Innovation in Action

The JPB Research Network on Toxic Stress

Developing measures for a new era in early childhood policy and practice

Biological information is frequently collected to evaluate our health. We take our temperature to determine whether we have a fever (and whether it’s going up or down); we measure lead levels in blood to screen for toxic exposures that require prompt treatment (and to evaluate the effectiveness of that treatment); we measure red blood cell levels to screen for anemia (and to confirm its successful resolution); and we measure blood pressure and cholesterol levels to identify treatable risk factors for cardiovascular disease before they become symptomatic. With advances in science and technologies, we now have new and emerging opportunities to use biological information wisely to assess how adverse experiences and preventive interventions are affecting the foundations of health and development in young children before serious problems arise.

What Is the JPB Research Network on Toxic Stress?

The JPB Research Network is a multi-university group of researchers who are developing a scientifically valid battery of biological and behavioral measures that address the following:

  • The need for better metrics to identify young children who are more sensitive to adversity than others and thus more likely to have difficulties in development before overt problems appear (i.e., screening).
  • The need for scalable measures of stress effects, resilience, and core capacities, beginning in infancy, that are sensitive to the influence of interventions on social-emotional, cognitive, and health indicators (i.e., impact evaluation).
  • The imperative of ensuring that all measures of health and development in young children are used to empower parents and pediatricians to work together to promote child well-being and enhance resilience (i.e., “first do no harm”).

The measures developed by the JPB Research Network are currently being field-tested in community sites and informed by the expertise of the Community and Parent Leadership Council and Pediatric Thought Leaders.

The Network’s History and Expansion into the Pediatric Innovation Initiative

The JPB Research Network on Toxic Stress was launched in March 2015, supported by generous grant support from The JPB Foundation. Recognizing the need for multiple areas of expertise, the initial Network membership included scientists, pediatric clinicians, and community leaders with strong representation from communities of color. Today, those three groups are represented by the three collaborative arms of the Pediatric Innovation Initiative: The JPB Research Network on Toxic Stress (scientists), the Pediatric Thought Leaders (healthcare providers), and the Community and Parent Leadership Council (national community leaders). This continuing collaboration is essential for developing validated, feasible, and scalable measures that will be “ready for prime time” application for all children and families.

The Candidate Measurement Battery

The initial selection of candidate measures for the JPB battery was guided by five principles: (1) attention to both environmental and genetic factors; (2) assessment at multiple levels, including molecular, cellular, physiological, and behavioral assays; (3) reliable information on both risk factors and assets in the family and community context; (4) the need for data collection to be logistically, ethically, and financially acceptable within community settings; and (5) the imperative that findings are accessible and empowering for parents as well as clinicians.

The following are a few examples (among many others) of the metrics being investigated for the final measurement battery:

Biological Metrics

Inflammation. Three specific indicators (“pro-inflammatory cytokines”) of immune system activation—which at consistently high levels are associated with a range of health problems later in life—can be detected in saliva samples.

Telomeres. These caps located at the ends of chromosomes—which normally shorten over time and demonstrate accelerated shortening in response to significant stress—can be measured in cells collected via a cheek swab.

Stress hormones. In addition to cortisol accumulation, which provides an index of chronic stress activation over several weeks or even months – several other steroid hormones can be measured from a snippet of hair.

Behavioral Metrics

Executive function skills. These skills, which are enhanced by adult scaffolding and highly sensitive to disruption from stress, can be measured by the Minnesota Executive Function Scale during a primary care visit. This five-minute, tablet-administered, standardized assessment provides automated scoring for young children beginning at age two years.

Social and Behavioral Context Metrics

The social contexts in which families live, and work can affect exposure to both stressors and the resilience resources utilized to cope with adversity—and accurate measurement of these dimensions is essential for promoting the healthy development of young children. Our evolving parent survey focuses on multiple indicators adapted from some of the best available measures related to the following domains: (1) family structure and resources in the home environment; (2) social relationships; (3) psychological resilience; (4) stability/change in the environment; (5) negative life events; (6) chronic stressors; (7) discrimination; (8) neighborhood stressors; (9) immigration-related stressors; and (10) maternal mental health.

When fully validated, the final battery will make it possible to measure child stress effects and resilience, family assets and stressors, and key behavioral indicators in children as young as four months of age; target preventive services before overt problems emerge; and measure short-term impacts of interventions on learning, behavior, social-emotional development, and health indicators to facilitate rapid-cycle learning and iteration.

JPB Research Network on Toxic Stress Members


Jack P. Shonkoff, M.D. Julius B. Richmond FAMRI Professor of Child Health and Development, Harvard T.H. Chan School of Public Health and Harvard Graduate School of Education; Professor of Pediatrics, Harvard Medical School and Boston Children’s Hospital; Director, Center on the Developing Child at Harvard University


  • Nicole Bush, Ph.D. Professor, Departments of Psychiatry and Pediatrics, Center for Health and Community; Lisa and John Pritzker Distinguished Professor of Developmental and Behavioral Health; Director, Division of Developmental Medicine, University of California, San Francisco
  • Megan R. Gunnar, Ph.D. Regents Professor; Distinguished McKnight University Professor, College of Education and Human Development; Director, Institute of Child Development, University of Minnesota
  • Takao K. Hensch, Ph.D. Professor of Molecular & Cellular Biology, Harvard University; Professor of Neurology, Boston Children’s Hospital; Director, Child Brain Development, CIFAR; Director, IRCN, UTIAS; Director, NIMH Silvio Conte Center
  • Pat R. Levitt, Ph.D. Chief Scientific Officer, Senior Vice President, and Director, The Saban Research Institute; Simms/Mann Chair in Developmental Neurogenetics, Developmental Neuroscience & Neurogenetics Program, Children’s Hospital Los Angeles; WM Keck Provost Professor in Neurogenetics Department of Pediatrics, Keck School of Medicine, University of Southern California; Science Co-Director, National Scientific Council on the Developing Child
  • Michael J. Meaney, Ph.D. Director, Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research; James McGill Professor, Departments of Psychiatry, Neurology & Neurosurgery; Co-Scientific Director, Ludmer Centre for Neuroinformatics & Mental Health and Director, Sackler Program for Epigenetics & Psychobiology, Douglas Research Centre, McGill University
  • Patricia Pelufo Silveira, M.D., Ph.D. Associate Professor, Department of Psychiatry, McGill University; Scientific Director, Genetics and Epigenetics Pillar, Ludmer Centre for Neuroinformatics & Mental Health; Associate Director, Integrated Program in Neuroscience (IPN), McGill University; Member of the College of the Royal Society of Canada
  • Natalie Slopen, Psy. D. Assistant Professor, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health.
  • David R. Williams, Ph.D., M.P.H. Chair, Department of Social and Behavioral Sciences and Florence and Laura Norman Professor of Public Health, Harvard T.H. Chan School of Public Health; Professor of African and African American Studies and of Sociology, Harvard University

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