Toxic stress is a prolonged or even permanent physiological response to a stressor, which can cause damage in the body.[1] Stress in general, is any stimulus or event that causes physical excitement and the release of stress hormones.[2] These can be either positive or negative events. The event or stimulus that causes a stress response is called a stressor. The stress response consists of physiological changes caused by the sympathetic nervous system, such as an increase in breathing, heart rate and blood pressure and is also known as a "fight-or-flight" response.[1] Normally the body returns to a basic state (baseline) when the stressor is no longer present. In case of toxic stress, the body returns to the basic state only very slowly, or not at all, when the stressor is removed. This prolonged or permanent physiological response can cause damage to the body.[1] The difference between a normal stress reaction and toxic stress is the absence of caregiver support, reassurance or emotional attachment.[3]
Causes
editAbuse
editAbuse can occur in three different ways: psychological, physical and sexual. In the following cases the abuse can lead to toxic stress. Psychological abuse can appear when a parent or another adult in a homely surrounding frequent or very frequent swear at or insult the child.[4] Also when a parent or another adult in a homely surrounding frequent or very frequent act in a way that made the child afraid they would be physically hurt, psychological abuse appears. Physical abuse can occur when a parent or another adult in a homely surrounding frequent or very frequent push, grab or slap the child. It’s possible that the child have marks or were injured because it was hit so hard.[4] Sexual abuse can appear when an adult or a person that’s five years older than the child ever touch or palm their body in a sexual way the child. Or when the adult or person that’s five years older than the child tried or had oral, anal or vaginal intercourse with the child, there is sexual abuse.[4]
Neglect
editAttachment is important for a child's stress regulation. It is the affective bond between a child and its parent that develops in the early years of life. There are two ways of attachment, a baby can attach safe or unsafe.[5] When a child is unsafe attached, she develops stress and after a few years it can progress to toxic stress. A cause of an unsafe attachment is neglect.[5] This can be expressed in emotional or physical neglect. A child has emotional needs. When a parent or parents unintentionally reacts unadequately to these needs, it is a case of emotional neglect. Psychical neglect appears when the parent/parents or guardian does not take good care of or abuses the child.[4] Neglect can cause damage to the child's brain at an early age. Brain plasticity ensures that the children's brains can easily adapt to certain situations. This means that if the parents or caregivers react structurally negatively to the child, the child will strengthen connections that she needs in negative circumstances and weaken connections that she needs in positive surroundings.[6] If this persists for a long period of time, this process can be a possible explanation of how stress can develop into toxic stress.[6]
Household dysfunction
editA dysfunction in the household can cause toxic stress, this can arise in six different ways. Primary the child’s parents got divorced or separated.[4] Second if the child was exposed to violence against her mother, this means if they know their mother was hit, threatened or hurt by someone else. Something that is linked to this cause is the fact that attachment is often transferred from parent to child.[4] A parent with a safe attachment style has a great chance that their child will attach to them in a safe way. The same applies to unsafe attachment.[5] Third cause is if the child lived with someone who has or had an addiction. The addict often has a problem with alcohol or drugs.[4] Poverty is also one of the elements that brings a lot of stress. Several factors play a role in this, such as bad health, education, food and shelter. Over time, it can cause toxic stress in the family.[7][5] Another way in which household dysfunction can occur is whenever a member of the household has or has had a mental illness, attempted suicide or is depressed. This has a great impact on the child living in that household. The last factor that has influence on the development of toxic stress is criminal behavior in the homely environment, an example of this is if a member went to prison.[4]
The effects of toxic stress on children
editChildren with toxic stress has become a public health problem. It’s defined as the extreme, frequent or extensive activation of stress that causes anxiety in children and can have negative consequences for their physical and mental health.[8] Toxic stress in children occurs when a child is repeatedly exposed to stressful situations such as abuse, neglect and household dysfunctions without the presence and support of an adult who buffers the experience.[9] Experiences like these are called ACE’s (Adverse Childhood Experiences). Toxic stress effects children in an unhealthy way, it raises stress levels resulting in the release of stress related hormones.[10]
Biological effects
editToxic stress in young children has an effect on neural, hormonal and immune systems, which in turn causes mental and physical health issues[11]
Though brain development and connectivity is strongly influenced by genes, the environment plays a role in shaping the brain as well. When neural pathways are used frequently, the connectivity improves making it easier to use. Therefore, when a child experiences a lot of stress, this pathway becomes easy to use and later in life they will have a heightened stress response.[12]
Specifically children are highly sensitive for the biological effects, since toxic stress affects children in their developmental period. During this time a child’s brain is very plastical and since it is still developing, the effects of toxic stress may stay on the long term, because the body alters itself to the stress situation.[4]
The brain of a child who has developed toxic stress early in life is physically smaller than that of a healthy child, the brain structure differs, this causes problems in learning and memory.[13]
It is found that prolonged exposure to toxic stress in children, as a result of early life adversity, alters structural and functional stress-sensitive regions of the brain. For example it could result in alterations in the amygdala and the hippocampal area’s and the prefrontal cortex. These regions are associated with regulating the SAM and HPA axes, which play an important role in the body’s way of dealing with stress, for example by influencing the heart rate, alertness and the regulation of fight or flight responses.[4]
Toxic stress influences hormones. It can result in chronic activation of the HPA axis, which results in increased CRH levels, raised afternoon cortisol levels, and decrease of morning cortisol levels. In the long term, it is possible that HPA hyperactivity decreases, and in severe cases of toxic stress it is possible that the activity of the HPA axis decreases so much that there is a lack of hormonal levels or the hormonal levels are very low.[4]
When the HPA axis is chronically dysregulated, the immune system will be affected too. This is, because the responses of the immune system are influenced by glucocorticoids, which is a hormone that is active in making glucose and it is an stress hormone: in stressful situations there will be more glucocorticoids.[4] Another very important substance of the immune system is the molecule cykotine, which is a molecule that regulates immunity and is very important for the development and metabolism of most organ systems.[14] When there is chronically or severe toxic stress, there can be a dysregulation of the immune system and these corresponding hormones and molecules[15]
Social Effects
editThe exposure to toxic stress in children can also result in anxiety disorders and social skill deficits.[11] Because neural pathways are so plastic in early life, toxic stress creates a problem in the use of the stress response. Children will respond to quickly, extremely and for to long when they detect a possible threat. Where a healthy child sees a neutral face, a child with toxic stress might see a angry face and panic.[13]
The effects of toxic stress on adults
editAdults who either experienced toxic stress as a child or later in life are impacted heavily as well. One consequence of toxic stress is a more rapidly aging process, these adults will, for example, have problems with memory.[11]
People with toxic stress are at higher risk to develop cardiovascular diseases, cancer, diabetes, stroke and asthma.[16] Not only that, the elevated stress response can be the underlying cause of depression, alcoholism and drug abuse. These effects unfortunately will be a source of stress for any future child this person might have, consequently passing the toxic stress on to the child.[10]
Prevention and treatment
editEducation
editBuffers can help children bring their abnormal stress levels to normal levels.[1] This is not about stress that everyone experiences, but about high stress levels because children experience violent events at a young age such as chronic neglect, recurrent abuse or poverty. [17] Therefore, education plays a major role in preventing and curing toxic stress. Positive parenting, support, resilience and trust from the environment can help children deal with adversity and prevent and cure toxic stress levels. Families with a lot of stress also have an effect on the stress level of the children.[1] Therefore, it is extra important that children have stable and nurturing relationships with friends and family to avoid this toxic stress. Often, the prevention and cure can also be addressed by the caregiver. It would be effective trying to eliminate the caregiver's stress factors, such as poverty or violence, so that the caregiver can subsequently provide a safe and stable environment for the child.[1]
Nutrition
editTo cure or prevent toxic stress, the sources of toxicity should be removed so the basic body functions can be restored. One major source of toxicity is food. There are toxin-producing foods which, when fermenting and putrefying, produce toxic substances and gasses that enter the portal system and the blood stream.[18]
The liver is the main organ to detoxify the body. When it damages itself by altering a toxic molecule, it needs anti-oxidants to protect itself. These anti-oxidants are vitamins A, C, E, selenium, zinc, proanthocyanidins, beta carotenes. The liver then uses these nutrients to break down the toxins into substances the body can use or that the body will eliminate.[18]
Another proven way to reduce toxic stress or mitigate its effects, is breastfeeding. Not only by its substantial properties, but also by its behavioural properties.[19] The skin-to-skin contact immediately after birth releases maternal oxytocin. Oxytocin makes the blood vessels dilate so there is thermoregulation between the mother and her infant resting on her chest. In addition, oxytocin promotes maternal calmness.[20]
Breastfeeding influences the increase of white matter in the brain and other developmental processes in the brain.[21] New neuronal connections should be forming and developing during childhood. Toxic stress disrupts this process.[22] Since breastmilk has direct effect on brain development, it may protect the brain from the damage done by toxic stress.[23]
Psychological treatment
editAn integrative approach to the prevention of stress can play an role in the treatment and prevention of toxic stress in childhood.[1]
Timely intervention and reducing the stressors is needed to the treatment of toxic stress. There is no specific treatment for toxic stress. Every individual has other needs, and the treatment should be focused on the needs of an individual. Multiple approaches can be used to helping children to shut off their stress response.[1]
There are conventional approaches such as referral to psychology, psychiatry and social work. Evidence supports the use of cognitive behavioral therapy, child-parent psychotherapy, parent-child interaction therapy and trauma-focused psychotherapy when therapy is needed for children that are showing symptoms of toxic stress. Hypnosis, guided images, progressive muscle relaxation and music therapy are mind-body interventions that have been shown to reduce stress.[1]There is also an integrative approach as a treatment for toxic stress. An integrative approach can reduce the stress response and building resilience. Relaxation response and breathing techniques can be helpful to treat toxic stress. Mindfulness-based stress reduction or mindfulness-based cognitive therapy can be useful because it decreases anxiety, improves the mood, reliefs mental distress and enhances the well-being of an individual.[1]
References
edit- ^ a b c d e f g h i j Franke, Hillary A. (NaN). "Toxic Stress: Effects, Prevention and Treatment". Children. 1 (3): 390–402. doi:10.3390/children1030390.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: unflagged free DOI (link) - ^ Gluck - Learning and Memory_ From Brain to Behavior 3rd Edition c2016 - Free Download PDF.
- ^ Odgers, Candice L.; Jaffee, Sara R. (18 March 2013). "Routine Versus Catastrophic Influences on the Developing Child". Annual Review of Public Health. 34 (1): 29–48. doi:10.1146/annurev-publhealth-031912-114447. ISSN 0163-7525.
- ^ a b c d e f g h i j k l Bucci, Monica; Marques, Sara Silvério; Oh, Debora; Harris, Nadine Burke (1 August 2016). "Toxic Stress in Children and Adolescents". Advances in Pediatrics. 63 (1): 403–428. doi:10.1016/j.yapd.2016.04.002. ISSN 0065-3101.
- ^ a b c d Geenen, Greet (January 2016). "In het begin was er armoede Helpende handen voor jonge kinderen en hun ouders in armoede" (PDF). Signaal. 94: 20–41.
- ^ a b "Toxische stress".
{{cite journal}}: Cite journal requires|journal=(help) - ^ https://www.armoedefonds.nl/wat-is-armoede
- ^ Beal, J (2019). "SURFconext - Select an institution to login to the service". engine.surfconext.nl.
- ^ Murray, John S. (January 2018). "Toxic stress and child refugees". Journal for Specialists in Pediatric Nursing. 23 (1): e12200. doi:10.1111/jspn.12200.
- ^ a b Condon, Eileen M.; Sadler, Lois S. (18 July 2018). "Toxic Stress and Vulnerable Mothers: A Multilevel Framework of Stressors and Strengths". Western Journal of Nursing Research. 41 (6): 872–900. doi:10.1177/0193945918788676.
- ^ a b c Shern, David L.; Blanch, Andrea K.; Steverman, Sarah M. (2016). "Toxic stress, behavioral health, and the next major era in public health". American Journal of Orthopsychiatry. 86 (2): 109–123. doi:10.1037/ort0000120.
- ^ Garner, A. S. (1 November 2013). "Home Visiting and the Biology of Toxic Stress: Opportunities to Address Early Childhood Adversity". PEDIATRICS. 132 (Supplement): S65–S73. doi:10.1542/peds.2013-1021d.
- ^ a b Schonkhoff, Jack P (2014). "National Scientific Council on the Developing Child. (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 3. Updated Edition".
{{cite journal}}: Cite journal requires|journal=(help) Cite error: The named reference "Danielle4" was defined multiple times with different content (see the help page). - ^ Granger, Douglas A. (2015). "Immunology and Developmental Psychopathology". Developmental Psychopathology. doi:10.1002/9780470939390.ch17.
- ^ Raison, Charles L.; Miller, Andrew H. (September 2003). "When Not Enough Is Too Much: The Role of Insufficient Glucocorticoid Signaling in the Pathophysiology of Stress-Related Disorders". American Journal of Psychiatry. 160 (9): 1554–1565. doi:10.1176/appi.ajp.160.9.1554.
- ^ Johnson, S. B.; Riley, A. W.; Granger, D. A.; Riis, J. (21 January 2013). "The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy". PEDIATRICS. 131 (2): 319–327. doi:10.1542/peds.2012-0469.
- ^ "The Toxic Stress of Early Childhood Adversity: Rethinking Health and Education Policy". Center on the Developing Child at Harvard University.
- ^ a b Tips, Jack (1997). "The toxic stress cycle and mental health". The Humanistic Psychologist. 25 (2): 150–161. doi:10.1080/08873267.1997.9986878. ISSN 1547-3333.
- ^ Hallowell, Sunny G.; Froh, Elizabeth B.; Spatz, Diane L. (January 2017). "Human milk and breastfeeding: An intervention to mitigate toxic stress". Nursing Outlook. 65 (1): 58–67. doi:10.1016/j.outlook.2016.07.007. ISSN 0029-6554.
- ^ Charpak, Nathalie; Ruiz, Juan Gabriel; Zupan, Jelka; Cattaneo, Adriano; Figueroa, Zita; Tessier, Rejean; Cristo, Martha; Anderson, Gene; Ludington, Susan; Mendoza, Socorro; Mokhachane, Mantoa; Worku, Bogale (2005). "Kangaroo Mother Care: 25 years after". Acta Paediatrica. 94 (5): 514–522. doi:10.1111/j.1651-2227.2005.tb01930.x. ISSN 1651-2227.
- ^ Deoni, Sean C. L.; Dean, Douglas C.; Piryatinsky, Irene; O'Muircheartaigh, Jonathan; Waskiewicz, Nicole; Lehman, Katie; Han, Michelle; Dirks, Holly (15 November 2013). "Breastfeeding and early white matter development: A cross-sectional study". NeuroImage. 82: 77–86. doi:10.1016/j.neuroimage.2013.05.090. ISSN 1053-8119.
- ^ "The Science of Neglect". Center on the Developing Child at Harvard University.
- ^ Bode, Lars; McGuire, Mark; Rodriguez, Juan M.; Geddes, Donna T.; Hassiotou, Foteini; Hartmann, Peter E.; McGuire, Michelle K. (1 September 2014). "It's Alive: Microbes and Cells in Human Milk and Their Potential Benefits to Mother and Infant". Advances in Nutrition. 5 (5): 571–573. doi:10.3945/an.114.006643. ISSN 2161-8313.