The Importance of Play
We examine the child brain: looking how the Victorians viewed babies, ask could early childhood stress, like changing schools, parents divorcing or having an anxious, overbearing mother, EVER be a good thing? Plus we examine the brains of young criminals and ask could brain anatomy and activity findings better inform youth rehabilitation services.....
In this episode
01:46 - A Story of Neglect
A Story of Neglect
with Brad, NSPCC
In America alone, four children die every day as a result of abuse. Worldwide, at least 12 out of every 10, 000 children are affected by abuse. There are likely many more cases that go unreported. Child abuse does not discriminate across gender, it affects boys and girls equally. Those with a physical or mental disability, however, are twice as vulnerable.
It can take the form of physical abuse, emotional abuse (so ignoring, rejecting, isolating or verbally abusing the child) or neglect where a child may be left hungry or dirty, without adequate clothing, shelter, supervision, medical or health care.
Brad reported what he found to the NSPCC.
Brad - I'm a telephone engineer by trade and I was doing a routine call. I walked up to the door as normal and introduced myself to the woman. The minute she opened the door, a smell hit me. I mean, it really hit me. The amount of rubbish and mess was staggering. I have to literally wade ankle-deep through rubbish, beanbags of garbage or bin and eaten cans, empty pizza boxes. To be honest, I didn't know what I was putting my feet in. the cats were all over the place. I could certainly smell the urine and faeces. But when I actually got to my workstation, the flies were landing on my face. I noticed that on the set, along with the two adults was a young toddler. This shocked me. I could not imagine the child living in this kind of environment. She had a ground in dirt that I know as a parent, wasn't every day dirt. It wasn't rough and tumble playing out dirt. It was ground in built of over time. It was clear she had nowhere to play and didn't play.
Thank you to the NSPCC for the use of their audio clip.
03:49 - Can Words Damage the Brain?
Can Words Damage the Brain?
with Dr Anne-Laura van Harmelen, Cambridge University
Sticks and stones may break your bones, but words will never hurt you. True, or false? The effects of emotional abuse revealed...
Naked Scientist Amelia Perry spoke to Dr Anne-Laura van Harmelen on the effects of emotional maltreatment, including neglect, on the brains of children...
Hannah - We'll be hearing later about growing up in a physically abusive environment. But first, Naked Scientist Amelia Perry spoke to Dr. Anne-Laura van Harmelen on the effects of emotional maltreatment, including neglect, on the brains of children.
Anne-Laura - So, my research actually suggests that sticks and stone may break your bones but words and neglect might hurt your brain. The effects of emotional maltreatment on a later behaviour have been studied a lot and there's a whole cascade of negative consequences of emotional maltreatment. So, people have more behavioural problems, they have more psychological problems, people are more anxious, more depressed.
Amelia - What do your brain studies show us about maltreatment's effect on the actual brain, on their development?
Anne-Laura - I have studied the effects of emotional maltreatment in childhood on the structure of the brain so the anatomy, and the functioning, so how the brain works in adults that reported emotional maltreatment. I found that emotional maltreatment is related with a smaller part of the brain, the medial prefrontal cortex which is really important for emotion regulation, stress response, and it's also really, really important for self-referential thinking. So, thinking about yourself, about others, and what's really interesting is that part of the brain is also more responsive when these individuals with emotional maltreatment are in a really negative interpersonal situation. So, when they're being ostracised, they have more activation in that brain part which we think reflects more negative self and other referential thinking. So, they're just dwelling on that negative experience and kind of ending up in a negative loop of negative thinking styles and negative cognitions.
Amelia - So, the actual size of this region in the brain is actually decreased quite severely in these cases then with people suffering maltreatment. But what do we know about brain development in early life? Just how malleable are our brains in this vital period before adolescence?
Anne-Laura - Well, the brain continues to develop well into adulthood and especially in childhood and adolescence, parts of the brain that are really important for emotion regulation and stress response are developing still. So, they're also very sensitive to all kinds of influences from outside. Increased stress in that developmental time-periods changes the amount of hormones that are present in the brain and those hormones can actually change the way the brain grows. So, we know that stress during this developmental time-periods can be detrimental to brain development.
Hannah - Anne-Laura van Harmelen speaking with Amelia Perry.
06:37 - Rebuilding Lives
with Camila Batmanghelidjh, Kids Company, Professor Katya Rubia from Kings College London, Eamon Mccrory, University College London
Camilla Batmanghelidjh set up Kids Company, a UK based charity that supports over 36,000 young children, who have experienced abuse. In recognition of her work, in 2013 she was named one of the UK's 100 most powerful women by BBC Radio 4's Woman's Hour, and appointed an honorary Commander of the Order of the British Empire (CBE). Kids Company works to rebuild abused children's lives, firstly by boosting resilience, as Camila explains to Hannah Critchlow...
Camilla - The way we wrap resilience around vulnerable children is by considering their practical, emotional and aspirational needs. So, we'll buy children underwear, toothbrush, find them somewhere to live. A third were under 14 who arrive at our street level centres are sleeping on the floor. We'll buy them a bed and then we look at giving them attachment figures either by strengthening the people who care for them within their family or by getting our staff to function as substitute parental figures so that the children can have this sense of a caring adult who's there for them through thick and thin. And then through the adult's imagination, we try and imagine the children into the future and help the children think about what they might want to achieve in the future.
Hannah - I can imagine that quite a lot of these children will have observed quite a lot of violence in their early years. And so, they've acquired that kind of violence, aggressive way of defending themselves almost in social situations. How on Earth do you deal with that and how do you try and build a more reasonable outlook?
Camilla - The majority of the children who come to our street level centres, their primary way of protecting themselves is through violence. They sometimes choose violence as a defence mechanism. So, they'll carry knives, sometimes firearms. In fact, UCL looked at our kids - our 16 to 24-year olds and they found that 1 in 5 of them had been shot at and/or stabbed with 50% witnessing shootings and stabbings in the last year.
The children are realistic if you like, about the violence they're exposed. Within the confines of their own possibilities, i.e. them, left to themselves to fend for themselves, they work out different ways of protecting themselves. But there is another layer of violence which is what I call intentional violence. The second layer of violence they have is what I call responsive violence.
The kids actually completely lose it emotionally. In fact, they have words for this. They call it, "I flipped or I switched." What they mean by that is that their stress levels get to such a point where it's almost as if their brain blows and they enter a space of extraordinary rage during which they can smash up a space, they can hurt people. They don't actually even see people properly. They often superimpose the faces or the behaviours of past perpetrators on staff and then end up attacking staff, imagining that it was a perpetrator in the past that is in the here and now. So, there is some kind of an explosive reactive violence that they're capable of. It lasts about 45 minutes during which the child is completely overwhelmed and after which, the child often says to us, "God! I don't know what happened." They can't believe what the destruction they have generated because it almost like an out-of-body experience for them.
When I first started working with these children 18 years ago, the one thing that struck me, I actually brought a group of scientists to look at these children's behaviours to try and acquire a better understanding of what was happening. What the scientists have found collectively is that as a result of chronic childhood maltreatment, the brain functioning of these children is different. Because of that, their perceptions and the way they compute other people's behaviours reactions and emotions are completely different.
Hannah - Professor Eamon Mccory from University College London has worked with Camilla and describes his findings, scanning the brains of children who have been abused.
Eamon - Chldren who have experienced abuse at home is that there's a heightened response in threat related centres of the brains involved in anticipatory brain processing. So, it seems that maltreatment at home is associated with a heightened sensitivity to possible threats, but also an increased anticipation that that might be associated with negative outcome in terms of possibly being hit or struck. But in addition, we carried out an fMRI study where we show angry faces, representing a threat too. Also, in a subliminal way, so kids have no conscious experience of having perceived threat and we still see a very similar pattern of results. So, even when children aren't aware of the threat in their environment, early adversity seems to etch in the brain in a way to make it attentive to environmental cues that may signal possible threats.
Hannah - Is there any way that you can kind of change the brain back to normal as it were, so that they're not hypersensitive to kind of anger and potential threats in the environment?
Eamon - So, that's a brilliant question. At UCL, we're coming now with the first longitudinal study of kids who have experienced maltreatment using fMRI and that is going to allow us to address that very question. Because what you really need to look at is whether in some children, do those brain differences normalise? So, when they're moved into say, foster family, when they receive certain kinds of intervention, do those brain response normalise in line with other typically developing kids? And so, what we really have to do is follow kids up over time and measure those brain responses and see whether they change. So, we're currently halfway through now, a 4-year ESRC funded study where we're doing exactly that and we just finished stage 1 and we're hoping in about a year and half's time to be able to bring all of the kids back and see how they've developed. We're looking both at brain structure and brain function, and we would predict that some of the kids will have faired pretty well and we expect to show some normalisation of brain response. But it's unclear whether some differences might persist and that's what we're going to be looking at.
Hannah - And collaborator, Professor Katya Rubia from King's College London on her findings.
Katya - We did this task, an inhibition task where people are forced to make mistakes in 50% of the trials. So, we were particularly interested in error monitoring because children with child abuse been shown to have problems with processing negative feedback. So, what we basically found is they had enhanced activation in an error processing network in the brain. We think that this is because they're hypersensitive to negative feedback and probably due to their experience because whenever they did a mistake, probably led to physical abuse. They slow down more when they do a mistake and this is interesting because this has also been found in people with anxiety. And of course, these children have very high anxiety. So, they're basically living in fear of making mistakes. Doing the motion processing task, they had abnormal enhanced activation in fear processing regions - the anterior medial prefrontal cortex which is crucial for fear. So, we think this is because they have, due to their experience with physical abuse in childhood, there's hypersensitive to the motion of fear. Lastly, during concentration, we found reduced activation in concentration area.
Hannah - By looking at anatomy and activity, we can see that children who suffer from child abuse also suffer brain damage. The circuits in their brains are hypersensitive to threats. Susceptible to fear, they find concentrating difficult and their brains are hard wired to freeze up when making decisions and their conditions where they might experience punishment. Looking at statistics, those who suffered child abuse are 9 times more likely to become involved in criminal activity and 30% of abused and neglected children or later, abuse their own children, continuing the cycle. Could these brain circuits ever be rewired back to normal to restore the child's behaviour and break the vicious cycle of criminality and abuse? Back to Camilla on how spending up to 2 years with Kids Company seems to do just that.
Camilla - They look specifically at 12 to 17-year old highly criminal boys that after 15 months, these dramatic improvements in their emotional processing. But also, that you could see changes in brain functioning when the kid's brains were looked at and I think it's the closest we've got to being able to evidence the potency of love and its impact on brain functioning.
Hannah - Wow! So, you can actually see the hard wiring of the child's brain being affected by being exposed to stress and early life and then you can see how that correlates in terms of the rehabilitation programme with improved behaviour in these teenagers after being with you for - between a year and 2 years.
Camilla - Yes. The other interesting evidence that's coming through is that in conditions when you punish this type of child, actually, the error networks of the brain go into overdrive, i.e. the kids end up making more and more mistakes. They don't correct their behaviour when they're punished whereas the control group who haven't been maltreated have a capacity to correct. I think what this proves is the underlying chronic anxiety state that is prevalent in these children even if they appear to be invincible and very aggressive, and non-caring. Actually, underneath it, what you've got is a terrorised kid with high levels of anxiety.
Hannah - So, you're saying that basically, these children, because they've suffered such trauma in early life, it's affected their brain in such a way that they can't process punishment in a way that a normal child would.
Camilla - Yes, that's true. They don't process punishment in a way that's corrective. In fact, punishment make more errors.
Hannah - In that case, does this have ramifications for youth offenders programme rehabilitation schemes with the prison for example in UK?
Camilla - It's a great question you ask actually because in fact, if you'll look across the world in youth offending programmes and child custody programmes, there is an above 75% re-offending rate internationally. The only really successful programme of youth custody that has been around was one in turkey where the model was closest to family care, i.e. care behaviour formed the majority of the intervention. That programme ended up being the most successful out of international penal interventions in relation to vulnerable children. But in England, the re-offending rate is just under 80% in child custody, youth offending, and youth custody. Now, if this had been a school that was failing at the rate of just under 80% or a heart hospital, people would've come shut it down and said it doesn't work. In fact, I think what this research is demonstrating is going to turn the penal reform programme right around on its head because a.) it means that the children do not have the neuronal capacity to control their own behaviours appropriately. I.e. it's not that their brain is like another normal child and then they happen to make poor moral choices which you imagined that through punishment, you can correct, i.e. you can make them make better choices. That is not the case. What the researcher is showing is that these kids' brains are so damaged that in the first place, they don't stop, they don't think, they don't have the capacity to retrieve the memory of being punished to use it to correct their behaviours. In fact, you're looking at an invisible brain injury if you like. It's arguable whether we could describe them as criminals. I think we have to completely remove this word and start thinking about the fact that these kids have got impaired abilities to control their emotions, and their energy. In years to come, we look back on our behaviour now in relation to vulnerable children, and it will classed as a type of absurd witchcraft that came from irrationality. Because we are so sure that their behaviour is a product of poor moral choices, we almost absorb ourselves of the responsibility to protect them and care for them appropriately.
21:41 - What was it like in Oliver Twist's day?
What was it like in Oliver Twist's day?
with Dr Hannah Newton, Cambridge University
The Victorians had a firm belief in punishing criminals, and were particular shocked by children who crossed the line of the law. You may be familiar with Charles Dicken's Victorian classic novel, where the young Oliver Twist, picks a pocket or two with Fagin's London based gang.
When Dickins wrote this book, children as young as 10 were being sent to prison.
Naked Scientist Amelia Perry caught up with Dr Hannah Newton, from Cambridge University to explore how children were treated back in the day...
Hannah N. - Obviously, there are cases of children being treated badly in any period, but to be honest, I think really, this is quite a big myth in the history of childhood. When you look back at parent's diaries and letters and personal documents from the early modern period and before, the overwhelming picture is kindness to children and concern about them and their upbringing. Part of the issue is that we have a slightly different conception of childhood to how people in the past understood it. And for us, the idea of a child starting work at a young age seems to us incompatible with a concept of childhood. But in the early modern periods, it was actually a necessity for financial survival that children contributed to the family income. It didn't mean they didn't see their children as children and children were still thought to be different from adults and things that distinguish them where their love play, the curiosity, their need for affection and love.
Amelia - I know lots of parenting manuals exist. My mum has got about 20 on her shelf and it seems almost there are two different strands of parenting. One, there's this strict authoritarian manner or there's the more kind of nurturing laid back approach. Do you think those kind of approaches existed that many years ago?
Hannah N. - Yes, I think they did actually. There's a lot of literature produced in the 17th century about how to be a good parent and they thought it was a very important subject. They tend to take a kind of moderate view. They believe that children should be nurtured and loved, and that the primary duty of parents is to love and care for their children, but they also have very high expectations of children's behaviour and they think that children should be obedient. I think in terms of different strands of parenting, this is detectable because you can see parents writing in their letters and their diaries about parenting. Mothers occasionally, I think there's a gender element, mothers are often accused of being rather too fond of their children and spoiling them. But there's equally great concern about being overly strict with children. Bringing a child up in fear is thought to be not necessarily very good for the child's own development. So, in the end really, it's about moderation. They think love and affection, but also, discipline and knowing their boundaries.
Amelia - So, how did people view children's brains back then? What do they think about them?
Hannah N. - The main overriding characteristics of children was their moisture. They thought that when you are born, you have absolutely masses of moisture which filled up and saturated your body and your brain. It was this moisture which accounted for children's tendencies to dripple and cry and the soft texture of their skin. I suppose, they looked at old people and they thought that old people are rather dry and wrinkly, and ageing was therefore seen as a cooling and drying process. So, you're warm with lots of heat and moisture, and you progressively dried out and cool down, until eventually, you died and that was the cause of natural death. This moisture had a massive impact on children's brains. It was thought to - one author wrote that children's brains are drowned and drunk with moisture and humours. This was why children weren't very rational and it also accounted for their emotional tendencies. Children cry very easily and get very happy and very sad very quickly. That emotional fluctuation was put down to the fact that the rational soul, the part of the soul responsible for reason was slightly incapacitated by all these liquid. And for this reason, children's brains are thought to be like wax. They were very impressionable which made them peculiarly capable of learning and also made them - the time in their life really when their personality was thought to be formed. This was really why parents needed to show affection to their children and teach them all the right manners and morals that they would need for the rest of their life. The brain was most impressionable for all infants. There's good and bad little children, babies who were thought to have very poor memories because their brains are so wet and so drenched that they couldn't really retain any impressions. But as a child got to the age of about 7, it dried out slightly and then suddenly became the perfect consistency for learning which is why children start to school at 7. The other issue is that I suppose, the treatment of a child, how they were brought up was thought to be particularly important in that age group because they would remember how they have been treated.
Amelia - So, are there any records of brutality against children occurring in these early periods?
Hannah N. - Yes, there is. The old Bailey records contain evidence of witness statements for crimes. They include cruelty to children. There was some allowance for correcting children. They called it moderate correction which meant beating a child but it wasn't supposed to be violent. I think the word 'beat' for us comes at images of really violent aggressive physical assault. But in the early mum period, it was perhaps more like how we might understand slapping or smacking a child. Having said that, they did use canes and they did use birch twigs in the early modern periods and I think there was considerable potential for this to turn into abuse. Having said that, it wasn't really advisable and it was prosecuted quite severely in the courts. The death of a child caused by beating was a heinous crime and was punishable by death for the perpetrator.
Hannah - Hannah Newton from Cambridge University.
27:24 - Can a Little Bit of Stress Help?
Can a Little Bit of Stress Help?
with Dr. Mathias Schmidt, Munich Max Plank Institute of Psychiatry
We close the show by discussing how a mild amount of stress in early life, could actually have a positive effect for some individuals.
Dr. Mathias Schmidt from the Munich Max Plank Institute of Psychiatry studies this, in mice....
Hannah - We close the show by discussing how a mild amount of stress in early life could actually have a positive effect for some Dr. Mathias Schmidt from the Munich Max Plank Institute of Psychiatry studies this, in mice...
Mathias - One of the major risk factors for depression that we know of from the environment is stress exposure. And here especially, stress exposure early in life seems to be very detrimental in determining the risk of later disease.
Hannah - In humans, the type of early childhood stresses that you're talking about that might predispose to depression are things like for example, being affected by violence at home or conflict at home, or even things like moving home or moving schools for example might increase your risk of depression later on in life.
Mathias - Yes, this is true. In mice obviously, we want to have our model system which is very controllable, but we don't want to do anything to the animals which is ethically not supportable. So, what we do is moderate stressors where we basically alter the environment of the mother in a way that the maternal behaviour gets more erratic or less predictable that basically also affects the offspring. Using that sort of model, we can then ask the question of, what is the long term consequence of that.
Hannah - By the stressing the mother, the baby mice actually is still weaning at that time and they're still taking her milk. In that case, could some of these stress factors be passed on through the milk?
Mathias - Yes. There's also a possibility that some of the stress factors of the mother are via the milk, getting into the baby pups. But actually, it was shown that most of the effects are really transmitted via maternal behaviour. So, the mother via her behaviour can actually have a very calming or a very upsetting effect on the offspring. It's really actually a little bit like in humans if you have a very predictable childhood with very clear rules and not erratic situations, then this is usually not very stressful and good. If the situation is very difficult and non-predictable, this is usually what's really stressful for kids and is also very stressful for mice.
Hannah - But it's not the case that every single child that might have to move schools or move house or might experience conflict within their home that they all go on to develop depression or anxiety for example. So, are you seeing that with the mice as well, that some mice are absolutely fine with this early experience in life and some mice just do seem to get depression?
Mathias - Yes. So, this is actually the core of our research approach. So, what we see indeed is that as in humans, not all individuals exposed to stress eventually develop a depression-like symptom.
Hannah - What is that slightly depressed or anxious mice look like?
Mathias - We measure behaviours in terms of anxiety as relatively straightforward. Mice are afraid of open spaces or they are afraid of very bright areas but on the other hand, they want to explore their environment, maybe search for food. So, we generate a little test arena where there's a conflict between exploring and hiding from that part of the arena, we have a very anxious mouse that will not explore those areas. We can measure other things like hormonal regulation and motivation to get reward for instance which is also altered in depressed patients and we can really transpose it quite nicely into the animals.
Hannah - So, you were saying that some mice that experience stress during early childhood still are bold mice, they go and explore their environment. They also seem to have motivation for reward as well. So, why is it that some mice seem okay and others don't?
Mathias - Yes. As in humans, there's a strong genetic component of psychiatric disorders and depression. We see that in humans, we can also confirm that in animals. Here, we have to picture indeed to manipulate the genetic background of these animals and manipulate specific genes. By doing that, we can shift the balance of vulnerability and resilience to stress.
Hannah - So, some of the mice's genetics, they can either be very resilient to early life stresses or they could be very predisposed to depression and anxiety. So, is it the same in humans?
Mathias - Yes, we also find genetic risk factors for depression in humans. On the one hand, stress is a risk factor for disease, but on the other hand, it is adaptive in a way. So, if you're exposed to at least moderate levels of adversity and stress early in life then this can actually shape your physiology in a way, that you're better adapted to similar situations in adulthood.
Hannah - And the stress factor, so the stress hormone in humans is something called cortisol and the cortisol system in the brain is still developing in babies in the first 5 years and even further on into life. So, could it be that stressful experience as very early on childhood could then tweak or change that cortisol system or sensitivity in the brain to then actually help make some children more resilient in the future.
Mathias - Yes. This is indeed what we find. It's not only the cortisol system but the stress system is really an orchestrated system with many factors which are active in the brain and in the periphery. They basically shape the physiology of an individual. Those experiences early in life within a certain range at least, they're really meant to shape your body in a way so that it can deal better with similar situations. We all know that stress is part of everyday life and was, for millions of years before and just our physiology is adapted in a way to deal with that and also, to develop into that. So, if you're growing up in a very adverse circumstances then your body should better adapt to that so that you can actively cope with the situation later on. We are now living where a lot of things change very quickly and I think this is the core of the problem because you're growing up in a very protected home maybe. But then you have to face many stressors in adult life or vice versa. You're growing up on the very adverse situations, but then your adult life is very different.
Hannah - What genes are involved in this resilience to stress? Is it the cortisol system or is it different genes?
Mathias - We do find genes which are involved in the regulation of the stress system such as the main system which is producing cortisol as an end-product in humans, which are also directly modulating the vulnerability of animals to stressful life events.
Hannah - So bottom line then is that stress in early childhood might not actually be a bad thing. it might make you more resilient and more likely to flourish later on in life. Do you think we'll ever get to a stage where we could have biomarkers? So, biological markers which could indicate whether an individual is going to grow up to be a very resilient person later in life or whether they can be more likely to become depressed.
Mathias - Yes. So, this is exactly the way we're going. We hope to get there in the near future. At the moment, as I said, depression is diagnosed just by the symptoms and treated with the same drugs - independent or what genetic background you have, depending on what early life history you have. We are hoping in the animal model, this is really working quite well to identify biomarkers that allow us then to really individualise our treatment and our diagnoses to say, "Patient A has this specific early life history together with the specific set of genes which explains why he or she is suffering from depression and as for her specific treatment, the same treatment would not work in patient B because he or she has a different history, a different set of genes, and just need some different treatment." We just have to step away from this one drug for everyone and just really go on to this personalised medicine and help people.
Hannah - And that's all we have time for this month, I'm afraid. If you have any questions or comments, please do get in touch. It's firstname.lastname@example.org. thanks to all those who took part in the programme, the NSPCC, Amelia Perry, Dr. Anne-Laura van Harmelen, Camilla Batmanghelidjh, Eamon McCurry, Katya Rubia, Hannah Newton and Mathias Schmidt. Signing off, I'm Hannah Critchlow with this special Naked Neuroscience episode supported by the Federation of European Neuroscience Societies. See you next month to open our minds.