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,

2010

CHILDHOOD IS FOR LEARNING

!!!

12

13

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

19

20

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

1:4!

1:4!

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

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

Child

ren

with

Dev

elop

men

tal

Del

ays

1-2 3 54 6 7

20%

40%

60%

80%

100%

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

25

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

Odd

s Ra

tio

0 1 2 3 4 5,6 7,8

0.5

1

1.5

2

2.5

3

3.5

26

Childhood Adversity Poor Adult Outcomes

Toxic Stress

Epigenetic Modifications

Disruptions in Brain Architecture

Behavioral Allostasis

Linking Childhood Experiences and Adult Outcomes

28

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

Behavioral Allostasis

Acute causes of death are the exception, not the

rule

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

Behavioral Allostasis

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

35

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

40

BOOKS

16 mos. 24 mos. 36 mos.

Cu

mu

lati

ve V

ocab

ula

ry (

Word

s)

College Educated Parents

Working Class Parents

Welfare Parents

Child’s Age (Months)

200

600

1200

400

800

1000

Data Source: Hart & Risley (1995) Slide Source: © 2011, Center on the Developing Child at Harvard University

41

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

© 2011, Center on the Developing Child at Harvard University

43

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