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Toxic stress and trauma endanger children

“It’s a best friend thing. We always be holding on to each other,” said Destiny Sommelier 10, right, who walks with friends Akeeylah Kelly, 8, and Saniya Bryant, 10, near their bus stop on Wednesday, Oct. 21, 2015, in Ferguson, Mo. The girls often walk past the home of deceased classmate Jamyla Bolden.
“It’s a best friend thing. We always be holding on to each other,” said Destiny Sommelier 10, right, who walks with friends Akeeylah Kelly, 8, and Saniya Bryant, 10, near their bus stop on Wednesday, Oct. 21, 2015, in Ferguson, Mo. The girls often walk past the home of deceased classmate Jamyla Bolden. Tribune News Service

The white casket is low enough for most of Jamyla Bolden’s elementary school classmates to gaze directly into the face of their friend, her eyes closed, her lashes long.

The children have come to the wake at Wade Funeral Home on an August evening to say goodbye to Jamyla, a fellow fourth-grader at Koch Elementary School who had been shot through a window as she completed her homework on her mother’s bed.

Destiny Sonnier, 9, stands behind a relative in the second pew. She cannot look at her friend’s body.

Destiny had spent the summer with Jamyla.

Poverty overwhelms their parents with debt, housing and transportation problems, and they struggle to keep the power on. Their family histories include sexual abuse, domestic violence, incarceration and foster care.

Akeelah Kelly, 8, had played outside with Jamyla on Ellison Drive hours before she was killed.

Jamyla had lived in a highly segregated, low-income Ferguson neighborhood filled with young children and endless stress.

Gun violence is just one part of the burden for many of Jamyla’s friends and classmates.

Poverty overwhelms their parents with debt, housing and transportation problems, and they struggle to keep the power on. Their family histories include sexual abuse, domestic violence, incarceration and foster care.

Two of Jamyla’s closest friends — Akeelah and Destiny — have endured many of those struggles, both before Jamyla’s death and in the months since.

It has long been known that growing up in impoverished and dangerous neighborhoods dims life prospects.

When children don’t get a break from the stress their developing bodies go on a stress hormone production binge that can alter typical gene expression within their DNA.

But now a commanding body of medical research presents a disturbing, biological picture of why.

It suggests that the stress itself — if left unchecked — is physically toxic to child development and health.

Brain imaging, biochemical tests, genetic testing and psychiatric trials show toxic stress ravages growing children — inviting maladies such as asthma, obesity, heart disease, high blood pressure, diabetes, kidney disease and stroke in adulthood.

When children don’t get a break from the stress — when adults can’t or don’t know how to shield their children from it — their developing bodies go on a stress hormone production binge that can alter typical gene expression within their DNA. In some cases, parts of their brains are smaller and their chromosomes shorten.

Those biological and developmental changes trigger lifelong health consequences that can ultimately shorten lives.

Some pediatricians who treat children in mostly poor neighborhoods describe a toxic stress epidemic.

“I see all these beautiful babies, and I think of all the statistics, and I can calculate which of these babies is going to have problems because their home environment is so stressed that they are never going to get the right support they need to turn on those genes to get a happy involvement in life,” said Kenneth Haller, an associate professor of pediatrics at St. Louis University School of Medicine and a fellow with the American Academy of Pediatrics.

The toxic stress Haller describes isn’t limited to children of poverty.

We have kids who start out looking great as infants, and as they grow I can see their parents more and more distracted by all the things in their lives like food insecurity and housing insecurity. And what I ultimately see is that these kids on some level start to shut down.

Kenneth Haller, an associate professor of pediatrics at St. Louis University School of Medicine and a fellow with the American Academy of Pediatrics

Middle-class and affluent children are not immune from the traumas of domestic violence, drug overdoses and natural disasters such as floods, to name a few.

But in neighborhoods such as Jamyla’s, those stress factors are concentrated because of poverty. And that adds up to what many view as a public health crisis.

“We have kids who start out looking great as infants, and as they grow I can see their parents more and more distracted by all the things in their lives like food insecurity and housing insecurity,” Haller said. “And what I ultimately see is that these kids on some level start to shut down.”

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Jamyla was killed in August while doing homework, when a man now in police custody shot into a bedroom window. Police do not believe she was the intended target.

Jamyla was bleeding to death in the arms of a veteran police officer, a man who would later sob at her wake.

At night, children heard the chop of hovering police and media helicopters. Tear gas lingered like fog some mornings.

Jamyla’s death on Ellison Drive happened shortly after the one-year anniversary of the fatal shooting of Michael Brown by a police officer in the same neighborhood. Everyone had hoped things would finally calm down.

During the Brown protests, West Florissant Avenue, the street right behind Ellison, filled with protesters, police lines and looted and damaged stores. At night, children heard the chop of hovering police and media helicopters. Tear gas lingered like fog some mornings.

Destiny Sonnier’s fear and grief were palpable then and remain so. They linger in her own house just 300 yards down the street from Jamyla’s and in the night air that often pops with gunfire.

Two years earlier, while she was living with her grandmother and dad, he disappeared. He was found shot dead and dumped in a lot in Kinloch, his legs bound by zip ties.

Destiny is now being raised by her grandmother with an aunt and a cousin in the same tidy house. Her mother sometimes takes her on weekends but is busy raising Destiny’s half siblings.

Destiny longs to leave the house and violence on Ellison Drive, but she knows that is unlikely. She often gets angry.

“My grandma says if we move, it’s just going to be like this on the other streets,” she said.

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Few area researchers know more about the effects of unrelenting stress on children than Washington University psychiatrist Joan Luby.

For 15 years Luby has studied 90 low-income children from the St. Louis area, tracking their development through brain imaging.

Luby’s research offers hope. She said children living in poverty with caregivers who are attentive to their needs are less vulnerable.

Her findings suggest that children living in poverty — unless given emotional support to buffer their stress — have smaller volumes of white and gray brain matter, particularly in the critical regions of the brain known as the hippocampus and amygdala.

Last year, Luby published a paper directly linking poverty to smaller brain volumes in developing children. In January, another of Luby’s studies linked poverty to poor connectivity within certain regions of children’s brains. They are two of dozens of studies finding adverse developmental effects on the brain.

Luby’s research offers hope. She said children living in poverty with caregivers who are attentive to their needs are less vulnerable. Brain scans show these positive relationships and other support can actually protect the brain from abnormal development.

“I think the thing that is probably most frustrating about it is that we really understand it and even know this is actually preventable,” said Luby. “So the science should be informing the public policy for prevention, but right now, it’s not.”

The alarms on toxic stress have been sounding for years.

Decades of research affirm that as stress hormones escalate in children, they are exposed to a range of health dangers. Those include inflammation of the circulatory system, diminished heart and kidney health, higher fat production and storage in the body and suppressed immune function.

Newer research suggests the damage occurs at a genetic level.

Simply put, children who have suffered sustained violence and trauma can have miswired brains primed for fear and at the ready for “fight or flight.”

One study looked at the length of telomeres on the chromosomes of 9-year-old boys under toxic stress. Telomeres are the caps that buffer the long strands of nucleotides that extend from the ends of chromosomes. Telomeres normally degrade during aging, causing the ends of the chromosomes to shorten. That shortening is considered one of the key causes of aging and disease. But the study found the 9-year-old boys living in toxic stress had telomeres on average 40 percent shorter than those of boys living without such stress.

And the harm extends to behavioral and mental health.

Simply put, children who have suffered sustained violence and trauma can have miswired brains primed for fear and at the ready for “fight or flight.” That challenges their ability to learn and function socially.

Anne Kessen Lowell, the former director of SouthSide Early Learning Center, a mixed-income child care facility in St. Louis, said teachers encounter children who are jittery, temperamental and unable to sit still or focus.

“We are far too likely to point fingers at parents and households when they need our help and support,” she said.

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Perhaps the most troubling research on toxic stress is how trauma experienced by adults is transferred to children.

For the classmates and friends of Jamyla, such as Destiny and Akeelah, that means their well-being is tied not only to their own stress, but also — perhaps more critically — to the stresses of their mothers.

It starts in the womb.

Research suggests a mother’s stress hormones can be passed to a developing fetus. Sometimes the effect is so profound that the fetus can’t endure it, leading to pre-term birth — with often fatal results.

In the St. Louis area’s poorest ZIP codes, infant mortality rates rival Third World countries’.

Researchers also have found toxic stress may alter the expression of genes in the DNA of developing fetuses. Certain proteins may more easily latch on to a particular sequence in the DNA. Studies suggest the process turns off gene expression that helps the body lower its output of stress hormones. Essentially, babies with extremely stressed mothers can lose the ability to fully dial back the production of those stress hormones for life.

The troubles continue in infancy.

Research by Cynthia Rogers, a psychiatrist at the Washington University School of Medicine, has found distinct links between a mother’s depression and toxic stress, particularly among mothers in poverty.

Maternal depression can hinder a new mother’s ability to bond with her baby. The resulting neglect — the absence of direct attention — triggers the release of stress hormones in the child, while stunting development of neural pathways that promote language, learning and social skills.

“We know with certainty that children with depressed mothers have poorer outcomes,” Rogers said.

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The links to toxic stress during childhood and poor health are further borne out by a landmark 1998 federal study and ensuing research on adverse childhood experiences — known as ACEs.

Thousands of participants from every social, economic and racial background were asked to fill out a survey to determine if they were exposed to any of 10 traumas while growing up — such as neglect, physical and sexual abuse, incarceration of a relative and substance abuse.

Those who were exposed to four or more “adverse experiences” had triple the lifetime risk of heart disease and lung cancer and a 20-year deficit in life expectancy, one researcher said.

Indeed, Rajeev John, a social worker at Affinia Healthcare, formerly Grace Hill, said the vast majority of his low-income patients have histories of multiple childhood traumas along with worries about finances, employment, poor schools, jailed loved ones and crime.

“Children pick up on all their stress. It is invariably affecting the children,” John said.

Cambria reported this story with the support of the Fund for Journalism on Child Well-being, the Dennis A. Hunt Fund for Health Journalism and the National Health Journalism Fellowship, programs of USC Annenberg’s Center for Health Journalism.

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