Programs help children cope with severe, ongoing stress
ASHEVILLE, N.C. A quiet, unsmiling little girl with big brown eyes crawls inside a cubicle, hugs a stuffed teddy bear tight, and turns her head away from the noisy classroom.
The safe spaces, quiet times and breathing exercises for her and the other preschoolers at the Verner Center for Early Learning are designed to help kids cope with intense stress so they can learn. But experts hope there’s an even bigger benefit — protecting young bodies and brains from stress so persistent that it becomes toxic.
It’s no secret that growing up in tough circumstances can be hard on kids and lead to behaviour and learning problems. But many researchers believe that ongoing stress during early childhood — from grinding poverty, neglect, parents’ substance abuse and other adversity — can smoulder beneath the skin, harming kids’ brains and other body systems.
And research suggests that can lead to some of the major causes of death and disease in adulthood, including heart attacks and diabetes.
“The damage that happens to kids from the infectious disease of toxic stress is as severe as the damage from meningitis or polio or pertussis,” says Dr. Tina Hahn, a pediatrician in rural Caro, Mich.
She says her No. 1 goal as a physician is to prevent toxic stress. Hahn routinely questions families about stresses at home, educates them about the risks and helps them find ways to manage.
Mounting research on potential biological dangers of toxic stress is prompting a new public health approach to identifying and treating the effects of poverty, neglect, abuse and other adversity. While some in the medical community dispute that research, pediatricians, mental health specialists, educators and community leaders are increasingly adopting what is called “trauma-informed” care.
The approach starts with the premise that extreme stress or trauma can cause brain changes that may interfere with learning, explain troubling behaviour, and endanger health. The goal is to identify affected children and families and provide services to treat or prevent continued stress. This can include parenting classes, addiction treatment for parents, school and police-based programs and psychotherapy.
Many preschoolers who mental health specialist Laura Martin works with at the Verner Center have been in and out of foster homes or they live with parents struggling to make ends meet or dealing with drug and alcohol problems, depression or domestic violence.
They come to school in “fight or flight” mode, unfocused and withdrawn or aggressive, sometimes kicking and screaming at their classmates. Instead of adding to that stress with aggressive discipline, the goal is to take stress away.
“We know that if they don’t feel safe then they can’t learn,” Martin said. By creating a safe space, one goal of programs like Verner’s is to make kids’ bodies more resilient to biological damage from toxic stress, she said.
At school, square cards taped at kids’ eye level remind them in words and pictures that lunch is followed by quiet time, then a snack, then hand-washing and a nap. Breathing exercises have kids roar like a lion or hiss like a snake to calm them. A peace table helps angry kids work out conflicts with their classmates.
Under normal stress situations — for a young child that could be getting a shot or hearing a loud thunderstorm — the stress response kicks in, briefly raising heart rate and levels of cortisol and other stress hormones. When stress is severe and ongoing, those levels may remain elevated, putting kids in a persistent “fight or flight” mode, said Harvard University neuroscientist Charles Nelson.
Toxic stress is not the same as post-traumatic stress disorder. PTSD is a distinct mental condition that can result from an extremely traumatic event, including combat, violence or sexual abuse. Experts say it can occur in adults and children who live with persistent toxic stress, including children in war-torn countries, urban kids who’ve been shot or live in violence-plagued neighbourhoods, and those who have been physically or sexually abused.
Yet there are skeptics of the toxic stress theory, including Tulane University psychiatrist Dr. Michael Scheeringa, an expert in childhood PTSD. Scheeringa says studies supporting the idea are weak, based mostly on observations, without evidence of how the brain looked before the trauma.