A large number of adverse experiences (ie, toxic stressors) in childhood can trigger a toxic stress response.456 These range from the commonplace (eg, parental divorce) to the horrific (eg, the 6 year old "soldier" ordered to shoot and kill his mother7). Adversity can affect development in myriad ways, at different points in time, although early exposures that persist over time likely lead to more lasting impacts. Moreover, adversity can become biologically embedded, increasing the likelihood of long term change. Contextual factors are important.