Toxic Stress and Early Brain Development

Lindsey Moss, MSW, LCSW

Valerie Glascock, LPA

Growth of Brain

200

400

600

800

1000

1200

1400

1600

Conception 5 10 15 20

Conception to BirthBirth to Age 20Birth

Source: A.N. Schore, Affect Regulation and the Origin of the Self, 1994.

3

Who

le B

rain

Wei

ght

in G

ram

s

CEREBRALCORTEXCEREBRALCORTEX

LIMBIC SYSTEMLIMBIC SYSTEMBRAINSTEMBRAINSTEM

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 StressPositive Stress

Moderate, short-lived stress responsesModerate, short-lived stress responses Examples include meeting new people, dealing Examples include meeting new people, dealing

with frustration, getting an immunization, or with frustration, getting an immunization, or adult limit-settingadult limit-setting

An important and necessary aspect of healthy An important and necessary aspect of healthy development that occurs in the context of development that occurs in the context of stable and supportive relationships.stable and supportive relationships.

www.developingchild.harvard.edu

Tolerable StressTolerable Stress

Stress responses that could be disruptive, but Stress responses that could be disruptive, but are buffered by supportive relationshipsare buffered by supportive relationships

Examples include death or serious illness of a Examples include death or serious illness of a loved one, a frightening injury, parent divorce, loved one, a frightening injury, parent divorce, a natural disaster, terrorism, or homelessnessa natural disaster, terrorism, or homelessness

Generally occurs within a time-limited period, Generally occurs within a time-limited period, which gives the brain an opportunity to recover which gives the brain an opportunity to recover from potentially damaging effects. from potentially damaging effects.

www.developingchild.harvard.edu

Toxic StressToxic Stress

Prolonged stress in the absence of the Prolonged stress in the absence of the buffering protection of adult support buffering protection of adult support

Examples include extreme poverty, abuse, Examples include extreme poverty, abuse, chronic neglect, severe maternal depression, chronic neglect, severe maternal depression, substance abuse, or family violencesubstance abuse, or family violence

Disrupts brain architecture and leads to highly Disrupts brain architecture and leads to highly reactive stress response systems, increasing reactive stress response systems, increasing the risk of physical and mental illness.the risk of physical and mental illness.

www.developingchild.harvard.edu; 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 MaltreatmentRisk of Child Maltreatment

In a study of 188 children under age 3 with In a study of 188 children under age 3 with newly opened child protection cases, 66% had newly opened child protection cases, 66% had developmental delays which met the eligibility developmental delays which met the eligibility criteria for early interventioncriteria 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, Even in Their Sleep, Babies are Learning….Babies are Learning….

Even during sleep, infants show reactions to Even during sleep, infants show reactions to angry voices (based on fMRI scans)angry voices (based on fMRI scans)

Infants from high conflict homes showed the Infants from high conflict homes showed the greatest reactivity in brain areas linked to greatest reactivity in brain areas linked to stress and emotion regulationstress 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?