Fighting toxic stress tough but possible, symposium speakers say

Dig deeper

Though such associations have become well known, Burke Harris said, very few pediatricians screen for ACEs. Failing to discover the underlying problems in children’s lives can lead to misguided treatment – a symptom of the issue’s hidden complexities and an example of the immense effort that fighting it demands.

Many behavioral problems associated with toxic stress, for example, may come across as ADHD but are caused by the chronically elevated inflammatory, or “fight-or-flight” response that stressed children live with, she said. While that response evolved to help us survive momentary dangers, like encountering a bear in the forest, “the problem is what happens when that bear comes home every night.”

Without screening for that underlying stress, a doctor might prescribe the first-line ADHD treatment of ritalin, a stimulant, she said. But in a child enduring a chronic stress response the medication likely won’t do much good. Instead, if screening reveals ACEs, Burke Harris not only works to mitigate the stresses, but also prescribes children guanfacine, which calms the nervous system and reduces blood pressure.

Keynote speaker Geoffrey Canada, president of the Harlem Children’s Zone, which provides individualized education and social support for thousands of children from birth through college, told a similar anecdote about the need to dig deeper. Years ago, a social worker in HCZ’s after-school program alerted him to a child who began to display bizarre behaviors such as talking to himself. Rather than just sending the child to a doctor, Canada sent the social worker to visit the home. The visit revealed that the tiny apartment was infested with rats and the child’s mother, who needed to work, had tasked the boy with guarding his younger sisters all night from being bitten. The boy’s problem was not mental illness so much as a profound lack of sleep.

“If you aren’t willing to take the time to actually figure out what’s happened to a child you might treat the child for something that isn’t really causing that kid to be sick,” Canada said. “You have to really take the time to understand.”

The desire to dig deeper brought Dr. Ravi Raju to the lab of Picower Institute Director Li-Huei Tsai, where he is a Picower Clinical Fellow. After observing stark health and income disparities among Boston children during his pediatrics residency at local hospitals, Raju decided to do fundamental research on how deprivation amid poverty affects the brain. Using an experimental protocol in which mice are deprived of nesting materials, an important component of pup rearing, Raju has shown that baby mice appear to adapt via specific changes in gene expression. Those that do remain resilient. Those that don’t become very anxious. Studying those genes and the molecular pathways they affect when expressed is revealing potential therapeutic targets for mitigating toxic stress, he said.

Far from Boston, in India, MIT economics professor Frank Schilbach is conducting randomized controlled trials of interventions meant to help alleviate poverty cycles. His research shows how intricately problems in households are intertwined. Among poor workers, for instance, back-breaking labor leads to debilitating pain. With poor healthcare, many laborers start drinking to feel better. Difficulties at home, including for their children often follow. Right in the middle of this cycle, he’s found, is poor sleep, an often underappreciated factor where interventions could help workers and therefore also their children.

Indeed, even babies show amazing acumen in what they pick up from the adults around them, said MIT cognitive scientist Laura Schulz, professor in the Department of Brain and Cognitive Sciences. She described one project in her lab demonstrating that babies will match the degree of effort they observe a grown-up making when trying to figure a task out. Another set of experiments shows how tightly an adult can constrain a child’s thinking, for better or worse. If an adult specifically demonstrates only one feature of a multi-featured toy, for example, a child won’t explore the toy to discover any of its other features.

Speaking up

As important as speakers said it is for scientists, physicians and social workers to engage in deep, energetic efforts to understand the underlying cognitive abilities and vulnerabilities of children, several other speakers emphasized how crucial it is for afflicted communities and people to insist on being heard when things aren’t right.

They were told the water was fine... Science is not meant to live in publications and journals and ivory towers. The purpose of science is to benefit our communities.

-- Mona Hanna-Attisha

Dr. Mona Hanna-Attisha, associate professor of pediatrics at Michigan State University, spoke at the symposium about the extensive research she did to prove the horrible extent of lead poisoning among children in Flint, Mich., after the city infamously switched its water supply a few years ago. At first, she said, community complaints about foul water were dismissed, but research documented how wrong that was.

“They were told the water was fine,” she said. “Science is not meant to live in publications and journals and ivory towers. The purpose of science is to benefit our communities.”

After she revealed the problem, social and health services have increased in the city, but now the fight continues to sustain funding for those restorative efforts, said Hanna-Attisha, who recently won an MIT Media Lab “Disobedience Award.”

Though pollution is an abundant problem, other speakers described how the environment can protect against toxic stress. Marc Berman, assistant professor of psychology at the University of Chicago described several studies he’s done showing that exposure to trees and natural scenes may improve cognition. Meanwhile Jonathan F.P. Rose, a prominent builder of progressive mixed-income communities, described how his developments incorporate vegetation, as well as medical and social services rather than just providing housing.

But several speakers made it clear that they’ve had to advocate and sometimes fight systems to mitigate toxic stress in their communities. On a panel, with Frank Farrow of the Center for the Study of Social Policy and Boston University pediatrician Renee Boynton-Jarrett, local parents Lisa Melara and Gihan Suliman spoke of their tireless volunteer work to help parents in need find supportive resources in the community and to understand their rights. Later in the day, journalist and filmmaker Jose Antonio Vargas, CEO of Define American, described his work in creating communities among undocumented immigrants such as himself, to help fight hatred by ensuring their stories are told.

Throughout the day, speakers pulled few punches about how ongoing problems of poverty, violence, substance abuse and racism continue to produce toxic stress in children, even as they also reported their strides in research and community action to mitigate its effects.

In his talk, Harvard University Professor and child health expert Jack Shonkoff noted that for all the advances in research and community services, their impact has not been nearly enough. He put it all in terms of the “Stockdale Paradox,” named for a former U.S. Prisoner of War in Vietnam. To survive, one must never lose hope of ultimately prevailing, goes the paradox, even while remaining brutally honest about how dire the current situation really is.