全球智库信息集成服务系统

In previous work on women’s leadership, the Center for American Progress has explored an array of factors that lead women to fall behind in public life. Rejecting the notion that the women’s leadership gap (as well as the pay gap and empowerment gap generally) can be closed if enough women are enjoined solely to “lean in,” CAP has argued that women’s outcomes are shaped by a combination of social and structural forces that marginalize, and even eject, women at all levels of the work pipeline. Those forces include a lack of work-family policies; an inhospitable work culture; and enduring, often unconscious, racial and gender bias.¹

CAP’s previous work has also, however, shown that any accounting of women’s progress (or lack thereof) in attaining leadership roles in the United States cannot be told as a single story. As inequality in the United States has widened, the gaps among women have grown greater as well. Over the past four decades, the disconnect in the fortunes of college-educated women and their noncollege-educated sisters has grown larger than ever before.² And white women have fared far better than women of color in attaining leadership roles in the public sector and rising through the ranks of corporate America.

The roots of inequality, both between men and women and among women themselves, stem from early life. At the start, some children are provided with the kinds of opportunities, tools, and resources that put them on track for success, while others are pulled off track by life experiences that impede their abilities to learn and flourish. The ways in which the inequities of childhood—in areas such as education, health, neighborhood safety, economic security, and access to high-quality childcare, just for starters—can lead to unequal outcomes in adulthood have been explored by many scholars in recent years.⁶ However, this report aims to carve out a new and insufficiently discussed aspect of childhood inequity for greater study and attention. Specifically, this report examines how the unacknowledged and untreated toll of toxic stress, often stemming from trauma, saps the potential of far too many girls and women, disrupting their educational trajectories and limiting their abilities to achieve their dreams.

Trauma and toxic stress—that is to say, stress that is powerful, frequent, or unyielding, and largely unmediated by adult support⁷—are not, of course, problems limited to girls and women. But they often stem from experiences that occur disproportionately in the lives of girls and women—and of girls and women of color in particular.

Women in the United States are more likely than men to live in poverty. ⁹ They are far more likely to experience sexual abuse and assault. ¹⁰ Moreover, girls and women of color must also deal with racism in all its overt and covert forms. The psychological toll of this lived reality is consequential yet all too often overlooked or misunderstood. Girls and women who internalize their problems pass under the radar, while those who “act out” are stigmatized, and, in the case of girls and women of color in particular, may be criminalized. For this reason, scholars have begun talking in terms of a “sexual abuse to prison pipeline” for girls of color in addition to the “school to prison pipeline” long recognized as a deplorable outcome for too many students of color.¹¹

This report aims to take its place alongside the burgeoning literature on the girl-specific school-to-prison pipeline and create a bridge to work on women’s leadership, arguing that the psychological fallout from toxic stress and trauma must be counted among the structural factors that impede too many girls’ long-term prospects in school and, later, in the workplace.

Considerable public attention has so far focused on the psychological issues, and sometimes dramatic derailment, of high-achieving girls—college-bound, generally white, and generally upper-middle class.¹² But the same sort of worry that animates conversations about middle- and upper-middle-class girls pulled under by pathological levels of pressure and stress has not carried over to an equivalent consideration of the psychological fallout of toxic stress caused by poverty, racism, or trauma. A combination of explicit and implicit bias, criminalization, incomprehension, and stigma has tended, in particular, to obscure the distress of girls of color and bury their experiences and their needs.

The adultification¹³ and criminalization of African American girls who have histories of toxic stress and trauma are perhaps the most dramatic and troubling manifestations of the ways that the psychological needs of women and girls of color are overlooked and misunderstood. But they are not the only ones. There is a pervasive lack of sensitivity to the ways in which girls of color signal emotional distress—a widespread failure on the part of adults that results in too many girls falling through the cracks at school. The price these young women pay in missed educational and, later, work opportunities translates into a major loss in human capital in the United States.

This report will suggest a range of policy areas that should be explored for new solutions. In particular, it will propose:

• Adopting policies to reduce and prevent toxic stress in vulnerable families, including raising the minimum wage to $15 per hour and providing access to affordable and high-quality childcare, paid family leave, and predictable scheduling

• Increasing funding for schools to train personnel in trauma-informed practices and hire more culturally competent psychologists, counselors, and social workers capable of screening students for signs of trauma and identifying impediments to learning before they lead to school failure, in addition to:

• Ending “zero tolerance” school disciplinary policies in favor of measures that foster compassion, problem-solving, and inclusion for girls of color

• Empowering students with mental health issues that affect their school performance and ability to learn as well as their families to understand how they can assert their right to an Individualized Education Program (IEP) or 504 plan designed to help students thrive in school under the terms of the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act

• Supporting and expanding legislation, such as the Affordable Care Act (ACA), that can make mental health services affordable, accessible, and on par with physical health care, with special attention to boosting the quality; racial and ethnic diversity; language skills; and cultural awareness and sensitivity of care providers

• Encouraging community-based actions to fight mental health stigma and increase awareness of what toxic stress looks like and how it can be treated and, to the greatest degree possible treated, mitigated and prevented

Most, if not all, children suffer some adversity in their early lives, and most, if not all, experience some stress. But not all are exposed to the kinds of adverse childhood experiences—sexual; physical or emotional abuse or neglect; living in poverty or with household substance abuse or mental illness; having a family member incarcerated; or witnessing domestic violence¹⁴—that, particularly in combination, can lead to toxic stress. According to child development experts, toxic stress is stress that is powerful, frequent, or unyielding, and largely unmediated by adult support. ¹⁵

Toxic stress hijacks the body’s immune and endocrine systems and is damaging for a child’s developing brain. It can affect attention, memory, planning, future stress responses, ¹⁶ and the ability to learn new skills.¹⁷ It can leave a child with an impaired ability to deal with powerful or negative emotions, leading to behavioral problems in school, possible self-harm, and substance abuse problems in adolescence. ¹⁸ All of this can make a child more likely to drop out of school, adding up to a “chain of adversity,” as termed by the authors of a 2004 study of adults who had witnessed violence as children, which can bring with it a lifetime of negative consequences.¹⁹ Those consequences include heart disease, diabetes, frequent mental distress, substance abuse, depression, poor work performance, low academic achievement, financial stress, risk for domestic violence, suicide attempts, unintended pregnancies, early sexual activity, young parenthood, and sexual violence.²⁰

The damage, however, is not inevitable. The degree of harm is proportional to the number and intensity of the stressors a child experiences. ²¹ For example, having divorced parents in and of itself does not necessarily rise to the level of toxic stress. On the other hand, the chronic experiences of racism, living in an unsafe neighborhood, and experiencing community violence do.²² A considerable body of research literature shows that, with consistent support from caring adults, even children who have experienced severe trauma can prove resilient. ²³ But without that support, the brain changes wrought by too heavy a dose of adversity can cause a child to flounder in school and can put her on a track toward future work difficulties and dashed dreams.

There is strong evidence that a wide range of policies—including subsidized childcare, living wage legislation, paid family leave, paid sick leave, and fair scheduling practices—can decrease the odds of toxic stress at home by increasing families’ economic security, enhancing parents’ mental health, and allowing parents to be more physically and psychologically available to meet their children’s needs. ²⁴

These policies, which are discussed in the recommendation section below, should be considered key elements of efforts to prevent the long-term effects of toxic stress.

Ever since the mid-1990s, researchers associated with the Centers for Disease Control and Prevention (CDC) and partner institutions have surveyed increasingly diverse samples of people in the United States to gauge their level of exposure to adverse childhood experiences. These researchers have consistently found that girls experience higher rates of adverse childhood experiences than boys, ²⁵ particularly when it comes to sexual abuse²⁶; that children living in poverty have greater exposure to adverse childhood experiences than children in more prosperous families;²⁷ and children of color have more adverse childhood experiences than white children. (The exception being children of color and white children at the very lowest income level, and except when it came to living with a parent with substance abuse or mental illness).²⁸

The effects of these unequal doses of adversity are compounded by the fact that girls, children of color, and low-income children are far less likely than boys, white children, and higher-income children, respectively, to receive appropriate help and support if they start showing the kinds of problems at home and in school that are associated with exposure to adverse childhood experiences and toxic stress.³⁰ Some of these problems include depression, learning difficulties, and challenges with self-regulation.

Considerably higher percentages of children from low-income families have mental health problems than do children overall.³¹ Girls suffer higher rates of depression than boys, starting at puberty.³² There are some indications that girls who experience trauma are more likely than boys to develop PTSD³³ and also that girls are more vulnerable than boys to psychological fallout from the stresses of family difficulties and poverty. ³⁴

And yet—perhaps because they tend to internalize rather than externalize their symptoms of pain—girls are half as likely as boys to use mental health services to help them deal with trauma, stress, or other difficulties that impact their functioning.³⁵ Children of all racial and ethnic groups are affected by mental health issues. Yet children of color are far less likely than white children to receive mental health services, and, if they do receive support, are less likely to receive high-quality care.³⁶

Lack of support, racism, stigma, and shame

In part, the dearth of support is a problem of access: School psychologists, counselors with a mental health focus, and social workers are sorely lacking in schools serving communities of color. Mental health resources in communities of color generally are scarce, and seeking mental health care—whether by adults or for children—is often viewed with derision or suspicion. There are historical reasons for this: For example, pervasive racism in the mental health system in the past has led to African Americans being, on the one hand, overpathologized with serious mental disorders and, on the other, underdiagnosed with more common problems such as depression.³⁷ Even today, African American clients continue to report racism and microaggressions from non-African American therapists.³⁸ The mental health workforce is disproportionately white—in 2013, 83.6 percent of the active psychology workforce was white, and African Americans accounted for just 5.3 percent of practitioners³⁹—and often lacks the language skills and cultural sensitivity to work effectively with immigrant communities. A lack of recognition of the role that poverty, violence, racism, and discrimination play in causing toxic stress and mental health issues remains an issue, as does a tendency to downplay the important role that family, friends, and community institutions such as churches play in helping people cope.

Stigma and shame, particularly in communities of color, are also major barriers standing in the way of acknowledging, treating, and preventing the effects of toxic stress in vulnerable girls and women. ⁴⁰ Yet the shame and silence, especially surrounding sexual assault and abuse, can worsen the effects of trauma and make it more difficult for survivors to access help. As Kimberlé Williams Crenshaw, a professor at UCLA School of Law and Columbia School of Law, put it during a 2016 YWCA policy briefing on trauma and violence in the lives of girls of color: “It’s a parallel system of denial — part of the everyday practice of marginalization.”⁴¹

Racism also plays a powerful and pernicious role in the underrecognition and undertreatment of the mental health needs of girls of color. When trauma is overlooked or undiagnosed, it can lead to other behaviors—including disruptive behavior in the classroom—that are a common reaction to both trauma and injustice that some experts see as help-seeking and adaptive.⁴² African American girls are often met with uncomprehending and hostile responses from teachers and other school personnel who tend to be disproportionately white.⁴³ Instead of counseling, these students receive punishment and—all too often—suspensions, expulsions, and referrals to law enforcement.⁴⁴ Indeed, according to the authors of a 2015 report from the National Crittenton Foundation and National Women’s Law Center, “For girls with mental health needs, the juvenile justice system becomes a proxy for the mental health system in too many cases.” ⁴⁵ Overall, African American children are almost three times less likely than white children to receive mental health care when they show signs of distress and nearly four times as likely to be suspended for minor classroom misconduct.⁴⁶ According to one 2017 report, black girls are four times more likely to be arrested and seven times more likely to be suspended than their white counterparts.⁴⁷

In her 2016 book, Pushout: The Criminalization of Black Girls in Schools, Monique W. Morris explores how looking at black children through such a biased lens, combined with the use of zero tolerance school disciplinary policies, has created a situation where black girls as young as 6 or 7 years old have been arrested at school for throwing tantrums or being disruptive. Morris notes that, black girls are commonly labeled “irate,” “insubordinate,” “disrespectful,” or “uncontrollable” by their teachers, and while making up just 16 percent of the female student population in the United States, they are nearly one-third of all girls referred to law enforcement and more than one-third of all girls arrested in school.⁴⁸

Once pushed out, these girls do not easily get back on track. Nearly 48 percent of black girls who are expelled from school in the United States do not then have access to educational services, Morris writes.⁴⁹ Harsh disciplinary policies are known to be a risk factor for dropping out of high school—an event that leads to future low-wage work and, often, unemployment and even incarceration.⁵⁰

While Asian American girls, by and large, are not criminalized, they, too, can suffer the effects of a brain drain caused by unacknowledged depression and stress—a so-called “web of pain,” described by Boston University professor of social work Hyeouk Chris Hahm. This pain, she writes, stems from internalizing the “model minority” stereotype, racial discrimination, and a “fractured identity”—a term she uses to describe having to navigate the very different cultural worlds and expectations of their often foreign-raised parents and their American-raised peers. The multitude of different cultures and countries of national origin make collective studies of Asian American families problematic—and there is still a dearth of research. However, recent studies by the Asian American Federation have shown that, in 2014, Asian American adolescent girls had the highest rate of depression among all racial and ethnic groups in the United States, while Asian American women between the ages of 15 and 24 had some of the highest rates of suicide across all racial groups. Although Asian American immigrant families experience an outsized dose of stress—stemming from poverty; acculturation; the pressure on adults to work long hours and support an extended family; and on children to succeed at a very high level in school; coupled with significant rates of domestic violence—the federation notes Asian Americans are also among the least likely of all racial and ethnic groups to seek out mental health care due to a lack of awareness, cultural stigma, and language barriers. ⁵¹

Luis H. Zayas, dean of the School of Social Work at the University of Texas at Austin and author of the 2011 book Latinas Attempting Suicide: When Cultures, Families and Daughters Collide,⁵² has suggested that complex cultural pressures account for significantly elevated rates of emotional distress among young Latinas as well. In 2015, according to the CDC’s “High School Youth Risk Behavior Survey,” 46.7 percent of Hispanic or Latino girls in ninth through 12th grades reported having felt sad or hopeless almost every day for two weeks in a row, so much so that they stopped doing some of their usual activities in the 12 months before the survey. That number was a considerably higher percentage than for African American, Asian, or white girls. Hispanic or Latino girls were also the most likely of these groups to have attempted or made a plan to attempt suicide in the past year.⁵³ Suicide attempts by Latina teenagers, Zayas has written, may be a “cultural idiom of distress”—a way of expressing the painful contradictions they face between parental expectations of behavior and American culture, particularly around autonomy and individuation. “Among Latina teen suicide attempters,” Zayas writes, “the experience of marginalization and alienation is central: young women may be caught between two or more life-ways that are not congruous and [find] little help from those around [them] in negotiating the resultant tensions.”⁵⁴

Lack of support and treatment feed the persistence of mental health problems and their consequences

The link between mental distress and school performance is clear: Mental health problems such as depression or PTSD are linked to higher rates of missing school, lower educational achievement, and dropping out of school, as well as to higher rates of suspension and expulsion. ⁵⁵ Depression can also lead to an increased chance of parenthood at a young age—known to be one of the key drivers of low-income women dropping out of school due to a lack of structural supports both during pregnancy and after. ⁵⁶

In their 2014 report, “Unlocking Opportunity for African American Girls,” the NAACP Legal Defense and Education Fund and National Women’s Law Center make a strong case that the level of toxic stress—compounded by the number and types of stressors and volume of reoccurrence—experienced by an undue number of African American girls has had a significant impact on their ability to thrive in school. The compound pressures lead to their underachieving and falling behind other groups of girls in high school completion and college attendance. “Trauma — from sexual harassment and assault, community violence, and the daily stressors of racism and sexism — can have a negative effect on academic performance for any child,” the authors write. “For African American girls, the build-up of overlapping forms of trauma may have an even more negative effect.”⁵⁷

The stresses of poverty, racism, abuse, and other trauma do not end with childhood, and their effects on performance do not end in high school.

Anxiety and depression are approximately twice as likely to afflict women than men⁵⁸—a consistent finding that researchers attribute, at least in part, to women’s greater exposure to stressors such as exposure to violence and abuse. ⁵⁹ Living with day-to-day gender bias is a factor too. Women’s common experience of role overload—to clarify, all the duties that attend the “second shift” of unpaid work at home that begins when the paid work day is over—has also been identified as a driver of stress-induced anxiety and depression. ⁶⁰ Even pay discrimination has been shown to play a role in women’s increased rates of anxiety and depression. ⁶¹

Women of color are disproportionately subjected to an accumulation of forces that negatively impact mental well-being, what Diane R. Brown and Verna M. Keith, editors of In and Out of Our Right Minds: The Mental Heal