The Alberta Family Wellness Initiative (AFWI) mobilizes knowledge about early brain development and its connection to lifelong physical and mental health, including addiction. We bring together stakeholders from many callings to collaborate on health solutions that will directly impact families and individuals. 


Academy on Violence and Abuse was created to address the concerns highlighted in a 2002 report released by the Institute of Medicine (IOM). The report, which challenged the health care community to better educate and train health professionals about the often-unrecognizable health effects of violence and abuse, inspired a group of health care professionals to converge in effort to gain recognition and understanding for violence and abuse as health care issues. Their goal is to continue expanding health education and research to integrate knowledge about violence and abuse into the training of all health professionals to promote safe families, safe workplaces and safe communities. 


ACEs Connection is a social network that supports communities to accelerate the global ACEs science movement. There over two hundred ACEs Connections sites that support local ACEs initiatives in neighborhoods, cities, counties, regions and states across the country. (There are also a few interest-based communities, such as ACEs in Education and ACEs in Pediatrics.) Also, there are community facilitators in the Northeast/Mid-Atlantic, Southeast, Midwest, West, Northwest, and three in California that work with local communities to start and grow ACEs initiatives. ACEs Connection also disseminates information packets about how to start an ACEs initiative or expand ones that is just getting started. 


ACESTooHigh  is a news site that reports on research about adverse childhood experiences, including developments in epidemiology, neurobiology, and the biomedical and epigenetic consequences of toxic stress. The Organization also covers how people, organizations, agencies and communities are implementing practices based on the research. This effort includes developments in education, juvenile justice, criminal justice, public health, medicine, mental health, social services, and cities, counties and states.  


American Academy of PediatricsThe Trauma Toolbox for Primary Care is a 6-part series was designed with the primary care practice in mind – those who may or may not be familiar with adverse childhood experiences (ACEs) and the process of asking families about exposure to ACEs or other traumatic events.


American Psychiatric Association is an organization of psychiatrists working together to ensure humane care and effective treatment for all persons with mental illness, including substance use disorders. It is the voice and conscience of modern psychiatry. Its vision is a society that has available, accessible quality psychiatric diagnosis and treatment. 


America’s Promise Alliance is devoted to helping to create the conditions for success for all young people, including the millions currently being left behind. 


Anxiety and Depression Association of America (ADAA) is an international nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research. ADAA focuses on improving quality of life for those with these disorders. ADAA provides education about the disorders and helps people find treatment, resources, and support. 


Brazelton Touchpoints Center collaborates with partners nationwide to establish scalable and sustainable, low-cost, low-tech interventions that propel children’s healthy development and build the internal capacity of – and strengthen the collaborative relationships among – families, parents, caregivers, providers, and communities. 


The California Endowment is a private health foundation that provides grants to community-based organizations throughout California. The foundation is currently investing in the development of school-wide models that teach educators, school staff, and students about the impact of childhood trauma, along with strategies for healing and building resilience.


Campaign for Trauma-Informed Policy and Practice’s mission is to create a resilient, trauma-informed society where all individuals and families have the opportunity and the supports necessary to thrive.


The Centers for Disease Control and Prevention  has set up an informational hub for information on the original Adverse Childhood Experiences study and many of the academic studies that followed the publication of the original study.


Got Your ACE Score? As an exercise for the screening, you might want to print out copies of the Adverse Childhood Experience questionnaire for viewers to fill out. This will give them a sense of how the ACEs Study was conducted and also help them contextualize their own life experiences through the lens of the ACEs Study. Be sure to be cautious in asking attendees to discuss their results with the rest of the group; many of the experiences asked about in the ACEs questionnaire have the capacity to be deeply traumatic. You might consider asking them what their final score was, but they should not be asked to share which experiences they’ve had unless they choose to.


The Center on the Developing Child at Harvard University is a leading organization in the field of early childhood development science. Headed by Jack P. Shonkoff, M.D., the Center is dedicated to building a research and development platform for science-based innovation that achieves breakthrough outcomes for children facing adversity and transforming the policy and practice landscape to support and demand change. Their website contains a wide array of resources based on the work of the National Scientific Council on the Developing Child covering topics such as adverse childhood experiences, toxic stress, and fostering resilience.


The Centre for Studies on Human Stress (CSHS) is dedicated to improving the physical and mental health of Canadians by empowering individuals with scientifically grounded information on the effects of stress on the brain and body. 


Center For Youth Wellness  is part of a national effort to revolutionize pediatric medicine and transform the way society responds to kids exposed to significant adverse childhood experiences and toxic stress. Led by founder and CEO Dr. Nadine Burke Harris, CYW was created to respond to an urgent public health issue: early adversity harms the developing brains and bodies of children. In partnership with Bayview Child Health Center, CYW screens every young person it sees for Adverse Childhood Experiences (ACEs). The organization heals children’s brains and bodies by piloting treatments for toxic stress and sharing our findings nationally. CYW’s goal is to prevent toxic stress by raising awareness among those who can make a difference: from parents and pediatricians to policy makers.


Child Mind Institute is an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Our teams work every day to deliver the highest standards of care, advance the science of the developing brain and empower parents, professionals and policymakers to support children when and where they need it most. 


Child Trauma Academy (CTA) is a not-for-profit organization based in Houston, Texas working to improve the lives of high-risk children through direct service, research and education. 


Children’s Home Society of America is a national nonprofit leader and advocate dedicated to improving the lives of children and families in America. 

EMPath or Economic Mobility Pathways helps low-income families move out of poverty and assists other non-profits and government to better accomplish this goal. We do this work by creating new coaching tools and approaches for human service workers that are informed by scientific discoveries on how trauma, stress and oppression impact human behavior, decision-making, development, and health. EMPath’s core work is to educate human service workers about toxic stress and its impacts and how to apply this knowledge in working with low-income families to strengthen their chances of getting ahead. 


Fostering Resilience prepares children and teens to thrive through both good and challenging times. 


Futures Without Violence is a health and social justice nonprofit with a simple mission: to heal those among us who are traumatized by violence today – and to create healthy families and communities free of violence tomorrow. For more than 30 years, FUTURES has been providing groundbreaking programs, policies, and campaigns that empower individuals and organizations working to end violence against women and children around the world. 


Georgetown Law Center on Poverty & InequalityThe Center’s marginalized girls work seeks to identify and remove barriers to the health and wellbeing of low-income adolescent girls and girls of color and raise awareness of girls’ unique assets and needs. In addition, it develops and promotes policies and programs that broaden educational and workforce development opportunities for low-income girls and girls of color, and identifies and addresses trauma as the root cause of behavior that can lead girls into the juvenile justice system. Through this work, the Center ultimately aims to help empower girls to lead healthy and productive lives.


Harlem Children’s Zone has achieved unprecedented success, helping thousands of children and families and disrupting the cycle of generational poverty in Central Harlem through innovative and effective programs. Their pipeline begins at birth and helps kids every step of the way until college graduation through exceptional education, social services, family support, health, and community-building programs. By continuously assessing the progress of its youth, the Harlem Children’s Zone can leverage the power of its pipeline to fine-tune its programs and ensure that it is fully addressing the needs of every child, at every age.


MARC is a learning collaborative of 14 communities actively engaged in building the movement for a just, healthy and resilient world. 


Mental Health America (MHA) is one of the nation’s leading community-based nonprofits dedicated to addressing the needs of those living with mental illness and to promoting the overall mental health of all Americans. Their work is driven by their commitment to promote mental health as a critical part of overall wellness, including prevention services for all, early identification and intervention for those at risk, integrated care, services, and supports for those who need it, with recovery as the goal. MHA also provides a Back to School Toolkit with helpful resources, tools tips and information.


Mind in the Making, a program of the Bezos Family Foundation, is an unprecedented effort to share the science of children’s learning with the general public, families, and professionals who work with children and their families and to translate this research into action. The overall goal of Mind in the Making and its partner Vroom is to use the knowledge from developmental research to promote engaged learning and executive function based life skills in adults and children. 


National Association of Social Workers (NASW) is the largest membership organization of professional social workers in the world, with more than 120,000 members. NASW works to enhance the professional growth and development of its members, to create and maintain professional standards, and to advance sound social policies. 


The National Center on Domestic Violence, Trauma & Mental Health provides training, support, and consultation to advocates, mental health and substance abuse providers, legal professionals, and policymakers as they work to improve agency and systems-level responses to survivors and their children. Their work is survivor defined and rooted in principles of social justice. 


National Child Traumatic Stress Network (NCTSN) Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) brings a singular and comprehensive focus to childhood trauma. They are committed to raising the standard of care while increasing access to services. Combining knowledge of child development, expertise in the full range of child traumatic experiences, and dedication to evidence-based practices, the NCTSN changes the course of children’s lives by changing the course of their care. 


National Children’s Alliance (NCA) is the national association and accrediting body for Children’s Advocacy Centers (CACs). Formed in 1988, NCA has been providing support, technical assistance, and quality assurance for CACs, while serving as a voice for abused children for more than 25 years. A Children’s Advocacy Center is a child-friendly facility in which law enforcement, child protection, prosecution, mental health, medical and victim advocacy professionals work together to investigate abuse, help children heal from abuse, and hold offenders accountable. 


The National Council for Behavioral Health works to address mental illnesses and addictions that affect individuals, children and families. The National Council partners with the Child Mind Institute to raise awareness of children’s mental health Issues. 


National Crittenton Foundation catalyzes social and systems change for girls and young women impacted by chronic adversity, violence, and injustice. 


National Resilience Institute began as a grassroots community resiliency project. Its mission was to stop the loss of life and to find proven solutions to build more resilient kids, families, and communities. What unfolded was a five-year quest that took them across the country and around the globe in search of evidence-based skills and tools that empower people to prepare for, adapt to, and grow through traumatic disruptions with strength. 


The Robert Wood Johnson Foundation supports research and programs throughout the nation which are working to address the impact of adverse childhood experiences and help every child have a healthy start in life.


The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.


The Sanctuary Institute provides training and consultation services to the organizations that work with vulnerable adults, children and families with an aim to help an agency’s leaders reclaim a culture of hope and innovation. Defending Childhood.


VetoViolence is a source of trainings, tools, and resources for violence prevention professionals. The site features interactive tools and trainings designed to help practitioners stop violence before it begins. Link: 


Zero To Three envisions a society that has the knowledge and will to support all infants and toddlers in reaching their full potential. During the first three years of life, emotionally nourishing relationships lay the foundation for lifelong health and well-being. By supporting the caring adults who touch the lives of infants and toddlers, we hope to maximize our long-term impact in ensuring all infants and toddlers have a bright future.

Films & Videos

Resilience (2016): Resilience examines how toxic stress can trigger hormones that wreak havoc on the brains and bodies of children, putting them at a greater risk for disease, homelessness, prison time, and early death. While the broader impacts of poverty worsen the risk, no segment of society is immune. Resilience, however, also chronicles the dawn of a movement that is determined to fight back. Trailblazers in pediatrics, education, and social welfare are using cutting-edge science and field-tested therapies to protect children from the insidious effects of toxic stress—and the dark legacy of a childhood that no child would choose.Produced: James Redford and Karen Pritzker 


Paper Tigers (2015): Set within and around the campus of Lincoln Alternative High School in the rural community of Walla Walla, Washington, Paper Tigers asks the following questions: What does it mean to be a trauma-informed school? And how do you educate teens whose childhood experiences have left them with a brain and body ill-suited to learn? In search of clear and honest answers, Paper Tigers hinges on a remarkable collaboration between subject and filmmaker. Armed with their own cameras and their own voices, the teens of Paper Tigers offer raw but valuable insight into the hearts and minds of teens pushing back against the specter of a hard childhood. Produced: James Redford and Karen Pritzker 


The Beginning of Life (2016): One of the greatest neuroscience breakthroughs is having discovered that babies are far more than a genetic load. The development of all human beings lies on the combination of genetics, the quality of the relationships and the environment they are set on. The Beginning of Life invites everyone to reflect: are we taking good care of this unique moment, which defines both the present and future of humankind? *available on Netflix Covers the broader topic of the importance of early years in childhood development, and features subjects worldwide including Dr. Shonkoff.



Invisible Scars (2015): Invisible Scars explores Child Sexual Abuse (“CSA”) through the eyes of Johnna Janis, a woman, mother, wife, and friend who appears strong and confident. She candidly reveals the life-long struggles she has faced from the events that have haunted her since childhood. This film also presents an opportunity for the public to become educated, to understand the prevalence and devastating impact of child sexual abuse in our society, and to support efforts to help prevent other children from becoming victims. Available on Amazon.


No Small Matter (2018): No Small Matter is a feature-length documentary film and national engagement campaign that shares powerful stories and stunning truths about the human capacity for early intelligence and the potential for quality early care and education to benefit America’s social and economic future. This multifaceted project reveals how our country is raising its youngest citizens, why making the most of this time in their lives is so crucial, and most importantly, what we can do to change the perception of when learning begins. You can pre-order the film here.


The Raising of America (2015): The acclaimed five-part documentary series and companion tools illustrate how a strong start for all our kids can lead to better individual outcomes AND a healthier, safer, more prosperous and equitable America. The series’ Signature Hour asks how we might make a strong start the birthright of every infant in the U.S. The four additional episodes dive in for a closer look. Will the U.S. invest in its youngest children and their families, or will it squander its own future? 


Unnatural Causes: Is Inequality Making Us Sick? (2008): Unnatural Causes is the acclaimed documentary series broadcast by PBS and now used by thousands of organizations around the country to tackle the root causes of our alarming socio-economic and racial inequities in health. The four-hour series crisscrosses the nation uncovering startling new findings that suggest there is much more to our health than bad habits, health care, or unlucky genes. The social circumstances in which we are born, live, and work can actually get under our skin and disrupt our physiology as much as germs and viruses. 


“How Does the Toxic Stress of Poverty Hurt the Brain?” (2015): A growing body of research shows that the stress of growing up in poverty can have long-term effects on children’s brains and cognitive development. How can so-called “toxic stress” be prevented? NewsHour Weekend’s Megan Thompson reports. This is part of an ongoing series of reports called “Chasing the Dream,” which reports on poverty and opportunity in America. 


Ordinary Magic: Resilience in Development by Ann S. Masten

The Deepest Well by Nadine Burke Harris

The Power of Presence by Joy Thomas Moore

How Children Thrive by Mark Berlin

Building Resilience in Children and Teens by Kenneth R. Ginsburg

Mind in the Making by Ellen Galinsky

Touchpoints – Birth to Three by T. Berry Brazelton and Joshua D. Sparrow

Touchpoints Three to Six: Your Child’s Emotional and Behavioral Development by T. Berry Brazelton and Joshua D. Sparrow

From Neurons to Neighborhoods: The Science of Early Childhood Development edited by Jack P. Shonkoff and Deborah A. Phillips 

The Orchid and the Dandelion: Why Some Children Struggle and How All Can Thrive by W. Thomas Boyce

Whatever It Takes: Geoffrey Canada’s Quest to Change Harlem and America by Paul Tough

Fist Stick Knife Gun: A personal History of Violence by Geoffrey Canada

Giving Kids a Fair Chance by James J. Heckman

Health and Education in Early Childhood: Predictors, Interventions, and Policies by Arthur J. Reynolds, Arthur J. Rolnick and Judy A. Temple

Childhood Programs and Practices in the First Decade of Life by Reynolds, Arthur J. Reynolds, Arthur J. Rolnick and Michelle M. Englund

Integrated Early Childhood Behavioral Health in Primary Care by Rahil D. Briggs

Animations: Adversity & Resilience

Toxic Stress Effect on The Brain

(from the Center on the Developing Child at Harvard)

Serve and Return

(from the Center on the Developing Child at Harvard)

Introduction to Epigenetics
How Stress Affects the Brain and Genes

Build a Healthy Brain and Future

(from the Alberta Family Wellness Initiative)

ACEs Primer

(KPJR Films)

Impact Partners

Josh Sparrow, MD


BRAZELTON TOUCHPOINTS CENTER at Boston’s Children’s Hospital

Associate Professor of Psychiatry, Part-time, Harvard Medical School



Touchpoints – Birth to Three by T. Berry Brazelton and Joshua D. Sparrow

Touchpoints Three to Six: Your Child’s Emotional and Behavioral Development by T. Berry Brazelton and Joshua D. Sparrow



Child Flourishing Symposium 2014 – Joshua Sparrow

Touchpoints: Supporting Parents

Elisabeth D. Babcock, MCRP, PhD

President and CEO

EMPath – Economic Mobility Pathways 


Background Information

Basic Facts About the Adverse Childhood Experience Study

In 1995, Drs. Robert Anda and Vincent J. Felitti, who at the time worked for the Centers for Disease Control and Prevention and Kaiser Permanente, respectively, conducted a seminal study that would come to change the way medical professionals thought about childhood adversity and its long-term effects. Anda and Felitti compiled a ten yes-or-no question survey which asked respondents about their adolescent experiences with the following: divorced or separated parents, physical abuse or neglect, emotional abuse or neglect, sexual abuse, witnessing domestic violence in the household, substance abuse in the household, mental illness in the household, and family members sent to prison. Each yes answer would add 1 to the respondent’s ACE score; thus, a subject’s “ACEs score” reflected how many categories they had been exposed to during childhood. That score, in turn, was compared to the subject’s physical and mental health outcomes later in life.


What Did the Study Show?

Anda and Felitti administered these surveys to over 17,000 Health Maintenance Organization members from Southern California receiving physical exams during two data collection periods between 1995 and 1997. The results they collected were astounding:

  • An individual with 4 or more ACEs (as compared to someone with 0 ACEs) in their past was found to be 2.5 times more likely to develop COPD or hepatitis, 4.5 times more likely to be depressed, and 12 times more likely to attempt suicide.
  • Subjects exposed to 7 or more ACEs were 3 times more likely to contract lung cancer and 3.5 times more likely to develop ischemic heart disease—which kills more Americans than any other disease.  
  • Higher ACE scores translate to more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases.  
  • Research done in a group of adult criminal offenders showed a significantly higher number of ACEs than in the compared normative group.
  • Respondents with 4 or more ACEs were more likely to become alcoholics as adults, become depressed, and perpetrate domestic violence. These individuals were twice as likely to smoke and 7 times more likely to become an alcoholic.
  • If you have one ACE, there is an 87% chance that you have two or more, and individuals with six or more ACEs are substantially more likely to die prematurely than those who had experienced no ACEs.

Toxic Stress

The National Scientific Council on the Developing Child, in collaboration with the FrameWorks Institute, coined the term “toxic stress” in 2005 to describe the underlying physiological disruptions produced by excessive stress system activation in young children that can lead to impairments in learning, behavior, and both physical and mental health. Four years later, this term first appeared in the peer-reviewed literature, accompanied by a call for rethinking health promotion and disease prevention for adults by focusing greater attention on the long-term effects of adversity early in life. Seven years after the term was introduced, the first AAP technical report and policy statement on toxic stress called for the need to rethink the practice of primary care pediatrics.

Adverse childhood experiences create toxic stress by putting the child in an environment where they do not feel safe and where there is no caregiver around consoling them. Without the support of a caregiver to provide reprieve from this stress, it persists, resulting in difficulties later in life.

  • Studies show that childhood abuse literally shrinks the brain. The most consistent findings have been decreased size of the prefrontal cortex (responsible for higher-level motor control, inhibitory control, attention, working memory, personality expression, emotion and motivation regulation, and moderating learned social behavior), and of the anterior cingulate cortex (which affects impulse control among other things).
  • Examples of situations that might cause positive stress reactions are the first day with a new caregiver (a teacher, a babysitter, what have you) or receiving an injected immunization.
  • Tolerable stress refers to stress responses that are are strong enough to potentiate damage to brain or body, but are buffered out by supportive relationships with adults who help the child adapt. Tolerable stress events can be life threatening (things like natural disasters and muggings are examples of this), but necessarily occur for a limited amount of time, giving the subject a chance to recover and those around the subject a chance to offer support.
  • A problem arises when we are exposed to these hormones in excessively high or prolonged quantities. Professionals consider stress to be “toxic” if it is extreme, frequent, and/or extended in the absence of a supportive adult relationship.


Adverse childhood experiences create toxic stress by putting the child in an environment where they do not feel safe and where there is no caregiver around consoling them. Without the support of a caregiver to provide reprieve from this stress, it persists, resulting in difficulties later in life.


  • Studies compiled at the Harvard Center for the Developing Child now show that childhood abuse literally shrinks the brain. The most consistent findings have been decreased size of the prefrontal cortex (responsible for higher-level motor control, inhibitory control, attention, working memory, personality expression, emotion and motivation regulation, and moderating learned social behavior), and of the anterior cingulate cortex (which affects impulse control among other things).
  • Additionally, neuroscientists have recently found that, even though we now know neurons regenerate into adulthood, individuals exposed to adversity in early life have decreased neurogenesis in the hippocampus (which is key for memory and executive function).
  • With the emergence of new technologies like the fMRI (functional MRI), researchers can now see not only what the brain looks like, but how it functions and responds to certain stimuli. This has been key in discovering how toxic stress affects the brain—not only are key areas of the brain shrinking, the connections are weaker.


There is also a scientific consensus that the ecological context in which a child is raised “modulates the expression of one’s genotype.” Children inherit approximately 23,000 genes from their parents, but not every gene does what it was designed to do. Experiences leave a chemical “signature” on genes that determines whether and how the genes are expressed. Collectively, those signatures are called the epigenome. Thus, while it is impossible for toxic stress to physically change the content of one’s genetics, sustained exposure to extremely stressful situations can alter the way in which genotypes are expressed.

The Economic Costs of Toxic Stress

Prominent economists have begun analyzing the social cost of adverse childhood experiences. According to the National Institutes for Health, the total lifetime financial costs of just one year’s worth of new child maltreatment cases are estimated to be $124 billion. This estimate includes the cost of healthcare, child welfare, criminal justice, education, and productivity loss. The enormous price tag that comes with our failure to address this public health crisis begs the question: how much money we could save by investing in quality early childhood programs?  


Nobel prize winning economist James Heckman demonstrated that high quality birth-to-five programs for disadvantaged children deliver a 13% annual rate of return on investment – a far better rate of return than stock market investors can expect.  Heckman’s findings were largely based on two long term studies – one from Ypsilanti, Michigan and one from Chapel Hill, N.C. Both provided free preschool to children from low-income families. At age 40, the subjects from the Ypsilanti study were far more likely than their peers to have graduated from high school and have jobs. They were more likely to own homes and less likely to have needed social services. The boys were more likely to have grown up to raise their own children and less likely ever to have been arrested. Children from the program in Chapel Hill had higher test scores than their peers through adolescence and were more likely to have gone to college.  Heckman’s analysis quantified what the program saved the state and federal government in social welfare expenses, what increased tax revenue accrued from higher wages, and, most significantly, what the government had saved in police, court, and prison costs. Ultimately, Heckman concluded that each dollar spent at age 4 was worth between $60 and $300 in savings by age 65.


Another high-profile study conducted by professor Arthur Rolnick from the Humphrey School of Public Affairs at the University of Minnesota estimated that dollars invested in high-quality preschool education for disadvantaged kids paid an inflation-adjusted 16 percent annual return. In the words of Rolnick, this is an investment that the private section would grab right away. If policy makers seem unwilling to invest in children at risk from low-income families, perhaps a hard-nosed cost benefit analysis will be more persuasive. Ultimately, viewers may conclude that failing to take action to reduce childhood toxic stress is more costly than our society can possibly afford.


The chief resource at our disposal in counteracting the harmful effects of toxic stress is referred to by scientists as “resilience.” Resilience, as defined by the Alberta Family Wellness Initiative, refers to “the skills and abilities that develop through experience and allow us to adapt and stay healthy even in circumstances of severe stress or hardship.” In considering resilience, many scientists use the analogy of a scale. Protective experiences and coping skills are organized to one side, counterbalanced by adversity and experiences often associated with toxic stress. Thus, resilience is evident when the protective experiences and coping skills “outweigh” the adversity by giving the subject the resources they need to persevere through that adversity.

Resilience is partly determined by genetics. Some people are born highly sensitive to the effects of toxic stress, while others are more able to withstand stress without suffering lasting damage to the brain’s architecture. However, ones resilience to toxic stress can change over time; protective experiences and coping skills can be used to increase one’s resilience, and negative experiences like those that cause toxic stress can deteriorate it if not counteracted by positive experiences. Thus, resilience can be understood as the fulcrum in the scale metaphor. The starting point of the fulcrum is more or less determined by genetic predisposition, but can be altered by life experiences. Because resilience is a result of this intertwining of nature (genetically inherited resistance to stress) and nurture (the presence of a caring adult either in the family or the community to act as a protective force that shields and helps the child learn to deal with stress), children who thrive in situations of serious hardship tend to have both a strong biological resistance to adversity and strong relationships with adults in their family or community.


Children who do will in the face of serious adversity typically have not only a strong biological disposition towards resilience AND strong relationships with adults in their family or community. Thus, the nature and nurture components of resilience are equally important. In general, parents and caregivers can help children build resilience by:


  1. Developing and facilitating supportive adult-child relationships from an early age: One important type of interaction between caregiver and child that helps develop resilience from an early age is that of “serve and return.” Serve and return interactions, which occur between infants or young children and their parents, are crucial in shaping brain architecture. The child “serves” by babbling, gesturing, or crying, and the parent “returns” by responding appropriately, i.e. using eye contact, repeating the child’s babble, using words, or comforting the child. These interactions build and strengthen neural connections that aid in the development of communication and social skills. Serve and return interactions help to build a loving, supportive, and responsive environment for the child’s development. The responsive relationships they help to develop are so essential to the child’s growth, their absence can be incredibly harmful to both the child’s development and their well-being. When an adult’s responses to a child are unreliable, inappropriate, or absent altogether, they risk disrupting the brain’s developing architecture and impairing the child’s physical, mental, and emotional health in the future.
  2. Building a sense of self-efficacy and control in the child: While it is important to offer children support to protect them from toxic stress, it is also important to give them the resources to function independently. Supporting and nurturing their developing independence better prepares them for the challenges of adult life.
  3. Providing opportunities to strengthen adaptive skills and self-regulatory capacities:  Just as it is crucial to protect children from toxic stress and adverse childhood experiences, so too is it important to help children build up a set of tools with which to handle situations that of positive or tolerable stress. This is a crucial component of building resilience, as it enables the child to face those struggles on an individual level.
  4. Mobilizing sources of faith, hope, and cultural traditions: These practice situate the child within a larger community by adding faith leaders and community members to their network of supportive caregivers. These figures thus expand the child’s base of support, helping them cope better with whatever threats they may face.


It is important to note that, while fostering resilience at an early age is important because it helps to protect the child against the threats of toxic stress, one can strengthen their resilience to toxic stress and adverse experience at any time regardless of their age. For instance, regular exercise, stress-reduction practices, and programs that bolster one’s executive function capacities can all help both children and adults adapt to, and perhaps even prevent, the damage caused by adversity.


Sources for information about Toxic Stress, Epigenetics, Resilience, and Serve and Return from The Harvard Center on the Developing Child

Toxic Stress



Serve and Return


Sources for information about Adverse Childhood Experience Study

Felitti, VJ et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults.” Am J Prev Med. 1998 May; 14(4):245-58

Reavis J et al. Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We Possess Our Own Lives?. The Permanente Journal. 2013 Spring;17(2):44-48

Anda, Robert F., and Vincent J. Felitti. “The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders and Sexual Behavior: Implications for Healthcare .” The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic, edited by Ruth A. Lanius et al., Cambridge University Press, 2011, pp. 77–87

“Adverse Childhood Experiences and the Risk of Premature Mortality,” pg. 394