Effects of Early Experience on Brain and Body

Abstract

This chapter explains how early life experiences affect neurodevelopment. A child’s early environment influences synapse formation in the cerebral cortex and gene expression in the hypothalamic–pituitary–adrenal axis (our stress response system). By altering these pathways, significant childhood trauma can adversely affect a person’s ability to cope with later stress, impacting lifelong health, success, and well-being.

A devil, a born devil, on whose nature Nurture can never stick; on whom my pain, humanly taken, all lost, quite lost.-William Shakespeare (1610)

Parents wonder why the streams are bitter, when they themselves have poisoned the fountain.-John Locke (1689)

The past is never dead. It’s not even past.-William Faulkner (1950)

Appendices

Appendix A: Tables with Possible Answers to the Vignettes

3.1.1 Vignette 3.1: Justin Smith

Table 3.1.1

Facts	Hypotheses	Information needed	Learning issues
Justin is an 18-month-old boy	Justin may be a victim of physical and emotional neglect	Is he really delayed?	What is toxic stress and how can it affect development?
His biological mother is a single parent, poor, and a methamphetamine user	He may also be a victim of abuse	Does he have a medical condition or neurodevelopmental disorder that causes developmental delays and flat emotional affect?	Why is it important to enrich Justin’s emotional and physical circumstances as soon as possible?
His foster mother thinks he is not speaking or interacting the way kids his age should	These circumstances could have exposed him to “toxic stress”
Justin and his family’s medical histories are unknown

Table 3.1.2

Facts	Hypotheses	Information needed	Learning issues
Justin has multiple developmental delays	His developmental delays and blunted social responses are likely the result of emotional deprivation, insecure attachment to his biological mother, and an impoverished environment	Does he have a medical condition that could cause failure to thrive (e.g., cystic fibrosis, celiac disease, hypothyroidism, lead poisoning)?	How does attachment affect development? What type of attachment does Justin display?
He does not have autism	He is malnourished due to neglect		How can we distinguish failure to thrive caused by social versus medical problems?
He has “failure to thrive” (weight below 3rd percentile)	His biological mother did not take care of his basic needs		What kinds of treatments and therapies does Justin need to physically, emotionally, and intellectually improve?
He is anemic	His weakened and uncomfortable physical condition has likely interfered with learning and social enjoyment
He has excoriated diaper rash
He has dental decay
He is already gaining weight in foster care

Table 3.1.3

Facts	Hypotheses	Information needed	Learning issues
No biological cause of his physical and developmental problems was found	Justin is forming a secure attachment to his foster mother	Will Justin be in a stable, nurturing, and enriched environment for the rest of his childhood?	What traits help some children be “resilient” despite early trauma?
His medical and dental problems have been addressed	His response to good nutrition, love, and an enriched environment indicates his problems were rooted in social, not medical problems		Why is poverty a risk factor for child maltreatment?
His emotional responsiveness, growth and development are all improving with a loving and enriched environment	He may respond differently to stress in the future because of his early experiences, and have lingering problems with trust, attention, and learning		How could our society reduce the incidence and impact of “toxic stress?”
	Or, intervention may have come soon enough to help overcome his early circumstances (especially if he is resilient)		How does love (or its absence) affect health?

3.1.2 Vignette 3.1: Leticia Reed

Table 3.2.1

Facts	Hypotheses	Information needed	Learning issues
Leticia Reed is a 42-year-old woman	Mrs. Reed’s lifestyle has led to chronic, disabling health problems	What keeps her from changing her habits and improving her health?	How does mental health affect physical health, and vice versa?
She has peripheral artery disease, diabetes, peripheral neuropathy, obesity, and a history of cervical cancer	Her mental health issues may contribute to her unhealthy lifestyle choices	What is her attitude toward the upcoming procedure, and those trying to help her?
She is scheduled for a left foot amputation	Her mental health issues may impair coping with her upcoming surgery and rehabilitation	Does she have social and financial support to help her with rehabilitation?
She is a tobacco user
She has PTSD, depression, and BPD with a history of parasuicidal behavior

1. PTSD post-traumatic stress disorder, BPD borderline personality disorder

Table 3.2.2

Facts	Hypotheses	Information needed	Learning issues
Leticia was sexually abused as a child and witnessed domestic violence between her parents	Her traumatic childhood may have affected important brain regions that control insight, empathy, emotion, and language, impairing her ability to cope with stress, maintain stable, trusting relationships, learn and succeed	Does she have traits she could draw upon to improve her health or circumstances?	How do ACEs affect later physical and mental health, high-risk behaviors, and success in relationships and employment?
Her mother was depressed, her stepfather was incarcerated	Her history of adverse childhood events may have altered her HPA axis and cortisol levels, increasing her risks of chronic health problems		How does maternal depression impact children?
She has been poor her entire life and works in low-wage jobs	Her childhood may have impaired her own ability to be an attentive, loving parent, extending trauma to the next generation
She is divorced and lives alone
She was depressed when her son was young
Her son has a history of drug use

1. ACEs adverse childhood experiences, HPA axis hypothalamic–pituitary–adrenal axis

Appendix B: Answers to Review Questions

• 1. e

• 2. c

• 3. e

• 4. b

• 5. a