Risk and Protective Factors

In order to reduce the effects of toxic stress on children’s health, it is important to not only to identify its risk and protective factors, but also empower families by helping them to develop and bolster protective factors, such as resilience. The National Research Council and Institute of Medicine (2009)1 define protective factors as “a characteristic at the biological, psychological, family, or community level that is associated with lower likelihood of problem outcomes or that reduces the negative impact of a risk factor on problem outcomes” (p. xxvii). Risk factors refer to as “a characteristic at the biological, psychological, family or cultural level that precedes and is associated with a higher likelihood of problem outcomes” (p. xxvii).

In children, risk factors for toxic stress include neglect and abuse, family violence, extreme poverty, substance abuse, and parental mental health problems.2,3 However, it should be noted that not every child who was exposed to adversity, or toxic stress develops health problems.

Research has shown that protective factors, such as resiliency, and strong social and emotional support buffer the effects of toxic stress. Some children are resilient. Resilience is the “ability to adapt well in the face of adversity, trauma, tragedy, threats or significant sources of stress.” It is the ability to bounce back from difficult experiences. Several factors play a role in resilience including personality, biology, high IQ, empathy, social problem-solving. 4


1National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

2Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., . . . Wood, D. L. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246. doi:http://dx.doi.org/10.1542/peds.2011-2663.

3 Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities building a new framework for health promotion and disease prevention. JAMA: Journal of the American Medical Association, 301(21), 2252-2259. doi:http://dx.doi.org/10.1001/jama.2009.754

Miller-Lewis, L., Searle, A. K., Sawyer, M. G., Baghurst, P. A., & Hedley, D. (2013). Resource factors for mental health resilience in early childhood: An analysis with multiple methodologies. Child and Adolescent Psychiatry and Mental Health,

Rutter, M. (2013). Annual research review: Resilience—Clinical implications. Journal of Child Psychology and Psychiatry, 54(4), 474-487.

Cowen, E.L.; Wyman, P.A.; Work, W. C. Resilience in highly stressed urban children: concepts and findings. Bull. N. Y. Acad. Med. 1996, 73, 267–284.

Laporte, L., Paris, J., Guttman, H., Russell, J., & Correa, J. A. (2012). Using a sibling design to compare childhood adversities in female patients with BPD and their sisters. Child Maltreatment, 17(4), 318-329. doi:http://dx.doi.org/10.1177/1077559512461173.