By: Jennifer Chubinski, in collaboration with Judith Harmony, Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center.
“Imagine if scientists discovered a toxic substance that increased the risks of cancer, diabetes and heart, lung and liver disease for millions of people. Something that also increased one’s risk for smoking, drug abuse, suicide, teen pregnancy, sexually transmitted disease, domestic violence and depression – and simultaneously reduced the chances of succeeding in school, performing well on a job and maintaining stable relationships? It would be comparable to hazards like lead paint, tobacco smoke and mercury. We would do everything in our power to contain it and keep it away from children. Right?”
This is one of the best article introductions I have read. It appeared in The New York Times in a story by David Bornstein about protecting children from toxic stress. His point was that researchers have understood for a long time that toxic stress is associated with an alarming collection of lifelong health and socio-emotional problems for kids, including everything listed above.
If you don’t have time to read this entire blog, watch this video – it does most of my job for me.
So the bad news is that kids soak up everything around them, including the toxic aspects of their environment.
Relationships and experiences during early life leave lasting and dramatic imprints on a child, imprints that will affect a child’s future physical and mental health, behaviors, the capacity to learn and navigate complex social networks, and the capacity to become economically self-sufficient. Experiencing major and recurring adversity between birth and age 5, the years of rapid brain development and susceptibility, derails normal healthy brain development and causes prolonged harmful physiological stress responses. The consequences include increased risk of impaired cognitive and non-cognitive (personality) development, inappropriate behavior and chronic health disorders that persist throughout life and can be transmitted across generations.
(As a side note, this is the point in my research on this issue where I am terrified, being a mother of three children 5 years old and younger.)
What is toxic stress?
Contributors to toxic early childhood adversity may include food and housing insecurity; parental unemployment or family poverty; unresolved traumatic experiences; ineffective parenting; physical, emotional or sexual abuse; chronic neglect; domestic violence; parental substance addiction; or incarceration of a family member.
What is most important to note is that many of these causes of childhood adversity affect families of all socioeconomic classes, races and ethnicities.
What does the research say about toxic stress?
Evidence that early childhood adversity is a powerful determinant of mental, physical and behavioral disorders and health costs has been measured using the Adverse Childhood Experiences (ACE) study. The Centers for Disease Control and Prevention and the Kaiser Permanente Health Appraisal Clinic in San Diego surveyed thousands of adults about their childhood experiences (younger than 18 years old) of abuse, neglect and family dysfunction as part of their comprehensive physical examinations. The incidence of reported childhood adversity was alarming, with 59% reporting one or more ACE.
ACEs during childhood correlated in adults with increased risk of major illness (heart disease, diabetes, cancer, chronic lung disease, hepatitis and skeletal fractures), increased risk behaviors (smoking, sexually transmitted diseases) and poor self-rated health. Even more powerful correlations were found with depression and attempts to commit suicide. Moreover, the correlation increased in proportion to the ACE score. For example, individuals who experienced four adverse incidents were 260 percent more likely to have chronic obstructive pulmonary disease and five times more likely to abuse drugs compared with individuals who had not experienced childhood adversity.
The ACE survey has been added to the CDC Behavioral Risk Factor Surveillance System and 20 states have implemented it, including Ohio (in 2010). State datahave been reasonably consistent. Between 50 and 60 percent of people have at least one ACE, while approximately one in five people have an ACE score of 3 or greater. Emotional abuse was more common than physical and sexual abuse, while adult substance abuse was more likely than other household dysfunctions. Approximately 15 to 20 percent of students live with a parent who has an ACE score of 4 or more. The cumulative data show a familiar story: the higher the ACE score, the higher the incidence of high-risk behaviors and poor physical and mental health.
This infographic from the Robert Wood Johnson Foundation provides an excellent summary:
A recent white paper released by the United Way of Greater Cincinnati, Health Barriers to Learning for Children, Birth to 3rd Grade recognizes that the early childhood years lay the foundation for later physical and socio-emotional well-being and economic self-sufficiency. Specifically the report highlights the link between barriers to health and reduced capacity to learn. It cites toxic stress produced by prolonged and/or excessive adversity as a significant barrier.
What do the data look like in our region?
Unfortunately, we lack a measure of the number of children in Greater Cincinnati who suffer from significant toxic stress. We do know that every year in Hamilton County there are 65,000 to 70,000 calls to 241-KIDS about suspected maltreatment, one of the major causes of toxic stress. Of these, evidence warranted further investigation into the safety and well-being of 6,408 children. Maltreatment was substantiated or indicated for 2,909 (42%) – a remarkable 1.6% of the total children in the county. In 2011, eight of every 1,000 children were in child protective custody; the mean stay per child was 511 days. To put these numbers in context, 53,091 of the county’s children – 29% - were living in poverty that year. Toxic stress is an epidemic.
In addition to the social costs of toxic stress, the direct economic costs are staggering. Considering only child maltreatment, $85.6 million in public money was spent in Hamilton County in 2009 to support children suspected of being maltreated and documenting that maltreatment (e.g., investigations, court hearings, services for children and families, subsidies for foster parents).
There’s some good news! Kids soak up everything around them, including the positive aspects of their environment.
Fortunately, evidence indicates that the effects of traumatic stress and adversity on a child can be moderated by the support of nurturing parents and/or adult caregivers, an engaging and stimulating environment and, where needed, early interventions designed to help the child and family cope with deprivation, stress, violence and depression. Early childhood interventions have the greatest impact for children who experience the greatest social and economic disparities. Even so, the development and health of all children, independent of socioeconomic status, can benefit from a safe and nurturing environment and from enrichment programs during their early childhood. The best way to prevent toxic stress is to build adults’ abilities to deal in positive ways with children.