See the Helpless and Hopeless Child?

“How a mother responds to her baby’s cries can make a big difference in the child’s ability to learn, develop, and thrive. While a warm, supportive response can help the baby calm down and feel secure, a distant or angry reaction leaves the child to fend for herself in a scary world. Over time, the lack of nurturing in the face of adversity in childhood can contribute to 'toxic stress' – a harmful level of stress that can affect the child’s well-being well into adulthood.”

– Yale Nursing Matters, Fall 2015

Have you ever seen a child who appears helpless and hopeless? The child does not want to listen or respect the rules. And, it seems the more that people try to help the child, the more defensive he or she becomes. Withdrawn and wounded, the hopeless child is an alien among others young people who are immersed in making critical life decisions and adjustments.

“Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. It can tip a child’s developmental trajectory and affect physiology. It can trigger chronic inflammation and hormonal changes that can last a lifetime. It can alter the way DNA is read and how cells replicate, and it can dramatically increase the risk for heart disease, stroke, cancer, diabetes—even Alzheimer’s.”

– Nadine Burke Harris, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity

The truth is that “helpless and hopeless” child you see may well be under unbelievable adversity and suffering from toxic stress. Adverse Childhood Experiences (ACE) is the term given to the study to explain chronic or toxic stress. It occurs when a child experiences prolonged, severe and frequent stress without support from an adult. Let's put the lion's share of blame for a child's hopelessness where it belongs – in the laps of the adults in change.

“An unpredictable parent is a fearsome god in the eyes of a child.”

-- Susan Forward, Toxic Parents: Overcoming

Their Hurtful Legacy and Reclaiming Your Life

Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity – such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship – without adequate adult support. Such toxic stress can have damaging effects on learning, behavior, and health across the lifespan.

Toxic parents and caregivers do not treat their children with respect as individuals. They won’t compromise or take responsibility for their child's behavior, and they won't apologize or seek help for their own inadequacies. Often these parents have a mental disorder or a serious addiction. Wounds from abusive or dysfunctional parents make growth difficult (even impossible) for their impressionable children.

“Toxic stress is the prolonged experience of significant adversity,” says Monica Ordway, PhD, APRN, PNP-BC, Assistant Professor at Yale School of Nursing (YSN). Left unchecked, toxic stress in early childhood strains the stress response system and even alters the developing brain. Ordway explains:

“Over time, without intervention, toxic stress will lead to an increase in adverse health outcomes that would last a lifetime for these children.”

Stress essentially shuts down the body so that it can survive, reverting to its most basic needs and relegating functions that it perceives aren’t for immediate survival. That ranges from executive functioning – the more complex calculating and planning ahead – to the capacity for empathy. When a child is living under a long period of toxic stress, the body doesn’t put effort into developing those higher-level functions. It’s also more difficult for them to regulate emotions.

The Harvard Center on the Developing Child found (“The Impact of Early Adversity on Child Development,” 2007) …

“When strong, frequent, or prolonged adverse experiences such as extreme poverty or repeated abuse are experienced without adult support, stress becomes toxic, as excessive cortisol disrupts developing brain circuits … The more adverse experiences in childhood, the greater the likelihood of developmental delays and other problems. Adults with more adverse experiences in early childhood are also more likely to have health problems, including alcoholism, depression, heart disease, and diabetes.”

Now, this all sounds very clinical and straightforward; however, the reality of toxic stress is the stuff of nightmares. Abusive and dysfunctional parents instill so many negative traits with their monstrous words and actions that their children become “hopeless” – hopeless in both their own eyes and in the eyes of a disbelieving society. In the elongated stress that often begins so early in their life, these children suffer immeasurable damage that can continue for their entire lifetime. Who could adequately measure the horror of such fallout?

Toxic stress can even affect a child’s physical growth – slowing them down from putting on height and weight. Epidemiologist Dr Scott Montgomery and his team at the Royal Free Hospital in London discovered …

"Youngsters who live in very stressful situations have been found to have less growth hormone. If they are taken out of that unhappy situation, the hormone levels recover …The danger is that if the stress goes on for long, it can stunt growth permanently."

There’s also an increased propensity to be involved in criminal activities, both as victim and perpetrator. James Garbarino, PhD and psychological expert witness (Academic Pediatrics (2017), reports …

“It should not come as a surprise that childhood adversity is common and prominent among individuals who kill people. Childhood adversity leads to trauma and toxic stress, and trauma and toxic stress lead to the kind of developmental damage that in turn can lead to violence (as one among many outcomes, or other outcomes such as substance abuse and mental health that could similarly have repercussions for incarceration either as juveniles or adults) in the United States …

“The fact that the ACEs score (adverse childhood experiences) accounts for 65% of the variation in suicide attempts, 55% of the variation in substance abuse, 45% of the variation in depression, and 30% of the variation in violent behavior makes clear the developmental relevance of adversity and toxic stress.”

(Felitti, V.J., Anda, R.F., Nordenberg, D. et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998.)

Prevention and Intervention

Science and common sense shows that providing stable, responsive, nurturing relationships in the earliest years of life can prevent or even reverse the damaging effects of early life stress, with lifelong benefits for learning, behavior, and health. Child development experts may not be able to eliminate the triggers of toxic stress – poverty, neglect, abuse – but they can help support families from the prenatal stage onward

Safe, stable, and nurturing relationships with the support of a caring adult (adults) dramatically decrease a child's stress response, even in the face of significant adversity such as divorce or death of a family member. The presence of protective adults makes it possible for a young child to adapt to stress in healthy ways that facilitate growth and healthy development.

This understanding should behoove us to shift the focus of preventative health care from the doctor’s office to the community. Failure to respond with time and resources is deliberately choosing to “pay later,” placing billion dollar band-aids on problems that will never go away.

Pediatricians are asked to involve schools, community, and government to help aid with toxic stress interventions. Advocacy on a national level is imperative to lobby for funding of meaningful programs and to gain support, financially and otherwise for pediatric healthcare workers to appropriately and adequately screen for toxic stress in the office setting.

Just consider these projections from the National Bureau of Economic Research …

“Estimates suggest that the crime induced by abuse costs society about $6.7 billion per year at the low end and up to $62.5 billion at the high end. The estimates depend on the social costs attributed to crime, and specifically, whether those costs include estimates of willingness to pay to avoid crime.

“It would be interesting to compare these figures to the cost of preventing maltreatment, but few intervention programs have been proven to be effective in rigorous studies. The sole exception is randomized trials of nurse home-visit programs that start in infancy, which have shown that they can reduce the incidence of substantiated cases of maltreatment by 50 percent. At a cost of about $4,000 per child, the total cost of providing this service to all children would be about $16 billion.

“Given that the crime induced by abuse is only one of the social costs of maltreatment, these estimates suggest that such a home visiting program might well pay for itself in terms of reducing social costs, even based on conservative estimates of the costs of crime. If society attaches some benefit to improving the lives of poor children (beyond the value we attach to saving people money), then the cost-benefit analysis of prevention programs begins to look even more favorable.”

“DEPRESSION”

BY Cara Delvigne

Who am I? Who am I trying to be?

Not myself, anyone but myself.

Living in a fantasy to bury the reality,

Making myself the mystery,

A strong facade disguising the misery.

Empty, but beyond the point of emptiness,

Full to brim with fake confidence,

A guard that will never be broken,

Because I broke a long time ago.

I’m hurting but don’t tell anyone.

No one needs to know.

Don’t show or you’ve failed.

Always okay, always fine, always on show.

The show must go on.

It will never stop.

The show must not go on,

But I know it will.

I give up. I give up giving up.

I am lost.

I don’t need to be saved,

I need to be found.