As I read through Justin's chart, I began to imagine his life as it unfolded. At age 2, Justin had been given a diagnosis of "static encephalopathy," meaning that he had severe brain damage of unknown origin that was unlikely to improve. He had been taken to the doctor because he was severely developmentally delayed: unable to walk or say even a few words by the time most children are actively exploring toddlers who have begun to speak in sentences. Tragically, when Arthur had brought Justin in for medical check-ups, no one inquired about his living situation. And no one took a good developmental history. The boy had been tested for various physical ailments, and his brain had been scanned, revealing atrophy (shrinkage) of the cerebral cortex and enlargement of the fluid-filled ventricles in the center of the brain. In fact, his brain looked like that of someone with advanced Alzheimer's disease; his head circumference was so small that it put him below the second percentile for children his age.
Back then, many doctors were still unaware of the damage that neglect alone can do to the brain. They assumed that something so clearly visible on scans had to be evidence of a genetic defect or intrauterine insult; they couldn't imagine that early environment alone could have such profound physical effects. But studies done by our group and others later found that orphans who were left to languish in institutional settings without receiving enough affection and individual attention do indeed have visibly smaller head sizes and tinier brains. The brains show obvious damage, virtually identical to that seen in Justin.