ABE Survey Results Part 2: Babyhood Emotional Neglect (BEN) and the new BEN Score

The Adverse Babyhood Experiences (ABE) Survey Results Part 1 looked at symptoms and indicators of bonding disruptions in parents, which may influence risk for chronic illness in their children. Part 2 introduces Babyhood Emotional Neglect, or “BEN,” a new concept assessing indications of bonding disruptions for babies. Today’s post shares more survey results and the surprisingly high scores on the BEN Score Graph. The power of understanding and recognizing bonding disruptions, and BEN, is that it offers the chance for repair and prevention for adults and parents as well as for children.

Results in this post are likely to be relevant for many blog readers given that 60% of survey responders have lived with a chronic illness or chronic physical condition, and 40% with a mental health condition.

Introducing BEN

BEN was proposed by trauma therapist Penny Boyland, a somatic experiencing practitioner (SEP) also trained in acupuncture and Chinese medicine and the founder of Somatic Tao. She’s created a short video that includes a description by Dr. Gabor Mate of how early neglect can influence very appropriate responses, which can be associated later with symptoms such as anxiety. Penny suggested adding questions about experiences of babyhood emotional neglect to ABEs and the ABE survey because babyhood is a time when we are at our most vulnerable and when effects of neglect are the most potent.

As Penny describes, “Knowledge of BEN is one of the first steps in reducing risk of growing up with:

• nervous system dysregulation
• an anxious, avoidant or disorganized attachment style
• inability to manage emotions
• living in a state of functional freeze

Babyhood Emotional Neglect:

1) can look different from neglect of older children

2) is a risk factor for ACEs (adverse childhood experiences) such as abuse ⁽¹⁾Mead, V. P. (2020). Adverse babyhood experiences (ABEs) increase risk for infant and maternal morbidity and mortality, and chronic illness. Journal of Prenatal and Perinatal Psychology and Health, 34(4), 1-33. https://chronicillnesstraumastudies.com/adverse-babyhood-experiences-abes-increase-risk-for-infant-and-maternal-morbidity-and-mortality-and-chronic-illness-mead-jopppah-2020/, which are known risk factors for chronic illness and mental health conditions, and

3) involves a distinct set of risk factors for chronic conditions different from ACEs.

Penny recommended the friendly name BEN, influenced in part by the attachment work of psychologist Dr. Jonice Webb, author of Running on Empty: Overcome Your Childhood Emotional Neglect (2012) who coined the term Childhood Emotional Neglect, sometimes shortened to CEN.

The concept of BEN is supported by research in bonding ⁽²⁾Klaus, M. H., & Kennell, J. H. (1976). Maternal-infant bonding. Mosby and other bodies of evidence summarized in my journal article on ABEs ⁽³⁾Mead, V. P. (2020). Adverse babyhood experiences (ABEs) increase risk for infant and maternal morbidity and mortality, and chronic illness. Journal of Prenatal and Perinatal Psychology and Health, 34(4), 1-33. https://chronicillnesstraumastudies.com/adverse-babyhood-experiences-abes-increase-risk-for-infant-and-maternal-morbidity-and-mortality-and-chronic-illness-mead-jopppah-2020/.

15 Indicators of Babyhood Emotional Neglect

Together, Penny and I have developed 15 ABEs to identify BEN that may reflect bonding disruptions in parents, including effects of high stress or trauma that primary caregivers have experienced. As with all kinds of adversity, trauma’s effects on parents is not their fault or choice, and recognizing symptoms offers opportunities for healing, treatment and repair for parents as well as their kids. If you have recommendations for other BEN questions please let me know.

BEN asks about your best guess regarding experiences before your 3rd birthday, some of which may come from stories that are part of the family lore. Each BEN is given one point.

Did you experience any of the following events from conception until your 3rd birthday? These are examples of emotional neglect. Make your best guess. Select all that apply:

1. Absence: There was an absence of supportive, nurturing caregiving
2.  Alone: I was left alone a lot, such as in my crib
3.  Attunement: I experienced a lack of emotional understanding / attunement from caregivers
4.  Bonding: I don’t think my mother bonded / felt emotionally connected with me
5.  Burden: I was a burden / children were a burden in my family
6.  Cry it out: My caregiver(s) practiced “cry it out” / often left me to cry
7.  Eating: My caregiver(s) fed me on a strict time schedule
8.  Gazing: There was an absence of connecting eye contact with me
9.  Holding: I was not held or carried in close physical contact much or often
10.  Reflection: My primary caregiver was unable to really see me or reflect me
11.  Sleep training: My parents used a schedule to train me / teach me to sleep without help from a primary caregiver(s)
12.  Soothing: I did not experience much soothing, regulation or support for distress
13.  Touch: I did not experience much touch or nurturing touch early in life
14.  Unavailability: My primary caregiver was unable to fully connect / was emotionally unavailable
15.  Unpredictability: A sense of unpredictability made my caregivers unsafe to go to for nurture

The BEN Score (from 0 to 15)

The graph above shows scores for Babyhood Emotional Neglect, coined as a BEN score. The BEN score is new and consists of up to 15 points. It is different from the adverse childhood experience (ACE) score, which is an increasingly well known indicator of trauma with a score of up to 10 ACEs for experiences of different kinds of adversity before your 18th birthday.

An intriguing observation is the shape of the BEN Score graph, which has a significant number of responses in almost every score column. This means that as many people have very high scores, and therefore high exposures to BEN, as do people who had few to no exposures to BEN. This is quite different from an ACE score graph, as one example, where a lot fewer people have high scores than low scores.

Initial review of the BEN scores and the graph raises questions about common practices in Western culture such as sleep training, leaving babies to cry it out, and feeding on schedule.  Many of these practices were recommended before it was understood that babies are deeply sensitive, aware, and in need of contact, close proximity and emotional support and attunement to help regulate their immature nervous systems, developing physiology and organ systems.  Furthermore, the new concept of BEN points to such practices reducing or interfering with emotional attunement and thus potentially representative of situations that can be associated with BEN.

Whether the shape of the BEN score graph will turn out to be meaningful, such as in risk for chronic illness or other health conditions, will be something I look into more deeply in the future.

Almost Half of BEN Scores are 10 or Higher

Almost half of all survey respondents had a BEN score of 10 or more. This further suggests that a lot of people experienced a lack of attunement and other bonding disruptions and that it may be an important risk factor for chronic illness and other health conditions, as has been proposed in other research.

Greatest Aspect of BEN: Lack of Attunement

In the graph above it is noteworthy that 75% of survey respondents experienced the BEN of a lack of emotional attunement by their adult caregiver(s) before their 3rd birthday. This was the most common BEN.

The graph is from 60 total ABE survey responses from a few weeks ago. The BEN of lack of attunement remains at 75% with 66 out of 86 total responses at the time of writing this post.

A lack of attunement is one of the most common signs and sources of developmental trauma and complex PTSD, which are risk factors for chronic illness ⁽⁴⁾Puig, J., Englund, M. M., Simpson, J. A., & Collins, W. A. (2012, Jul 23). Predicting adult physical illness from infant attachment: A prospective longitudinal study. Health Psychology, 32(4), 409-417. https://doi.org/10.1037/a0028889, ⁽⁵⁾Maunder, R. G., & Hunter, J. H. (2001, Jul-Aug). Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine, 63(4), 556-567. https://doi.org/10.1097/00006842-200107000-00006 .

Opportunities for Repair and Prevention

It is too soon to tell whether observations in this first look at the ABE survey graphs imply that bonding disruptions are important risk factors for chronic illness or perhaps just common in our culture. The observations, however, appear consistent with research that bonding disruptions are important risk factors for asthma and that, when addressed, can lead to a reversal of asthma in children ⁽⁶⁾Madrid, A. (2005, October). Helping children with asthma by repairing maternal-infant bonding problems. American Journal of Clinical Hypnosis, 48(3-4), 199-211. https://doi.org/10.1080/00029157.2005.10401517. ABEs are risk factors for chronic illnesses and bonding disruptions appear to be a common denominator among these risk factors. In this vein, the BEN score may turn out to be a way to quickly identify indicators of risk for health conditions similar to how ACEs (adverse childhood experiences) are risk factors.

The benefit of recognizing symptoms and BEN is that healing bonding disruptions can help repair and reverse symptoms in parents and babies. It is possible that repair early in life may also play an under-recognized role in prevention, such as if these early symptoms of nervous system dysregulation are also signs for early risk of progressing to chronic illness, mental illness, cancer and more. This will be assessed further with deeper analyses and additional responses to the ABE survey, which you can take below if you haven’t already or where you can update your responses if you took it prior to my major survey update in mid December 2024.

Resources and Links

You will find a list of resources in Part 1 of the ABE Survey results, with examples and tools that support healing for children, such as recovery from asthma; as well as healing in adults and parents, including for asthma and other chronic illnesses and health conditions.

For more on the research behind ABEs see this Comprehensive Guide.

What’s Your BEN Score?

Take or Update the ABE Survey. The ABEs survey asks about pre and perinatal events specific to this time period until your 3rd birthday. If you took the ABE survey before the major update I made to the survey in December 2024 consider updating your survey. Your prior responses have been retained:

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Add Your Health Conditions or Good Health

If you have not already done so, I invite you to add your health conditions or state of Good Health to the Health Conditions Survey.

Your responses to this survey are especially important to help evaluate the role of adverse events in risk. If you are in Good Health your responses are essential for establishing norms and guidance and I invite you to take the survey as well. Anyone can take the surveys from the following page that includes all the surveys in one place.