Early Brain and Child Development: The Impact of Toxic Stress and Adverse Childhood Experiences

Noreen Womack, MD, FAAPStrengthening Families Training

Institute3/18/2015

• Relay the recent research that has advanced our understanding about the first 1,000 days of a human brain

• Toxic stress and how it prevents the early human brain from learning

Objectives

Strategic InitiativesUrgent child health and member priorities and initiatives that are national in scope. Each priority moves through 3 phases of AAP commitment (planning,

implementation, and integration) over a 3-5 year period.

Better Baby Brains

The Parable of the Crow and the Chicken

The New Caledonian CrowScience Magazine,

CHILDHOOD IS FOR LEARNING

Early Brain & Child Development• The first 1,000 days offer a critical window for

social and emotional attachment, with rapid brain development that does not occur at any other time and sets humans apart

MEG: Magnetoencephalogram

CONSTRUCTING BABY BRAINS FROM SCRATCH

• http://developingchild.harvard.edu/resources/multimedia/videos/three_core_concepts/brain_architecture/

700 New Neural Connections Every Second

Image source: Conel, JL. The postnatal development of the human cerebral cortex. Cambridge, Mass: Harvard University Press, 1959 17

Three crucial things that the human brain needs in early childhood

• Free play • Learning how their actions affect their immediate physical environment• Serve and return interaction, or interactive face-to-face time with dependable adults

There is no app for this

Still Face Experiment

https://www.youtube.com/watch?v=apzXGEbZht0

Stress

Toxic Stress

• http://developingchild.harvard.edu/resources/multimedia/videos/three_core_concepts/toxic_stress/

ACE StudyWomen Men Total

• Abuse (n=9,367)(n=7,970)(17,337)– Emotional 13.1% 7.6% 10.6%– Physical 27.0% 29.9% 28.3%– Sexual 24.7% 16.0% 20.7%

• Household Dysfunction– Mother Treated Violently 13.7% 11.5% 12.7%– Household Substance Abuse 29.5% 23.8% 26.9%– Household Mental Illness 23.3% 14.8% 19.4%– Parental Separation or Divorce 24.5% 21.8% 23.3%– Incarcerated Household Member 5.2% 4.1% 4.7%

• Neglect*– Emotional 16.7% 12.4% 14.8%– Physical 9.2% 10.7% 9.9%

* Wave 2 data only (n=8,667) Data from www.cdc.gov/nccdphp/ace/demographics

90-100% Chance of Developmental Delays When Children Experience 6-7 Risk Factors

Number of Risk Factors Data Source: Barth, et al. (2008)

1-2 3 54 6 7

Graphic adapted from 2011, Center on the Developing Child at Harvard University

3:1 Odds of Adult Heart Disease After 7-8 Adverse Childhood Experiences

Adverse Experiences

Source: Dong, et al. (2004) via Center on the Developing Child at Harvard University

0 1 2 3 4 5,6 7,8

Childhood Adversity Poor Adult Outcomes

Toxic Stress

Epigenetic Modifications

Disruptions in Brain Architecture

Behavioral Allostasis

Linking Childhood Experiences and Adult Outcomes

EpigeneticsGenes are NOT destiny!

You can nurture nature…

TOXIC STRESS disrupts brain architecture…Increases neural connections dedicated to fear and anger,

and prunes connectionsdedicated to reasoning,learning, memory and emotional regulation

Acute causes of death are the exception, not the

Unhealthy behaviors, Unhealthy Lifestyles

If these unhealthy lifestyles are manifestations of behavioral allostasis, a FUNDAMENTAL cause of

death is TOXIC STRESS!

How do those automatic processes form in the first place!?

Childhood Adversity Poor Adult Outcomes

Linking Childhood Experiences and Adult Outcomes

Toxic Stress

Epigenetic Modifications

Disruptions in Brain Architecture

Maladaptive behaviors

Non-communicable Diseases

Improve caregiver/community capacity to prevent or minimize toxic stress (e.g. – efforts to promote the safe, stable and nurturing relationships that turn off the physiologic stress response)

Improve caregiver/community capacity to promote healthy, adaptive coping

skills (e.g. - efforts to encourage rudimentary but foundational SE,

language, and cognitive skills )

Adverse Childhood Experiences

Social, Emotional, and

Cognitive Impairment

Adoption of

Health-Risk Behaviors

Disease &Disability

Early DeathDeath

Conception

Freely reproducible slide from the Centers for Disease Control and Prevention.

Understanding Impact of Adverse Childhood Experiences

But wait, there’s more (bad news)

• We’ve just learned that adverse childhood experiences (ACEs) can lead to toxic stress and poor lifestyle choices and ultimately disease and premature death.

• Not paying attention to the critical 1,000 days can lead to poor Kindergarten preparedness, decreased literacy, poor graduation rates, and failure to supply our future workforce

THE GOOD NEWS - THINGS WE CAN DO

• Discourage screen time for any child less than 2 years old!!!!!!!!!!!!

• Promote the 5 R’s • Educate your parents, yourself and your

lawmakers about the importance of the first 1,000 days and the role early education plays

Do not use Screen Time for any child

Less than twenty-four

Months Old!!!

#dirtydiaper

The 5 R’s

• Read together every day with your child• Rhyme, play and cuddle with your child every day• Develop routines, particularly around meals,

sleep and family fun• Reward your child with praise for successes to

build self-esteem and promote positive behavior• Develop a strong and nurturing relationship with

your child as the foundation for their healthy development

Educate Families and Lawmakers

Eric Knudsen, James Heckman, Judy Cameron and Jack ShonkoffProceedings of National Academy of Sciences (PNAS), July 5, 2006

ReturnPer $

Invested

Carneiro, Heckman, Human Capital Policy, 2003

Age1860

“The most effective strategy for strengthening the future workforce, both economically and neurobiologically, and improving its quality of life is to invest in the environment of disadvantaged children during the early childhood years.”

15% Return on Investment

16 mos. 24 mos. 36 mos.

College Educated Parents

Working Class Parents

Welfare Parents

Child’s Age (Months)

The Foundation of a Successful Society is Built in Early Childhood

HEALTHY CHILD DEVELOPMENT

Educational Achievement

Economic Productivity

Responsible Citizenship

Lifelong Health

Strong Communities Healthy Economy

Successful Parenting of Next Generation

YOU make the difference

“It is easier to build strong children than to repair broken men. “ Frederick Douglass

Or in other words…

http://www.youtube.com/watch?v=WkWbu54LJ_8

Early Brain and Child Development: The Impact of Toxic Stress and Adverse Childhood Experiences

Documents

THE OPIOID EPIDEMIC IN TENNESSEE · Building Strong Brains initiative aims to address adverse childhood experiences (ACEs) and other sources of childhood toxic stress that are risk

Toxic Stress! Childhood Roots of Health Inequities:

Adverse Childhood Experiences (ACES), Complex Trauma and ... · Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong

Adverse and Toxic Drug Reactions

Early Adverse Experiences · Adverse Childhood Experiences 1/8/18 Florida State University Center for Prevention & Early Intervention Policy 1 Adverse Childhood Experiences: How Faith

Adverse Childhood Experiences International Questionnaire ... · Adverse Childhood Experiences International Questionnaire Pilot study ... an Adverse Childhood Experiences International

Adverse Childhood Experiences and Evidence Based Kernels

Adverse Childhood Experiences and Trauma-Informed Care

Adverse Childhood Experiences: Implications For Supervised ...€¦ · –Difficulty handling challenges. Case Scenario 1 •Children who experience toxic stress often have their

Adverse Childhood Experiences and their Relationship to

Adverse Childhood Experiences: The Journey in Scotland · Adverse Childhood Experiences: The Journey in Scotland Sara Dodds Adviser on Adverse Childhood Experiences Improving Health

Adverse childhood experiences: Building consensus on what

Braiding and Layering Funding for Adverse Childhood

Adverse Childhood Experiences (ACE) Research: Implications

Adverse Childhood Experiences: Where Sciences Collide · Adverse Childhood Experiences: Where Sciences Collide Robert Anda, MD, MS National Summit on Adverse Childhood Experiences

Evaluating the Effectiveness of Adverse Childhood

Adverse Childhood Experiences - AFMC...What are adverse childhood experiences, trauma and toxic stress? How do ACEs, trauma and toxic stress affect a child’s well -being and behavior?

Adverse Childhood Experiences (ACE) Research: Extension, …aceresponse.org/img/uploads/file/aces_webinar2.pdf · Adverse Childhood Experiences Score Number of categories of childhood

FEATURE ADVERSE CHILDHOOD EXPERIENCES BUILDING ON …

Preventing ADVERSE CHILDHOOD EXPERIENCES