[11] When comparing adverse experiences by poverty level,
frequent economic hardship is excluded as an adverse experience, to compare children independent of that hardship.
Toxic stress response can occur when a child experiences strong,
frequent, and / or prolonged adversity — such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and / or the accumulated burdens of family
economic hardship — without adequate adult support.