Toxic Stress in Early Childhood

31st Annual Kansas Division for Early Childhood ConferenceFebruary 28, 2013

Kaela Byers, LMSWUniversity of KansasSchool of Social Welfare

Sharah Davis-Groves, LMSWUniversity of Kansas School of Social WelfareNortheast Kansas Infant-Toddler Services

Kathy Byrnes, MA, LMSW

University of KansasSchool of Social Welfare

Kristin Pedersen, MA, CCC-SLPUniversity of Kansas Schiefelbusch Speech-Language-Hearing ClinicNortheast Kansas Infant-Toddler Services

Agenda• Overview of Toxic Stress

• What is it?• How does it impact children?• How do you recognize it?• New research on addressing Toxic Stress

• How does Toxic Stress impact families and your work with families?

• Strategies for coping with the effects of Toxic Stress in your work with families.

• How can your program support you?• Challenges and opportunities in Early Intervention Services.

Toxic Stress: What is it?• In 2005 the National Scientific Council on the Developing Child

proposed a scientifically grounded taxonomy of the stress experience to delineate between normative challenges that promote growth and development and challenges that may be threatening to child development.• Positive Stress• Tolerable Stress• Toxic Stress

Reference: National Scientific Council on the Developing Child. (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper #3. Available at: http://www.developingchild.net.

Positive Stress• Positive stress is the reaction to typical daily experiences that

provide opportunities for grown and learning.

Tolerable Stress• Tolerable Stress is the reaction to more serious stressors

(community violence, natural disaster, frightening accident, illness, death of a loved one, etc.) and has the potential to damage the child’s brain structure if left unchecked.• These stressors subside over time or are

buffered by supportive caregiver relationships.• Caregiver support

• Promotes feelings of safety• Facilitate acquisition of coping and

recovery skills• Protect against escalation of tolerable

stress to toxic stress.

Toxic Stress• Toxic stress is the reaction to strong, prolonged,

uncontrollable, or chronic stressors activate the body’s stress response system (e.g. abuse, neglect, parental substance abuse, maternal depression, etc.).

• Toxic Stress occurs in the absence of a stable and responsive adult or caregiver to offer buffering protection to the child.

• Ongoing activation of the body’s regulatory/stress response system over time results in changes tothe architecture of the brain.

• Changes to the brain can promote short-term effects on behavior and

learning as well as long-term impairments such as chronic and stress-related health and mental

health problems.

Ecobiodevelopmental Framework

Reference: http://developingchild.harvard.edu/resources/multimedia/interactive_features/biodevelopmental-framework/

Toxic Stress: What Impact Does It Have On Children?

• Toxic Stress may result in disruption of the child’s stress regulatory system.

• This disruption increases vulnerability to:• Ability to detect and respond to emotionally stressful stimuli

such as distress cues of others• Internalizing disorders (anxiety and depressive disorders)• Externalizing disorders (early onset aggression, oppositional

defiant or conduct disorder, disruptive behavior disorder, antisocial behavior)

• Chronic pain syndromes• Immune-related disorders• Cognitive deficits• Disorganized attachment

References: Gunnar & Donzella, 2002; Gunnar & Vazquez, 2001; Heim, Ehlert, & Hellhammer, 2000; Heim & Nemeroff, 2001; McBurnett, Lahey, Rathouz & Loeber, 2000; Pajer, Gardner, Rubin, Perel, & Neal, 2001

Toxic Stress: How can you recognize it in children?

• No current validated screening tool• Key: Observation• Internalizing/Externalizing disorder symptoms• May not exhibit symptoms• Recognize constellations of

risk factors• Awareness of parenting

style and attachmentcharacteristics

• Next steps in measurement/screening

Toxic Stress: Next Steps• Early identification of families for early home-based services• Two-pronged approach to early childhood intervention

• Compensatory mechanisms to temper the effect of toxic stress exposure in conjunction with elimination of risk factors• Ex. Promote nurturance, non-frightening parenting behaviors,

following the child’s lead• Biobehavioral interventions to reverse negative changes, restore

functioning, and build capacity to buffer against future stressors• Neurosequential Model of Therapeutics (NMT)• Attachment and Biobehavioral Catch-Up

• Promotes healthy regulatory system development by enhancing attachment and responsive parenting

• Promising evidence: more secure attachment, better behavioral and biological regulation, fewer reported behavioral problems, long-term efficacy

References: Dozier, Bick, & Bernard, 2011; Dozier, Lindhiem, Lewis, Bick, Bernard, & Peloso, 2009; Dozier, et al., 2006; Ferraro & Kelly-Moore, 2003; Lewis-Morrarty, Dozier, Bernard, Terracciano, & Moore, 2012; Perry, 2009

Toxic Stress: How Does It Impact Families and Your Work With Them?

• Family engagement in services – Understanding how TS impacts the Dance or the partnership!1) Start where families are - listen to more than their words to

understand the impact of TS.A. What is the family’s understanding of their child’s special

needs or environmental needs? B. What TS symptoms do you see in caregivers & children?C. How do these symptoms of TS impact your work with the

family?D. What do caregivers need to address the impact of the TS? E. What can we do within our roles to link caregivers with

resources to meet the needs?References - Eggbeer, Shahmoon-Shanok, & Clark 2010;Gallager, Fialka, Rhodes, Arceneaux, 2002; Lippicott, Williams, & Wilkins, 2012; McCalister & Thomas, 2007; Virmani & Ontai, 2010

Toxic Stress: What Can You Do About It?

2) What do YOU need to deal with the impact of the TS families are experiencing?

A. Acknowledge the impact on you. B. Assess how you feel when you leave? C. What do you do with those feelings? D. What is your strategy to unload/differentiate your life from

the families you work with? What restores you? Where is your safe place to process? http://cehdvision2020.umn.edu/wp-content/uploads/2012/07/Reflective-Supervision.pdf

References: Baker, 2003; Dunn, Bell, & Bellah, 2012; Professional Self Care in Social Work, 2008;Watson & Gatti, 2012; McCalister & Thomas, 2007

Toxic Stress: What Can You Do About It?

3) What can YOU do to take care of yourself over time as you work with families experiencing TS?

A. Review strategies that promote personal and professional well-being. (handout)

B. Make a self care plan. http://www.e-psychologist.org/index.iml?mdl=exam/show_article.mdl&Material_ID=1

Toxic Stress: How Can Your Program Provide Support?• How do you use team meeting times?

• To vent, share, coach, listen, refresh, rejuvenate• Is there a balance between business and fun?• What types of support and feedback are given?

• How do you check in with each other? During the week• Calls, emails, face to face time between co-visits• Do you know your team members? What they need?

• Who are the people on the team that are skilled at providing support? By discipline or personality

• Making sure we take breaks in year-round service provision• vacation time, days off, covering for each other

• Do you know your self? Do you know what you need and when? Do you know how to ask for help?

Toxic Stress: Challenges & Opportunities in Early Intervention Services

1) Taking time to deal with the impact of TS on families and workers.

2) Difficult to assess TS & determine change over time (no tools out there yet), and to articulate impact of TS on children’s social emotional development.

3) Being patient with self and families.4) Staying focused on goals due to multiple needs in the

environment.5) Balance between meeting family needs and staying within

the scope of our roles. 6) Collaboration across agencies to meet the family needs

takes time and consistent effort.

Questions

ReferencesBaker., E.K., (2003). Caring for Ourselves as Psychologists. Retrieved from

http://www.e-psychologist.org/index.iml?mdl=exam/show_article.mdl&Exam_ID=1&Article_ID=1 on December 15, 2012.

Dozier, M., Bick, J., & Bernard, K. (2011). Attachment-based treatment for young, vulnerable children. In J.D. Osofsky (Ed.) Clinical Work with Traumatized Young Children. New York: The Guilford Press, pp. 75-95.

Dozier, M., Lindhiem, O., Lewis, E., Bick, J., Bernard, K., Peloso, E. (2009). Effects of a foster parent training program on young children’s attachment behaviors: Preliminary evidence from a randomized clinical trial. Child and Adolescent Social Work Journal, 26(4), 321-332.

Dozier, M. Peloso, E., Lindhiem, O., Gordon, M.K., Manni, M., Sepulveda, S., Ackerman, J.., Benier, A., & Levine, S. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62(4), 765-783.

Dunn, T., Bell, L., & Bellah, L. (2002). Thinking about reflection. Retrieved from http://www.zerotothree.org/about-us/areas-of-expertise/reflective-practice-program-development/one-program-shares-its-experience.html on November 15, 2012.

Eggbeer, L., Shahmoon-Shanok, R., & Clark, R. (2010). Reaching toward an evidence base for reflective supervision. Zero to Three, 31(2), 39-45.

Ferraro, K.F., & Kelley-Moore, J.A. (2003). Cumulative disadvantage and health: Long-term consequences of obesity? American Sociological Review, 68(5), 707-729.

Gallager, G.A., Fialka, J., Rhodes, C., Arceneaux, C., (2002). Working with Families: Rethinking Denial. Young Exceptional Children, 5(2), 11-17.

ReferencesGunnar, M.R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development.

Psychoneuroendocrinology, 27, 199-220.

Gunnar, M.R., & Vazquez, D.M. (2001). Low cortisol and a flattening of expected daytime rhythm: Potential indices of risk in human development. Development and Psychopathology, 13, 515-538.

Heim C., & Nemeroff, C.B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Society of Biological Psychiatry, 49, 1023-1039.

Heim, C., Ehlert, U., & Hellhammer, D.H. (2001). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25, 1-35.

Levine, S., Wiener, S.G., & Coe, C.L. (1993). Temporal and social factors influencing behavioral and hormonal responses to separation in mother and infant squirrel monkeys. Psychoneuroendocrinology, 18(4), 297-306.

Lewis-Morrarty, E., Dozier, M., Bernard, K., Terracciano, S.M., & Moore, S. (2012). Cognitive flexibility and theory of mind outcomes among foster children: preschool follow-up results of a randomized clinical trial. Journal of Adolescent Health, 51, S17-S22.

McBurnett, K., Lahey, B.B., Rathouz, P.J., & Loeber, R. (2000). Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Archives of General Psychiatry, 57, 38-43.

McCalister , C.L., & Thomas, T., (2007). Infant Mental Health and Family Support: Contributions of Early Head Start to an Integrated Model for Community-Based Early Childhood Programs. Infant Mental Health Journal, 28(2), 192-215.

ReferencesNational Association of Social Workers. (2008). Professional Self-Care and Social Work. Social Work Speaks.

National Scientific Council on the Developing Child. (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper #3. Available at: http://www.developingchild.net.

Pajer, K., Gardner, W., Rubin, R.T., Perel, J., & Neal, S. (2001). Decreased cortisol levels in adolescent girls with conduct disorder. Archives of General Psychiatry, 58, 297-302.

Perry, B.D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14, 240-255.

Rosenblum, L.A., & Andrews, M.W. (1994). Influences of environmental demand on maternal behavior and infant development. Acta Paediatrica, Supplement 397, 57-63.

Rosenblum, L.A., Coplan, J.D., Friedman, S., Bassoff, T., Gorman, J.M., & Andrews. M.W. (1994). Adverse early experiences affect noradrenergic and serotonergic functioning in adult primates. Society of Biological Psychiatry, 35(4), 221-227.

Virmani, E. A., & Ontai, L. L. (2010). Supervision and training in child care: does reflective supervision foster caregiver insightfulness? Infant Mental Health Journal, 31(1), 16-32.

Watson, C., Gatti, S.N., (2012). Professional Development Through Reflective Consultation in Early Intervention. Infants and Young Children, 25, 2, 109-121.