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Solutions that work: Positive relationships can counter harmful effects of stress on the brain

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Solutions that work: Positive relationships can counter harmful effects of stress on the brain

Picture of Nancy  Cambria
Fourth-grade classmates Rayell Hickman (left) and Kendal Bolden decorate the desk of his sister Jamyla Bolden at Koch Elementary School in September. Jamyla was killed in a drive-by shooting on Aug. 20, 2015, while doing her homework inside her mother’s bedroom.
St. Louis Post-Dispatch
Sunday, February 21, 2016

There’s hope for fighting toxic levels of stress in children — hope you can actually see in brain scans from research conducted by St. Louis psychiatrist Joan Luby.

In scientific terms, the images show that children’s brain development can be sheltered from the ravages of trauma, such as violence, abuse and poverty.

In more human terms, the brain scans show that positive relationships with parents, family and others can protect and heal.

Luby’s research at the Washington University School of Medicine has documented that children in poverty without that support have smaller volumes in parts of their brain dealing with stress management, learning and executive decisions. Children in the same stressful circumstances, but with positive supports, have normal-sized brains.

It’s a concept that has been reinforced through other research. Children and adults cope with stress better when they have developed emotional resilience. And that resilience is built through positive relationships.

That kind of support can lower a child’s abnormal output of stress hormones — a key biological threat to health and development.

The takeaway for parents is a hopeful one: When stress threatens the well-being of children, simple, proven techniques work. It’s a message that has relevance to all parents, regardless of neighborhood or income level.

Ruth Coleman got a crash course in stress when she, her husband and her four children were in the midst of losing their Warrenton home to foreclosure. They were forced to move into a mobile home in a rural town.

But thanks to a referral from her youngest son’s Early Head Start program, they were already taking a parenting class that offered techniques to help the family cope.

She said the class gave them strategies to keep perspective and maintain a sense of humor. So, when her youngest children, ages 4 and 8, started loudly arguing over a banana during an interview, she let it slide because, “it’s not going to make a hill of beans whether they were fighting over a banana today.”

Coleman said she now lets her youngest son direct his play with her. Letting him make the rules took away power struggles and enabled her to better bond with him — a key factor in keeping toxic levels of stress at bay.

Ultimately, child advocates in St. Louis say toxic stress is a preventable health problem here — with adequate public and civic investment.

St. Louis has programs and initiatives dealing with toxic stress. But only 30 percent of the children in the region in need of mental health and behavioral support get it, according to a survey by the St. Louis Mental Health Board.

Investment has been further hindered by biases against the poor, who are likely to need the services most.

“We are far too likely to point fingers at poor parents and households when they need our help and support,” said Anne Kessen Lowell, the former director of SouthSide Early Childhood Center.

Luby argues this is not rocket science. Solutions have been known for years.

She and others point to a blueprint for combating toxic stress among children and families in St. Louis.

Strengthen family bonds

Unique Davis, 11, of the Old North neighborhood in St. Louis, has a father who went to prison when she was 5. He’s serving an 18-year sentence.

Depression and anxiety are rampant among children who have parents or other loved ones in prison. In Missouri, the number of children with parents in prison is about 48,000, about the population of Chesterfield.

These children worry fiercely about their parents, and vice versa, said Hakee Mitchell, founder and executive director of Assisting Children of Prison Parents, an organization in Ferguson that offers tutoring and mentoring.

In November, the group arranged for Unique to visit her father.

Moments after Unique spotted him in the prison visitors’ room, she ran into his arms. They played cards and talked about the future when her dad would someday be free.

“It’s almost like a sense of calm comes over them,” Mitchell said of the prison visits. “It’s like, ‘OK, I’ve had questions, and now they’ve been answered.’ ”

Know trauma symptoms

Toxic stress and trauma trigger outbursts over incidents that other children handle more easily. From elementary grades through high school, that can lead to suspension or expulsion and possible juvenile court involvement.

Jennings schools Superintendent Tiffany Anderson wants staff and students to understand trauma and ways to de-escalate that stress response.

Under the guidance of Washington University School of Medicine pediatrician Sarah Garwood, the school district received a $60,000 grant from Missouri Foundation for Health to help staff and students better understand trauma and stress.

It is one of many trauma education initiatives taking place locally and statewide in the fields of education, health, youth services and juvenile rehabilitation.

Staff and students are learning how past trauma can be reactivated by triggers such as certain words or smells or confrontation that reminds children of past violence. They focus on tamping down confrontations. The district plans to create safe places in each school for students to work through sudden anger and other painful emotions.

“We’re giving teachers a new framework on how they respond to student behaviors,” said Anthony Robinson, the district’s director of secondary education.

Start before birth

Babies born to depressed or stressed mothers are less likely to receive the nurturing they need. And that hurts brain development when it’s needed most.

It’s why Cynthia Rogers, a psychiatrist and researcher with WU’s School of Medicine, created a program at Barnes-Jewish and St. Louis Children’s hospitals that screens new mothers for depression.

In late October, Keonshay Clark, 22, was identified as needing help after she gave birth to her second daughter, DaKodah, at Barnes-Jewish. She needed to find a new place to live within the month.

Social workers at the hospital referred Clark to Nurses for Newborns, a home-visiting program that tracks the health of the baby and supports the mom.

“We are really there to lift them up in their parenting role,” said Melinda Ohlemiller, chief executive at Nurses for Newborns, who said about 40 percent of the new moms they serve test positive for depression.

Empower moms with hope

New moms dealing with toxic stress often feel isolated and hopeless.

Kendra Copanas, chief executive of the Maternal Child and Family Health Coalition, said mothers, particularly in the African-American community, often do not seek help.

Copanas said agencies in St. Louis are trying to break that isolation in unique ways. The maternal child coalition, for example, recently started a “Letters of Love” campaign in which volunteers write letters of congratulations and support to expectant and new moms in stressful situations.

The coalition also hosts a mothers support group. One of the members is Shanette Upchurch, 42, a mother of four from Riverview. Upchurch copes with isolation, depression, debt and a history of abuse. Work is hard. Twenty years ago, Upchurch said she saw firsthand how toxic stress in her life was damaging her children. It was the day she was called to come quickly to the school office. She found her kindergartner throwing desks and chairs in the principal’s office.

Therapy revealed her son had absorbed years of trauma from watching his mother being beaten by a partner. He was exhibiting a “fight or flight” response common to children under intense stress.

Her son is now a high school graduate, employed and an involved dad.

“But it took so much just to get him as a functioning person,” she said.

Five years ago, after her youngest child was born, Upchurch signed up for home-visiting services and therapy, and joined the support group. She said the group changed her outlook on life and parenting. She’s so hooked she convinced her daughter, 19, and her daughter-in-law to join.

“I need to be at these meetings,” she said. “When I come here it’s like family.”

Teach parenting strategies

Some parents never got the nurturing they needed when they were young and have few parenting models, said John Constantino, a psychiatrist and researcher with WU’s School of Medicine. These parents may not know the best ways to fully connect with their own children, particularly amid high stress.

Constantino is managing a federally funded trial program in the St. Louis region to protect children from toxic stress. It uses a specialized parenting education program to train groups of parents with children enrolled in Early Head Start programs.

The program supplies “good enough” parenting tips and teaches praise as a first response. Ultimately the strategies help parents better enjoy their parenting role, and their children’s behavior improves, Constantino said.

“It makes parents more attuned to protect their kids from their stress,” Constantino said.

Coleman, who took the class with her husband amid their foreclosure crisis, said the class taught her the value of simple but focused play time with her children.

“That type of play says, I’ve got this 15 minutes with you,” she said. “No matter what else is going on in my life, you’re my center of attention for this 15 minutes.”

Encourage wellness

One evening a month, Dr. Thomas Kernan takes off his white medical coat and heads into a conference room at an Affinia Health Care clinic to conduct a Mind-Body Skills Group for patients, most of them low-income, dealing with toxic stress.

Kernan, along with a social worker, teaches relaxation and breathing skills, guided imagery and meditation to help patients reduce stress. He said regular relaxation techniques can be as effective as medication to alleviate high blood pressure, diabetes, heart disease and other maladies.

Kernan is a graduate of the national Center for Mind Body Wellbeing, which has studied the effects of stress relaxation and mindfulness in struggling populations around the world, including refugees. In St. Louis, he said his patients typically have histories of trauma.

“All of these kids and families that I see that are exposed to these toxic effects of stress would benefit from learning some self-care skills to help decrease those effects,” he said.

Kernan goes so far as to hand out to patients a self-recorded, 15-minute CD called “Soft Belly,” which promotes breathing through your belly, mimicking how infants breathe. He tells them to use the CD five times a week.

With his soothing voice and ambient music and ocean waves in the background he asks patients “begin to breathe through your nose and out through your mouth, relaxing and letting go with each exhalation … letting your belly be soft.”

Talk about stress

Wellness programs of all sorts are now considered a necessity for health, particularly among the poor — so much so that the St. Louis Regional Health Commission launched the wellness initiative Alive and Well STL to reduce toxic stress regionwide.

It aims to make the concepts of stress reduction and positive relationships more universally known and practiced in the region. Benefits should ultimately trickle down to children.

Connie Fisher of Mental Health America of Eastern Missouri, who gives stress information training through the initiative, said people still lack basic information on reducing stress. Even 10 to 15 minutes a day of mindfulness — being completely present in the moment — can make a huge difference, she said.

More widely, Alive and Well STL aims to remind everyone they have power to help someone in pain during stressful times. They may not be able to change gun violence or poverty, but the group argues that small words and actions can incrementally make a big difference.

“A big part of this is the availability of caring and loving supportive people around us,” said Joe Yancey, chief executive of Places for People and spokesman for the Alive and Well initiative. “Because the reality is, at the end of the day, my well-being is dependent on the well-being of my neighborhood, of my co-workers, of my child’s school and its families.”

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

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