American Academy of Pediatrics Casts Spotlight on Childhood Adversity

How might we improve our nation’s educational achievements, spur economic productivity, cut crime, and lessen inequalities in health?

The Center on the Developing Child at Harvard has an answer: Protect young children from adversity. And the American Academy of Pediatrics (AAP) has taken the challenge.

This month the AAP issued a policy statement, crystallizing decades of scientific research on the damaging effects of early childhood adversity into five formal recommendations for the pediatric community. Key strategies in these recommendations included breaking down the barriers between physical and mental health, training all doctors about the importance of reducing toxic stress in children, and encouraging pediatricians to take the lead in education and advocacy efforts targeting this societal scourge.

Co-authored by Jack P. Shonkoff, MD, Professor of Child Health and Development and Director of the Center on the Developing Child, the AAP’s call to action was accompanied by a technical report describing the myriad lifelong consequences of toxic stress in childhood.

Some of these findings were featured in the NY Times. They will also be highlighted tomorrow at the inaugural Conte-CBS Colloquium on Mental Health, featuring a lecture by Shonkoff entitled “The Biology of Adversity and the Early Childhood Roots of Impairments in Learning, Behavior, and Health.”

The Molecular Traces of Adversity

So what exactly is toxic stress? These are the things no child should have to endure—such as physical, emotional, or sexual abuse, extreme neglect, hunger, exposure to violence, having a caregiver who is addicted to drugs or alcohol or suffers from severe mental illness. Often these types of toxic stressors are endured without consistent support from another adult.

Long after any obvious physical evidence of toxic stress disappears, scars may remain at the molecular level. In 2009, researchers at McGill University discovered “how adversity gets under the skin”—identifying a biochemical mark in the brains of suicide victims that correlates with histories of child abuse. Specifically, the promoter of the glucocorticoid receptor gene NR3C1 was epigenetically modified—methylated—such that the gene was expressed at lower levels in the hippocampi of suicide victims who had been abused, compared to suicide victims who had not been abused.

Last month, a separate study of adults with mental illness who had been abused as children suggested that the extent of NR3C1 methylation (examined via blood samples) may actually correlate with the severity or type of trauma experienced—as well as that trauma can be quantified or categorized.

Early childhood adversity may even be linked to premature cellular aging, according to new findings from The Bucharest Early Intervention Project. This unique, international clinical trial, headed by Charles Nelson, PhD, Professor of Pediatrics at Harvard and Director of the Division of Developmental Medicine at Children’s Hospital Boston, compares foster care to orphanage life for young Romanian children and over the years has yielded lots of evidence on the horrifying developmental consequences of severe child neglect and social deprivation.

In the latest study, led by Stacey Drury, MD, PhD, Assistant Professor of Psychiatry and Neurology at Tulane University, the team examined the length of telomeres—protective DNA caps on the ends of chromosomes, which get shorter as we age—and found that adversity seems to accelerate telomere shortening. The more exposure children had to institutional care in early childhood, the shorter their telomeres were later on.

While questions abound as to how toxic stress is transduced into these types of molecular changes, and what interventions are most effective, what the AAP statement points out is indisputable—early childhood adversity is an area where we desperately need to translate science into social change.

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