Researchers find abuse, neglect cause toxic stress in children


Young children who are exposed to continuous abuse and neglect can suffer damage to the brain that affects everything from their ability to learn and make a living to their physical and mental health. It ultimately costs society millions of dollars in lost productivity and expenditures for health care, education and human services supports.

Years of research show that the maltreatment of children actually causes the brain to develop differently.

Jim Hudziak, an MD and the director of the University of Vermont’s Center for Children, Youth and Families, is a researcher who has measured the impact of trauma on children.“We know that negative early life events are changing the structure of a child’s brain and his ability to learn and all his future life experiences,” Hudziak says.

The genome – the complete DNA sequence that makes each person unique – can be altered by negative life events affecting children’s health in the present as well as later in life.

Young children’s brains develop rapidly. In the first few years, 700 new neural connections are made every second, according to Harvard’s Center on the Developing Child.

When children live in stressful situations, without a supportive parent or caregiver, these connections can be disrupted. The adversity can be caused by abuse, neglect, an alcoholic or drug-addled parent, mental illness, exposure to violence or extreme economic hardships. (See companion piece, “Substance abuse contributing to increase in number of neglected children”)

Called “adverse childhood experiences,” these incidences can cause what’s known as “toxic stress,” which severely impacts brain development.

Researchers have learned that both positive and negative experiences influence neural connections – those that are turned on again and again become stronger and those that are rarely engaged cease to exist.

When children are growing up in unusually stressful and long-lasting traumatic situations, they are constantly stuck in the “fight or flight” response that releases stress hormones that damage their tiny infrastructure.

“When this system is activated too often and too intensely, certain genes responsible for shutting down the system don’t produce the protein needed to shut off the hyper-arousal,” said Dr. David Rettew, director of the Pediatric Psychiatric Clinic at UVM’s Medical Center and VCCYF.

A constant state of fear leads to the problems with learning, behavior and health that these kids experience later in life, he added.

Doctors call it a “toxic stress response.” The adversity that produces the stress hormone’s constant presence changes the way the gene is expressed and the way the different parts of the brain connect to one another, according to Rettew. A child’s genes are “inextricably linked” to the environment in which he grows up, he said.

Put another way, genes are the brain’s blueprint, but experiences decide how the genes are used and may determine not to use some of them at all.

Other approaches

While the Vermont Family Based Approach has been shown to be an effective program addressing toxic stress, there are many other groups in Vermont working with at-risk families.

“Vermont is working hard to identify families at risk through a no wrong door approach to connecting with services,” said Breena Holmes, a 20-year veteran pediatrician as well as the director of Maternal and Child Health at the Vermont Department of Health.

Pediatricians play a big role in identifying possible problems from families in stress to actual abuse or neglect. They follow the Bright Futures guidelines for Health and Supervision of Infants, Children and Adolescents, to determine if a child or family is dealing with dangerous levels of adversity.

But even before the children are born, at-risk mothers – those that are young, live in poverty, or have a history of substance abuse – are spotted by their primary care doctors, explains Holmes. Those mothers-to-be that accept services from the Women, Infants and Children (WIC) clinics are also introduced to parental supports.

Holmes says that the Children’s Integrated Services Approach includes home visiting and early interventions with at-risk families.

“We recently launched a specialized call center for children and families called Help Me Grow which is part of our state’s 2-1-1 system through the United Ways. We have a skilled group of child care providers both in centers and in the home who work daily to strengthen families. We also work closely with families through Economic Services, including Reach Up,” she added.

Neglect, also, can cause toxic stress in infants and early childhood, said Traci Sawyers, an early childhood health policy expert at Building Bright Futures, an early childhood advocacy organization. She points to a 2012 landmark Harvard University study that, she says, found “that neglect can cause more harm to a child’s development than physical trauma because of the high persistence of toxic stress” that it causes. (The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Development of the Brain)

Babies need stable, caring and interactive relationships with an adult. They will attempt to interact with their parents with facial expressions, cooing or babbling and gesturing. Nature expects the adult to respond with gentle gestures and soft words, but when that consistently doesn’t happen, or the feedback is inappropriate, then the child’s brain won’t form properly. This is called the “serve and return” relationship and it is vital to a child’s healthy growth.

“The serve and return relationship is biologically essential. When parents are repeatedly missing their baby’s cues the brain becomes altered and threatens the child’s well-being,” said Sawyers, who wrote a policy brief on the issue to try to bring attention to the problem in Vermont.

“Neglect may not be deliberate, but parents need to be assisted and helped in how to interact with children in a positive way. We need to watch for early warning signs to get in there quickly to help the family,” she said.

From infancy to school age there is a tremendous opportunity to build a child’s social and emotional health as well as their ability to learn and do well in school and life, according to Sawyers. On the other hand, without the proper interactions and supports during those early years these children are on a path with dire life-long consequences.

“No one can concentrate very well when they are afraid,” Rettew said. It even affects the outer ribbon of the brain, thinning it out when Rettew says a “critical thickness” is necessary for learning.

“Kids who have been abused or have neglect early in life and over long periods of time develop a much more complex array of behavioral problems. They have trouble with anger, trouble regulating their emotions, trouble paying attention, they experience anxiety and mood swings,” explained Rettew.

The long-term consequences of toxic stress include failure to achieve in school, higher risk of teen pregnancies, substance abuse, diabetes, cardiovascular disease, poverty, criminality, mental illness and ultimately an early death.

“The cost of trauma in childhood is astronomical,” says Rettew. “It sets in motion a cascade of things that are hard to stop.”

And then there are the economic costs for society.

“The average lifetime cost per victim of nonfatal child maltreatment is $210,000 (2010 dollars) including $33,000 in childhood health care costs, $11,000 in adult medical costs, $144,000 in productivity losses, $8,000 in child welfare costs, $7000 in criminal justice costs, and $8,000 in special education costs. The lifetime costs are even higher for victims who die from child abuse – the estimated cost per death is $1.3 million dollars,” according to a January 2015 report to the Legislature, Integrating ACE-Informed Practice into the Blueprint for Health, prepared by the Department of Vermont Health Access and the Green Mountain Care Board.

The best way to help the children of neglect, abuse and trauma is to intervene early and attempt to change their environment. Rettew said that introducing optimal parenting can stop — and might even reverse — the damage.

Sawyers finds that families dealing with financial hardship, substance abuse, or a parent with mental health issues have the deck stacked against them.

“In many cases they want to do what is right for their kids. We need to put programs in place to help alleviate the stress they are going through and shield the child from persistent ongoing stress so that the parents can positively bond with their kids,” she said.

Hudziak couldn’t agree more. He and his UVM team came up with a clinical method called the Vermont Family Based Approach to stem the toxic stress experienced by children.

He calls his technique “teetering the totter” after the playground game. The idea is that if negative experiences lead to negative results, then positive events should have a positive effect on the brain and alter the life course of these children.

“If negative things lead to negative outcomes then turn it upside down and let positive things lead to positive outcomes,” he said.

Hudziak believes in changing the arc by treating and strengthening the entire family as well as other important people orbiting the child. Every family that joins the program is assessed and triaged into one of three groups: the well group, the at-risk group and the affected group. All are assigned a wellness coach to teach effective parenting and nutrition. They promote exercise and integrate music and reading into the family’s life.

“I truly believe that every child in our country should have someone read a book to them, kick a ball with them, play music and hear music with them,” Hudziak said.

The at-risk families have a family therapist coach who works on psychotherapeutic treatment. The ill group is also assigned a psychiatrist.

Because the brain is always developing, Hudziak says, it is possible through promoting a healthy environment for those children who have dealt with adversity to change what is happening in the brain.

“We are all biological creatures and we all endure adversity,” said Hudziak. “A central thesis of our work is how to better understand why adversity affects children differently.” Some abused children are resilient and function fairly well and his team is trying to figure out why and how to replicate resilience in others.

A new frontier that Hudziak and his team are studying is epigenetics or how the function of the genome can be changed by abuse.

“Epigenetics or post genomic modification is the biological explanation of how the environment can turn off or silence specific genes. For example some children who have been abused have epigenetic modifications that turn off important genes responsible for dealing with stress. In this science a methyl molecule is attached to the phosphate backbone of DNA and blocks it from working. This process is similar to having a tree fall across train tracks. The tracks are still the same however the trains can’t run,” according to Hudziak. He and other researchers have found that abuse, neglect and trauma silence genes that are important when dealing with stress and adversity.

The VFBA is working from the hypothesis that they can manipulate the environment to stimulate the epigenome to get it to turn on the right genes to fix the results of toxic stress with their method of treatment.

Their research is catching on — a number of universities in the United States are trying to incorporate VFBA’s concepts into what they do, according to Hudziak. “There are trials in Singapore, Rotterdam and Amsterdam. This is a disruptive kind of medicine from intervention to health promotion,” he added.