What follows is a snip-it of an excellent article from the Opinionator section of the New York Times by David Bornstein. Within the article are hyperlinks to excellent source material on childhood toxic stress, its impact on children and new methods to prevent harm or treat children who are exposed to toxic stress. I have taken snippets of each of these hyperlinks to create an annotated index to the sources from Mr. Bornstein’s article. I hope that this will encourage further reading and understanding on this topic. Having spend 31 years as a social worker in child protective services it has been my experience that chronic and repetitive stress on children is both pervasive and incredibly damaging. It takes new protective service workers years of experience to recognize toxic stress and fully appreciate how damaging it truly is. The whole field of protective services is more oriented towards responding to physical abuse and acute safety risks than it is to chronic neglect or repetitive lower level trauma. – Brian T. Lynch, MSW
Protecting Children From Toxic Stress
New York Times – October 30, 2013
Imagine if scientists discovered a toxic substance that increased the risks of cancer, diabetes and heart, lung and liver disease for millions of people. Something that also increased one’s risks for smoking, drug abuse, suicide, teen pregnancy, sexually transmitted disease, domestic violence and depression — and simultaneously reduced the chances of succeeding in school, performing well on a job and maintaining stable relationships? It would be comparable to hazards like lead paint, tobacco smoke and mercury. We would do everything in our power to contain it and keep it far away from children. Right?
Well, there is such a thing, but it’s not a substance. It’s been called “toxic stress.” For more than a decade, researchers have understood that frequent or continual stress on young children who lack adequate protection and support from adults, is strongly associated with increases in the risks of lifelong health and social problems, including all those listed above.
Toxic stress response: Occurs when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.
When toxic stress response occurs continually, or is triggered by multiple sources, it can have a cumulative toll on an individual’s physical and mental health—for a lifetime. The more adverse experiences in childhood, the greater the likelihood of developmental delays and later health problems, including heart disease, diabetes, substance abuse, and depression. Research also indicates that supportive, responsive relationships with caring adults as early in life as possible can prevent or reverse the damaging effects of toxic stress response.
Centers For Disease Control and Prevention
Survey shows 1 in 5 Iowans have 3 or more adverse childhood experiences
Iowa’s 2012 ACE survey found that 55 percent of Iowans have at least one adverse childhood experience, while one in five of the state’s residents have an ACE score of 3 or higher.
In the Iowa study, there was more emotional abuse than physical and sexual abuse, while adult substance abuse was higher than other household dysfunctions.
This survey echoed the original CDC ACE Study in that as the number of types of adverse childhood experiences increase, the risk of chronic health problems — such as diabetes, depression, heart disease and cancer — increases. So does violence, becoming a victim of violence, and missing work days.
From the American Academy of Pediatrics
The Lifelong Effects of Early Childhood Adversity and Toxic Stress
- 1. Benjamin S. Siegel, MD,
- 2. Mary I. Dobbins, MD,
- 3. Marian F. Earls, MD,
- 4. Andrew S. Garner, MD, PhD,
- 5. Laura McGuinn, MD,
- 6. John Pascoe, MD, MPH, and
- 7. David L. Wood, MD
Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. [snip]
WORKING PAPER #3
Excessive Stress Disrupts the Architecture of the Developing Brain
New research suggests that exceptionally stressful experiences early in life may have long-term consequences for a child’s learning, behavior, and both physical and mental health. Some types of “positive stress” in a child’s life—overcoming the challenges and frustrations of learning a new, difficult task, for instance—can be beneficial. Severe, uncontrollable, chronic adversity—what this report defines as “toxic stress”—on the other hand, can produce detrimental effects on developing brain architecture as well as on the chemical and physiological systems that help an individual adapt to stressful events. This has implications for many policy issues, including family and medical leave, child care quality and availability, mental health services, and family support programs. This report from the National Scientific Council on the Developing Child explains how significant adversity early in life can alter—in a lasting way—a child’s capacity to learn and to adapt to stressful situations, how sensitive and responsive caregiving can buffer the effects of such stress, and how policies could be shaped to minimize the disruptive impacts of toxic stress on young children.
Suggested citation: National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Retrieved from http://www.developingchild.harvard.edu
Strengthening Adult Capacities to Improve Child Outcomes: A New Strategy for Reducing Integenerational Poverty
Jack P. Shonkoff, Harvard University – Posted April 22, 2012
It’s clear that high-quality early childhood programs can make a measurable difference for children in poverty, but we must do more. Advances in neuroscience, molecular biology, and the behavioral sciences provide the evidence needed to build on best practices and to forge new ideas that can address the factors that contribute to intergenerational poverty. One promising path is to focus on fostering the skills in adults that allow them to be both better parents and better employees.
Science tells us that children who experience significant adversity without the buffering protection of supportive adults can suffer serious lifelong consequences. Such “toxic stress” in the early years can disrupt developing brain architecture and other maturing biological systems in a way that leads to poor outcomes in learning, behavior, and health. [snip] …[T]he goal is to prevent or mitigate the consequences of toxic stress by buffering young children from abuse or neglect, exposure to violence, parental mental illness or substance abuse, and other serious threats to their well-being.
Success in this area requires adults and communities to provide sufficient protection and supports that will help young children develop strong, adaptive capacities. Since many caregivers with limited education and low income have underdeveloped adaptive skills of their own, interventions that focus on adult capacity-building offer promising opportunities for greater impacts on children.
One area of development that appears to be particularly ripe for innovation is the domain of executive functioning. These skills include the ability to focus and sustain attention, set goals and make plans, follow rules, solve problems, monitor actions, delay gratification, and control impulses.[snip]
Stress reactivity and attachment security.
Institute of Child Development, University of Minnesota, Minneapolis 55455, USA.
Seventy-three 18-month-olds were tested in the Ainsworth Strange Situation. These children were a subset of 83 infants tested at 2, 4, 6, and 15 months during their well-baby examinations with inoculations. Salivary cortisol, behavioral distress, and maternal responsiveness measures obtained during these clinic visits were examined in relation to attachment classifications. In addition, parental report measures of the children’s social fearfulness in the 2nd year of life were used to classify the children into high-fearful versus average- to low-fearful groups. In the 2nd year, the combination of high fearfulness and insecure versus secure attachment was associated with higher cortisol responses to both the clinic exam-inoculation situation and the Strange Situation. Thus, attachment security moderates the physiological consequences of fearful, inhibited temperament. Regarding the 2-, 4-, and 6-month data, later attachment security was related to greater maternal responsiveness and lower cortisol baselines. Neither cortisol nor behavioral reactivity to the inoculations predicted later attachment classifications. There was some suggestion, however, that at their 2-month checkup, infants who would later be classified as insecurely attached exhibited larger dissociations between the magnitude of their behavioral and hormonal response to the inoculations. Greater differences between internal (hormonal) and external (crying) responses were also negatively correlated with maternal responsiveness and positively correlated with pretest cortisol levels during these early months of life.
[read more: http://www.ncbi.nlm.nih.gov/pubmed/8666128 ]
- Intervention: A home visitation program for low-income families with young children at high risk of emotional, behavioral, or developmental problems, or child maltreatment.
- Evaluation Methods: A well-conducted randomized controlled trial.
- Key Findings: At the three-year follow-up, a 33% reduction in families’ involvement with child protective services (CPS) for possible child maltreatment. At the one-year follow-up, 40-70% reductions in serious levels of (i) child conduct and language development problems, and (ii) mothers’ psychological distress.
- Other: A study limitation is that its sample was geographically concentrated in Bridgeport, Connecticut. Replication of these findings in a second trial, in another setting, would be desirable to confirm the initial results and establish that they generalize to other settings where the intervention might be implemented.
Download a printable version of this evidence summary (pdf, 4 pages)
Effects of Child FIRST one year after random assignment:
Compared to the control group, children in the Child FIRST group were –
- 68% less likely to have clinically-concerning language development problems, as measured by a trained assessor (10.5% of Child FIRST children had such problems versus 33.3% of control group children).
- 42% less likely to have clinically-concerning externalizing behaviors, such as aggression or impulsiveness, as reported by their mothers (17.0% of Child FIRST children versus 29.1% of control group children).
Compared to the control group, mothers in the Child FIRST group were –
- 64% less likely to have clinically-concerning levels of psychological distress, based on self-reports (14.0% of Child FIRST mothers versus 39.0% of the control group mothers).
- The study did not find statistically-significant effects on (i) the percent of children with clinically-concerning internalizing behaviors (e.g., depression or anxiety); (ii) the percent of children with clinically-concerning dysregulation (e.g., sleep or eating problems); (iii) the percent of mothers with clinically-concerning parenting stress; or (iv) the percent of mothers with clinically-concerning depression.3
[read more: http://toptierevidence.org/programs-reviewed/child-first ]
Research Finds a High Rate of Expulsions in Preschool
By TAMAR LEWIN
New York Times – Published: May 17, 2005
So what if typical 3-year-olds are just out of diapers, still take a daily nap and can’t tie their shoes? They are plenty old enough to be expelled, the first national study of expulsion rates in prekindergarten programs has found.
In fact, preschool children are three times as likely to be expelled as children in kindergarten through 12th grade, according to the new study, by researchers from the Yale Child Study Center.
Preschool and child care expulsion and suspension: Rates and predictors in one state.
Gilliam, Walter S.; Shahar, Golan
Infants & Young Children, Vol 19(3), Jul-Sep 2006, 228-245. doi: 10.1097/00001163-200607000-00007
ABSTRACT : Rates and predictors of preschool expulsion and suspension were examined in a randomly selected sample of Massachusetts preschool teachers (N = 119). During a 12-month period, 39% of teachers reported expelling at least one child, and 15% reported suspending. The preschool expulsion rate was 27.42 per 1000 enrollees, more than 34 times the Massachusetts K-12 rate and more than 13 times the national K-12 rate. Suspension rates for preschoolers were less than that for K-12. Larger classes, higher proportion of 3-year-olds in the class, and elevated teacher job stress predicted increased likelihood of expulsion. [snip]
[read more: http://psycnet.apa.org/psycinfo/2009-04570-007 ]
Traumatic and stressful events in early childhood: Can treatment help those at highest risk?
ABSTRACT: This study involves a reanalysis of data from a randomized controlled trial to examine whether child–parent psychotherapy (CPP), an empirically based treatment focusing on the parent–child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs)
Listening to a Baby’s Brain: Changing the Pediatric Checkup to Reduce Toxic Stress
Listening to a baby’s heartbeat. Examining a toddler’s ears. Testing a preschooler for exposure to lead. These critical screenings have long been the hallmarks of early childhood checkups. Now, leading pediatricians are recommending major changes to the checkups of the future. The American Academy of Pediatrics (AAP) wants primary care doctors to screen their youngest patients for social and emotional difficulties that could be early signs of toxic stress. Read more >>
From the American Academy of Pediatrics
Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health
Andrew S. Garner, MD, PhD, Jack P. Shonkoff, MD, Benjamin S. Siegel, MD, Mary I. Dobbins, MD, Marian F. Earls, MD, Andrew S. Garner, MD, PhD, Laura McGuinn, MD, John Pascoe, MD, MPH, David L. Wood, MD
ABSTRACT : [snip] To this end, AAP endorses a developing leadership role for the entire pediatric community—one that mobilizes the scientific expertise of both basic and clinical researchers, the family-centered care of the pediatric medical home, and the public influence of AAP and its state chapters—to catalyze fundamental change in early childhood policy and services. AAP is committed to leveraging science to inform the development of innovative strategies to reduce the precipitants of toxic stress in young children and to mitigate their negative effects on the course of development and health across the life span.
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HEALTHY, HAPPY KIDS GROW UP TO CREATE A HEALTHY, HAPPY WORLD.
This is a community of practice network. We use trauma-informed practices to prevent ACEs & further trauma, and to increase resilience.
[read more: http://acesconnection.com/ ]
ABOUT DAVID BORNSTEIN:
David Bornstein is the author of “How to Change the World,” which has been published in 20 languages, and “The Price of a Dream: The Story of the Grameen Bank,” and is co-author of “Social Entrepreneurship: What Everyone Needs to Know.” He is a co-founder of theSolutions Journalism Network, which supports rigorous reporting about responses to social problems.