The Lifelong Effects of Early Childhood Adversity and Toxic Stress
The Lifelong Effects of Early Childhood Adversity and Toxic Stress
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DOI：
10.1542/peds.2011-2663
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发表时间：
2012-01-01
期刊：
影响因子：
8
通讯作者：
Garner, Andrew S.
中科院分区：
文献类型：
--
作者：
Shonkoff, Jack P.;Garner, Andrew S.
在神经科学，分子生物学，基因组学，发展心理学，流行病学，社会学和经济学等不同领域的研究进展正在催化我们对整个生命周期的健康和疾病的理解的重要范式转变。这一关于人类发展的融合性多学科科学对我们改善儿童生活前景和加强社会的社会和经济结构的能力具有深远影响。基于这些多方面的研究，本报告提出了一个生态生物发展框架，说明早期经历和环境影响如何在影响新兴大脑结构和长期健康的遗传倾向上留下持久的印记。该报告还研究了有毒压力的破坏性影响的广泛证据，提供了有趣的见解，将早期逆境与后来的学习，行为以及身心健康损害联系起来的因果机制。这个框架对医学实践的影响，一般来说，特别是儿科，是潜在的变革。他们认为，许多成人疾病应被视为发育障碍，开始在生命的早期和持久的健康差距与贫困，歧视，或虐待，可以减少缓解有毒的压力在童年。生态生物发展框架还强调了对儿科实践的重点和边界进行新思考的必要性。它呼吁儿科医生既要作为健康儿童发展的一线监护人，又要作为战略定位的社区领导人，为新的科学战略提供信息，为教育成就、经济生产力、负责任的公民身份和终身健康奠定坚实的基础。儿科2012;129：e232-e246
Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health. Pediatrics 2012;129:e232-e246