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1
Dr Nils Bergman
MB ChB, DCH, MPH, MD
(USA equiv: MD, MPH ,PhD)
Cape Town, RSA
www.skintoskincontact.com
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
Speaker DisclosureUnder ACCME guidelines:
a) I am the South African distributor of
MIRIS : Human Milk Analyzer
b) My wife markets educational materials and shirts related
to the talk content – NINO ACADEMY
www.ninobirth.org
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
The Brain
EPIGENETICS
EVOLUTIONARYBIOLOGY,
NEUROSCIENCE,EPIGENETICS
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
THE HUNTER GATHERER (cont)
Infant care patterns in such societies (which are closest to our origins):
1 Infant carried most of time2 Mother sleeps with infant same bed3 Immediate feeding response to crying4 Breastfeeding 24 months or more5 Father frequently and closely involved ...
“For species such as primates, the mother IS the environment.”
Sarah Blaffer Hrdy, Mother Nature (1999)
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
Nothing an infant can or
cannot do makes sense,
except in light of mother’s body
2
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“except in the light
of mother’s body.”
EVOLUTIONARYBIOLOGY,
NEUROSCIENCE,EPIGENETICS
Skin-to-skin contact
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
CENTRAL DOGMA – all biological processes
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
Key that unlocks the neuroscience:
Skin-to-skin contact
“Cells which
FIRE TOGETHER, WIRE TOGETHER,
and those which don’t, won’t.”
Carla Shatz
Prof Hugo Lagercrantz
Neuronal migration
The brain is not a computer, it is a jungle
G Edelman
Convolutions of the cortex
One million new synapses/second at 1 year!
0 10 20 30 40w 6m 2y 10y 60y
Birth
NEUROGENESIS
Myelination
Arborisation
SYNAPTOGENESIS
Programmed cell deathCOMPETITIVEELIMINATION
NEURONAL PLASTICITYMIGRATION
3
0 10 20 30 40w 1y 3y 13y 50y 80y
28 Birth Puberty
MAXIM
AL O
CCURRENCE
Synapses
Dendrification:
peak 2m & 6m
0 10 20 30 40w 1y 3y 13y 50y 80y
28 Birth Puberty
MAXIM
AL O
CCURRENCE
RELATIVE BRAIN ACTIVITY
METABOLIC ACTIVITY
peaks3 years
NEW SYNAPSE FORMATION
The HARD DISK
Computer has 500 GB=500 000 000 000 b
Brain connections = 500 000 000 000 000 000 000
50 billion neurons, 50000 synapses, 2000 neuron networks
SYNAPSE DEVELOPMENT
At birth, the human being has more synapses in its brain than at any other stage of life.
Impulse
Presynaptic neuron
Vesicle
Transmitters
Synaptic cleft
ReceptorsPostsynaptic
neuronPostsynaptic activity
SENSORY STIMULUS
synapse store chemical signal
chemical signal stronger
THRESHOLD EXEMPT from elimination
(synapse stabilised)PATHWAY
(Rima Shore 1997)
4
fetal REM sleep(or active sleep) seems to be
particularly importantto the developing organism
... spontaneous synchronous firing
Marks et al 1995
REMNR1NR2NR3SWS
ACQUISITION CONSOLIDATION MEMORYFORMATION
poly-sensory input transfer information P wavesshort-term memory “SNR” strong signals returns infostored cortex amygdala / to neocortex:
hippocampus organizedAwake and REM NREM stage 4 REM
BRAIN WIRING
Stanley Graven 2006
BRAIN WIRING
Peirano 2003
EARLY DEVELOPMENT
Gestational age20w all structures completed
parallel development of structure & function
(Hugo Lagercrantz 2004)
Brain growth depends on experiences !!
5
NEURO DEVELOPMENT
NEURO PHYSIOLOGY
NEURO BEHAVIOUR
NEURO DEVELOPMENT
NEURO BEHAVIOUR
Gestational age 20wall structures completed
BRAIN WIRING
PATHWAYS CIRCUITS NETWORKS
Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”
Sequence• Neural circuits that process basic information
are wired earlier than those that process more
complex information.
• Higher circuits build on lower circuits, and
skill development at higher levels is more
difficult if lower level circuits are not wired
properly.
Slide by: Jack P. Shonkoff, M.D.
R Shore
Critical period concept :
“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”
Schore
Critical period :
“Early interpersonal events positively and negativelyimpact the
structural organisationof the brain.”
“The perinatal sensorium is never in chaos …. DEVELOPMENT IS
EVER MORE ORDERED
COMPETENT
COMPETENT MORECOMPLEX
COMPETENT
ALWAYS! MORE FLEXIBLE
1st 28w unmyelinated
immobilise
2nd 2 m sympathetic
fight or flight
3rd 6 m myelinated vagus
engage/disengage
Laughlin 1991
6
DVC
VVC
SNS
100%
28w PMA
OLD vagus (dorsal vagal complex)
Sympathetic nervous system)
Social vagus (ventral vagal complex)
From Porges, Schore, others…
• Higher circuits build
on lower circuits,
development more difficult if
lower circuits not wired properly.
DVC
VVC
SNS
DVC
VVC
SNS
DVC
VVC
SNS
100%
28w PMA 48w PMA2 months 6 months
Jacksonian Dissolution - BERGMAN
The more threatened the PREMATURE,the SOONER 'primitive' (or regressed) becomes the style of thinking and behaving. (Perry 1995)
DVC
VVC
SNS
Our cortex distinguishes us from
other animals …
BUTThe “primitive”hindbrain is vital We can learn
about ourselves from animals, and mammals!
THE “OLD” BRAIN HAS
3 PROGRAMMES
DEFENCE NUTRITION REPRODUCTION
EVOLUTIONARY BIOLOGY
DEFENCE NUTRITION REPRODUCTION
HORMONES NERVES MUSCLES
endocrine autonomic NS somatic
HIGHLY CONSERVED NEURO-ENDOCRINE
BEHAVIOR
7
Clinics in Perinatology,
June 2004, Vol 31(2) page 210
Stanley Graven
Early neurosensory visual
development of fetus and newborn.
“It is a serious mistake to assume that the
principles derived from careful animal studies
do not apply to human infants.
All mammals have set sequence of behaviours at birth ………….
……. All with a single purpose : to
BREASTFEED
After birth, events are
determined …
… by the neonate
stimulating the mother!
(Rosenblatt 1994)
Breast-feeding is “established
through a set of mutual,
complex sensory stimulations
in mother and child.”
(Kjellmer & Winberg 1994)
HABITAT
DETERMINES
BEHAVIOUR
BEHAVIOUR ENSURES
BIOLOGICALNEEDS
Warming, feeding andprotection behavioursare intricately, inseparablylinked to the right place.
(Alberts 1994)
= NUTRITION PROGRAMME
8
Warming, feeding andprotection behavioursare intricately, inseparablylinked to the right place.
(Alberts 1994)
= NUTRITION PROGRAMME“Habitat – niche” place determinebehaviors that ensure basic needs.
ALBERTS “habitat – niche”
In the right habitat, developing organism behaves competently.
“Each state of development
is a form of completeness,
rather than an approximation
the final adult goal”
Fetus “fetally mature” competent in uterus
Newborn “neonatally” mature competent on mother
Infant competent in the attachment environment
Adult mature competent in world
ALBERTS “habitat – niche” All mammals have set sequence of behaviours at birth ………….
……. All with a single purpose : to
BREASTFEED
In all mammals …….
….. the newborn is responsible for initiating breastfeeding,
not the mother !!
EXCEPT IN HUMAN ???
Sequence human newborn breast-feeding
Pre-requisite = habitat
hand to mouth
tongue moves
mouth moves
eye focuses nipple
crawls to nipple
latches to nipple
suckles
(Widstrom et al 1994)
9
“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) There are “needed neural processes” !
Activation of Olfactory Cortex in Newborn
Infants After Odor Stimulation:
A Functional Near-Infrared
Spectroscopy Study
SMELL vanilla / colostrum / water (control)
read NIRS activity FRONTAL LOBE
In the 14 babies
older than 24 h
there was no
significant
difference
between the
changes in [Hb
O2] during control
and colostrum
exposure
Those babies
showing the
greatest
increase in
[Hb O2] were
between 6 and
24 h old at
testing
• This was confirmed by
demonstration of a statistically
significant negative correlation
between changes in [Hb O2] and
postnatal age (r 520.64, p 5 0.001
with 95% confidence interval) (Fig.
4). Those babies showing the
greatest increase in [Hb O2] were
between 6 and 24 h old at testing
• In the 14 babies older than 24 h
there was no significant difference
between the changes in [Hb O2]
during control and colostrum
exposure
10
The first hours after birth are a
CRITICAL PERIOD
mutual psycho-neuro-physiological
caregivers
R Shore
Critical period concept :
“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”
“The newborn may appear
helpless, but
raises its own temperature,has a higher blood glucose,metabolic adaptation faster.
(Widstrom 1987)
METABOLIC ADAPTATION
SSC started in the first 20 minutes after birth
SSC CotBlood glucose (1 hr) 3.17 2.56Base excess drop 3.4 1.8
(Christenson 1992)
Warming, feeding and
protection behaviours areintricately, inseparablylinked to the right place.
(Alberts 1994)
“The perinatal sensorium is never in chaos ….DEVELOPMENT IS
EVER MORE ORDERED
COMPETENT
COMPETENT MORECOMPLEX
COMPETENT
ALWAYS! MORE FLEXIBLE
1st 28w unmyelinated
immobilise
2nd 2 m sympathetic
fight or flight
3rd 6 m myelinated vagus
engage/disengage
11
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
The Brain
EPIGENETICS
BIRTH SKIN-TO-SKIN CONTACTPLACE DEPENDENT COMPETENCE
In the right habitat, developing organism behaves competently.
EVOLUTIONARYBIOLOGY,
NEUROSCIENCE,EPIGENETICS
PERINATAL NEUROSCIENCE and SKIN-TO-SKIN CONTACT
When does the infant
become conscious?
Scientific American 1986
Scientific American Mind 2009
You can never reach the same highlevels of catecholamine levels
during your whole life as at birth
Reduced catecholamine surge after C-section
Vaginal delivery Elective C-section
The infant brain is not
blank!Resting activity
-“stream of
consciousness”
12
The newborn brain consumes 50 %
of all the blood glucose-
In the adult 20 %
Scientific American 2010
The infant brain is not
blank!Resting activity
-“stream of
consciousness”
Noradrenergic neurons from
LOCUS COERULEUS
Awake at birth
AWAKE / ALERT CENTRE
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
AT BIRTH,
the brain has TWO CRITICAL SENSORY NEEDS:
SMELL & CONTACTconnect direct to the amygdala
THE NEWBORN
BRAIN
SKIN-TO-SKINCONTACT
fires and wires
the amygdala-prefronto-orbital cortical pathway (PFOC)
AMYGDALA:EmotionalProcessingUnit CPU
Prefrontal cortexExecutive
function
SOCIAL and EMOTIONAL
INTELLIGENCE
13
Frontal alpha EEG asymmetry= a measure of temperament
( i.e. trait emotion).
an index of potential risk for emotion-related psychopathology.
a sizable literature ( +/- 100 studies ) embeds the measure in a network of psychological and behavioural constructs, thus bestowing frontal EEG asymmetry with sizable construct validity as a measure of an underlying approach-related or withdrawal-related motivational style,or as an index of potential risk for
emotion-related psychopathology.
Frontal alpha EEG asymmetry
Greater Left-sided EEG asymmetry greater positive affect and greater psychological and greater physiological resilience
Greater Right-sided EEG asymmetry greater negative affect and poorer psychological and poorer physiological resilience
Thibodeau 2006
Aaron Jones et al. (2004)conducted a study of four groups
of mother – infant dyads:EEG done on baby at 1 month of age
The first group wasDepressed-Bottlefed
EEG asymmetrycorrelates as
expected ...Aaron Jones 2004
Frontal EEG asymmetry at 1 month
-0.25
-0.2
-0.15
-0.1
-0.05
0
0.05
0.1
0.15
DBt DBr NDBt NDBr
Ln
(R)
- L
n(L
)
Depressed-Breastfed Breastfeeding is PROTECTIVE
Schore
In early postnatal life, maintenance of critical levels of tactile input … is important for normal brain maturation.
Areas of the amygdala …. are in a critical period of maturation,… in the first two months of life
14
In humans, oxytocin increases gaze to the
eye region of human faces and enhances
interpersonal trust and the ability to infer
the emotions of others from facial cues.
Interpersonal awareness
Emotions
Kerstin
Uvnas-Moberg
Ross 2009
Simulation theory:EMPATHY is generated by inner imitationof actions of others
Morphing emotion AMYGDALA FUSIFORMGYRUS
Smell
Skin contact
FACE RECOGNITIONCENTRE
OXYTOCIN
EMOTIONCONTROL CENTRE
15
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
SchoreIn early postnatal life,maintenance of
critical levels of tactile input … is important for normal brain maturation.
Areas of the amygdala …. are in a critical period of maturation,… in the first two months of life
Basic neuroscience:neurons, synapses
fire and wire,PATHWAYSCIRCUITSNETWORKS
SCIENTIFIC BASIS For Skin-to-Skin Contact
Clinics in Perinatology,
June 2004, Vol 31(2) page 210
Stanley Graven
Early neurosensory visual
development of fetus and newborn.
“It is a serious mistake to assume that the
principles derived from careful animal studies
do not apply to human infants.
The risk of suppression or disruption of
needed neural processes ... is very significant and potentially lasts a life time.
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“needed neural
processes”
16
28 days old, 30 w PMA
R Shore
Critical period concept :
“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”
a kind of invisible hothouse
“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)
“... createsa kind of invisible hothousein which the infant’s development can unfold.”
(Hofer in Gallagher 1992) a
SEES
Mum’s eyes
Hand TOUCH
Mum’s skinSkin-to-skin
CONTACT
SENSATIONS THAT WIRE BRAIN
Back FEELS
Mum’s arm
holding
TASTES
Mum’s milk
Ear HEARS
Mum’s voice
SMELLS
Mum’s milk
WARMED on
Mum’s front
MOVES
with Mum
Slide from JILL BERGMAN
a kind of invisible hothouse
BREAST - FEEDING=
BRAIN - WIRING
17
NEWBORN DEVELOPMENT
skin-to-skin contactTactile stimulations build the
amygdala - preorbital
cortical tract
during the first 8 weeks
The next pathway requires
eye-to-eye contact
This is the basis of healthy
right brain development!
NEWBORN DEVELOPMENT
Tactile stimulations facilitate “the flow of affective information
from the infant … to the mother”“the language of mother and infantconsists of signals produced by the
autonomic nervous systemof both parties”.
This is the basis of healthy development!Schore 2001a
Myron Hofer
… the private realm ofsensory stimulation constructed by the mother and infant from numberless exchanges of subtle clues.
(Gallagher 1992)
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
Through “hidden maternal regulators” ...
warmth activity levelmilk heart rate
“ physiological set points “internal working modelsscripts – templates
Through “hidden maternal regulators” ...
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
18
Through “hidden maternal regulators” ...
“ physiological set points “
“ internal working models’“ scripts – templates”
REGULATION
the objective is to achieve theability to establish:
‘STABILITY THROUGH CHANGE’
The foundation for INFANT MENTAL HEALTH
SENSORY STIMULATION
AUTONOMICBODY CONTROL
EMOTIONAL EXCHANGES
WELL-BEING
HEALTH
The First Idea: How Symbols, Language,
and Intelligence Evolved from our
Primate Ancestors to Modern Humans
Stanley I. Greenspan & Stuart G. Shanker
The First Idea
“It is necessary for a child to be engaged in a series of affective (emotional) interactions that give rise to the developmentof motor sensory and social capacities,which, when combined with symbol formation, lead to language.
Greenspan & Shanker 2006, p39
The First Idea (p39)
“The symbolic use of language, in turn, creates the foundationfor more advanced social and intellectual capacities, including higher and higher levelsof reflective thinking.
Greenspan & Shanker 2006, p39
SENSORY STIMULATION
BODYLANGUAGE
AUTONOMICBODY CONTROL
EMOTIONAL EXCHANGES
COMMUNICATIONWELL-BEING
SPEECHHEALTH
19
ATTACHMENT - REGULATION
the objective is to achieve theability to establish an efficiently regulated right brain:
‘STABILITY THROUGH CHANGE
The foundation for INFANT MENTAL HEALTH
Schore 2001a
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintainhealthy emotional functioning in the after-math of stressful experiences”
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
SENSORY STIMULATION
BODYLANGUAGE
AUTONOMICBODY CONTROL
EMOTIONAL EXCHANGES
COMMUNICATIONWELL-BEING
SPEECHHEALTH
The brain is a
SENSORY ORGANBREAST - FEEDING
=BRAIN – WIRING
SOCIAL ORGAN
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
20
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
Under-activity
EUSTRESS
Over-activity
Positive Stress
= Eustress
• An important and necessary
aspect of healthy development
that occurs in the context of
stable and supportive relationships.
Positive Stress
• Moderate, short-lived stress responses, such
as brief increases in heart rate or mild changes
in stress hormone levels.
• An important and necessary aspect of healthy
development that occurs in the context of
stable and supportive relationships.
Slide by: Jack P. Shonkoff, M.D.
Tolerable Stress
• Stress responses that could disrupt brain
architecture, but are buffered by supportive
relationships that facilitate adaptive coping.
• Generally occurs within a time-limited period,
which gives the brain an opportunity to recover
from potentially damaging effects.
Slide by: Jack P. Shonkoff, M.D.
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D. CORTISOL
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“buffering protection
of adult support”
21
Perry: Responses to threat
DISSOCIATION
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
Jacksonian Dissolution
The more threatened the individual,the more 'primitive' (or regressed) becomes the style of thinking and behaving.
Perry 1995
DVC
VVC
SNS
SEPARATION DYSREGULATES
CORTISOL
SEES
Mum’s eyes
Hand TOUCH
Mum’s skinSkin-to-skin
CONTACT
Back FEELS
Mum’s arm
holding
TASTES
Mum’s milk
Ear HEARS
Mum’s voice
SMELLS
Mum’s milk
WARMED on
Mum’s front
MOVES
with Mum’s
SEPARATION is
LIFE THREATENING
(WRONG PLACE)
22
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“buffering protection
of adult support”
EVOLUTIONARYBIOLOGY,
NEUROSCIENCE,EPIGENETICS
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D. CORTISOL
Scientific
American,December 2011
INK
“Genome” – genes of species
“Genotype” - genes in specimen
… highly conserved neuro-endocrine behaviors
INK
PENCIL
23
“Genome” – genes of species
“Genotype” - genes in specimen
“Phenotype” – specimen resulting from
gene – environment interaction
… highly conserved neuro-endocrine behaviors
INK
Pencil
MICHAEL MEANEY
Unsafe environment activates HPAaxis (autonomic nervous system, ANS).
“In response to stress, CRF
… and vasopressin are
released … anterior pituitary
… synthesis release ACTH
…glucocorticoids ”CORTISOL
MICHAEL MEANEY epigenetics
CORTISOL
“Genome” – genes of species
“Genotype” - genes in specimen
“Phenotype” – specimen resulting from
gene – environment interaction
… highly conserved neuro-endocrine behaviors
INK
Pencil
HG BABY HG BABYLOW Grooming care
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
UNHEALTHYadult
LOW Grooming LG
Makes MOTHER
CORTISOL
LG BABY LG BABYHIGH grooming care
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
HEALTHYadult
HIGH Grooming HG
Makes MOTHER
OXYTOCIN
24
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“BIRTH” – earliest environment
Earliest care at birth matters
Same gene switched
MICHAEL MEANEY epigenetics
Early stress alters gene expression,with health impact across lifespan.
CORTISOL
SEPARATION causesPROTEST – DESPAIR
(hyperactivity depression)
PROTEST – DESPAIRis accompanied by
DYSREGULATIONThis pathology ... cannot be cured ...
Social deprivation alters neurobiological systems.
Scientific Committee 2002
3-day separation:
induces physiological changes (immune,system, heart rate, sleep, cortisol, loss of body temperature..
anaclitic depression:•hyperactivity•conservation- withdrawal;•death or recovery
Slide & photo from
James McKenna
CONCLUSIONSScientific findings do not support the perceived benefits of permanent, preweaning mother–infant separation.
NO separation6 months
Continued contact 18 m
25
Primate separation studies
Maternal Separation Paradigm0w 1w 2w 3w 4w 5w 6w 12w
n 4 Mat MNSgroup reared no mothern 4 Mat MNS group as aboven 4 Mat (control)
Gene specific for the AMYGDALA( GUYC1A3)
Separated at 1 week:
LOW gene expression
Increased self soothing Anxiety
Decreased sociality Depression
MR – Mother Reared
Locomotion passive active
Stereotypicity neurotic relaxed
Sitting togetherreclusive social
Peer Reared - PR
Peer Reared - PR
MR – Mother Reared
Plasma CORTISOL response to STRESS (2y)
CORTISOL
Primate separation studies
Maternal Separation ParadigmEarly Deprivation (ED) vs control (CON)
0d 2d 28d 48wED n 11 Mat 30 -120 min daily
CON n 4 Mat 48w
CORTISOL
Repeated shortseparations:
LOW gene expression
Correlate to human adult depression
26
Repeated shortseparations:LOW gene expression
smalller hippocampal volume
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
These findings translate previous results from rats / monkeys to humans
2ND
KNOCK
CORTISOL
27
Sabatini
Arabadzisz Als
Luby CORTISOL
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
BRUCE McEWEN allostasis
CORTISOL
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
HEALTH
elevated activity of mediators,
with return to baseline and no impact on
health.
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
HEALTH
elevated activity –sustained over time,
or severe … changes the “set
points” for homeostasis(e.g. increasing blood pressure, change in cholesterol level)
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
CORTISOL
28
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
HEALTH
the point at which chronic load results in actual
disease or abnormal conditions.
2ND
KNOCK
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
DISEASEHEALTH
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
Spectrum of health:
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
PR - Peer Reared
MR – Mother Reared
Plasma CORTISOL response to STRESS (2y)
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
DISEASEHEALTH MR PR
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
29
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS
ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
The Fetal Matrix:
PREDICTIVEADAPTIVE
RESPONSES(PARs)
Gluckman &Hanson 2005
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
BARKER ‘thrifty phenotype’
“Fetal programming hypothesis”
Developmental Origins of
Health and Disease
DOHaD
Epigenetic processes operate in the human fetus, and beyond.
DOHAD
Developmental
Origins of
Health and
Adult Disease
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
Adaptation and MALADAPTATION …
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
“Scientific foundation” … a synthesis
The Brain
EPIGENETICS
30
Schore:
“Infant trauma will interfere withcritical period limbic organisation ...
future capacity to adapt ...correlated with maladaptive adult mental health”
Schore:
“long term alterations brain function
“risk for developing severe psycho-pathologies at later stages of life.”
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
HEALTH DISEASE
“Scientific foundation” … a synthesis
The Brain
EPIGENETICS
EXPECTED UNEXPECTED
“risk for developing severe psycho-pathologies at later stages of life.”
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
SPECTRUM of expression in POPULATION
HEALTH DISEASE
“Scientific foundation” … a synthesis
Platform for better understanding of PUBLIC HEALTH.… policy and practice that impacts the care of mothers and babies.
The Brain
EPIGENETICS
EXPECTED UNEXPECTED
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintainhealthy emotional functioning in the after-math of stressful experiences”
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“except in the light
of mother’s body.”
31
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“needed neural
processes”
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“buffering protection
of adult support”
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
ZERO
SEPARATION
MOTHERis the key to
neurodevelopment …
… because she is the
RIGHT PLACE !!
... the newborn child is a small human being, with all its senses developed,
open and receptive.(John Lind, 1979)