Whether you are worried about your performance at work, your students doing well on their next exam, being there for your children, meeting new people, or being a good partner to your loved one, everyone has experienced anxiety, uncertainty, and stress. They are a part of daily life, but their prevalence and severity differ person to person and time to time. Anxiety is a feeling of worry or unease typically about something with an uncertain outcome. This worry and uncertainty can cause stress, which can have a negative impact on behavior and health. Some stress is natural and even beneficial, however too much stress can negatively impact brain development and have long term consequences.

America is Stressed Out. Stress, anxiety, and uncertainty are even more rampant following the 2016 election. The Southern Poverty Law Center conducted an online survey with over 10,000 K-12 teachers, counselors, and administrators across the country. 90% of educators indicated that the school climate has been negatively affected, and most of them believe it will have long-lasting impact. 80% described increased student anxiety and concern regarding the impact of the election on themselves and their families.

Stress and the Brain. When we are stressed, the limbic system kicks in. The limbic system includes:

• The hippocampus - involved in mood and emotional regulation as well as memory.
• The amygdala - involved in emotion and motivation,
• The hypothalamus - involved in producing stress hormones such as adrenaline, noradrenaline, and cortisol.
• The prefrontal cortex - involved in regulating anxiety and making decisions.

Short bursts of stress are natural and even beneficial, however strong and prolonged activation of the stress response results in toxic stress and too much cortisol production, which can negatively impact long-term learning, behavior, and health.

Chronic stress alters neural pathways between the hippocampus and amygdala, making us more reactive to negative events.

• Prolonged stress causes the hippocampus to shrink, negatively impacting memory.
• The amygdala exhibits decreased emotional and mood regulation while increasing anxiety and PTSD-like behaviors (McEwen, Nasca, & Gray, 2016).
• You may see students:
• Having difficulty remembering what happened during the day.
• Finding it more difficult to calm down and regulate their moods and emotions.
• Being fearful, self-conscious, hot-tempered, or apathetic.
• Clenched fists, blushing, or crying.

The prefrontal cortex (PFC), which is involved in decision making, working memory, cognitive flexibility, and response inhibition, is also negatively impacted by chronic stress.

• PFC neurons debranch and dendrites shrink which results in cognitive rigidity, meaning you cannot adapt your approach and strategies as quickly and efficiently.
• You may also become more vigilant, looking out for additional stressful items.
• You may see loss of impulse control and self-regulatory behaviors in students, compromised decision making, or difficulty sustaining attention and work.

Thus chronic stress is a vicious cycle. Students' attention is focused on searching for additional stressors, their memory is weakened except for emotionally charged or fear-inducing events, and they are more irritable and less able to regulate their emotions.

Brain Neuroplasticity Can Help Overcome Impact of Stress. Despite these negative effects, there is hope. One study found that four weeks of chronic stress negatively impacted prefrontal processing and attentional control, however these effects were reversible one month after the stress ended, highlighting the plasticity and resiliency of the PFC cells. Neuroplasticity means the brain is malleable, adaptive, and shaped by experience. Thus just as negative environments and experiences can negatively impact the brain, positive environments and experiences can positively impact the brain. Supportive relationships and stress reduction can heal the brain, and teachers can nurture students' innate capacities for high performance.

Impact of Stress on Decision Making. Unsurpris-ingly, in addition to core cognitive functions, more complex functions such as decision making are also impacted by chronic stress. Risk and reward are processed differently in decisions made under stress (Mather & Lighthall, 2012). Acute stress enhances learning about positive outcomes but impairs learning about negative outcomes of choices. It also amplifies gender differences in strategies during risky decisions, with males take more risks and females less risk under stress.

Impact on Genetics. In addition to these cognitive outcomes, stress can also impact genetics. Telomeres are long repetitive regions at the end of each chromosome in a strand of DNA. Along with the enzyme telomerase, they protect the ends of chromosomes from degrading or fusing with other chromosomes (Shaikh-Lesk, 2014). "A number of studies have linked stress with shorter telomeres, a chromosome component that's been associated with cellular aging and risk for heart disease, diabetes and cancer" (Lu, 2014). When telomeres are too diminished, they set the aging process in motion along with the associated health risks. The type and severity of stress determine how big the impact on telomeres is, with exposure to chronic early life stress having the most negative impact. One study also found that while cumulative stress has more impact on telomeres, short-term stress may also negatively impact telomere length (Mathur et al., 2016).

Stress Reduction

While chronic stress negatively impacts brain structure and function, stress reduction and positive environments hold promise to heal the brain. Acute and short-term stress are natural and to be expected, so we need to focus on reducing long-term and chronic stress.

There are several ways to buffer stress's negative effects such as:

• Establishing and maintaining supportive, warm, and caring relationships
• Interactive and high-quality parenting, as well as caring relationships with adults in one's life
• Establishing meaningful relationships with peers
• Regularly exercising
• Maintaining a healthy diet
• Getting regular sleep
• Laughing
• Practicing mindfulness and meditation
• Reducing uncertainty and thus anxiety and stress, by learning from personal experience, observational learning from others' experiences, and broader cultural learning through cautionary tales and anecdotes (Weber & Johnson, 2008).

Helping Our Students Handle Stress. Additionally, as a teacher and school leader, you are in a unique position to help students develop positive behaviors and strategies to deal with stress. As a teacher, you can be mindful in your classroom and adjust practices to reduce student anxiety and stress, and as a school leader you can work to develop a warm, supportive, and nurturing school environment and encourage teachers to implement the following suggestions.

• Be clear about instructions
• Write down expectations for an assignment
• Present directions one step at a time so as not to overwhelm the child
• Provide more frequent feedback
• Step back and extend an extra measure of kindness
• Help the child find an adult to talk to. (Mason, Rivers Murphy, & Jackson (in preparation).

Ref erences

Lu, S. (2014). How chronic stress is harming our DNA.

American Psychological Association.

Mason, C., Rivers Murphy, M. & Jackson (in preparation). Mindfulness: Creating Heart Centered Communities where children thrive, and flourish. 

Mather, M., & Lighthall, N. R. (2012). Risk and reward are processed differently in decisions made under stress. Current Directions in Psychological Science, 21(1), 36-41.

Mathur et al. (2016). Perceived stress and telomere length: A systematic review, meta-analysis, and methodologic considerations for advancing the field. Brain, Behavior, and Immunity, 54, 158-169.

McEwen, B. S., Nasca, C., & Gray, J. D. (2016). Stress effects on neuronal structure: hippocampus, amygdala, and prefrontal cortex. Neuropsychopharmacology, 41(1), 3-23.

Shaikh-Lesko, R. (2014). Telomeres show signs of early-life stress. The Scientist.

Southern Poverty Law Center. (2016). The Trump effect: The impact of the 2016 presidential election on our nation's schools.

Weber, E. U., & Johnson, E. J. (2008). Decisions under uncertainty: Psychological, economic, and neuroeconomic explanations of risk preference. Neuroeconomics: Decision Making and the Brain, 127-144. 

 

A 15-year-old lashes out amidst a fit of rage in his high school classroom. He throws a marker, screams at his teacher, and hits a classmate. Not only does he exhibit antisocial behavior at school, but he also uses drugs, destroys his own property, and is deliberately cruel to his siblings. Not only is his emotional well-being under duress but his grades are below average as well as his intelligence quotient and cognitive ability. Recently after being in a car accident, he was given an MRI, and it was determined that the size of his brain was abnormally small.

Could an underlying cause be that he was malnourished as a child?

Long-term Consequences of Malnutrition. Usually when we think of a child starving we envision protruding stomachs, emaciated limbs, and infomercials asking for $1 a day donations. While yes, malnutrition causes immediate damage to the body and manifests as a myriad of immediate heterogeneous symptoms, it would seem that the long-term damage that is done to the brain of a child is not given as much consideration as the immediate damage done to a child's anatomy. The short-term damage caused by hunger can be dangerous and may even result in death - consider news stories of hikers lost on mountains. However, long-term effects of malnutrition are often insidious.

In a study that was conducted by the University of Southern California on the island of Mauritius off the southeast coast of Africa, the behavioral, cognitive, and nutritional development of 1,000 children was studied over 14 years, beginning at age 3. The children who were malnourished children) had a 41% increase in aggression at age 8; a 10 % increase in aggression and delinquency at age 11; and a 51% increase in violent and antisocial behavior at age 17 compared to the children who received adequate nutrition.

Another study done by the University of Chile found that malnourishment affected brain development. Malnourishment actually stunted the growth of the brain. The study also concluded that IQ was affected by those who suffered malnourishment as children and that children who were in the lowest socio-economic groups were more likely to experience malnutrition

Impact of Hunger on the Brains of Babies and Young Children. According to research, a single incidence of malnutrition during the first three years of life can have long-term negative impact on a child and particularly on the child's personality. This could be due to the fact that the brain is our organ that is most dependent on energy to function, especially in babies. Thus, if calories are not being consumed for the conversion to energy, this can have catastrophic effects later on in life.

Scientific research and study have identified hunger & malnutrition in children as the potential cause for the following ailments and deficiencies:

• Brain Damage
• Stunted growth
• Kwashiorkor (protruding stomach-due to lack of protein)
• Marasmus (caused by lack of caloric intake-emaciation)
• Antisocial behavior
• Increased aggression
• Suboptimal brain circumference
• Hostility
• Decreased IQ
• Lower graduation rates/Higher dropout rates
• Neuroticism
• Decreased cognitive function
• Personality changes
• Changes in Mood
• Stunted growth
• Learning disabilities

We can see from research that malnutrition can have long-term consequences on the human brain ranging from stunting the actual growth of the brain itself to having several psychological repercussions.

Impact into Adulthood. What we don't see is what do these long-term effects mean for the children's' futures as human beings? How are their life trajectories affected? Will they be able to go to college? Will they be able to gain meaningful employment? Will it affect their ability to have healthy relationships?

What if we look at malnutrition through a long-term societal lens? Does malnutrition make our economies less robust and cause us to allocate more funding to criminal justice and heath care?

While poor nutrition can have a dramatic impact on an individual, the impact of malnutrition extends to capability of its adult citizens to lead productive lives. In a sense, the economies around the world suffer from the impact of malnutrition, but to what extent? Imagine the nascent talent and productivity that is lost because of malnutrition, something seemingly so easy to solve but something that continues to befuddle us.

Right to Live without Hunger. In 1974 the UN General Assembly issued the Universal Declaration on the Eradication of Hunger and Malnutrition. The 12 principles of the declaration centered on the premise that every man, woman, and child has an "inalienable right" to live without hunger or malnutrition.

Yet across the world children continue to live without the food and the sustenance they need to be the global citizens we want them to become.

Research suggests that this inalienable right is one that we cannot continue to deprive our children of; for if we do, the long-term ramifications will not only affect their brains but their futures as well.

References

Lichtman, N.(2006). "Running on empty: The global fight against hunger is as fierce as ever." Current Health 2, a Weekly Reader publication, , p. 12+. Academic OneFile,

Szalavitz, M. (2013, April 11). How childhood hunger can change adult personality. Time.

University of Southern California. (2004, November 19). Malnutrition in early years leads to low IQ And later antisocial behavior, USC study finds. Science Daily.

Roula, a mother, explains her devastating experience in Syria during a siege: "...nothing was available. The children were crying for food and water, and if they got sick there were no doctors, no medicines and no food. You would watch your child getting sicker and sicker and there's nothing you could do about it." (Martlew, 2013).

In Middle Eastern countries ravaged by war, many families are concerned as they face an underlying threat that could quietly undermine the future of their children. That threat is hunger and malnutrition. According to a UN report, over 4 million Syrians, half of them children, need emergency food assistance. A non-governmental organization report estimates an even higher number in need: 10.5 million (Martlew, 2013). 

Increased Malnutrition in Young Children. Over the last several years, countries such as Afghanistan and Syria have been experiencing a rise in malnutrition in young children. The constant years of war and terror have put strains on these countries in multiple ways, making it difficult for families to feed their children. Attacks and sieges on villages force people to stay hidden for extended periods of time with little food or water.

The ongoing wars have stressed the economy and people's lifestyles, resulting in widespread poverty. Families have little money for food or medical care. While aid services, like UNICEF, try to provide clean water, food, and medical care, many complications can cut families off from these services. Other factors also cause hunger and malnutrition:

• Crop shortages and crop failures make food even scarcer. As a result of ongoing war, Syria has experienced an estimated $2 billion of damage to agricultural crops and loss of livestock (Martlew, 2013).
• Cultural aspects play a part as well; women tend to give birth to many children and have trouble supporting and feeding them.
• Many women are also uneducated and do not understand the benefits of breastfeeding, such as providing key nutrients and preventing illnesses. Instead, women give their children powdered milk. With poor water quality, this milk can cause diarrhea, which, in excessive amounts, leads to malnutrition.

The long-term effects for many children in Afghanistan and Syria is severe malnutrition. These children do not receive sufficient nutrients to support basic bodily functions. Prolonged malnutrition, and particularly  protein energy malnutrition and iron deficiency, can lead to serious health problems. Children may have stunted growth, and weakened immune systems, making them more susceptible to illnesses and viruses. Examples of conditions caused by severe malnutrition are kwashiorkor (protein deficiency), marasmus, and heart failure, all of which have devastating side effects (Nordland, 2014).

Developmental Symptoms. According to the organization Orphan Nutrition, malnutrition has developmental symptoms as well. Nutrients help develop a growing child's brain and, without the proper amount, children may experience cognitive problems. Examples of long term cognitive issues that can affect children are "attention deficit disorder, impaired school performance, decreased IQ scores, memory deficiency, learning disabilities, reduced social skills, reduced language development, reduced problem-solving abilities." Any child with these conditions would have difficulty functioning, especially in school.

Disrupted Education in War Torn Countries. For years, the educational system was broken in countries like Afghanistan. Luckily, many aid services and donors have helped to build and improve education. USAID, for example, has helped build over 16,000 schools in Afghanistan, which provide education to millions of students, including girls, who were previously not allowed to attend. Unfortunately, other factors such as terrorist activities by the Taliban have closed down many of these schools. One report from 2012, for example, showed that 550 schools had been recently closed at the time. In 2015, another 615 schools were closed due to the ongoing violence. An Associated Press report in April, 2016 reported that, "The heaviest closures were in nearby Zabul, where more half the province's schools - 140 out of 242 schools - shut their doors." The Human Rights Watch reported that sometimes schools in Afghanistan
are used as military bases by the Afghan government, putting children at risk because the schools become military targets.

However, even in the midst of the battles, other non-governmental agencies have helped bring services, such as special education, to Afghanistan. UNESCO runs the Inclusive and Child Friendly Education program, which provides schooling to children with different backgrounds and disabilities, including the kind caused by malnutrition. Through their work, many children with disabilities are able to go to a normal school, which may have not been possible before improvements in education occurred.

Although they are not always successful, UNICEF and other aid services are helping children with the hunger and malnutrition crisis in Afghanistan. They specifically try to provide food and supplies that are therapeutic to children that are severely malnourished.

• UNICEF works with Bost Hospital, a clinic where malnourished children can receive food and treatment for free.
• Other organizations and volunteers are trying to help the hunger crisis in Syria.
• Save The Children and the UN have provided food and support to millions of children and families, but also fall short of their goals due to the many complications of war.

Over the years, children and families in Afghanistan and Syria have been plagued with war, uncertainty, starvation, and malnutrition. The efforts of philanthropist organizations, volunteers, and donors have helped millions of children obtain food and education. However, there are still many in the need of everyday supplies that most take for granted. Becoming aware of the issues that exist in these countries and supporting the many services that bring relief to millions of children and families is essential to solving the crisis and saving lives.

References

Martlew, N. (2013). Hunger in a war zone: The growing crisis behind the Syria crisis. Save The Children.

Nordland, R. (2014, January 4). Afghanistan's worsening, and baffling, hunger crisis.  New York Times.

Orphan Nutrition. (2016). Impact of malnutrition on health and development.

Udani, P.M. (1992). Protein energy malnutrition (PEM), brain and various facets of child development. Indian Journal of Pediatrics, 59,2,165-186 (U.S. National Library of Medicine, National Institutes of Health.)

UNESCO. (2010). Inclusive & child-friendly education in Afghanistan : Success stories Kabul, Afghanistan: Ministry of Education.

USAID. (2016). Afghanistan education: Fact sheet.