Monday, June 17, 2013

Protecting Children from Toxic Stress

A new video from Frontiers of Innovation at Harvard’s Center on the Developing Child highlights the importance of promoting the well-being and skills of parents and caregivers to promote healthy child development. The 5-minute video, entitled Building Adult Capabilities to Improve Child Outcomes: A theory of change emphasizes the way that toxic stress can harm children’s development and argues that the best way to prevent children from being exposed to toxic stress is to strengthen the capabilities of their parents and other adults in their lives.  

Learning to manage daily life stress such as dealing with frustration, meeting new people or getting vaccinations is an important part of children’s growth and development. If, however, a child experiences long periods of intense, repeated stress or does not have a caregiver who is responsive to the child’s need for emotional support, the stress level becomes toxic. According to the American Academy of Pediatrics (AAP), severe toxic stress in childhood can weaken the architecture of a child’s brain and other growing systems. Over time, toxic stress will increase their risk of developmental delays, learning disabilities, and childhood behavior problems, as well as diabetes, heart disease, depression, drug abuse, alcoholism and other major health problems as adults. Risk factors for toxic stress in childhood include living in extreme poverty, experiencing abuse and neglect, exposure to family or neighborhood violence and the substance abuse or mental health issues of a caregiver.  

According to a 2012 policy statement by the AAP, parents and other caregivers play a crucial role in buffering such sources of stress by responding to the child’s distress with love and support. Absent this type of caring support, children are less equipped to learn how to manage stress and emotions in times of difficulty. Empowering parents with the skills to meet children’s emotional needs and deal with difficult problems such as poverty and family violence is therefore essential to children’s well-being. A parent cannot prevent violent crimes or natural disasters from occurring in their neighborhood, but they can develop skills to protect the emotional well-being of their children when these sources of stress occur.  

In a commentary for Spotlight on Poverty and Opportunity, Jack P. Shonkoff, director of the Center on the Developing Child at Harvard University, highlighted the importance of ‘executive function’ skills for parents and caregivers, which include ‘the ability to focus and sustain attention, set goals and make plans, follow rules, solve problems, monitor actions, delay gratification, and control impulses’.According to Shonkoff, these are skills that are learned most rapidly between the ages of three and five, with a second window of accelerated development in adolescence and early adulthood. The part of the brain that controls executive function skills remains plastic until age 25 or even 30. Shonkoff argues that this second period of growth provides an opportunity to help young parents whose own development was undermined by early-life adversity to strengthen these skills, which he calls ‘the building blocks of resilience’. Shonkoff recommends that early childhood providers and workforce development agencies incorporate the development of executive function skills into their programming to strengthen the capacity of parents and other caregivers in order to build strong, healthy families and reduce children’s risk of toxic stress.  

In the video, Building Adult Capabilities to Improve Child Outcomes, they argue that strengthening the capacity of everyone who interacts with children is one of the best ways to promote healthy early development and prevent children from being exposed to toxic stress. The video also emphasizes the importance of the wider community in reinforcing these efforts and the need for effective policy that helps families overcome barriers to well-being such as poverty, family and neighborhood violence, child maltreatment and parental mental health or substance abuse issues. While skill-building for parents and caregivers is described as a bridge to help children overcome obstacles, the video highlights the role of policy in removing these obstacles from their path altogether. Mitigating the harmful effects of stress can improve child well-being, but the ideal would be to prevent children from being exposed to risk factors such as violence and poverty altogether.  

The US Department of Health and Human Services, Administration for Children and Families (ACF) said in an information memorandum that many state and county child welfare systems are investing significant funds in providing services intended to improve well-being outcomes for children and their families such as counseling, parenting classes, and life skills training, but that ‘a number of studies suggest that some of these services are not grounded in the best available evidence and may be provided to children without sufficient attention to their specific maltreatment and trauma histories’. It is important to consider outcome-focused and research-informed solutions to ensuring the needs of children and their families are being appropriately addressed. To that end, policymakers may wish to explore evidence-based approaches to services to help children who have suffered maltreatment in their healing process. They may also wish to consider incorporating evidence-based or research-informed programs for families that reduce the risk of child abuse and neglect as well as the risk of toxic stress that can result from maltreatment. 

In addition to broader policy efforts to promote the well-being of families and address gaps in child mental health care, new state and local-level policies and programs are attempting to incorporate executive function skills into early learning and parent education programs. Frontiers of Innovation has begun working with organizations in sites across the United States to establish working groups and develop neighborhood-level efforts to strengthen the capacity of parents and create opportunities to develop executive function skills. Washington State is the first state to participate in Frontiers of Innovation - with the aim of creating state-level policy change that benefits young children and families statewide by reducing barriers to learning and positive health outcomes. In particular, early learning policies in Washington State aim to promote the development of ‘executive function’ skills. Washington State has incorporated executive function skills into their 2012 Early Learning and Development guidelines by including an introductory text on executive function, as well as expanding their developmental indicators and strategies for parents and caregivers with a focus on these skills. The state has developed an online training module for teachers, caregivers, trainers of early education professionals and Quality Rating and Improvement System coaches.  

However, while skill-building can help parents cope with the challenges that threaten their family’s well-being and reduce the likelihood of toxic stress in children, it is essential that their efforts are supported by policy change to address the social issues such as poverty and violence that put their children at risk in the first place. Neighborhoods with high rates of poverty and violent crime expose entire communities of young children to an increased risk of toxic stress. Policies that promote family economic stability to reduce childhood poverty and policy approaches that prevent children from being exposed to violent crime in their neighborhoods can therefore have a major impact on reducing toxic stress for young children throughout the community. 

Effective policy approaches to family violence are also important for the prevention of toxic stress in children; according to the Bureau of Justice Statistics, between 2001-2005 there were children under the age of 12 living in 35.2% of households where intimate partner violence was occurring. Seeing a parent being abused has serious emotional consequences for children. The availability of mental health care and substance abuse treatment programs for parents is also critical. Policies that promote access to appropriate care can have a big impact on reducing the risk of toxic stress for children whose parents do struggle with mental illness or substance dependency. At the state level, policies to provide parents with mental health and substance abuse treatment supports can be incorporated into programs such as workforce development.

State policymakers may wish to consider expansion of poverty-reduction policies and efforts to prevent children from being exposed to violence in their communities, as well as re-examining the mental health and substance abuse programs that are available to parents in their state.  

Policymakers could also consider ways that active skill building could be incorporated into early childhood education, workforce development and parenting education programs – and could consider implementing protective and promotive factor frame works into those settings. They may wish to partner with health care and human service professionals in their state to promote screening for toxic stress risk factors in well-child visits or through expanding home visiting programs and find ways to support parents in reducing their children’s exposure to toxic stress.
For more information about reducing child poverty and promoting children’s social, emotional and behavioral health, please visit To learn about CSSP’s Strengthening Families Initiative aimed at reducing child abuse and neglect by building protective and promotive factors visit


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