When children endure toxic stress, it can have lifelong impacts on their health, education and well-being. Dr. Philip A. Fisher, professor of psychology and research scientist at the Prevention Science Institute at the University of Oregon, believes traditional evidence-based interventions are too cumbersome and expensive to replicate widely. He argues that researchers, program developers and policymakers must become more flexible and innovative in finding ways to mitigate the effects of toxic stress.

Dr. Fisher spoke Thursday evening at the annual Community Lecture Series hosted by the Marsico Institute for Early Learning and Literacy at the University of Denver. This Q&A, which has been edited for length and clarity, took place earlier in the day.

Q: How did you get interested in the topic of toxic stress?

Dr. Phillip A. Fisher, senior scientist at the Oregon Center for Social Learning.
Dr. Philip A. Fisher

A: In high school, I started volunteering in a residential treatment center for severely emotionally disturbed kids. I worked at summer camps for troubled kids during college.

What I continued to encounter were these things that really didn’t have adequate explanations. So, why were so many of the kids we were working with from disadvantaged communities, from poor backgrounds? Sure, kids who don’t have opportunities don’t do as well, but it didn’t really explain why there were the specific kinds of issues that we saw in these kids.

The models that were out there…mostly consisted of assigning labels to kids. You have conduct disorder. You have attention deficit disorder. They didn’t say much about what was going on.

Q: What is toxic stress?

A: It has to be put out there first and foremost, not all stress is toxic…We know that some stress is probably not a bad thing. It actually can help make people stronger.

In early childhood what [toxic stress] really means is prolonged activation of these bodily systems…that are designed to help us respond to stress, in the absence of any kind of supportive care.

If there’s a lot of distress that a child or infant is experiencing—they’re hungry, they’re tired, they’re scared—and it happens consistently over long periods of time and there’s no caregiving adult present—somebody to help buffer the child from the experiences of stress—that’s when things move from tolerable to toxic.

Q: How does toxic stress manifests itself in children?

A: Kids become much more sensitive to stress in their lives. So, when they experience stress, they tend to function more poorly. We see that not only in terms of their ability to concentrate and focus in class but also health vulnerabilities. They’re more likely to get sick. They’re more likely, over their life span, to have problems with things like diabetes, heart disease and obesity.

It’s also increasingly clear that toxic stress really does have the potential to disrupt the architecture of the developing brain…so (kids who experience) significant toxic stress, of some types, have more difficulty with self-control. In a classroom setting, they tend to be more impulsive. They tend to be the ones more likely to lash out or do things not consistent with the rules. They have a hard time shifting their attention flexibly from one thing to another.

Q: What are the implications of toxic stress for educators tasked with helping children achieve academically?

A: The first thing is just to understand that those kids aren’t (misbehaving) because they’re troublemakers or they’re willfully disobeying you. One of the things that’s become clear from our research is that those kids just don’t process information very well.

(If kids are) doing something that’s not what they’re supposed to be doing, corrective feedback might not be getting through. That’s one of the reasons…having more individualized support for the child, making the signals really clear to them, can be really, really helpful.

Q: You’ve talked about developing flexible, low-dose programs that help with toxic stress. Why is that important?

Where we started developing programs that helped to offset toxic stress, they were large, expensive programs. What I’ve become convinced in the last 10 years is that we’re not going to have impact at scale if that’s all that’s available. It’s just not going to happen.

We have to get a lot smarter about…cutting to the core of what needs to happen most. It’s not like the system’s broken and we should throw it out, but we need to augment what’s out there with other ways of approaching of knowledge development…We have to be committed to a broad array of strategies, and a process of learning about them in a much more rapid-cycle way.

I think school is the perfect innovation platform…If you engineer things properly, then each year can be a new opportunity to gather information, to figure out what’s working and for whom…and for those for whom it’s not, to engineer new approaches.

Q: Right now, what do you consider the most promising interventions for dealing with toxic stress?

A: The majority of the ones that are out there, they’re at a point where there’s good proof of concept. One of the hallmarks of the toxic stressors that we’re talking about is that kids don’t really learn good cause and effect.

A baby crying (will think), “Maybe somebody’s going to come pick me up. Maybe they’re not. Maybe if they pick me up, they’re going to shake me. Maybe they’re not.” That whole learning process really goes sideways.

The things that…help turn that around are things that make it very clear to the child that the environment is consistent, predictable and responsive, and then also warm and nurturing.

Q: You’ve described healthy interactions between children and caregivers with a tennis analogy, “serve and return.” What is that?

A: We define serve and return very precisely. It’s an instance in which the child initiates some action, either puts the focus of their attention on the adult or something else in their immediate environment and the adult shares the child’s focus of attention and (responds).

(A serve) could be the child fussing or that they’re delighted. It could be that they’re gazing at something. It could be that they’re pointing to something and saying what it is. The return of the serve is really what’s critical.

Q: What is the video coaching program, Filming Interactions to Nurture Development, or FIND,  you’ve helped develop?

A: It involves basically showing people, using video, instances of themselves engaged in “serve and return” with the children they’re taking care of. Showing people instances of themselves doing this is a profound experience…because they’re seeing something that is the building block of healthy brain development.

What we think is different about this is were not coming from a place of people need to do something they don’t know how to do and therefore we have to instill new skills. I think that’s one of the reasons our existing programs are so costly and cumbersome. They come from the starting point of people are deficient in something and we have to start from the ground up.