A brief reheating of the refrigerator mother

The Telegraph has a well-intentioned but confused article about how child neglect affects the brain and what can be done about it.

What’s the difference between these two brains? asks The Telegraph. “The primary cause of the extraordinary difference between the brains of these two three-year-old children,” says the journalist, “is the way they were treated by their mothers.”

According to the paper “The child with the much more fully developed brain was cherished by its mother, who was constantly and fully responsive to her baby. The child with the shrivelled brain was neglected and abused.”

Firstly, it’s worth saying that reduced brain size is clearly related to neglect and abuse but the images are not a typical representation of this.

These scans were originally published in an article on child abuse by neuroscientist Bruce Perry who drew them from an unpublished abstract [pdf] of a study on neglect in children, which didn’t control for malnutrition or drug exposure during pregnancy.

They’re described as showing CT scans of three-year-olds, one normal and the other neglected who has a head size smaller 97% of children his or her age. This would make him or her almost diagnosable with microcephaly, a neurological disorder of small head size usually caused by a genetic defect.

This difference in brain size has actually been found in those without the genetic defect. In fact, this difference was found in a study of severely neglected Romanian orphans but severe malnutrition was also a significant factor.

In other words, unless you include ‘starvation’ under the concept or ‘poor interaction with the mother’ the scans really don’t represent what typically happens to children who are emotionally neglected.

Oddly, the Telegraph article spins brain development as specifically depending on the mother, giving an undercurrent of traditional mother-blaming.

Neurologists are beginning to understand exactly how a baby’s interaction with their mother determines how, and indeed whether, the brain grows in the way that it should.

The ghost of the refrigerator mother rises again.

The piece is full of other neurological howlers: “Eighty per cent of brain cells that a person will ever have are manufactured during the first two years after birth” is just baffling, considering we are born with almost all the neurons we will ever have.

The number of synapses – connections between brain cells – does increase after birth but at most by about two thirds. The number peaks between about one and four years, depending on the brain area, and then it rapidly decreases as the brain removes unused connections in a process called synaptic pruning.

The words of neuroscientist Allan Schore seem to have be carefully selected to bolster this scientific misunderstanding, despite the fact his actual quotes do not suggest that he thinks brain cells ‘grow’ after birth.

Furthermore, the idea that “if a baby is not treated properly in the first two years of life, the genes for various aspects of brain function, including intelligence, cannot operate” is seemingly a fuzzily remembered misunderstanding of the role of stress on the epigenetics of neural development.

In fact, it looks like the piece has been written to support a government commissioned report by MP Graham Allen developed from an earlier report by think tank The Centre for Social Justice.

Both present the brain scans, somewhat misleadingly, as a reasonable illustration of emotional neglect, and the first report, scientifically, is a bit ropey. The second though, is surprisingly good.

It actually talks little about the brain, doesn’t feel the need to get into mother-blaming, argues that more support is needed for young children below the age of three from early intervention programmes.

This is a valuable approach and a valid point of view, which The Telegraph article is right behind, but neither brain-shrivelling mothers nor scare tactics are needed.

Link to somewhat confused Telegraph article.
Link to scientific review on brain effects of child abuse.

5 thoughts on “A brief reheating of the refrigerator mother”

  1. It’s great to get your perspective on this. I thought The Telegraph was one to be trusted but I love your “truth”, ie facts backed up my solid evidence.

  2. Disclosure: Bruce Perry is one of my co-authors. The problem here is that it’s hard to severely emotionally neglect a child *and* feed him well. There are 2 reasons for this. One is that if you are severely neglecting the child, by definition, you are ignoring pleas for help or spending much time feeding him.

    The second reason is more interesting and has to do with a well-documented condition called “failure to thrive.” This is seen in neglected infants and is linked with a reduction in the release of growth hormone. It is probably related to what happens to the “runt” in animals that have litters (where reductions in this hormone are also seen). Basically, it doesn’t get enough licking, nuzzling, etc. and that actually turns down growth hormone. The result of this is that even if nutrients are available, the animal doesn’t use them well and basically slowly dies. We literally need physical affection to get signals for survival.

    So there will be no way to disentangle neglect and malnutrition because you can’t have severe neglect without malnutrition. Whether some of the brain results are due to the malnutrition doesn’t matter because the fundamental cause of the problem is the neglect.

    If you have a copy of The Boy Who Was Raised as A Dog, we discuss neglect at length in context of failure to thrive

    1. @ Maia Szalavitz
      If there is ‘no way’ to disentangle neglect and malnutrition (or hormone deficiencies or genetic variation) then what conclusions can we draw about the brain anomalies associated with neglect? What grounds are there for assuming they are due to emotional neglect or sensory deprivation, as Perry does? What you seem to be saying is that Perry’s hypothesis is untestable.

      I’ve looked at his paper in more detail here;http://movingonfrombowlby.wordpress.com/2012/11/11/bruce-perry-on-nature-and-nurture/

  3. Mainstream weekend newspapers talking about neglect, vulnerability, connections between child development and neglect that has a science to underpin it, and people are spending time arguing about hypotheses and accuracy of ‘actual’ brain damage blah blah!?! Come on people, this is an opportunity to be seized with time spent on how we can do the absolute best for vulnerable children so they don’t have to spend a lifetime in adult services, recovering from damage with stories they don’t understand. Perspective my lovelies, perspective!

  4. I find it odd that no one has commented on the ct scan images. The one on the left is clearly a result of brain swelling probably from physical trauma. There is a complete lack of sulci present, the lateral ventricals look very tight and there is lack of grey white matter present throughout. The scan on the right looks grossly normal. Also the is no scale for reference, they have probably blown up the image and are these two images from children in the same or similar growth percentile for age? And are they of children at all. Obviously just used any old image to support a story, puts the credibility of the whole article into question.

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