Children’s Bureau/ACYF/ACF/HHS

800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

ISSUE BRIEF

April 2015

Understanding the 

Effects of Maltreatment 

on Brain Development

WHAT’S INSIDE

How the brain develops

Effects of maltreatment 

on brain development

Implications for 

practice and policy

Summary

Additional resources

References

In recent years, there has been a surge 

of research into early brain development. 

Neuroimaging technologies, such as magnetic 

resonance imaging (MRI), provide increased 

insight about how the brain develops and how 

early experiences affect that development.

One area that has been receiving increasing 

research attention involves the effects of 

abuse and neglect on the developing brain, 

especially during infancy and early childhood. 

Much of this research is providing biological 

explanations for what practitioners have 

long been describing in psychological, 

emotional, and behavioral terms. There 

is now scientific evidence of altered brain 

functioning as a result of early abuse and 

neglect. This emerging body of knowledge 

has many implications for the prevention 

and treatment of child abuse and neglect.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

2

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.

This issue brief provides basic information on 

typical brain development and the potential effects 

of abuse and neglect on that development. The 

information is designed to help professionals 

understand the emotional, mental, and behavioral 

impact of early abuse and neglect in children who 

come to the attention of the child welfare system.

How the Brain Develops

What we have learned about the process of brain 

development helps us understand more about the 

roles both genetics and the environment play in our 

development. It appears that genetics predispose us to

develop in certain ways, but our experiences, including 

our interactions with other people, have a significant 

impact on how our predispositions are expressed. 

In fact, research now shows that many capacities 

thought to be fixed at birth are actually dependent on 

a sequence of experiences combined with heredity. 

Both factors are essential for optimum development 

of the human brain (Shonkoff & Phillips, 2000). 

Early Brain Development

The raw material of the brain is the nerve cell, called 

the neuron. During fetal development, neurons are 

created and migrate to form the various parts of the 

brain. As neurons migrate, they also differentiate, or 

specialize, to govern specific functions in the body 

in response to chemical signals (Perry, 2002). This 

process of development occurs sequentially from 

the “bottom up,” that is, from areas of the brain 

controlling the most primitive functions of the body 

(e.g., heart rate, breathing) to the most sophisticated 

functions (e.g., complex thought) (Perry, 2000a). 

The first areas of the brain to fully develop are the 

brainstem and midbrain; they govern the bodily functions 

necessary for life, called the autonomic functions. 

At birth, these lower portions of the nervous system 

are very well developed, whereas the higher regions 

(the limbic system and cerebral cortex) are still rather 

primitive. Higher function brain regions involved in 

regulating emotions, language, and abstract thought 

grow rapidly in the first 3 years of life (ZERO TO 

THREE, 2012). (See Exhibit 1 for more information.)

Exhibit 1 – Functions of Brain Regions

Lower

Higher Abstract Thought

Concrete Thought

Affiliation

Attachment

Sexual Behavior

Emotional Reactivity

Motor Regulation

Arousal

Appetite/Satiety

Sleep

Blood Pressure

Heart Rate

Bruce D. Perry, M.D., Ph.D.

www.ChildTrauma.org Body Temperature

Cortex

Limbic

Midbrain

Brainstem

The Growing Child’s Brain

Brain development, or learning, is actually the process 

of creating, strengthening, and discarding connections 

among the neurons; these connections are called 

synapses. Synapses organize the brain by forming 

pathways that connect the parts of the brain governing 

everything we do—from breathing and sleeping to 

thinking and feeling. This is the essence of postnatal 

brain development, because at birth, very few synapses 

have been formed. The synapses present at birth 

are primarily those that govern our bodily functions 

such as heart rate, breathing, eating, and sleeping. 

The development of synapses occurs at an astounding 

rate during a child’s early years in response to that child’s 

experiences. At its peak, the cerebral cortex of a healthy 

toddler may create 2 million synapses per second (ZERO 

TO THREE, 2012). By the time children are 2 years old, 

their brains have approximately 100 trillion synapses, 

many more than they will ever need. Based on the 

child’s experiences, some synapses are strengthened 

and remain intact, but many are gradually discarded. 

This process of synapse elimination—or pruning—is 

a normal part of development (Shonkoff & Phillips, 

2000). By the time children reach adolescence, about 

half of their synapses have been discarded, leaving the 

number they will have for most of the rest of their lives. 
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

3

Another important process that takes place in the 

developing brain is myelination. Myelin is the white fatty 

tissue that forms a sheath to insulate mature brain cells, 

thus ensuring clear transmission of neurotransmitters 

across synapses. Young children process information 

slowly because their brain cells lack the myelin 

necessary for fast, clear nerve impulse transmission 

(ZERO TO THREE, 2012). Like other neuronal growth 

processes, myelination begins in the primary motor 

and sensory areas (the brain stem and cortex) and 

gradually progresses to the higher-order regions that 

control thought, memories, and feelings. Also, like other 

neuronal growth processes, a child’s experiences affect 

the rate and growth of myelination, which continues 

into young adulthood (Shonkoff & Phillips, 2000). 

By 3 years of age, a baby’s brain has reached almost 

90 percent of its adult size. The growth in each 

region of the brain largely depends on receiving 

stimulation, which spurs activity in that region. This 

stimulation provides the foundation for learning.

Adolescent Brain Development

Studies using MRI techniques show that the brain 

continues to grow and develop into young adulthood (at 

least to the midtwenties). White matter, or brain tissue, 

volume has been shown to increase in adults as old as 32 

(Lebel & Beaulieu, 2011). Right before puberty, adolescent 

brains experience a growth spurt that occurs mainly in 

the frontal lobe, which is the area that governs planning, 

impulse control, and reasoning. During the teenage 

years, the brain goes through a process of pruning 

synapses—somewhat like the infant and toddler brain—

and also sees an increase in white matter and changes to 

neurotransmitter systems (Konrad, Firk, & Uhlhaas, 2013). 

As the teenager grows into young adulthood, the brain 

develops more myelin to insulate the nerve fibers and 

speed neural processing, and this myelination occurs last 

in the frontal lobe. MRI comparisons between the brains 

of teenagers and the brains of young adults have shown 

that most of the brain areas were the same—that is, the 

teenage brain had reached maturity in the areas that 

govern such abilities as speech and sensory capabilities. 

The major difference was the immaturity of the teenage 

brain in the frontal lobe and in the myelination of that 

area (National Institute of Mental Health, 2001).

Normal puberty and adolescence lead to the 

maturation of a physical body, but the brain lags 

behind in development, especially in the areas that 

allow teenagers to reason and think logically. Most 

teenagers act impulsively at times, using a lower area 

of their brains—their “gut reaction”—because their 

frontal lobes are not yet mature. Impulsive behavior, 

poor decisions, and increased risk-taking are all part 

of the normal teenage experience. Another change 

that happens during adolescence is the growth and 

transformation of the limbic system, which is responsible 

for our emotions. Teenagers may rely on their more 

primitive limbic system in interpreting emotions and 

reacting since they lack the more mature cortex that 

can override the limbic response (Chamberlain, 2009).

Plasticity—The Influence of Environment

Researchers use the term plasticity to describe the brain’s 

ability to change in response to repeated stimulation. 

The extent of a brain’s plasticity is dependent on the 

stage of development and the particular brain system 

or region affected (Perry, 2006). For instance, the lower 

parts of the brain, which control basic functions such 

as breathing and heart rate, are less flexible, or plastic, 

than the higher functioning cortex, which controls 

thoughts and feelings. While cortex plasticity decreases 

as a child gets older, some degree of plasticity remains. 

In fact, this brain plasticity is what allows us to keep 

learning into adulthood and throughout our lives.

The developing brain’s ongoing adaptations are the 

result of both genetics and experience. Our brains 

prepare us to expect certain experiences by forming 

the pathways needed to respond to those experiences. 

For example, our brains are “wired” to respond to the 

sound of speech; when babies hear people speaking, 

the neural systems in their brains responsible for speech 

and language receive the necessary stimulation to 

organize and function (Perry, 2006). The more babies are 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

4

exposed to people speaking, the stronger their related 

synapses become. If the appropriate exposure does 

not happen, the pathways developed in anticipation 

may be discarded. This is sometimes referred to as the 

concept of “use it or lose it.” It is through these processes 

of creating, strengthening, and discarding synapses 

that our brains adapt to our unique environment. 

The ability to adapt to our environment is a part of normal 

development. Children growing up in cold climates, 

on rural farms, or in large sibling groups learn how to 

function in those environments. Regardless of the general 

environment, though, all children need stimulation 

and nurturance for healthy development. If these are 

lacking (e.g., if a child’s caretakers are indifferent, hostile, 

depressed, or cognitively impaired), the child’s brain 

development may be impaired. Because the brain adapts 

to its environment, it will adapt to a negative environment 

just as readily as it will adapt to a positive one. 

Sensitive Periods

Researchers believe that there are sensitive periods 

for development of certain capabilities. These refer to 

windows of time in the developmental process when 

certain parts of the brain may be most susceptible to 

particular experiences. Animal studies have shed light 

on sensitive periods, showing, for example, that animals 

that are artificially blinded during the sensitive period for 

developing vision may never develop the capability to 

see, even if the blinding mechanism is later removed.

It is more difficult to study human sensitive periods, but 

we know that, if certain synapses and neuronal pathways 

are not repeatedly activated, they may be discarded, 

and their capabilities may diminish. For example, infants 

have a genetic predisposition to form strong attachments 

to their primary caregivers, but they may not be able to 

achieve strong attachments, or trusting, durable bonds 

if they are in a severely neglectful situation with little 

one-on-one caregiver contact. Children from Romanian 

institutions who had been severely neglected had a much 

better attachment response if they were placed in foster 

care—and thus received more stable parenting—before 

they were 24 months old (Smyke, Zeanah, Fox, Nelson, 

& Guthrie, 2010). This indicates that there is a sensitive 

period for attachment, but it is likely that there is a 

general sensitive period rather than a true cut-off point for 

recovery (Zeanah, Gunnar, McCall, Kreppner, & Fox, 2011).

While sensitive periods exist for development and 

learning, we also know that the plasticity of the brain 

often allows children to recover from missing certain 

experiences. Both children and adults may be able 

to make up for missed experiences later in life, but 

it is likely to be more difficult. This is especially true 

if a young child was deprived of certain stimulation, 

which resulted in the pruning of synapses (neuronal 

connections) relevant to that stimulation and the loss of 

neuronal pathways. As children progress through each 

developmental stage, they will learn and master each 

step more easily if their brains have built an efficient 

network of pathways to support optimal functioning.

Memories

The organizing framework for children’s development 

is based on the creation of memories. When repeated 

experiences strengthen a neuronal pathway, the pathway 

becomes encoded, and it eventually becomes a memory. 

Children learn to put one foot in front of the other to 

walk. They learn words to express themselves. And they 

learn that a smile usually brings a smile in return. At some 

point, they no longer have to think much about these 

processes—their brains manage these experiences 

with little effort because the memories that have been 

created allow for a smooth, efficient flow of information. 

The creation of memories is part of our adaptation to our 

environment. Our brains attempt to understand the world 

around us and fashion our interactions with that world in a 

way that promotes our survival and, hopefully, our growth, 

but if the early environment is abusive or neglectful, our 

brains may create memories of these experiences that 

adversely color our view of the world throughout our life.

Babies are born with the capacity for implicit memory, 

which means that they can perceive their environment 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

5

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.

and recall it in certain unconscious ways (Applegate 

& Shapiro, 2005). For instance, they recognize their 

mother’s voice from an unconscious memory. These 

early implicit memories may have a significant impact 

on a child’s subsequent attachment relationships.

In contrast, explicit memory, which develops around 

age 2, refers to conscious memories and is tied to 

language development. Explicit memory allows children 

to talk about themselves in the past and future or in 

different places or circumstances through the process 

of conscious recollection (Applegate & Shapiro, 2005). 

Sometimes, children who have been abused or suffered 

other trauma may not retain or be able to access explicit 

memories of their experiences; however, they may retain 

implicit memories of the physical or emotional sensations, 

and these implicit memories may produce flashbacks, 

nightmares, or other uncontrollable reactions (Applegate 

& Shapiro, 2005). This may be the case with very young 

children or infants who suffer abuse or neglect.

Responding to Stress

We all experience different types of stress throughout 

our lives. The type of stress and the timing of that stress 

determine whether and how there is an impact on the 

brain. The National Scientific Council on the Developing 

Child (2014) outlines three classifications of stress:

 Positive stress is moderate, brief, and generally a 

normal part of life (e.g., entering a new child care 

setting). Learning to adjust to this type of stress is an 

essential component of healthy development. 

 Tolerable stress includes events that have the 

potential to alter the developing brain negatively, but 

which occur infrequently and give the brain time to 

recover (e.g., the death of a loved one).

 Toxic stress includes strong, frequent, and prolonged 

activation of the body’s stress response system (e.g., 

chronic neglect).

Healthy responses to typical life stressors (i.e., positive 

and tolerable stress events) are very complex and may 

change depending on individual and environmental 

characteristics, such as genetics, the presence of a 

sensitive and responsive caregiver, and past experiences. 

A healthy stress response involves a variety of hormone 

and neurochemical systems throughout the body, 

including the sympathetic-adrenomedullary (SAM) system, 

which produces adrenaline, and the hypothalamicpituitary-adrenocortical (HPA) system, which produces 

cortisol (National Council on the Developing Child, 2014). 

Increases in adrenaline help the body engage energy 

stores and alter blood flow. Increases in cortisol also help 

the body engage energy stores and also can enhance 

certain types of memory and activate immune responses. 

In a healthy stress response, the hormonal levels will 

return to normal after the stressful experience has passed.

Effects of Maltreatment on 

Brain Development

Just as positive experiences can assist with healthy 

brain development, children’s experiences with child 

maltreatment or other forms of toxic stress, such as 

domestic violence or disasters, can negatively affect brain 

development. This includes changes to the structure 

and chemical activity of the brain (e.g., decreased size 

or connectivity in some parts of the brain) and in the 

emotional and behavioral functioning of the child (e.g., 

over-sensitivity to stressful situations). For example, 

healthy brain development includes situations in which 

babies’ babbles, gestures, or cries bring reliable, 

appropriate reactions from their caregivers. These 

caregiver-child interactions—sometimes referred to 

as “serve and return”—strengthen babies’ neuronal 

pathways regarding social interactions and how to get 

their needs met, both physically and emotionally. If 

children live in a chaotic or threatening world, one in 

which their caregivers respond with abuse or chronically 

provide no response, their brains may become hyperalert 

for danger or not fully develop. These neuronal pathways 

that are developed and strengthened under negative 

conditions prepare children to cope in that negative 

environment, and their ability to respond to nurturing and 

kindness may be impaired (Shonkoff & Phillips, 2000). 
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

6

The specific effects of maltreatment may depend 

on such factors as the age of the child at the time 

of the maltreatment, whether the maltreatment was 

a one-time incident or chronic, the identity of the 

abuser (e.g., parent or other adult), whether the child 

had a dependable nurturing individual in his or her 

life, the type and severity of the maltreatment, the 

intervention, how long the maltreatment lasted, and 

other individual and environmental characteristics. 

Effects of Maltreatment on Brain 

Structure and Activity

Toxic stress, including child maltreatment, can have 

a variety of negative effects on children’s brains:

 Hippocampus: Adults who were maltreated may 

have reduced volume in the hippocampus, which is 

central to learning and memory (McCrory, De Brito, & 

Viding, 2010; Wilson, Hansen, & Li, 2011). Toxic stress 

also can reduce the hippocampus’s capacity to bring 

cortisol levels back to normal after a stressful event has 

occurred (Shonkoff, 2012). 

 Corpus callosum: Maltreated children and 

adolescents tend to have decreased volume in the 

corpus callosum, which is the largest white matter 

structure in the brain and is responsible for interhemispheric communication and other processes (e.g., 

arousal, emotion, higher cognitive abilities) (McCrory, 

De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011).

 Cerebellum: Maltreated children and adolescents 

tend to have decreased volume in the cerebellum, 

which helps coordinate motor behavior and executive 

functioning (McCrory, De Brito, & Viding, 2010). 

 Prefrontal cortex: Some studies on adolescents 

and adults who were severely neglected as children 

indicate they have a smaller prefrontal cortex, which is 

critical to behavior, cognition, and emotion regulation 

(National Scientific Council on the Developing Child, 

2012), but other studies show no differences (McCrory, 

De Brito, & Viding, 2010). Physically abused children 

also may have reduced volume in the orbitofrontal 

cortex, a part of the prefrontal cortex that is central to 

emotion and social regulation (Hanson et al., 2010). 

 Amygdala: Although most studies have found that 

amygdala volume is not affected by maltreatment, 

abuse and neglect can cause overactivity in that area 

of the brain, which helps determine whether a stimulus 

is threatening and trigger emotional responses 

(National Scientific Council on the Developing Child, 

2010b; Shonkoff, 2012).

 Cortisol levels: Many maltreated children, both in 

institutional and family settings, and especially those 

who experienced severe neglect, tend to have lower 

than normal morning cortisol levels coupled with 

flatter release levels throughout the day (Bruce, Fisher, 

Pears, & Levine, 2009; National Scientific Council on 

the Developing Child, 2012). (Typically, children have 

a sharp increase in cortisol in the morning followed 

by a steady decrease throughout the day.) On the 

other hand, children in foster care who experienced 

severe emotional maltreatment had higher than 

normal morning cortisol levels. These results may 

be due to the body reacting differently to different 

stressors. Abnormal cortisol levels can have many 

negative effects. Lower cortisol levels can lead to 

decreased energy resources, which could affect 

learning and socialization; externalizing disorders; 

and increased vulnerability to autoimmune disorders 

(Bruce, Fisher, Pears, & Levine, 2009). Higher cortisol 

levels could harm cognitive processes, subdue immune 

and inflammatory reactions, or heighten the risk for 

affective disorders.

 Other: Children who experienced severe neglect 

early in life while in institutional settings often have 

decreased electrical activity in their brains, decreased 

brain metabolism, and poorer connections between 

areas of the brain that are key to integrating complex 

information (National Scientific Council on the 

Developing Child, 2012). These children also may 

continue to have abnormal patterns of adrenaline 

activity years after being adopted from institutional 

settings. Additionally, malnutrition, a form of neglect, 

can impair both brain development (e.g., slowing the 

growth of neurons, axons, and synapses) and function 

(e.g., neurotransmitter syntheses, the maintenance of 

brain tissue) (Prado & Dewey, 2012).

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

7

Exhibit 2 provides an illustration of these brain areas.

Exhibit 2—Brain Diagram

Credit: Tapert, S. F., Caldwell, L., & Burke, C. (2004/2005).

Alcohol and the adolescent brain: Human studies. 

Alcohol Research & Health, 28(4), 205–212.

We also know that some cases of physical abuse can 

cause immediate direct structural damage to a child’s 

brain. For example, according to the National Center 

on Shaken Baby Syndrome (n.d.), shaking a child can 

destroy brain tissue and tear blood vessels. In the shortterm, this can lead to seizures, loss of consciousness, 

or even death. In the long-term, shaking can damage 

the fragile brain so that a child develops a range of 

sensory impairments, as well as cognitive, learning, 

and behavioral disabilities. Other types of head injuries 

caused by physical abuse can have similar effects.

Epigenetics

A burgeoning field of research related to brain 

development is epigenetics. Epigenetics refers 

to alterations to the genes that do not include 

structural changes to the DNA nucleotide 

sequence (Orr & Kaufman, 2014). An epigenetic 

modification occurs when chemical “signatures” 

attach themselves to genes, which, in turn, helps 

determine how the genes are expressed (i.e., 

whether they are turned on or off). These changes 

can affect the expression of genes in brain cells, 

may be permanent or temporary, and can be 

inherited by the person’s offspring (National 

Scientific Council on the Developing Child, 2010a). 

The chemical experiences are initiated by life 

experiences, both positive and negative, as well as 

nutrition and exposure to toxins or drugs (National 

Scientific Council on the Developing Child, 2010a). 

Although the field of epigenetics is still in its infancy, 

studies have indicated that child maltreatment 

can cause epigenetic modifications in victims. In 

one study of individuals with posttraumatic stress 

disorder (PTSD), those who had been maltreated 

as children exhibited more epigenetic changes 

in genes associated with central nervous system 

development and immune system regulation than 

nonmaltreated individuals with PTSD (Mehta et 

al., 2013). Furthermore, the findings indicated 

that the maltreated individuals had up to 12 times 

more epigenetic changes than nonmaltreated 

individuals, which may mean that maltreated 

individuals may experience PTSD uniquely and 

may require different types of treatment than 

other groups with PTSD. Another study found 

decreased hippocampal glucocorticoid receptor 

expression, which affects HPA activity, in suicide 

victims with histories of child abuse compared to 

nonabused suicide victims (McGowan et al., 2009).

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

8

Effects of Maltreatment on Behavioral, 

Social, and Emotional Functioning

The changes in brain structure and chemical 

activity caused by child maltreatment can have a 

wide variety of effects on children’s behavioral, 

social, and emotional functioning.

Persistent Fear Response. Chronic stress or repeated 

trauma can result in a number of biological reactions, 

including a persistent fear state (National Scientific 

Council on the Developing Child, 2010b). Chronic 

activation of the neuronal pathways involved in the fear 

response can create permanent memories that shape the 

hild’s perception of and response to the environment. 

While this adaptation may be necessary for survival 

in a hostile world, it can become a way of life that is 

difficult to change, even if the environment improves. 

Children with a persistent fear response may lose their 

ability to differentiate between danger and safety, and 

they may identify a threat in a nonthreatening situation 

(National Scientific Council on the Developing Child, 

2010b). For example, a child who has been maltreated 

may associate the fear caused by a specific person or 

place with similar people or places that pose no threat. 

This generalized fear response may be the foundation 

of future anxiety disorders, such as PTSD (National 

Scientific Council on the Developing Child, 2010b).

Hyperarousal. When children are exposed to chronic, 

traumatic stress, their brains sensitize the pathways for 

the fear response and create memories that automatically 

trigger that response without conscious thought. This 

is called hyperarousal. These children may be highly 

sensitive to nonverbal cues, such as eye contact or 

a touch on the arm, and they may be more likely to 

misinterpret them (National Scientific Council on the 

Developing Child, 2010b). Consumed with a need to 

monitor nonverbal cues for threats, their brains are 

less able to interpret and respond to verbal cues, even 

when they are in an environment typically considered 

nonthreatening, like a classroom. While these children 

are often labeled as learning disabled, the reality is that 

their brains have developed so that they are constantly 

on alert and are unable to achieve the relative calm 

necessary for learning (Child Trauma Academy, n.d.).

Increased Internalizing Symptoms. Child maltreatment 

can lead to structural and chemical changes in the areas 

of the brain involved in emotion and stress regulation 

(National Scientific Council on the Developing Child, 

2010b). For example, maltreatment can affect connectivity 

between the amygdala and hippocampus, which can 

then initiate the development of anxiety and depression 

by late adolescence (Herringa et al., 2013). Additionally, 

early emotional abuse or severe deprivation may 

permanently alter the brain’s ability to use serotonin, 

a neurotransmitter that helps produce feelings of 

well-being and emotional stability (Healy, 2004).

Diminished Executive Functioning. Executive 

functioning generally includes three components: 

working memory (being able to keep and use information 

over a short period of time), inhibitory control (filtering 

thoughts and impulses), and cognitive or mental 

flexibility (adjusting to changed demands, priorities, 

or perspectives) (National Scientific Council on the 

Developing Child, 2011). The structural and neurochemical 

damage caused by maltreatment can create deficits in 

all areas of executive functioning, even at an early age 

(Hostinar, Stellern, Schaefer, Carlson, & Gunnar, 2012; 

National Scientific Council on the Developing Child, 2011). 

Executive functioning skills help people achieve academic 

and career success, bolster social interactions, and assist 

in everyday activities. The brain alterations caused by 

a toxic stress response can result in lower academic 

achievement, intellectual impairment, decreased IQ, and 

weakened ability to maintain attention (Wilson, 2011).

Delayed Developmental Milestones. Although neglect 

often is thought of as a failure to meet a child’s physical 

needs for food, shelter, and safety, neglect also can be 

a failure to meet a child’s cognitive, emotional, or social 

needs. For children to master developmental tasks in 

these areas, they need opportunities and encouragement 

from their caregivers. If this stimulation is lacking during 

children’s early years, the weak neuronal pathways that 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

9

developed in expectation of these experiences may 

wither and die, and the children may not achieve the 

usual developmental milestones. For example, babies 

need to experience face-to-face baby talk and hear 

countless repetitions of sounds in order to build the brain 

circuitry that will enable them to start making sounds 

and eventually say words. If babies’ sounds are ignored 

repeatedly when they begin to babble at around 6 

months, their language may be delayed. In fact, neglected 

children often do not show the rapid growth that normally 

occurs in language development at 18–24 months 

(Scannapieco, 2008). These types of delays may extend to 

all types of normal development for neglected children, 

including their cognitive-behavioral, socio-emotional, 

and physical development (Scannapieco, 2008).

Weakened Response to Positive Feedback. Children 

who have been maltreated may be less responsive to 

positive stimuli than nonmaltreated children. A study 

of young adults who had been maltreated found 

that they rated monetary rewards less positively than 

their peers and demonstrated a weaker response to 

reward cues in the basal ganglia areas of the brain 

responsible for reward processing (Dillon et al., 2009). 

Complicated Social Interactions. Toxic stress can 

alter brain development in ways that make interaction 

with others more difficult. Children or youth with toxic 

stress may find it more challenging to navigate social 

situations and adapt to changing social contexts 

(Hanson et al., 2010). They may perceive threats in 

safe situations more frequently and react accordingly, 

and they may have more difficulty interacting with 

others (National Scientific Council on the Developing 

Child, 2010b). For example, a maltreated child may 

misinterpret a peer’s neutral facial expression as anger, 

which may cause the maltreated child to become 

aggressive or overly defensive toward the peer. 

Impact of Maltreatment 

on Adolescents

The effects of maltreatment can continue to 

influence brain development and activity into 

adolescence and adulthood. These effects may 

be caused by the cumulative effects of abuse or 

neglect throughout their lives or by maltreatment 

newly experienced as an adolescent.

Most teens act impulsively at times, but for teens 

who have been maltreated, this impulsive behavior 

may be even more apparent. Often, these youth 

have developed brains that focus on survival, 

at the expense of the more advanced thinking 

that happens in the brain’s cortex (Chamberlain, 

2009). An underdeveloped cortex can lead to 

increased impulsive behavior, as well as difficulties 

with tasks that require higher-level thinking and 

feeling. These teens may show delays in school 

and in social skills as well (Chamberlain, 2009). 

They may be more drawn to taking risks, and they 

may have more opportunities to experiment with 

drugs and crime if they live in environments that 

put them at increased risk for these behaviors. 

Maltreatment as a younger child can have 

longitudinal negative effects on brain development 

during adolescence. Adolescents with a history 

of childhood maltreatment can have decreased 

levels of growth in the hippocampus and amygdala 

compared to nonmaltreated adolescents (Whittle 

et al., 2013). Adolescents also may experience 

the effects highlighted in the previous section.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

10

Implications for Practice and Policy

The knowledge we gained from research examining the 

effects of maltreatment on brain development can be 

helpful in many ways. With this information we are better 

able to understand what is happening within the brains 

of children who have been abused and neglected. In 

fact, much of this research is providing concrete/scientific 

evidence for what professionals and caregivers have long 

described in behavioral, emotional, and psychological 

terms. We also now know that children who were reared 

in severely stressful environments can see positive 

effects on brain development and functioning when 

their living environments improve. For example, children 

who lived in Romanian institutions and then moved into 

foster care settings had larger total volumes in cortical 

white matter and the posterior corpus callosum than 

children who remained in institutional care (though 

these volumes were smaller than never-institutionalized 

children) (Sheridan, Fox, Zeanah, McLaughlin, & Nelson, 

2012). We can use this information to improve our systems 

of care and to strengthen our prevention efforts.

The Role of the Child Welfare System

While the goal of the child welfare system is to protect 

children, many child welfare interventions—such as 

investigation, appearance in court, removal from home, 

placement in a foster home, etc.—may actually reinforce 

the child’s view that the world is unknown, uncontrollable,

and frightening. A number of trends in child welfare 

may help provide a more caring view of the world to 

an abused or neglected child. These trends include:

 Trauma-informed care

 Family-centered practice and case planning, including 

parent-child interaction therapy

 Individualized services for children and families

 The growth of child advocacy centers, where children 

can be interviewed and assessed and receive services 

in a child-friendly environment 

 The use of differential response to ensure children’s 

safety while providing nonadversarial support to 

families in low-risk cases

 The promotion of evidence-based practices

Federal Focus on TraumaInformed Care

More child welfare agencies are using a traumainformed approach to serve children and families. 

They are considering the impact of traumatic 

events, such as maltreatment, domestic violence, 

being separated from loved ones, and the 

effects of poverty, on children and families and 

incorporating practices that acknowledge the 

effects of current and intergenerational trauma. 

During the past decade, the U.S. Department of 

Health and Human Services (HHS) has emphasized 

the use of trauma-informed care by agencies 

and professionals. It funded grants focusing on 

this approach, such as the Promoting Well-Being 

and Adoption After Trauma cluster (2013) and 

the Integrating Trauma-Informed and TraumaFocused Practice in Child Protective Service (CPS) 

Delivery cluster (2011). (For more information 

about the latter cluster, view the related 

Children’s Bureau Express article at https://

cbexpress.acf.hhs.gov/index.cfm?event=website.

viewArticles&issueid=132&articleid=3392.) HHS 

also has incorporated trauma-informed care 

into its guidance to States, including a letter to 

all the directors of State and Tribal child welfare 

agencies (see http://www.hhs.gov/secretary/

about/blogs/childhood-trauma-recover.html). 

For more information about traumainformed care, visit Child Welfare Information 

Gateway at https://www.childwelfare.

gov/topics/responding/trauma. 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

11

Prevention. Child welfare systems that devote significant 

efforts to prevention may be the most successful in 

helping children and families and promoting healthy 

brain development. By the time a child who has 

been abused or neglected comes to the attention 

of professionals, some negative effects are likely. 

Prevention efforts should focus on supporting and 

strengthening children’s families so that children have 

the best chance of remaining safely in their homes 

and communities while receiving proper nurturing and 

care. These efforts may target the general population 

(“primary” or “universal” prevention) by educating the 

public and changing policies to promote healthy brain 

development. Prevention efforts also may target children 

and families considered to be at-risk of developing 

problems (“secondary” or “selected” prevention). 

Prevention efforts for at-risk families should focus on 

strengthening the family and building on the family’s 

positive attributes. Recent prevention resource guides 

from the HHS Children’s Bureau (2015) encourage 

professionals to promote six “protective factors” 

that can strengthen families, help prevent abuse and 

neglect, and promote healthy brain development:

 Nurturing and attachment

 Knowledge of parenting and of child and youth 

development

 Parental resilience

 Social connections

 Concrete supports for parents

 Social and emotional competence for children

Brain research underscores the importance of prevention 

efforts that target the youngest children. For example, 

early childhood home visiting programs for expectant 

and new mothers, who might be at-risk because of their 

age, income, or other circumstances, show promise for 

mitigating maternal stress, thus keeping adversity from 

becoming toxic stress (Garner, 2013). Parent education 

programs also serve as a prevention method that 

can promote protective factors and lead to positive 

outcomes for both parents and children. The Centers for 

Disease Control and Prevention (CDC) developed the 

Essentials for Childhood Framework to help communities 

prevent child maltreatment. This framework is based 

on establishing safe, stable, and nurturing relationships 

between children and caregivers. (See http://www.

cdc.gov/ViolencePrevention/childmaltreatment/

essentials/index.html for more information.)

Early Intervention. Intensive, early interventions 

when the brain is most plastic are much more effective 

than reactive services as the child ages (Perry, 2009). 

In recognition of this fact, Federal legislation requires 

States to develop referral procedures for children ages 

0–36 months who are involved in a substantiated case 

of child abuse or neglect. Once a child is identified, 

States must provide intervention services through Early 

Intervention Plans funded under Part C of the Individuals 

with Disabilities Education Improvement Act. A number 

of States developed innovative programs to meet these 

requirements and to identify and help the youngest 

victims of abuse and neglect (Child Welfare Information 

Gateway, 2013). (For more information about early 

intervention, refer to Addressing the Needs of Young 

Children in Child Welfare: Part C—Early Intervention 

Services at https://www.childwelfare.gov/pubs/partc/.)

One theory about healing a damaged or altered brain 

is that the interventions must target those portions of 

the brain that have been altered (Perry, 2000b). Because 

brain functioning is altered by repeated experiences that 

strengthen and sensitize neuronal pathways, interventions 

should not be limited to weekly therapy appointments. 

Interventions should address the totality of the child’s life, 

providing frequent, consistent replacement experiences 

so that the child’s brain can begin to incorporate a new 

environment—one that is safe, predictable, and nurturing. 

The following are examples of models and interventions 

available to child welfare and related professionals 

to assist children and youth who have been 

maltreated or otherwise exposed to toxic stress:

 The neurosequential model of therapeutics (NMT)

is based on the fact that the higher brain functions 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

12

(e.g., speech, relational interactions) depend on input 

from lower brain functions (e.g., stress responses) 

(Perry, 2009). Many clinical interventions, however, 

focus on the higher brain functions rather than the 

lower brain functions, which may be the source of the 

child’s issues. NMT has three central elements: (1) a 

developmental history that helps delineate the timing, 

nature, and severity of developmental challenges; (2) 

a current assessment of functioning to help determine 

which neural systems and brain areas are affected 

and what the developmental level of the child is in 

various areas (e.g., speech, social skills); and (3) specific 

recommendations for the interventions to be used, 

with a focus on the sequence of the interventions 

(i.e., focusing on deficits in the lower brain first and 

progressing to the higher brain functions).

The Attachment and Biobehavioral Catch-up (ABC) 

for Infants and Young Children intervention is 

designed for the parents of young children who have 

experienced early adversity (Dozier & Fisher, 2014). 

ABC is implemented during 10 sessions in the parents’ 

homes and includes both the parents and children. The 

sessions focus on providing clear feedback to parents 

about nurturance and following their child’s lead, 

and include the review of video clips of interactions 

between the parents and child. A study of ABC found 

that children who received the intervention showed 

a steeper slope of cortisol production and higher 

wake-up cortisol values (i.e., healthier cortisol levels) 

than nonintervention children (Dozier & Fisher, 2014). 

These effects were still seen even at 3 years after the 

intervention.

 Multidimensional Treatment Foster Care for 

Preschoolers (MTFC-P), which typically lasts 9 to 12 

months, helps parents learn and practice behavior 

management techniques (Dozier & Fisher, 2014). This 

helps children experience a more controlled and 

stable environment, which, in turn, helps enhance their 

regulatory capabilities. Foster parents are trained prior 

to placement, and program staff are available 24 hours 

a day to provide support. A support group is available, 

too. Children also participate in a weekly therapeutic 

playgroup to practice self-regulatory skills. If children 

will be returning to their birth families, MTFC-P staff 

provide training to the birth parents as well. Similar 

to the ABC intervention, children receiving MTFC-P 

had more stable cortisol levels than those who did not 

receive MTFC-P (Dozier & Fisher, 2014).

Children’s recovery depends on a variety of factors, 

including the timing, severity, and duration of the 

maltreatment or other toxic stress, the intervention itself, 

and the individual child’s response to the maltreatment 

(National Scientific Council on the Developing Child, 2012). 

In some cases, doctors may prescribe psychotropic 

medications for certain mental health conditions, 

such as depression or anxiety. The Children’s Bureau 

developed a guide, Making Healthy Choices: A Guide 

on Psychotropic Medications for Youth in Foster Care, 

to help adolescents better understand their options. 

The guide is available at https://www.childwelfare.gov/

pubs/makinghealthychoices. For more information about 

psychotropic medications, visit Child Welfare Information 

Gateway at https://www.childwelfare.gov/topics/

systemwide/mentalhealth/effectiveness/psychotropic. 

The Role of Caregivers

Many children who suffered abuse and neglect are 

removed from their homes (for their safety) by the child 

welfare system. Extended family, foster parents, or group 

home staff may temporarily care for these children, and 

some will be adopted. In these cases, educating caregivers 

about the possible effects of maltreatment on brain 

development, and the resulting symptoms, may help 

them to better understand and support the children in 

their care. Child welfare workers may also want to explore 

any past abuse or trauma experienced by parents that 

may influence their parenting skills and behaviors.

It is important for caregivers to have realistic expectations 

for their children. Children who havebeen abused 

or neglected may not be functioning at their chronological 

age in terms of their physical, social, emotional, and 

cognitive skills. They may also be displaying 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

13

unusual and/or difficult coping behaviors. For 

example, abused or neglected children may:

 Be unable to control their emotions and have frequent 

outbursts

 Be quiet and submissive

 Have difficulties learning in school

 Have difficulties getting along with siblings or 

classmates

 Have unusual eating or sleeping behaviors

 Attempt to provoke fights or solicit sexual experiences

 Be socially or emotionally inappropriate for their age

 Be unresponsive to affection

Understanding some basic information about the 

neurobiology underlying many challenging behaviors 

may help caregivers shape their responses more 

effectively. They also need to know as much as 

possible about the particular circumstances and 

background of the individual children in their care.

In general, children who have been abused or neglected 

need nurturance, stability, predictability, understanding, 

and support (Committee on Early Childhood, Adoption 

and Dependent Care, 2000). They may need frequent, 

repeated experiences of these kinds to begin altering 

their view of the world from one that is uncaring or 

hostile to one that is caring and supportive. Until that 

view begins to take hold in a child’s mind, the child may 

not be able to engage in a truly positive relationship, 

and the longer a child lives in an abusive or neglectful 

environment, the harder it will be to convince the child’s 

brain that the world can change. Consistent nurturing 

from caregivers who receive training and support may 

offer the best hope for the children who need it most.

Summary

In 2012, approximately 686,000 children were determined 

to be victims of abuse and/or neglect (U.S. Department 

of Health and Human Services, 2013), but it is likely 

that many more children are actually suffering under 

adverse conditions. These children may have already 

suffered damage to their growing brains, and this 

damage may affect their ability to learn, form healthy 

relationships, and lead healthy, positive lives.

One lesson we have learned from the research on 

brain development is that environment has a powerful 

influence on development. Stable, nurturing caregivers 

and knowledgeable, supportive professionals 

can have a significant impact on these children’s 

development. Focusing on preventing child abuse 

and neglect, helping to strengthen families through 

trauma-informed systems and practices, and ensuring 

that children receive needed services are some of 

the most important efforts we can undertake.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

14

Glossary

 Amygdala: A component of the limbic system that is involved in the expression and perception of emotion1

1 National Institutes of Health, National Institute on Drug Abuse. (2010). The brain: Understanding neurology. Retrieved from http://science.

education.nih.gov/supplements/nih2/addiction/other/glossary/glossary.html

 Axon: The fiber-like extension of a neuron through which the cell carries information to target cells1

 Basal ganglia: Deeply placed masses of gray matter within each cerebral hemisphere that assist in voluntary 

motor functioning2

2 National Institutes of Health, National Library of Medicine, MedlinePlus (http://www.nlm.nih.gov/medlineplus/mplusdictionary.html)

 Brainstem: The structure at the base of the brain through which the forebrain sends information to, and 

receives information from, the spinal cord and peripheral nerves1

 Cerebellum: A portion of the brain that helps regulate posture, balance, and coordination1

 Cerebral cortex: The intricately folded surface layer of gray matter of the brain that functions chiefly in 

coordination of sensory and motor information. It is divided into four lobes: frontal, parietal, temporal, and 

occipital2

 Corpus callosum: The largest white matter structure in the brain. It connects the left and right cerebral 

hemispheres and facilitates communication for emotion and higher cognitive abilities3

3 Hart, H., & Rubia, K. (2012). Neuroimaging of child abuse: A critical review. Frontiers in Human Neuroscience, 6. Retrieved from http://www.

ncbi.nlm.nih.gov/pmc/articles/PMC3307045/

 Cortisol: A glucocorticoid produced by the adrenal cortex that mediates various metabolic processes, has 

anti-inflammatory and immunosuppressive properties, and whose levels in the blood may become elevated 

in response to physical or psychological stress2

 Epigenetics: The study of how environmental factors like diet, stress, and post-natal care can change gene 

expression (when genes turn on or off) without altering DNA sequence4

4 National Institutes of Health, National Institute of Mental Health. (n.d.). Brain basics. Retrieved from http://www.nimh.nih.gov/health/

educational-resources/brain-basics/brain-basics.shtml#Glossary

 Executive functioning: A group of skills that help people focus on multiple streams of information at the 

same time and revise plans as necessary5

5 National Scientific Council on the Developing Child. (2011). Building the brain’s “air traffic control” system: How early experiences shape 

the development of executive function (Working Paper 11). Retrieved from http://developingchild.harvard.edu/index.php/resources/

reports_and_working_papers/working_papers/wp11/

 Frontal lobe: One of the four divisions of each cerebral hemisphere. The frontal lobe is important for 

controlling movement, thinking, and judgment1

 Gray matter: Neural tissue, especially of the brain and spinal cord, that contains cell bodies as well as 

some nerve fibers, has a brownish gray color, and forms most of the cortex and nuclei of the brain, the 

columns of the spinal cord, and the bodies of ganglia2

 Hippocampus: A component of the limbic system that is involved in learning and memory1

 Hypothalamic-pituitary-adrenocortical (HPA) system: A hormonal system that produces cortisol in the 

outer shell of the adrenal gland to help regulate the body’s stress response system6

6 National Scientific Council on the Developing Child. (2014). Excessive stress disrupts the architecture of the developing brain (Working 

Paper 3). Retrieved from http://developingchild.harvard.edu/resources/reports_and_working_papers/working_papers/wp3/

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

15

 Limbic system: A set of brain structures that regulates our feelings, emotions, and motivations and 

that is also important in learning and memory. Includes the thalamus, hypothalamus, amygdala, and 

hippocampus1

 Midbrain: The upper part of the brainstem, which controls some reflexes and eye movements7

Myelin: Fatty material that surrounds and insulates axons of some neurons1

 Neuron: A unique type of cell found in the brain and body that is specialized to process and transmit 

information1

 Neurotransmitter: A chemical produced by neurons to carry messages to other neurons1

 Plasticity: The capacity of the brain to change its structure and function within certain limits. Plasticity 

underlies brain functions, such as learning, and allows the brain to generate normal, healthy responses to 

long-lasting environmental changes1

 Prefrontal cortex: A highly developed area at the front of the brain that plays a role in executive functions 

such as judgment, decision-making, and problem-solving, as well as emotional control and memory4

 Receptor: A protein that recognizes specific chemicals (e.g., neurotransmitters, hormones) and transmits the 

message carried by the chemical into the cell on which the receptor resides1

 Sensitive period: Windows of time in the developmental process when certain parts of the brain may be 

most susceptible to particular experiences

 Sympathetic-adrenomedullary (SAM) system: A hormonal system that produces adrenaline in the central 

part of the adrenal gland to help regulate the body’s stress response system and triggers the “fight or flight” 

response6

 Synapse: The site where presynaptic and postsynaptic neurons communicate with each other1

 Temporal lobe: One of the four major subdivisions of each hemisphere of the cerebral cortex that assists in 

auditory perception, speech, and visual perceptions1

 White matter: Neural tissue, especially of the brain and spinal cord, that consists largely of myelinated nerve 

fibers bundled into tracts that help transmit signals between areas of the brain. It gets its name from the 

white color of the myelin2

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

16

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.

Additional Resources

California Evidence-Based Clearinghouse for 

Child Welfare (CEBC)—The CEBC identifies 

and disseminates information about evidencebased practices in child welfare, including trauma 

treatment for children and youth. http://www.

cebc4cw.org/topic/trauma-treatment-for-children/

Center on the Developing Child—Founded and 

directed by Jack Shonkoff, M.D., the Center publishes and 

links to research on early brain development, learning, 

and behavior and how to apply that knowledge to policies 

and practices. www.developingchild.harvard.edu

Centers for Disease Control and Prevention (CDC)— 

The CDC website offers several publications that promote 

safe, stable, and nurturing relationships to prevent 

child maltreatment. CDC also sponsors the Adverse 

Childhood Experiences study. http://www.cdc.gov/

ViolencePrevention/childmaltreatment/essentials/index.html

http://www.cdc.gov/violenceprevention/acestudy/

Child Trauma Academy—This website offers 

online courses, trainings, and other resources 

on early brain development and the impact 

of maltreatment. www.childtrauma.org/

From Neurons to Neighborhoods: The Science of 

Early Childhood Development—This book was written 

in 2000 by a committee of experts (Committee on 

Integrating the Science of Early Childhood Development, 

J. P. Shonkoff and D. A. Phillips, eds.). It highlights 

findings of neurobiology and explores how we can 

nurture and protect young children. http://www.nap.

edu/catalog/9824/from-neurons-to-neighborhoodsthe-science-of-early-childhood-development.

The National Child Traumatic Stress Network—

This federally funded initiative is a collaboration of 

academic and community-based service centers with 

a mission to improve access to care, treatment, and 

services for traumatized children and adolescents. 

The website includes an assortment of publications, 

toolkits, and trainings. http://www.nctsn.org/

ZERO TO THREE—This national nonprofit organization 

offers resources, training, and support for professionals 

and parents of young children. The online Baby Brain 

Map is a useful tool for showing how brain development 

parallels very young children’s behavior/ http://

www.zerotothree.org/ www.zerotothree.org/site/

PageServer?pagename=ter_util_babybrainflash 

References

Applegate, J. S., & Shapiro, J. R. (2005). Neurobiology 

for clinical social work theory and practice. 

New York: W. W. Norton & Company.

Bruce, J., Fisher, P. A., Pears, K. C., & Levine, S. (2009). 

Morning cortisol levels in preschool-aged foster 

children: Differential effects of maltreatment 

type. Developmental Psychobiology, 51, 14–23.

Chamberlain, L. B. (2009). The amazing teen 

brain: What every child advocate needs to 

know. Child Law Practice, 28(2), 1-2, 22–24.

Child Trauma Academy. (n.d.). The amazing human brain 

and human development. Retrieved from http://www.

childtraumaacademy.com/amazing_brain/index.html

Child Welfare Information Gateway. (2013). Addressing 

the needs of young children in child welfare: Part 

C—early intervention services. Retrieved from 

https://www.childwelfare.gov/pubs/partc/ 

Committee on Early Childhood, Adoption, and 

Dependent Care. (2000). Developmental 

issues for young children in foster care. 

Pediatrics, 106(5), 1145–1150.

Dillon, D. G., Holmes, A. J., Birk, J. L., Brooks, 

N., Lyons-Ruth, K., & Pizzagalli, D. A. (2009). 

Childhood adversity is associated with left basal 
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

17

ganglia dysfunction during reward anticipation in 

adulthood. Biological Psychiatry, 66, 206–213.

Dozier, M., & Fisher, P. A. (2014). Neuroscience enhanced 

child maltreatment interventions to improve 

outcomes. Social Policy Report, 28(1), 22–24.

Garner, A. S. (2013). Home visiting and the biology 

of toxic stress: Opportunities to address early 

childhood adversity. Pediatrics, 132, S65¬–S73.

Hanson, J. L., Chung, M. K., Avants, B. B., Shirtcliff, E. 

A., Gee, J. C., Davidson, R. J., & Pollak, S. D. (2010). 

Early stress is associated with alterations in the 

orbitofrontal cortex: A tensor-based morphometry 

investigation of brain structure and behavioral 

risk. Journal of Neuroscience, 30, 7466–7472.

Healy, J. M. (2004). Your child’s growing mind: 

Brain development and learning from birth to 

adolescence. New York: Broadway Books.

Herringa, R. J., Birn, R. M., Ruttle, P. L., Burghy, C. 

A., Stodola, D. E., Davidson, R. J., & Essex, M. J. 

(2013). Childhood maltreatment is associated with 

altered fear circuitry and increased internalizing 

symptoms by late adolescence. Proceedings 

of the National Academy of Sciences of the 

United States of America, 110, 19119–19124.

Hostinar, C. E., Stellern, S. A., Schaefer, C., Carlson, S. 

M., & Gunnar, M. R. (2012). Associations between 

early life adversity and executive function in 

children adopted internationally from orphanages. 

Proceedings of the National Academy of Sciences 

of the United States of America, 109, 17208–17212.

Konrad, K., Firk, C., & Uhlhaas, P. J. (2013). Brain 

development during adolescence: Neuroscientific 

insights into this developmental period. Deutsches 

Arzteblatt International, 110(25), 425–431.

Lebel, C., & Beaulieu, C. (2011). Longitudinal development 

of human brain wiring continues from childhood into 

adulthood. Journal of Neuroscience, 31, 10937–10947.

McCrory, E., De Brito, S. A., & Viding, E. (2010). 

Research review: The neurobiology and genetics 

of maltreatment and adversity. Journal of 

Psychology and Psychiatry, 51, 1079–1095.

McGowan, P. O., Sasaki, A., D’Alessio, A. C., Dymov, 

S., Labonté, B., Szyf, M., ... Meaney, M. J. (2009). 

Epigenetic regulation of the glucocorticoid 

receptor in human brain associates with childhood 

abuse. Nature Neuroscience, 12, 342–348.

Mehta, D., Klengel, T., Conneely, K. N., Smith, A. 

K., Altmann, A., Pace, T. W., ... Binder, E. B. 

(2013). Childhood maltreatment is associated 

with distinct genomic and epigenetic profiles 

in posttraumatic stress disorder. Proceedings 

of the National Academy of Sciences of the 

United States of America, 110, 8302–8307.

National Center on Shaken Baby Syndrome. (n.d.). Physical 

consequences of shaking. Retrieved from http://www.

dontshake.org/sbs.php?topNavID=3&subNavID=23 

National Institute of Mental Health. (2001). Teenage brain: 

A work in progress (Fact Sheet). Retrieved from https://

public.health.oregon.gov/HealthyPeopleFamilies/

Youth/AdolescentGrowthDevelopment/

Documents/teenbrain.pdf

National Scientific Council on the Developing 

Child. (2010a). Early experiences can alter gene 

expression and affect long-term development 

(Working Paper 10). Retrieved from http://

developingchild.harvard.edu/resources/

reports_and_working_papers/working_papers/wp10/

National Scientific Council on the Developing Child. 

(2010b). Persistent fear and anxiety can affect 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

18

young children’s learning and development 

(Working Paper 9). Retrieved from http://

developingchild.harvard.edu/index.php/resources/

reports_and_working_papers/working_papers/wp9/

National Scientific Council on the Developing Child. (2011). 

Building the brain’s “air traffic control” system: How 

early experiences shape the development of executive 

function (Working Paper 11). Retrieved from http://

developingchild.harvard.edu/index.php/resources/

reports_and_working_papers/working_papers/wp11/ 

National Scientific Council on the Developing Child. 

(2012). The science of neglect: The persistent 

absence of responsive care disrupts the developing 

brain (Working Paper 12). Retrieved from http://

developingchild.harvard.edu/index.php/resources/

reports_and_working_papers/working_papers/wp12/

National Scientific Council on the Developing Child. 

(2014). Excessive stress disrupts the architecture of 

the developing brain (Working Paper 3). Retrieved 

from http://developingchild.harvard.edu/resources/

reports_and_working_papers/working_papers/wp3/

Orr, C. A., & Kaufman, J. (2014). Neuroscience and 

child maltreatment: The role of epigenetics 

in risk and resilience in maltreated children. 

Social Policy Report, 28(1), 22–24.

Perry, B. D. (2000a). The neuroarcheology of childhood 

maltreatment: The neurodevelopmental costs of 

adverse childhood events. Child Trauma Academy. 

Retrieved from http://www.juconicomparte.

org/recursos/Neuroarcheology%20of%20

childhood%20maltreatment_zmH8.pdf

Perry, B.D. (2000b). Traumatized children: How 

childhood trauma influences brain development. 

Child Trauma Academy. Retrieved from 

http://www.aaets.org/article196.htm 

Perry, B. D. (2002). Childhood experience and 

the expression of genetic potential: What 

childhood neglect tells us about nature and 

nurture. Brain and Mind, 3, 79–100.

Perry, B. D. (2006). Applying principles of 

neurodevelopment to clinical work with maltreated 

and traumatized children: The neurosequential 

model of therapeutics. In N. B. Webb (Ed.), 

Working with traumatized youth in child welfare 

(pp. 27–52). New York: The Guilford Press.

Perry, B. D. (2009). Examining child maltreatment through 

a neurodevelopmental lens: Clinical applications 

of the neurosequential model of therapeutics. 

Journal of Loss and Trauma, 14, 240–255.

Prado, E., & Dewey, K. (2012). Nutrition and brain 

development in early life. Retrieved from http://www.

cmamforum.org/Pool/Resources/Nutrition-braindevelopment-early-life-A-TTechnical-Brief-2012.pdf 

Scannapieco, M. (2008). Developmental outcomes 

of child neglect. The APSAC Advisor, 

Winter. Elmhurst, IL: American Professional 

Society on the Abuse of Children.

Sheridan, M. A., Fox, N. A., Zeanah, C. H., McLaughlin, 

K. A., & Nelson, C. A., III. (2012). Variation in 

neural development as a result of exposure to 

institutionalization early in childhood. Proceedings 

of the National Academy of Sciences of the 

United States of America, 109, 12927–12932.

Shonkoff, J. P. (2012). The lifelong effects 

of early childhood adversity and toxic 

stress. Pediatrics, 129, e232–e246.

Shonkoff, J. P., & Phillips, D. A. (2000). From 

neurons to neighborhoods: The science of 

early childhood development. Washington, 

D.C.: National Academy Press.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/brain-development.
U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau

Understanding the Effects of Maltreatment on Brain Development https://www.childwelfare.gov

Smyke, A. T., Zeanah, C. H., Fox, N. A., Nelson, C. 

A., & Guthrie, D. (2010). Placement in foster care 

enhances attachment among young children in 

institutions. Child Development, 81, 212–223.

U.S. Department of Health and Human Services. (2013). 

Child maltreatment 2012. Retrieved from http://

www.acf.hhs.gov/sites/default/files/cb/cm2012.pdf 

U.S. Department of Health and Human Services, 

Children’s Bureau. (2015). Making meaningful 

connections: 2014 prevention resource guide. 

Retrieved from https://www.childwelfare.gov/topics/

preventing/preventionmonth/resource-guide/ 

Whittle, S., Dennison, M., Vijayakumar, N., Simmons, 

J. G., Yücel, M., Lubman, D. I., ... Allen, N. B. (2013). 

Childhood maltreatment and psychopathology 

affect brain development during adolescence. 

Journal of the American Academy of Child 

& Adolescent Psychiatry, 52, 940–952. 

Wilson, K. R., Hansen, D. J., & Li, M. (2011). The 

traumatic stress response in child maltreatment 

and resultant neuropsychological effects. 

Aggression and Violent Behavior, 16(2), 87–97.

Zeanah, C. H., Gunnar, M. R., McCall, R. B., Kreppner, 

J. A., & Fox, N. A. (2011). VI. Sensitive periods. 

Monographs of the Society for Research 

in Child Development, 76, 147–162.

ZERO TO THREE. (2012). FAQ’s on the brain. Retrieved 

from http://www.zerotothree.org/child-development/

brain-development/faqs-on-the-brain.html 

Suggested citation:

Child Welfare Information Gateway. (2015). 

Understanding the effects of maltreatment on brain 

development. Washington, DC: U.S. Department of 

Health and Human Services, Children’s Bureau.