Dr Nils Bergman - Gaga. | An independent creative consultancy.enzu.vlov.be/media/filebook/files/perinatal Neuroscience SSC.pdf · Dr Nils Bergman PERINATAL NEUROSCIENCE and SKIN--TOTO--SKIN

Dr Nils BergmanDr Nils Bergman

PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT

Dr Nils BergmanDr Nils Bergman

MB MB ChBChB, DCH, MPH, MD, DCH, MPH, MD

(USA equiv: MD, MPH ,PhD)(USA equiv: MD, MPH ,PhD)

Cape Town, RSACape Town, RSA

www.skintoskincontact.comwww.skintoskincontact.com

Speaker Disclosure


Under ACCME guidelines:Under ACCME guidelines:

a)a) I am the South African distributor ofI am the South African distributor ofMIRIS : Human Milk AnalyzerMIRIS : Human Milk Analyzer

b)b) My My wife markets educational materials and shirts related wife markets educational materials and shirts related to the talk content to the talk content

Kangaroo Mother Care Kangaroo Mother Care PromotionsPromotions

NEUROSCIENCE


NEUROSCIENCEEVOLUTIONARY

BIOLOGY,EPIGENETICS


600gr,600gr, 26 26 w w GA, 48 GA, 48 hrshrs

600gr,600gr, 26 26 w w GA, 48 GA, 48 hrshrs


Even at 600gr,Even at 600gr,26 w GA26 w GA

Even at 600gr,Even at 600gr,26 w GA26 w GA

SkinSkin--toto--skin contactskin contact

What is going on in that What is going on in that brain?brain?





Evolutionary Biology and Evolutionary Biology and Modern Neuroscience Modern Neuroscience ––

What Mothers Always KnewWhat Mothers Always Knew

NEUROSCIENCENEUROSCIENCE

The DNAThe DNAEverything elseEverything else

EVOLUTIONARYEVOLUTIONARY

BIOLOGYBIOLOGY

“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis

The BrainThe Brain

EPIGENETICSEPIGENETICS




BIOLOGYBIOLOGY

The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION


The BrainThe Brain


The PlaceThe Place

ENVIRONMENTENVIRONMENT

EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION




BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place



Hominines were prey at Sterkfontein, “Cradle of Mankind”

55 Father frequently Father frequently and closely involved ...and closely involved ...

THE HUNTER GATHERER (cont)THE HUNTER GATHERER (cont)

Infant care patterns in such societies Infant care patterns in such societies (which are closest to our origins):(which are closest to our origins):

11 Infant carried most of timeInfant carried most of time11 Infant carried most of timeInfant carried most of time22 Mother sleeps with infant same bedMother sleeps with infant same bed33 Immediate feeding response to cryingImmediate feeding response to crying44 Breastfeeding 24 months or moreBreastfeeding 24 months or more55 Father frequently and closely involved ...Father frequently and closely involved ...

“For species such as “For species such as primates, the mother primates, the mother ISIS the environment.”the environment.”Sarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)

Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.

Sarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)

“For species such as “For species such as primates, the mother primates, the mother ISIS the environment.”the environment.”Sarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)


The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONSarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)The PlaceThe Place



Nothing an infant can or Nothing an infant can or

cannot do makes sense, cannot do makes sense,

except in light of mother’s bodyexcept in light of mother’s body





BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place






BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



“except in the light of “except in the light of

mother’s body.”mother’s body.”




BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



SkinSkin--toto--skin contact skin contact

For the human newborn For the human newborn –– this this place / environment is place / environment is




BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place



Skin-to-skin contact




BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place



Skin-to-skin contact

CENTRAL DOGMA CENTRAL DOGMA –– all biological processesall biological processes




BIOLOGYBIOLOGY

The BrainThe Brain


The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONThe PlaceThe Place



SkinSkin--toto--skin = key that skin = key that unlocks the neuroscience !unlocks the neuroscience !

NEUROSCIENCE NEUROSCIENCE SUMMARYSUMMARY

90% of what we know90% of what we knowabout the brain has about the brain has been discovered inbeen discovered inbeen discovered inbeen discovered in

the last 15 yearsthe last 15 years

Society of Neuroscience estimateSociety of Neuroscience estimateDr Sandra Witelson, McMasterDr Sandra Witelson, McMaster

Dr Stanley Graven (2004)

“Cells which

FIRE TOGETHER, FIRE TOGETHER, WIRE TOGETHERWIRE TOGETHERFIRE TOGETHER, FIRE TOGETHER, WIRE TOGETHERWIRE TOGETHER,,and those which

don’t, won’t.”Carla Shatz

NEUROGENESIS

Myelination

Arborisation

SYNAPTOGENESIS

NEURONAL NEURONAL PLASTICITYPLASTICITYMIGRATION

0 10 20 30 40w 6m 2y 10y 60yBirth

Myelination

Programmed cell deathCOMPETITIVEELIMINATION

MAXIMAL O

CCURRENCE

Synapses

0 10 20 30 40w 1y 3y 13y 50y 80y28 Birth Puberty

MAXIMAL O

CCURRENCE

Synapses

Dendrification:peak 2m & 6m

MAXIMAL O

CCURRENCE

RELATIVE BRAIN ACTIVITY

METABOLIC ACTIVITY

peaks3 years

NEW SYNAPSE FORMATION

0 10 20 30 40w 1y 3y 13y 50y 80y28 Birth Puberty

MAXIMAL O

CCURRENCE

3 years

Impulse

Presynaptic neuron

VesicleVesicle

Transmitters

Synaptic cleft

ReceptorsPostsynapticneuron

Postsynaptic activity

SENSORY STIMULUS SENSORY STIMULUS

synapse store chemical signalsynapse store chemical signal

chemical signal strongerchemical signal stronger

THRESHOLD THRESHOLD ��EXEMPT from eliminationEXEMPT from elimination

(synapse stabilised)(synapse stabilised)PATHWAYPATHWAY

(Rima Shore 1997)(Rima Shore 1997)

fetal REM sleepfetal REM sleep(or active sleep) seems to be(or active sleep) seems to be

particularly importantparticularly importantto the developing organism to the developing organism

... spontaneous ... spontaneous synchronous firingsynchronous firing

Marks et al 1995

Panksepp 1998Siegel 2005

REMNREM 4REM REMNREM 4SWS

REM

Stanley Graven 2006

AS (20 mins) QS (40 mins)

REMREM

BRAIN CYCLINGBRAIN CYCLING

REMREMNR1NR1NR2NR2NR3NR3SWSSWS

Stanley Graven 2006


ACQUISITIONACQUISITION

RAMRAMNR3NR3SWSSWS

ACQUISITIONACQUISITION

polypoly--sensory inputsensory inputshortshort--term memory term memory stored cortex stored cortex

Awake and REMAwake and REM

NeocortexNeocortexconsciousnessconsciousnessshort term memoryshort term memory

CPUCPU

AMYGDALA:AMYGDALA:

GPSGPS

Amodio 2008

AMYGDALA:AMYGDALA:

EmotionalEmotionalProcessing Processing UnitUnit

HIPPOCAMPUSHIPPOCAMPUSMemory functionMemory functionand spatial codeand spatial code


CONSOLIDATIONCONSOLIDATION

SWSSWSACQUISITIONACQUISITION CONSOLIDATIONCONSOLIDATION

polypoly--sensory inputsensory input transfer informationtransfer informationshortshort--term memory term memory “SNR” strong signals“SNR” strong signalsstored cortex stored cortex amygdala / amygdala /

hippocampus hippocampus Awake and REMAwake and REM NREM stage 4NREM stage 4


MEMORY FORMATIONMEMORY FORMATION

NR3NR3SWSSWS

ACQUISITIONACQUISITION CONSOLIDATIONCONSOLIDATION MEMORYMEMORYFORMATIONFORMATION

polypoly--sensory inputsensory input transfer informationtransfer information P wavesP wavesshortshort--term memory term memory “SNR” strong signals“SNR” strong signals returns inforeturns infostored cortex stored cortex amygdala / amygdala / to neocortex:to neocortex:

hippocampus hippocampus organizedorganizedAwake and REMAwake and REM NREM stage 4NREM stage 4 REMREM

Stanley Graven 2006


BRAIN WIRINGBRAIN WIRING

SWSSWS

ACQUISITIONACQUISITION CONSOLIDATIONCONSOLIDATION MEMORYMEMORYFORMATIONFORMATION

polypoly--sensory inputsensory input transfer informationtransfer information P wavesP wavesshortshort--term memory term memory “SNR” strong signals“SNR” strong signals returns inforeturns infostored cortex stored cortex amygdala / amygdala / to neocortex:to neocortex:

hippocampus hippocampus organizedorganizedAwake and REMAwake and REM NREM stage 4NREM stage 4 REMREM

Stanley Graven 2006

BRAIN WIRINGBRAIN WIRING

Peirano 2003

Panksepp 1998

EARLY DEVELOPMENTEARLY DEVELOPMENT

Gestational ageGestational age20w20w all structures completedall structures completed

parallel development parallel development of structure & functionof structure & functionof structure & functionof structure & function

(Hugo Lagercrantz 2004)(Hugo Lagercrantz 2004)

Brain growth Brain growth depends on experiences !!depends on experiences !!

NEURO DEVELOPMENTNEURO DEVELOPMENT

NEURO PHYSIOLOGYNEURO PHYSIOLOGY

NEURO BEHAVIOURNEURO BEHAVIOUR

NEURO DEVELOPMENTNEURO DEVELOPMENT

NEURO BEHAVIOURNEURO BEHAVIOUR

Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”

Sequence•• Neural circuits that process basic information Neural circuits that process basic information are wired earlier than those that process more are wired earlier than those that process more are wired earlier than those that process more are wired earlier than those that process more complex information.complex information.

•• Higher circuits build on lower circuits, and Higher circuits build on lower circuits, and skill development at higher levels is more skill development at higher levels is more difficult if lower level circuits are not wired difficult if lower level circuits are not wired properly.properly.

Slide by: Jack P. Shonkoff, M.D.

R ShoreR Shore

Critical period concept :Critical period concept :

“Windows of opportunity in early “Windows of opportunity in early “Windows of opportunity in early “Windows of opportunity in early life when a child’s brain is life when a child’s brain is exquisitely primed to receive exquisitely primed to receive sensory input in order to develop sensory input in order to develop more advanced neural systems.”more advanced neural systems.”

SchoreSchore

Critical period :Critical period :

“Early interpersonal events “Early interpersonal events positively positively and negativelyand negativelypositively positively and negativelyand negativelyimpact the impact the

structural organisationstructural organisationof the brain.”of the brain.”

“The perinatal sensorium “The perinatal sensorium is never in chaos ….is never in chaos ….DEVELOPMENT IS DEVELOPMENT IS ��

EVER MORE ORDEREDEVER MORE ORDERED

11stst 28w unmyelinated28w unmyelinated11 28w unmyelinated28w unmyelinated

22ndnd 2 m sympathetic2 m sympathetic

33rdrd 6 m myelinated vagus6 m myelinated vagus

AUTONOMIC NERVOUS SYSTEMAUTONOMIC NERVOUS SYSTEM



11stst 28w unmyelinated28w unmyelinated

MOREMORECOMPLEXCOMPLEX

MORE FLEXIBLEMORE FLEXIBLE

11 28w unmyelinated28w unmyelinated

immobiliseimmobilise


fight or flightfight or flight


engage/disengageengage/disengage

“The perinatal sensorium “The perinatal sensorium is never in chaos …. is never in chaos …. DEVELOPMENT IS DEVELOPMENT IS ��


COMPETENTCOMPETENT 11stst 28w unmyelinated28w unmyelinated

Laughlin 1991

COMPETENTCOMPETENT

COMPETENTCOMPETENT MOREMORECOMPLEXCOMPLEX

COMPETENTCOMPETENT

ALWAYS!ALWAYS! MORE FLEXIBLEMORE FLEXIBLE







100%100%

OLD vagus (dorsal vagal complex)OLD vagus (dorsal vagal complex)

Sympathetic nervous system)Sympathetic nervous system)

Social vagus (ventral vagal complex)Social vagus (ventral vagal complex)

DVC

VVC

SNS

28w PMA28w PMA

From Porges, Schore, others…

•• Higher circuits build Higher circuits build on lower circuits, on lower circuits, development more difficult ifdevelopment more difficult if

lower circuits not wired properly.lower circuits not wired properly.

100%100%

DVC

VVC

SNS

DVC

VVC

SNS

DVC

VVC

SNS

28w PMA28w PMA 48w PMA48w PMA2 months2 months 6 months 6 months ��

Jacksonian DissolutionJacksonian Dissolution

The more threatened the individual,The more threatened the individual,the more 'primitive' (or regressed) the more 'primitive' (or regressed) becomes the style of becomes the style of thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995)

DVC

VVC

SNS

JacksonianJacksonian Dissolution Dissolution -- BERGMANBERGMAN

The more threatened the The more threatened the PREMATUREPREMATURE,,the the SOONERSOONER 'primitive'primitive' (or regressed) ' (or regressed) becomesbecomes the style of the style of thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995)

DVC

VVC

SNS

Basic neuroscienceBasic neuroscience::neurons, synapsesneurons, synapsesfire and wire,fire and wire,

SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact

fire and wire,fire and wire,two kinds of two kinds of sleepsleepcritical periods,critical periods,

hierarchy of layershierarchy of layers





BIOLOGYBIOLOGY

The BrainThe Brain










BIOLOGYBIOLOGY

The BrainThe Brain






DO YOU BELIEVE IN

EVOLUTION ? NO.

EVOLUTION ? NO.

YOU DON’T THINK HUMANS EVOLVED FROM THINK HUMANS EVOLVED FROM MONKEYS?

YOU DON’T THINK HUMANS EVOLVED FROM

I SURE DON’T SEE ANY THINK HUMANS

EVOLVED FROM MONKEYS?

SEE ANY DIFFERENCE.

I SURE DON’T SEE ANY DIFFERENCE.

NEUROBEHAVIOUR

I SURE DON’T SEE ANY DIFFERENCE.

Our cortex distinguishes us from

other animals …


other animals …

BUTThe “primitive”The “primitive”hindbrain is similar …


other animals …

BUTThe “primitive”The “primitive”hindbrain is vital We can learn

about ourselves from animals, and mammals!

THE “OLD” BRAIN HAS THE “OLD” BRAIN HAS

3 PROGRAMMES3 PROGRAMMES

EVOLUTIONARY BIOLOGYEVOLUTIONARY BIOLOGY

3 PROGRAMMES3 PROGRAMMES

DEFENCE NUTRITION REPRODUCTION


HIGHLY CONSERVED HIGHLY CONSERVED NEURONEURO--ENDOCRINEENDOCRINE

BEHAVIORBEHAVIOR

HORMONESHORMONES NERVESNERVES MUSCLESMUSCLES

endocrineendocrine autonomic NS autonomic NS somaticsomatic



BEHAVIORBEHAVIOR



REPRODUCTIONNUTRITIONDEFENCE


BEHAVIORBEHAVIOR

REPRODUCTIONNUTRITIONDEFENCE




BEHAVIORBEHAVIOR



Clinics in Clinics in PerinatologyPerinatology,,June 2004, June 2004, VolVol 31(2) page 21031(2) page 210

Stanley GravenStanley GravenEarly Early neurosensoryneurosensory visual visual development of fetus and newborn.development of fetus and newborn.

“It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the principles derived from careful animal studies principles derived from careful animal studies do not apply to human infants. do not apply to human infants.

principles derived from careful animal studies principles derived from careful animal studies

All mammals have set sequence All mammals have set sequence of behaviours at birth ………….of behaviours at birth ………….

……. ……. All with a All with a ……. ……. All with a All with a single purpose : tosingle purpose : to

BREASTFEEDBREASTFEED

After birth, events are determined … … by the neonate … by the neonate stimulating the mother!

(Rosenblatt 1994)

Breast-feeding is “establishedthrough a set of mutual,complex sensory stimulations complex sensory stimulations in mother and child.”

(Kjellmer & Winberg 1994)

HABITATHABITAT

DETERMINES DETERMINES DETERMINES DETERMINES

BEHAVIOURBEHAVIOUR

BEHAVIOUR BEHAVIOUR ENSURESENSURESENSURESENSURES

BIOLOGICALBIOLOGICALNEEDS NEEDS

Warming, feeding andWarming, feeding andprotectionprotection behavioursbehavioursare intricately, inseparablyare intricately, inseparablylinked to the right place.linked to the right place.linked to the right place.linked to the right place.

((AlbertsAlberts 1994)1994)

= NUTRITION PROGRAMME= NUTRITION PROGRAMME

Warming, feeding andWarming, feeding andprotectionprotection behavioursbehavioursare intricately, inseparablyare intricately, inseparablylinked to the right place.linked to the right place.linked to the right place.linked to the right place.

((AlbertsAlberts 1994)1994)

= NUTRITION PROGRAMME= NUTRITION PROGRAMME“Habitat “Habitat –– niche” niche” �� place determineplace determinebehaviors that ensure basic needs.behaviors that ensure basic needs.

ALBERTS “habitat ALBERTS “habitat –– niche”niche”

“Each state of development“Each state of development

is a form of completeness, is a form of completeness,

rather than an approximation rather than an approximation

In the right habitat, developing In the right habitat, developing organism behaves competently.organism behaves competently.


the final adult goal”the final adult goal”


Fetus Fetus �� ““fetallyfetally mature” mature” �� competent in uteruscompetent in uterus

NewbornNewborn �� ““neonatallyneonatally” mature” mature �� competent on mothercompetent on mother

InfantInfant �� competent in the attachment environmentcompetent in the attachment environment

AdultAdult �� mature mature �� competent in worldcompetent in world

All mammals have set sequence All mammals have set sequence of behaviours at birth ………….of behaviours at birth ………….

……. ……. All with a All with a ……. ……. All with a All with a single purpose : tosingle purpose : to

BREASTFEEDBREASTFEED

In all mammals …….

….. the newborn is responsible for initiating initiating breastfeeding,

not the mother !!

In all mammals …….

….. the newborn is responsible for initiating initiating breastfeeding,

not the mother !!

EXCEPT IN HUMAN ???

Sequence human newborn breastSequence human newborn breast--feedingfeedingPrePre--requisite = habitatrequisite = habitat

hand to mouthhand to mouthtongue movestongue movesmouth movesmouth moveseye focuses nippleeye focuses nippleeye focuses nippleeye focuses nipplecrawls to nipplecrawls to nipplelatches to nipplelatches to nipplesuckles suckles

(Widstrom et al 1994)(Widstrom et al 1994)

“The newborn may appear helpless, but displays an impressive and purposeful motor activity which, without maternal assistance, brings the baby to the nipple.

(Michelson et al 1996)

“The newborn may appear helpless, but

raises its own temperature,raises its own temperature,raises its own temperature,raises its own temperature,has a higher blood glucose,has a higher blood glucose,metabolic adaptation faster.metabolic adaptation faster.

(Widstrom 1987)

METABOLIC ADAPTATIONMETABOLIC ADAPTATION

SSC started in the first SSC started in the first 20 minutes after birth20 minutes after birth

SSC SSC CotCotSSC SSC CotCotBlood glucoseBlood glucose (1 hr)(1 hr) 3.173.17 2.562.56Base excess dropBase excess drop 3.43.4 1.81.8

(Christenson 1992)(Christenson 1992)

Images courtesy of Prof Peter Hartmann, UWA

Warming, Warming, feeding andfeeding andprotection protection

behavioursbehaviours arearebehavioursbehaviours areareintricately, inseparablyintricately, inseparablylinked to the right place.linked to the right place.

(Alberts 1994)(Alberts 1994)

Thermal image from Joy Browne, Denver

Thermal image from Joy Browne, Denver



COMPETENTCOMPETENT 11stst 28w unmyelinated28w unmyelinatedCOMPETENTCOMPETENT

COMPETENTCOMPETENT MOREMORECOMPLEXCOMPLEX

COMPETENTCOMPETENT

ALWAYS!ALWAYS! MORE FLEXIBLEMORE FLEXIBLE







BIRTH SKINBIRTH SKIN--TOTO--SKIN CONTACTSKIN CONTACT

BIRTH SKINBIRTH SKIN--TOTO--SKIN CONTACTSKIN CONTACTPLACE DEPENDENT COMPETENCEPLACE DEPENDENT COMPETENCE


“Each state of development“Each state of development

is a form of completeness, is a form of completeness,




the final adult goal”the final adult goal”

BIRTH SKINBIRTH SKIN--TOTO--SKIN CONTACTSKIN CONTACTPLACE DEPENDENT COMPETENCEPLACE DEPENDENT COMPETENCE





BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place








BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place






BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place



AT BIRTH,AT BIRTH,

the brain has the brain has TWO TWO CRITICAL CRITICAL SENSORY SENSORY SENSORY SENSORY NEEDSNEEDS::

SMELL & CONTACTSMELL & CONTACT

AT BIRTH,AT BIRTH,

the brain has the brain has TWO TWO CRITICAL CRITICAL SENSORY SENSORY SENSORY SENSORY NEEDSNEEDS::

SMELL & CONTACTSMELL & CONTACTconnect direct to the amygdala connect direct to the amygdala

THE THE NEWBORNNEWBORN

BRAINBRAIN

SKINSKIN--TOTO--SKINSKINCONTACTCONTACTCONTACTCONTACT

fires and wiresfires and wires

the the amygdalaamygdala--prefrontoprefronto--orbital orbital cortical pathway cortical pathway (PFOC)(PFOC)

AMYGDALAAMYGDALA::Prefrontal Prefrontal cortexcortex AMYGDALAAMYGDALA::EmotionalEmotionalProcessingProcessingUnit CPU Unit CPU

Prefrontal Prefrontal cortexcortexExecutive Executive functionfunction

approach / avoidapproach / avoid

AMYGDALAAMYGDALA::Prefrontal Prefrontal cortexcortex AMYGDALAAMYGDALA::EmotionalEmotionalProcessingProcessingUnit CPU Unit CPU

Prefrontal Prefrontal cortexcortexExecutive Executive functionfunction

SOCIAL and EMOTIONALSOCIAL and EMOTIONAL

INTELLIGENCEINTELLIGENCE

SOCIAL SOCIAL EMOTIONALEMOTIONALINTELLIGENCEINTELLIGENCE INTELLIGENCEINTELLIGENCE

Behavioural Behavioural activation systemactivation systemrewardreward--basedbased(dopamine)(dopamine)

Frontal alpha EEG asymmetryFrontal alpha EEG asymmetry= a measure of temperament = a measure of temperament

( i.e. ( i.e. traittrait emotion). emotion).

an index of potential risk for an index of potential risk for emotionemotion--related psychopathology.related psychopathology.emotionemotion--related psychopathology.related psychopathology.

a sizable literature ( +/a sizable literature ( +/-- 100 studies ) embeds the 100 studies ) embeds the measure in a network of psychological and behavioural measure in a network of psychological and behavioural constructs, thus bestowing frontal EEG asymmetry with constructs, thus bestowing frontal EEG asymmetry with sizable construct validity as a measure of an underlying sizable construct validity as a measure of an underlying approachapproach--related or withdrawalrelated or withdrawal--related motivational style,related motivational style,or as an index of potential risk for or as an index of potential risk for

emotionemotion--related psychopathology. related psychopathology.

Frontal alpha EEG asymmetryFrontal alpha EEG asymmetry

Greater LeftGreater Left--sided EEG asymmetrysided EEG asymmetry�� greater positive affect and greater positive affect and �� greater psychological and greater psychological and �� greater physiological resilience greater physiological resilience �� greater physiological resilience greater physiological resilience

Greater RightGreater Right--sided EEG asymmetry sided EEG asymmetry �� greater negative affect and greater negative affect and �� poorer psychological and poorer psychological and �� poorer physiological resiliencepoorer physiological resilience

Thibodeau 2006

Aaron Jones et al. (2004)Aaron Jones et al. (2004)conducted a study of four groups conducted a study of four groups

of mother of mother –– infant dyads:infant dyads:EEG done on baby at 1 month of ageEEG done on baby at 1 month of age

The first group wasThe first group wasThe first group wasThe first group wasDepressedDepressed--BottlefedBottlefed

EEG asymmetryEEG asymmetrycorrelates ascorrelates as

expected ...expected ...Aaron Jones 2004

DepressedDepressed--Breastfed Breastfed Breastfeeding is PROTECTIVEBreastfeeding is PROTECTIVE

SchoreSchore

In early postnatal life, In early postnatal life, maintenance of critical maintenance of critical levels of tactile input … levels of tactile input … is important for normal is important for normal is important for normal is important for normal brain maturation. brain maturation.

Areas of the amygdala …. Areas of the amygdala …. are in a critical period of maturation,are in a critical period of maturation,… in the first two months of life… in the first two months of life

Smell

Skin contact

Smell

Skin contact

Smell

Skin contact

BrainBrain--to brainto brainFaceFace--toto--facefaceEyeEye--toto--eyeeye

Interpersonal awareness

Emotions

EyeEye--toto--eyeeyevoice,voice,hands, hands, movementsmovements

CarlyCarly & Ethan, 12h& Ethan, 12h

Smell

Skin contact

Interpersonal awareness

Emotions

Kerstin

In humans, oxytocinincreases gaze to the eye region of human faces and enhances interpersonal trust and the ability to inferthe emotions of others from facial cues.

Kerstin Uvnas-Moberg

Ross 2009

Smell

Skin contact

Smell

Skin contact

Smell

Skin contact

Smell

Skin contact

SchoreSchoreIn early postnatal life,In early postnatal life,maintenance of maintenance of critical levels of critical levels of tactile input … is tactile input … is important for normal important for normal important for normal important for normal brain maturation. brain maturation.

Areas of the Areas of the amygdalaamygdala …. …. are in a critical period of maturation,are in a critical period of maturation,… in the … in the first two months first two months of lifeof life



fire and wire,fire and wire,PATHWAYSPATHWAYSCIRCUITSCIRCUITSNETWORKSNETWORKS

163

Photo: Karolinska Institute, Stockholm28 days old, 30 w PMA

164


Clinics in Clinics in PerinatologyPerinatology,,June 2004, June 2004, VolVol 31(2) page 21031(2) page 210

Stanley GravenStanley GravenEarly Early neurosensoryneurosensory visual visual development of fetus and newborn.development of fetus and newborn.

“It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the principles derived from careful animal studies principles derived from careful animal studies do not apply to human infants. do not apply to human infants. The risk of suppression or disruption of The risk of suppression or disruption of

needed neural processes ... needed neural processes ...

is very significant and potentially lasts a life time.is very significant and potentially lasts a life time.

STANLEY GRAVENSTANLEY GRAVEN

“ … NEEDED “ … NEEDED “ … NEEDED “ … NEEDED

NEURALNEURAL

PROCESSES” PROCESSES”




BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



“needed neural “needed neural

processes” processes”




BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



169


28 days old, 30 w PMA

SOCIAL SOCIAL EMOTIONALEMOTIONALINTELLIGENCEINTELLIGENCE INTELLIGENCEINTELLIGENCE

Behavioural Behavioural activation systemactivation systemrewardreward--basedbased(dopamine)(dopamine)

R R ShoreShore

Critical period concept :Critical period concept :Critical period concept :Critical period concept :

“Windows of opportunity in early “Windows of opportunity in early life when a child’s brain is life when a child’s brain is exquisitely primed to receive exquisitely primed to receive sensory input in order to develop sensory input in order to develop more advanced neural systems.”more advanced neural systems.”

a kind of invisible hothouse

“the wiring of the brain’s pathways “the wiring of the brain’s pathways is best supported when it can integrate quality sensory input through several pathways at once, particularly during critical periods of development.” (McCain 1999)

“... creates“... createsa kind of a kind of invisible hothouseinvisible hothouseinvisible hothouseinvisible hothousein which the infant’s in which the infant’s development can unfold.”development can unfold.”

(Hofer in Gallagher 1992)(Hofer in Gallagher 1992) aa


… through several

pathwaysat once …

SEESSEESMum’s eyesMum’s eyes

SENSATIONS THAT WIRE BRAINSENSATIONS THAT WIRE BRAIN

Ear HEARS Ear HEARS Mum’s voiceMum’s voice

SMELLS SMELLS Mum’s milkMum’s milk MOVES MOVES

with Mum’swith Mum’s

Hand TOUCHHand TOUCHMum’s skinMum’s skin

SkinSkin--toto--skinskinCONTACTCONTACT

Back FEELSBack FEELSMum’s armMum’s armholdingholding

TASTES TASTES Mum’s milkMum’s milk

WARMED on WARMED on Mum’s front Mum’s front


Slide from JILL BERGMAN Slide from JILL BERGMAN


SENSATIONS THAT WIRE BRAINSENSATIONS THAT WIRE BRAIN



with Mumwith Mum






with Mumwith Mum

Slide from JILL BERGMAN Slide from JILL BERGMAN


… through several

pathwaysat once …


BREAST - FEEDING==

BRAIN - WIRING


BREAST - FEEDING==

BRAIN - WIRING

NEWBORN DEVELOPMENT

skinskin--toto--skin contactskin contactTactile stimulations build the amygdala - preorbital cortical tract during the first 8 weeks during the first 8 weeks

The next pathway requires eyeeye--toto--eye contacteye contact

This is the basis of healthyright brain development!

NEWBORN DEVELOPMENTNEWBORN DEVELOPMENT

Tactile stimulationsTactile stimulations facilitate facilitate “the flow of “the flow of affective informationaffective information

from the infant … to the mother”from the infant … to the mother”“the “the language of mother and infantlanguage of mother and infant“the “the language of mother and infantlanguage of mother and infantconsists of signals produced by the consists of signals produced by the autonomic nervous systemautonomic nervous systemof both parties”.of both parties”.

This is the basis of healthy development!This is the basis of healthy development!Schore 2001a

Myron Hofer Myron Hofer

… the private realm of… the private realm of… the private realm of… the private realm ofsensory stimulation constructed sensory stimulation constructed by the mother and infant from by the mother and infant from numberless exchanges of numberless exchanges of subtle clues.subtle clues.

(Gallagher 1992)(Gallagher 1992)

The BOND The BOND

REGULATIONREGULATION

The BOND The BOND is made up of the is made up of the sensory inputs sensory inputs from the parent from the parent to the infantto the infant

Bowlby 1969, 1973, 1980

Through “hidden maternal regulators” ... Through “hidden maternal regulators” ...

warmth warmth �� activity levelactivity levelwarmth warmth �� activity levelactivity levelmilkmilk �� heart rateheart rate

“ “ physiological set points physiological set points ““internal internal working modelsworking modelsscripts scripts –– templatestemplates

Through Through “hidden maternal regulators” ... “hidden maternal regulators” ...

a mother precisely controls everya mother precisely controls everyelement of her infant’s physiologyelement of her infant’s physiology,,

from its heart rate to its from its heart rate to its from its heart rate to its from its heart rate to its release of hormonesrelease of hormones

from its appetite to the from its appetite to the intensity of its activityintensity of its activity



“ physiological set points ““ physiological set points “

“ internal working models’“ internal working models’“ scripts “ scripts –– templates”templates”


the objective is to achieve thethe objective is to achieve theability to establish:ability to establish:ability to establish:ability to establish:

‘STABILITY THROUGH CHANGE’‘STABILITY THROUGH CHANGE’

The foundation for The foundation for INFANT MENTAL HEALTHINFANT MENTAL HEALTH

Scientific model:Scientific model:

“simplified “simplified

abstract viewabstract viewabstract viewabstract viewof complex of complex

reality”reality”

SENSORY STIMULATIONSENSORY STIMULATION

AUTONOMICAUTONOMIC

EMOTIONAL EXCHANGESEMOTIONAL EXCHANGES

AUTONOMICAUTONOMICBODY CONTROLBODY CONTROL

WELLWELL--BEINGBEING

HEALTHHEALTH


AUTONOMICAUTONOMIC



WELLWELL--BEINGBEING

HEALTHHEALTH

The First Idea: How Symbols, Language, and Intelligence Evolved from our Primate Ancestors to Modern HumansStanley I. Greenspan & Stuart G. Shanker

The First Idea The First Idea

“It is necessary for a child to be “It is necessary for a child to be engaged in a series of affective engaged in a series of affective (emotional) interactions that give (emotional) interactions that give rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor sensory and social capacities,sensory and social capacities,which, when combined with symbol which, when combined with symbol formation, lead to language. formation, lead to language.

Greenspan & Shanker 2006, p39


“It is necessary for a child to be “It is necessary for a child to be engaged in a series of affective engaged in a series of affective (emotional) interactions that give (emotional) interactions that give rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor sensory and social capacities,sensory and social capacities,which, when combined with symbol which, when combined with symbol formation, lead to language. formation, lead to language.



“It is necessary for a child to be “It is necessary for a child to be engaged in a series of affective engaged in a series of affective (emotional) interactions that give (emotional) interactions that give rise to the developmentof motor rise to the developmentof motor

Peek a boo … from Peek a boo … from FritziFritzi DrostenDrosten

rise to the developmentof motor rise to the developmentof motor sensory and social capacities,sensory and social capacities,which, when combined with symbol which, when combined with symbol formation, lead to language. formation, lead to language.


The First Idea (p39)The First Idea (p39)

“The symbolic use of language, “The symbolic use of language, in turn, creates the foundationin turn, creates the foundationfor more advanced social and for more advanced social and intellectual capacities, including intellectual capacities, including intellectual capacities, including intellectual capacities, including higher and higher levelshigher and higher levelsof reflective thinking.of reflective thinking.



BODYBODYAUTONOMICAUTONOMIC


BODYBODYLANGUAGELANGUAGE


COMMUNICATIONCOMMUNICATIONWELLWELL--BEINGBEING

SPEECHSPEECHHEALTHHEALTH

DUAL CODING DUAL CODING REGULATION REGULATION -- ATTACHMENTATTACHMENT

Greenspan & Shanker 2006

DUAL CODING DUAL CODING REGULATION REGULATION -- ATTACHMENTATTACHMENT

Greenspan & Shanker 2006

ATTACHMENT ATTACHMENT -- REGULATIONREGULATION

the objective is to achieve thethe objective is to achieve theability to establish an ability to establish an efficiently regulated right brain:efficiently regulated right brain:

‘STABILITY THROUGH CHANGE‘STABILITY THROUGH CHANGE

The foundation for The foundation for INFANT MENTAL HEALTHINFANT MENTAL HEALTHSchore 2001a

RESILIENCERESILIENCE(= STRESS RESISTANCE)(= STRESS RESISTANCE)

“capacity to maintain healthy “capacity to maintain healthy emotional functioning in the afteremotional functioning in the after--emotional functioning in the afteremotional functioning in the after--math of stressful experiences”math of stressful experiences”

Scientific model:Scientific model:

“simplified “simplified

abstract viewabstract viewabstract viewabstract viewof complex of complex

reality”reality”


BODYBODYAUTONOMICAUTONOMIC


BODYBODYLANGUAGELANGUAGE


COMMUNICATIONCOMMUNICATIONWELLWELL--BEINGBEING

SPEECHSPEECHHEALTHHEALTH


BREAST - FEEDING==

BRAIN - WIRING

The brain is a

SENSORY ORGANBREAST - FEEDINGBREAST - FEEDING

=BRAIN – WIRINGSOCIAL ORGAN



fire and wire,fire and wire,two kinds of two kinds of sleepsleepcritical periods,critical periods,

hierarchy of layershierarchy of layers



fire and wire,fire and wire,PATHWAYSPATHWAYSCIRCUITSCIRCUITSNETWORKSNETWORKS

PERINATAL PERINATAL neuroscienceneuroscience::

Birth is critical periodBirth is critical period


Birth is critical periodBirth is critical periodEarly experience:Early experience:

-- Physical regulationPhysical regulation-- Emotional regulationEmotional regulation

Maternal presenceMaternal presence




BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place






BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



The BOND The BOND


The BOND The BOND is made up of the is made up of the sensory inputs sensory inputs from the parent from the parent to the infantto the infant

Bowlby 1969, 1973, 1980

Positive StressPositive Stress•• Moderate, shortModerate, short--lived stress responses, such lived stress responses, such as brief increases in heart rate or mild changes as brief increases in heart rate or mild changes in stress hormone levels.in stress hormone levels.in stress hormone levels.in stress hormone levels.

•• An important and necessary aspect of healthy An important and necessary aspect of healthy development that occurs in the context of development that occurs in the context of stable and supportive relationships.stable and supportive relationships.


Positive Stress= Eustress UnderUnder--

activityactivity

EUSTRESSEUSTRESS

OverOver--activityactivity

= Eustress

•• An important and necessaryAn important and necessaryaspect of healthy developmentaspect of healthy developmentthat occurs in the context of that occurs in the context of stable and supportive relationships.stable and supportive relationships.


a mother precisely controls everya mother precisely controls everyelement of her infant’s physiologyelement of her infant’s physiology,,

from its heart rate to its from its heart rate to its from its heart rate to its from its heart rate to its release of hormonesrelease of hormones

from its appetite to the from its appetite to the intensity of its activityintensity of its activity




Tolerable StressTolerable Stress

•• Stress responses that could disrupt brain Stress responses that could disrupt brain architecture, but are buffered by supportive architecture, but are buffered by supportive relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.

•• Generally occurs within a timeGenerally occurs within a time--limited period, limited period, which gives the brain an opportunity to recover which gives the brain an opportunity to recover from potentially damaging effects.from potentially damaging effects.


Toxic StressToxic Stress

•• Strong and prolonged activation of the body’s Strong and prolonged activation of the body’s stress management systems in the absence of stress management systems in the absence of the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.

JACK SHONKOFFJACK SHONKOFF

“Buffering protection “Buffering protection “Buffering protection “Buffering protection

of adult support” of adult support”



•• Disrupts brain architecture and leads to stress Disrupts brain architecture and leads to stress management systems that respond at relatively management systems that respond at relatively lower thresholds, therebylower thresholds, thereby increasing the risk of increasing the risk of stressstress--related physical and mental illnessrelated physical and mental illness ..





BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



“buffering protection “buffering protection


Perry:Perry: Responses to threatResponses to threat


VIGILANCEVIGILANCE


FREEZEFREEZE


DISSOCIATIONDISSOCIATION


REFLEXIVEREFLEXIVE

Jacksonian DissolutionJacksonian Dissolution

The more threatened the individual,The more threatened the individual,the more 'primitive' (or regressed) the more 'primitive' (or regressed) becomes the style of becomes the style of becomes the style of becomes the style of thinking and behaving.thinking and behaving.

Perry 1995 Perry 1995

DVC

VVC

SNS

SEPARATION DYSREGULATES











SEPARATION isSEPARATION is

LIFE LIFE LIFE LIFE THREATENINGTHREATENING

(WRONG PLACE)(WRONG PLACE)




BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place









Scientific

INKINK

Scientific American,

December 2011

“Genome” “Genome” –– genes of speciesgenes of species

“Genotype” “Genotype” -- genes in specimengenes in specimen

… highly conserved … highly conserved neuroneuro--endocrine behaviorsendocrine behaviors

INKINK

PENCILPENCIL

“Genome” “Genome” –– genes of speciesgenes of species

“Genotype” “Genotype” -- genes in specimengenes in specimen

… highly conserved … highly conserved neuroneuro--endocrine behaviorsendocrine behaviors

INK

“Phenotype” “Phenotype” –– specimen specimen resulting fromresulting from

gene gene –– environment interactionenvironment interaction

INK

Pencil




Slide by: Jack P. Shonkoff, M.D. CORTISOL

MICHAEL MEANEYMICHAEL MEANEY

“In response to stress, CRF“In response to stress, CRF

… and vasopressin are … and vasopressin are

released … anterior pituitaryreleased … anterior pituitary

Unsafe environment activates HPAUnsafe environment activates HPAaxis axis (autonomic nervous system, ANS)(autonomic nervous system, ANS). .

released … anterior pituitaryreleased … anterior pituitary

… synthesis release ACTH… synthesis release ACTH

……glucocorticoidsglucocorticoids �� ””CORTISOL

MICHAEL MEANEY MICHAEL MEANEY epigeneticsepigenetics

LG Low Grooming High Grooming HGLG Low Grooming High Grooming HG

LG BABY LG BABY HG BABYHG BABY

MOTHER MOTHER MOTHERMOTHER

UnhealthyUnhealthy HEALTHYHEALTHY

adult adult adultadultMakes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER

LG Low Grooming LG Low Grooming High Grooming HGHigh Grooming HG

Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER






LG BABYLG BABY LG BABYLG BABY

High grooming careHigh grooming care



HEALTHYHEALTHY

adultadultLG Low Grooming High Grooming HGLG Low Grooming High Grooming HG

Makes MOTHER Makes MOTHERMakes MOTHER Makes MOTHER









LG BABYLG BABY HG BABYHG BABY




HG BABY HG BABY HG BABYHG BABY

LOW grooming careLOW grooming care



UN UN -- HEALTHYHEALTHY

adultadultLG Low Grooming LG Low Grooming

Makes MOTHER Makes MOTHER


Earliest care Earliest care at birth mattersat birth matters

Same gene Same gene �� switchedswitched

HG BABY HG BABY HG BABYHG BABY

LOW grooming careLOW grooming care



UN UN -- HEALTHYHEALTHY

adultadultLG Low Grooming LG Low Grooming

Makes MOTHER Makes MOTHER

CORTISOL






Same gene Same gene �� switchedswitchedThe PlaceThe Place





Same gene Same gene �� switchedswitchedThe PlaceThe Place



“BIRTH” “BIRTH” –– earliest environmentearliest environment

Primate separation studiesPrimate separation studies

Maternal Separation ParadigmMaternal Separation Paradigm0w0w 1w1w 2w2w 3w3w 4w4w 5w5w 6w 6w �� 12w12w

n 4n 4 Mat Mat MNSMNS ��group reared no mothergroup reared no mothern 4 n 4 Mat Mat �� MNSMNS �� group as abovegroup as aboven 4n 4 Mat Mat �� ((controlcontrol))

Gene specific for the AMYGDALAGene specific for the AMYGDALA( GUYC1A3)( GUYC1A3)

Separated at 1 week:Separated at 1 week:

LOW gene expressionLOW gene expression

Increased self soothingIncreased self soothing�� AnxietyAnxiety

Decreased socialityDecreased sociality�� DepressionDepression

Primate separation studiesPrimate separation studies

Maternal Separation ParadigmMaternal Separation ParadigmEarly Deprivation (ED) vs control (CON)Early Deprivation (ED) vs control (CON)

0d0d 2d2d �� 28d28d �� 48w48wED n 11ED n 11 Mat Mat 30 30 --120 min daily120 min daily ��

CON n 4 CON n 4 Mat Mat �� 48w48w

Repeated shortRepeated shortRepeated shortRepeated shortseparations:separations:

LOW gene expressionLOW gene expression

Correlate to human adult depressionCorrelate to human adult depression

2ND2ND

KNOCK

SEPARATION causesSEPARATION causes

PROTEST PROTEST –– DESPAIRDESPAIR(hyperactivity (hyperactivity �� depression)depression)

PROTEST PROTEST –– DESPAIRDESPAIRis accompanied by is accompanied by

DYSREGULATIONDYSREGULATION

Social deprivation Social deprivation alters neurobiological systems. alters neurobiological systems.

This pathology ... cannot be cured ...This pathology ... cannot be cured ...Scientific Committee 2002

3-day separation:

induces physiological changes (immune,system, heart rate, sleep, cortisol, loss of body temperature..

anaclitic depression:anaclitic depression:•hyperactivity•conservation- withdrawal;•death or recovery

Slide & photo fromJames McKenna

CONCLUSIONSCONCLUSIONSScientific findings do not support the Scientific findings do not support the perceived benefits of permanent, perceived benefits of permanent, preweaningpreweaningmothermother––infant separation.infant separation.

NO separation6 months

Continued contact 18 m

Sabatini

Arabadzisz

BRUCE BRUCE McEWENMcEWEN allostasisallostasis

(similar to earlier … )(similar to earlier … )


the objective is to achieve thethe objective is to achieve theability to establish:ability to establish:ability to establish:ability to establish:

‘STABILITY THROUGH CHANGE’‘STABILITY THROUGH CHANGE’

The foundation for The foundation for INFANT MENTAL HEALTHINFANT MENTAL HEALTH

VocabularyVocabulary

Homeostasis the coordinated operation of Homeostasis the coordinated operation of physiological processes that maintain physiological processes that maintain the steady state required to sustain lifethe steady state required to sustain life

AllostasisAllostasis the mechanism by whichthe mechanism by whichAllostasisAllostasis the mechanism by whichthe mechanism by whichhomeostatic systems are maintained in balancehomeostatic systems are maintained in balanceas life cycle and environment changesas life cycle and environment changes

AllostaticAllostatic state state elevated activity of elevated activity of mediators, with returnmediators, with returnto baseline and no impact on health.to baseline and no impact on health.

AllostasisAllostasis the mechanism by whichthe mechanism by whichhomeostatic systems are maintained in balance …homeostatic systems are maintained in balance …

AllostaticAllostatic state state elevated activity of mediators,elevated activity of mediators,with return to baseline and no impact on health.with return to baseline and no impact on health.

AllostaticAllostatic load load elevated activity elevated activity ––AllostaticAllostatic load load elevated activity elevated activity ––sustained over time, or severe …sustained over time, or severe …�� changes target cells of mediators,changes target cells of mediators,and so changes the “set points” for homeostasisand so changes the “set points” for homeostasis(e.g. increasing blood pressure, (e.g. increasing blood pressure,

change in cholesterol level)change in cholesterol level)

�� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��

PERCEPTIONSPERCEPTIONS

“NEUROCEPTION”“NEUROCEPTION”

RESPONSERESPONSESTRESSSTRESS

ALLOSTASIS ALLOSTASIS

PsychologicalPsychological

NeurologicalNeurological

EndocrineEndocrine

Immune Immune


ALLOSTATIC STATEALLOSTATIC STATE

HEALTHHEALTH DISEASEDISEASE

ALLOSTATIC LOADALLOSTATIC LOAD

ALLOSTATIC OVERLOADALLOSTATIC OVERLOAD

WELLWELL--BEING BEING �� SUSCEPTIBILITY SUSCEPTIBILITY �� MORBIDITY MORBIDITY �� MORTALITYMORTALITY

ALLOSTATIC LOAD:ALLOSTATIC LOAD:

TOXICSTRESS

SensitivityHIGH

2ND

KNOCK

ALLOSTATIC LOAD:ALLOSTATIC LOAD:“wear and tear that results from “wear and tear that results from chronic chronic overactivityoveractivity

(or (or underactivityunderactivity))of of allostaticallostatic systems.”systems.”

(McEwen 1998, 1999)(McEwen 1998, 1999)

UnderUnder--activityactivity

EUSTRESSEUSTRESS

OverOver--activityactivity






BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



CORTISOL








EndocrineEndocrine

Immune Immune







ALLOSTATIC LOAD:ALLOSTATIC LOAD:

TOXICSTRESS

SensitivityHIGH

2ND

KNOCK

ALLOSTATIC LOAD:ALLOSTATIC LOAD:“wear and tear that results ….“wear and tear that results ….

SPECTRUM of expression in SPECTRUM of expression in POPULATIONPOPULATION


The Fetal Matrix: The Fetal Matrix:

PREDICTIVEPREDICTIVEADAPTIVEADAPTIVEADAPTIVEADAPTIVERESPONSESRESPONSES

(PARs)(PARs)Gluckman &Hanson 2005

BARKER ‘thrifty phenotype’BARKER ‘thrifty phenotype’

“Fetal programming hypothesis”“Fetal programming hypothesis”

Developmental Origins of Developmental Origins of

Health and DiseaseHealth and DiseaseHealth and DiseaseHealth and Disease

DOHaDDOHaD

Epigenetic processes operate Epigenetic processes operate in the human fetus, and beyond.in the human fetus, and beyond.

DOHADDevelopmentalDevelopmentalOrigins ofHealth andAdult Disease





BIOLOGYBIOLOGY

The BrainThe Brain





Adaptation and Adaptation and MALADAPTATION …MALADAPTATION …

Developing Developing Brain Brain (1)(1)

NeurogenesisNeurogenesis

Neural morphologyNeural morphology

SynaptogenesisSynaptogenesis

MyelinationMyelination

Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain

Fewer dendritic spinesFewer dendritic spines

Poorer connectionsPoorer connections

Fewer glial cells, less myelinFewer glial cells, less myelin

TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL










Enduring (4)Enduring (4)consequencesconsequences


consequencesconsequencesAttenuated L brain devlopmentAttenuated L brain devlopment

Poor R / L integrationPoor R / L integration

Irritability limbic systemIrritability limbic system

Poorer function vermisPoorer function vermis










Sensitivity (3)Sensitivity (3)GeneticGenetic

GenderGender



GenderGender

TimingTiming

Developmental rateDevelopmental rate

GCR densityGCR density















GenderGender



GenderGender

TimingTiming







Neuropsychiatric Neuropsychiatric vulnerabilitiesvulnerabilities (5)(5)

Dissociative identity disorderDissociative identity disorder

DepressionDepression Personality disorderPersonality disorder

Substance abuseSubstance abuse

Post Traumatic Stress DisorderPost Traumatic Stress Disorder











GenderGender



GenderGender

TimingTiming






















GenderGender



GenderGender

TimingTiming












StimulationStimulation

ResilienceResilience

MENTAL HEALTHMENTAL HEALTH

Schore: Schore:

“Infant trauma will interfere with“Infant trauma will interfere withcritical period limbic organisation ...critical period limbic organisation ...

future capacity to adapt ...future capacity to adapt ...correlated with maladaptive correlated with maladaptive adult mental health”adult mental health”

SchoreSchore: :

“long term alterations brain function“long term alterations brain function

“risk for developing severe psycho“risk for developing severe psycho--pathologies at later stages of life.”pathologies at later stages of life.”




BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place







BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place




EXPECTED UNEXPECTED EXPECTED UNEXPECTED









EndocrineEndocrine

Immune Immune










BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place









BIOLOGYBIOLOGY



The BrainThe Brain


The PlaceThe Place





Platform for better understanding of Platform for better understanding of PUBLIC HEALTHPUBLIC HEALTH..

… policy and practice that impacts the care of mothers and babies.… policy and practice that impacts the care of mothers and babies.





BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place








BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



“needed neural “needed neural

processes” processes”




BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place








BIOLOGYBIOLOGY

The BrainThe Brain




The PlaceThe Place



ZERO ZERO

SEPARATIONSEPARATION

ZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZERO

SEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATION

MOTHERMOTHERis the key tois the key toneurodevelopment …neurodevelopment …neurodevelopment …neurodevelopment …

… because she is the … because she is the

RIGHT PLACE !!RIGHT PLACE !!

MOTHERMOTHERis the key tois the key toneurodevelopment …neurodevelopment …neurodevelopment …neurodevelopment …

EEnvironment ofnvironment ofEEvolutionary volutionary AAdaptednessdaptedness

“EEA”“EEA”EEnvironment ofnvironment ofEEnvironment ofnvironment ofEEvolutionary volutionary AAdaptednessdaptedness

PERINATAL PERINATAL neuroscienceneuroscience::


FIRST: socioFIRST: socio--emotionalemotionalTHEN: sensory inputsTHEN: sensory inputsNEXT: regulationNEXT: regulationLATER: resilienceLATER: resilience

Primate neurosciencePrimate neuroscience::Stress Stress �� cortisolcortisol

brain alterations brain alterations ��


brain alterations brain alterations ��MALMAL--adaptationadaptation

Social / EmotionalSocial / Emotional

MATERNALMATERNAL--INFANTINFANTSEPARATIONSEPARATION


SEPARATIONSEPARATION

HAS HAS NONO SCIENTIFIC SCIENTIFIC

FOUNDATION.FOUNDATION.

HUMAN neuroscienceHUMAN neuroscience::Stress Stress �� cortisolcortisol

brain alterations brain alterations ��


brain alterations brain alterations ��MALMAL--adaptationadaptation

Social / EmotionalSocial / Emotional

SEPARATIONSEPARATIONDYSDYS--REGULATESREGULATES

(short(short--term)term)


(short(short--term)term)

LongLong--termtermmaladaptationmaladaptation &&susceptibilitysusceptibility

Nelson & Panksepp 1998

SAFE UNSAFE

For the human newborn, it is the habitat which determines which brain determines which brain programme is operating, which then determines the behaviour (niche).

HABITAT

MOTHER

MATERNAL DEPENDENCE

OTHER

MATERNAL SEPARATION

HABITAT

MATERNALMOTHER

MATERNAL DEPENDENCE

OTHERALTERNATE

There are only these two habitat choices available

HABITAT

MATERNALMOTHER

MATERNAL DEPENDENCE

OTHERALTERNATE

AM I AM I SAFESAFE HERE ??HERE ??

HABITAT NICHE

BREAST-MOTHER FEEDING

SAFESAFE ? ? �� YESYES

OTHER PROTEST-DESPAIR

SAFESAFE ? ? �� NONO

HABITAT NICHE MEANS

BREAST- VAGALMOTHER FEEDING (PSNS)

OTHER PROTEST- STRESSDESPAIR (SNS)

HABITAT NICHE MEANS RESULT

BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH

OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)


SKIN-TO-SKIN CONTACT


SEPARATION


SKIN-TO-SKIN CONTACT

THE PLACE MODELPLACE MODEL


SEPARATION

Relationships are the “Active Ingredients" of Early Experience

•• Nurturing and responsive interactions build Nurturing and responsive interactions build healthy brain architecture that provides a strong healthy brain architecture that provides a strong foundation for later learning, behavior, health.foundation for later learning, behavior, health.foundation for later learning, behavior, health.foundation for later learning, behavior, health.

•• When protective relationships are not provided, When protective relationships are not provided, persistent stresspersistent stress results in elevated cortisol results in elevated cortisol levels that disrupt brain architecture by levels that disrupt brain architecture by impairing cell growth and interfering with the impairing cell growth and interfering with the formation of healthy neural circuits.formation of healthy neural circuits.

Jack P. Shonkoff, M.D.


•• Nurturing and responsive interactions build Nurturing and responsive interactions build healthy brain architecture that provides a strong healthy brain architecture that provides a strong foundation for later learning, behavior, health.foundation for later learning, behavior, health.


•• When protective relationships are not provided, When protective relationships are not provided, persistent stresspersistent stress results in elevated cortisol results in elevated cortisol levels that disrupt brain architecture by levels that disrupt brain architecture by impairing cell growth and interfering with the impairing cell growth and interfering with the formation of healthy neural circuits.formation of healthy neural circuits.


The PLACE MODELThe PLACE MODEL

�� scientifically derived scientifically derived �� alternative approach alternative approach �� falsifiable/testable hypothesisfalsifiable/testable hypothesis

NeuroscienceNeuroscienceEvolutionary biologyEvolutionary biology

NeuroscienceNeuroscienceEvolutionary biologyEvolutionary biology

primatologyprimatologyEpigeneticsEpigeneticsTOXIC STRESSTOXIC STRESS

DOHADDOHAD

... the newborn child ... the newborn child ... the newborn child ... the newborn child is a small human being, is a small human being, with all its senses developed, with all its senses developed,

open and receptive.open and receptive.(John Lind, 1979)(John Lind, 1979)

327

Photo: Karolinska Institute, Stockholm

Documents

Dr Nils Bergman - Gaga. | An independent creative consultancy.enzu.vlov.be/media/filebook/files/perinatal Neuroscience SSC.pdf · Dr Nils Bergman PERINATAL NEUROSCIENCE and SKIN--TOTO--SKIN