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      Routine Versus Catastrophic Influences on the Developing Child

      1 , 2
      Annual Review of Public Health
      Annual Reviews

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          Abstract

          Exposure to toxic stress accelerates the wear and tear on children's developing bodies and leaves a lasting mark on adult health. Prior research has focused mainly on children exposed to extreme forms of adversity, such as maltreatment and extreme neglect. However, repeated exposure to less severe, but often chronic stressors is likely to play as large, if not larger, of a role in forecasting children's future mental and physical health. New tools from neuroscience, biology, epigenetics, and the social sciences are helping to isolate when and how the foundations for adult health are shaped by childhood experiences. We are now in the position to understand how adversity, in both extreme and more mundane forms, contributes to the adult health burden and to identify features in children's families and environments that can be strengthened to buffer the effects of toxic stressors. We are also positioned to develop and implement innovative approaches to child policy and practice that are rooted in an understanding of how exposure to toxic stressors can become biologically embedded. The stage is set for the creation of new interventions—on both grand and micro scales—to reduce previously intractable health disparities.

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          Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults

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            Ecological Momentary Assessment

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              The lifelong effects of early childhood adversity and toxic stress.

              Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.
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                Author and article information

                Journal
                Annual Review of Public Health
                Annu. Rev. Public Health
                Annual Reviews
                0163-7525
                1545-2093
                March 18 2013
                March 18 2013
                : 34
                : 1
                : 29-48
                Affiliations
                [1 ]Sanford School of Public Policy and the Center for Child and Family Policy, Duke University, Durham, North Carolina 27708; email:
                [2 ]Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104 and MRC Social, Genetic, and Developmental Psychiatry Centre, King's College London, London, SE5 8AF, United Kingdom; email:
                Article
                10.1146/annurev-publhealth-031912-114447
                23297656
                df143a7c-7839-4476-b952-73b143201a35
                © 2013
                History

                Sociology,Education,Social policy & Welfare,Psychology,General behavioral science,Family & Child studies

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