ence on children who might otherwise be expected to succumb to the deleterious circumstances of their early lives.
Recent work has explored the presence of posttraumatic stress symptoms in maltreated children, with a special concern for potential alterations in fear-stress physiology that have been found to accompany reactions to trauma among adults and older children. Work is currently ongoing with children 3 years and under to discover how trauma manifests itself in preverbal children (Scheeringa and Zeanah, 1995). By 4 and 5 years of age, however, trauma symptoms typically assessed in older children and adults can be observed (Pynoos and Eth, 1985; Scheeringa et al., 1995). Many children who show these symptoms following traumatic experiences appear to recover when their circumstances improve. In others, however, there is evidence of fairly long-term alterations in the physiology of the fear-stress system, seen in higher levels and atypical daily patterns of cortisol and adrenaline production, that correspond to the duration of maltreatment (De Bellis et al., 1999b; Hart et al., 1996; Kaufman, 1996; Kaufman and Charney, 1999; Pynoos et al., 1996a, 1996b). More severe physiological changes are noted when children suffered for longer periods before rescue (De Bellis and Putnam, 1994; De Bellis et al., 1999b).
Do these changes in the physiology of fear-stress in children have developmental consequences? Certainly chronic abuse in childhood is associated with problems in emotion and behavioral regulation (Pynoos et al., 1995). In addition, maltreatment in childhood is a risk factor for multiple forms of psychopathology that are often seen to co-occur with post trauma symptoms (Cicchetti and Lynch, 1995; Kaufman, 1996; National Research Council, 1993). Many suspect that chronic activation of the physiology of stress during periods of rapid brain development may be producing pathology because of the effects of stress physiology on brain development (e.g., Cicchetti, 1994). However, there has been only one peer-reviewed scientific study that imaged the brains of maltreated children.
The 44 children in this study had all been sexually abused, typically beginning between ages 2 and 6, and most had also been physically abused beginning between ages 1 and 3 and had witnessed violence in the home. The duration of abuse varied but averaged around 3 or more years. These children, who were all of school age at the time of testing and had been living in stable, presumably nonabusive circumstances for several years, were all selected to meet clinical criteria for posttraumatic stress disorder, and many also met criteria for depression and other clinical syndromes (De Bellis et al., 1999a). The imaging data showed that, compared with physically and mentally healthy children matched for age and sex, these children had smaller brain volumes, larger lateral ventricles (i.e., the fluid-filled cavities of the brain), and smaller areas of connection (i.e., the corpus callosum) between the left and right sides of the brain. Most importantly,