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The Medical Case for Early Intervention

The recent discovery of the catastrophic consequences of environmental stress in a child’s development has led leaders in the medical field to express their concern on the phenomenon of toxic stress. Toxic stress is a medical condition that arises when children are raised in an at-risk environment in which their developmental need for strong social relationships is not met.  The result of this absence is that their bodies’ stress response is set into overdrive leading to extensive biological and neurological ramifications. Toxic stress is thought to be a lead indicator of why individuals from low-income environments are significantly more likely to suffer early deaths. Mounting research indicates that targeting toxic stress is of grave importance.

The Lifelong Effects of Early Childhood Adversity and Toxic Stress
The American Academy of Pediatrics

“Longitudinal Studies document the long-term consequences of childhood adversity indicate that alterations in a child’s ecology can have measurable effects on his or her developmental trajectory, with lifelong consequences for educational achievement, economic productivity, health status, and longevity.” – The American Academy of Pediatrics

What is Toxic Stress?
Toxic stress is defined by the American Academy of Pediatrics as “the excessive or prolonged activation of the physiologic stress response systems in the absence of the buffering protection afforded by stable, responsive relationships.” In other words, when a child is not properly cared for early in his or her lifetime lacks the protective relationships critical to healthy development. Here, it is argued, one’s nature is largely dependent on nurture.

When this social reinforcement is absent, a highly disruptive physiologic response takes place, producing “biological memories” that interrupt a child’s development. Such interruption has the ability to disrupt brain circuitry and other critical regulatory systems to such a severe extent that it can continue to influence physiology, behavior, and health. In short, placing a child in an unstable environment can lead to high levels of stress that deter adaptive capacities, coping skills, and social relationships for the rest of his or her life.

Biology Behind the Issue
Bodily functioning is regulated through a multitude of systems critical to keeping the body in a state of homeostasis, or balance. Consistent elevation in stress-related hormones can lead to a wearing of the organ and brain systems when coping with this excess, also known as an “allostatic load.” Heightened stress leads to over activation of stress related symptoms resulting in impaired levels of cortisol, deters one’s inflammatory response and interrupts normal functioning. Although the body is designed to handle brief periods of increased stress due to sudden tragic acts or threats to life, it is not capable of managing the constant elevation brought on by toxic stress. Thus, adversity at an early age can forever alter the architecture of the brain by causing permanent damage to one’s amygdala, orbitofronal cortex, hippocampus, and medial pre-frontal cortex.

Why it Matters
Impairments to these parts of the brain lead to grave implications in physical and mental health. There is a high correlation between toxic stress and engaging in health-threatening behaviors, including substance abuse, gambling, obesity, and promiscuity. Furthermore, the consequences of toxic stress predispose individuals to higher rates of risk-taking, such as joining a gang, school failure, violent crime, and single parenthood. Toxic stress additionally impairs one’s ability to maintain supportive social networks. With up to 40% of early deaths being attributed to behavioral and lifestyle patterns, these consequences of toxic stress matter a great deal. Toxic stress serves as a significant deterrent to one’s overall health, with victims suffering increased incidences of cardiovascular disease, viral hepatitis, liver cancer, asthma, pulmonary disease, autoimmune disease, and depression. The impact of these effects is exacerbated by the fact that roughly 30% of early deaths are attributable to lack of adequate medical care and socioeconomic discrepancies.

“Protecting young children from adversity is a promising, science-based strategy to address many of the most persistent and costly problems facing contemporary society, including limited educational achievement, diminished economic productivity, criminality, and disparities in health.” – American Academy of Pediatrics

 How to Prevent the Onset of Toxic Stress
By lessening the adverse environments that many children are forced to endure, the harmful effects of toxic stress could be significantly mitigated. Toxic stress manifests when a child’s physiologic stress response system is in overdrive. To ensure that this system’s functioning is brought back to baseline there is no better solution than to target parents directly. Because toxic stress is highly correlated with depression, substance abuse, domestic and community violence, and food scarcity within a child’s home, it is critical to focus resources in areas where these factors are most prevalent. Successful deterrents to the onset of toxic stress include educational efforts targeting caregivers and educators, stability of home and school environments, community based mentor initiatives, family based therapies, and finally more aggressive identification and intervention when toxic stress is present. Other succinct measures to aid in the eradication of toxic stress include addressing maternal depression, providing counseling on the importance of the mother-child bond, and more broadly, expanding the concerns of child welfare to also pertain to the social, emotional, and cognitive components of maltreatment.

“This is the biology of social class disparities. Early Experiences are literally built into our bodies.” – Dr. Jack Shonkoff, Harvard Pediatrician and leader of American Academy of Pediatrics

Why it is overlooked
The reason toxic stress, though scientifically proven, has yet to be widely recognized within the medical community is the emphasis on sick care. The connection between toxic stress and later implications of developmental disorders has been cemented, yet early intervention is commonly overlooked because the implications of toxic stress do not fully manifest until later in one’s lifetime. Toxic stress is one of the newly recognized “millennial morbidities” that has surfaced in modern times due to a deeper exploration of the socioeconomic disparities in care. According to the American Academy of Pediatrics, over the last 58 years ethnic and racial inequalities in health care have been worsening, meaning the implications of toxic stress are getting increasingly severe.

“The causal sequences of risk that contribute to demographic differences in educational achievement and physical well-being threaten our country’s democratic ideals by undermining the national credo of equal opportunity.” – The American Academy of Pediatrics

Challenges
Despite solutions being determined for addressing toxic stress there have been many barriers by way of financial and logistical challenges. Screening for possible incidences of toxic stress, providing necessary services when this ailment is proven present, and rallying community support are not at all small feats, but measures that need to be progressed aggressively.  

Sources Cited:

Dobbins, M., Earls, M.F., Garner, A.S., McGuinn, L., Pascoe, Shonkoff, J.P., Siegel, B.S.,  & Wood, D.L. “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health” (2011). Pediatrics: Official Journal of the American Academy of Pediatrics, 129, 224-231. <http://pediatrics.aappublications.org/content/129/1/e224.full.pdf+html>

— Prepared by Ashlin Orr, Kinder Institute Intern, 2011-12.