You’ve heard this before: that traumatic experiences in early childhood like neglect and abuse are common and are strongly associated with risk-taking and unhealthy lifestyles. Findings from the Adverse Childhood Experiences study, ongoing since the early 1990s, have linked these negative experiences with a higher risk for alcoholism, depression, heart and liver disease, sexually transmitted infections, teen pregnancy, and other problems. For some time now, many doctors and observers alike viewed these ailments as resulting from unhealthy lifestyles adopted as coping mechanisms by those raised in chaotic, stressful environments.
But as Pediatrics’ reports summarize, years of research have demonstrated just how utterly vulnerable—physically vulnerable—the young brain is to toxic stress. If positive stress or tolerable stress is a sudden gust that whips things up momentarily and then settles back down, toxic stress is a hurricane that can permanently damage vital structures.
Here’s how: Three key areas in the young child’s brain are highly sensitive to large and ongoing doses of the stress hormones, and each can be molded, literally, by toxic stress. Toxic stress enlarges the amygdala, a brain structure that activates the stress response, triggering excessive release of stress hormones and bumping the risk for uncontrolled fear and anxiety. The prefrontal cortex normally helps to keep the amygdala’s stress-activating role in check, but toxic stress can cause a loss of neurons and alter its ability to lessen the amygdala’s activity; affected children may have difficulty coping with stress in later years. In a similar way, toxic stress can change the architecture of the hippocampus—important in memory and mood—and impair skills related to understanding and emotion.
As a general internist who takes care of adult patients with a litany of chronic diseases, here’s what knocks my socks off: the notion that early toxic stress isn’t just vaguely bad, but can create concrete, physical effects. Unmitigated toxic stress can leave a physical mark like a tattoo, imprinted forever. No matter how normal and unstressed a child’s subsequent years, no matter how loving their parents or guardians, the early-childhood toxic-stress tattoo can doom a person to a heightened risk for chronic health problems in adulthood. Heart disease, diabetes, asthma, hypertension, autoimmune diseases: All of these can be triggered by the physical changes that result from early toxic stress. Not everybody who experiences toxic stress will end up with these problems, but the risk doesn’t go away.
This is a staggeringly huge and complicated issue that affects individual children and society as a whole. (In 2008, state and local child protective services estimated that 772,000 children were maltreated in the United States.) A number of articles have suggested various approaches toward a solution. The Pediatrics position paper calls for pediatricians to go beyond simply identifying toxic stress to referring children and parents to effective and accessible programs and resources; primary care pediatricians, they exhort, should serve as liaisons to a multitude of services that can mitigate toxic environments. Jonathan Cohn, in last month’s New Republic, calls for more spending devoted to early-childhood programs; Paul Tough in The New Yorker homes in on how treating adverse childhood experiences can improve adult health; and Nicholas Kristof implores us to improve children’s lives by reducing toxic stress early.
But to institute such major changes, parents and policymakers alike must develop a clear understanding of what childhood stress really means. It’s not a one-size-fits-all term, and frankly, discussions like that in Psychology Today are damaging and trivializing the reality of toxic childhood stress. There’s a world of a difference between one young child who cries himself to sleep with nurturing parents hovering in the next room and one who cries night after night and is never comforted.
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