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

The DOI matches its Crossref record; 200 of the 200 references it cites were found in a registry or an index; 1 of the 194 sources its claims cite were checked for support.

Deviations from the Expectable Environment in Early Childhood and Emerging Psychopathology

Open access
Humphreys, Kathryn L, Zeanah, Charles H·2015·Neuropsychopharmacology

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.

Overview

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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

200 of 200 references verified0 citation errors · 0 not checkable

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Verification

Claims the paper makes

159 Not checked yet · 41 Own interpretation · 3 No basis given · 1 Supported so far · 1 Own method

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Show all 135 claims

  • It may state two separate claims as one. 54
  • Probably not a substantial claim. 22
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

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Citations

Cites

Show all 199 references

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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Metadata

Authors
Humphreys, K. L., & Zeanah, C. H.
Affiliations
Tulane University (US)
Corresponding author
Zeanah, Charles H
Venue
Neuropsychopharmacology
Published
2014-07-07
Volume
40
Issue
1
Pages
154-170
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
OpenAlex
W2071747875
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
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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