Genie had a horrifically deprived childhood (Figure 1). For over 10 years, starting from the age of 20 months, she was isolated in a small, closed room, and much of the time she was tied to a potty chair. Her mentally ill parents provided food, but nobody held Genie or spoke to her. When she was released from her confinement and observed by researchers at the age of 13, her size made her appear only 6 or 7 years old (Rymer, 1993).

Figure 1  Genie
(Bettmann/Getty Images.)

Other, less horrendous forms of family deprivation also result in failure of growth. This syndrome is referred to as psychosocial dwarfism to emphasize that the growth failure arises from psychological and social factors mediated through the central nervous system and its control over endocrine functions (Green et al., 1984). Often when children suffering from psychosocial dwarfism are removed from stressful circumstances, they begin to grow rapidly. The growth rates of five such children, before and after periods of emotional deprivation, are shown in Figure 2 (Sirotnak et al., 2004).

Figure 2  Psychosocial Dwarfism
Growth rates of abused children before and after removal from the abusive situation. Removal from the abusive situation is indicated by the asterisk in each case.

How do stress and emotional deprivation impair growth? Growth impairments appear to be mediated by changed outputs of several hormones, including growth hormone (GH), cortisol, and other hormones, known as somatomedins (which are ordinarily released by the liver in response to GH). GH and the somatomedins normally stimulate cell growth.

Some children with psychosocial dwarfism show almost a complete lack of GH release (Albanese et al., 1994). Disturbed sleep has also been suggested as a cause of this failure, because GH is typically released during certain stages of sleep, and children under stress show disturbed sleep patterns (Gardner, 1972). Other children who exhibit psychosocial dwarfism show normal levels of GH but low levels of somatomedins, and these hormones, along with GH, appear to be necessary for normal growth. Still other children with this condition show elevated levels of cortisol, probably as a result of stress, that inhibit growth. Finally, some affected children show none of these hormonal disturbances, so there must also be other routes through which emotional experiences affect growth. For Genie, relief came in time to restore much of her body growth, but her mental development remains severely limited; she has never learned to say more than a few words, and now in her fifties, she lives in an institution.

References

Albanese, A., Hamill, G., Jones, J., Skuse, D., et al. (1994). Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism. Clinical Endocrinology (Oxford) 40: 687–692.

Gardner, L. I. (1972). Deprivation dwarfism. Scientific American 227(1): 76–82.

Green, W. H., Campbell, M., and David, R. (1984). Psychosocial dwarfism: A critical review of the evidence. Journal of the American Academy of Child Psychiatry 23: 39–48.

Rymer, R. (1993). Genie: An abused child’s flight from silence. New York, NY: HarperCollins.

Sirotnak, A. P., Grigsby, T., and Krugman, R. D. (2004). Physical abuse of children. Pediatrics in Review 25: 264–277.