New Study Seeks to Manage Toxic Stress in Children

Two female, African-American pediatricians in Oakland are heading a study into how dangerous childhood adversity can be on children’s health.


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Mickel King, Karen Daley, Jeremiah Riley, Malachi King, and Iesha James practice meditation.

Photo by Constanza Hevia

Iesha James arrived at Oakland’s UCSF Benioff Children’s Hospital outpatient satellite on Claremont Avenue on a summer afternoon with two of her three boys in tow. Karen Daley, a licensed marriage and family therapist, greeted the group at the door with a big smile and hugs all around, like a family reunion. James is the biological mother of Jeremiah, 12, and the legal guardian to her third cousins, Mickel, 10, and Malachi, 9. As she puts it, “These are my boys.” (On this day, Mickel was off at sleep-away camp.) Daley is the director of Oakland Children’s Resiliency Clinic where Mickel and Malachi along with King had recently completed six weekly two-hour sessions focused on connecting the mind and body.

The Resiliency Clinic’s program provides a unique kind of treatment — group therapy housed in a hospital-based clinic where parents or caregivers and their children meet with other families to learn about stress, the brain, and the body. Daley, who has a warm voice and a habit of calling her young patients “kiddos,” facilitates the sessions. “We work on ways to self-regulate, problem solve, and manage what’s out of control in their lives. The clinic and the care is informed by the trauma these kids face,” said Daley.

Malachi smiled as he explained what they did in the sessions, counting off the activities on his fingers. “We learned how to control our bodies. There’s this thing called belly breathing. You blank your mind and calmly breath in and out. It makes me feel relaxed,” he said adding that he uses this strategy at home when he gets mad at his brother. He went on, “No. 2, we sat with our legs crossed as Ms. Karen [Daley] hit a bell with a, uh ...” Daley jumped in, “A mallet.” Malachi then made the pinging sound of a bell with the hum that follows. “It’s a pretty sound. You listen and focus,” he said. Malachi described several other mindfulness techniques he now uses to manage anger, sadness, and frustration including squeezing a stress ball, watching glitter slowly float in a bottle of fluid, writing down his feelings in a notebook, and pointing to the part of his body where he feels negative emotions, like his heart when it pounds and beats fast, so James can give it a soothing rub.

The Resiliency Clinic is the treatment piece of a large, randomized study designed to evaluate how childhood adversity — physical or emotional abuse, neglect, household dysfunction, violence, or homelessness — affects a child’s health. Pediatricians Dayna Long and Nadine Burke-Harris are leading the Oakland-based study and collaborating with other UCSF researchers to explore how these traumatic life events connect to the body and illness. “Children who experience trauma repeatedly release stress hormones. That’s an appropriate biological response,” explained Long. “But that leaves them at risk for developing toxic stress, which impacts their developing brains and bodies and leads to poor health and behavioral issues.” With the study, Long and colleagues are trying to reframe the problem. “It’s not what’s wrong with this child,” said Long, “But what happened to this child?”

photo of dayna long and psychotherapist karen daley by constanza hevia

The Children’s study is an update to a pivotal trial conducted at Kaiser Permanente in the late 1990s, which showed a clear connection between childhood trauma and chronic health and social problems, but with a few significant differences. The Kaiser study included primarily white, older, middle-class adults. The participants in the Children’s study are kids up to age 11 years and almost all are African American or of color and receiving Medi-Cal, a direct reflection of the hospital’s patient population. “The fact that this study was thoughtfully developed by two black, female physicians, Long and Burke-Harris, was important for our African-American families,” said Daley, who was also involved with the study design and recruiting patients.

James and the boys were enrolled in the study after meeting Long at a clinic visit. Both boys have asthma, one of the chronic diseases linked to long-term stress disorder, said Daley. James became the boys’ legal guardian eight years ago when they were 1 and 2 years old. Their biological mother, King’s cousin, had faced her own childhood stressors, including a mother murdered, a father incarcerated, frequent moves, and foster care. Ultimately she was unable to care for the boys, and King stepped in, but she acknowledged that it hasn’t been easy. “I was overwhelmed trying to understand what they were going through and how to support them,” said James. Both boys have been hospitalized for asthma attacks; Mickel has angry outbursts and struggles with following rules; Malachi tends to withdraw. James had to get quickly up to speed on how to manage their asthma and deal with the emotional issues, too. “I was raised to get over it. That your feelings don’t matter,” said James. She realized that she needed a different parenting approach with these boys and thought the study presented an opportunity for improving parenting skills. “I’m always interested in learning more about how to raise three boys.”

Five hundred and fifty-five patients in total will be followed in the trial. The study is tracking a range of biological and genetic markers to help pediatricians understand how stress effects things like the gut, hormone levels, and immune response. Long said so far, the results of the Resiliency Clinic intervention have been remarkable. And Daley has been very impressed with how forthcoming families have been. They hope to be able to incorporate resiliency training into routine patient care in the future. “We are giving these folks a voice, a place to talk about what they are dealing with, that their story matters,” said Daley. “It’s important that those stories are told and that we listen.”

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