The crisis within

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S PE C I A L R E P OR T

THE CRISIS

WITHIN

How toxic stress and trauma endanger our children Special section • How stress can hurt growing brains and how to limit damage. Behind Lifestyle Editorial • The costs to society from toxic stress are too high to ignore. A14 Online • Watch children connect with parents in prison; take a trauma survey. STLtoday.com/stress

LAURIE SKRIVAN • lskrivan@post-dispatch.com

“We started praying this year. It’s something I felt we needed to do,” says Mardie Sonnier, 67, of Ferguson. Sonnier leads her grandchildren Destiny Sonnier (right), 9, and Anthony Murry, 6, along with neighbor Akeelah Kelly, 8, in prayer before they leave for the bus stop in October. The ritual had included the girls’ friend Jamyla Bolden, 9, before she was shot to death in August. Neighborhood children also grappled with months of unrest after the death of Michael Brown.

The smelter, weakened by cheap aluminum, is winding down as the region braces itself Nicklaus: Smelter or not, utility legislation shouldn’t be rushed.

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num prices tumbled in the 1980s, Steve Glenn lost his job at Noranda Aluminum.

“But I knew I was coming back,” Glenn said Tuesday from the floor of the aluminum smelter, where he’s now a supervisor.

Even in the depths of the Great Recession, older workers assured a 20-something Aaron Ragan that his layoff would be only temporary.

“It didn’t feel like there was a finality to it — until now,” said Ragan, a journeyman electrician

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the U.S. Department of Justice lawsuit against this city, perhaps none was more pivotal than a presentation by Ferguson Finance Director Jeffrey Blume on Feb. 6.

Before an audience of roughly 200 people, Blume outlined one dismal financial picture after another.

Near the end, he hit on a positive note — at least for some. A proposed “consent decree,” negotiated between Ferguson and the Justice

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SECTION S

SPE C I A L R E P OR T

THE CRISIS

WITHIN The stress of crime and poverty tears at children, research shows — inhibiting brain growth, inviting disease and ultimately slashing life spans

Best friends and neighbors Destiny Sonnier, 9, and Akeelah Kelly, 8, shout, “Justice for Jamyla!” during a community march against violence in August. Jamyla Bolden, 9, was a fellow fourth-grader at Koch Elementary School near Ferguson who had been shot through a window as she did her homework on her mother’s bed.

STORY BY NANCY CAMBRIA • St. Louis Post-Dispatch | PHOTOS BY LAURIE SKRIVAN • St. Louis Post-Dispatch

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he white casket is low enough for most of Jamyla Bolden’s elementary school classmates to gaze directly into the face of their friend, her eyes closed, her lashes long.

A childish angel adorns the interior satin lid just above the fine profile of Jamyla’s face and gazes down wide-eyed on the children.

A message beneath it reads, “You shall fly with new wings.”

The children have come to the wake at Wade Funeral Home on an August evening to say goodbye to Jamyla, a fellow fourth-grader at Koch Elementary School who had been shot through a window as she completed her homework on her mother’s bed.

They stand in the cement block chapel next to parents and grandparents at the casket, most too shy and uncomfortable to speak.

STORY CONTINUES ON PAGE 2

“I was her best friend. She was like my sister,” says Akeelah Kelly, 8, who finds comfort in her mother’s arms during a vigil for Jamyla Bolden, 9, in August. Akeelah had played outside with Jamyla on Ellison Drive in Ferguson hours before Jamyla was killed.

SOLUTIONS THAT WORK • Relationships can counter damage of stress. PAGE 8 THE SCIENCE OF STRESS • See how toxic stress affects development. PAGE 10

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“MY GRANDMA SAYS IF WE MOVE, IT’S JUST GOING TO BE LIKE THIS ON THE OTHER STREETS.” DEST I N Y SON N I ER

“She’s just angry. Everything makes her mad,” says Mardie Sonnier about her granddaughter Destiny Sonnier, 9, as the two sit outside their home in Ferguson in October. “She’s been through a lot, and she’s doing a good job taking care of herself,” Sonnier says. “I made sure she’s in with a counselor.” Destiny lost her father in 2013 and her friend Jamyla Bolden last year to violence. Soon after Jamyla was shot, Mansur Ball-Bey, 18, a cousin of Destiny’s, was shot and killed by police. Sonnier, 67, would like to adopt Destiny, but she is certain she could never raise the adoption fee.

CONTINUED FROM PAGE 1 The narrow slivers of stained-glass windows barely draw in outside light.

The children seek solace deep in their parents’ arms. Some of the boys put their hands in their pockets to resist the urge to reach out.

Destiny Sonnier, 9, stands behind a relative in the second pew. She cannot look at her friend’s body.

Destiny had spent the summer with Jamyla.

They had formed a dance crew, making up complex routines, the more difficult to master, the better.

“I would tell her all of my secrets and everything,” Destiny said.

Akeelah Kelly, 8, had played outside with Jamyla on Ellison Drive hours before she was killed. Now, she approaches the casket, quietly and steadfast — like a grown-up little lady, her mother said.

But when she returns home, she cries.

Jamyla had lived in a highly segregated, low-income Ferguson neighborhood filled with young children and endless stress.

Gun violence is just one part of the burden for many of Jamyla’s friends and classmates.

Poverty overwhelms their parents with debt, housing and transportation problems, and they struggle to keep the power on. Their family histories include sexual abuse, domestic violence, incarceration and foster care.

Two of Jamyla’s closest friends — Akeelah and Destiny — have endured many of those struggles, both before Jamyla’s death and in the months since.

It has long been known that growing up in impoverished and dangerous neighborhoods dims life prospects.

But now a commanding body of medical research presents a disturbing, biological picture of why.

It suggests that the stress itself — if left unchecked — is physically toxic to child development and health.

Brain imaging, biochemical tests, genetic testing and psychiatric trials show toxic stress ravages growing children — inviting maladies such as asthma, obesity, heart disease, high blood pressure, diabetes, kidney disease and stroke in adulthood.

When children don’t get a break from the stress — when adults can’t or don’t know how to shield their children from it — their developing bodies go on a stress hormone production binge that can alter typical gene expression within their DNA. In some cases, parts of their brains are smaller and their chromosomes shorten.

Those biological and developmental changes trigger lifelong health consequences that can ultimately shorten lives.

Some pediatricians who treat children in mostly poor neighborhoods describe a toxic stress epidemic.

“I see all these beautiful babies, and I think of all the statistics, and I can calculate which of these babies is going to have problems because their home environment is so stressed that they are never going to get the right support they need to turn on those genes to get a happy involvement in life,” said Kenneth Haller, an associate professor of pediatrics at St. Louis University School of Medicine and a fellow with the American Academy of Pediatrics.

The toxic stress Haller describes isn’t limited to children of poverty.

Middle-class and affluent children are not STORY CONTINUES ON NEXT PAGE

“I just want to be better,” says Destiny Sonnier, who reads her homework out loud in October.

Destiny often reads with her grandmother. On this day, her grandmother spent most of the day in bed; she has been ailing since suffering a heart attack.

“I wanted to work on my self-esteem,” says Destiny Sonnier, who signed herself up for counseling sessions after school at Koch Elementary. Destiny is trying to sort out her feelings about her father’s murder and her friend’s death. She said her counselor reminds her that she is very strong.

“She helps me go through how I’m feeling ... about all the things happening to me.”

“Learning some of the new moves can be hard,” says Destiny Sonnier, who practices with the dance team last month at Koch Elementary School near Ferguson.

Destiny had formed a dance crew with her neighbor Jamyla Bolden, making up complex routines.

Jamyla was shot and killed in her home in August.

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“Lord, help us make it through this day,” says Destiny Sonnier, 9, who drops to her knees after performing a cartwheel routine with her cousin Anthony Murry, 6, in October. “We pray so we won’t get shot,” says Destiny, who lost her father to gun violence in April 2013 and her friend Jamyla Bolden in August.

Destiny’s chores include taking care of Anthony when her ailing grandmother isn’t feeling well.

Mardie Sonnier, 67, mostly depends on oxygen tanks that keep her in her small bedroom most of the day.

“It’s a best friend thing. We always be holding on to each other,” says Destiny Sonnier (center), who walks with her best friend, Akeelah Kelly, 8, as they head to the school bus stop in October with Destiny’s cousin Anthony Murry, 6, along Ellison Avenue in Ferguson. Their friend Jamyla Bolden was killed at her home across the street. After Jamyla died, Akeelah would panic on the school bus when it passed Jamyla’s house.

CONTINUED FROM PAGE 2 immune from the traumas of domestic violence, drug overdoses and natural disasters such as floods, to name a few.

But in neighborhoods such as Jamyla’s, those stress factors are concentrated because of poverty. And that adds up to what many view as a public health crisis.

“We have kids who start out looking great as infants, and as they grow I can see their parents more and more distracted by all the things in their lives like food insecurity and housing insecurity,” Haller said. “And what I ultimately see is that these kids on some level start to shut down.”

A MEMBER OF THE DANCE CREW Jamyla was killed in August while doing homework, when a man now in police custody shot into a bedroom window. Police do not believe she was the intended target.

Jamyla was bleeding to death in the arms of a veteran police officer, a man who would later sob at her wake.

Jamyla’s death on Ellison Drive happened shortly after the one-year anniversary of the fatal shooting of Michael Brown by a police officer in the same neighborhood. Everyone had hoped things would finally calm down.

During the Brown protests, West Florissant Avenue, the street right behind Ellison, filled with protesters, police lines and looted and damaged stores. At night, children heard the chop of hovering police and media helicopters. Tear gas lingered like fog some mornings.

Destiny Sonnier’s fear and grief were palpable then and remain so. They linger in her own house just 300 yards down the street from Jamyla’s and in the night air that often pops with gunfire.

Two years earlier, while she was living with her grandmother and dad, he disappeared. He was found shot dead and dumped in a lot in Kinloch, his legs bound by zip ties.

Destiny is now being raised by her grandmother with an aunt and a cousin in the same tidy house. Her mother sometimes takes her on weekends but is busy raising Destiny’s half siblings.

Destiny longs to leave the house and violence on Ellison Drive, but she knows that is unlikely. She often gets angry.

“My grandma says if we move, it’s just going to be like this on the other streets,” she said.

Her grandmother, Mardie Sonnier, would like to adopt Destiny, but she is certain she could never raise $1,700 in needed adoption fees.

After her son was killed, Mardie Sonnier, 67, suffered a heart attack that makes it hard to breathe.

She mostly depends on oxygen tanks that keep her in her small bedroom most of the day. Destiny helps the house function. Her maturity is reflected in her chores. She makes sure her grandmother takes her medicine. She

reads stories to her grandmother in bed. And she plays with her little cousin.

Sometimes their play includes spontaneous cartwheels and headstands in the yard after school. But that play has a twist. Last fall, on a warm late afternoon, she and her cousin stopped their flips, knelt on the grass facing each other, and put their hands together in prayer. They repeated it like a dance routine.

“If we pray, we won’t get shot,” Destiny said.

A FRIEND ON ELLISON DRIVE Two days after Jamyla’s death, Akeelah Kelly attends a vigil in front of her friend’s house.

She holds a balloon and cries. Photographs of her deep distress appear in the local news.

Jamyla was one of the first girls to introduce herself when Akeelah moved to Ellison Drive with her mom and sister.

Natasha Brown (no relation to Michael Brown) hoped suburban life would give the family a break from violence in their old St. Louis neighborhood. The house was federally subsidized and affordable. There was a neighborhood school.

Instead they settled into a new world of stress. Michael Brown was shot within months of their arrival.

A receptionist with Better Family Life’s neighborhood assistance center on nearby West Florissant Avenue describes the area as a war zone. The stress in residents runs deeper than the Michael Brown shooting, with many reliving past and present traumas such as family violence and homelessness.

“A lot of people already have post-traumatic stress disorder from their pasts,” said Yolanda Nelson between walk-in clients seeking help with their utility bills. “That just doesn’t go away.”

After Jamyla died, Akeelah would panic on the school bus when it passed Jamyla’s house.

The driver arranged a special stop for Akeelah on a corner just past sight of her friend’s house.

Brown, 30, named her daughter Akeelah after the main character in the movie “Akeelah and the Bee,” in which a girl from a poor Los Angeles neighborhood makes it to the national spelling bee.

But her Akeelah has had to overcome so much more, including the murder of her friend.

“I had never seen that type of pain come from my child. And that hurt,” Brown said.

‘A COLD FEELING’ Trauma and fear permeated Jamyla’s neighborhood, even before she was killed.

On Aug. 8, a group of mostly Koch Elementary children were celebrating a ninth birthday party outside at the Northwinds Apartments complex, a five-minute walk from Jamyla’s house.

About a dozen children and young adults played on the common lawns some 25 yards from the teddy-bear tree — a stuffed-animal memorial for a man who was found shot dead in a car a year ago.

Three young men bolted out of an apartment in a dispute. At least one of them had a gun and began shooting before they ran off and jumped into separate cars. No one was hurt.

“Everybody ran in the house and dove to the floor,” recalled Darlene Evans, 45, a mother of 10, five of them under age 12.

“After that, I told the children, ‘You could be next,’” Evans said.

Evans’ youngest kids went to bed in her bedroom, hunkered down on the floor and on the mattress, wrapped in quilts, but low and away from windows.

Two weeks later, Jamyla was shot.

“It just was a cold feeling,” Evans said, rubbing her hands down her arms.

TOXIC STRESS SHORTENS LIVES Few area researchers know more about the effects of unrelenting stress on children than Washington University psychiatrist Joan Luby.

For 15 years Luby has studied 90 low-income children from the St. Louis area, tracking their development through brain imaging.

Her findings suggest that children living in poverty — unless given emotional support to buffer their stress — have smaller volumes of white and gray brain matter, particularly in the critical regions of the brain known as the hippocampus and amygdala.

Last year, Luby published a paper directly linking poverty to smaller brain volumes in developing children. In January, another of Luby’s studies linked poverty to poor connectivity within certain regions of children’s brains. They are two of dozens of studies finding adverse developmental effects on the brain.

Luby’s research offers hope. She said children living in poverty with caregivers who are attentive to their needs are less vulnerable.

Brain scans show these positive relationships and other support can actually protect the brain from abnormal development.

“I think the thing that is probably most frustrating about it is that we really understand it and even know this is actually preventable,” said Luby. “So the science should be informing the public policy for prevention, but right now, it’s not.”

The alarms on toxic stress have been sounding for years.

Decades of research affirm that as stress hormones escalate in children, they are exposed to a range of health dangers. Those include inflammation of the circulatory system, diminished heart and kidney health, higher fat production and storage in the body and suppressed immune function.

Newer research suggests the damage occurs at a genetic level.

One study looked at the length of telomeres on the chromosomes of 9-year-old boys under toxic stress. Telomeres are the caps that buffer the long strands of nucleotides that STORY CONTINUES ON NEXT PAGE

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“I HAD NEVER SEEN THAT TYPE OF PAIN COME FROM MY CHILD. AND THAT HURT.” NATASH A BROW N

Akeelah Kelly, 8, pauses before going to bed in November. The family had been without gas heat since September. They were using electric space heaters to warm their home on Ellison Drive in Ferguson. They were also without electricity in September due to a delinquent utility bill.

CONTINUED FROM PAGE 3 extend from the ends of chromosomes.

Telomeres normally degrade during aging, causing the ends of the chromosomes to shorten. That shortening is considered one of the key causes of aging and disease.

But the study found the 9-year-old boys living in toxic stress had telomeres on average 40 percent shorter than those of boys living without such stress.

And the harm extends to behavioral and mental health.

Simply put, children who have suffered sustained violence and trauma can have miswired brains primed for fear and at the ready for “fight or flight.” That challenges their ability to learn and function socially.

Anne Kessen-Lowell, the former director of SouthSide Early Learning Center, a mixedincome child care facility in St. Louis, said teachers encounter children who are jittery, temperamental and unable to sit still or focus.

“We are far too likely to point fingers at parents and households when they need our help and support,” she said Psychotherapist Debra Zand, of Danis Pediatrics at Cardinal Glennon Children’s Hospital, said she is often referred young patients with unexplained behavioral problems.

One boy she treated played with a small dollhouse in her office, she recalled. He picked through its rooms and clutched a miniature wooden bathtub in his hand. Zand asked him what he’d picked.

“He called it a coffin,” she said.

Zand said such problems are caused by multiple layers of trauma and stress.

“This is a way of life for the family, and the kids don’t know any different.”

“Every bit counts,” says Natasha Brown, 30, in October at a north St. Louis County plasma clinic.

She and her husband regularly give blood, and net about $35 each. After this visit, she was headed to buy shoes for her older daughter.

A RISK BEFORE BIRTH Perhaps the most troubling research on toxic stress is how trauma experienced by adults is transferred to children.

For the classmates and friends of Jamyla, such as Destiny and Akeelah, that means their well-being is tied not only to their own stress, but also — perhaps more critically — to the stresses of their mothers.

It starts in the womb.

Research suggests a mother’s stress hormones can be passed to a developing fetus.

Sometimes the effect is so profound that the fetus can’t endure it, leading to pre-term birth — with often fatal results.

In the St. Louis area’s poorest ZIP codes, infant mortality rates rival Third World countries’.

Researchers also have found toxic stress may alter the expression of genes in the DNA of developing fetuses. Certain proteins may more easily latch on to a particular sequence in the DNA. Studies suggest the process turns off gene expression that helps the body lower its output of stress hormones. Essentially, babies with extremely stressed mothers can lose the ability to fully dial back the production of those stress hormones for life.

The troubles continue in infancy.

Research by Cynthia Rogers, a psychiatrist at the Washington University School of Medicine, has found distinct links between a mother’s depression and toxic stress, particularly among mothers in poverty.

Maternal depression can hinder a new mother’s ability to bond with her baby. The resulting neglect — the absence of direct attention — triggers the release of stress STORY CONTINUES ON NEXT PAGE

Akeelah Kelly hangs out in her bedroom while praying with her older sister, stepsister and a friend in Ferguson in November. When the power was turned off, Akeelah slept at a friend’s house.

“I can do just a little bit of everything, including hair,” jokes Demont Kelly, 33, who fixes his daughter Akeelah’s braid in their car in October outside his wife’s house on Ellison Drive in Ferguson. Kelly is active in his daughters’ lives, but he is banned by state law from living in their Section 8 house because he owes a court fine that would clear his probation.

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Natasha Brown drills her daughter Akeelah on spelling words as her other daughter and husband cook dinner in December at her house in Ferguson.

“I always struggled in school,” Brown says. “I am tough on my girls to always do their best in school.”

Akeelah Kelly and Destiny Sonnier play basketball with other kids in November outside Akeelah’s home in Ferguson. Akeelah’s backyard borders West Florissant Avenue, the hub of protests after the shooting of Michael Brown. Akeelah’s mother, Natasha Brown, says: “In the 30 years I lived in St. Louis, I never saw a dead body, until I moved here. I brought my kids here to get away from certain things, and I put them right in the middle of everything.”

CONTINUED FROM PAGE 4 hormones in the child, while stunting development of neural pathways that promote language, learning and social skills.

“We know with certainty that children with depressed mothers have poorer outcomes,” Rogers said.

TALLYING TRAUMA The links to toxic stress during childhood and poor health are further borne out by a landmark 1998 federal study and ensuing research on adverse childhood experiences — known as ACEs. Thousands of participants from every social, economic and racial background were asked to fill out a survey to determine if they were exposed to any of 10 traumas while growing up — such as neglect, physical and sexual abuse, incarceration of a relative and substance abuse.

Those who were exposed to four or more “adverse experiences” had triple the lifetime risk of heart disease and lung cancer and a 20year deficit in life expectancy, one researcher said.

Indeed, Rajeev John, a social worker at Affinia Healthcare, formerly Grace Hill, said the vast majority of his low-income patients have histories of multiple childhood traumas along with worries about finances, employment, poor schools, jailed loved ones and crime.

“Children pick up on all their stress. It is invariably affecting the children,” John said.

Both Natasha Brown, Akeelah’s mother, and Darlene Evans, the mother at the Northwinds Apartments birthday party, took the ACEs survey at the request of the Post-Dispatch. They reported eight childhood traumas each.

Brown said she was molested as a child within her extended family. She spent her teens in foster homes and residential institutions after her mother gave her up to raise her other sisters. She had her first child with her now husband at 16, and vowed always to keep her children.

Evans also was sexually abused during childhood, she said. Beatings provoked her to run away. She attempted suicide as a preteen.

Both mothers have significant health issues that began showing in early adulthood. Evans has high blood pressure and suffered a serious stroke last year. Brown has asthma and knees that wore out before she turned 30. It’s impossible to say whether those medical conditions resulted from trauma in childhood, and yet those maladies are linked by research to toxic stress.

And now, they say their lives in Ferguson sometimes feel as dangerous and stressful as their childhoods.

In the months that followed Jamyla’s death, the women have confronted crime, a lack of transportation, health issues, a loss of utilities and debt. At times they are able to offer

the kind of love and support experts say can help children avoid the dangers of toxic stress.

Sometimes they have been able to access public programs to help them and their children.

Other times, they find themselves paralyzed by their situations and on the edge of “losing it.”

Though they don’t know the science of toxic stress, they say they often worry their kids are being harmed because of their struggles.

‘I CAN’T FIX IT’ In early September, about a week after Jamyla’s funeral, Natasha Brown is sitting on her couch when the hum of her appliances falls silent. She is struck with a stress common among the poor in St. Louis: Her electricity has been shut off. She was $1,800 behind on her bill and could not negotiate a payment plan because of a bounced check.

Brown drives to various agencies to find assistance. She receives offers of a hundred dollars here, some more elsewhere, but not enough to clear the bill and get the power back on.

Akeelah, her sister and a cousin who lives with them are sent each day after school to sleep at a friend’s house.

Without power, Brown fears she’ll lose her rent voucher — and the house — and that could trigger the loss of her children to foster care.

She had given up a good job cleaning medical equipment when her knees failed and she needed surgeries, leaving behind more than $20,000 in medical bills.

She and her husband, Demont Kelly, regularly give blood at a north St. Louis County plasma clinic: about a $35 net for each of them, nothing close to what they need.

Kelly, 33, is an attentive dad, but he is banned by state law from living in their Section 8 house because he owes a court fine that will clear him of probation on a minor felony charge.

By mid-September, Brown is really struggling.

“This situation — I feel like I can’t fix it,” Brown said. She knows the family’s troubles are hurting her children. Akeelah is cursing and arguing at school. She and her sister beg to go back to their own rooms each day after school.

“Akeelah says she is fine,” Brown said. “But if you knew her before this all happened, you know that she is not. As a mother, you know that she is hurting.”

In October, Brown finds utility assistance after St. Louis County releases special funds to aid residents in Ferguson.

The power is turned on, and the family returns home.

Some of the stress lifts. Akeelah begins riding the school bus past Jamyla’s house without fear. Behavior reports come home from school with more “green lights” than red ones. And Brown starts working a temporary job at a factory in St. Charles.

After months of turmoil, she feels calm.

Laughter and regular prayers return to the household — signs of the type of mental resilience researchers say can protect children from toxic stress.

The family starts scanning classifieds for a safer place to live. Just before Christmas, Brown gets a call and erupts into tears. She is offered a security guard position with St. Louis Public Schools with a start date after the new year.

And yet, as Brown and her children approach winter, new anxieties emerge.

For several weeks, the gas is cut off, sending her and the girls to bed some nights amid the orange glow of three whirring space heaters.

Then, just before the new year, the family car is repossessed.

DESTINY’S BIG WORRY In early fall, Destiny Sonnier decides to attend counseling sessions after school. She is sorting out her feelings about her father’s murder and Jamyla’s death. She said her counselor reminds her to see things differently and to remember that she is very strong.

“She helps me go through how I’m feeling at home and how I’m feeling about all the things happening to me,” Destiny said. “I’ll be angry because of all this stuff, and I’ll be thinking in my head, why did this stuff happen to me?”

Through the fall, she takes step classes at school, serves as a school bus monitor and plays outside with her cousin.

Her grandmother tries hard to remind Destiny she is still a little girl despite her troubles.

But as the year goes on, the grandmother shelters a worry.

With a murder trial approaching this year for two defendants, she knows she has to tell Destiny for the first time about the harsher details of her father’s death. It is only a matter of time before she reads about it in the newspaper.

In the meantime, Mardie Sonnier provides an important relief for her granddaughter and others.

Every school day she invites the neighborhood children inside her tiny kitchen to pray in a cramped circle before the bus comes. The ritual had included Jamyla before she was killed.

Some mornings Akeelah makes her way across the street to join Destiny and others in the circle. Sometimes the prayer is simple: God, get us to the school bus safely.

Despite the comfort of morning prayers, Destiny heads into winter with another worry.

She knows the circle will likely shrink again.

“My friend, Akeelah, she is going to move,” she said. “And Jamyla, I don’t have her to play with no more. So what’s to do?”

Destiny does not want to be left behind on Ellison Drive.

Nancy Cambria • 314-340-8238 • @nanecam on Twitter ncambria@post-dispatch.com Laurie Skrivan • @LaurieSkrivan on Twitter lskrivan@post-dispatch.com

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DA R LEN E EVA NS

THE CYCLE OF STRESS D

STORY BY NANCY CAMBRIA • St. Louis Post-Dispatch | PHOTOS BY LAURIE SKRIVAN • St. Louis Post-Dispatch

arlene Evans, 45, a single mother of 10 children living on disability without a car, has been coping since childhood with dangerous levels of stress.

That stress can deeply affect her children, especially her youngest, twins Alex and Lexi, and their brother, Aaron.

Evans reflects how toxic stress attacks maternal health and then moves on to impair prenatal and early childhood well-being.

Her family, of the Northwinds Apartments complex in Ferguson near West Florissant Avenue, is precisely the kind of household that public health experts say needs support and programs.

That’s true even though her decision to have so many kids makes her unpopular in policy debate about who should receive federally funded entitlements.

And yet, the size of her family — combined with a lack of financial resources to manage it — is what poses perhaps the greatest risk of toxic stress harming her children.

Darlene Evans shows off her “Navy Mom” T-shirt to a clerk at the Family Dollar. Evans’ oldest daughter, Diamond, is in the Navy Reserve.

EVEN NOW, INTENSE WORRIES The current stress of caring for five children under 12 can be so intense, Evans said, she sometimes hides in the closet off her bedroom and prays.

Even outside the household, she has grave worries. Her second oldest son is finishing out a federal sentence on a gun possession charge.

She cobbled together the cash to pay for a private attorney to try to keep him out of jail. “I try to think he’s around the corner or at his girlfriend’s house,” she said.

Evans vowed to raise her youngest children differently from the “spare the rod, spoil the child” way she was brought up.

She grew up in the Darst-Webbe public housing complex in St. Louis. Evans suffered multiple childhood traumas. When she was about 7, she saw a man roll out of an elevator and die from a stabbing.

She attempted suicide before she turned 13.

“I just said things were going to be better for my children,” she said.

Her children do not go hungry. There are piles of clothes in the basement that Evans has procured from charities or purchased on discount.

In December, a small Christmas tree was up and decorated by her kids in the living room. She is proud that her oldest daughter, Diamond, is in the Navy Reserve.

Speech and language pathologist Susan Dutton works on vowel pronunciation with twins Lexi and Alex, 2, in October.

GETTING CRITICAL HELP “I don’t let them go outside (alone) anymore,” says Darlene Evans, 45, as she takes a walk with her five youngest children in August in front of their home in the Northwinds Apartments in Ferguson. From left to right are Warren, 10; Alex, 2; Aaron, 3; Lexi, 2; and Destiny, 9. Four days earlier, several of her children witnessed a shooting across the street.

Evans took an important step last August when she enrolled the twins in First Steps, a state-funded home visit program for young children with disabilities and developmental delays.

When occupational therapist Susan Dutton first met the children, Lexi barely spoke beyond a whisper. Aaron was hyper and unable to follow directions.

Over three months of visits, the children drastically improved. Dutton further nudged Evans to enroll the twins in a free preschool program to get them up to speed.

“This is how I relax. I like my glass of wine and cigarettes,” says Darlene Evans, mother of 10 children, as she winds down one evening in August.

AN AGONIZING CHOICE Three years ago, Evans found out she was pregnant with twins. She put off prenatal care partly out of denial.

She had eight children already and had given birth to Aaron less than a year earlier. She found an agency to put the twins up for adoption.

The stress during her pregnancy was intense. The relationship with the father was unstable.

When contractions started coming early, she was admitted to a hospital on bed rest. Baby Aaron, and her older children, Warren and Destiny, then around 6 and 7, were placed in temporary private foster care.

It pained Evans deeply to know another family celebrated Aaron’s first birthday and saw him take his first steps. She regrets it to this day.

On Feb. 4, 2013, Evans delivered Alex and Lexi 11 weeks early in what one doctor called “a life-or-death situation.” Chronic stress and maternal depression have been significantly linked to premature births.

The next day, Evans saw the twins in the NICU tethered to machines.

Lexi had porcelain light skin and long delicate fingers. Alex “really looked like a big chocolate kiss.” She held little Alex against her skin.

“When I sat there, the only thing that came over my mind was a voice, like, ‘You had all these other children. You didn’t give them up, why should I give these up?’”

The decision to keep them led to more stress. Lexi once stopped breathing, and Evans revived her with CPR. Alex still uses a feeding tube.

At times Evans juggled the twins in one arm and Aaron in another.

She recalls going into the bathroom and screaming at the top of her lungs under the pressure.

Alex, 2, and Aaron, 3, help their mother, Darlene Evans, with her walker after a stroke in October. By December, through what seemed like her force of will, Evans was walking normally.

A CRISIS

“I always wake up early. I can’t sleep. I am afraid I will get shot,” says Destiny Evans, 9, who watches cartoons alone at 6 a.m. on a Friday.

PARENTING WITH STRESS Evans’ own health problems, neighborhood turmoil and family disputes sometimes disrupt the household routine and her ability to parent. In late summer, after random gun violence erupted within feet of where the children were celebrating a birthday outside, the family could not sleep at nights. Mornings were a struggle.

Some days Destiny and Warren readied for school on their own. The

twins and Aaron frequently slept until noon.

This is concerning because the children are at the tail end of a period of critical brain development where reading, communication and nurturing help the brain create vital neural connections. Research finds the absence of attention can stress the child and harm that brain development.

There was another stress that lurked in Evans’ household. Evans deals with high blood pressure, a condition that research suggests could be tied to the stress and trauma in her childhood.

In October she suffered a stroke and awoke in the hospital.

She was discharged a week later with a metal walker that her toddlers clung to while she walked. Evans ended up refusing to use it.

By December, seemingly of her own grit, she was walking normally.

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02.21.2016

SOLUTIONS

THAT WORK Positive relationships and stress-management tools can counter harmful effects on the brain

“Daddy, look at me,” says Unique Davis, 11, as she dances during a visit with her father, Eugene Davis, at the Southeast Correctional Center in Charleston, Mo., in November. Unique had not seen her father in three years. Unique’s visit was coordinated by Assisting Children of Prison Parents in Ferguson, which strives to keep children connected with incarcerated parents. Unique’s father went to prison when she was 5.

STORY BY NANCY CAMBRIA • St. Louis Post-Dispatch | PHOTOS BY LAURIE SKRIVAN • St. Louis Post-Dispatch

T

here’s hope for fighting toxic levels of stress in children — hope you can actually see in brain scans from research conducted by St. Louis psychiatrist Joan Luby.

In scientific terms, the images show that children’s brain development can be sheltered from the ravages of trauma, such as violence, abuse and poverty.

In more human terms, the brain scans show that positive relationships with parents, family and others can protect and heal.

Luby’s research at the Washington University School of Medicine has documented that children in poverty without that support have smaller volumes in parts of their brain dealing with stress management, learning and executive decisions. Children in the same stressful circumstances, but with positive supports, have normal-sized brains.

It’s a concept that has been reinforced through other research. Children and adults cope with stress better when they have developed emotional resilience. And that resilience is built through positive relationships.

That kind of support can lower a child’s abnormal output of stress hormones — a key biological threat to health and development.

The takeaway for parents is a hopeful one: When stress threatens the well-being of children, simple, proven techniques work. It’s a message that has relevance to all parents, regardless of neighborhood or income level.

Ruth Coleman got a crash course in stress when she, her husband and her four children were in the midst of losing their Warrenton home to foreclosure. They were forced to move into a mobile home in a rural town.

But thanks to a referral from her youngest son’s Early Head Start program, they were already taking a parenting class that offered techniques to help the family cope.

She said the class gave them strategies to keep perspective and maintain a sense of humor. So, when her youngest children, ages 4 and 8, started loudly arguing over a banana during an interview, she let it slide because, “it’s not going to make a hill of beans whether they were fighting over a banana today.”

Coleman said she now lets her youngest son direct his play with her. Letting him make the rules took away power struggles and enabled her to better bond with him — a key factor in keeping toxic levels of stress at bay.

Ultimately, child advocates in St. Louis say toxic stress is a preventable health problem here — with adequate public and civic investment.

St. Louis has programs and initiatives dealing with toxic stress. But only 30 percent of the children in the region in need of mental health and behavioral support get it, according to a survey by the St. Louis Mental Health Board.

Investment has been further hindered by biases against the poor, who are likely to need the services most.

“We are far too likely to point fingers at poor parents and households when they need our help and support,” said Anne Kessen Lowell,

“I will carry a gun when I am older — but I will never need to carry one because I am a peacemaker,” says Brandon Albritton (left), 13, a member of the dance troupe the Peacemakers.

They practice a dance set to an original song titled, “I Surrender,” in August in the Northwinds Apartments complex in Ferguson. Cynthia Barnett, who lives in the complex, started the group along with La’Keisha Ellis of University City. The two met during protests after the Michael Brown shooting in 2014. Barnett said: “I wanted to create something positive for the kids. I wanted to give them something to do instead of being another statistic like Mike Brown.”

the former director of SouthSide Early Childhood Center.

Luby argues this is not rocket science. Solutions have been known for years.

She and others point to a blueprint for combating toxic stress among children and families in St. Louis.

STRENGTHEN FAMILY BONDS Unique Davis, 11, of the Old North neighborhood in St. Louis, has a father who went to prison when she was 5. He’s serving an 18year sentence.

Depression and anxiety are rampant among children who have parents or other loved ones in prison. In Missouri, the number of children with parents in prison is about 48,000, about the population of Chesterfield.

These children worry fiercely about their parents, and vice versa, said Hakee Mitchell, founder and executive director of Assisting Children of Prison Parents, an organization in Ferguson that offers tutoring and mentoring.

In November, the group arranged for Unique to visit her father.

Moments after Unique spotted him in the prison visitors’ room, she ran into his arms.

They played cards and talked about the future when her dad would someday be free.

“It’s almost like a sense of calm comes over them,” Mitchell said of the prison visits. “It’s like, ‘OK, I’ve had questions, and now they’ve been answered.’”

KNOW TRAUMA SYMPTOMS Toxic stress and trauma trigger outbursts over incidents that other children handle more easily. From elementary grades through high school, that can lead to suspension or expulsion and possible juvenile court involvement.

Jennings schools Superintendent Tiffany Anderson wants staff and students to understand trauma and ways to de-escalate that stress response.

Under the guidance of Washington University School of Medicine pediatrician Sarah Garwood, the school district received a $60,000 grant from Missouri Foundation for Health to help staff and students better understand trauma and stress.

It is one of many trauma education initiatives taking place locally and statewide in the fields of education, health, youth services and juvenile rehabilitation.

Staff and students are learning how past trauma can be reactivated by triggers such as certain words or smells or confrontation that reminds children of past violence. They focus on tamping down confrontations. The district plans to create safe places in each school for students to work through sudden anger and other painful emotions.

“We’re giving teachers a new framework on how they respond to student behaviors,” said Anthony Robinson, the district’s director of secondary education.

STORY CONTINUES ON NEXT PAGE

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THE CRISIS WITHIN

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“I learned not to sweat the small stuff,” says Ruth Coleman, whose son Ian (right), 4, cuddles with her as she fills out a reading log for an older son Dylan, 8, last month in their mobile home in Truesdale. Coleman and her husband, John, took a parenting course through Early Head Start when they were losing their house to foreclosure. She said the class gave them strategies to keep perspective and maintain a sense of humor.

CONTINUED FROM PAGE 8 START BEFORE BIRTH Babies born to depressed or stressed mothers are less likely to receive the nurturing they need. And that hurts brain development when it’s needed most.

It’s why Cynthia Rogers, a psychiatrist and researcher with WU’s School of Medicine, created a program at Barnes-Jewish and St. Louis Children’s hospitals that screens new mothers for depression .

In late October, Keonshay Clark, 22, was identified as needing help after she gave birth to her second daughter, DaKodah, at BarnesJewish. She needed to find a new place to live within the month.

Social workers at the hospital referred Clark to Nurses for Newborns, a home-visiting program that tracks the health of the baby and supports the mom.

“We are really there to lift them up in their parenting role,” said Melinda Ohlemiller, chief executive at Nurses for Newborns, who said about 40 percent of the new moms they serve test positive for depression.

EMPOWER MOMS WITH HOPE New moms dealing with toxic stress often feel isolated and hopeless.

Kendra Copanas, chief executive of the Maternal Child and Family Health Coalition, said mothers, particularly in the African-American community, often do not seek help.

Copanas said agencies in St. Louis are trying to break that isolation in unique ways. The maternal child coalition, for example, recently started a “Letters of Love” campaign in which volunteers write letters of congratulations and support to expectant and new moms in stressful situations.

The coalition also hosts a mothers support group. One of the members is Shanette Upchurch, 42, a mother of four from Riverview. Upchurch copes with isolation, depression, debt and a history of abuse. Work is hard. Twenty years ago, Upchurch said she saw firsthand how toxic stress in her life was damaging her children. It was the day she was called to come quickly to the school office.

She found her kindergartner throwing desks and chairs in the principal’s office.

Therapy revealed her son had absorbed years of trauma from watching his mother being beaten by a partner. He was exhibiting a “fight or flight” response common to children under intense stress.

Her son is now a high school graduate, employed and an involved dad.

“But it took so much just to get him as a functioning person,” she said.

Five years ago, after her youngest child was born, Upchurch signed up for home-visiting services and therapy, and joined the support group. She said the group changed her outlook on life and parenting. She’s so hooked she convinced her daughter, 19, and her daughter-in-law to join.

“I need to be at these meetings,” she said.

“When I come here it’s like family.”

TEACH PARENTING STRATEGIES Some parents never got the nurturing they needed when they were young and have few parenting models, said John Constantino, a psychiatrist and researcher with WU’s School of Medicine. These parents may not know the best ways to fully connect with their own children, particularly amid high stress.

Constantino is managing a federally funded trial program in the St. Louis region to protect children from toxic stress. It uses a specialized parenting education program to train groups of parents with children enrolled in Early Head Start programs.

The program supplies “good enough” parenting tips and teaches praise as a first response. Ultimately the strategies help parents better enjoy their parenting role, and their children’s behavior improves, Constantino said.

“It makes parents more attuned to protect their kids from their stress,” Constantino said.

Coleman, who took the class with her husband amid their foreclosure crisis, said the class taught her the value of simple but focused play time with her children.

“That type of play says, I’ve got this 15 minutes with you,” she said. “No matter what else is going on in my life, you’re my center of attention for this 15 minutes.”

Fourth-grade classmates Rayell Hickman (left) and Kendal Bolden decorate the desk of his sister, Jamyla Bolden, at Koch Elementary School in September. Jamyla was killed in a drive-by shooting on Aug. 20, 2015, while doing her homework inside her mother’s bedroom. Counselors and teachers felt the art project would help the children in their grieving process.

GET INVOLVED How do you take a break from stress? Share a photo on Instagram of a healthy habit. In the caption, describe how it helps you, and then add the hashtag #takeabreakSTL. Join a free Post-Dispatch community forum, “Parenting and Grandparenting Under Stress.”

7 p.m. Thursday at the New Northside Missionary Baptist Church Conference Center, 8645 Goodfellow Boulevard.

RSVP is required. 314-340-8900 or sign up online at STLtoday.com/stressfree.

MORE ONLINE

Watch a video about managing stress, featuring the Weatherbird.

See how a program helps children connect with parents in prison.

Take the ACEs survey, a tool for measuring trauma and health risks.

STLtoday.com/stress

ABOUT THIS PROJECT Nancy Cambria reported this story with the support of the Dennis A. Hunt Fund for Health Journalism and the National Health Journalism Fellowship, programs of USC Annenberg’s Center for Health Journalism. She has worked at the Post-Dispatch since 2005.

Laurie Skrivan has worked at the Post-Dispatch since 1997. A St. Louis native, she was part of the team that won a Pulitzer Prize in 2015 for covering the unrest in Ferguson.

ENCOURAGE WELLNESS One evening a month, Dr. Thomas Kernan takes off his white medical coat and heads into a conference room at an Affinia Health Care clinic to conduct a Mind-Body Skills Group for patients, most of them low-income, dealing with toxic stress.

Kernan, along with a social worker, teaches relaxation and breathing skills, guided imagery and meditation to help patients reduce stress. He said regular relaxation techniques can be as effective as medication to alleviate high blood pressure, diabetes, heart disease and other maladies.

Kernan is a graduate of the national Center for Mind Body Wellbeing, which has studied the effects of stress relaxation and mindfulness in struggling populations around the world, including refugees. In St. Louis, he said his patients typically have histories of trauma.

“All of these kids and families that I see that are exposed to these toxic effects of stress would benefit from learning some self-care skills to help decrease those effects,” he said.

Kernan goes so far as to hand out to patients a self-recorded, 15-minute CD called “Soft Belly,” which promotes breathing through your belly, mimicking how infants breathe. He tells them to use the CD five times a week.

With his soothing voice and ambient music and ocean waves in the background he asks patients “begin to breathe through your nose and out through your mouth, relaxing and letting go with each exhalation … letting your belly be soft.”

TALK ABOUT STRESS Wellness programs of all sorts are now considered a necessity for health, particularly among the poor — so much so that the St. Louis Regional Health Commission launched the wellness initiative Alive and Well STL to reduce toxic stress regionwide.

It aims to make the concepts of stress reduction and positive relationships more universally known and practiced in the region.

Benefits should ultimately trickle down to children.

Connie Fisher of Mental Health America of Eastern Missouri, who gives stress information training through the initiative, said people still lack basic information on reducing stress. Even 10 to 15 minutes a day of mindfulness — being completely present in the moment — can make a huge difference, she said.

More widely, Alive and Well STL aims to remind everyone they have power to help someone in pain during stressful times. They may not be able to change gun violence or poverty, but the group argues that small words and actions can incrementally make a big difference.

“A big part of this is the availability of caring and loving supportive people around us,” said Joe Yancey, chief executive of Places for People and spokesman for the Alive and Well initiative. “Because the reality is, at the end of the day, my well-being is dependent on the well-being of my neighborhood, of my coworkers, of my child’s school and its families.”

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02.21.2016

THE SCIENCE

OF STRESS Toxic stress occurs when too many stressful events and traumas pile up. Children are the most vulnerable. Stress hormones — including those passed on by a stressed mother in the womb — can hurt brain development and even alter chromosomes.

Without a break from the stress, children can develop various social problems. Even worse, they face a higher risk for a wide range of diseases through adulthood.

Chromosome Telomeres

Shortened telomeres

IT STARTS BEFORE BIRTH Toxic stress may transfer from a mother to her developing baby in the womb.

Researchers have found expectant mothers suffering from depression produce higher levels of stress chemicals, which reduce fetal growth and increase risk for premature labor.

Current studies suggest maternal depression may further repress the expression of a gene in the fetus meant to control the overproduction of stress chemicals. That overproduction can cause a lifetime of poor health and behavioral issues.

This is doubly troubling because a mother dealing with her own toxic stress may not be capable of adequately nurturing her infant, causing further stress response in the child.

DOWN TO THE CHROMOSOMES

DIMINISHED BRAIN VOLUME

Research suggests toxic stress can alter gene expression and even chromosomes.

One study looked at the length of telomeres on the chromosomes of 9-year-old boys under toxic stress.

Telomeres are the caps that buffer the long strands of nucleotides that extend from the ends of the chromosomes. Telomeres normally degrade during aging, causing the ends of the chromosomes to shorten. That shortening is considered one of the key causes of aging and disease. The study found the 9-year-old boys living in toxic stress had telomeres on average 40 percent shorter than those of boys living without such stress.

Brain imaging done by dozens of researchers has found that children under extreme stress have less volume in both gray and white matter of the brain.

Particularly troubling are findings indicating that stress stunts the hippocampus region of the brain.

The hippocampus, among other things, helps humans process fear.

When it’s smaller, children may lose their full capacity to differentiate between threat and safety, so the world feels like a scarier place.

A HOST OF DISEASES Unhealthy amounts of stress hormones alter multiple biochemical processes in the body, everything from the immune system to the inflammatory response. The following maladies have been tied to toxic stress: Mental illness, substance abuse and behavioral problems

NEURAL CONNECTIONS From birth through age 3, the brain produces about 700 neural connections per second. Neurons cluster and branch off as they grow.

Optimal neural production in young children is dependent on positive interaction with adults and the world around them.

Cooing, snuggling, reading and talking to infants help neurons grow. Neurobiologists call the vital interaction “serve and return.” And neglected children often lack it.

The problem snowballs for children raised amid stress. Such children build more neural pathways to cope with and respond to danger.

When children reach their preteens, the brain prunes its neural branches, keeping the pathways that are most used and discarding the ones that are not — including potentially positive ones. For a child living under toxic stress, the brain is, in essence, built around stress.

Cancer Obesity Diabetes Autoimmune disease

Asthma High blood pressure and heart disease

Kidney disease

Gastrointestinal problems

SOCIAL, BEHAVIORAL ISSUES Studies suggest that stressed children perceive anger in facial expressions that most others perceive to be friendly or neutral.

This can hinder them from forming healthy relationships. A host of other behavioral problems can develop.

When stress hormones constantly course through the body, the child remains restless, ready to launch into primal flight-or-fight responses when faced with experiences that seem less threatening to others.

This makes taking turns, sharing and sitting still in preschool and school more difficult.

Children with toxic stress are more likely to act out or become disruptive to gain control of a situation when they feel threatened.

Illustrations: Tribune News Service, 123rf.org Face images from study by Seth D. Pollak, Michael Messner, Doris J. Kistler and Jeffrey F. Cohn

TIPS FOR TACKLING STRESS We all have stress, but there’s good news. You can fight it.

And simple remedies work. Try these tips recommended by Connie Fisher of Mental Health America of Eastern Missouri.

Take a break • Even 5 to 10 minutes of relief from stress a day can derail the damaging effects of stress hormones. It’s all about practicing living in the moment and putting things in perspective.

Just breathe • Intentional breathing — oxygen and mindfulness together — does wonders for bringing the body back into chemical balance. Take a deep, deep breath. Feel your belly expand. Hold it all in for five seconds.

As you release, calmly and slowly say the word “peace.”

Make a list of tasks you can accomplish • List-making enables you to break a day or project that seems insurmountable into doable tasks.

Better yet, studies show the physical act of crossing things off your to-do list releases a tiny hit of dopamine in your brain. That neurotransmitter triggers a pleasure response, the same thing you get from sex or chocolate.

Keep a journal • Therapists say it helps get your head and body in balance.

Learn something different • The idea is to use another part of your brain to break you out of old thinking and your typical stress response.

Write your worries • If you are kept awake by stress, before you go to bed write out your top five worries. Read them, then tear them up.

Take your problem for a walk • Research shows walking, particularly outside, reduces your blood pressure and your stress.

Spend time with friends • How many times do you run into an acquaintance and say, “We should get together soon,” but never follow through? The next time, put a visit on the calendar.

If needed, seek help • Even the strongest people sometimes need professional help to get through the rough patches and trauma.

RESOURCES IN ST. LOUIS For programs and information on reducing toxic stress Alive and Well STL, 314-446-6454, aliveandwellstl.com To find help with stress and other mental health issues Mental Health America of Eastern Missouri: 314-773-1399, mha-em. org/resources/local-resources.html For assistance with heat, housing, food, child care, emergency shelter and other critical issues Call 2-1-1, a hotline provided by United Way of Greater St. Louis.

To download the 2-1-1 mobile app or chat online, go to 211helps.org.

For 24-hour referrals to free counseling and other behavioral health programs for children, call the local Youth Connection Helpline: CITY OF ST. LOUIS 314-485-4635 or text: 2TALK to 31658 ST. LOUIS COUNTY 314-628-2929 or text: 4HLP to 31658 ST. CHARLES COUNTY 636-642-0642 or text: BSAFE to 31658