I came across an article in the September/October 2012 issue of Scientific American MIND concerning the effect that stress can have on children and their capacity to learn. The researcher summarized years of work and ongoing studies showing the effect of stress hormones on the developing neural connections in the prefrontal cortex (the part of the brain right behind your forehead). That is where the “executive functions” take place. Executive functions include a wide variety of ‘under the radar’ processes that impact on how someone functions on a second-by-second basis. It helps to regulate what you pay attention to, and what memories are used to interpret and process situations that you are presented with. It effects how well you regulate your emotional response to a situation. In short, it is the “CEO” of your brain. The pattern of connections that develop in the prefrontal cortex is of profound importance in how the developing child will be able to cope with the demands of life.
As we all know, this is an increasingly stressful world, made only worse over the last several years with the economic issues that many of us have had to face. Kids are not immune from awareness of that stress, and have always had to endure with the difficult situations that their parents have found themselves in. But does it impact on their brain development? Apparently so.
The research sites a direct correlation between salivary cortisol levels and executive functioning in children who are exposed to an academic and social stress. Cortisol is one of the main “stress hormones” used by the body to respond to stressful events. The researchers found that kids with the best executive functioning had a normal pattern of cortisol response when stressed . . . it started low . . . went up during the stress . . . and then went down again. Kids who have been identified as having poor executive functioning showed either sustained high levels of cortisol, or a high level of cortisol that dropped precipitously during the stress. Both of the groups of kids with cortisol response dysfunction were identified as being prone to aggressive behavior and to poor impulse control.
Where do yo think THESE kids end up . . . RIGHT!!!! In my office.
Where I likely diagnose them with ADHD–an executive function based disorder that is, apparently, influenced by the body’s own response to stress. And then prescribe medicine to improve neurotransmitter functioning in the prefrontal cortex. What has seemed like a great intervention, is now feeling like a band-aid. I have no doubt about the benefits of the medicine, but what if we could intervene early and help to alleviate the stress that is felt by these kids so that their brains can develop normally? What if we could intervene NOW and help manage their level of stress and, perhaps, improve their academic and social functioning with less . . . or no . . . medicine.
How great would THAT be!!!
One of the stumbling blocks to this process, is that parents (and society) often feel that the medicine is enough. It can be SO beneficial SO quickly that it appears as if nothing else is needed. “OK . . . so . . . I give this medicine to my out-of-control-failing-school-kid and . . . shazaaaaammmm!!!! . . . . he/she is suddenly getting B’s and A’s and I don’t have to worry about this anymore!!!” But what if the REAL answer to this is stress management and other life management skills. What if we could routinely measure and identify those kids with neurotransmitter and stress-hormone dysregulation and intervene in the early stages of brain development with stress management strategies that could make a lasting difference? What if we could learn how to intervene to make healing possible? So many hopeful paths.
For me, the take home message from this article was the need to intervene early and to provide stress management to children, parents and families as early as possible, and to NOT let the intervention be solely based on medication. This will likely make a difference in the short run, and may make a profound difference to a child’s academic and social outcome in the long run.
–Dan Hartman, MD
