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 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 being field-tested by the practice sites of the Pediatric Innovation Cluster and informed by the expertise of the Community Leadership Council.

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 equal numbers of scientists, pediatric practitioners, 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 Innovation Cluster (pediatric practitioners, office staff, and site-based parent/community members); and the Community 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 select examples of the metrics being considered 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.

Epigenetics. A novel “pediatric epigenetic clock” that calculates the discrepancy between a child’s chronological age (which increases at the same rate for everyone) and biological age (which advances at a faster rate in response to adversity) can be measured in cells collected via a cheek swab.

Stress hormones. Cortisol accumulation, which provides an index of chronic stress activation over several weeks or even months, can be measured from a short snippet of hair.

Electroencephalogram (EEG). A measure of the brain’s electrical activity, which provides a readout of neurobiological “embedding” of early life stress, can be recorded with a portable device in a pediatric office setting.

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. This five-minute, tablet-administered, standardized assessment provides automated scoring for young children beginning at age 2 years; the Network is currently testing a novel assessment for children younger than age 2.

Eye tracking. This promising measure of attention in very young infants offers a window into the development of evolving brain systems that are sensitive to excessive stress activation. It can be administered successfully through an automated, screen-based test in an office setting, although broad-based use will require the development of less costly equipment.

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 identify child stress effects and resilience, family assets and stressors, and key behavioral indicators in children as young as 2 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

Chair

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

Senior Investigators

Harvard University

  • Takao K. Hensch, Ph.D. Professor of Molecular & Cellular Biology, Center for Brain Science, Harvard University; Professor of Neurology, Harvard Medical School and Boston Children’s Hospital; Director, Conte Center at Harvard University
  • Charles A. Nelson, Ph.D. Richard David Scott Chair in Pediatric Developmental Medicine Research, Boston Children’s Hospital; Professor of Pediatrics and Neuroscience, Harvard Medical School
  • David R. Williams, Ph.D., M.P.H. Florence and Laura Norman Professor of Public Health at the Harvard T.H. Chan School of Public Health and Professor of African and African American Studies and of Sociology at Harvard University

McGill University

  • Michael J. Meaney, Ph.D. Director, Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research; Professor, Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; James McGill Professor, Departments of Psychiatry, Neurology & Neurosurgery; Scientific Director, Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University
  • Patricia Pelufo Silveira, M.D., Ph.D. Assistant Professor, Department of Psychiatry, McGill University

Rockefeller University

  • Bruce S. McEwen, Ph.D. Alfred E. Mirsky Professor; Head of Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, Rockefeller University

University of California, San Francisco

  • W. Thomas Boyce, M.D. Lisa and John Pritzker Distinguished Professor of Developmental and Behavioral Health, Departments of Pediatrics and Psychiatry, University of California, San Francisco
  • Nicole Bush, Ph.D. Associate Professor, Departments of Psychiatry and Pediatrics and Director of the Division of Developmental Medicine, University of California, San Francisco

University of Minnesota

  • 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

University of Southern California

  • Pat R. Levitt, Ph.D. Simms/Mann Chair in Developmental Neurogenetics, Institute for the Developing Mind, Children’s Hospital Los Angeles; W. M. Keck Provost Professor in Neurogenetics, Keck School of Medicine, University of Southern California

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