Warm, supportive relationships with adults to whom children are attached, can reduce effects of chronic stress.

Many young children fall behind their peers in language and learning, even as early as age three. In classrooms, they often have difficulty focusing their attention, thinking, and managing their emotions. A high proportion of these children have grown up in adversity, often linked to poverty. However, we have not fully understood how adversity causes these behaviors, so finding solutions has been difficult.

Increasingly, though, we are learning that these difficult behaviors can spring from actual biological changes in these young children, produced by their chronic exposure to stress. When children face chronic stress, hormones are released that affect their brain functioning and, as a result, their cognitive processing can be impaired. This, in turn, can make it difficult for children to concentrate, remember things, manage their emotions and follow instructions, as well as to regulate their behavior. The symptoms will be familiar to any early years child-care worker or teacher, particularly those working in disadvantaged communities.

Shocking though it may be that adversity actually harms children biologically, there is good news. These biological effects are not necessarily hard-wired in young children to create dysfunction that cannot be changed. Research shows that interventions, particularly in the form of warm, supportive relationships with adults to whom children are attached, can reduce release of these stress hormones and even reverse the behavioral and other effects of hormone overload.

“There is accumulating evidence that public assistance programs can benefit children by reducing pressures on them and on their families.”

We have, in short, more and more sound evidence of good interventions that can normalize the biological functions of children otherwise debilitated by their exposure to adversity and the resulting stress hormones. Even better, this normalizing of biological functioning can bring positive behavioral changes.

Policy makers, therefore, should be aware of accumulating evidence that public assistance programs can aid the process by reducing pressures on children and on their families. Meanwhile, the lesson for social work practitioners is that they should think multi-generationally. Because major sources of stress in young children’s lives arise from family experience, and because the quality of parental care is children’s major resource for buffering stress, they should consider interventions involving both parents and children to fully address the children’s stress.

How do stress hormones have such influence? There are multiple stress hormones, but research has focused on cortisol, partly because of its importance and partly because it is relatively easy to measure. It can be gathered from saliva and be assayed. Producing cortisol is one of the ways our bodies react to the onset of stress. Its presence helps to account for rapid heart rate, sweaty palms and a range of other characteristics, including focusing on threats and finding it hard to control our emotions.

It is normal to have some cortisol in our systems. But cortisol activity can become abnormal when children experience chronic adversity. Children in these situations can become hyper-reactive – their cortisol shoots much higher than for typical children, so they tend to overreact. They may fall apart when things go wrong or respond excessively to peers’ provocations in ways that other children would not.

Chronic stress can also produce a second abnormal cortisol pattern, reflected in very low levels of cortisol. Children who show these unusually low levels of cortisol may not even get the morning spike in cortisol levels that normal people do, making them hypo-reactive, less responsive than one would normally expect.

The hyper-reactive pattern seems particularly common among children who often face threat. They may come from homes where they are abused or situations in which they feel in danger. Children in poverty can also show the hyper-reactive pattern. By contrast, the hypo-reactive response is more often seen in children who have been denied nurturing support, perhaps because they have been neglected, rather than abused. The hypo-reactive cortisol pattern is helping us appreciate how lack of support and nurturing for a child can have just as profound a biological and behavioral effect as can the stress of feeling threatened by abuse.

Behavioral research shows that the effects of poverty are more significant the younger a child is. The damage may even begin prenatally, when mothers experience chronic stress. Over time, these effects are also compounded. If early adversity continues, the disruption of a child’s biological system worsens. That can increase wear and tear on the body, which grows over time as an individual is exposed to repeated or chronic stress, a concept known as allostatic load,. We know, for example, that regular stress cortisol secretion suppresses immune function, which may help explain why children in poverty and other kinds of adversity often experience more illness.

However, we are also learning that if we can catch children early and change the circumstances that contribute to their stress, they can be put on a healthier path. In some cases, with intensive support, they can show signs within weeks of normalized biological functioning, accompanied by behavioral change. Interventions have been shown to benefit children in foster care, for example. After they experience a sustained period of supportive care, combined with efforts to address some of their special challenges (such as regulating their own behavior), they show normalized biological functioning and stronger attachments to their caregivers.

Biological effects of stress can be buffered by supportive social interaction. So, for example, a study of children in families in rural poverty found that some children’s chronic exposure to domestic violence resulted in elevated cortisol when they were aged two. However, when mothers were seen responding supportively to them, much of the negative biological impact was reduced.

These findings are consistent with multiple studies showing that the presence of a caregiver or social partner can help to reduce biological stress reactivity. So, if children can get the kind of support they need and can change their living circumstances to get that support, the benefits can be not only social and emotional but biological as well. For children to get this kind of support, however, there must be an adult who can help them.

The emerging evidence demands interventions that focus not only on young children in adversity, but also on their relationships with key adults, particularly those who might be inducing stress or who might help to buffer its effects. Public policies should focus on treating children who face chronic adversity, in particular on reducing family stress through income assistance, access to health care and high-quality child care and education programs, early home visitation that is alert to signs of stress, nutrition assistance and other kinds of family support. The U.S. is now testing two generation programs that take a holistic approach by combining high-quality early education for children with job training and parenting programs to provide benefits for the whole family.

Early screening can also help children. Pediatric specialists should look not only for signs of physical health and wellbeing but also for signs of stress or poor relationships. In a remarkable study in Mexico, the government designed a conditional cash transfer anti-poverty program. It offered cash benefits to families provided they followed key requirements regarding child and family health, such as providing adequate nutrition and taking children for regular medical checkups. The results were impressive. Preschoolers’ cortisol response improved, and children most at risk of mental health problems – those with depressed mothers – showed the greatest benefit. The Mexican study is just the latest piece of accumulating evidence that public assistance programs can benefit children biologically as well as behaviorally.

Policy Implications

Public policies should focus on treating children who face chronic adversity, in particular on reducing family stress through income assistance, access to health care and high-quality child care and education programs, early home visitation that is alert to signs of stress, nutrition assistance and other kinds of family support.

Practice Implications

If we can catch children at risk early and change the circumstances that contribute to their stress, they can be put on a healthier path.

References

 Thompson RA & Haskins R (2014), Early stress gets under the skin: Promising initiatives to help children facing chronic adversity, The Future of Children