The Brain Architects by The Center on the Developing Child at Harvard University

February 07, 2020 Toxic Stress: Protecting the Foundation

What is toxic stress? What effects can it have on a child’s body and development, and how can those effects be prevented? What does it mean to build resilience? This episode of The Brain Architects explores what “toxic stress” means, and what we can do about it.

Contents

Podcast

Panelists

Additional Resources

Transcript

Host Sally Pfitzer is once again joined by Center Director Dr. Jack Shonkoff as they dive into the different types of stress, including what makes certain stress “toxic,” while other stress can be tolerable or even positive for children. They discuss the effects that toxic stress can have on developing brains, as well as what it means to be resilient to sources of stress, and how parents and caregivers can help encourage that resilience in children. Dr. Shonkoff also emphasizes the point that, even for those who may have experienced toxic stress, “it’s never too late to make things better.”

Then, listen to a panel discussion featuring Pediatrician Dr. Kathleen Conroy, Community Mental Health Worker Cerella Craig, Professor and Researcher Dr. Megan Gunnar, and Training Director for Rise Magazine Jeanette Vega, as they discuss the various ways in which they encounter toxic stress and its effects in their work. The panelists speak openly about how toxic stress can affect families and children—including ways in which the systems set up to help can be the cause of further stress—and how to talk about toxic stress in a way that doesn’t make things feel hopeless to those who have experienced it. They also dig into strategies they employ in their various fields to help children and families deal with stress, and move what might be toxic stress back to tolerable levels. Download the episode and subscribe to the podcast today.

Panelists

Dr. Kathleen Conroy, Associate Clinical Director, Boston Children’s Primary Care, and Assistant Professor, Harvard Medical School

Cerella Craig, Community Mental Health Worker, New Haven, CT

Megan Gunnar, Professor and Director of the Institute of Child Development, University of Minnesota

Jeanette Vega, Training Director, Rise magazine

Additional Resources

Resources from the Center on the Developing Child

A Guide to Toxic Stress

Stress and Resilience: How Toxic Stress Affects Us, and What We Can Do About It

Infographic: What We Can Do About Toxic Stress

Infographic: ACEs and Toxic Stress: Frequently Asked Questions

Key Concepts: Resilience

Resources Regarding the Separation and Detention of Migrant Children and Families

Three Principles to Improve Outcomes for Children and Families

Science to Policy and Practice: Applying the Science of Child Development in Child Welfare Systems

InBrief: Applying the Science of Child Development in Child Welfare Systems

Working Paper: Excessive Stress Disrupts the Architecture of the Developing Brain

Working Paper: The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain

Resources from Our Panelists

Jeanette Vega

RISE TIPS: Visits With Children in Foster Care

RISE TIPS: Service Planning

Risemagazine.org features lots of stories by parents involved in the child welfare system for other parents.

Transcript

Sally: Welcome to The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children, and take what you’re hearing from our experts and panels and apply it to your everyday work. In today’s episode, we’re going to explore this concept called toxic stress, which is a buzzword you may have heard and potentially used incorrectly. So we’re going to discuss what toxic stress is and what it can do to a child’s body and development, and we’ll learn a little bit more about what we can do to counteract its effects. Here to discuss this topic of toxic stress with us is professor of child health and development and the director of the Center on the Developing Child, Dr. Jack Shonkoff. Hey Jack.

Jack: Hey Sally.

Sally: So glad to have you back with us today.

Jack: Great to be here.

Sally: Today, we’re digging into a topic that has quite a bit of research around it and a lot of different ideas out there in terms of what it actually is and how it affects children’s brains. And this is the topic of toxic stress. So from your perspective, could you just give us a little bit of background on what is toxic stress and how did the term come to be?

Jack: This is a really important one to talk about. The story starts with

a group of scientists working together to figure out how to make biological aspects of stress understandable for the public. When we talk about stress, we’re talking about not the thing that causes stress, but the body’s response to stress, what’s going on inside of our bodies biologically. And in the culture in the United States, there’s no sympathy for stress. To think about the impacts of stress on children is something we should worry about. It’s a roadblock of people saying, “Let them just suck it up and get over it.” But you can’t ask babies to pull themselves up by their bootstraps. So, the stress response can save our lives, but its only meant to be up long enough to deal with the threat and then go back. So, the first thing we did was come up with a very simple three category way of thinking about stress. The first level we called positive stress. What’s positive stress for a very young child? It’s the stress of the first day in a childcare center where people are all strangers. It triggers the stress response, but it doesn’t last very long when there are adults who help you deal with the stress and deal with the strangeness of the childcare center and the stress system comes back down and you’re back to baseline. The next level we call tolerable stress. Tolerable stress is there’s a serious illness in a family or you’ve just survived a natural disaster. Again, it’s the same stress system getting activated. The question is, how do you get it back down? And when it’s a really serious threat, that’s where serve and return interactions and supportive relationships are critical. It first creates a sense of safety for the child, “You’ll be okay, I’m here, I’m taking care of you.” It also is modeling and helping children build their own coping skills to deal with stress, which is critical for a healthy life. The third level is what we call toxic stress, and by that it’s the same elevation of all of these biological responses. The system doesn’t go back to baseline quickly and it stays elevated for days or weeks or months. What causes toxic stress? It’s not so much what causes the stress, it’s whether there are people there who will help you deal with it and feel more comfortable. So, toxic stress is when there is no reliable adult to help you through. It’s the stress from severe chronic neglect. It’s the stress from being in deep poverty or in a violent environment where you don’t feel like anybody is helping you feel safe. Toxic stress is about the absence of adult support to get through. And we’ve learned to talk about that always connected to the idea of resilience because kids can do well in horrible circumstances if there’s an adult to help them through. It’s usually a parent, but it doesn’t have to be a parent, it could be another family member, it could be a neighbor, it could be a preschool teacher, it could be a childcare provider. We don’t talk about toxic stress anymore without talking about how you build resilience to make sure that any potential toxic stress gets converted into tolerable stress.

Sally: Could you talk a little bit more about what you mean by resilience and is there a way that we know how to actively build that in brains?

Jack: Resilience is learning coping skills, it’s learning adaptive skills, it’s being able to feel a sense of control over what’s going on. But when children are very young and they feel less control and the resilience is built by adults creating a sense of safety and protection and then modeling for children. There isn’t a day that goes by for any child at any age where there aren’t challenges and what parents are doing in terms of building resilience without calling it resilience is they’re helping the child develop a sense of what scientists call agency, a sense that you have some control over your own life. It’s things like what you eat and whether you only eat candy or will eat some reasonably healthy foods, whether you learn to share your toys. The critical issue for children is are the adults who care for them able to provide a sense of safety? Sometimes the adults are so traumatized themselves that they can’t without help. This is why when you’re on an airplane and they say if the oxygen masks come down, put your own mask on first before you assist your child. That’s based on good scientific understanding. Adults have to be capable of providing that. If you have at least one secure relationship that is, gives you a sense of safety and security, you are on your way to building resilience. ‘Cause, it’s those relationships that provide safety and help model coping behavior that are the active ingredients in building resilience.

Sally: As challenging as it can be to talk about and as uncomfortable as it can be to really think through, could you tell us a little bit about what does actually happen to a brain of a child who’s experiencing toxic stress? I think it’s really important for listeners to understand the biological implications of what this trauma can really be doing for children.

Jack: Yeah, I’m really glad you asked that question because different parts of the body that are dimensions of the stress response system have different effects in different ways. So for example, very high levels of stress hormones, particularly one that’s called cortisol, which in the acute situation is very protective, it helps make you more alert and it helps you deal with stress. If that stress hormone stays up for a long period of time, it actually starts to have a negative wear and tear effect on parts of the brain. So, the parts that are most vulnerable to chronically elevated stress hormones are a parts of the brain that affect your memory, that affect your ability to regulate your emotions and behaviors. There are other parts of the stress system, for example, elevated inflammation. If that stays very high, that can affect parts of the brain that make you more at risk for serious cognitive thinking problems and actually later in your life increase your risk for dementia, but at the same time it’s affecting other parts of the body. Inflammation creates heart disease. It increases the risk for a lot of chronic illnesses like arthritis. It’s the wear and tear effect on the body of this stress activation, which actually accelerates aging. But remember, every time we talk about this, this is not a doomsday scenario because stress is normal. Stress is part of our everyday life. It’s not about whether you’re experiencing stress, it’s about whether there are adults to help you learn how to deal with it and help you feel safe.

Sally: Yeah. If a child experiences toxic stress or if a listener is thinking about the toxic stress they experienced in their childhood, what would you sort of say to them about these outcomes that you’ve described?

Jack: Anytime I give a lecture anywhere or a presentation, there are always people in the audience who are sitting there saying, “Oh my goodness, this is me.” I know that because they come up to you after you’ve given a presentation and people will say, “I’m really understanding what’s been going on in my life in a different way.” For some people it’s very frightening. For some people it’s a relief to say, “This isn’t my fault. I’m not a weak character. Now I understand.” But what’s most important is that none of us is perfect, none of us has a life without challenges, but the brain and the rest of the body is always trying to get back on track. That’s the other thing about biology. If you’re weighted down with risk factors and problems in your life and you find supports and you find ways to build better skills to cope, the brain can’t wait to get back on track, it is always trying to do that. We know this is something that we don’t have to passively sit by and accept. We can always do something. We can always make things better, always. Better to get it right early, the first time. Better to prevent problems than try to figure out how to treat them later. But it’s never too late to make things better. It’s never too late to improve outcomes.

Sally: Jack, as we wrap up here, I wanted to think a little bit more with you about how parents or caregivers or anyone who’s really interacting with these children who might be experiencing stress can make sure that these stress responses are more tolerable as opposed to more toxic.

Jack: Yeah. This is a really important question because there’s so many times when we oversimplify the story. I think the key difference between tolerable and toxic stress at any age is not the cause of the stress, but how your body is dealing with the stress. And the younger you are, the more you depend upon adults to kind of provide that protection. Although there’s no age at which we do it by ourselves. So we’re always looking for support. Um, I think what’s really important for, particularly for parents to understand and, and providers of, of early care and education who spend lots of time with kids is that very often the challenges facing the children may be more than a parent or a childcare provider alone can deal with. And there’s no shame in saying I need help. I need help to protect my child. I need help to make sure that my child is protected in the face of these circumstances we’re dealing with, or I need help to be able to help my child develop better skills, to cope, and to be more resilient. I think one of the most dangerous things and one of the most harmful things that we do is to basically send a message to parents and childcare providers and others who are facing serious challenges and tough circumstances to kind of say to them, you know, “This is all on you and, and, um, if you don’t do a good job, you know, X things are gonna happen.” I think one of the healthiest and most promising ways for any of us to deal with, with threat and challenge is to be able to say when we need help. And so it’s not just the help that children need from adults, um, can only best be given when adults who need help themselves to do that are comfortable enough and we make it easy enough to provide that help for the adults. The relationship is between the young child and the adult is critical. Adults thrive in their own environment of relationships. None of us can do everything by ourselves. And if we understand that importance, then we will minimize, if not eliminate toxic stress in the lives of everybody.

Sally: Thank you, Jack, for being here and for talking with us about this really important concept. I think it’s especially important to note that while toxic is extremely serious, it’s also not the end of the road for anyone and that there’s lots of things we can do to mitigate against the effects. When we come back, we’ll chat with a few special guests to discuss the work that they do to actually prevent toxic stress and support those who’ve experienced it.

Musical interlude

Sally: Joining us today to talk about toxic stress is Professor Megan Gunnar. She’s the professor and director of the Institute of Child Development University of Minnesota. Hey Megan.

Megan: Hi, it’s wonderful to be on this conversation.

Sally: Also on the call we have Jeanette Vega, who’s the training director at Rise magazine. Hi, Jeanette.

Jeanette: Hi. Thank you so much for inviting me on this podcast today.

Sally: Also here is Dr. Kathleen Conroy, associate clinical director, Boston Children’s Primary Care and assistant professor at the Harvard Medical School. Hi Kathleen, glad to have you.

Kathleen: Thanks so much for having me.

Sally: And also joining us is Cerella Craig who’s a community mental health worker, New Haven, Connecticut. Welcome to the podcast, Cerella.

Cerella: Hi, happy to be here. I’m looking forward to speaking with you all today.

Sally: Cerella, I’m wondering actually if you could provide some insight for us on if you see the effects of toxic stress in the work that you do directly with families.

Cerella: Yes, so one of my primary responsibilities as a research assistant and community health worker is recruiting people who are at high risk for toxic stress into mental health services. What for me that sometimes looks like is a mom who’s very untrusting or who is very skeptical and almost as a result of losing trust of systems that have constantly failed her. We’re not talking about the type of neglect that may have come from a parent. It’s a different neglect. So we’re talking about a neglect from systems that have failed to serve these moms. Now, what I see is really a lack of trust, a lack of belief that there’s the ability to help.

Sally: Jeanette, I’m wondering what you have been seeing from your perspective.

Jeanette: I’ve been working with parents for the past 15 years that were affected by the child welfare system, the school system, hospital systems. They were telling us that they were facing toxic stress themselves. I lost my son, I ended up losing my job, I had to quit going to school. I ended up losing family members and it just felt like my anger would jump from a hundred to a thousand on a daily basis because these things were constantly happening to me and they were repeatedly happening for a long period of time. That’s what families face when they face child welfare and when we’ve been studying this at Rise, how the child welfare system is giving parents toxic stress, they’re giving parents five different services to do in a week and they have to visit their children weekly and do therapy and parenting and anger management classes.

Sally: Kathleen, are you seeing a similar situation? I know you work a lot with young parents, and I’d be curious to hear if you have seen similar distrust as Cerella described, but also what the effects of toxic stress have been on some of the children that you’ve been working with.

Kathleen: We see a lot of families who have been failed time and time again or challenged time and time again by trying to access systems that should be set up to help them, systems like public benefits, school systems, childcare systems, the healthcare system, which often put a lot of barriers in people’s way. We know there’s a ton of implicit bias in these systems. We know there’s a ton of negativity in these systems and often people who are particularly low-income people are trying to access resources in these systems and spending a lot of their time doing that, I think this can become a form of trauma and in of itself for folks. Indeed, I think we spend a lot of time attempting to build trust and repair in some cases. I think one of the advantages we have in pediatrics is that we get to have longitudinal relationships with patients, which is one of the things that’s really joyful about it. But sometimes we see things develop over time with families where we’ll see an infant who appears to be thriving with a family because they’re meeting their gross motor milestones and they’re going along through their first year of life. And it’s only later that we start to see some developmental outcomes that might not be as ideal and recognize that often these kids were experiencing a lot of stress and that we’ve maybe missed the opportunity to help parents work on that with their child. That’s one of the things that we’ve started to pay a lot of attention to in pediatrics is how do we talk to families about the stress their children are experiencing? How do we acknowledge that children experience stress? How do we distinguish tolerable from non-tolerable stress? And how do we help parents best work with their kids and promote their development? Since we know that parents are working so hard on that, how do we help them in the best way that we can?

Sally: Yeah. Jeanette, I’m wondering if you have any guidance from your work that you do in communicating directly with parents and thinking about how they talk about this toxic stress and how they are able to kind of work through it with their children.

Jeanette: At Rise, we’ve been working into getting knowledgeable about toxic stress. I ran that statement science tells us that healthy brain architecture depends on genes and environment by my parents’ staff this week, and a parent says it just sounds like scientists are saying that if you are a person of color—referring to the genes—and if you live in low-income communities—referring to the environments—that your family members are just screwed and you will get toxic stress.

Kathleen: I think that Jeanette, you’re pointing out such a wonderful and really important point that if we start talking about certain circumstances as determinative, right? Like, oh, if you’re experiencing this or that, then there’s this irreparable harm done and it’s a simple equation. And in fact, if we’re portraying it that way, we’re selling both the idea and people short, right? Because what we know is that many, many parents are parenting really well despite facing significant adversity–they’re modeling building relationships, they’re modeling emotional self-regulation under difficult circumstances. And I think we need to remind parents that when they are showing those amazing skills to their children and when they’re portraying as much love and consistency as they can under difficult circumstances, that’s actually building their children’s life skills, right? They’re actually giving their child something. I think it’s a really good point that if we’re talking about things being determinative, we are going to lose our audience for this message and we’re going to be very incorrect.

Sally: Yeah, Megan, I’m wondering what you have been seeing from your perspective as a scientist directly working on this research, responding to both of those questions that were posed.

Megan: Oh boy, these are very big challenges and precisely some of the ones that we were worried about as we worked on the language. It is really to try to translate the science so we can change what we know children need and what we do for kids, really on the structural level of societal change. The original reason to talk about it as involving both genes and experience was to get away from the idea that if you weren’t doing well it was because you were born that way. Now we have this massive problem for as a society we need to remove the barriers or reduce the barriers for families and children who are growing up in situations or living in situations that are not supportive of brain health. Right? It’s not that nobody in those environments will experience brain health because families are amazing at what they are doing to try to compensate for everything that’s coming down on them. But as a society we should start removing some of those barriers. So it depends on your experiences, but parents are great. And even in these difficult circumstances, most parents are doing well. The problem is the complexity of this and trying to get the message weighted appropriately so that we acknowledge the fact that there are inequities in our society and those inequities are increasing the risk of harm to our kids and to our future society, while not, at the same time, going deterministic. So I think that means that when you’re working with individuals, you say, “Look, we understand. None of this is going away until we make the structural changes that makes our society more just and equitable for everyone. But in the meantime, what can we do to help you protect, buffer and support your child?” Right?

Cerella: Megan, what I’ve seen a lot of that comes around teaching people skills that they can use in real time. I think in a perfect world, this change would happen a lot quicker than in reality. It’s going to happen, so in the meantime, what we need to do and what I’ve seen to be effective is to send parents home with skills, with tools that can teach them how to do either meditation practices or breathing exercises or steps to learn problem solving techniques. Some of these structures at home where they can promote their own wellbeing and that of their children. I think that’s really the best shot we have at ensuring some of the wellbeing of mothers and children around toxic stress because it’s not going to go away, so we really have to teach some concrete skills that can be used in the moment, that are easy, that are cheap, that are accessible. I think that’s one way parents can be encouraged to promote health within their home.

Megan: Oh, I agree completely. Yes. And it’s just combined with the message that we know this is not your fault, is the piece that sometimes, I know you all are giving, but I’m not sure that we are making it really clear when we talk about toxic stress that we don’t think it’s the fault of the families. What we believe is it’s the fault of the way we’ve constructed society, but what do we do to help families mitigate those negative influences?

Sally: Yeah. Cerella, I really appreciated your specific examples of resources that parents or caregivers can use. I think a lot of people listening to this podcast may have experienced toxic stress themselves. They may know children that are experiencing toxic stress and what we want to make sure we do is leave people with the impression that there’s hope, there’s opportunity to build resilience. I’d be curious to hear from others what kinds of skills and resources you’ve given to parents or caregivers or worked with them to develop that might be beneficial for others listening.

Jeanette: What we found helpful at Rise and what parents have said has been helpful, even for myself, is definitely having at least one person who’s very supportive. Having that peer-to-peer support with someone who understands what you’re going through has been amazing and just parents overcome little situations.

Cerella: I can definitely support what you said around social support being a tool that you’ve seen parents use. You’ll hear people say the best part about this intervention was hearing that there were other women going through the same things that I’m going through. Outside of just that anecdotal evidence, can any of the scientists speak to some of the implications of social support and has that from a toxic stress perspective been shown to be helpful?

Megan: So one of the most powerful buffers of stress is supportive relationships. We call it social buffering. It works across the mammalian species, whether you’re a rat with another rat, a parent with a child or two adults. So having another person with you who is emotionally supportive is a very powerful stress buffer. It’s the best we got, which is why the kind of history that you might have that makes it hard to trust others is something to be of concern and where we might want to help families or parents repair so that they can find people that they can trust. The work you’re doing and the way that you’re going about doing it, it is relationships, right? Relationships are the key thing across all of human development, child into adulthood.

Cerella: Can we talk a little bit about how a lack of basic needs served as a barrier and how those things need to be addressed first. Very specifically, if you have a family who’s hungry, we can’t start a conversation about resilience until I can focus enough to hear what you’re saying if you’re my pediatrician.

Jeanette: I’ve been doing surveys here from parents. What are their basic needs and what is it that drives their families to stress or crisis mode? I was shocked to find out that the first thing most parents say is food, lack of enough food to last me the whole month, they say public assistance doesn’t provide enough food stamps to last the whole month. They get like, “I’m hungry. I’m not thinking straight. I’m not planning for my future. I’m just thinking about when am I getting that meal for my children and myself for tonight?” I don’t think parents can even focus on bigger issues unless we start acknowledging, like you said, and being aware that when parents are facing basic needs issues, they’re not going to focus on the bigger issues that are causing them any stress in their life. Another strategy that we use is breaking down what’s going on in your life. Like I said, I work with parents affected by the child welfare system. What I tell them is, “If you’re feeling toxic stress, let’s break down what’s going on in your life and prioritize what you need to do. So let’s say you don’t have food and you’re also about to get evicted from your apartment, let’s concentrate on getting food on that table for today and tomorrow and then next week let’s get working on the eviction.”

Kathleen: The other thing we have to do is just making careful that we ask parents what it is they want to focus on, right? Because I think sometimes you guys are talking about this concept of hierarchy of needs, right? And I think the hierarchy of needs on some level is deeply biological, right? None of us function well when we haven’t eaten or slept, when we don’t feel safe, right? And so of course it makes sense that we need to meet our most basic needs first. I think sometimes in places where we’re prepared to meet more than one need, we also just want to make sure that we’re not assuming where somebody is coming in and we want to ask them what the needs are that they want to work on. That’s something I think healthcare needs to do a lot better on is to say, “Can I let you guide?” Which is the part that’s most important here and something that I think many of us are trying to get better at in our practice.

Sally: Up next, our panelists are going to answer some of your social media questions.

Musical interlude

Sally: So now that you’ve answered a lot of my questions, we’re gonna have an opportunity to answer some questions from our social media followers. This first one I’m going to address to you Megan. This comes from Fishlovesphoenix from Instagram, who asks, “What about babies who were born with medical issues? My baby had to sleep away from me for two months after he was born premature and I’m stressing over the lifelong effects. What can I do to minimize them? Or is it too late? He’s three now.”

Megan: Well, it’s never too late. Ever. Even, it’s not even too late for me and I’m in my 60s. The issue of premature birth and needing to be in an NICU for a period of time is a significant issue. This is not the environment that we evolved to develop in and there’s been a lot of work in neonatal intensive care units on how to make that environment more supportive of the infant’s development. And some of that has had to do with as soon as the baby is stable, being able to support the development of that infant with the parent. Now the part that’s important for the baby, it probably doesn’t have to be the actual parent, it’s the touch and the stroking and the holding and so on, once the baby’s stable. But for the parent it’s that it’s critically important. It is important to help the parent feel that they’re able to take care of that child and do well by that child and that when the child comes home they are going to be able to provide for what the child needs. There is a great deal of plasticity left in development and many, many, many babies who were born prematurely go on to do just incredibly well.

Sally: Yeah, that’s great. Kathleen, do you want to address the same question from your perspective as a pediatrician?

Kathleen: Well, I just really agree with everything that Megan said. This notion that she introduced of plasticity just means things are changing and have the capacity to change and improve over time. I think that parents do a tremendous amount of good when their children are in the NICU and they are able with a stable baby to hold and do the skin to skin with that baby. And I know parents often really enjoy that and the kids enjoy it too. Then I also think about for these folks who you have so many nights after you take that baby home and you are instilling all the good, caring, and attachment during that time period. For folks who’ve had to have that experience or at an older age with a medically complex child providing that wonderful consistency when the child is able to have it goes a long way.

Sally: Great. We have another question from Fieryboots2, who asks, “What can I do right now to help protect my child against the harmful effects of stress?” And I’m wondering, Cerella, if you could give us some ideas that you’ve seen with your work.

Cerella: I think the best that we can do to really model some of those healthy practices coming to mind when we’re talking about parents and children. I think breathing exercises, and I keep going back to that because it’s simple, it’s easy and I think some of the scientists will attest to the fact that it’s almost like a physiological reset within your body when you are feeling these really intense feelings. It’s a quick method that you can use to bring yourself down and there are a ton of ways that you can do this with your child as well and get them into the practice of bringing themselves off that ledge when they’re really hyped up in terms of big feelings. I think the more that we can just try to model some of those healthy coping mechanisms for our children, that could really go a long way.

Jeanette: As a parent myself, I think nothing is more powerful than just love and compassion to the children and just understanding what the child is feeling and actually talking to them about it, depending on their age level, has been very helpful for some families also.

Megan: I agree with everything that was just said. One of our challenges though I believe is making sure that we’re protecting them from the potential impact of toxic stress versus protecting them from stress. Stress is actually an important part of growing up and experiencing and learning to handle it and not having people take care of it for you completely is critical to be enabled to develop resilience and we talk about that as positive stress. Positive stress doesn’t look like you’re happy, it often looks like you’re very unhappy, frustrated, angry. And as parents and teachers and so on, we sometimes have great desire to take that pain away, whereas it’s normative pain. So, we’ve been talking about toxic stress to really identify the serious stress issues that many children face.

Kathleen: I’ll just say I think whenever we’re thinking about whether we need to shield our kids from stress, I think we should be asking is there a life skill my child is trying to build here that I want to give them the opportunity to build? Whether that’s learning to go to sleep on their own or learning to walk into school by themselves, things that we really want the child to be able to do and thrive in versus protecting the child from something that’s in fact traumatic. And I think when we can test it a bit with that question, we may be able to sort out the difference between tolerable stress and life skills promotion versus toxic stress.

Sally: That was a really great conversation and I just really want to thank all of you for your time being here and for giving us your expertise on these topics. And up next, Dr. Shonkoff is back to discuss a common misconception people have about toxic stress.

Musical interlude

Sally: And we’re back with Dr. Jack Shonkoff, we’re talking about toxic stress. And Jack, this is a particularly favorite part of the podcast for me, we’re thinking about myths and I think there are many of them when it comes to toxic stress. So for you, what is the most important myth that you would like to dispel related to this issue?

Jack: I would say the biggest misconception of toxic stress is when people talk about it to describe the cause of the stress, rather than understand it’s the biology of the stress response. It refers to what’s going on inside your body when your stress system is activated. Toxic stress is not referring to what’s toxic about the cause of the stress activation, it’s how does the body deal with serious threats. Toxic stress is how your body is responding and nobody is helping you feel safe. Think about some of these school shootings. Everyone has experienced the same trauma, but there’s tremendous variability in how people respond to it. That’s the way we need to think about toxic stress. It’s not the trauma, it’s the response and the response is wide. And most people do not experience toxic stress because most people have somebody to turn to. It’s not in any way minimizing the horror of the event, but that’s not what toxic stress is about. And toxic stress is when you’re all by yourself for more than a day or two, or more than a couple of days, it’s when you’re all by yourself for weeks and months.

Sally: When you’re talking, I’m thinking about the situation at the border, which is so heartbreaking thinking about that sometimes children are being separated from their caregiver for such a long stretch of time. You can just imagine that system being activated for–

Jack: Right. But here’s where a misunderstanding can work on either side. So let’s stick with the border separation, or we could take survivors of a school shooting because it’s the same. From a toxic stress point of view, it’s the same. So if someone wants to pull out from that, some child who has done remarkably well and survived, and puts up as an example of, “You see that kid over there? Look at what that child went through and that child is really okay. So the rest of you should also be that strong.” That’s just so wrong, not to mention unfair. But scientifically it’s wrong because, yeah, there are people who get through.

Jack: In the same way that if a child is completely incapacitated and devastated with life-long, serious mental health and physical problems, it would be equally wrong to say, “See that child? That’s what we have done to every child who’s been separated from parents. That’s what we’ve done to every child who’s been a survivor of a school shooting.” It’s just not true. So, if there’s one thing the science is just screaming at us, it’s about human variation, it’s about you can’t over-generalize. But the concept of toxic stress is real. It’s real. It’s physical. It’s biological. The threat of toxic stress and what it could lead to is real. No scientists disagree with that.

Sally: I really appreciate you being here Jack and for sharing that really important information. Up next, we’re going to talk a little bit more about how to apply this information and have conversations about toxic stress with people in your lives.

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Sally: So, if this conversation left you wanting to discuss toxic stress further, we thought that it might be helpful to leave you with some meaningful ways to talk about it. If you bring up the subject, make sure to always talk about toxic stress alongside the idea of resilience. The two always go hand in hand because recovery from the effects of toxic stress is possible, though it is hard work. You can say something like, “Toxic stress can be harmful to healthy development, but there are always ways to heal from it and no one who’s experienced toxic stress is damaged beyond repair.” The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @Harvardcenter, Facebook @Centerdevelopingchild, and Instagram at @Developingchildharvard. Brandi Thomas, Charley Gibney and Kristen Holmstrand are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org. The podcast is recorded at PRX Podcast Garage in Allston, Massachusetts.

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