Separated families and the urgency of the ticking clock

Pablo Ortiz and his 3-year-old son Andres (left), and Roger and his 4-year-old Roger Jr. (first names only given), speak at a press conference at the Annunciation House immigrant shelter in El Paso on July 11, 2018. Photo by Ivan Pierre Aguirre for The Texas Tribune

Thousands of immigrant children and parents have been separated forcibly after entering the U.S. at the Texas-Mexico border. Countless commentaries have been published. Tens of thousands have marched. An executive order was issued. A federal judge ruled that children must be reunited with their parents within a tight timeline. Yet there is little evidence that the people responsible for solving this crisis fully understand the “ticking time bomb” of toxic stress.

Toxic stress in children is not defined by the nature or magnitude of a threat. It’s about the body’s ongoing, physical response in the absence of the buffering protection of a parent or other familiar caregiver that restores a sense of security and helps reduce the stress response. When that protective relationship is available, potentially harmful stresses become tolerable, not toxic. When it is not available, the stress response continues with serious consequences.

Persistent activation of stress hormones can disrupt developing brain circuits that affect a child’s ability to focus attention, control impulses and learn effectively. Increased inflammation can accelerate atherosclerosis and lead to later heart disease. Continuously elevated blood sugar can produce insulin resistance and diabetes. Toxic stress is not an acute problem. It’s the result of excessive and persistent biological activation that has a wear-and-tear effect on our bodies over time. As days and weeks go by, and the psychological assault of ongoing separation prevents that activation from calming down, its physical toll increases.

Families seeking asylum have already been subjected to significant adversities. Some have been better able to buffer their children from these stresses than others. Abrupt separations at the border have imposed extraordinary traumas and additional physiological disruptions on all of these children and their parents, and the healing process will require more than simple reunification. Most important, programs that work with the child and parent together will be far more effective than any treatment provided for the child alone.

Political, legal and administrative challenges typically defy simple solutions; the basic needs of children are clear. Healthy development depends on an environment of supportive relationships that provide stability, security and responsiveness. This is particularly critical in the early childhood years. Serious disruption of those relationships can lead to later problems in learning, behavior and health. Although few of us have conscious memories of our early life experiences, many impairments in physical and mental health indicate that the body does not forget.

Toxic stress is about the ticking clock of persistent biological disruptions in the absence of a supportive caregiver. The biology of adversity, common sense and human decency all converge around two powerful conclusions: Reunite every child and parent immediately; and provide coordinated treatment for both of them together to begin to heal the damage that we have done.

Dr. Jack P. Shonkoff

Doctor, professor at Harvard University

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