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Cited by 232Child Abuse and TraumaChild and Adolescent Psychosocial and Emotional DevelopmentPsychoanalysis and Psychopathology Research

Deviations from the expectable environment in early childhood and emerging psychopathology

Open access
Humphreys, Kathryn L, Zeanah, Charles H·2015·Neuropsychopharmacology
DOI 10.1038/npp.2014.165PMC PMC4262894
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Abstract

Current frameworks for understanding the link between early adverse childhood experiences and later negative life outcomes, including psychopathology, focus on the mediating negative impact on brain and biological systems in the developing child resulting broadly from stress and trauma. Although this approach is useful, we argue that the framework could be functionally extended by distinguishing the effects of two different types of abnormal input, both deviations from the expectable environment in early childhood. Specifically, we review the consequences of inadequate input (eg, neglect/deprivation) and harmful input (eg, abuse/trauma) on brain and biological development. We then review evidence on the differential links between each type of abnormal input to four selected domains of psychopathology (indiscriminate social behavior, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and conduct problems), and consider potential mechanisms for inadequate and harmful input to lead to these outcomes. We conclude that the careful consideration of the type of deviation from the expected environment, while acknowledging the practical difficulties in assessing this, is likely to lead to clearer understanding of the mechanism of risk for psychopathology, and that tailored approaches to prevention and intervention may be informed by considering the unique consequences of inadequate and harmful input when experienced in early childhood.

AI snapshot

Written from the paper’s full text.

TL;DR

This review proposes distinguishing two deviations from the expectable early environment—inadequate input (neglect/deprivation) and harmful input (abuse/trauma)—rather than treating early adversity as a single stress/trauma construct. It reviews evidence that both types alter brain and biological development and show overlapping but potentially distinct links to indiscriminate social behavior, PTSD, ADHD, and conduct problems.

Key findings

  • The paper argues that inadequate input and harmful input both disrupt development but may have different neurobiological and behavioral consequences; it calls for parsing broad adversity into these two components to clarify mechanisms and tailor prevention/intervention.
  • For PTSD, Widom (1999) reported no difference in risk among adults maltreated as children by sexual abuse (23%), physical abuse (19%), or neglect (17%), all higher than nonmaltreated comparison (10%); lifetime PTSD risk was 38%, 33%, and 31%, respectively. In a child welfare sample, posttraumatic symptoms were similar for physical abuse (10%), sexual abuse (13%), and neglect (13%) (Kolko et al, 2010).
  • For ADHD, youth investigated by child welfare had nearly 19% ADHD prevalence versus 5% in the general population; in BEIP at 54 months, institutionalized children were more likely to meet ADHD criteria than never-institutionalized children (21% vs 3%, OR=7.4). Ouyang et al (2008) found supervision neglect predicted inattentive (OR=1.6) and hyperactive (OR=1.5) types, physical neglect predicted inattentive type (OR=2.1), and physical/sexual abuse predicted inattentive type (OR=1.6 and 2.6).
  • For conduct problems, physical abuse before age 5 was associated with four times higher likelihood of conduct problems in 3rd/4th grade (Dodge et al, 1995); childhood sexual abuse had OR=6.32 for conduct disorder (Cutajar et al, 2010). For indiscriminate behavior, persistent signs after early serious deprivation were estimated at 10–20% of children.

Methods

  • Narrative/selective review, not an empirical study or meta-analysis; the authors review evidence on inadequate versus harmful input and four selected psychopathology domains: indiscriminate social behavior, PTSD, ADHD, and conduct problems.
  • Draws heavily on three longitudinal studies: Widom’s prospective cohort of 4,900 children abused/neglected before age 12 with >600 matched comparisons interviewed at age 29; the English and Romanian Adoptees Study of Romanian institution-reared children adopted at different ages and assessed at 4, 6, 11, and 15 years; and the Bucharest Early Intervention Project, an RCT of foster care versus institutional care in 6- to 30-month-olds assessed at 30, 42, and 54 months with follow-ups at 8 and 12 years.
  • Main analysis is a conceptual synthesis of behavioral, neurobiological, and psychopathology findings, including proposed mechanisms such as HPA-axis/cortisol changes, EEG patterns, cortical thinning, amygdala–prefrontal connectivity, attention bias to threat, and gene–environment interactions.

Limitations

  • Stated: human environments cannot be experimentally controlled; inadequate and harmful input often co-occur; the review cannot fully consider developmental timing/sensitive periods; and assessing onset, duration, and severity of negative exposures is difficult, especially in young children unable to report their experiences.
  • Stated: co-occurrence and confounding are major issues—over 50% of ACE Study participants reporting childhood physical neglect also endorsed physical abuse, while approximately 20% of physically abused youth also reported physical neglect; prenatal substance exposure and parental psychopathology may also confound outcomes.
  • Evident: the review is selective rather than systematic, many cited findings are described as preliminary or in need of replication, and the evidence base is uneven across the four psychopathology domains.

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Integrity signals

Registry

Crossref · 10.1038/npp.2014.165

Cites

202 of 202 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

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  • Premisecitation

    Human infants are born with a strong propensity to form attachments to a small number of caregiving adults.

    “Human infants are born with a strong propensity to form attachments to a small number of caregiving adults with whom they interact regularly and substantially in the earliest years of life (Bowlby, 2008).”
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  • Premisecitation

    Each type of deviation (inadequate and harmful input) has been associated with a broad array of maladaptive outcomes, including various domains of psychopathology.

    “Importantly, each type has been associated with a broad array of maladaptive outcomes, including various domains of psychopathology (National Research Council, 2013).”
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    • cites National Research Council, 2013

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  • Interpretationreasoning

    Careful consideration of the type of deviation from the expected environment is likely to lead to clearer understanding of the mechanism of risk for psychopathology.

    “We conclude that the careful consideration of the type of deviation from the expected environment, while acknowledging the practical difficulties in assessing this, is likely to lead to clearer understanding of the mechanism of risk for psychopathology”
    Quote in the paperNot a substantial claim
  • Interpretationnone given

    There are differential links between inadequate input and harmful input to four selected domains of psychopathology: indiscriminate social behavior, PTSD, ADHD, and conduct problems.

    “We then review evidence on the differential links between each type of abnormal input to four selected domains of psychopathology (indiscriminate social behavior, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and conduct problems)”
    Quote in the paperSubstantial claim
  • Premisecitation

    Relationships with caregivers provide an essential role in helping infants regulate their physical and emotional response to stressors.

    “relationships with caregivers also provide an essential role in helping infants regulate their physical and emotional response to stressors (Tronick, 1989).”
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    Findingnone given

    Abuse may co-occur with neglect in early childhood, but to date no evidence has demonstrated that physical or sexual abuse alone leads to indiscriminate behavior.

    “Abuse may co-occur with neglect in early child- hood, but to date no evidence has demonstrated that physical or sexual abuse alone leads to indiscriminate behavior.”
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  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Tailored approaches to prevention and intervention may be informed by considering the unique consequences of inadequate and harmful input when experienced in early childhood.

    “tailored approaches to prevention and intervention may be informed by considering the unique consequences of inadequate and harmful input when experienced in early childhood.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Both inadequate input and harmful input represent deviations from the expectable environment.

    “both inadequate input and harmful input represent deviations from the expectable environment (a concept introduced by Nelson and colleagues to describe the effects of adversity at the neural level; Curtis et al, 2002;Fox et al, 2010;Nelson et al, 2014).”
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    • cites Curtis et al, 2002

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    • cites Fox et al, 2010 source

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    • cites Nelson et al, 2014

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  • Classified as probably not a substantial claim.

    Premisenone given

    Current frameworks for understanding the link between early adverse childhood experiences and later negative life outcomes focus on the mediating negative impact on brain and biological systems resulting broadly from stress and trauma.

    “Current frameworks for understanding the link between early adverse childhood experiences and later negative life outcomes, including psychopathology, focus on the mediating negative impact on brain and biological systems in the developing child resulting broadly from stress and trauma.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The distinction between inadequate and harmful input may help guide intervention efforts and policy, and extends prior frameworks.

    “The distinction between these two types of deviation from expectable environmental input may help guide both intervention efforts and policy in this area, and extends prior frameworks that focused more broadly on stress and trauma without specific regard to differential types of input from the environment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Toxic stress disrupts developing brain circuitry and other organ systems, having long-term implications for physical and mental health.

    “The concept of 'toxic stress,' the cumulative and pernicious effect of multiple, chronic environmental adversities, is believed to disrupt developing brain circuitry and other organ systems, having long-term implications for physical and mental health (Shonkoff and Garner, 2012).”
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    • cites Shonkoff and Garner, 2012 source

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    Interpretationnone given

    The framework could be functionally extended by distinguishing the effects of two different types of abnormal input, both deviations from the expectable environment in early childhood.

    “we argue that the framework could be functionally extended by distinguishing the effects of two different types of abnormal input, both deviations from the expectable environment in early childhood.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Heightened plasticity of the brain in early life is a key feature of human development, and the infant brain relies upon environmental experiences in order to develop.

    “Heightened plasticity of the brain in early life is a key feature of human development, and the infant brain relies upon environmental experiences in order to develop (Greenough et al, 1987).”
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    Interpretationnone given

    Potential mechanisms exist for inadequate and harmful input to lead to these outcomes.

    “consider potential mechanisms for inadequate and harmful input to lead to these outcomes.”
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    Premisecitation

    The transactional model considers developmental outcomes, including psychopathology, as a function of ongoing transactions between the individual and the environment.

    “The transactional model of development, first proposed by Sameroff and Chandler (1975), considers developmental outcomes, including psychopathology, as a function of ongoing transactions between the individual and the environment, which exert continual effects on one another.”
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    Premisecitation

    Institutional rearing appears to result in reduced electrical activity in higher frequencies and increased electrical activities in lower frequencies, but for children placed with families before 24 months, normalization of brain functioning has been demonstrated.

    “Institutional rearing appears to result in reduced electrical activity in higher frequencies and increased electrical activities in lower frequencies (Marshall et al, 2004(Marshall et al, , 2008;;Tarullo et al, 2011), but for children placed with families before 24 months, Vanderwert et al (2010) demonstrated normalization of brain functioning.”
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    Study design and conductreasoning

    The BEIP RCT design reduces selection bias, includes assessments while children lived in deprived conditions, and allows causal conclusions to be drawn about the effects of environmental enhancement.

    “As a result of the RCT design, this study reduces selection bias that may be present in adoption studies, includes assessments of children while they lived in deprived conditions, and allows causal conclusions to be drawn about the effects of environmental enhancement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The differing impact of inadequate vs harmful input may be seen in specific neurobiological and behavioral outcomes.

    “Although neglect/deprivation and trauma/abuse both involve the potential removal of expectable environmental experiences, the differing impact of these two forms of deviation (ie, inadequate vs harmful input) may be seen in specific neurobiological and behavioral outcomes.”
    Quote in the paperNot a substantial claim

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    Interpretationcitation

    Many of these findings should be considered preliminary and in need of replication, but they point to neurobiological effects of deprivation on brain structure and function in young children.

    “Many of these findings should be considered preliminary and in need of replication, but they do point to neurobiological effects of deprivation on brain structure and function in young children.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Adults who experienced maltreatment in childhood had smaller hippocampal volume, indicating a possible sleeper effect of maltreatment in childhood.

    “Although not observed in maltreated children, adults who experienced maltreatment in childhood had smaller hippocampal volume, indicating a possible sleeper effect of maltreatment in childhood (Woon and Hedges, 2008).”
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    Premisecitation

    Indiscriminate behavior is rare in epidemiological studies, but it is one of the most common social abnormalities described in young children living in institutions and in those adopted out of institutions.

    “Indiscriminate behavior is rare in epidemiological studies (Egger et al, 2006;Gleason et al, 2011b), but it is one of the most common social abnormalities described in young children living in institutions (Zeanah et al, 2002(Zeanah et al, , 2005) ) and in those adopted out of institutions (Bruce et al, 2009;Chisholm, 1998;Rutter et al, 2010a).”
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    Premisereasoning

    To date it is unclear the degree to which each set of responses is related to the varying types of stresses on the system (ie, inadequate or harmful input), as studies typically consider both forms of early adverse experiences together.

    “However, to date it is unclear the degree to which each set of responses is related to the varying types of stresses on the system (ie, inadequate or harmful input), as studies typically consider both forms of early adverse experiences together.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Children who were physically or sexually abused in early childhood had smaller diurnal decreases in cortisol than neglected children, but only in abused children with high internalizing symptoms.

    “For example, children who were physically or sexually abused in early childhood had smaller diurnal decreases in cortisol than neglected children, however, this was only found in abused children with high internalizing symptoms (Cicchetti and Rogosch, 2010).”
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    Premisecitation

    Young children express PTSD symptoms from each cluster somewhat differently than older individuals, and the algorithm for determining diagnostic threshold is slightly different, but the clinical picture is more similar than different.

    “Young children express symptoms from each cluster somewhat differently than older individuals, and the algorithm for determining diagnostic threshold is slightly different than for older individuals, but the clinical picture is actually more similar than different (Scheeringa et al, 2011).”
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    Premisecitation

    In 29-year-old adults who had experienced childhood maltreatment, there was no difference in risk for PTSD among those who had experienced sexual abuse (23%), physical abuse (19%), or neglect (17%), but all were at greater risk than a nonmaltreated comparison group (10%).

    “Widom (1999) reported that in 29-year-old adults who had experienced childhood maltreatment, there was no difference in risk for PTSD among those who had experienced sexual abuse (23%), physical abuse (19%), or neglect (17%), but all were at greater risk than a nonmaltreated comparison group (10%).”
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    Premisecitation

    Children with more prolonged institutional rearing showed reduced amygdala discrimination and more indiscriminate behavior.

    “Those children with more prolonged institutional rearing showed reduced amygdala discrimination and more indiscriminate behavior.”
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    • cites Olsavsky et al, 2013

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    Premisecitation

    Only about 25 to 30% of individuals exposed to a traumatic event develop PTSD, although many more develop subthreshold symptomatology.

    “Yet, only about 25 to 30% of individuals exposed to a traumatic event develop PTSD, although many more develop subthreshold symptomatology (Kessler et al, 1995).”
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    Premisecitation

    Children with PTSD had smaller brain volume in a number of regions, including the PFC, but had larger frontal lobe cerebrospinal fluid volume than nonmaltreated youth, after matching for socioeconomic status.

    “A similar study examined brain volume after matching for socioeconomic status and found that children with PTSD had smaller brain volume in a number of regions, including the PFC, but had larger frontal lobe cerebrospinal fluid volume than nonmaltreated youth (De Bellis et al, 2002).”
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    Premisecitation

    Although no differences were found in amygdala or hippocampal volume in children with and without PTSD, smaller cerebral volumes among children with PTSD was found.

    “Although no differences were found in amygdala or hippocampal volume in children with and without PTSD, smaller cerebral volumes among children with PTSD was found (De Bellis et al, 2001).”
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    Premisecitation

    Type, severity, and intentionality of the trauma may affect risk for PTSD, and those exposed to multiple traumas may develop more severe and/or different numbers of PTSD symptoms, as well as other related biopsychosocial impairments, than those exposed to single event traumas.

    “Type, severity, and intentionality of the trauma may affect risk for PTSD, and those exposed to multiple traumas may develop more severe and/or different numbers of PTSD symptoms, as well as other related biopsychosocial impairments, than those exposed to single event traumas (Ford et al, 2006;Suliman et al, 2009;van der Kolk, 2003).”
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    Interpretationcitation

    Fractional anisotropy in the corpus callosum was negatively correlated with a measure of anxiety, indicating that reduced myelination as a result of trauma may mediate the association between trauma exposure and psychopathology.

    “Further, fractional anisotropy in the corpus callosum was negatively correlated with a measure of anxiety, indicating that reduced myelination as a result of trauma may mediate the association between traumaexposure and psychopathology.”
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    • cites Jackowski et al, 2008

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    Premisecitation

    Children who have been physically abused require greater resources to disengage from angry faces and show greater accuracy at identifying angry facial expression targets during a Go/No-Go type task.

    “In addition to increased detection of angry emotional expression, children who have been physically abused require greater resources to disengage from angry faces (Pollak and Tolley-Schell, 2003), and show greater accuracy at identifying angry facial expression targets during a Go/No-Go type task (Pollak et al, 2001).”
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    • cites Pollak et al, 2001

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    Premisecitation

    Girls with ADHD were significantly more likely to have been sexually abused than their non-ADHD counterparts, although no increased evidence of experiences of physical abuse were found.

    “Girls with ADHD were significantly more likely to have been sexually abused than their non-ADHD counterparts, although no increased evidence of experiences of physical abuse were found (Briscoe- Smith and Hinshaw, 2006).”
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    Interpretationreasoning

    Abused children are vigilant to threat in the environment, a key symptom of PTSD, although the bias may be more specific to social than physical threats.

    “These attentional biases appear to indicate that abused children are vigilant to threat in the environment, a key symptom of PTSD, although the bias may be more specific to social than physical threats.”
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    Premisecitation

    The worldwide prevalence of ADHD is estimated at 5%.

    “The worldwide prevalence of ADHD is estimated at 5% (Polanczyk et al, 2007).”
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    Premisecitation

    Among children who experienced severe neglect in the form of institutional care during early childhood, signs of ADHD are highly prevalent, and these problems are often found in combination with other deprivation-specific mental health problems.

    “Among children who experienced severe neglect in the form of institutional care during early childhood, signs of ADHD are highly prevalent, and these problems are often found in combination with other deprivation-specific mental health problems (eg, quasi-autism, disinhibited attachment, cognitive impairment) (Kreppner et al, 2007;Rutter et al, 2010a).”
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    Premisecitation

    Among Romanian adoptees, older age of placement into their adoptive home was linearly related to ADHD symptoms, indicating a dose-response effect for ADHD and deprivation experiences.

    “However, among the Romanian adoptees, older age of placement into their adoptive home was linearly related to ADHD symptoms, indicating a dose-response effect for ADHD and deprivation experiences.”
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    Premisecitation

    The type of symptoms associated with maltreatment may be specific to inattention and impulsivity, as a sample of school age children who experienced abuse or neglect had more severe levels of inattention and impulsivity, but not hyperactivity, compared with nonmaltreated children.

    “Also, the type of symptoms associated with maltreatment may be specific to inattention and impulsivity, as a sample of school age children who experienced abuse or neglect had more severe levels of inattention and impulsivity, but not hyperactivity, compared with nonmaltreated children (Becker-Blease and Freyd, 2008).”
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    Premisecitation

    Twin studies have supported high levels of heritability for ADHD, indicating a strong genetic basis for the disorder.

    “Etiologically, twin studies have supported high levels of heritability (Levy et al, 1997) for ADHD, indicating a strong genetic basis for the disorder.”
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    • cites Levy et al, 1997 source

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    Premisecitation

    ERP data indicate differential P300 activity in abused children, such that smaller P300 amplitude was found when viewing angry target faces, but no difference was found in other emotional target faces.

    “Event-related potential (ERP) data indicate differential P300 activity in abused children, such that smaller P300 amplitude was found when viewing angry target faces, but no difference was found in other emotional target faces (Pollak et al, 1997).”
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    • cites Pollak et al, 1997

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    Premisecitation

    In a sample of children and adolescents with a range of psychopathology, the rates of trauma exposure were found to be highest in individuals with comorbid ADHD and oppositional defiant disorder (ODD), indicating a potential causal role in the association between trauma and disruptive behavior disorders.

    “In a sample of children and adolescents with a range of psychopathology, the rates of trauma exposure were found to be highest in individuals with comorbid ADHD and oppositional defiant disorder (ODD), indicating a potential causal role in the association between trauma and disruptive behavior disorders (Ford et al, 2000).”
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    Premisecitation

    Supervision neglect predicted both the inattentive type (OR 1.6) and hyperactive type (OR 1.5), while physical neglect was a strong predictor of the inattentive type (OR 2.1) but was not significantly associated with hyperactive type.

    “The type of neglect may differentially impact ADHD symptom domains, as research from the National Longitudinal Study of Adolescent Health (AddHealth) indicated that supervision neglect (placing the child at risk for physical or psychological harm), predicted both the inattentive type (OR ¼ 1.6) and hyperactive type (OR ¼ 1.5), while physical neglect was a strong predictor of the inattentive type (”
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    • cites Ouyang et al, 2008 source

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    Premisecitation

    The effect of EEG power appeared specific to ADHD symptoms, as there was no association between EEG power and either internalizing symptoms or disruptive behavior symptoms.

    “Importantly, the effect of EEG power appeared specific to ADHD symptoms, as there was no association between EEG power and either internalizing symptoms or disruptive behavior symptoms.”
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    • cites McLaughlin et al, 2010 source

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    Premisecitation

    Research from the BEIP identified EEG patterns that mediated the association between institutionalization and ADHD symptoms, which is consistent with evidence of EEG differences in those with ADHD from non-institutionalized samples.

    “However, research from the BEIP identified EEG patterns that mediated the association between institutionalization and ADHD symptoms (McLaughlin et al, 2010), which is consistent with evidence of EEG differences in those with ADHD from non-institutionalized samples (Snyder and Hall, 2006).”
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    • cites Snyder and Hall, 2006

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    Premisecitation

    Institutional rearing leads to prevalence rates of ADHD of around 20%, which is four times greater than the worldwide prevalence figure.

    “Institutional rearing leads to prevalence rates of ADHD of around 20% (Rutter et al, 2010a;Zeanah et al, 2009), which is four times greater than the worldwide prevalence figure.”
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    Premisecitation

    Other studies indicate no differences in trauma exposure between children with and without ADHD, although notably the age in which trauma exposure was measured was not isolated to early life.

    “However, other studies indicate no differences in trauma exposure between children with and without ADHD (Wozniak et al, 1999), although notably the age in which trauma exposure was measured was not isolated to early life.”
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    • cites Wozniak et al, 1999

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    Premisecitation

    Romanian children reared in institutions had higher levels of ADHD symptoms and exhibited widespread reductions in cortical thickness across prefrontal, parietal, and temporal regions compared with never institutionalized Romanian children.

    “Specifically, investigators demonstrated that Romanian children reared in institutions had higher levels of ADHD symptoms and exhibited widespread reductions in cortical thickness across prefrontal, parietal, and temporal regions compared with never institutionalized Romanian children.”
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    • cites McLaughlin et al, 2013

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    Premisecitation

    Cortical thickness in the middle frontal gyrus, orbitofrontal cortex, supramarginal gyrus, and inferior parietal cortex significantly mediated the association between institutional rearing and inattention, and thickness in the middle frontal gyrus, orbitofrontal cortex, and superior temporal gyrus mediated the association with impulsivity.

    “Further, cortical thickness in the middle frontal gyrus, orbitofrontal cortex, supramarginal gyrus, and inferior parietal cortex significantly mediated the association between institutional rearing and inattention, and thickness in the middle frontal gyrus, orbitofrontal cortex, and superior temporal gyrus mediated the association with impulsivity.”
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    Premisecitation

    Data from the AddHealth study indicate that both physical abuse and sexual abuse predicted ADHD inattention type (OR 1.6 and 2.6, respectively), while only physical abuse was a significant predictor of hyperactive type (OR 1.3).

    “Data from the AddHealth study indicate that both physical abuse and sexual abuse predicted ADHD inattention type (OR ¼ 1.6 and 2.6, respectively), while only physical abuse was a significant predictor of hyperactive type (OR ¼ 1.3) (Ouyang et al, 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ouyang et al, 2008 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In preschool children, 80% of those with PTSD had comorbid ODD, and nearly 80% of parents reported onset of ODD after the traumatic event.

    “In preschool children, 80% of those with PTSD had comorbid ODD, and nearly 80% of parents reported onset of ODD after the traumatic event (Scheeringa et al, 2003).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Scheeringa et al, 2003

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A subset of youth with conduct problems can be reliably identified as early as age 3 years, with modest to moderate stability in externalizing psychopathology from early childhood into adolescence.

    “Recent work has emphasized the origins of conduct problems in early childhood (first 3-5 years), indicating that a subset of youth with conduct problems can be reliably identified as early as age 3 years, with modest to moderate stability in externalizing psychopathology from early childhood into adolescence (Shaw et al, 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Shaw et al, 2012

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individual differences in coping self-efficacy were identified as a potential mediator of the association between child abuse and ADHD, suggesting that the attention problems experienced following abuse may be related to poorer coping.

    “Importantly, although not confined to abuse during young childhood, the study identified individual differences in coping selfefficacy as a potential mediator of the association between child abuse and ADHD, suggesting that the attention problems experienced following abuse may be related to poorer coping.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Singer et al, 2012

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Children with ADHD may be more likely to elicit negative or harsh parenting, as parents with children with ADHD are significantly more likely to use corporal punishment compared with parents of children without ADHD, thus, risk for abuse may be higher among children with ADHD.

    “Children with ADHD may be more likely to elicit negative or harsh parenting, as parents with children with ADHD are significantly more likely to use corporal punishment compared with parents of children without ADHD (Alizadeh et al, 2007), thus, risk for abuse may be higher among children with ADHD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Alizadeh et al, 2007

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cortical thinning explained 20% of the association between institutionalization and inattention and 27% of the association between institutionalization and impulsivity.

    “Cortical thinning explained 20% of the association between institutionalization and inattention and 27% of the association between institutionalization and impulsivity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites McLaughlin et al, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Twin studies have provided evidence for moderate to high levels of heritability for conduct problems and related traits, such as callous-unemotional features, although environmental factors should be considered in the development of conduct problems.

    “Twin studies have provided evidence for moderate to high levels of heritability for conduct problems and related traits, such as callous-unemotional features (Viding et al, 2007), although environmental factors should be considered in the development of conduct problems.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Viding et al, 2007

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Coercive parent-child interactions are found in higher rates among abusive parents, indicating a potential confluence of harmful environmental inputs in these families.

    “These types of coercive parent-child interactions are found in higher rates among abusive parents, indicating a potential confluence of harmful environmental inputs in these families (Patterson, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Patterson, 2002

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both emotional abuse and physical abuse in the early years have been linked to aggression and externalizing symptoms in school-age children, with greater abuse severity predicting increased symptoms.

    “as both emotional abuse and physical abuse in the early years has been linked to aggression and externalizing symptoms in school-age children, with greater abuse severity predicting increased symptoms (Manly et al, 2001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Manly et al, 2001 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Gene-environment interactions have been found following physical abuse and later antisocial behavior, with a functional polymorphism in the monoamine oxidase A gene that appeared to increase vulnerability to antisocial behaviors among boys who were abused.

    “Similarly, gene  environment interactions have been found following physical abuse and later antisocial behavior, with a functional polymorphism in the monoamine oxidase A gene that appeared to increase vulnerability to antisocial behaviors among boys who were abused (Kim-Cohen et al, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kim-Cohen et al, 2006 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Heightened morning cortisol and decline in cortisol across the day were associated with physical aggression, while low morning cortisol and relatively flat diurnal cortisol change were associated with relational aggression.

    “In one study, heightened morning cortisol and decline in cortisol across the day were associated with physical aggression, while low morning cortisol and relatively flat diurnal cortisol change were associated with relational aggression (Murray-Close et al, 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Murray-Close et al, 2008

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Neglect, physical abuse, and sexual abuse all predict emotional dysregulation, which in turn predicted externalizing symptoms.

    “Neglect, physical abuse, and sexual abuse all predict emotional dysregulation, which in turn predicted externalizing symptoms (Kim and Cicchetti, 2010),”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kim and Cicchetti, 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prenatal exposure to alcohol was found to predict child maltreatment (composite of physical and sexual abuse and neglect).

    “Prenatal exposure to alcohol was found to predict child maltreatment (composite of physical and sexual abuse and neglect) (Smith et al, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Smith et al, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Many children experience both harmful and inadequate input.

    “Of course, many children experience both harmful and inadequate input,”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Prenatal exposure to illicit substances may be a common, confounding factor to consider in the outcomes of children who experienced either type of deviation from the expected environment.

    “Also, prenatal exposure to illicit substances may be a common, confounding factor, to consider in the outcomes of children who experienced either type of deviation from the expected environment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    The lack of an attentive caregiver reduces both the potential for buffering stressful experiences and for fostering experience expectant developmental processes.

    “the lack of an attentive caregiver reduces both the potential for buffering stressful experiences and for fostering experience expectant developmental processes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Over 50% of individuals from the ACE Study who reported childhood physical neglect also endorsed physical abuse during childhood, whereas approximately 20% of physically abused youth also reported physical neglect.

    “Over 50% of individuals from the ACE Study who reported childhood physical neglect also endorsed physical abuse during childhood, whereas approximately 20% of physically abused youth also reported physical neglect (Dong et al, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dong et al, 2004 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Compared with only half of the nonabused girls who had comorbid ADHD and ODD, all of the abused girls met criteria for both disorders.

    “In other words, compared with only half of the nonabused girls who had comorbid ADHD and ODD, all of the abused girls met criteria for both disorders.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Briscoe-Smith and Hinshaw, 2006 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Social neglect and deprivation lead to indiscriminate social behavior that is phenotypically similar to the indiscriminate behavior associated with microdeletions on the seventh chromosome.

    “Similarly, the fact that social neglect and deprivation lead to indiscriminate social behavior that is phenotypically similar to the indiscriminate behavior associated with microdeletions on the seventh chromosome begs similar questions about molecular pathways (Soares et al, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Soares et al, 2013

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Negative input clearly impacts the developing brain, but so does positive input.

    “Negative input clearly impacts the developing brain, but so does positive input.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Quality of parents' nonverbal cues to their 14- to 18-month-old children contributed to vocabulary at 54 months, even after controlling for quantity of language provided.

    “For example, a recent study demonstrated that quality of parents' nonverbal cues to their 14-to 18-month-old children contributed to vocabulary at 54 months, even after controlling for quantity of language provided (Cartmill et al, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cartmill et al, 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Among infants in a Russian institution, more than half displayed facial phenotypic signs of prenatal exposure to alcohol, which tended to be substantiated by maternal history when available.

    “Among infants in a Russian institution, more than half displayed facial phenotypic signs of prenatal exposure to alcohol, which tended to be substantiated by maternal history when available (Miller et al, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Miller et al, 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    To date, the evidence regarding the association for increased risk for specific domains of psychopathology ranges from strong to uncertain depending on the type of input, and the level of potential mechanisms outlined by extant research varies.

    “To date, the evidence regarding the association for increased risk for specific domains of psychopathology ranges from strong to uncertain depending on the type of input (eg, inadequate vs harmful), and the level of potential mechanisms outlined by extant research varies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Until broad environmental risks, such as poverty, maltreatment, and parental psychopathology are parsed into more specific components as they impact circuitry, it will be difficult to elucidate mechanisms involved in sculpting the brain.

    “Still, until broad environmental risks, such as poverty, maltreatment, and parental psychopathology are parsed into more specific components as they impact circuitry, it will be difficult to elucidate mechanisms involved in sculpting the brain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A gap remains between identifying descriptive accounts of aberrant behaviors and types of symptoms and an understanding of the mechanisms by which experiences in differing environmental conditions lead to different patterns of function.

    “Contemporary research is beginning to explore brain structure and function associated with various psychopathological profiles, but a gap remains between identifying descriptive accounts of aberrant behaviors and types of symptoms and an understanding of the mechanisms by which experiences in differing environmental conditions lead to different patterns of function.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In addition to the type of adverse experience, chronicity of the abuse or neglect also has an important role in outcomes, with a dose-response effect often observed in negative outcomes.

    “In addition to the type of adverse experience, chronicity of the abuse or neglect also has an important role in outcomes, with a dose-response effect often observed in negative outcomes (Jonson-Reid et al, 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Jonson-Reid et al, 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    Considerable work remains in elucidating the neurobiological pathways by which early adverse experiences result in increased risk for negative psychopathological outcomes.

    “Yet, considerable work remains in elucidating the neurobiological pathways by which early adverse experiences result in increased risk for negative psychopathological outcomes.”
    Quote in the paperNot a substantial claim
70 of 70

  • The paper relies on this without support.

    Early negative experiences, including living in poverty and harsh and especially coercive parenting, are risk factors for conduct problems.

    “Early negative experiences, including living in poverty and harsh and especially coercive parenting, are well-known risk factors for conduct problems.”

  • The paper relies on this without support.

    Institutional rearing is a form of severe neglect or inadequate input.

    “Among children who experienced severe neglect in the form of institutional care during early childhood, signs of ADHD are highly prevalent”

  • The paper relies on this without support.

    Traumas result in an initial activation of the HPA axis and the adrenergic system, which are initially adaptive, but prolonged or excessive activation have deleterious effects on physical and mental health, including posttraumatic symptomatology.

    “Traumas result in an initial activation of two different stress response systems-the HPA axis that regulates cortisol and the adrenergic system activated by the locus ceruleus-which are both initially adaptive, but prolonged or excessive activation have a number of deleterious effects on physical and mental health, including posttraumatic symptomatology.”

  • The paper relies on this without support.

    Posttraumatic stress reactions should be considered on a continuum, and symptoms considered pathological may represent more severe manifestations of the biological stress response system.

    “Although PTSD is often studied using a binary framework, there is substantial evidence that posttraumatic stress reactions should be considered on a continuum and that symptoms considered pathological may represent more severe manifestations of the biological stress response system.”

  • The paper relies on this without support.

    Behaviorally difficult children are more likely to be moved in foster care.

    “Although it is likely that behaviorally difficult children are more likely to be moved,”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Brett ZH, Humphreys KL, Smyke AT, Gleason MM, Nelson CA, Zeanah CH et al. (in press-b). 5HTTLPR genotype moderates the longitudinal impact of early caregiving on externalizing behavior. Dev Psychopathol.
  2. Humphreys KL, Zeanah CH, Scheeringa MS (in press). Infant development. The first 3 years of life. In: Tasman A, Kay J, Lieberman JA, First MB, Riba M, (eds) Psychiatry 4th edn Wiley-Blackwell.
  3. Rutter M, Sonuga-Barke EJ, Castle J (2010b). I. Investigating the impact of early institutional deprivation on development: background and research strategy of the English and Romanian Adoptees (ERA) study. Monogr Soc Res Child Dev 75: 1–20. · DOI
  4. Sameroff AJ, Chandler MJ (1975). Reproductive risk and the continuum of caretaking casualty. Rev Child Dev Res 4: 187–244.
  5. Sroufe LA (1983). Infant-caregiver attachment and patterns of adaptation in preschool: the roots of maladaptation and competence. Dev Policy Concern Child with Spec Needs (Minnesota Symp Child Psychol 16: 41–83.
  6. Zeanah CH, Gleason MM (in press). Attachment disorders in early childhood: clinical presentation, causes, correlates and treatment. J Child Psychol Psychiatry.

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Related

Authors
Humphreys, K. L., & Zeanah, C. H.
Affiliations
Tulane University (US)
Corresponding author
Zeanah, Charles H
ORCID
Venue
Neuropsychopharmacology
Publisher
Springer Science and Business Media LLC
Published
2014-07-07
Volume
40
Issue
1
Pages
154-170
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
DOI
10.1038/npp.2014.165
PMC
PMC4262894
OpenAlex
W2071747875
Semantic Scholar
79ca5b27dc38b3841c9fb2b33846b50c04c1e4c2
Cited by
231
References
199
Citations by year
2026: 11 · 2025: 24 · 2024: 19 · 2023: 23 · 2022: 24 · 2021: 27 · 2020: 25 · 2019: 25 · 2018: 13 · 2017: 18 · 2016: 13 · 2015: 6 · 2014: 3
FWCI
2.02
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Neuropsychopharmacology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Environmental Health Sciences
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
early childhood adversity, adverse childhood experiences, psychopathology, brain development, biological development, post-traumatic stress disorder, attention deficit hyperactivity disorder, conduct problems, prevention and intervention
MeSH terms
Mental Disorders, Child, Child Development, Developmental Disabilities, Child, Preschool, Humans, Psychopathology, Social Environment

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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