Institute For The Future

The Toxic Effects of Childhood Stress

 

The American Academy of Pediatrics released a fascinating, and potentially transformative, statement a couple of weeks ago about something that would seem to be a simple, almost insignificant problem: Stress. Their point, detailed in a separate background piece details mounting evidence from fields like neuroscience, epigenetics and sociology that toxic stress exposure--in effect, prolonged exposure to particularly harsh conditions--in prenatal and early childhood settings create long-term problems ranging from social and behavioral problems to higher risks of chronic diseases and shorter lives. The AAP describes its approach to alleviating stress with a mouthful--an ecobiodevelopmental framework for health--that hints at a key concept: That in the coming years, many of our most important breakthroughs in well-being won't come from doctor's offices, but through improvements in our social and physical environments.

 

Both articles are worth reading in-depth, but here are a couple of key excerpts that highlight the role of early stress in shaping long-term well-being:

 

 

 

Within the ongoing interplay among assets for health and risks for illness, toxic stress early in life plays a critical role by disrupting brain circuitry and other important regulatory systems in

ways that continue to influence physiology, behavior, and health decades later. In short, an EBD approach to childhood adversity suggests that (1) early experiences with significant stress

are critical, because they can undermine the development of those

adaptive capacities and coping skills needed to deal with later challenges; (2) the roots of unhealthy lifestyles, maladaptive

coping patterns, and fragmented social networks are often found

in behavioral and physiologic responses to significant adversity that emerge in early childhood; and (3) the prevention of long-term, adverse consequences is best achieved by the buffering protection afforded by stable, responsive relationships that help children develop a sense of safety, thereby facilitating the restoration of their stress response systems to baseline.

 

 

 

 

And in the technical paper:

 

 

 

First, current health promotion and disease prevention policies

focused largely on adults would be more effective if evidence-based

investments were also made to strengthen the foundations of health

in the prenatal and early childhood periods. Second, significant reductions in chronic disease could be achieved across the life course by decreasing the number and severity of adverse experiences that threaten the wellbeing of young children and by strengthening the protective relationships that help mitigate the harmful effects of toxic stress. The multiple domains that affect the biology of

health and development—including the foundations of healthy development, caregiver and community capacities, and public and private sector policies and programs—provide a rich array of targeted opportunities for the introduction of innovative interventions, beginning in the earliest years of life.

 

 

 

 

At another point, the paper's authors, led by Jack P. Shonkoff, argue that identifying strategies to reduce toxic childhood stress is "the next chapter of innovation in pediatrics [that] remains to be written."

 

It's that process of writing that chapter that has the potential to be incredibly contentious and to challenge our basic assumptions and institutions, however. In a column on the subject, Nicholas Kristoff highlights programs such as home nurse visits in homes with babies, that have measured results demonstrating long-term gains in health and behavior when those kids get older.

 

But it seems to me that the long-term implications of this research suggest that some of the most important strategies to mitigate stress won't involve hospitals or doctors or nurses at all, but will involve things like early childhood education programs--things that are harder to fund, and harder to measure, as health interventions.