Toxic Stress and Early Brain Development Lindsey Moss, MSW, LCSW Valerie Glascock, LPA

Whole Brain Weight in Grams

CEREBRAL CORTEX CEREBRAL CORTEX LIMBIC SYSTEM BRAINSTEM

Experiences Build the Brain developingchild.harvard.edu

Role of Experience Repeated use strengthens brain connections If connections are not used, they are more likely to be “pruned” away The brain “grows itself” for the environment it experiences Emotion and relationships appear to play particularly important roles in shaping the brain’s development

What is Stress? Stress results when there is a threat to our well-being AND We attempt to defend ourselves from that threat Stress

Stress Response Brain and body coordinate to release a series of biochemicals that prepare us to: – Fight – Flee – Freeze Response developed for physical threat – Usually intense, but short-lived – Allows us to return to a baseline comfort level

Body’s Response to Stress Increase in heart rate Increase in blood pressure Increase in breathing rate Increase in muscle tone Release of stored sugar into the blood Hypervigilance (alert to threat) Tuning out of all non critical information

Normal and Chronic Stress Chronic Stress Normal Stress

Positive Stress Moderate, short-lived stress responses Moderate, short-lived stress responses Examples include meeting new people, dealing with frustration, getting an immunization, or adult limit-setting Examples include meeting new people, dealing with frustration, getting an immunization, or adult limit-setting An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships. An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships.

Tolerable Stress Stress responses that could be disruptive, but are buffered by supportive relationships Stress responses that could be disruptive, but are buffered by supportive relationships Examples include death or serious illness of a loved one, a frightening injury, parent divorce, a natural disaster, terrorism, or homelessness Examples include death or serious illness of a loved one, a frightening injury, parent divorce, a natural disaster, terrorism, or homelessness Generally occurs within a time-limited period, which gives the brain an opportunity to recover from potentially damaging effects. Generally occurs within a time-limited period, which gives the brain an opportunity to recover from potentially damaging effects.

Toxic Stress Prolonged stress in the absence of the buffering protection of adult support Prolonged stress in the absence of the buffering protection of adult support Examples include extreme poverty, abuse, chronic neglect, severe maternal depression, substance abuse, or family violence Examples include extreme poverty, abuse, chronic neglect, severe maternal depression, substance abuse, or family violence Disrupts brain architecture and leads to highly reactive stress response systems, increasing the risk of physical and mental illness. Disrupts brain architecture and leads to highly reactive stress response systems, increasing the risk of physical and mental illness. Pediatrics, 2012

Toxic Stress Derails Development developingchild.harvard.edu

Long Term Health Impact of Adverse Childhood Events ACE Study – CDC Asked about 10 stressful childhood experiences Looked at long-term health outcomes ACE predicted 10 major causes of adult illness and death Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, & Marks (1998)

Compared to persons with an ACE score of 0, those with an ACE score of 4 or more were: 2 times as likely to be smokers 4 times more likely to be depressed 7 times more likely to be alcoholic 10 times more likely to have injected street drugs 12 times more likely to have attempted suicide

ACE predicted higher rates of: Chronic obstructive pulmonary disease (COPD) Fetal death Heart attack and stroke Obesity Liver disease Risk for intimate partner violence Sexually transmitted diseases (STDs) Unintended pregnancies

Model of Causality

Body’s Response to Stress Increase in heart rate Increase in blood pressure Increase in breathing rate Increase in muscle tone Release of stored sugar into the blood Hypervigilance (alert to threat)

Risk of Child Maltreatment In a study of 188 children under age 3 with newly opened child protection cases, 66% had developmental delays which met the eligibility criteria for early intervention In a study of 188 children under age 3 with newly opened child protection cases, 66% had developmental delays which met the eligibility criteria for early intervention In a In a sample of 125 foster children under age 6, over 80% had developmental or emotional problems (and 50% had both) Massachusetts Early Childhood Linkage Initiative, 2005 Klee, Kronstadt, & Zlotnick, 1997

Impact of Poverty on Parenting Poor preschool children more likely to have abnormal cortisol (stress hormone) patterns These patterns were linked to impaired problem-solving, attention, and emotional regulation (and later school achievement) These links are correlated with a harsh and demanding parenting style Blair, 2012

And the circle continues… Family stressors such as low maternal education, low income, and unsafe neighborhoods are strong predictors of adverse outcomes (especially when they occur in combination) Family stress is linked to negative child outcomes primarily through a harsh and controlling parenting style Vernon-Feagans, Family Life Project, 2013

Even in Their Sleep, Babies are Learning…. Even during sleep, infants show reactions to angry voices (based on fMRI scans) Even during sleep, infants show reactions to angry voices (based on fMRI scans) Infants from high conflict homes showed the greatest reactivity in brain areas linked to stress and emotion regulation Infants from high conflict homes showed the greatest reactivity in brain areas linked to stress and emotion regulation Graham, Fisher, & Pfeifer, 2013

Effects of Toxic Stress in Early Childhood “Limbic irritability” – reactive stress response A low threshold for daily stressors Impaired brain structures responsible for memory formation, attention, and self-control Risk for school failure, behavior problems Compromise of immune system, perhaps permanently Teicher, 2000; Pollak, 2009; Essex, 2003

So What Can We Do?