A new resource for physicians and teachers to work together to address the adverse behavioral impacts of toxic stress in early childhood

What if kindergarten teachers better understood how delayed neural development from toxic stress affects behavior of children in their class

Photo of Donald Barr
4 8

Written by

Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

The story in the New York Times grabbed my attention. A 6-year old girl from a poor household in Brooklyn entered kindergarten, but only lasted a few weeks. She couldn’t follow directions. She threw tantrums, screaming and throwing pencils. The teacher wasted no time to put this girl on the “Got-to-go” list. Why didn’t the teacher realize that the girl was only manifesting delayed development of the brain’s hippocampus as a consequence of growing up in a stressful environment? I need to find out by talking to teachers who work with these types of high-risk children. If I can learn from these teachers what they understand about the causes of disruptive classroom behavior manifested by some children, I can work with my colleagues to develop new resources for teachers – both those currently in the classroom and those undergoing training. In 2016 the American Academy of Pediatrics issued a policy statement titled Poverty and Child Health in the United States. Citing a, “growing body of research [that] shows that child poverty is associated with neuroendocrine dysregulation that may alter brain function,” the report concludes that, “Children living in poverty are at increased risk of difficulties with self-regulation and executive function, such as inattention, impulsivity, defiance, and poor peer relationships.” It proposes a national policy that, “the early detection and management of poverty-related disorders is an important, emerging component of pediatric scope of practice.”

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)



Location: Where is your organization headquartered? [State]

  • California

Location: Where is your organization headquartered? [City]


Location: Where is your project primarily creating impact? [State]

  • California

Location: Where is your project primarily creating impact? [City]

East Palo Alto, Palo Alto, Redwood City, Mountain View, San Jose (all in CA)

Problem: What problem is this project trying to address?

In its early stages, this project will integrate biomedical knowledge from the School of Medicine with resources for teacher training in the School of Education. The goal is to develop new curricula for teacher training, and new learning resources for current teachers, so they can understand the behavioral manifestations of high-stress social environments in their students. Teachers can avoid judgment, and adapt their teaching to meet these needs. By engaging current teachers in developing these resources based on the model of community based participatory research, we can then disseminate the resources while also initiating research on the impact of these resources on enhancing the educational success of children most at risk.

Teachers and pediatricians need to collaborate to identify children from disadvantaged backgrounds who manifest delayed emotional development, and to intervene as early as possible in both the early childhood and the school context to provide the social-emotional learning necessary for these children to move on to cognitive learning later in school. Interventions at this stage have the potential of preventing behaviors in adolescence and early adulthood that can compromise lifelong health status.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Children who are differently abled
  • Low-income communities

Does your model work within any of the following sectors?

  • Childcare
  • Child and Family Services
  • Education
  • Mental Health

Year Founded


Project Stage

  • Idea (poised to launch)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

Based on early discussions with leading neuroscientists and with leaders in the Teacher Training program at the Stanford Graduate School of Education, we will begin to develop written material (e.g., textbooks, journal articles) as well as resources for teachers-in-training (e.g., web-lectures, visual aids, discussion prompts). These will provide a basic explanation of current knowledge in the ways the social and physical environment during early childhood can delay neural development of key brain structures necessary for emotional control as well as for cognitive learning. It will also introduce the concept of social-emotional learning, which has been shown to reverse many of the behavioral impediments from this neural development delay.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

This is a new project, and has not yet been implemented.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $50k - $100k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Most of the developmental work will be done by salaried faculty at Stanford and at other institutions. The funding will support graduate-level staff and material costs of implementing the project, and of evaluating its outcomes in a methodologically valid manner

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

The Primary School (http://www.theprimaryschool.org/) is a new project, funded by the Zuckerbergs' private foundation, to develop a new preschool/school in East Palo Alto, which will work in close collaboration with the Ravenswood Family Health Center (http://ravenswoodfhc.org/), a non-profit community clinic in East Palo Alto. We hope to use this new school/health care model as a format on which we can develop our learning resources not only for the teachers in this new school, but in current and future teachers in a range of educational contexts.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

Quoting from the attached Commentary, “the determinants of health are best conceptualized as biosocial phenomena, in which health and disease emerge through the interaction between biology and the social environment.” Early childhood is the optimal time to intervene to prevent the adoption of unhealthy behaviors during adolescence and early adulthood. The early school experience plays a crucial role in affecting these behavioral patterns. It is time for the medical profession and the educational profession to begin to collaborate on identifying and implementing these interventions.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email

Referral: If you discovered the Challenge thanks to an organization or person other than Ashoka, who was it? (the answer will not be public)

Robert Wood Johnson Foundation

Program Design Clarity

The principal beneficiary of this project will be teachers who work with children age 3-7, with a focus on those who work with children experiencing high levels of early childhood stress. We will work with these teachers to provide them with a better understanding of the ways elevated levels of stress affect child behavior and learning due to developmental delay in the neural stress response system and cognitive control system. The first step will be a series of interviews with a sample of teachers in the area, from which we will develop and test new learning resources for these teachers.

Community Leadership

We will follow a community-based participatory research model to work with teachers and administrators in local school districts to enhance teacher understanding of the neural impact of early childhood stress, and to identify strategies to provide needed support for children experiencing developmental delay. We will also work with local pediatricians to strengthen their collaboration with schools for children identified at high risk of delay.

Age of Children Impacted

  • 1.5 -3
  • 3 - 5
  • 6 - 12

Spread Strategies

Once we have worked locally to enhance teacher understanding of the impact of childhood stress and strengthen support from pediatricians in addressing the needs of affected children, we will disseminate this model through publications and national meetings in order to initiate broader adoption of these changes and ongoing research to evaluate their impacts on the early school experiences and subsequent educational success of high risk children.

Reflect on how your work helps children to thrive. How are you cultivating children’s sense of self, belonging, and purpose through your model?

In order to thrive in school and later in life, children need a strong sense of self-efficacy and a future-oriented time perspective. Children who enter school with delayed stress response capacity are often identified by their teachers as “conflictual”, which contributes to those children disengaging from the classroom environment. These are the very children most at risk for developing low self-efficacy and a weak sense of belonging in school.

Leadership Story

As both a practicing physician and an academic sociologist I have developed a strong sense of the ways that inequality impacts wellbeing throughout the life course. I have seen how this impact is most powerful in early childhood, and can leave behavioral residues that are extremely difficult to overcome. I have come to appreciate the role of delayed development of key neural elements in the early childhood as the source of behaviors viewed as disruptive in the classroom. I have also come to appreciate how few school teachers learn about the role this neural delay in affecting child behavior.

Leader's LinkedIn Profile (URL)


Attachments (1)


Join the conversation:

Photo of Donald Barr

I appreciate that the others who have responded to my post see the value of developing collaboration between teachers and health care providers in addressing the developmental challenges faced by some of our country's most vulnerable children.

View all comments