Toxic stress and children’s outcomes

Toxic Stress and Children’s Outcomes, a new report published jointly by the Economic Policy Institute and the Opportunity Institute, urges policymakers and educators to join health care researchers and clinicians in paying greater attention to the contribution of “toxic stress” to deterioration in children’s academic performance, behavior, and health.

The epidemiological research literature is rich with discussions of how toxic stress in children predicts depressed outcomes. And yet policymakers, educators, researchers, and clinicians have only recently begun to explore policies and interventions that might help to mitigate toxic stress and its effects on children.

“Stress” is a commonplace term for bodily chemical changes in response to frightening or threatening events or conditions. A normal response to a frightening or threatening situation is the production of hormones that can affect almost every tissue and organ in the body. Tolerable stress can contribute to better performance if individuals react by heightening their focus on the fright or threat without distraction.

But when frightening or threatening situations occur too frequently or are too intense, and when protective factors are insufficient to mitigate children’s stress to a tolerable level, these hormonal changes are deemed “toxic” and can impede children’s behavior, cognitive capacity, and emotional and physical health. Toxic stress produces not heightened focus but the opposite, a decrease in performance levels.

Examples of severe, frequent, or sustained events that can produce toxic stress are psychological, physical, and sexual abuse; having a parent or close relative incarcerated; witnessing neighborhood or domestic violence; physical or emotional neglect; family financial hardship; homelessness; racial discrimination; parental divorce or separation; placement in foster care or kinship care; property loss or damage from a fire or burglary; or having a family member become seriously ill or injured, hospitalized, or die.

The lowest-income children are more likely to experience frightening or threatening events. In part because African American families fall disproportionately lower in the income distribution than white families, black children are more likely than white children to experience such events. The additional stress experienced by black children because of racial discrimination and bias also helps explain why this condition is more prevalent among low-income black children than among low-income children generally.

Exposure to frightening or threatening events or conditions does not necessarily result in toxic stress. Children’s susceptibility can be reduced by their psychosocial context, including protective neighborhood, family, or school conditions, as these can help children develop effective self-regulation, i.e., the ability to respond more constructively to emotions and to manage behavior in response to frightening or threatening events. For instance, when children have a network of stable, responsive relationships and caregivers with the financial, psychological, and social resources to nurture and protect them, they are more likely to cope successfully with frightening or threatening events.

The observation that psychosocial context and behavior are connected is hardly news, but three more recent advances are noteworthy. First, research in human development and several of the neurosciences provide biomedical models for the dynamics of chronic stress, adversity, and resilience. These models provide a far richer, science-based framework connecting a student’s context with both socioemotional and academic outcomes. The link between student outcomes and their experience of housing insecurity or neighborhood violence is not just a matter of correlations and intuition, it is a matter of biology, chemistry, epigenetics, and so forth.

Second, the same science tells us that adversity is not destiny because the brain is malleable. That is, brain chemistry and even anatomy can be changed in positive ways by interrupting the stress cycle or introducing supportive forces to the child’s context.

Third, and most critical for policy and politics, the research points us to science-based strategies for mitigating the effects of poverty, structural racism, and other adversity on learning—thereby reducing education outcome disparities. Brain science offers insights that could be transformative in the generations-long struggle for education equity. Interventions based on this science can strengthen the protective factors that prevent frightening or threatening events from provoking a child’s toxic stress.

The report Toxic Stress and Children’s Outcomes recommends that practitioners in social work, educational practice, and health care implement such programs. Schools, for example, can contribute to protecting children against the effects of frightening or threatening events. While teachers cannot fix the roots of the problem—discrimination, poverty, and segregation—there are school-based approaches that can offset some of the effects of toxic stress on children’s academic achievement, behavior, and health. For example, school staff can learn how to de-escalate a student’s unproductive behavior by emotionally connecting with the child and removing the child from the overwhelming context before redirecting the child toward schoolwork.

To improve the support that children exposed to frightening or threatening experiences receive, Toxic Stress and Children’s Outcomes also recommends that adults working in preschools, elementary, and secondary schools receive training to help them understand how such experiences affect students’ learning and behavior.

Toxic Stress and Children’s Outcomes further recommends that high-quality support for parents and parents-to-be be made more accessible. Support programs such as home visits and/or therapy services by community health workers, nurses, and other health specialists can offset the damaging effects of exposure to frightening or threatening conditions by building the capacity of caregivers to provide children with safe, stable, and nurturing relationships that help to develop children’s adaptive and positive coping skills.

An example of such an initiative is The Nurse Family Partnership, a program in which registered nurses visit women before and after childbirth, help coordinate physician and hospital visits, and provide guidance on healthy behavior during pregnancy. These visits contribute to improving parent–child interactions, decrease the risk of child maltreatment, and generally contribute to improving children’s environments. In doing so, home visits create conditions that protect children from the effects of toxic stress.

As health care professionals have started to turn their attention to this important problem, so should educators. Greater public awareness of this insidious morbidity can help us better understand the persistence of achievement gaps by race and income and point the way to policy that can address these gaps.