AAP: The countless cruel outcomes of a bad childhood

October 13, 2008

About ten minutes into the plenary presentation by Jack Shonkoff, MD, Harvard School of Public Health, he said, essentially, “no kidding.”

About ten minutes into the plenary presentation by Jack Shonkoff, MD, HarvardSchool of Public Health, he said, essentially, “no kidding.”

Shonkoff had been showing data from a retrospective study on childhood risk factorsfor adult depression. For each serious risk factor for developmental delays –parental substance abuse, violence in the home, poverty, etc – the rateof depression rose.

“The general population would probably say, ’Well, I’m not surprised,’”Shonkoff said. Of course a rougher childhood would lead to a greater chance ofhaving a mood disorder. “What’s not as intuitive,” he went on,was that similar data existed for heart disease’s connection to excessive stress duringchildhood.

And for diabetes. And for stroke. And for cardiovascular problems. “We couldspend all day showing you the data,” Shontoff said.

“Biology tells us early life experiences are built into our body,”one of his slides read. And too much stress, at too early an age, wires the brainto require less and less of a trigger to promote the stress reactions. A childhard-wired for anger, fear, and self-defense is the result.

There are three types of stress. One is “positive stress,” the strugglestoddlers go through when they’re disciplined or when they “can’thave five cookies.” Buffered by supportive relationships, these ultimatelyteach children a sense of what they can (and can’t) control.

Then there’s tolerable stress: death of a family member, a long-term illness,“a natural disaster like Hurricane Katrina, an unnatural disaster like 9-11.”It’s a potential problem, but with solid relationships this stress isnot harmful.

Then there’s toxic stress, which causes a prolonged activation of the stressresponse system. Sustained high cortisol levels can disrupt the delicate circuitryof the hippocampus. When the brain “moves onto” the next level ofdevelopment, it grows less plastic, and unable to change its encoded deficiencies.

Going forward, society needs to focus on the toxic stress levels. “Get overit” isn’t going to cut it: these kids are neurologically incapableof getting over it. Developing evidence-based intervention techniques will makesure a scientifically-validated problem received an equally well-researched treatment.

And the focus has to be early in life, when brain changes are possible. We can’tkeep telling “40-year-olds to start eating better,” Shontoff joked.Sooner is better.