Architect of “toxic stress” steps down from Harvard center

CATEGORY: CONTROL OF LANGUAGE AND IDEAS

Jack Shonkoff, M.D., founder, Center on the Developing Child at Harvard University

Source: Center on the Developing Child newsletter, April 3, 2024
Read time: 3 minutes 
 
This Happened
On April 3, 2024, the Center on the Developing Child at Harvard University announced that Jack P. Shonkoff, M.D., has decided to step down at the end of June after 18 years as Center Director.
 
Who is Jack Shonkoff?
Shonkoff’s most well-known contribution is coining and then disseminating the concept of “toxic stress,” which has been cited over 20,000 times in science articles, many more times in the media, and helped to transform the ideological debate on how to raise children. He is a pediatrician who focused most of his academic career on advocacy and social policy. He has been first or secondary author on over 50 journal publications, most of them commentaries or policy recommendations, and over 30 book chapters. He has had prominent roles in national organizations and testified to Congress about the well-being of children.
 
The Premise
Shonkoff’s advocacy has had an extraordinary influence on the field of pediatrics and shaping public perception by setting an intellectual narrative that children are far more fragile than previously thought and society must protect them from stress and adverse experiences.
 
In 1998-2000, he chaired a committee of experts on child development who published a policy monograph for the National Academy of Sciences which concluded that child development is derailed on a massive level by environmental stressors, and for the first time created the concept of “stressors that are toxic” [1].
 
Next, in 2003, while at Brandeis University, Shonkoff spearheaded the creation of the National Scientific Council on the Developing Child, which, despite the name was not a national government agency; the council was simply a private group of like-minded scholars with a stated mission to transform social policy. Their aim was to change the care of very young children from “a private, family matter” to influence national policy about children based on new neuroscience [2].
 
Then, in 2006, Shonkoff moved to Harvard University and became the founding director of the Center on the Developing Child. By then, the Council, which followed Shonkoff to Harvard, was worried that “just saying ‘stress’ more loudly wasn’t going to get them where they needed to go” [2]. The Council agreed to invent and disseminate the phrase “toxic stress.” Further, to convey their message more clearly to the public, they also invented a hierarchical taxonomy of positive stress, tolerable stress, and toxic stress. With a few years, their efforts made toxic stress widely accepted.
 
Prior to Shonkoff’s advocacy, there had never appeared a cogent connection between childhood psychological stress and derailed child development; the concept of stressors that are toxic had been used only to describe animals, mostly fish and shrimp, poisoned by pollutants. His synthesis appeared to be a stunning connection of psychological stress to major adult disease and dysfunction.
 
The concept of toxic stress is nearly identical to, and borrows heavily from, the adverse childhood experiences (ACE) movement, which claims, based on weak, cross-sectional studies, that stress and trauma in childhood permanently damages brains and causes a wide range of serious medical illnesses. The concept is also nearly identical to the claims in the 2014 best-selling book by Bessel van der Kolk, The Body Keeps the Score.
 
Analysis
The great tragedy of Science—the slaying of a beautiful hypothesis by an ugly fact.
—Thomas Henry Huxley
 
Shonkoff was a master at pulling together cherry-picked research through a wordsmith’s skill with academic rhetoric and humanitarian sentiment to convince others that he had finally found the source of nearly all childhood suffering. Toxic stress would have been a useful theory to provide levers for policy makers to pull to raise children out of chronic misery.
 
None of it, however, is true.
 
The supporters of toxic stress and ACE push back on any criticism by asserting that there is a widespread consensus and the scientific debate is over. As Shonkoff wrote in 2000, “The scientific evidence on the significant developmental impacts of early experiences, caregiving relationships, and environmental threats is incontrovertible…The overarching question of whether we can intervene successfully in young children’s lives has been answered in the affirmative and should be put to rest” [1].
 
Shonkoff omitted, however, or perhaps didn’t realize given his limited experience as a researcher, that the ACE research upon which he heavily leaned, is one-hundred percent cross-sectional in nature, which has zero power to provide causal conclusions. When individuals have been studied prospectively with assessments gathered before trauma and repeated after trauma, most studies fail to support toxic stress, and the few that do have been unreplicable [3]. A mechanism for how ACEs can cause a massive array of both mental and physical dysfunctions from psychological stress, including many that are normal, everyday stressors, has never been found.
 
What’s Next?
At age of approximately 78, it’s not clear what’s next for Shonkoff. The announcement stated that he plans “to dedicate all his time to an external, field facing agenda. Jack is not retiring…He will focus his time and energy on engaging directly with policymakers and community-based leaders who are eager to leverage scientific insights…”
 
Whether he has scientific insights is arguable. It is conceivable that his legacy will instead be a doctor who was gripped by a progressive leftist ideology that children are fragile and then found studies that fit while ignoring better science. Toxic stress is not a scientific term. It is a marketing slogan.
 
 
REFERENCES
[1] National Research Council and Institute of Medicine. "From Neurons to Neighborhoods: The Science of Early Childhood Development," National Academy Press, (2000).
[2] Center on the Developing Child at Harvard University. "A Decade of Science Informing Policy: The Story of the National Scientific Council on the Developing Child," (2014).
[3] Andrea Danese et al. "The origins of cognitive deficits in victimized children: Implications for neuroscientists and clinicians," American Journal of Psychiatry 174 (2017): 349-361.
Julia A. DiGangi et al. “Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature.” Clinical Psychology Review 33 (2013):728-744.
Michael S. Scheeringa. "Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre-trauma neurobiology in relation to posttraumatic stress symptoms," International Journal of Methods in Psychiatric Research (2020).
 
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