1. Inclusive Education and Diversity in Early Years
Regional ECCD Conference
ARAB RESOURCE COLLECTIVE
5-7 November 2009
Effects of Continuous
Extreme Stress on Early
Childhood Development
Presented by
Rita Merhej
Clinical Psychologist
Lebanon

2. Outline
• Born and Raised in a Chronic Stress Zone
• The Physiological impact of stress on early
child (brain) development
• The “Achievement Gap”
• Psycho-behavioral implications on child
development

3. Born and raised in a Chronic Stress
Zone
Stress is when you perceive an imbalance between the
demands of an unpredictable situation and the resources you
need to cope with them.
Examples of stressors (Holmes and Rahe’s list) :
• death of spouse (100)
• divorce (60)
• fired at work (45)
• retirement (40)
• sex difficulties (35)
• moving to new residence (15)
• vacation (10)
• minor financial loan (10)
• minor violation of the law (5)

4. Chronic Stress : stress that continues over a long
period of time :
Examples: having a serious illness, being the
victim of discrimination, living near a noisy
airport
Catastrophic events : sudden, unexpected, life-
threatening experiences or traumas.
Examples : sexual assault, military combat,
natural disaster, terrorist attacks

5. Millions of children are born and raised in zones
of Chronic stress characterized by :
Catastrophic events of a Repetitive nature…

6. Example : the “Gaza Syndrome”
Children in some Arab countries live exceptionally
stressful experiences where traumas are
excessive, repeated and of long duration :
• The whole society feels threatened, support
systems are very fragile and could break down
anytime.
• The resulting psychological and behavioral
symptoms from this situation have been called by
some experts the “Gaza Syndrome”

7. Psychological and Behavioral
Symptoms
The repetitiveness and escalation of stressors in the life of the young
child produce symptoms that transcend the known Post-Traumatic
Stress Disorder (PTSD) symptoms:
• Most important is the inhibited anger where the child represses
his anger and aggression as if waiting for the moment of revenge.
• This latent anger hurts the child : he is in a state of continuous
tension, and this is often accompanied with sleep disorders and
hate feelings toward the others, usually translated in aggressive
behavior toward any person who triggers these feelings in him
(ex: if his friend teases him while playing, he will hit him violently)

8. In such High Stress contexts:
• It is impossible to fulfill the child’s physiological and material needs
• It is impossible to deliver affection, security and protection
• His daily normal routine is entirely disrupted
• He does not have opportunities to learn new exciting things
• He is given responsibilities that are beyond his age, maturity and
capabilities
• He does not get the attention, support and appreciation he needs from
his environment (too busy attending to higher priority emergency survival
issues)
• He does not have hope in a better tomorrow
• His social skills are affected by the on-going changes and breakdown in
societal and moral values around him

9. Child’s Response: FIGHT or FLIGHT
FIGHT
Aggressive behavior : child identifies
with the “Aggressor” so maybe he
will stay alive (survival instinct).
Concepts (justice and moral values)
become linked to the aggressive
reality of war, and to the social
and media teachings he is
exposed to (which glorify
violence, revenge and
fanaticism).
Idea that killing is an acceptable way
to resolve conflicts (even a moral
act).
FLIGHT
Isolation from others and
withdrawal away from all that
causes pain an hurt.
Oblivion of the traumatic dimension
of the event and obsessive focus
on the trivial elements of the
event (“banalization” of the pain)

10. Role of the Environment: a Buffer
In Arab and Islamic societies, stress is
received in a collective way (not individually)
The bonds within the nuclear and extended
families are very strong
So is the social bond between the
community, neighborhood or city members
Great role played by Religion in reinforcing
faith and social bonding and unity

11. These factors play an important role in
reducing and absorbing the effects of stress

12. Factors affecting Child’s Responses
• Responses vary from one child to another
(age, temperament, family relationships…)
• Child’s perception of the Traumatic event:
Ex: death of the father : did he die as a
“martyr”, a hero, or was it a purely hazardous
death?
• The Child’s intellectual maturation: his
capacity to understand and interpret the
stressful event
• The Child’s ability to express himself

13. Physiology of Stress in Child
Development

14. The Physiological impact of stress on
early child (BRAIN) development
• At birth, the baby’s brain is not complete.
This is why the first years of life are crucial in
the completion of the brain’s development
• For a healthy brain development, a baby
needs:
good nutrition
good stimulation
a stable and safe environment
positive learning opportunities

15. When exposed to Danger or a
Fearful Stimulus:
The body enters into a state of alarm:
The hypothalamus delivers neurotransmitters
into the blood vessels to alert different glands of
the body to secrete the appropriate hormones.
►the neurotransmitters trigger the Sympathetic
Nervous System to secrete Adrenalin and
Noradrenalin.

16. Adrenalin (or Stress Hormone):
• Produces energy
• Responsible for the physiological symptoms that put
the body in a state of alert to prepare it to face
danger :
 muscle tension
 accelerated heartbeat
 increase in blood pressure
 acceleration of breathing rate
 dilation of the pupil

17. What if the Stressful situation is of long
duration (chronic) and repeated ?
The state of chronic physiological alarm (chronic
overarousal) due to the continuous overflow of
stress hormones, can stay for a long period

18. • The human being can live in such a state for a long
time but on the expense of his internal resources
that weaken over time, and with the high probability
of a malfunctioning in his Immune System:
1. He becomes highly vulnerable to infections,
allergies, ulcers, cancerous tumors, arthritis (Selye’s
diseases of adaptation)
2. Chronic overarousal also contributes to coronary
heart disease (CHD), leading to heart attacks.

19. On a developmental level:
There is a strong relationship between:
• the child’s exposure to chronic stress (living in
a state of continuous physiological overarousal)
and
• the development of his brain functions during
his first years.

20. A chronic state of physiological
overarousal
Has negative effects on the child’s:
1) Physical health
2) Psychological health
3) Intellectual health

21. Physical health
• Allergies
• Infections
• Sleep disorders
• Eating disorders
• Enuresis
• Migraines
• Stomach pains

22. Psychological health
• Nightmares
• Behavioral regression
• Depression
• Aggression

23. Intellectual health
Between the 1st and 2nd year of life, the baby’s
brain is busy building a communication neural
network between:
the frontal cortex (thinking, awareness, logic,
planning, decision-making) AND other areas of
the brain in the Limbic system, mainly sites of
Emotions and Memory (amygdale and
hippocampus).

26. Chronic physiological overarousal also affects
structure and function of hippocampus (site of
short-term memory in the brain → the memory
we need to store and process information in order
to learn).

27. Implications:
The more the child is exposed to chronic and
high stress,
the more his brain will remain in a state of
physiological alert
the less his frontal lobe will be able to establish
and organize those neural links that allow him to
process and understand the situation around
him,and relate incoming sensory experiences to
cognition and logical thought

28. So…
• At the behavioral level, the child remains in a
chronic state of fear and impulsivity (physiological
overarousal)
• At the mental/intellectual level, this will
negatively affect the normal growth of the cortex
is hampered, preventing the child from acquiring
basic cognitive skills (language, expressive and
receptive skills, reading and mathematical
reasoning)

29. What does this mean ?
•Generations and generations of children are born and
raised in high chronic stress zones and they are not really
“using their brains”!
•The continuous exposure to high stress/traumas is leaving
their brains inactive because the brain is too busy
managing the overarousal physiological responses proper
to survival and self-defense and self-protection
•This is happening at the expense of the development of
higher mental functions which are supposed to develop
during the early years of a child’s life to prepare him for
more complex cognitive operations, needed for scholastic
achievement..

30. Effects
These children cannot:
1. Concentrate and Pay sustained adequate attention to a
topic because of too many unexpected distractions, no
environment stability, too much danger, hypersensitivity to
chaotic unpredictable sensory stimulations signaling
catastrophic events
2. Persevere on and complete a task because they got
accustomed to frequent sudden interruptions of daily
routine, forced displacement, painful surprising events
that destroy their everyday routine
3. Be motivated to learn and become successful members of
society because their reality steals away their dreams and
ambitions

31. Additional Effects
High degree of forgetfulness due to poor
concentration and attention
Loss of ability for creativity (as reflected in his
drawings and play)
Increased distractibility due to anxiety and fear-
dominated thoughts (mostly fear of losing
parents or recurrence of the traumatic event)
Increase in hesitation before acting and taking
initiatives due to anxiety and fear
.

32. Additional effects (continued)
•Obsessive thinking: instead of being open for
new thoughts and receptive to useful
information, he remains under the influence of
painful memories which contribute to increase
anxiety and fear and block the process of
learning
►obsessive thinking leads to catastrophization
of the event and its effects which results in low
self-esteem :“what happened is so terrible that I
can never overcome it because I am a weak
person.”

33. Additional effects (continued)
Increase in imagination: the child fantasizes
that he prevented the trauma from happening
or a different outcome had resulted.
this could be a coping defense strategy (used
in drawing and playing),
 but when the child realizes what really
happened, he feels guilty when he thinks
about what he could have done to prevent the
event.

34. Additional effects (continued)
Some children develop functional fixedness: the
child freezes when facing the trauma again and
doesn’t do anything to protect himself.
►major source of concern for psychologists
because :
(1) it endangers the child’s life
(2) it could be a sign of learned helplessness (the
child feels completely incapable to fight the
trauma so he adopts a total resignation
attitude).

35. There is a significant difference in the level of
scholastic performance and intellectual
achievement between children raised in safe and
stable environments and those living in areas of
high tension and hostilities where all basic
requirements for decent living are missing
(security, education, medical care…)
► the achievement gap

36. Let’s remember that to develop in a
healthy way, the brain needs:
• Opportunities for positive social interaction in a
stable, relaxed, secure environment
• Opportunities for learning new things
(concepts, relations, words…)
• Opportunities for play and constructive
exploration
(plus : safety, good hygiene, good nutrition,
proper medical care, etc…)

37. A call of warning and a call for
acting!
• Generations of children are growing in zones of
tension and military hostilities
• It is high time we realize the dangerous
implications on our children’s mental health and
mental development
• It is high time to intervene for ensuring a
stable, and safe environment for them where
they can grow in the warmth of their families
and go to school to learn and acquire healthy
social and moral values