US-based paediatrician Nadine Burke-Harris had a glut of attention deficit hyperactivity disorder (ADHD) cases at the clinic where she worked in Bayview, a poor area in San Francisco. She felt in her bones that these cases didn’t come out of the blue, and were directly linked to high levels of toxic stress in the community. Toxic stress, experienced through consistent exposure to violence, abuse and the consequences of poverty and inequality, has a lasting effect on the brain, notably in the way it perceives and processes stress. Burke-Harris asked herself whether the cause of the children’s ADHD symptoms was not a mental disorder, but a biological process that worked on the brain to disrupt normal functioning. “Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. It can tip a child’s development trajectory and affect physiology. It can trigger chronic inflammation and ...

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