Additional Resources for Practitioners

Kids Pick Up on Everything: How Parental Stress is Toxic to Kids

Code, D.

Parents worry about BPA in plastics and chemicals in food, but when it comes to children’s health, the real toxin is parental stress. Research shows that children can “catch” their parents’ stress just like they catch a virus, soaking up the stress that pervades a household until their developing nervous systems reach “overload.” Then kids act-out, or get sick. Author David Code explains the medical research showing how parental stress is a major risk factor in today’s epidemic of child health problems, from allergies and obesity to ADHD, asthma, and sensory disorders.

Optimistic Parenting

Durand, V.M.

A book to share with every family you know, Optimistic Parenting helps moms, dads, and other caregivers develop more positive thoughts and perceptions – a key ingredient of successful parenting and effective behavior management. Dr. V. Mark Durand delivers both philosophical hope and practical help to parents of children with a wide range of challenges.

Policy Statement: The Pediatrician's Role in Family Support and Family Support Programs Committee on Early Childhood, Adoption, and Dependent Care

Children's social, emotional, and physical health; their developmental trajectory; and the neurocircuits that are being created and reinforced in their developing brains are all directly influenced by their relationships during early childhood. This statement recommends opportunities for pediatricians to develop their expertise in assessing the strengths and stresses in families and in counseling families about strategies and resources.

Policy Statement: Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health

Advances in a wide range of biological, behavioral, and social sciences are expanding our understanding of how early environmental influences (the ecology) and genetic predispositions (the biologic program) affect learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity. A supporting technical report from the American Academy of Pediatrics (AAP) presents an integrated ecobiodevelopmental framework to assist in translating these dramatic advances in developmental science into improved health across the life span.

Developmental Status of Children of Teen Mothers: Contrasting Objective Assessments with Maternal Reports

Ryan-krause, P., Measdows-Oliver, M., Sadler, L., Swartz, M.K.

Descriptive study compared adolescent mothers’ subjective perceptions of their children’s development with objective developmental assessments. On the Bayley Scales of Infant Development (BSID), group mean scores all fell within the normal range. However, almost 20% of individual children had one or more delays. Almost 73% of mothers accurately assessed their children’s development on the (A&SQ) when compared to BSID results. Eighteen percent of mothers suspected delays when there were none objectively identified.

5-HTTLPR Status Moderates the effect of early adolescent substance use on risky sexual behavior.

Kogan, S.M., Beach, S.R., Philibert, R.A., Brody, G.H., Chen, Y.F., Lei, M.K.

A longitudinal, prospective design was used to investigate a moderation effect in the association between early adolescent substance use and risky sexual behavior 2 years later. A genetic vulnerability factor, a variable nucleotide repeat polymorphism (VNTR) in the promoter region of the serotonin transporter gene SLC6A4, known as 5-HTTLPR, was hypothesized to moderate the link between substance use at age 14 and risky sexual behavior at age 16. This VNTR has been associated with risk-taking behavior.

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Shonkoff, J.P., Garner, A. S.

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 Relationship of Adverse Childhood Experiences to a History of Premature Death of Family Members

Anda, R.F., Dong, M., Brown, D.W., Felitti, V.J., Giles, W.H., Perry, G.S.,…Dube, S.R.

To assess the association between adverse childhood experiences (ACEs), including childhood abuse and neglect, and serious household dysfunction, and premature death of a family member. Because ACEs increase the risk for many of the leading causes of death in adults and tend to be familial and intergenerational, we hypothesized that persons who report having more ACEs would be more likely to have family members at risk of premature death.

The Chronic Stress of Poverty: Toxic to Children

Harris, N.B.

First, adverse childhood experiences (ACE) are incredibly common. Nearly 67% of the study population had experienced at least one ACE, and 12.6% had experienced four or more. Second, there was a dose-response relationship between ACEs and health problems later on. That means that the higher the ACEs score, the worse the health outcomes are later in life. A person with four or more ACEs has a relative risk of chronic obstructive pulmonary disease (COPD) that is an astonishing 260% of the risk for someone with no ACEs—more than two-and-a-half times the risk. For hepatitis, it was 250% of the risk; for depression it was 460%. If a patient had seven or more ACEs, their relative risk of ischemic heart disease, the number one killer in the United States, was 360%—more than three-and-a-half times the risk of someone who had never undergone adverse childhood experiences.

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., Marks, J.S.

We undertook the Adverse Childhood Experiences (ACE) Study in a primary care setting to describe the long-term relationship of childhood experiences to important medical and public health problems. The ACE Study is assessing, retrospectively and prospectively, the long-term impact of abuse and household dysfunction during childhood on the following outcomes in adults: disease risk factors and incidence, quality of life, health care utilization, and mortality. In this initial paper we use baseline data from the study to provide an overview of the prevalence and interrelation of exposures to childhood abuse and household dysfunction.

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Shonkoff, J.P., Garner, A. S., Siegel, Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent care, and Section on Developmental and Behavioral Pediatrics

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. 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.

Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit American Academy of Pediatrics

Shonkoff, J.P., Boyce, T.W., McEwen, B.S.

Addressing Mental Health Concerns in Primary Care brings together a myriad of ready-to-use resources and tools on one instant-access CD-ROM. Look here for screening and assessment instruments, quick-reference care management advice, step-by-step care plans, time-saving documentation and referral tools, coding aids, billing and payment tips, parent handouts, community resource guides, and much more.

Understanding Early Childhood Mental Health

Stark, D.R., Chazan-Cohen, R.

In the book, Understanding early childhood mental health: a practical guide for professionals. Integrating infant mental health service into early education programs leads to better child outcomes and stronger parent-child relationships – the big question is how to do it appropriately and effectively. Ideal for in-service professional development and program administrators, this introductory text combines the authoritative guidance of more than a dozen respected mental health and early childhood experts.

Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice

Brandt, K., Perry, B.D., Seligman, S., Tronick, E.

The editors of Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice have assembled a comprehensive, theoretically insightful, and clinically useful volume for psychiatrists, psychologists, nurses, pediatricians, social workers, psychotherapists, and all other providers serving children and families from pregnancy through age 5. The book covers concepts from the nature of infant emotional and brain development to the practice of neurologically and relationally based therapies, and explores topics from child trauma to autism spectrum disorders.

Basics of Counseling in Infant-parent and Early Childhood Mental Health

Stroud, B., & Morgan, M.M.

The editors of Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice have assembled a comprehensive, theoretically insightful, and clinically useful volume for psychiatrists, psychologists, nurses, pediatricians, social workers, psychotherapists, and all other providers serving children and families from pregnancy through age 5. The book covers concepts from the nature of infant emotional and brain development to the practice of neurologically and relationally based therapies, and explores topics from child trauma to autism spectrum disorders.

A Summary for Monitoring Physical Health and Side-Effects of Psychiatric Medications in the Severely Mentally Ill Population

This publication provides information regarding common physical ailments that occur with greater frequency in the severely mentally ill population, documents screening/monitoring recommendations for these physical health issues, provides guidelines regarding management of pregnant/lactating women, and explores potential barriers that may adversely affect healthcare delivery as well as treatment adherence in this population.

Screening for autism spectrum disorders in infants before 18 months of age.

Cangialose, A., Allen, P.J.

The purpose of this article is to identify key developmental tasks that can be assessed by pediatric primary care providers to determine increased risk for Autism Spectrum Disorders (ASD) in infants at 9, 12, and 15 months prior to formal screening for ASD at 18 and 24 months.

Developmental Screenings and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five

Ringwalt, S.

This list of developmental screenings and assessment instruments was gathered through a review of infant mental health literature. Disabilities coordinators may use this information to address multiple developmental and social-emotional domains. The list includes a description, the age range for which the instrument was validated, and the scoring procedure.