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Toxic Stress In Childhood Can Lead To Emotional And Behavioral Problems In Adulthood

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In the summer of 2014, the American Academy of Pediatrics announced that it would be establishing the Center on Healthy, Resilient Children, an educational and service organization to help children who experience toxic stress. Pediatrician Robert Block, immediate past president of Academy spoke with Sound Medicine's Barb Lewis about the way toxic stress affects children and how the new center will seek to help.

Barb Lewis: According to the AAP, toxic stress interferes with kid’s normal brain development. They may go into adulthood with a brain that works differently due to their childhood experiences, leaving them with emotional, and behavior problems. Can you explain how this works?

Dr. Block: Toxic stress refers to unabated, everyday stress that is caused by very serious conditions, including poverty and domestic violence, other violence in the neighborhood or community that children are exposed to on a repeated basis. It's often coming from or stemming from the very people, parents, who are supposed to be nurturing them, who are instead exposing them to significant neglect or abuse or witnessing the domestic violence. So, you can see there’s a difference between worrying about homework and worrying about where your next meal might come from or worrying about whether today is another day where daddy is going to knock mommy around the house.

Now that we are recognizing that there are biological changes and atomic changes in the brain, changes in the way hormones influence the brain caused by toxic stress, it’s going to be important to ask questions of families to screen to see whether  children are exposed to those kinds of things. Just looking at the child or even just talking with the child often will not give us the hints that we need.

Lewis: Identifying children struggling with toxic stress can be a challenge for pediatricians. How do you go about addressing the factors that are causing the stress and starting to help these kids be more resilient?

Dr. Block: A lot of our patients we know when they come in unstable family situations, related to poverty or lack of appropriate care, or families in this situation. Those sorts of things. We try to screen for that. We try and use other partners, [such as] social workers for help with interviewing families. The problem now is that even if we identify them, we have to connect them to community resources to help them. This means we have to first have to help develop the community resources so that there are teams of physicians and associates in the community who we can ask help these families regain some stability. And you mentioned resilience. And that’s something that we really want to emphasize if possible. But isn’t going to come out of the blue. It’s something that needs to be worked on over time, to build some stability over time.

Lewis: One goal for the new center will be to examine what kinds of therapy might help kids in these situations than telling pediatricians and other child care experts what are their options. Ultimately, relieving toxic stress may require communities to help with the situation.

Dr. Block: The problem with the toxic stress is that the parents are involved.  So if the parents are using drugs or one is an alcoholic, or if the parents are engaged in domestic violence, then it’s going to be harder, because it’s going to be more difficult for you and me, as neighbors and acquaintances to deal with those problems because they are hidden. So, I think that it’s a matter right now of keeping an eye out, and understanding that toxic-stress symptoms are different of those from normal stress. And perhaps we can use any organizations, faith-based organizations to begin to develop community programs to help families.

Dr. Robert Block is the former president of the American Academy of Pediatrics, and is a professor of medicine at the University of Oklahoma in Tulsa.