AAP: Healthy relationships can help offset toxic stress

Healthy relationships can help offset toxic stress

Toxic stress can have lifelong negative effects. A new policy statement from the American Academy of Pediatrics (AAP) examines how healthy relationships may serve as a buffer.

It isn’t enough to try and prevent traumatic events in childhood. Supporting healthy growth also means helping children identify stable and supportive relationships in their life. These relationships can buffer bad experiences and promote resiliency, according to a recent policy statement from the American Academy of Pediatrics (AAP).

The policy statement updates previous data on the lifelong effects of toxic stress in children with information on the value of a nurturing relationship with at least 1 stable adult.

“Childhood toxic stress is a public health crisis that demands an integrated public health response. With a social isolating pandemic, a widening of disparities, and a reckoning with centuries of systemic racism, the concept of toxic stress has never been more relevant,” said Andrew Garner, MD, PhD, FAAP, a pediatrician from Westlake, Ohio, and clinical professor of pediatrics at Case Western Reserve University in Cleveland.

Garner, a member of the AAP committee that developed the report, explained that toxic stress can permanently remodel a child’s brain at the cellular level, resulting in behavioral changes that become biologically embedded. Addressing these stresses is 1 step to helping children at risk, but Garner said the policy focuses on what pediatricians can do to be proactive.

“Toxic stress is a deficits-based model in that it defines the problem. Toxic stress explains how many of our society’s most intractable problems—disparities in health, education and economic stability—are rooted in our shared biology but divergent experiences and opportunities,” he explained. “Conversely, relational health is a strengths-based model in that it defines the solution. Relational health explains how the individual, family, and community capacities that support the development and maintenance of safe, stable, and nurturing relationships also buffer adversity and build resilience across the life course.”

In 2012, the AAP outlined the dangers of toxic stresses—early childhood experiences that become biologically embedded and impact life-long development—in a policy statement. The recent policy statement updates the lessons from that report, focusing on how relational health can be used to buffer and support growth and resiliency in spite of toxic stress.1

Toxic stress refers to a wide range of childhood experiences that have physical, behavioral, and even cellular impacts on a developing child. Many of these experiences are the result of relationship challenges like the lack of a nurturing support system, and things like homelessness or insecurity over food and housing. These stresses can damage the entire trajectory of a child’s life, according to the policy statement, and may be to blame for some of the most challenging disparities that develop in adulthood.

The statement outlines new research that suggests that positive childhood experiences can have a protective effect against toxic stress, even working to reverse the effects of damaging experiences.

Safe, stable, and nurturing relationships are key to promoting relational health, according to the paper, because they not only buffer toxic stresses but they also help build resiliency. The policy statement therefore advocates for a new focus on not just preventing toxic stress, but also on promoting relational health.

“Promoting relational health and preventing toxic stress are 2 sides of the same coin. Toxic stress is a deficits-based model that describes what goes wrong in the absence of nurturing relationships,” Garner wrote in a summary of the new policy statement for AAP.2 “Conversely, relational health is a strengths-based model that describes what goes right when children are afforded safe, stable, and nurturing relationships and positive early experiences.”

Building relational health is a process that can take at least 2 generations, he added, noting that it takes multiple layers of family and community effort to support a child’s emotional needs. When a child’s support system functions in “survival mode” because of their own stresses, they aren’t able to provide a positive childhood experience or a background of supportive relational health for future generations.

“Understanding that process allows us to see how many ‘adult-onset’ diseases are actually ‘adult-manifest’ diseases with their origins in childhood,” he added.

Addressing these issues, which Garner called a public health crisis, requires both vertically and horizontally integrated efforts. Vertical efforts are rooted in a public health approach that supports stable relationships throughout childhood. Horizontal efforts can include policy and societal changes designed to support families and community health.

Garner said pediatricians are uniquely positioned to universally promote relational health; identify and address potential barriers to relational health; and utilize the common factors approach and refer to evidence-based therapies when relationships are strained. Some examples of universal promotions include educating parents about development, promoting lots of developmentally appropriate play, and supporting emotional intelligence by helping kids tap into their passions when distressed or bored.

“Potential barriers to relational health that the pediatrician might identify and address include: parental adversity as a child; parental mental illness or substance abuse; or the child’s exposure to poverty, violence, or racism,” Garner added. “Attachment and Biobehavioral Catch-up, Parent Child Interaction Therapy, and Child Parent Psychotherapy are all evidence-based interventions to support relational health, and pediatricians are well placed to advocate for the local development of these services.”

According to the report, another challenge is the fact that our society as a whole is moving toward increased division and social isolation, leading to even more barriers to the formation of stable, healthy relationships that can support relational health. AAP is working to develop practices and policies that can help support healthy relationships despite these challenges. A few starting points that have been identifies include:

  • Support nurturing relationships. This is a core function of the family-centered pediatric medical home and a focus of the statement. How to promote relational health in families is a hot topic in pediatric research, and pediatric primary practices may be the perfect place to focus intervention efforts.
  • Reduce external stress on families. Addressing family stressors such as financial circumstances or ill family members—even in adult members who are not normally included in the pediatric care spectrum—can go a long way toward overcoming barriers that increase toxic stress and make it more difficult to promote relational health. Clinicians can suggest programs that could help either ameliorate or solve such stress points.
  • Strengthen core life skills. Offering support for core life skills like executive function and self-regulation is something pediatricians are used to doing for children, but not other members of their families. Including parents and caregivers in these efforts by doing things like providing education on basic child-rearing and the importance of establishing daily routines.

Why you’re having a hard time reading your coworkers’ emotions lately

A critical way we maintain relationships is by being in tune with others—reading facial expressions, interpreting emotions, and responding. But this has been tough over the last year. We haven’t seen each other as much, so we may be out of practice. Moreover, mask mandates have been integral to public health but affected how we read emotions. The eyes may be the “windows of the soul,” but over the last year or so, we’ve learned, eye contact alone doesn’t tell the whole story.

This is to say communicating feels different when portions of our faces are covered. But in the same way we are coming back from the pandemic, we can also renew our appreciation for the facial expressions and body language signs that helped build relationships and rapport. In particular, smiling has intriguing implications. Challenges of reading emotions

Even in the best of circumstances, reading facial expressions is tough. Computer experts have even struggled to develop an algorithm that does it successfully. And despite the fact that facial responses are innate and automatic, the average person is often wrong about how they interpret expressions, or they are unaware of them. In addition, people interpret facial cues based on their own unique perspectives, which introduces even more variability into the process.

Our interpretation is also dulled when we can’t see a whole face. This is true when we’re wearing masks, but also when we’re wearing sunglasses and when we see faces from a distance or through a brief glance. A study by the University of Wisconsin found children struggled to identify expressions. When faces were covered with masks, they correctly identified sadness only about 28% of the time, anger 27%, and fear 18%. How to successfully sync up

Reading others’ expressions allows us to empathize and relate to the people around us. And human connection is critical to our well-being. We are hardwired to connect with others. In fact, a study by the Basque Centre on Cognition, Brain, and Language found when people were in conversations with others, their brain waves mirrored each other. In addition, we have an instinct to mimic facial expressions, which helps us experience and identify with others’ feelings, according to a research by the University of Wisconsin . We crave relationships, and seeing and interpreting signals from each other are important ways we form bonds.

There may also be a genetic component to the way we relate. According to research from Northwestern University , people’s ability to quickly recognize emotions was partly based on genetics, and those who recognized others’ emotions also expressed their own emotions more quickly; consequently, there is a reciprocal relationship between expressing and interpreting emotion. More research from University of Birmingham shows the […]

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