Wagner Rachael E, Jonson-Reid Melissa, Drake Brett, Kohl Patricia L, Pons Laura, Zhang Yi, Fitzgerald Robert T, Laudenslager Mark L, Constantino John N
Department of Psychiatry, Division of Child and Adolescent Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
Prev Sci. 2025 Mar;26(Suppl 1):78-89. doi: 10.1007/s11121-022-01366-4. Epub 2022 May 23.
Adverse experiences superseding a child's capacity to sustain regulation of emotion and adaptive function are theorized to constitute "toxic stressors" when they induce a deleterious biological response within an individual. We ascertained presumptive parameters of toxic stress among 164 low-income infants and toddlers (ages 4-48 months) from 132 families enrolled in Early Head Start (EHS). We randomized a subset of these families into a pilot intervention arm of parenting education (the Incredible Years, TIY), which supplemented the EHS curriculum. Official report child abuse and neglect (CAN) and child behavior were serially ascertained over the course of the study. We observed relatively low associations among maternal depression, CAN, caregiver-child relationship quality, hair cortisol, and adverse child behavioral outcomes. Moreover, despite poverty and the high prevalence (51%) of CAN in this sample, the frequency of clinical-level internalizing and externalizing behavior among the children did not exceed that of the general population, by their parents' report. The pilot supplementation of EHS with TIY improved attendance in group meetings but did not significantly reduce adverse behavioral outcomes or CAN. This study revealed marked independence of standard indices of toxic stress (child maltreatment, maternal depression, caregiver emotional unavailability) which have been presumed to be risk factors for the development of psychopathology. That they were weakly inter-correlated, and only modestly predictive of child behavioral outcomes in this EHS sample, caution against presumptions about the toxicity of individual stressors, highlight the importance of ascertaining risk (and compensatory influences) comprehensively, suggest buffering effects of programs like EHS, and demonstrate the need for greater understanding of what parameterizes resilience in early childhood.
当不良经历超过儿童维持情绪调节和适应功能的能力时，如果这些经历在个体内部引发有害的生物学反应，理论上就构成了“毒性应激源”。我们确定了参与“早期开端计划”（EHS）的132个家庭中164名低收入婴幼儿（4至48个月）的毒性应激推定参数。我们将这些家庭中的一部分随机分配到育儿教育的试点干预组（“不可思议的岁月”，TIY），该组对EHS课程进行了补充。在研究过程中，我们连续确定了官方报告的儿童虐待和忽视（CAN）情况以及儿童行为。我们观察到母亲抑郁、CAN、照顾者与儿童关系质量、头发皮质醇水平与儿童不良行为结果之间的关联相对较低。此外，尽管本样本中存在贫困以及较高的CAN发生率（51%），但根据家长报告，儿童临床水平的内化和外化行为频率并未超过一般人群。用TIY对EHS进行的试点补充提高了小组会议的出勤率，但并未显著降低不良行为结果或CAN。这项研究揭示了毒性应激的标准指标（儿童虐待、母亲抑郁、照顾者情感上的不可获得性）之间显著的独立性，这些指标曾被认为是精神病理学发展的风险因素。它们之间相关性较弱，在这个EHS样本中对儿童行为结果的预测作用也不大，这提醒我们不要对单个应激源的毒性进行臆断，强调了全面确定风险（和补偿性影响）的重要性，表明了像EHS这样的项目的缓冲作用，并证明有必要更深入了解是什么决定了幼儿期的复原力。
