The Crisis Within: How toxic stress and trauma endanger our children

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.

A childish angel adorns the interior satin lid just above the fine profile of Jamyla’s face and gazes down wide-eyed on the children. A message beneath it reads, “You shall fly with new wings.”

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.

They stand in the cement block chapel next to parents and grandparents at the casket, most too shy and uncomfortable to speak. The narrow slivers of stained-glass windows barely draw in outside light.

The children seek solace deep in their parents’ arms. Some of the boys put their hands in their pockets to resist the urge to reach out.

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Palm Springs resident Victor Yepello makes a day trip to the Mexican border town of Los Algodones for a follow up on his root canal with his dentist on Wednesday, May 25, 2016.

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. They had formed a dance crew, making up complex routines, the more difficult to master, the better.

“I would tell her all of my secrets and everything,” Destiny said.

Akeelah Kelly, 8, had played outside with Jamyla on Ellison Drive hours before she was killed. Now, she approaches the casket, quietly and steadfast — like a grown-up little lady, her mother said.

But when she returns home, she cries.

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.

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.

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“It’s a best friend thing. We always be holding on to each other,” says Destiny Sonnier (center), 9, who walks with her friend, Akeelah Kelly, 8, to the school bus stop in Ferguson in October with Destiny’s cousin Anthony Murry, 6. Their friend Jamyla Bolden was killed in her home across the street.

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.

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.”

A member of the dance crew

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.

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.

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Palm Springs resident Victor Yepello makes a day trip to the Mexican border town of Los Algodones for a follow up on his root canal with his dentist on Wednesday, May 25, 2016.

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.

Her grandmother, Mardie Sonnier, would like to adopt Destiny, but she is certain she could never raise $1,700 in needed adoption fees.

After her son was killed, Mardie Sonnier, 67, suffered a heart attack that makes it hard to breathe.

She mostly depends on oxygen tanks that keep her in her small bedroom most of the day. Destiny helps the house function. Her maturity is reflected in her chores. She makes sure her grandmother takes her medicine. She reads stories to her grandmother in bed. And she plays with her little cousin.

Sometimes their play includes spontaneous cartwheels and headstands in the yard after school. But that play has a twist. Last fall, on a warm late afternoon, she and her cousin stopped their flips, knelt on the grass facing each other, and put their hands together in prayer. They repeated it like a dance routine.

“If we pray, we won’t get shot,” Destiny said.

A friend on Ellison Drive

Two days after Jamyla’s death, Akeelah Kelly attends a vigil in front of her friend’s house. She holds a balloon and cries. Photographs of her deep distress appear in the local news.

Jamyla was one of the first girls to introduce herself when Akeelah moved to Ellison Drive with her mom and sister.

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“I was her best friend. She was like my sister,” says Akeelah Kelly, 8, who finds comfort in her mother’s arms during a vigil in Ferguson for Jamyla Bolden, 9, in August. Jamyla was one of the first girls to introduce herself when Akeelah moved to Ellison Drive with her mom and sister.

Natasha Brown (no relation to Michael Brown) hoped suburban life would give the family a break from violence in their old St. Louis neighborhood. The house was federally subsidized and affordable. There was a neighborhood school.

Instead they settled into a new world of stress. Michael Brown was shot within months of their arrival.

A receptionist with Better Family Life’s neighborhood assistance center on nearby West Florissant Avenue describes the area as a war zone. The stress in residents runs deeper than the Michael Brown shooting, with many reliving past and present traumas such as family violence and homelessness.

“A lot of people already have post-traumatic stress disorder from their pasts,” said Yolanda Nelson between walk-in clients seeking help with their utility bills. “That just doesn’t go away.”

After Jamyla died, Akeelah would panic on the school bus when it passed Jamyla’s house. The driver arranged a special stop for Akeelah on a corner just past sight of her friend’s house.

Brown, 30, named her daughter Akeelah after the main character in the movie “Akeelah and the Bee,” in which a girl from a poor Los Angeles neighborhood makes it to the national spelling bee.

But her Akeelah has had to overcome so much more, including the murder of her friend.

“I had never seen that type of pain come from my child. And that hurt,” Brown said.

‘A cold feeling’

Trauma and fear permeated Jamyla’s neighborhood, even before she was killed.

On Aug. 8, a group of mostly Koch Elementary children were celebrating a ninth birthday party outside at the Northwinds Apartments complex, a five-minute walk from Jamyla’s house.

About a dozen children and young adults played on the common lawns some 25 yards from the teddy-bear tree — a stuffed-animal memorial for a man who was found shot dead in a car a year ago.

Three young men bolted out of an apartment in a dispute. At least one of them had a gun and began shooting before they ran off and jumped into separate cars. No one was hurt.

“Everybody ran in the house and dove to the floor,” recalled Darlene Evans, 45, a mother of 10, five of them under age 12.

“After that, I told the children, ‘You could be next,’” Evans said.

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Evans’ youngest kids went to bed in her bedroom, hunkered down on the floor and on the mattress, wrapped in quilts, but low and away from windows.

Two weeks later, Jamyla was shot.

“It just was a cold feeling,” Evans said, rubbing her hands down her arms.

Toxic stress shortens lives

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.

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.

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.

Psychotherapist Debra Zand, of Danis Pediatrics at Cardinal Glennon Children’s Hospital, said she is often referred young patients with unexplained behavioral problems.

One boy she treated played with a small dollhouse in her office, she recalled. He picked through its rooms and clutched a miniature wooden bathtub in his hand. Zand asked him what he’d picked.

“He called it a coffin,” she said.

Zand said such problems are caused by multiple layers of trauma and stress.

“This is a way of life for the family, and the kids don’t know any different.”

A risk before birth

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.

Tallying trauma

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 Health Care, 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.

Both Natasha Brown, Akeelah’s mother, and Darlene Evans, the mother at the Northwinds Apartments birthday party, took the ACEs survey at the request of the Post-Dispatch. They reported eight childhood traumas each.

Brown said she was molested as a child within her extended family. She spent her teens in foster homes and residential institutions after her mother gave her up to raise her other sisters. She had her first child with her now husband at 16, and vowed always to keep her children.

Evans also was sexually abused during childhood, she said. Beatings provoked her to run away. She attempted suicide as a preteen.

Both mothers have significant health issues that began showing in early adulthood. Evans has high blood pressure and suffered a serious stroke last year. Brown has asthma and knees that wore out before she turned 30. It’s impossible to say whether those medical conditions resulted from trauma in childhood, and yet those maladies are linked by research to toxic stress.

And now, they say their lives in Ferguson sometimes feel as dangerous and stressful as their childhoods.

In the months that followed Jamyla’s death, the women have confronted crime, a lack of transportation, health issues, a loss of utilities and debt. At times they are able to offer the kind of love and support experts say can help children avoid the dangers of toxic stress. Sometimes they have been able to access public programs to help them and their children.

Other times, they find themselves paralyzed by their situations and on the edge of “losing it.”

Though they don’t know the science of toxic stress, they say they often worry their kids are being harmed because of their struggles.

‘I can’t fix it’

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Natasha Brown, 30, cooks dinner in October at her home in Ferguson. Brown, who lived most of her life in St. Louis, can’t wait for her Section 8 subsidized housing lease to run out so she can move her girls out of Ferguson.

In early September, about a week after Jamyla’s funeral, Natasha Brown is sitting on her couch when the hum of her appliances falls silent. She is struck with a stress common among the poor in St. Louis: Her electricity has been shut off. She was $1,800 behind on her bill and could not negotiate a payment plan because of a bounced check.

Brown drives to various agencies to find assistance. She receives offers of a hundred dollars here, some more elsewhere, but not enough to clear the bill and get the power back on.

Akeelah, her sister and a cousin who lives with them are sent each day after school to sleep at a friend’s house.

Without power, Brown fears she’ll lose her rent voucher — and the house — and that could trigger the loss of her children to foster care.

She had given up a good job cleaning medical equipment when her knees failed and she needed surgeries, leaving behind more than $20,000 in medical bills.

She and her husband, Demont Kelly, regularly give blood at a north St. Louis County plasma clinic: about a $35 net for each of them, nothing close to what they need.

Kelly, 33, is an attentive dad, but he is banned by state law from living in their Section 8 house because he owes a court fine that will clear him of probation on a minor felony charge.

By mid-September, Brown is really struggling.

“This situation — I feel like I can’t fix it,” Brown said. She knows the family’s troubles are hurting her children. Akeelah is cursing and arguing at school. She and her sister beg to go back to their own rooms each day after school.

“Akeelah says she is fine,” Brown said. “But if you knew her before this all happened, you know that she is not. As a mother, you know that she is hurting.”

In October, Brown finds utility assistance after St. Louis County releases special funds to aid residents in Ferguson.

The power is turned on, and the family returns home.

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Some of the stress lifts. Akeelah begins riding the school bus past Jamyla’s house without fear. Behavior reports come home from school with more “green lights” than red ones. And Brown starts working a temporary job at a factory in St. Charles.

After months of turmoil, she feels calm. Laughter and regular prayers return to the household — signs of the type of mental resilience researchers say can protect children from toxic stress.

The family starts scanning classifieds for a safer place to live. Just before Christmas, Brown gets a call and erupts into tears. She is offered a security guard position with St. Louis Public Schools with a start date after the new year.

And yet, as Brown and her children approach winter, new anxieties emerge.

For several weeks, the gas is cut off, sending her and the girls to bed some nights amid the orange glow of three whirring space heaters.

Then, just before the new year, the family car is repossessed.

Destiny’s big worry

In early fall, Destiny Sonnier decides to attend counseling sessions after school. She is sorting out her feelings about her father’s murder and Jamyla’s death. She said her counselor reminds her to see things differently and to remember that she is very strong.

“She helps me go through how I’m feeling at home and how I’m feeling about all the things happening to me,” Destiny said. “I’ll be angry because of all this stuff, and I’ll be thinking in my head, why did this stuff happen to me?”

Through the fall, she takes step classes at school, serves as a school bus monitor and plays outside with her cousin.

Her grandmother tries hard to remind Destiny she is still a little girl despite her troubles.

But as the year goes on, the grandmother shelters a worry.

With a murder trial approaching this year for two defendants, she knows she has to tell Destiny for the first time about the harsher details of her father’s death. It is only a matter of time before she reads about it in the newspaper.

In the meantime, Mardie Sonnier provides an important relief for her granddaughter and others.

Every school day she invites the neighborhood children inside her tiny kitchen to pray in a cramped circle before the bus comes. The ritual had included Jamyla before she was killed.

Some mornings Akeelah makes her way across the street to join Destiny and others in the circle. Sometimes the prayer is simple: God, get us to the school bus safely.

Despite the comfort of morning prayers, Destiny heads into winter with another worry. She knows the circle will likely shrink again.

“My friend, Akeelah, she is going to move,” she said. “And Jamyla, I don’t have her to play with no more. So what’s to do?”

Destiny does not want to be left behind on Ellison Drive.

[This story was originally published by St. Louis Post-Dispatch.]

Photos & videos by Laurie Skrivan/St. Louis Post-Dispatch.