How Trauma and Toxic Stress Impact Preschoolers and What You Can Do To Help Them Heal

We start with basic brain development, executive functioning skills and how/when they develop, and the ways that poverty and trauma (ACES) (including the quarantine) disrupt brain circuitry and create toxic stress/anxiety – which exacerbates behavior. This would also go a long ways toward getting everyone on board for putting a strong emphasis on social-emotional learning and providing activities to support healing from the trauma of the quarantine for at least the first month of the school year. (just my opinion)

Laying that foundation down, I think the teachers can come to a deeper understanding of why some children have such difficult behaviors, and we can then emphasize specifically what social and self-regulation skills are lacking. This would help get full “buy-in” of the Pyramid philosophy, which is that focus on behaviors being the result of missed social skills (and missed executive functions / brain dev. delays or impairment), the focus on prevention, and on teaching rather than “behavior management” or reactivity. Once everyone fully embraces that philosophy, then you could put the focus squarely on 1) preventing the conditions that trigger stress responses; and 2) teaching specific social skills and executive functions. 

What is Toxic Stress: Stressful situations provoke a physical response: blood pressure goes up, blood sugar increase, heart rate, stress hormone levels increase 

Chronic, long term exposure has profound consequences for young children’s bodies and brains

Disrupts brain circuits

Creates a chemical environment in which cortisol, the stress hormone, is chronically high, causing reactivity, fear, anxiety

Interferes with short-term Memory

Ability to Follow rules 

Controlling impulses

Families who live in poverty tend to experience more of these:

Drug abuse

Violence in the community

Failing schools

Social Stories for COVID19:

Handwashing Social Story:

Handout for Parents: Helping Your Child During the Pandemic:

Tips for Supporting Yourself during the Pandemic

  1. Brain Development: Every emotion, every feeling (sensory), and every behavior is processed by the brain. The development and condition of a child’s brain will therefore directly affect how a child behaves and what he/she can and cannot do. 
  2. Executive function and self regulation skills –  core capabilities that are developed with practice over time. Examples of executive function skills include impulse control, paying attention, following directions, persistence, and delay of gratification. 
    1. Neurons are rapidly connecting as we interact with the world. Complex circuits are built throughout childhood, and these connections make our core capabilities possible. The more we use these connections, the stronger and faster they become.
    2. Children practice these skills by playing, learning teamwork, adjusting to the people, rules, and practicing skills; we continue to develop them by managing things like sports, relationships, school, music, work. When we practice EF skills, circuits rapidly connect the Prefrontal Cortex to other parts of the brain. These circuits act like an air traffic control system in the brain, helping us to manage info and help us manage with intention, not on impulse. 
    3. There are also automatic responses that we need for survival, (fight or flight or freeze). If stress is too high or is constant, the automatic circuits become stronger or faster than our more advanced circuits like executive function skills. 
    4. Traumatic and stressful experiences activate other circuits, the ones needed for automatic responses.
    5. It is extremely hard to call on intentional skills (executive functions) when we are under stress.
    6. Here is a good 5 min. video on executive function.
  3. Toxic stress can cause the development of executive function skills to be seriously delayed or impaired. Brain architecture is literally disrupted in conditions of neglect, abuse, and/or violence, directly impairing the development of executive functions. 
    1. Poverty, violence, addiction, chaotic environments all lead to toxic stress
    2. Trauma or ongoing experiences in unsafe environments
    3. These are known as ACES: Adverse Childhood Experiences
  4. The key is to counterbalance the automatic circuits (impulses, fight, flight or freeze) by intentionally working on our intentional ones – building strong executive function skills.
  5. We need to redesign our systems so as to reduce the sources of stress in people’s lives
    1. Helping families meet basic needs and building on strengths 
    2. Helping parents learn how to manage their own stresses and emotions
    3. Support parents as positive, secure attachment figures for their children.
  6. Stronger brain circuits are built thru practice, in situations that matter.
    1. Adults can facilitate the development of a child’s executive function skills by establishing routines, modeling social behavior, and creating and maintaining supportive, reliable relationships.
    2. It is also important for children to exercise their developing skills through activities that foster creative play and social connections, teach them how to cope with stress, involve vigorous exercise, and over time, provide opportunities for directing their own actions with decreasing adult supervision.
  7. Basic Executive Functions:
    1. Working Memory – the ability to hold and manipulate information in our heads over short periods of time. Example: follow multiple step instructions such as “Go to your cubbies, put away your jackets, and come to the carpet.” It also helps children with social interactions, such as taking turns in a group activity.
    2. Inhibitory Control – the ability to filter our thoughts and impulses so that we can resist temptations, distractions, and habits and to pause and think before we act. This requires focus, paying attention, and self control. Children need to exercise this skill when they do things like wait in line, wait for a turn with a toy, and refrain from acting on aggressive impulses. It is also a skill that comes into play when we expect children to control their emotions even when they are angry, rushed, or frustrated. A good example is learning not to overreact when someone else gets the toy you wanted.
    3. Cognitive or Mental Flexibility – the ability to adjust to changed demands, priorities, and perspectives. To apply different rules in different settings. For example, use “outside” vs. “inside” voices. Children must learn to be flexible, in that being persistent and having self control are good, but being too rigid is a problem. Cognitive flexibility allows us to catch mistakes and fix them, to try new strategies, and to “think outside the box.” Children learn this skill when they have opportunities to experiment in different ways until they get something to work, and when they employ different solutions to work out a social problem with another child. 
  8. Basic behaviors that are part of executive functions (not an exclusive list): 
    1. Listening and paying attention
    2. Following directions
    3. Resisting impulsive urges
    4. Remaining persistent
    5. Completing tasks
    6. Follow rules
    7. Solving problems
    8. Organizing information
    9. Making plans
    10. Adapting to change
  9. The ages of 3 to 5 are a window of time in which tremendous brain and executive functions development occurs
  10. How do children develop executive function skills?
    1. Social play
      1. Changing rules
      2. Practicing social norms
      3. Testing skills that parents have been scaffolding for them
      4. Children have to learn how to play cooperatively. Those who cannot demonstrate sufficient EF competence will be pushed out of play situations, or will cause the play to fall apart.
      5. Toddlers still engage in parallel play, but during the pre-K years children are gradually developing the skills needed to function in cooperative and social play situations. By age 6 children should have mastered most of these basic skills.
      6. The executive function skills are some of the same skills needed to master academic tasks as social tasks. So the same children who cannot function in play generally have difficulty being good classroom citizens.
  11. What interferes with this brain development?  What are ACES? 
    1. Trauma
      1. Including COVID19 quarantine trauma, abuse, exposure to violence, severe loss
    2. The adverse effects of poverty and racism: chronic neglect or understimulation; chaotic home environments, community violence, domestic violence, etc.
    3. Chronic stress that is unmanageable; chronically resorting to fight, flight, freeze responses
  12. What is needed in order to repair the faulty brain circuitry? Establishing positive, secure relationships that involve tons of “serve and return” interactions. Reducing everyday stresses in children’s lives: means helping and supporting parents; teaching stress-coping skills like breathing, mindfulness, etc.
  13. Intentional activities, social play, and teacher-guided activities in which the teacher gradually reduces the amount of support she provides and the child have to engage their executive function skills at higher and higher levels.
  14. Planning May thru July 2020 Supports for Families:
  15. Providing materials to parents through take-home packets
    1. Information about COVID19, quarantine’s affects on children
    2. Visuals such as social stories about COVID19, actual visual schedules parents can use at home – There are lots of resources on the NCPMI website.
    3. Boosting Pyramid supports to parents to help them with their children’s SE learning at home, so children don’t regress as much  (again, NCPMI has all these resources)
    4. Defining (for staff) what kinds of SE supports they should be providing for parents between now and the end of this school year (May thru June).
      1. Help with stress reduction
      2. Help with understanding COVID19 and quarantine
      3. Help with emotional regulation capabilities
  16. Preparing for responding to children who are reacting to trauma and toxic stress when they come back in the fall
    1. Pyramid Model Practices
      1. Repeat of e-modules
      2. Requisition add’l e-module accounts
      3. Provision of TPOT list of practices
        1. Could be self-assessment / checklist
    2. Strategies for creating safe and positive classroom culture; Importance of structure and routines, and help creating them (especially for newer staff); AKA Tier 1 supports
    3. Specific strategies for building social-emotional skills, AKA Tier 2 supports


The Issues: Poverty/Trauma/ACES-🡪leads to Parental depression and other Parental responses such as anxiety, addiction, or even aggression.🡪Parental stress / depression / addictions or other poor coping choices–🡪lead to emotional and/or physical neglect of child, domestic violence or disturbances, etc.—🡪Results in Toxic stress: Impacts upon the biology and actual structures of the brain (chronically high heart rate, high cortisol levels, creation of unwanted stress circuits (for fight, flight, freeze responses) / impairs brain dev. and -🡪high cortisol and these unwanted structures result in heightened anxiety and chronic “activation” of stress responses; as well as interference with executive functioning development (impulse control, attention, self-regulation, frustration tolerance)-🡪this lack of EF skills shows up in Internalizing and Externalizing Behaviors. Relationships / “serve and return” interactions are the KEY interventions for reversing this entire process. Positive emotional attachment relationships are the one thing that has been identified that serves as a buffer for the impacts of ACES on children. Beyond this, creating safe, structured, consistent, positive environments, teaching explicit social skills, and use of Tier 2 Pyramid supports (social and executive function skills), and continued supports for parents are all needed.


Ounce of Prevention Video on  Poverty and its impacts: “Change the First 5 Years and You Change Everything”

“Brain Hero” video: explains how relationships/interactions build brains and how 

Early Experiences matter so much for shaping our brains. The brain expects interactions and experiences through back and forth exchanges with adults.

Each part of the child’s brain (social part, verbal part, cognitive parts, etc.) impacts the other parts. Cognitive and Social-Emotional cannot be separated. In other words, learning depends on stable relationships. Therefore, our ability to interact with children and for children to interact with us:

Affects mental health

Affects cognitive capacities

Affects the immune system

Cardio-vascular system

All of this is why its so important to intervene EARLY. Get brain development right the first time instead of trying to fix it later.

3 Core Concepts in Brain Development ( VIDEOS): 

  1. The Architecture of the Brain  1:56 minutes
  2. Serve and Return Interactions Shapes Brain Circuitry 1:42 minutes
  3. Toxic Stress Derails Healthy Development 1:52 min.

The Science of Neglect, One VERY COMMON form of Adverse Experience leading to Toxic Stress:

Explain Serve and Return (Show video of Dad watching TV with baby having conversation)

“Still-Faced” Experiment (showing the impact of emotional neglect upon a child)

The impact of lack of serve and return interactions – (neglect) and how that impacts the brain.

(Ross Greene) Types of Neglect:

  1. Occasional Inattention
  2. Chronic Understimulation = child who is understimulated throughout ages 0-3 can catch up in good ECE programs, with adequate stimulation, opportunities, and serve/return interactions
  3. Severe Neglect in a Family Context – prolonged periods of inattention, lack of basic needs meeting; children are much more likely to be neglected than any other kind of maltreatment. Need more intensive strategies to repair this damage.
  4. Severe Institutionalized Neglect – 

Interventions consist of teaching providers and caregivers and teachers about the Serve and Return process.

Link to Video on the impact of neglect:

ACES – Adverse Childhood Experiences

ACES includes traumas, but also (more importantly) includes systemic adversity such as violence in the community, racism and poverty. Because the body’s stress response does not distinguish between overt threats from inside or outside the home environment.

Trauma-informed care or practices: The ideal approach to ACEs is one that prevents the need for all levels of services: by reducing the sources of stress in people’s lives, whether basic needs like food, housing, and diapers, or more entrenched sources of stress, like substance abuse, mental illness, violent relationships, community crime, discrimination, or poverty. Supporting responsive relationships with a parent or caregiver can also help to buffer a child from the effects of stress, and helping children and adults build their core life skills—such as planning, focus, and self-control—can strengthen the building blocks of resilience. These three principles—reducing stress, building responsive relationships, and strengthening life skills—are the best way to prevent the long-term effects of ACEs.


“Constant Stress depletes precious energy the brain needs for healthy development in childhood and adulthood.”  Chronic activation of stress response systems in early childhood, especially without the ongoing presence of a responsive adult, can lead to toxic stress, which disrupts the healthy development of brain architecture. Experiencing toxic stress during these early years can affect learning, behavior, and health throughout the lifespan. It’s like revving a car engine for days or weeks on end—constant activation of the stress response has a wear-and-tear effect on the brain and other biological systems. Constant stress also depletes precious energy the brain needs for healthy development in childhood and adulthood to deal with consequential decisions—of which there are many for parents dealing with economic instability or other problems.

Stress derails healthy development. 

In severe conditions, the stress response stays activated. 

Overloaded developing systems due to chronic activation of stress response:  Toxic Stress

Prolonged activation due to stress can reduce NEURONS – brain development

Link to video:

Toxic Stress: Stressful situations provoke a physical response: blood pressure goes up, blood sugar increase, heart rate, stress hormone levels increase 

Chronic, long term exposure has profound consequences for young children’s bodies and brains

Disrupts brain circuits



Following rules

Controlling impulses

Families who live in poverty tend to experience more of these:

Drug abuse

Violence in the community

Failing schools

The most at risk group are parents who themselves grew up in poverty, were victims of abuse and neglect, experience abuse, domestic violence, etc.

Depression in parents has a devastating impact on children.

Depression rates are much higher in moms living in poverty and experiencing the above risk factors

Depressed parents are less interactive with their kids. Depressed parents don’t want to play, go places, interact, read with their children.  

The link between maternal depression and neglect and child behavior is clear. 

Longitudinal studies have also shown impacts upon children’s IQ’s. 

To help kids, we need to help parents.

Equipping parents helps bring them to a place where they can meet the needs of their children.

Poverty-🡪Parental depression / Trauma / ACES (community violence, domestic violence, losses, etc.)🡪emotional and/or physical neglect-🡪Toxic stress-🡪Impact upon brain: heightened anxiety; interference with executive functioning (impulse control, attention, self regulation, frustration tolerance)-🡪Internalizing and Externalizing Behaviors 

Why is there now a law against expelling children from Preschool?  Until IL adopted the “no expulsion” policy, public preschool programs were 3.4 more times likely to expel children for challenging behaviors  than the K-12 grades. Boys vs. girls, black children vs. white, and those diagnosed with a disability vs. non-disabled were 3 to 4 times more likely to be expelled. 

Because of the work by infant and early childhood mental health scholars such as Tronick, Brazelton, and Zeanah, it is understood that children’s behavioral problems and their social-emotional state, i.e. their mental health, cannot be separated. So when we are talking about challenging behaviors, what we are talking about is difficulties with their social and emotional adjustment, or early mental health issues.  There is a biological component to all mental health issues. For some, it is clearly a disorder, such as autism or sensory processing disorder, that is diagnosable. For others, the problems are relationship-based and/or the result of trauma or other forms of toxic stress. Regardless of the underlying cause, the brain, the emotions, and the behaviors of the child are all impacted. In the very young years, it is very hard to determine what the true causes are of the difficult behaviors we’re seeing. 

Externalizing Behaviors: Problems of Undercontrol (child cannot control emotions or impulses)

Internalizing Behaviors: Problems of Overcontrol (child has the excessive need to control his or her environment or emotions, resulting in highly anxious thoughts, feelings, and ultimately self-destructive behaviors)

Anxiety: Excessive fear of a perceived danger or threat. Anxiety drives most internalizing and externalizing behaviors. For example, fear may cause a child to withdraw or to lash out in protection.

Even hyperactivity can be anxiety based, as the anxious child is on high alert and unable to calm down.

Depression can also be the source of both internalizing and externalizing problems. Many children who are depressed are moody, irritable, and angry much of the time. Others are sad and withdrawn, lacking interest in activities, or lacking in focus.

Aggression, Emotional Outbursts, Defiance and Opposition: 

Emotional Reactivity: The inability to regulate strong emotions, particularly anger, leading to extreme responses such as tantrums, reactive (hitting, kicking, biting, etc.) and proactive aggression (bullying, coercion, controlling behaviors, hurting others with words and deeds on purpose).

Opposition and Defiance are associated with anger and purposeful hostility and aggression toward authority figures. Untreated, these can result in serious mental health diagnoses later on such as ODD and Conduct Disorder. 

The processes involved with opposition / defiance vs. tantrums and peer aggression may be different, but all of these behaviors can lead to some severe mental health disorders, as well as life, work, and academic issues throughout life.  Video called “It’s Possible” – filmed in Chicago / Projects / Educare

Social and Emotional Skills: Video –

Learning how to interact with others is critical to success in school.

Video: “Don’t Worry, I Got This” –

One who makes smart choices (well-adjusted)

The person who always dreams up good ideas (a thinker)

First one in my family to go to college (successful)

The one teachers love to have in their classrooms (well-liked)

The one you know won’t ever give up (Persistent)

Importance of a Positive School Culture: Watch first!

Language Nutrition: The development of the brain and learning is directly dependent upon language –  Discusses the 30 Million Word Gap studies; Achievement Gap; children must learn to read on level by 3rd grade. Those who don’t are 4 times more likely to not graduate high school.

Teaching Self-Regulation:

Games and Fun Activities

  1. Red Light Green Light
  2. Freeze
  3. Wacky Relay
  4. Self-Control Bubbles
    1. Pop then don’t pop bubbles (hold back) learning self control
  5. Ready, Set, Go!
    1. Race and substitute a different word for “GO”. Kids need to listen for the word

Research showed that practicing these self-regulation skills improved kids self regulation

Introduce topic of Self-Regulation / Self Control with Video: Cookie Monster Teacher Self-Regulation

Meeting children’s Sensory Needs to help them Focus and Learn

“The Gift” –

Culture and first language go together

Establishing Classroom Rules

    Post school-wide (universal) expectations and teach them with visuals

    Develop classroom rules that relate to them; inside, outside, centers, etc. (examples)

    Create Visuals for your classroom rules and go thru them the same way each day. (examples)

Stating Clear Behavioral Expectations:  Start the video at 0:42 min.

Stating behavioral expectations in advance requires planning

  1. Anticipate
  2. Develop a plan
  3. Prepare the children for what you expect to see.
    1. State at the beginning of activity or before the next activity
    2. Check for understanding
    3. Repeat expectations often
  4. Recognize and acknowledge children’s appropriate behaviors
    1. I see someone raising her hand!
    2. Oh, Benjamin cleaned up his space!

When should we state clear behavioral expectations?

  1. Whenever we are starting a new activity
  2. Prior to every Transition
  3. When 

Redirecting Behavior:  Start video at 1:05 min.

A positive and Proactive way of preventing and avoiding problem behavior. 

4 types of Redirecting: 

Verbally giving a simple instruction 

Physically using a gentle touch to interrupt problem behavior and guide the child to a more appropriate behavior.

With a Cue – pairing a visual cue with an instruction to prevent child’s challenging behavior, and guide the child to an alternative.

With Attention – the teacher draws the attention of a child who is on the verge of a problem behavior to a child who is engaged. 

Problem-Solving in the Moment: Start video at Skip :42 – 1:14 min

  1. Anticipate
  2. Be close: scan and move to where the action is.
  3. Provide Support: Remind children how to use words; use Solution Kit (picture cards); 
    1. Talk the children through the process of choosing a solution and solving the problem
  4. Create Multiple Solutions
    1. Have the child get the solution kit or basket of options. 
    2. Child looks thru the options and teacher reads them with the child.
    3. Help the child pick an option
  5. Celebrate Success:
    1. Be sure to acknowledge and celebrate times when children solve problems successfully.
    2. Talk about “Being Problem Solvers”

Giving Children Responsibilities:  Start video and skip :28 – :54

Giving responsibilities helps promote sharing, cooperation, caring behaviors toward others.

Giving responsibilities means teachers plan for and offer activities to be valued members of the classroom. Children are involved in meaningful ways to help the classroom run better.

3 Strategies:

  1. Offer Meaningful Roles: Sweeping; Passing out plates, etc.  “I need someone to organize our booksheo we can all find our favorite books.”
  2. Let Children Lead the class when appropriate (help children feel confident and competent). Lead parts of lessons; 
  3. Encourage Children to help each other. Help learning cooperation, sharing, and caring. Empathy. 
    1. Suggest child ask another child to join them in plan
    2. Teacher models comforting and caring behaviors
    3. Teacher recognizes when children help each other – “Nice teamwork!”