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CO G N I T I O N | OPINION

Adversity in Early Childhood Can

Impair Brain Development
Adverse early childhood experience leaves persisting
traces in brain structure, highlighting the importance of
preventive measures for healthy brain development

By Cordula Hölig, Ramesh Kekunnaya, Brigitte Röder on May

12, 2023

Credit: kohei_hara/Getty Images

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Growing up in poverty or experiencing any

adversity, such as abuse or neglect, during early
childhood can put a person at risk for poor
health, including mental disorders, later in life.
Although the underlying mechanisms are poorly
understood, some studies have shown that
adverse early childhood experience leaves
persisting (and possibly irreversible) traces in
brain structure.

As neuroscientists who are investigating sensitive

periods of human brain development, we agree:
safe and nurturing environments are a
prerequisite for healthy brain development and
lifelong well-being. Thus, preventing early
childhood adversity undoubtedly leads to
healthier lives.

Poverty and adversity can cause changes in brain

development. Harms can come from exposure to
violence or toxins or a lack of nutrition,
caregiving, perceptual and cognitive stimulation
or language interaction. Neuroscientists have
demonstrated that these factors crucially
influence human brain development.

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We don’t know whether these changes are

reversed by more favorable circumstances later
in life, however. Investigating this question in
humans is extremely difficult. For one, multiple
biological and psychological factors through
which poverty and adversity affect brain
development are hard to disentangle. That’s
because they often occur together: a neglected
child often experiences a lack of caregiving
simultaneously with malnutrition and exposure
to physical violence. Secondly, a clear beginning
and end of an adverse experience is hard to
define. Finally, it is almost impossible to fully
reverse harsh environments in natural settings
because most of the time it is impossible to move
children out of their families or communities.

In a recently published study in Cerebral Cortex,

we and our colleagues investigated the
reversibility of altered brain structure in
individuals who had recovered their sight after
suffering from congenital blindness. Visual
deprivation can be considered an extreme form
of aberrant early childhood experience, and
congenital blindness is known to cause a
reduction in brain surface area similar to other
types of aberrant childhood experience.

In this German-Indian collaboration, we used

noninvasive magnetic resonance imaging (MRI)
to examine the structure of the cerebral cortex,
the folded outer layer of the brain that hosts
billions of nerve cells and oversees perception,
action and higher-level thinking. Our study
investigated 21 children and adults—aged six to
36 at the time of the study—who had been born
blind because of dense bilateral cataracts and
who had gained sight through cataract removal
surgery only months or even years later.
Cataracts are the most common treatable cause
of blindness worldwide. In Western countries,
neonates born with cataracts typically receive
surgery shortly after birth. In many resource-
poor countries, however, cases regularly remain
untreated for several years. Individuals with
reversed cataracts constitute a unique human
model for assessing the reversibility of impaired
brain structure after aberrant childhood
experience because the reason for their blindness
can be fully eliminated at a clearly defined time
point in life. Previous research has suggested that
despite sight restoration surgery, individuals
treated late for congenital blindness typically do
not recover full visual capabilities but remain
visually impaired throughout life.

In our recent study, individuals with reversed

congenital cataracts were identified by the LV
Prasad Eye Institute in Hyderabad, India. On
average, they had been blind for seven years and
had undergone cataract removal surgery 11 years
prior to the study. We compared this group with
three others: individuals with permanent
congenital blindness; sight-recovery individuals
who had vision at birth and only later developed
cataracts; and sighted controls. From the brain
scans, we created a three-dimensional model of
each participant’s brain and used it to measure
the surface area and thickness of the visual
cerebral cortex.

We looked at the visual parts of the cerebral

cortex to understand how early experiences
shape the brain during development. In typical
brain development, the cortical surface area
expands until puberty, whereas cortical thickness
 increases during the first two years of life and
decreases thereafter. This initial increase in
cortical thickness is considered to reflect an
explosion of synapses, that is, connections
between neurons, while the subsequent thinning
is thought to reflect a pruning away of unused
connections. Structural changes are essential for
the refinement and maturation of neural circuits.

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In our study, we observed that individuals with

reversed congenital cataracts had a smaller visual
cortical surface area and a higher thickness than
what is found in sighted individuals of their
respective age. Despite many years of having
their vision restored, these sight-recovery
individuals had a visual cortex that more closely
resembled the corresponding visual areas of
individuals with permanent blindness. Similar
changes were not detected in individuals with
reversed cataracts that emerged later in
childhood. Importantly, the degree of structural
impairment predicted how well the patients
learned to see.

These results suggest that impaired brain

structure caused by aberrant early childhood
experience will not fully recover after restoring
typical experience later in life. Unlike the local
effects of blindness on visual brain regions, the
effects of poverty and adversity have often been
found to be more widespread across the brain,
likely because of the combined impact of the
multiple biological and psychological hazards.
Thus, based on our recent findings, it can be
expected that experiencing harsh environments
early in life results in irreversible structural
changes in multiple regions of the brain, which
might explain why these individuals are more
susceptible to ill health, including mental
disorders.

The new findings underscore the critical role of

preventive measures in promoting healthy brain
development in children. Ensuring access to safe
environments, affordable health care, healthy
food and appropriate education gives children
the opportunity to develop and stay physically
and mentally healthy.

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This is an opinion and analysis article, and the

views expressed by the author or authors are
not necessarily those of Scientific American.

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ABOUT THE AUTHOR(S)

Cordula Hölig is a cognitive neuroscientist in the Biological

Psychology and Neuropsychology lab at the University of
Hamburg in Germany.

Ramesh Kekunnaya is a pediatric ophthalmologist and

director of the Child Sight Institute at the LV Prasad Eye
Institute in Hyderabad, India.

Brigitte Röder is a cognitive neuroscientist, head of the

Biological Psychology and Neuropsychology lab at the
University of Hamburg in Germany and a visiting scholar at the
LV Prasad Eye Institute in Hyderabad, India.

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