Toxic Stress

The Behavior Bootcamp

Do We All Have Toxic Stress? Maybe…

By: Dr. B

I received a text from a Special Education Director a few days ago, stating “Dr B we need you, we have a kiddo that looks like your kind of student.” I set up a meeting with the team and found out that the child was diagnosed with ADHD and this 6 year old was hitting, kicking, biting, and eloping from school. The team explained that they were concerned because he was making statements about how he wanted to hurt them. I asked the team if they knew if the student had an ACE’s screening, Adverse Childhood Experiences, and they indicated thatt they had not heard. In a 2019 article by Lisette K.M. Walbeehm-Hol and Jamiu O. Busari stated that only 17% of providers complete an ACE’s screening (2022). I quickly pulled up a screening tool while we chatted and based on a brief conversation noted 3 indicators.

Here is a list of the ACE’s indicators:

Physical, Emotional, or Sexual Abuse
Emotional or Physical Neglect
Incarceration of a parent
Divorce or Separation of a parent
Mental Illness within the home
Domestic Violence within the home
Bullying
Racism
Natural Disaster
Refugee Experiences
Witnessing a Violent Crime

(Isler, 2023)

Next we reviewed the list of symptoms for toxic stress in children;

Withdrawal
Defiance
Aggression or risky behavior (often times targeted to someone or themselves)
Sleep Disturbances and/or nightmares
Memory Problems
Confusion/Disorientation
Poor Concentration
Difficulty identifying people or objects
Physical Pain - headaches, stomach aches, digestive issues, etc.
Overwhelmed
Anxious or afraid
Depression, disinterest
Racing thoughts
Irritable, angry, impatient
Hyper, unable to calm down, always in motion
Lethargic and unable to feel rested

Obviously, this list could indicate a number of things, one of which is ADHD, which is why it’s so important that an ACE’s screening be completed and why a medical intervention like medication may not provide the appropriate intervention. This student, according to the educators, was displaying 8 of the symptoms.

So, What is Toxic Stress?

According to the ACES’s Aware (“Aces Aware” 2024) Toxic stress is the body’s response to lasting and serious stress. Meaning that the body goes into the freeze/flight/fight response over and over again, typically not ending in a 3 month or longer period. When this happens, the body can’t turn off the stress or even adequately evaluate stress normally. This causes the fear center of the brain (limbic system, amygdala) to increase in size (Texas Children). This causes the area of the brain to become overactive and is especially dangerous for children whose biology is developing. In response to this stress children develop maladaptive coping skills, poor stress management, unhealthy lifestyles, mental illness, and physical diseases according to the National Library of Medicine article by Hillary Franke (2014). It can also lead to health issues, mental illness, substance issues, issues with cognitive functioning, immune functioning and more.

A student that I started working with 2 months ago is a high school student in which we have identified at least 7 ACE indicators. This student has been diagnosed with several mental health issues, ADHD, and her academic testing shows an IQ that is much lower than had been estimated 3 years prior to the recent evaluation she had. She is also out of school quite frequently for an autoimmune disorder she has been diagnosed with in the last year. Could Toxic Stress be impacting her? Toxic stress is chronic and the presence of 4 or more ACE’s is an indication that someone is more likely to experience Toxic Stress.

So, if you don’t have ACE indicators, or you only have one or two, can you have Toxic Stress?

Yes, you absolutely can, the list is not exhaustive and there are definitely other issues that could create stress. For instance, COVID 19 created a very unique stress. The behavioral incidences the year returning to school after the lock-down from COVID 19 were significantly lower than they had been prior to COVID 19. However, the behavioral incidences that have been occurring in the past year are significantly higher than pre-COVID. Symptoms that could indicate Toxic Stress are also more prevalent in the past three years.

How do we support those that could exhibit toxic stress?

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