Researchers examine effects of toxic stress on children's brain development

They stood in a clean room on the upper floor of a new, government-built apartment building. From the window, it was a spare but pleasant space for somebody to make a temporary home.

One glance ut the window, however, showed a different world: crack addicts, just finishing a hit, sprawled on the pavement, many half-dressed. The pavement was heated to the point of pain by the 100-degree weather, but none were sober enough to recognize their skin was burning. Fumes filled the humid air, wafting into open doors and windows. Police watched nearby.

This was no dystopian novel. It was October in São Paulo, Brazil, in an area known as Cracklandia. And it wasn't just adults who lived and died there.

"We watched children," said Mastergeorge, chairwoman of the Department of Human Development and Family Studies at Texas Tech University. "It just broke my heart to look at these young children in abandoned buildings eating a piece of bread, and they're hanging their shorts out over this windowsill and the street is just filled with people who are abusing drugs. They're inhaling toxic fumes. That is what they witness every single day."

The two researchers -- Trejos-Castillo is a professor in the same department -- have spent their careers examining what's broken in schools, homes, government and society and the effect that damage has on children. More importantly, they look at what can be done to fix these problems.

That is how they came to be standing in an upstairs room of a detox facility in downtown São Paulo, looking at the scene in Cracklandia. Mastergeorge and Trejos-Castillo were among the half-dozen Texas Tech researchers who partnered with Brazilian researchers through the São Paulo Research Foundation (FAPESP). FAPESP donated $20,000 over a two-year period through the São Paulo Researchers International Collaboration (SPRINT) program, and Texas Tech matched the money.

Trejos-Castillo and Mastergeorge, along with Andrea Jackowski, a researcher from the Federal University of São Paulo, are examining the effects of toxic stress on the brain development of children using functional magnetic resonance imaging (fMRI) technology. The Texas Tech researchers spent a week in São Paulo in October to meet with current and potential collaborators and see what the children whose brains they're studying see every day and how the experiences of these children could be applied to the world over. It turns out, it's not so different elsewhere.

"We have forgotten what the basic needs of a child are: feeling safe, cared for, loved, protected and supported," Trejos-Castillo said. "The very basic things that should happen in a family, we may be forgetting about these."

What is toxic stress?

Stress comes from the car breaking down and putting the repair on a credit card, setting you back financially for a couple of months.

Toxic stress comes from a constant, unending worry about money, wondering where food is going to come from, if there's enough money to pay rent, not being able to afford a much-needed doctor's visit, not being able to leave an abusive spouse because of a lack of resources.

The first, while difficult in the moment, does not consume a person's life. The end is in sight, and in the long run he or she will suffer little because of it. The second, if left unchecked, can literally become a part of the people struggling with it. Toxic stress is pervasive. It bleeds into every aspect of a person's life, offering no respite or recourse. There is no visible end. It is that person's normal.

Clinically, Mastergeorge said, toxic stress is defined as "unrelieved activation of the body's stress management system due to strong, frequent and/or prolonged adversity such as physical/emotional abuse, neglect, extreme poverty, exposure to violence and other traumatic events without adequate adult support."

There's also no outlet to relieve this stress, Trejos-Castillo said. People who experience stress or even trauma, such as witnessing a terrible car accident, usually are able to go home, talk it out with a spouse or friend, eat dinner with the family, cry, take a long bath or walk or find some way to release the stress of what they experienced. That's not true with toxic stress.

"In this case you're not able to de-escalate the stress," Trejos-Castillo said. "You're exposed to stress continuously for a long period of time, and then the body basically starts developing non-positive ways of coping with the stress."

The causes of toxic stress are varied. Abuse (verbal, emotional, physical and sexual) and neglect can cause toxic stress, as can extreme poverty or witnessing violence, including domestic violence between parents or violence in the community.

What is the effect of toxic stress on children?

Some of the effects have been determined, particularly in recent years. Improved technology and society's recognition that long-term exposure to trauma causes damage have led researchers in recent years to pinpoint certain effects of toxic stress. Children experience externalizing behaviors like aggression and internalizing behaviors like anxiety and depression.

The difficulty for many observers is these behaviors aren't exclusive to children whose development has been stunted by how they grew up, and often people see only an aggressive child who's acting out, not a child who's acting out trying to get someone to notice the constant pain he or she experiences.

The trauma causing toxic stress and its effects also can have the subtle but equally dangerous effect of normalization. Children who don't have a bigger worldview may come to think domestic violence happens in every family or people being shot in the streets is a part of life. They expect to get caught up in gang violence, go to prison or die young.

"Some talk about how long they're going to live," Trejos-Castillo said. "It sounds very pessimistic, but they say they don't expect to live more than 25 years because that's what they see."

What is perhaps scarier for the researchers is how insidious this toxic stress is. Jackowski collected fMRI data of children who experienced toxic stress, and Mastergeorge and Trejos-Castillo analyzed that data. What they see is unrelenting, unending trauma seeps into a child's brain development, altering his or her cognitive abilities and ability to function. A child reaches a point where trauma-affected behavior cannot be unlearned. The damage is already done.

Where are children most likely to experience toxic stress?

Syrian refugees have been exposed to trauma, both in their ISIS-controlled homeland and in the difficult journey away from Syria. Children who grow up in the favelas of Brazil, where drug- and gang-related crime are rampant, witness trauma that affects them.

It is not, however, a problem exclusive to the developing world. Children in the United States, including children in Lubbock, are exposed every day to the kind of stress and trauma that can damage their cognitive development.

Children in Texas are particularly vulnerable, both researchers said.

"Lubbock has one of the highest percentages of child abuse and neglect in Texas and in the country," Trejos-Castillo said. "It has to do, among other things, with a lot of ignorance and generational abuse in families."

It also has to do with the lack of funding and awareness from those making funding decisions, Mastergeorge said.

"Services have been cut at the state level, in particular to cities," she said. "We're learning from our international colleagues that we have much more in common than we would have thought."

Research so far hasn't shown much difference in how a child reacts to toxic stress based on geography. Children in East Lubbock who experience extreme poverty, children in south central Los Angeles and Brazil who see gang violence every day and children in Syria who see war all experience basically the same cognitive and behavioral effects.

"What's important for a layperson to understand is a child in East Lubbock who's experiencing toxic stress is very similar to a child you might see in another country who's homeless or who's been exposed to the bombings in Syria," Mastergeorge said.

"The way the body responds to toxic stress is similar across contexts -- we're all human beings; we're not very different from people in other parts of the world," Trejos-Castillo echoed.

What can be done to prevent or at least mitigate the effects of toxic stress? This is, after all, the million-dollar question. Knowing the effects is most valuable in how it informs the way society responds to these issues.

"It doesn't get better on its own," Trejos-Castillo said. "People feel like they'll grow out of that, it's just children and teens acting out."

Teachers, counselors, hospital workers

Much can be done by providing children with a safe space filled with people who can help them. To that end, Trejos-Castillo and Mastergeorge would like to focus on training school teachers and counselors to recognize the effects of trauma. Instead of taking a child who is acting out to the principal's office, calling his or her parents or sending the child to in-school suspension, a teacher may recognize the child is asking for help, albeit in a disruptive way.

"Probably the only place they actually feel safe and are able to show what they're going through is in school," Trejos-Castillo said.

Those who are in positions of authority should talk to the child, look for signs of trauma in their lives and take proactive steps to teach the children healthy coping mechanisms. Even actions as simple as explaining that what these children are experiencing is not normal can help.

"In a way it helps them realize what is going on in their house, although it's normal for them, it's not positive and it's not good, and they don't have to follow exactly the same kind of behaviors they're seeing," Trejos-Castillo said.

Teachers, counselors and religious leaders also need to know what challenges students are facing. Lubbock may not have the rampant gang violence that Brazil does, but for families in extreme poverty, the situations aren't noticeably different. However, poverty and its effects are less dramatic in terms of headlines and grabbing community attention.

"Hunger is a huge issue in in our culture that affects children every day," Mastergeorge said.

Policymakers

Get either of these women in a room with someone at the Texas Capitol and they'll give the same message every time: Texas needs to invest more money protecting and helping children and families affected by abuse, neglect and extreme poverty. If the state continues underfunding these programs, the children affected today likely will suffer the rest of their lives because of it, and the largely fixable problem will be passed onto another generation, thus exacerbating the problem.

"There's something called a return on investment, and it's true in development as well," Mastergeorge said. "We know if you invest early, the return on your investment is very, very high. We have data on that from economists and developmentalists; it's all been well-documented. I just hope the investment in funds for these families in need, especially in our state, is heard."

After media reports earlier this year showed almost 1,000 at-risk children in Texas had gone unseen by Child Protective Services employees for six months and the Department of Family and Protective Services had a budget shortfall of $40 million, the organization asked for millions to hire additional employees and pay their current employees more. Legislators have committed to take on the issue in the 2017 session.

It has to be a priority, Mastergeorge said.

"It's critical for our legislators and government officials to really understand the impact of poverty and stress, in particular toxic stress, on the outcomes for young children and children in general," Mastergeorge said. "If we don't do something to effect a more positive approach to children's development, we will continue to have long-term problems in our society."

Researchers

All three researchers expect their work to advance the collective knowledge not only of the effects of toxic stress on children but also where this question is leading, informing other researchers on similar studies. It also may destroy some assumptions researchers have held previously that restricted the questions they asked and open the door to additional collaboration.

"The research we do, the impact it can have on the field -- it's substantial," Mastergeorge said. "We talk about impacting professionals and the community at large, but there are other scientists who do work in the field and they need this information to help propel them forward in terms of what they're going to be doing both clinically and in the field."

"This is not a group of researchers' problem," Trejos-Castillo said. "This is society's problem."

Prevention vs. Intervention

Most people agree preventing problems is easier and more cost-effective than fixing what's already broken. However, that doesn't always pan out in the real world.

"A problem with prevention is you don't see the effects," Trejos-Castillo said. "When we do intervention we can say we changed something, but when we do prevention we're trying to not have the problem. As a culture we are really backward about that."

While pushing for opportunities for prevention, they're taking the situation as it is now and looking at ways to mitigate the harmful effects of toxic stress. Mastergeorge is a frequent and vocal supporter of programs like Early Head Start, which helps provide children with a safe environment for several hours throughout the week, thus relieving some of the pressure, but also works with parents and families to break the cycle of poverty, drug abuse or domestic violence that contributes to volatility at home.

Regardless of the focus, this research and related studies have made one point clear: a significant amount of work remains to reduce the far-reaching effects of extreme poverty and the related issues of drug abuse and domestic violence on children and families the world over. It's a difficult subject for researchers to consider because of the emotions that came when studying children who are suffering, but one they can't let go.

"Basically, to do this kind of work you have to have hope," Mastergeorge said. "I have a lot of hope that the work we do can make a difference. Not only is it essential that we pay attention to these areas that are very difficult to pull the veil off of and really take a hard look it, but I do strongly believe based on what I have observed both as a clinician and a researcher and also just being in the trenches with families that the kinds of preventions and interventions we can provide really do have an impact.

"I think that's why we do what we do."