The Need

Stable and nurturing caregiver-child relationships are the cornerstone of a child’s emotional well-being and the foundation for their language and cognitive development.  When young children live in environments with high levels of stress (such as extreme poverty, maternal depression, domestic violence, substance abuse, and homelessness) and do not have nurturing relationships, the children experience “toxic stress” that damages their young, developing brains. Disruption of brain architecture during this critical period leads to major problems in emotional and behavioral health, learning and memory, and physical health (including heart disease and diabetes) throughout the lifespan.

Early, intensive intervention can make a profound difference. It is able to decrease this environmental stress and to build strong, nurturing, responsive relationships that have been proven to prevent damage to the growing brain. This promotes healthy emotional, cognitive, and physical development.

It is far more effective to intervene early to promote healthy brain structures than to attempt to repair circuitry after it has been hard-wired.

Prevalence of Risk Factors that Can Cause Toxic Stress
in Young Children


  • In 2009, 24.3 % of children between the ages of 0-5 years lived below 100% of the federal standard of poverty.[1] This percentage has risen each year since 2001.
  • An additional 22% of young children under 6 years live in families whose income falls between 100 and 200% of the federal poverty level.[2]

Abuse and Neglect

  • The very young are at highest risk of maltreatment.  In 2009, there were 21 substantiated child maltreatment reports per 1000 children under age 1, compared with 12 reports for children ages 1-3, 11 for children ages 4-7.[3]
  • 80% of all fatalities resulting from maltreatment and abuse are children younger than 4 years old.[4]   Rates in urban centers may be substantially higher.

Maternal Depression

  • While about 12% of all women report depressive symptoms annually, for women with low income the rate doubles to 25%.  Low-income mothers of young children and pregnant and parenting teens report depressive symptoms in the 40 to 60% range. This rate is consistent across ethnic and linguistic communities.[5]


  • 1.6 million American children, or 1 in 45, are homeless within the year.  The rate of homelessness among children has increased 38% since 2007.[6]

Substance Abuse

  • In 2009, 23.5 million persons aged 12 or older needed treatment for an illicit drug or alcohol abuse problem. Much of this information comes from self-reports and may reflect low estimates.[7]
  • According to the CDC, the national rate for illicit drug abuse is 7%,[8] but national data suggests that the range of substance abuse among welfare recipients is between 6 and 37%.[9]

Domestic Violence

  • Rates of recent or current physical abuse range from 8.5% to 41.4%.[10]  At least 25% of women experience domestic violence in their lifetime, often in the presence of young children.[11]
  • Nationally, it is estimated that 15.5 million children were living in families in which intimate partner violence occurred within a single year.[12]
  • In 2008, 60 percent of children under the age of 17 were exposed to actual, not depicted, violence.[13]

Other Challenges

  • 25% of children under 6 years of age are exposed to at least 3 or more risk factors that include poverty.[14]  These problems are interrelated. 
  • Mothers who are victims of domestic violence are at high risk of depression and then are more likely to abuse substances such as alcohol and drugs.[15]
  • Other challenges, largely secondary to poverty and causing toxic stress in young children, include food insecurity, exposure to second-hand smoke, lead poisoning, lack of medical or dental home, increased risk of asthma and obesity.[16]

Negative Developmental Outcomes Resulting from Unaddressed Environmental Stresses

Mental Health

  • In the Bridgeport Hospital Pediatric Primary Care Center, 48% of children (0-3 years) screened positive for emotional and behavioral problems.[17]
  • Longitudinal research has documented that 50-60% of children with diagnosable mental health disorders at age six years could have been identified through screening in the first three years of life.[18]

Language Development & Literacy

  • Socioeconomic differences in language acquisition are notable well before children enter kindergarten affecting children’s ability to read and express themselves. By age four years, an average child in a professional family would have accumulated experience with almost 45 million words, while an average child in a welfare family would have accumulated experience with only 13 million words. Longitudinal research demonstrated a high correlation between vocabulary size at age three and language test scores at ages nine and ten in areas of vocabulary and reading comprehension.[19]

Physical Health

  • An extensive body of scientific evidence now shows that many of the most common chronic diseases in adults—such as hypertension, diabetes, cardiovascular disease, and stroke—are linked to processes and experiences occurring decades before, in some cases as early as prenatally.[20]
  • The Adverse Childhood Experiences Study (ACES) documents strong associations among multiple instances of traumatic or abusive childhood events (as recalled in adulthood) and an extensive array of conditions later in life, including cardiovascular disease, chronic lung disease, cancer, depression, alcoholism, and drug abuse. Individuals reporting more adverse childhood experiences also had substantially greater risks for life-threatening psychiatric disorders, overlapping mental health problems, teen pregnancies, obesity, physical inactivity, and smoking.[21]

With funding from: