Living in poverty is a major factor in the development of "toxic stress," which can cause irreversible, negative effects in the brains of children through 5 years old, according to Valley physicians.

Children exposed to violence, substance abuse, mental illness, physical and sexual abuse, or who have neglectful or absent parents, are more likely to develop attention-deficit hyperactivity disorder or depression, have lower IQs and are more at risk for chronic adult conditions such as diabetes, heart disease and alcoholism.

Many of the children who visit Dr. Jessica Pagana DeFazio's medical practice in Sunbury are from families living in poverty.

"It's rampant," DeFazio said of toxic stress in children. "This is what extreme poverty does to people."

More than 10 percent of Valley families live in poverty, which for a family of three is an $18,310 household income, and a family of four, $22,050, according to the U.S. Department of Health and Human Services.

Union has the highest poverty rate among the four Valley counties, at 13.2 percent, according to a 2007 report by the U.S. Department of Agriculture's Economic Research Service.

Montour has the lowest poverty percentage, 10.4, of the Valley counties.

The effects of toxic stress, DeFazio said, are permanent.

"It leaves an imprint on the brain that you cannot take off."

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On its way to reaching a trillion brain cells in adulthood, the brain forms 700 new neural connections every second during the first few years of life.

"The first three years of life is when many (neural connections) are formed," said Dr. Heather Hoover, a pediatric neuropsychologist at Geisinger Medical Center's Janet Weis Children's Hospital in Danville.

Synapses, which allow for functional communication between brain cells, form naturally, Hoover said.

But environmental stimulation will determine whether the synapses will be strong or weak.

Brain development occurs in three stages, beginning at three or four weeks after conception, with the development of vision and hearing. Language development is then followed by cognitive function, which is the problem-solving stage in which children learn cause and effect.

"In order to have that normal development, it requires stable interaction with adults," DeFazio said.

How to prevent toxic stress

Healthy interaction with children can prevent toxic stress. Unhealthy or a lack of interaction can promote it.

Compared with children whose parents have a higher education level and are in better financial condition, when children from poor families enter school, "There is already this achievement gap," said Kelly Swanson, communications director for the Early Learning Investment Commission, in Harrisburg, which consists of business leaders throughout the state who recognize that early childhood education and intervention is ultimately a work force development issue.

Some preschool programs can help children with development delays reach their proper maturation level before entering school.

"Kindergarten teachers have said they can tell immediately who had pre-kindergarten," Swanson said.

They are usually the ones found playing well and understanding how to follow directions.

"When they come in without those skills, teachers spend a lot more time getting children to focus and sit in their seats," Swanson said.

Brain's architecture changes

If toxic stress occurs before age 6 -- a crucial time when the brain is developing -- the brain's architecture changes, interrupting the brain's functional development, or brain power, Swanson said.

The result is lower IQs, and negative effects on a child's personality. Also, these children will have increased incidents of chronic adult diseases.

Prior to age 3, children don't have explicit memories, said Hoover, the pediatric neuropsychologist, but they do develop a sense of security that they carry with them throughout life.

Though no one can visualize the connections of synapses, Hoover said evidence shows children who experience trauma through abuse in general have smaller brain volumes.

Negative experiences early in life almost always lead to the overwiring of the limbic system, or the emotional brain, she said, and these children are more often on the verge of a tantrum.

"Life experiences do have a reciprocal affect on brain function," Hoover said. However, "Children can be exposed to trauma and abuse, and can still develop into well-functioning adults."

"Investment early on can save us money down the road," said Swanson, the Early Learning Investment Commission spokeswoman. "Social skills like being able to be creative and a team player -- they are all skills you need in the work force, and they are also being developed in the early years."

Adds DeFazio: "If you have good quality education and early care, you would have less people in prison, and more productive members of society. They will be more productive and happier later on."

Early intervention is crucial to the development of a child into a well-functioning adult.

"It's so much more difficult to fix it after the fact," DeFazio said. "Any positive intervention before kindergarten is going to be beneficial for the child's development.

Early detection key

Problems such as attention-deficit hyperactivity disorder, depression, or delays in development, if recognized early, will drastically reduce the amount of money and time spent later to try to reverse the negative imprints created when the child was a baby.

"It's so much more difficult than if you just had them in a loving, caring environment to begin with," DeFazio said. "A lot of it is education. Many people need to be counseled on how to parent appropriately because they did not learn it at home."

Pennsylvania has set early learning standards that give parents and caregivers a sense of where their child should be at certain ages, Swanson said.

"Intervention needs to be targeted to certain deficits," Hoover said. "If you identify problems early, there is a greater chance of positively changing those things."

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One of the most apparent standards is language development.

Any delay can be discovered by age 2 or 3, and can usually be corrected through speech and language therapy. Occupational therapy is given to children not developing appropriate use of fine motor skills or sensory development, and physical therapy for deficits in gross motor skills such as walking or balance.

The effects of toxic stress in children can be detected early, DeFazio said. Evidence is often seen in the form of behavioral abnormalities. Many of these children will not meet normal milestones such as reading or writing at the appropriate age.

"Fortunately, a lot of brain development remains pretty malleable in the preschool years," Hoover said. "Most evidence shows that the brain is most susceptible in a positive way to environmental changes during the first three years of life."

If a child is not showing interest socially in terms of cuddling, being affectionate, appropriate eye contact, and interactive play, those would also be causes for some concern and evaluation to determine if the child is on track developmentally, she said.

Up until age 3, children in need of early intervention can receive help through the state Department of Public Welfare. Once the child reaches 3, early intervention programs are offered through the Central Susquehanna Intermediate Preschool Program, funded by the state Department of Education. These services are provided in various facilities such as day care centers, nursery schools, preschool centers, special education classes or in the child's home.

"Parent-child interaction remains the most important component of facilitating good brain development," Hoover said.

There is no consistent evidence that shows any specific object or toy or program is something parents must invest in, she added.

"There isn't a particular one right way to teach a person," Hoover added. "The brain naturally comes wired to learn. Most children tend to learn, regardless of how they are taught."

Learning occurs through exploration, Hoover said. "That's why play is so essential to learning."

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The Nurse-Family Partnership is a grant-funded and not-for-profit program in which registered nurses meet regularly with first-time parents to guide them and monitor their child until it is 2 years old. During these meetings, parents receive education on how to be sure their child's brain develops in the most healthy way possible.

"We tell them hugs and kisses are very good for their baby's brain development," said Deb Forsythe, nurse coordinator.

Also important is reading to babies, especially nursery rhymes, Forsythe said, as well as music in general -- even before the baby is born. And, she added, the American Academy of Pediatrics says no television under the age of 2.

Some parents, DeFazio said, put an infant in front of the television all day long, and don't attend to the child's basic needs. These children do not have a loving adult providing stimulation and establishing a positive attachment.

"Exposing children through language and talking to them is a very important aspect of development," Hoover said. As are routines and consistent care-giving.

The best environment for a child to develop properly is a safe one, with loving and stable interaction with adults, and an absence of toxic stress, DeFazio said.

"You don't need a big house or a big yard," DeFazio said. "You don't need money to do that. You just need to be there emotionally for your children and place them in quality, loving, safe environments."

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