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. 2026 Mar 10;47(3):e70077. doi: 10.1002/imhj.70077

Family protective service involvement and reduced infant cortical grey matter volume

Francesca Penner 1,2,✉, Banu Ahtam 3, Yangming Ou 3,4, P Ellen Grant 3, Karlen Lyons‐Ruth 5
PMCID: PMC12972846  PMID: 41804289

Abstract

Among older children, neglect is linked to reduced cortical grey matter volume, whereas abuse is linked to reduced right amygdala volume. Less is known about whether similar effects of adversity are evident in infancy, a period of particularly rapid brain growth. This study evaluated whether family involvement with child protective services (CPS) was linked to differences in infant brain volumes (whole brain grey matter, cortical grey matter, right and left insular cortex, and right and left amygdala). Participants were recruited in the northeastern United States. Mothers (N = 55) reported on any family involvement with CPS as a parent. Infants completed a brain MRI between 4 and 25 months of age (M age = 11.56 months). Family CPS involvement was associated with lower infant whole brain grey matter volume, cortical grey matter volume, and left insular cortex volume. No relations to amygdala volumes were observed. Caregiving adversity may affect cortical grey matter development during infancy, with family CPS involvement as an accessible index identifying infants at risk.

Keywords: cortical grey matter, grey matter volume, infancy, insula, maltreatment

1. INTRODUCTION

Childhood maltreatment is a significant problem worldwide. In the United States in 2021, more than seven million allegations of maltreatment, including abuse, neglect, or sex trafficking, were made to Child Protective Services (CPS) (U.S. Department of Health & Human Services (HHS), 2023). Of these, 2.05 million were investigated and 600,000 children were found to be victims of maltreatment, representing a victimization rate of 8.1 per 1000 children. Neglect is the most common form of childhood maltreatment, representing 76% of victims in 2021 (U.S. Department of HHS, 2023). Notably, more than three million children were involved in investigations by CPS agencies, underlining that children who were not the identified victims (e.g., siblings) may have been affected by maltreatment occurring in the same household (U.S. Department of HHS, 2023). Moreover, family CPS involvement is a demonstrated risk to other children in the family, as families who have been involved with CPS are at increased risk for further child maltreatment (Hindley et al., 2006). In the current study, the family's history of involvement with CPS in regard to any of their children is treated as an index of risk for maladaptive care.

Key Findings

  1. Infants aged 4–25 months with a family history of CPS involvement demonstrated smaller whole brain grey matter volumes, cortical grey matter volumes, and left insular cortex volumes compared to infants without family CPS history.

  2. These associations appeared to be specific to cortical regions, with family CPS involvement not associated with infants’ subcortical right or left amygdala volumes.

  3. A maladaptive caregiving environment may affect infant neurodevelopment as early as 4 months of age, with parents’ history of CPS involvement a potentially accessible index of this risk.

The negative effects of maltreatment on child psychosocial development are well‐documented (Carr et al., 2020), and altered neurodevelopment is one potential mechanism posited to contribute to that link (McLaughlin et al., 2019). A growing literature demonstrates relations between early adversity and brain development, though primarily in middle childhood and adolescence (McLaughlin et al., 2019; Teicher et al., 2016). In addition, the dimensional model of adversity posits that threat versus deprivation may affect different aspects of brain development (McLaughlin et al., 2019). Deprivation experiences, such as institutional rearing, have been linked to reductions in cortical grey matter (Lurie et al., 2025; McLaughlin et al., 2019; Sheridan et al., 2012), while experiences of threat or abuse have been linked to reductions in right hemisphere amygdala volume (Teicher et al., 2016). However, most research examining the effects of early adversity on neurodevelopment has focused on middle childhood and older ages, with some studies including children as young as 4 years old (McLaughlin et al., 2019). Few studies have examined whether differences in cortical grey matter or amygdala volume are already observable in infancy.

Statement of Relevance to Infant and Early Childhood Mental Health

A limited literature has assessed links between caregiving adversity and brain development in infancy. This study contributes to growing evidence on the effects of maladaptive caregiving on infant brain development, finding that among infants aged 4–25 months, family history of Child Protective Service involvement was associated with smaller whole brain grey matter volume, cortical grey matter volume, and left insular cortex volume, but not amygdala volume. Study results extend into infancy prior findings showing associations between childhood neglect and reduced cortical grey matter volumes at older ages and add new evidence of possible early impacts on insular cortex volume. Reduced cortical volumes have been further linked to poorer cognitive outcomes in childhood and adulthood. Thus, the peripartum period may be an important window for the development of caregiver supports capable of protecting infant neurobiological and cognitive development.

Infancy is thought to be a critical period of brain development, due both to the rapid rate of brain growth over the first 2 years and to the high level of sensitivity to environmental inputs that accompanies such rapid growth (Fox et al., 1994). For example, whole brain grey matter volume (WBGMV) reaches 80% of adult volume in the first 2 years of life (Gilmore et al., 2012). Moreover, children under 1 year have the highest rate of maltreatment victimization relative to other age groups (U.S. Department of HHS, 2023). Therefore, infancy represents a period when there is a higher risk of maltreatment and simultaneously a sensitive period of neural development. Understanding how caregiving adversity in infancy affects infant brain development is critical to understanding the long‐term sequalae of early abuse and neglect. The current study sought to examine the relations between a family history of CPS involvement and infant brain volumes in both cortical and subcortical regions, assessed with MRI, among a high‐risk group of mothers oversampled for their own experiences of childhood maltreatment.

Though no prior studies have looked at CPS involvement, two previous studies in the current MRI sample have examined the mother's history of childhood maltreatment in relation to infant WBGMV and amygdala volume. The first linked reduced WBGMV and reduced infant right amygdala volume to overall maternal childhood maltreatment (MCM; Khoury et al., 2022); the second found that maternal childhood neglect, specifically, was associated with reduced infant WBGMV, while maternal childhood abuse, specifically, was associated with reduced right amygdala volume (Lyons‐Ruth, Li et al., 2023). This specificity echoed the link between neglect and reduced whole brain grey matter volume seen in the literature on older children, while extending this link to the intergenerational transmission of the mother's childhood neglect experiences.

Two other studies with the MRI sample did not include MCM. The first paper linked disrupted maternal interaction and elevated infant cortisol output to increased infant amygdala and hippocampal volumes (Khoury et al., 2023). The second paper examined aspects of maternal interaction in relation to amygdala volume and WBGMV, finding no relation to amygdala volume but showing a relation between maternal withdrawal and reduced WBGMV (Lyons‐Ruth, Ahtam et al., 2023). Thus, this second paper linked one index of directly experienced deprivation, maternal withdrawal, to reduced infant WBGMV as early as 4 months of age, in a sample who had not experienced the extreme neglect associated with institutional rearing.

Neglect is also frequent among CPS involved families (U.S. Department of HHS, 2023), and, for both researchers and service providers, CPS involvement is a more accessible potential index of early risk for reduced cortical development than video coding of mother–infant interaction. However, no previous studies in this sample have specifically examined either infant cortical grey matter or insular cortex volumes nor have any examined family CPS involvement in relation to infant brain volumes.

1.1. The current study

This study aimed to extend the literature by examining the association between family CPS involvement and brain volumes assessed in the first 2 years of life, in regions likely to be affected by maltreatment, including WBGMV, cortical GMV, right and left amygdala volumes, and right and left insular cortex volumes. The insular cortex is rarely investigated but is a key region connecting the amygdala to higher association areas in the cortex (Gogolla, 2017), and reduced insular cortex volumes have been associated with child maltreatment in child and adult samples (Lim et al., 2014). We hypothesized that CPS involvement would be associated with lower WBGMV, lower cortical GMV, lower insular cortex volumes, and lower right hemisphere amygdala volume in the first 2 years of life, consistent with brain volumes associated with neglect and with abuse in the literature on older children.

2. METHODS

2.1. Participants

Fifty‐five infants and their mothers from a larger cohort of 181 families participated in the MRI study. The goal of the larger study was to evaluate the effects of MCM on mother–infant behavior and neurobiology during the first 2 years postpartum. Mothers were recruited through prenatal classes, flyers, and local birth records. Participants were stratified such that at least 50% had experienced one or more forms of childhood maltreatment, as assessed during phone screening on the Adverse Childhood Experiences questionnaire (ACE; Felitti et al., 1998).

Exclusion criteria were: (a) English not a primary language, (b) maternal age over 44 years at infant birth, (c) infant <36 weeks gestation or <2500 g at birth, and (d) infant congenital defect or disorder.

Mothers and their infants participated in research assessments at infant age 4 months and 15 months. The first half of participants were offered infant MRI scans after the 15‐month assessment, and the second half after the 4‐month assessment to ensure a range of ages in the scans. Scans were conducted at night under natural (unsedated) infant sleep. Sixty‐two families declined to participate in the MRI session. Of the 119 remaining families, 52.10% (n = 62) were unsuccessful in completing the scan and 47.90% (n = 57) successfully completed the scan. (See Supplement for reasons for scan non‐completion.) Infants completing the MRI did not differ from infants not completing the MRI on demographic characteristics (sex, race/ethnicity, family income, gestational age, maternal education, maternal single parent status, p range = .45–.77) or on maternal childhood maltreatment severity [t(178) = −1.337, p = .183]. In the MRI sample, 58.1% (n = 32) of mothers reported at least one form of childhood abuse or neglect. Infants’ age at scan varied from 4 to 25 months, with 31 scans conducted before 15 months and 26 conducted after 15 months (for complete infant scan age distribution, see Supplemental Figure 1).

Of these 57 MRI participants, two were missing data on CPS involvement, resulting in a final sample of N = 55. Among the 55 infants, with respect to race, 65.5% (n = 36) were White, 23.6% (n = 13) were multiracial, 9.1% (n = 5) were Black or African American, and 1.8% (n = 1) were Asian. With respect to ethnicity, 9.1% (n = 5) were Hispanic or Latinx. All study procedures were approved by the Partners Healthcare Institutional Review Board (Protocol #: 2014P002522) and all mothers provided written consent for themselves and permission for their infants to participate prior to initiation of study procedures.

2.2. Measures

2.2.1. CPS involvement

At the 4‐ and 15‐month study assessments, mothers responded to questionnaire items about the family's involvement with CPS at any time as a parent, including “Have you ever received services from CPS?” If so: “What was the nature of the services? Which children were the focus of the services? Are you currently receiving services? Was a child ever placed in out‐of‐home care? If so, for how long? If so, in what kind of care?” Responses at both time points were combined to yield a single dichotomous variable indexing family CPS involvement at any point. The variable was initially coded as 0 = no involvement, 1 = CPS involved, and 2 = child removed from the home. Because only two children had been removed from the home in this sample, the variable was collapsed into two categories, 0 = Never involved, 1 = Family history of CPS involvement. Therefore, mothers were given a “1” if they answered “yes” to “have you ever received services from CPS?”

2.2.2. Demographic variables

Sociodemographic variables were assessed by questionnaire, including infant sex, gestational age at birth, and age at scan; household income; and mothers’ educational level.

2.2.3. Imaging data acquisition

Infant MRIs were performed with a 3.0 T Siemens Skyra scanner using a 64‐channel head coil. No sedation was used. Infants were scanned during natural sleep. The T1‐weighted acquisition used an advanced version of the Magnetization Prepared Rapid Acquisition Gradient Echo (MPRAGE) sequence, where fast, low resolution volumetric navigators were played each repetition period and were used for prospective motion correction (Tisdall et al., 2012). MPRAGE acquisition imaging parameters involve the following: voxel size = 1 × 1 × 1 mm3, repetition time (TR) = 2500–2540 ms, echo time (TE) = 1.65–2.37 ms, inversion time (TI) = 1450–1470 ms, field of view (FOV) = 192 × 192 mm2 and between 144–173 slices, enough to cover the entire brain of the infant. Additional details on image processing are available in Khoury et al. (2023) and in the Supplement. Whole brain volume (WBV), whole brain grey matter volume (WBGMV), cortical grey matter volume (cortical GMV), right/left hemisphere insular cortex volumes, and right/left hemisphere amygdala volumes were extracted.

2.3. Data analytic strategy

Data were inspected for outliers, with one outlier identified for amygdala volumes and insular cortex volumes, and one outlier for whole brain volume, representing two participants. Outliers were marked as missing and accounted for in regression models using full information maximum likelihood (FIML). For MPlus, all brain volume variables were divided by 1000 and age in days was divided by 100 to reduce large variances. Descriptive statistics and bivariate correlations were run in SPSS Version 29. Regression models were run in MPlus Version 8.1, using maximum likelihood estimation and 250 starts.

3. RESULTS

3.1. Descriptive statistics and covariate identification

Descriptive statistics are shown in Table 1. Eight mothers, 14.5% of the sample, reported involvement with CPS as an adult parent. Reasons for CPS involvement included alcohol misuse, methadone clinic involvement, father's substance misuse, domestic violence by father, reunification, parenting support, mother's care for children, and “not sure.”

TABLE 1.

Descriptive statistics.

N Minimum Maximum Mean or % (N) SD Skewness Kurtosis
Infant sex (male) 55 – – 49.1% (27) – – –
Infant gestational age at birth (weeks) a 55 36 42 39.50 1.62 −.46 −.73
Infant age at MRI scan (days) 55 122 750 351.89 186.50 .36 −1.28
Maternal education level 55 1 5 Median = 4 (Master's) −.52 −.68
Annual household income 55 1 8 Median = 5 ($76–100,000) −.26 −.34
Family CPS involvement 55 – – 14.5% (8) – – –
Infant whole brain grey matter volume 55 294,497 737,526 539,489.07 118,738.42 −.14 −1.21
Infant cortical grey matter volume 55 247,729 647,360 463,193.21 105,060.32 −.08 −1.26
Infant left insular cortex volume 54 1922 8998 5513.10 1844.63 −.10 −.77
Infant right insular cortex volume 54 1939 10,032 5318.34 1859.85 .08 −.42
Infant left amygdala volume 54 603 2041 1140.59 333.94 .71 .57
Infant right amygdala volume 54 621 2754 1265.57 440.26 1.30 2.43
Infant whole brain volume 54 709,725 1,519,437 1,046,975.95 177,606.28 .33 −.20
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Notes: Brain volume metric is mm3. CPS = child protective services. Maternal education level: 1 = high school graduate; 2 = associate degree; 3 = Bachelor's degree; 4 = Master's degree; 5 = doctoral degree. Maternal household income: 1 = $0–15,000; 2 = $16–25,000; 3 = $26–50,000; 4 = $51–75,000; 5 = $76–100,000; 6 = $101–150,000; 7 = $151–200,000; 8 = $201,000 or more.

a

Note that infants delivered prior to 36 weeks of gestation were not eligible for the study.

Bivariate correlations assessed potential covariates. Infant age at scan was positively associated with all brain volumes (r = .56–.82) except left and right amygdala volume; for consistency, age at scan was included as a covariate in all regression models. Infant WBGMV, infant cortical GMV, and infant left insular cortex volume were also positively associated with infant gestational age (r = .27–.32), despite study criteria excluding infants born prior to 36 weeks’ gestation. Therefore, gestational age was controlled in those regression models. Infant left insular cortex volume was also positively associated with maternal education (r = .32), so maternal education was included in models for left insular cortex. Infant sex and family income were not associated with infant brain volumes. However, due to larger male head size (Gilmore et al., 2012), infant sex is commonly controlled for in MRI analyses; for this reason, we covaried sex in all models. Whole brain volume was covaried as a further control for head size in all models. For all correlation values, see Supplemental Table 1.

3.2. Family CPS involvement and infant brain volumes

Regression models (Table 2), including covariates, revealed that family CPS involvement was significantly associated with lower overall GMV (ß = −.16), cortical GMV (ß = −.10), and left insular cortex volume (ß = −.25). There were no significant associations between family CPS involvement and right insular cortex volume or right or left amygdala volumes.1 Figure 1 depicts the association between CPS involvement and cortical GMV, partialling out the effects of WBGMV, age at scan, sex, and gestational age at birth.

TABLE 2.

Regression results assessing relations between family CPS involvement and infant brain volumes.

Effect Unstd beta SE β 95% CI p
LL UL
DV: Whole brain grey matter volume
Family CPS involvement −51.81 18.71 −.16 −88.49 −15.13 .006
Whole brain volume .41 .06 .63 .29 .53 <.001
Age at scan a 19.76 5.82 .32 8.36 31.16 .001
Sex 2.58 13.13 .01 −23.16 28.32 .844
Gestational age at birth b .50 4.07 .01 −7.48 8.49 .902
DV: Cortical grey matter volume
Family CPS involvement −28.74 14.43 −.10 −57.03 −.45 .046
Whole brain volume .40 .05 .68 .30 .49 <.001
Age at scan 16.16 4.45 .30 7.43 24.86 <.001
Sex 13.31 10.08 .07 −6.44 33.06 .187
Gestational age at birth .91 3.12 .01 −5.21 7.04 .770
DV: Left insular cortex volume
Family CPS involvement −1.27 .59 −.25 −2.43 −.11 .032
Whole brain volume .00 .00 −.05 −.00 .00 .814
Age at scan .54 .18 .57 .19 .89 .002
Sex .71 .41 .20 −.08 1.50 .080
Gestational age at birth .05 .14 .05 −.23 .33 .725
Maternal education .15 .19 .11 −.22 .53 .423
DV: Right insular cortex volume
Family CPS involvement −.67 .57 −.13 −1.79 .46 .247
Whole brain volume .00 .00 .04 −.00 .00 .822
Age at scan .57 .18 .58 .22 .92 .001
Sex .51 .42 .14 −.31 1.32 .220
DV: Left amygdala volume
Family CPS involvement −.00 .13 −.00 −.25 .24 .983
Whole brain volume .00 .00 .39 .00 .00 .098
Age at scan −.01 .04 −.08 −.09 .06 .713
Sex .11 .09 .17 −.07 .29 .219
DV: Right amygdala volume
Family CPS involvement .09 .17 .07 −.23 .42 .586
Whole brain volume .00 .00 .58 .00 .00 .012
Age at scan −.06 .05 −.26 −.16 .04 .223
Sex .02 .12 .03 −.21 .26 .847
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Notes: DV = dependent variable; Family CPS involvement: 0 = No involvement; 1 = any involvement by adult parent in family history through 15‐month study assessment; Infant sex: 1 = female, 2 = male. P values and confidence intervals are from unstandardized model results. Brain volume metric is mm3.

a

Age at scan computed in days.

b

Gestational age computed in weeks.

FIGURE 1.

FIGURE 1

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Scatterplot showing family CPS involvement in relation to infant cortical grey matter volume, with infant whole brain volume, age in days at scan, gestational age at birth, and sex partialled out. Brain volume metric is mm3.

3.3. Sensitivity analysis

Two previous studies with this sample documented associations first between total MCM and lower infant WBGMV (Khoury et al., 2022) and, subsequently, between maternal childhood neglect, but not abuse, and lower infant WBGMV (Lyons‐Ruth, Li et al., 2023). Bivariate correlations further indicated that maternal childhood neglect was positively associated with CPS involvement (r = .38; p < .01). Therefore, to assess whether maternal childhood neglect accounted for the relations found here between CPS involvement and infant regional brain volumes, models reported above that included total WBGMV, cortical GMV, and insular cortex volumes as dependent variables were rerun with maternal childhood neglect included. The effect of CPS involvement on WBGMV remained significant with maternal childhood neglect in the model (ß = −.13, p = .03), while the effect of maternal childhood neglect became non‐significant (ß = −.09, p = .13). In relation to left insular cortex, family CPS involvement remained marginally significant (ß = −.22, p = .054), while maternal childhood neglect was non‐significant (ß = −.09, p = .46). Finally, in the model predicting cortical GMV, neither CPS involvement (ß = −.08, p = .13) nor neglect (ß = −.05, p = .29) was significant, although CPS involvement had a somewhat larger effect size. This latter finding suggests that CPS involvement shares variance with maternal childhood neglect in relation to cortical GMV. Thus, in larger samples it will be important to assess whether CPS involvement may mediate the effect of maternal childhood neglect on infant cortical GMV. (For Methods for assessing maternal childhood neglect and full regression models, see Supplement.)

Prior work also linked maternal withdrawing interaction to lower overall infant WBGMV in this sample (Lyons‐Ruth, Ahtam et al., 2023). Therefore, to assess whether the mother's withdrawing interaction accounted for the relations found here between CPS involvement and infant brain volumes, the models for total WBGMV, cortical GMV, and insular cortex volumes were rerun with maternal withdrawal also included in the models. First, maternal withdrawal was not significantly associated with CPS involvement in bivariate correlations (r = .07, p > .05). In addition, the effects of both CPS involvement (ß = −.15, p = .01) and maternal withdrawal (ß = −.12, p = .02) on overall infant WBGMV remained significant with both in the same model. In the two remaining models, maternal withdrawal was not significantly associated with either cortical GMV (ß = .01, p = .92) or left insular cortex volume (ß = −.12, p = .27), while family CPS involvement remained significant in relation to left insular cortex volume (ß = −.24, p = .03) and marginally significant in relation to cortical GMV (ß = −.09, p = .06). Therefore, maternal withdrawal did not account for the variance in infant brain volumes associated with CPS involvement, but did account for additional variance in infant WBGMV. (For Methods for assessing maternal withdrawal and full regression models, see Supplement).

4. DISCUSSION

A large body of work has demonstrated the impact of childhood maltreatment on reduced cortical grey matter and right hemisphere amygdala volume among older children, adolescents, and adults (McLaughlin et al., 2019; Teicher et al., 2016). However, few studies have investigated whether adverse caregiving is associated with similar reductions in cortical and subcortical brain volumes in infancy. The present results in a high‐risk sample of mothers and their infants indicated that infants in families with a history of CPS involvement had significantly lower overall WBGMV and cortical GMV, as well as lower left insular cortex volume, during the first 2 years of life. Thus, this study extends into infancy the prior literature among older youth and adults showing reductions in overall WBGMV and cortical GMV following early childhood deprivation, such as institutional rearing (Lurie et al., 2025; Sheridan et al., 2012). The current results also find early reductions in WBGMV and cortical GMV in relation to a much more prevalent, but also ecologically valid, index of caregiving risk, namely, a history of family CPS involvement.

Fewer studies have examined the insular cortex in childhood in relation to experiences of maladaptive caregiving and none have examined this relation in infancy. However, meta‐analysis has linked childhood experiences of maltreatment to smaller insular cortex volumes (Lim et al., 2014). Current results suggest that this reduction in insular cortex may also be present in infancy in maladaptive caregiving environments.

The absence of amygdala effects associated with CPS involvement requires further follow‐up, but may stem from the combination of abuse and neglect that often characterizes families involved with CPS. There is some evidence that, in the first years of life, neglect may be associated with enlarged amygdala volume (Khoury et al., 2023; van Tieghem et al., 2021), while abuse may be associated with reduced right amygdala volume from the second year of life into adolescence and adulthood (Lyons‐Ruth et al., 2024; Lyons‐Ruth, Li et al., 2023; McLaughlin et al., 2019). Thus, studies that are able to separate the effects of abusive and neglecting caregiving among CPS‐involved families may be needed to better understand how different types of maladaptive care affect amygdala volume during the first two years of life.

The current results need replication, but suggest that CPS involvement, whether current or past, may serve as one valuable index of a family environment that is associated with reduced infant cortical grey matter. The specific effects on cortical grey matter echo the findings from infants reared in institutional care, thus suggesting a family environment lacking in adequate stimulation and responsive engagement (Sheridan et al., 2012). However, our results also extend this literature to include early reductions in insular cortex volume associated with CPS involvement. The insular cortex is a key brain region facilitating feedback between subcortical and cortical regions. As such, the insular cortex is involved in integrating information across the subcortical regions involved in emotional regulation, relaying that information to cortical regions, and then integrating feedback from higher cortical association areas back to modulate subcortical responses (Menon, 2015; Nieuwenhuys, 2012). Thus, reductions in this critical region involved in higher order regulation of emotional states could have important effects on later emotional control and executive function.

These results also converge with institutional studies (Sheridan et al., 2012) to demonstrate effects on brain development as early as 4 months of age. Therefore, the first implication of these results is the need for more studies to confirm these early effects on infant brain development. Given replication, the second implication is the need to support more stimulation and interaction for infants born into families with CPS involvement. In addition, the results enlarge the pool of at‐risk infants to include not only families currently involved with CPS but also those involved before the birth of the current infant.

Notably, the current study involved a high‐risk sample of mothers, more than half of whom (58.1%) had experienced childhood maltreatment. Likely because of this, the incidence of CPS involvement was considerably higher (14.5%) than estimated in the general population (8.1%; U.S. Department of HHS, 2023). Even in this high‐risk sample, however, CPS involvement emerged as a specific indicator of risk for infant neurodevelopment in cortical areas. Thus, history of CPS involvement may be a more sensitive and specific indicator of risk than screening for a history of maternal childhood maltreatment. Offering support services during the perinatal period to all mothers with a history of CPS involvement may be indicated to protect healthy infant brain development and save the considerable human and societal costs associated with infants whose development falls behind (McLaughlin et al., 2019).

However, it is also important to underscore the limitations of the CPS involvement variable. First, a family history of CPS involvement does not necessarily represent maternal maltreatment of the study infant. CPS involvement at any time in the mother's history as a parent was indexed here and often involved older children rather than the infant study participant. In addition, some involvement was due to concerns related to the father. The CPS variable also does not account for factors such as current or past timing of involvement, the nature of services received, the jurisdiction in which the involvement occurred, the duration of involvement, the voluntariness of involvement, and when involvement occurred relative to the study infant's birth and current age. However, children in families with a history of maltreatment are more likely to experience maltreatment themselves or to be negatively affected, even if they have not experienced maltreatment directly (U.S. Department of HHS, 2023). Therefore, to mitigate these limitations it is important not to over interpret the meaning of the CPS involvement variable in this study. Here CPS involvement represents an indicator of overall caregiving risk, including risk for neglect, abuse, and other maltreatment‐associated adversities, including maladaptive care and stress exposure. Keeping in mind the limitations of this variable, results are meaningful because they map on to prior research examining brain volumes in older children and adolescents which has similarly shown smaller cortical volumes tied to caregiving risk (specifically deprivation), signaling that these effects may begin early in life, pointing to the need for further research to test these associations further, and underlining the significance of early parenting interventions.

Additional limitations of this study include the difficulties in scanning unsedated infants (Ilyka et al., 2021), resulting in a modest sample size and a wide range of ages at scan. We controlled for infant age in days in all models to account for this limitation. In addition, all data were cross‐sectional, so causality cannot be inferred. Only 14.5% of the sample reported a history of CPS involvement, so that research in larger samples is needed. More work is also needed to explore mechanisms that might link CPS involvement to reduced infant cortical volumes, including exposure to gestational stress (Moog et al., 2022), maladaptive postnatal caregiving (Guyon‐Harris et al., 2021), and increased postnatal stress exposure (Khoury et al., 2023).

5. CONCLUSION

These findings provide important early indications that infants in families with a history of CPS involvement may be at risk for reductions in cortical brain regions. These results extend into infancy the literature at older ages tying depriving care, in particular, to lower cortical GMV (Sheridan et al., 2012) and provide new evidence of possible reductions in the insular cortex in early life. Such early reductions in cortical regions may increase a child's risk for deficits in cognitive and executive functioning (McLaughlin et al., 2019). Family CPS involvement may be one accessible and ecologically valid index for identifying infants at risk of altered neurobiological development in the first years of life, at a time when preventive interventions could be most effective.

FUNDING INFORMATION

This work was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01HD079484] to K. Lyons‐Ruth, M. Teicher, and P. E. Grant, a grant from the Mental Wellness Foundation to K. Lyons‐Ruth, and a grant from the National Institute on Drug Abuse [F32DA055389] to F. Penner.

HUMAN SUBJECTS APPROVAL

This study was approved by the Partners Healthcare IRB (Protocol #: 2014P002522).

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Supporting Information

IMHJ-47-0-s001.docx (3.5MB, docx)

ENDNOTE

1

Because additional analyses revealed that infants from CPS families tended, though non‐significantly, to be younger at age of scan (t(1,53) = 1.48, p = .15), analyses were rerun including only infants younger than 12 months at age of scan (N = 30) to more closely equate CPS and non‐CPS groups on age at MRI. All results reported above remained significant in the smaller cohort (see Supplement for full analyses and results).

DATA AVAILABILITY STATEMENT

Data will be available upon request from the senior author.

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Supplementary Materials

Supporting Information

IMHJ-47-0-s001.docx (3.5MB, docx)

Data Availability Statement

Data will be available upon request from the senior author.

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