Toxic Stress in Children and Adolescents

1. Toxic Stress in Children and Adolescents Reo Newring, Ph.D., LP Speaking of Children

2. Disclosure Information 2018 Speaking of Children Conference Toxic Stress in Children and Adolescents Reo W. Newring, Ph.D. I have no financial relationships to disclose.

3. Overview of Presentation • Define and give examples of toxic stress. • Discuss immediate effects of exposure to toxic stress. • Discuss long-term effects of exposure to toxic stress. • Familiarize the audience with risk and protective factors. • Provide recommendations for bolstering resilience and mitigating negative effects of toxic stress.

4. Toxic Stress Excessive or prolonged activation of the physiologic stress response systems in the absence of…stable, responsive relationships

5. Types of Stress Responses • Normal • Tolerable • Toxic

6. Normal Stress Response • Adverse event leads to brief stress response • Frustrations • Shots • First day of school • Recovery- fostered by a supportive adult • Sense-making • Learning to cope

7. Tolerable Stress Response Compared with a normal stress response, • Adverse event of greater magnitude • Serious illness • Natural disaster • Divorce • Death in the family • Stress response • Greater risk of physiological harm, effects on health and learning • Recovery- fostered by a supportive adult- is more difficult • Sense-making • Learning to cope

8. Toxic Stress Response • Persistent events and conditions and/or severe trauma • Adverse experiences • Lack of adult support • Harm to brain, body and psyche

9. Adverse Experiences • Natural and man-made disasters • Traumatic medical events • Violence • Discrimination • Poverty • Family dysfunction • Family tragedies

10. Immediate Effects of Toxic Stress When these events occur, these are some things that happen to kids: Emotional: Distress. Fear. Depression. Anxiety. Uncertainty. Biological: Sympathetic Nervous System response. Environmental changes: Loss of stability, predictability. The world stops making sense. Grown-ups stop making sense. Unthinkable things are now possible.

11. Long-Term Effects of Toxic Stress Over time, toxic stress continues to exacerbate and contribute to problems • Mental health • Physical health • Difficulties in functioning (school, job) • Difficulties in relationships (partnerships and parenting)

12. Effects of Toxic Stress on Mental Health • Anxiety • Depression • Addiction • Vulnerability to mental health problems • Problems with learning, memory & emotion • Emotional over-reactivity

13. Effects of Toxic Stress on Physical Health • Vulnerability to exaggerated future stress responses • Inflammatory responses • Auto-immune illnesses • Migraines • Chronic pain • Compromised immune system • Heart problems • Obesity • Dental problems

14. Effects of Toxic Stress on Function • School • Academic achievement • Focus • Behavior • Relationships with peers • Relationships with authority figures • Job • Performance • Focus • Behavior • Relationships with coworkers • Relationships with customers/clients • Relationships with management

15. Effects of Toxic Stress on Relationships • Immediate family • Trust • Interdependence • Support • Extended family • Community • Friendships • Romantic relationships • Children

16. Multiplicative Effects over Time • Toxic stress causes problems • Problems can lead to adverse events • Adverse events lead to toxic stress • Transactional process: each influences the other • Models & Mechanisms

17. Exponential Effects over Time • Genetics • Modification of genetic content and/or expression by outside experiences (developmental neurogenomics) • Passing it on

18. Infinite (?) Effects over Time Generations and communities

19. Risk Factors • Parent and home problems • Mental health concerns • maternal depression • Parental substance abuse • Parental marital discord • Incarceration • Socio-economic status • Low income • Domestic violence • Community factors • Violence • Drugs • Poverty • Limited resources

20. Protective Factors • Supportive relationships • Opportunities to succeed • Safe spaces

21. Best Buffer: • Supportive relationship with an adult

22. Prevention of Toxic Stress • Prevention of stressors & adverse events • Treatment, education, community interventions, public policy • Bolster resilience • Treatment, education, community programs

23. Mitigation of Toxic Stress Address any or all of the following: • Health • Sleep • Nutrition • Exercise • Treat illness • Family • Relationships • Direct and indirect (modelling) • Communication • Discipline • Trust & support • Financial/vocational problem solving • Affection & touch

24. Mitigation of Toxic Stress Learning the following skills: • Problem solving • Appropriate emotional expression • Appropriate & effective communication • Relating to others • Trust • Giving and accepting affection • Making sense • Acceptance • Self-esteem • Mindfulness

25. Summary • Toxic Stress • Adverse events, severe or chronic • Lack of support • Lifelong down-hill trajectory • Brain • Body • Mental health • Functioning • Cumulative • Help: • Address symptoms • Teach skills • Build a support system

26. Selected References American Academy of Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129, e232-e246. DOI: 10.1542/peds.2011-2663. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry & Clinical Neuroscience, 256, 174-186. DOI: 10.1007/s00406-005-0624-4. Bright, M. A., Thompson, L., Esernio-Jenssen, D., Alford, S., & Shenkman, E. (2015). Primary care pediatricians’ perceived prevalence and surveillance of adverse childhood experiences in low-income children. Journal of Health Care for the Poor and Underserved, 26, 686-700. DOI: 10.1353/hpu.2015.0080. Center for the Developing Child, Harvard University. Toxic Stress. Retrieved from https://developingchild.harvard.edu/science/key-concepts/toxic-stress/ on 3/26/19. Juster, R. P., Bizik, G., Picard, M., Asenault-Lapierre, G., Sindi, S., Trepanier, L., Marin, M. F., et al. (2011). A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development. Development and Psychopathology, 23, 725-776. DOI: 10.1017/s0954579411000289. Letourneau, N. (2012). Relationships are the antidote to toxic stress. Canadian Nurse. Retrieved from https://www.canadian-nurse.com/en/articles/issues/2012/march-2012/relationships-are-the-antidote-to-toxic-stress on 3/26/19. Livaditis, L. V. (2017). An interdisciplinary approach to toxic stress: Learning the lingo. Pediatrics, 140. DOI: 10.1542/peds.2017-2916. Melchior, M., Moffitt, T. E., Milne, B. J., Poulton, R., & Caspi, A. (2007). Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study. American Journal of Epidemiology, 166, 966-974. DOI: 10.1093/aje/kwm155. Miller, G. E., & Chen, E. (2010). Harsh family climate in early life presages the emergence of a proinflammatory phenotype in adolescence. Psychological Science, 21, 848-856. DOI: 10.1177/0956797610370161. Sofer, D. (2019). The lifelong reverberations of toxic stress. American Journal of Nursing, 119, 22-23. DOI: 10.1097/01.NAJ.0000552601.43287.61. Young, K. (2018). The effects of toxic stress on the brain & body—how to heal & protect. Retrieved from https://www.heysigmund.com/toxic-stress/ on 3/26/19.