Reduced prefrontal cortical gray matter volume in young adults exposed to harsh corporal punishment
Introduction
Corporal punishment (CP) has been defined as “the use of physical force with the intention of causing a child to experience pain but not injury for the purpose of correction or control of the child's behavior” (Straus et al., 1997). However, such discipline (or its excessive use) has been considered as a type of child maltreatment and has been identified as having various negative psychological and physiological consequences. A history of exposure to severe CP is reportedly associated with aggression, delinquency (Gershoff, 2002), antisocial and violent behaviors (Ambati et al., 1998, Ohene et al., 2006, Slade and Wissow, 2004, Straus et al., 1997), depression (Banks, 2002, Straus and Kantor, 1994), suicidal behavior (Straus and Kantor, 1994), and other psychiatric disorders such as PTSD (Medina et al., 2001) and substance abuse (Lau et al., 2005). Furthermore, CP is related to the intergenerational transmission of intimate partner and family violence (Deater-Deckard et al., 2003, Muller et al., 1995, Schwartz et al., 2006) and is associated with risk of being victim of physical abuse and risk of abusing one's own child or spouse (Gershoff, 2002).
Exposure to various forms of childhood abuse, including physical abuse, sexual abuse and neglect have been associated with alterations in brain structure (e.g., Andersen et al., 2008, Bremner et al., 1997, De Bellis et al., 1999De Bellis et al., 2002, De Bellis and Kuchibhatla, 2006, Richert et al., 2006, Teicher et al., 1997, 2004). Diffusion tensor differences have also been observed in young adults with high-level exposure to parental verbal abuse (Choi et al., 2008).
Is exposure to parental CP a sufficiently severe developmental stressor to be associated with discernible effects on brain morphometry? To address this question we chose to examine exposure to a form of CP that is widely considered to be excessive and unacceptable. The American Academy of Pediatrics (AAP) considers spanking with an open hand for the purpose of behavior modification to be an acceptable form of punishment. However, this form of punishment becomes unacceptable if it involves use of an object, extends to regions beyond buttocks and extremities, is conducted out of anger, or results in injury. We defined harsh CP (HCP) as a severe form of CP, in which an object (e.g., belt, paddle and hair brush) was used on occasion for the purpose of disciplining a child, provided it did not extend beyond the buttocks, was not conducted out of anger, and did not result in injury. We focused on HCP rather than ordinary CP, which is much more common, hypothesizing that HCP would be associated with a stronger signal and more discernible effects. If associations emerged between imaging findings and HCP it would justify studies in a larger group of subjects exposed to ordinary CP.
This study was designed to evaluate GMV using an unbiased, whole-brain, voxel-by-voxel approach in a non-clinical sample of late adolescents/young adults exposed to HCP during childhood. Our sample was screened to exclude extraneous factors (e.g., substance abuse, head injury, fetal drug exposure, exposure to physical, sexual or emotional abuse) that might have influenced brain development. We hypothesized that exposure to childhood HCP might alter the developmental trajectory of brain regions involved in regulating emotion, aggression, attention, and cognition.
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Participants and procedure
The McLean Hospital Institutional Review Board approved all procedures. Participants in the study were recruited from the community through an advertisement entitled “Memories of Childhood”. Screenings were conducted on 1455 volunteers using a detailed online assessment instrument with 2342 entry fields that provided a vast array of information regarding childhood history, development, and symptomatology. The questionnaire also included demographic information, such as subjects' and parents'
Results
HCP subjects reported mean duration of exposure to CP of 8.5 ± 3.5 years. Thirty-six percent of controls had limited exposed to ordinary CP, with an average exposure duration of 1.8 ± 3.0 years. Average age of onset and offset of CP in the HCP group was 3.9 ± 2.3 and 11.4 ± 2.5 years, respectively. HCP began almost concurrently with CP (4.2 ± 2.3 years). Subjects in the HCP group were predominantly male (65%), whereas controls were predominantly female (73%; Table 1). Parents of HCP subjects had, on
Discussion
This study examined the association between exposure to HCP and brain structure. HCP includes occasional use of objects to induce pain, and is considered an unacceptable form of punishment by the AAP. Results from this study apply to HCP, they do not apply to exposure to ordinary forms of CP that the AAP considers acceptable (but less effective than alternative forms of discipline).
Chronic exposure to HCP was associated with a marked reduction in GMV in the right medial frontal gyrus (MPFC,
Conflict of interest
The authors declare that there is no conflict of interest.
Acknowledgments
This study was supported by RO1 awards from the U.S.A. National Institute of Mental Health (MH-53636, MH-66222) and National Institute of Drug Abuse (DA-016934, DA-017846) to MHT. We thank Dr. H. Tanabe, National Institute for Physiological Sciences, Aichi, Japan for his assistance with data analyses.
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