CINCINNATI — The 13-year-old girl was raised in poverty by parents addicted to alcohol and methamphetamines. She didn't always get enough to eat. When she got upset, nobody responded.
She was finally removed from her family and placed in a residential treatment center in Indiana. The tiniest slights from other children or adults flooded her body with rage, grief and fear.
"When she got that way, she would break everything in her room and hit other kids and just run wild," said Dr. Erna Olafson, an associate professor of clinical psychiatry and pediatrics at Cincinnati Children's Hospital Medical Center and the University of Cincinnati Medical School.
Olafson consulted with the therapist who treated the girl, and neither she nor the therapist was sure the girl would get better.
Such is the power of "toxic stress," the medical term used to describe terrible, repetitive experiences that can harm brain development in children and lead to long-term health problems such as diabetes and cancer. Toxic stress can make it nearly impossible for children to learn in school or behave on the playground or relate to friends in a consistent, healthy way. Studies have shown that enough toxic stress even lowers kids' IQs.
That kind of stress can happen in any family where there is sexual abuse, domestic violence or addiction and neglect.
But the sad truth is it's far more common among kids and families living in poverty.
As our region's business, faith and civic leaders work to reduce the number of children living in poverty in Cincinnati and Hamilton County, they will be forced to confront that reality.
The good news is, kids who suffer from toxic stress can be helped.
And that's the point of a public forum later this month called "Hope for Children Who Experience Adversity and Trauma: Building on What Works." The forum will be from 5:45 to 8 p.m. Jan. 21 at the United Way Convening Center on Reading Road.
A panel of three local experts will explain what toxic stress is, why it's such a huge problem and the most effective ways to treat kids who experience it. The Woman's City Club of Greater Cincinnati and the Cincinnatus Association will present the forum.
The treatments and strategies aren't simple, and they aren't cheap. But Olafson has seen them work. Even with the 13-year-old girl whose case seemed almost helpless.
From Terrified to Calm
The therapist used a treatment called Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT. Olafson is a trainer for the therapy and has trained thousands of therapists since she became a certified trainer in 2005.
The treatment entails teaching about trauma and helping people understand that trauma's place in their lives. Therapists teach their young patients coping strategies. And, when a parent or other adult caregiver is in the picture, therapists teach those adults how to teach the children to manage the strong emotions they feel.
One of the most important elements of the treatment, Olafson said, is asking patients to share their stories and describe the specifics of what happened to them.
For the 13-year-old girl in Indiana, that meant asking her to write her life story and describing all the awful incidents she could remember. That helped the girl identify what Olafson calls "trauma themes." One of them was: "I never thought I could ask anyone for anything. So when I need something, I just go wild with terror."
"As she began to understand that, she knew that when she began to feel that kind of rush, this would pass," Olafson said. The girl knew, "I'll be OK. I can ask for help."
The girl began to calm down after seven months in treatment, Olafson said. After 13 months, she was placed in a foster home with an opportunity to be adopted. Although progress doesn't usually take so long with the TF-CBT, Olafson was amazed with the results.
It's astounding when you think about it: That 13 months of patient, caring treatment from a therapist could begin to heal 13 years of neglect.
Talking with Olafson gave me new hope for the thousands of children living in poverty in Cincinnati and Hamilton County — and for their parents, too.
Still, there's no question that the better way to treat the problems that come with toxic stress is to prevent it in the first place, said Dr. Robert Shapiro, director of the Mayerson Center for Safe and Healthy Children at Cincinnati Children's.
That's because toxic stress and exposure to adversity can actually change a child's immune system, changing their ability to stay well and fight infection, he said. A child's environment can even change how cells determine which genes are expressed, Shapiro said.
Creating healthy, safe and nurturing environments for kids makes much more sense than trying to undo the harm that toxic stress and adversity can do.
Reducing hunger, domestic violence, neighborhood violence and harsh parenting can help prevent toxic stress in the first place, Shapiro said.
Partnering With Parents
"Resiliency is built upon good nurturing time that children have with caring adults," he said. "Strengthening the relationship that kids have with their families will help to immunize children against adversity."
And while it's better to have those relationships from the start, there are other efforts in town working to create them for families in need.
The Consortium for Resilient Young Children, for example, has a program called Promoting Resilient Children where trained coaches visit preschools and Head Start programs to observe classrooms and recommend changes that can help kids with toxic stress.
Sometimes those recommendations are to institute a more specific routine or establish a quiet place where children can go — one at a time — to calm themselves, said Jennifer Zimmerman, the consortium's director.
"We call it a 'be by myself space,'" she said. "A quiet, comfy space for one child to be in. If they feel overwhelmed, they can go to this quiet space."
Other times, the coaches recommend kids have pictures of their parents they can look at before naptime or even entire photo albums they can flip through when they start to miss Mom or Dad.
The idea is to strengthen those connections between kids and their parents, Zimmerman said, because "that's what keeps them anchored to the world."
The consortium's Strengthening Families program helps connect parents in neighborhoods to help them build informal networks and support systems.
"A lot of families living in poverty or high-crime neighborhoods are very isolated because it's not safe to go outside and meet your neighbors," Zimmerman said. "Parents can share their experiences and build relationships with each other."
Zimmerman and Shapiro both will be part of the public forum, along with Olafson. And Zimmerman hopes the discussion will give people a better understanding of the dangers of toxic stress and how it impacts kids and their families.
The Woman's City Club and Cincinnatus hope the event will add to the community discussion about childhood poverty and help people understand what we as a region can do to help, said Susan Noonan, an executive committee member of both organizations.
"I just feel so strongly that instead of looking at the whole problem and feeling overwhelmed, you just keep taking these small steps and do these things one at a time," Noonan said.
It's certainly worth a shot.
Lucy May writes about the people, places and issues that define our region – to celebrate what makes the Tri-State great and also shine a spotlight on issues we need to address. Childhood poverty is an important focus for her and for WCPO this year.