Opinion: Children With Toxic Stress Are Being Misdiagnosed

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Ten years ago at my pediatric clinic in San Francisco, teachers, social workers and parents were bringing me child after child with concerns of ADHD.

As I examined my patients, I noticed that the highest rate of behavioral problems was occurring in the kids whose parents had drug addictions or mental illness, or those who were subject to violence at home.

When I dug into the science, what I found was that for most of these kids, the problem wasn’t run of the mill ADHD. For most of my kids the real problem is what the American Academy of Pediatrics now recognizes as “toxic stress.”

Toxic stress affects white kids, black and brown kids, rich, poor, urban, rural … it can affect anyone and it can happen anywhere.


Ultimately, it all boils down to our flight-or-fight response – what happens in our bodies when we experience something scary. But, when activated too often – like with repeated abuse, neglect or parental addiction – it can change the structure and function of children’s developing brains.

It can affect hormones, the immune system, even the way DNA is read and transcribed. And it dramatically increases the risk of both behavioral and health problems in childhood and in adulthood.

But right now, only 4 percent of pediatricians in the U.S. are screening for toxic stress. Most haven’t received any training on how to identify kids who are at risk.

This has to change.

Too many children with behavioral symptoms of toxic stress are being labeled with ADHD and given stimulants without any identification of the root cause. Many kids show no behavioral symptoms at all. Yet they are still more than twice as likely to go on to develop asthma, autoimmune disease, heart disease and cancer – and their life expectancy can be cut short by decades.

More than 34 million American children have had at least one adverse childhood experience like abuse or neglect — we need every medical professional in this country to be equipped with the right tools for universal screening.

When identified early, doctors, educators and caregivers can help reverse the biological effects of childhood trauma. Together, we can give every child a shot at a healthy life.