Toxic Stress and Children’s Outcomes

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Author(s): Economic Policy Institute

Published: May 1, 2019

Report Intro/Brief:
“”Stress” is a commonplace term for hormonal changes that occur in response to frightening or threatening events or conditions. When severe, these changes are termed “toxic” stress and can impede children’s behavior, cognitive capacity, and emotional and physical health.

Frightening or threatening situations are more sustained and are experienced more frequently by African American and socially and economically disadvantaged children, who also have less access to protective resources that can mitigate their stress to tolerable levels. This report describes the relative frequency of toxic stress by race and social class, and shows how it depresses children’s outcomes and contributes to the “achievement gap.” We conclude by suggesting policy and practice recommendations that can reduce the cognitive, behavioral, and health harm that toxic stress provokes.

Key Findings:

  • Social class and childhood stress. Beginning in infancy, lower social class children are more likely to have strong, frequent, or prolonged exposure to major traumatic events, the frightening or threatening conditions that induce a stress response.
  • Income and childhood stress. The lowest-income children are more likely to be exposed to frightening or threatening experiences than other children.
  • Race and childhood stress. Black children are more likely than white children to be exposed to frightening or threatening experiences.
  • Childhood stress and depressed outcomes. Independent of other characteristics, children exposed to more frightening and threatening events are more likely to suffer from academic problems, behavioral problems, and health problems.

These attributes present challenges to children’s school and life trajectories.

Policy Recommendations
Ultimately, larger social change is needed to address the economic and social conditions at the root of children’s toxic stress. But given that these larger social problems will not be remediated easily or quickly, policymakers must find other ways to improve current outcomes for children who are at high risk for toxic stress. We suggest the following interventions in policy and practice:

  • Provide supports for parents. To promote protective parenting—which can mitigate children’s toxic stress—we recommend implementation of support programs such as home visits and/or therapy services by community health workers, nurses, and other health specialists. These programs can offset the damaging effects of exposure to frightening or threatening conditions by building the capacity of caregivers to provide children with safe, stable, and nurturing relationships that help to develop children’s adaptive and positive coping skills.
  • Train school staff to support children. To prepare trauma-informed staff and improve how preschools and schools support children exposed to frightening or threatening experiences, adults in these settings should receive training to help them understand how such experiences affect students’ learning and behavior.
  • Address racially disparate policies and practices in schools. Schools should be especially careful to eliminate in-school experiences that can be so stressful that they themselves can generate a toxic stress response. Racially discriminatory discipline policies—indeed, racially disparate treatment of any kind, even if unintentional—can induce stress in children.
  • Engage health care professionals in screening and treatment. Health care professionals can contribute to preventing and treating the harmful effects of frightening or threatening experiences. All children should be routinely screened for such experiences. Health care professionals should be trained to understand how frightening or threatening experiences impact children’s cognitive, behavioral, and physical health outcomes, and screen and treat children for any resulting complications.”

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