abuse and Neglect: Implications for Policy and Practice
Each year within the US alone over 770,000 children are victimized by abuse and neglect (US Department of Health and Human Services, 2010), and this figure is likely to underestimate the extent of the problem. Researchers have long recognized that maltreatment has adverse effects on children’s mental health and academic achievement. Studies of adults show that adverse childhood experiences like maltreatment increase risk for chronic diseases of aging, including Type II diabetes and cardiovascular disease. What the field does not fully understand is why maltreatment has such pervasive effects. Studies on the neuroscience of maltreatment have begun to offer some clues. Victims of maltreatment differ from non-victims with respect to brain structure and function, hypothalamic-pituitary-adrenal-(HPA) axis and autonomic nervous system function, immune function, and epigenetic markers. These studies identify potential mechanisms by which maltreatment increases risk for poor mental and physical health and poor school performance by affecting systems that subserve memory, attention, the response to stress, and inflammation. The findings highlight the importance of broadening the scope of child welfare beyond child protection to include child wellbeing. A focus on child well-being would require integrated services, wherein comprehensive mental and physical health care are routinely offered to victims of maltreatment and case workers, pediatricians, and psychologists would work as teams to determine how best to deliver care to children and families in the child welfare system. In working with the family, such efforts could potentially reduce the risk of re-victimization which commonly jeopardizes long-term gains in child well-being.