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MOC II: Good 4 Growth

Counseling Parents

for

Optimal Development

Does Early Child Care Make a Difference? Carolina Abecedarian Study

1972-77: 111 Impoverished Children Randomized

57 ChildrenQuality Preschool8 hrs/ day birth to 5 yearsHealth careNutrition: 2 meals, 1 snackCognitive & Social stimulation

54 ChildrenControls

Medicaid, WIC, Food StampsNo child care

Campbell et al, Science 343:1478. 2014

•Survey: children, parents, teachers•Demographics•Health evaluation•Lab tests•Personality & Behavior•Cognition & Achievement

Follow-up years:12, 15, 21, 30 and mid-30s

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Every $1Spent at least a $7 Return

• Less likely to fail or repeat a grade

• 4 x more likely to graduate from college

• 4.4 x more likely to hold a skilled job

• Stronger social and emotional skills

• Less drinking, run-ins with the law

• More physically activeCampbell et al, Science 343:1478. 2014Campbell et al, Early Child Res Q, 23:452, 2008

Abecedarian Kids at 40 years: Health

Physical Health at 40

• Blood pressure

– Systolic: lower by 17.5 mm Hg

– Diastolic: lower by 13.5 mm Hg

• Lipids

– Good cholesterol 11 mg/dL higher

– Bad Lipids: 31% less (males)

• Obesity

– Fewer obese or severely obese

• Metabolic syndrome

– ¼ of Controls (typical);

– None from child care group

• Cardiovascular risk score

– 2 fold lower

Campbell et al, Science 343:1478. 2014Campbell et al, Science 343:1478. 2014

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What Made the Difference?4 THINGS

• Quality nutrition

• Health care

• Play-focused child care

• Social and emotional support

The Eco-Bio-Developmental Model

BiologyPhysiologic Adaptations

and Disruptions

Life Course

shapes

and together they drive

across the lifespan

Source: Andrew Garner, MD, PhD, FAAP

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Objectives for MOC II

• How the brain develops

• Executive function of the pre-frontal cortex

• Experiences alter gene expression

• Stress and how it shapes the child

• Scaffolding social-emotional skills

• Promoting parent-child relationships through talk, play, reading, routines, & discipline

• The role of play in learning

How the Brain Develops

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We are born with…Potential

•

Ready:

Brain cells, the spine, nerves and blood vessels form and grow during pregnancy

The Big Bang: Birth

Information floods the brain from

all 5 senses

muscles

movement & balance

The Developing Brain

Brain doubles in size in first yearTriples in size by the third yearMassive synaptic connections

Strengthened by use, lost if unused

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The First 1000 Days are Crucial

Emotional OutburstsFear Anxiety

ImpulsiveStressedReactive

The Mid BrainDevelops

First & Fast

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Behavior &

Discipline

A unique form ofServe-and-Volley

You Can’t Stop a Child’s Emotions

• Model healthy emotional self-management– Take a parent “time out” and speak respectfully

• Rely on your nurturing relationship– Reconnect, soothe and calm them

• Accept your child’s feelings as real (and normal)– You understand why they feel upset

• Shape your child’s behavior without punishment– Punishments don’t help deal with emotions

• Emotions are okay, but hurting others is not– Give them limits and words to describe their feelings

Laura Markham, PhD, Psychology Todaywww.ZerotoThree.org 2015

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The Frontal CortexDevelops

Slowly

Calculating

Plans AheadThinks FirstMulti-tasks

LogicalOrganized

The Front Brain

“The Air Traffic Control Center of the Brain”

Pre-Frontal Cortex

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DevelopmentCompleted

Executive Function Development

The Memory Center

• Synthesizes information• Encodes memories

– Spatial– Relational

• Highly metabolic• Regulates

stress response

Very responsive to lifestyle

Monti et al, Adv Nutr, 2014; 5:337s

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“Scaffolding”Adult support throughout everyday routines:highly responsive, encouraging, interactive,

and playful

www.EarlyLiteracyLearning.org

What Happens to the MotherHappens to the Baby

• Poor diet & inactivity

• Under- or over-weight

• Blood pressure and flow

• Corticosteroids

• Smoking, alcohol

• Physical, mental stress

• Toxins, drugs

• Chronic diseases

• Blood sugar

Mother’s stress affects baby’s stress response

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Fetal Experiences “Program” Future Disease

• Growth

• Obesity

• Hypertension

• Abnormal Lipids

• Cardiovascular Ds

• Diabetes

• Metabolic Syndrome

• Mental Health*

Epigenetics

Diet QualityPre-pregnancy/ Pregnancy/ Postnatal

Too little/ Imbalance/ Too Much

Metabolism ChangesFunction Changes

DEVELOPMENT IS CHANGED

Body composition Heart & Blood vessels

Appetite and energy control

Structure and Function Changes

Cells Dysfunction

Tissues Remodel

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Epigenetics: Which, When, & How Much

Genetics: What Proteins DNA Makes

When #2 Male Suddenly Becomes #1

Russell Fernald et al, Stanford U

#1 Male Coloring Typical African CichlidAstatotilapia burtoni

Within 12 hours changes in gene expression causedflorid color changes and an increase of 20% in size

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The Zenk Gene: an immediate response to social situations

Zebra Finch

Different types of songs(mating vs territorial calls)

eliciteddifferent gene expression patterns

in the Finch forebrain --within minutes --

adapting their behavior

David Clayton, et alU of Illinois

Social experience changesGene expression, which changes

Biology, which changesBehavior, which changes

who we are.

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How?

Histones are Changed by Events

“Stresses” modify DNA

* cytosine methylation

“Stresses” modify Histones

* acetylation

* methylation

* phosphorylation

* ubiquitilation

* histone types

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One board

Limited squares

Set number of pieces

Specific movements

. . .

Infinite possibilities

• Positive Stress

– Is brief, infrequent, mild or moderate

– Is normal in everyday life

– Motivates, builds exploration and curiosity,

and teaches the child to adapt

The child’s social and emotional support

Helps to manage stress

and allow a return to normal

Stress Shapes the Brain

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The Stress Response

Aversive Stimuli

Endocrine

Nervous

Immune/ Inflammatory

Systems

Hypothalamus: Homeostasis Central

•Light: daylength and circadian rhythms

•Olfactory stimuli

•Steroids and corticosteroids

•Neurally transmitted information

•Autonomic system input

•Blood-chemical-hormonal-homeostatic stimuli

•Invading microorganisms and body temperature

Stress is a real or perceived threat to homeostasis

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PFC, Amygdala, & Hippocampus

•Executive, emotion, memory•Regulate HPA axis•Affect glucocorticoid

& catecholamine release•Affect behaviors after stress•Terminate the stress response

ExperiencesSet theStage

• Hunger & Malnutrition

• Illness or Chronic disease

• Injury or trauma

• Neglect

• Violence & Abuse

• Family chaos

• Environmental stress

Severe Stress can Harm a Child

http://www.cdc.gov/violenceprevention/acestudy/

Tolerable? Toxic?

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Pheromones Signaling “Danger!”

Cedric Alaux, et alU of Illinois

Expression of genes for aggression increased

with repeated exposures

Regulatory genes (transcription factors)triggered a cascade of gene networks increasing aggressivenessover time

Apis mellifera scutellataKiller Bees

Apis mellifera ligusticaEuropean Honey Bees

Gene Robinson et alUniversity of Illinois

Social experiences alter gene expression, which alters behavior

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– Adverse childhood events (ACEs)

– Long lasting, frequent, or intense

– Perceived by the child as overwhelming

– Results in

• Anxiety

• Anger

• Emotional outbursts

• Fear

• Withdrawal

Damaging if the child does not have sufficient

social and emotional buffers

Toxic Stress Damages the Brain

Toxic Stress Impacts Life Long Health

Adverse Childhood Experiences

Social, Emotional, and

Cognitive Impairment

Adoption of

Health-Risk Behaviors

Disease &Disability

EarlyDeath

Death

Birth

Slide modified from V. J. Felitti

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Isolation is a Powerful Stress

Social vs Lonely People

• White blood cell DNA• Gene Expression differed in

> 200 genes (1% of genes)• Most controlled

inflammatory processes• 78 were hyper-active and

131 were sub-active

Same gene expression pattern in:

• Healthy adults

• Troubled teen females

• Poor children

• Depressed cancer patients

• Spouses of people dying of cancer

S Cole et al, Curr Directions Psych Sci, 2009; 18:132

Lickers & Groomers• Handling rat pups caused

anxiety & stress

• Maternal behavior*– High L&G

– Low L&G

• High = greater exploration, curiosity, socialization, healthier, less anxious, less aggressive

• Biochemical changes in brain: stress hormones

Series: M Meany et al, McGill University

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We Can Build

SOCIAL-EMOTIONAL BUFFERS

Self-Regulation

Coping, Persistence

Organization, Planning

Relief of anxiety and stress

Curiosity, Exploration

• Learned through experiences

• Modeled & reinforced

• Turn off stress hormones

• Lead to resilience, self-control, and social success

Shonkoff et al, Pediatrics. 2012 Jan;129(1):e232

www.CASEL.org

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Self-ControlIgnore distractions Control emotions

Stay focused

Flexible ThinkingSwitch perspectivesOvercome barriers

Consider “what if…”Assess different strategies

Working MemoryManipulate InformationPerform multiple steps

Remember and connect

Executive Function needs Practice

“The Magic of Everyday Moments”

T Berry Brazelton, MD

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Mealtime is Playtime

• Sight

• Smell

• Taste

• Texture

• Sound

• Food qualities

• Fine motor skills

• Exploration

• Independence

• Communication“The magic of everyday moments”

A Structured Day

• Morning

• Meals & Snacks

• Nap or “quiet time”

• Play times

• Bedtime steps

• Reading

• Sleep

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The #1 Factor

that determinedwhether parents read

to their childwas

a structured daily life

Sleep Should Anchor the Day

Sleep recommendations by age

– Infants

• Birth-2 months 12-18 hours

• 3-11 months 14-15 hours

– Toddlers/Children

• 1-3 years 12-14 hours

• 3-5 years old 11-13 hours

• 5-10 years old 10-11 hours

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How to Talk with a Child

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The Language Gap

The Study

• 42 families

• Video 1 hour/ month x 2.5 years in home

• 1,318 hours analyzed

• Families: – 13 = upper SES

– 10 = middle SES

– 13 = lower SES

– 6 = poverty (welfare)

Drs. Betty Hart & Todd Risley

A dramatic difference in words addressed to the child per hour

By age 4 years…

a child from a professional familyexperiences

45 million words, a child from

a working class family26 million words,

and a child in poverty13 million words

The 30 Million Word Gap

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Childhood Language Experiencesare Not the Same

Affirmations/ hr Prohibitions/ hr Ratio

Professional 32 5 6:1

Working Class 12 7 2:1

Impoverished 5 11 1:2

• Early language experiences are build on one another

• Brain development depends on stimulation

• Language experiences occur one-on-one --with emotion and expression

Hart & Risley, 1995

What Happened to Those Kids?

The Risley/ Hart Study: Now 3rd graders 9-10 yrs

• Restudied 29 of 42 families

• Age 3 experiences predicted:

• Peabody Picture Vocabulary Test of receptive language r = 0.58

• Test of Language Development & its subsets

r = 0.74

• Comprehensive Test of Basic Skills

r = 0.56

Dale Walker, et al

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A Critical Finding

“The relation between socioeconomic status and child-directed speech is

mediated by parental knowledge of

child development” *

*and that’s simple to fix

Rowe ML. J Child Lang, 2008; 35:185

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Specific Baby Talk

Mothers who…

• Pointed, described and affirmed the child’s object attentions (0-12 months) -- Exploration

• Practiced vocal imitations, expanded on child speech, and asked questions back (1-2 years) -- Elaboration

Had a child who learned…

• Sound imitations and first words

• Affect with words

• 50 words, combination speech, and talk about the past (memory)

• Pretend and symbolic play

Tamis-LeMonda, et al 2001

Focus on the Child’s Object of Attention

Add words and affect to the child’s exploration

“In this wayMother & Child

share a way of looking at the world”

Snow, 1986

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Language LiteracyYears Play Skills

1 Play with sounds Social communication

2 Play with words Grammar,communication

2-4 Play with songs, rhymes & chants

Literacy, expression

3-5 Play with grammar Cognitive, social, language

The Second Year

Play (Pretend)

Symbolism (Language)

RealityMake-believe

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How to Read to a Child:

Serve-and-Return with Books*

AAP Reading Promotion for Parentshttps://littoolkit.aap.org/Pages/home.aspx

Retelling the Story

Expressive Language&

Comprehension

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Story Retelling Strategies

• Story related to child’s interests/ experiences

• Reread stories

• Introduce story

• Review story

• Child elaborates the story

• Prompting questions & predictions

• Using visual aids or manipulatives

• Role playing

www.EarlyLiteracyLearning.org

Humans need

Social & Stimulating ENVIRONMENTS

• Boredom is a form of stress

• Chronic boredom causes depression & attention deficits

• Child neglect = an absence of social stimulation

Amoeba

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Enjoyable

Freely chosen

An end in itself*

Social

Basis of cognition

PLAY

How to Play

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Language is Play

0-12 mo: Plays with sounds

1-2 yrs: Plays with words

3-5 yrs: Songs, rhymes, chants

2-5 yrs: Plays with grammar

Play Pays Off

• Free play: brain connections, social-emotional, language, creative, symbolic thinking, curiosity, exploration

• Purposeful play: self-control, fundamental motor skills, communication, social-emotional learning, rules, peer relations, executive function, memory

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Socio-Dramatic Play

Pretend Play

• Represents perceived reality

• Asks “What if…”

• Executive functions: – Cognitive skills

– Communication

– Planning, organization

• Peer interaction

• Negotiation

• Creativity

“between reality & make-believe”

“Vital for Self-Regulation”

Play & Problem-Solving

Convergent

• Single Solution

• Self-control, persistence

Divergent

• Many possibilities

• Creative thinking

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The Benefits of Rough-and-Tumble Play

* Serve-and-Return with Screens

Cell phone, TV, video games, computers

The Magic of Everyday Moments

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QUESTIONS30, 31, 33, 34, 36, 37, 38

39, 40, 41, 43, 44, 45

A Neonate’s “Birthday Kit”

• Startle reflex (Moro)

• Palmar & plantar grasp

• Suck, swallow, gag

• Rooting reflex

• Stepping (placing) reflex

• Fencing posture

• Trunk curvature Skills will be expanded throughsensory-motor exploration

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Experiences in aStimulating Environment

• Lips, taste, smell

• All 5 senses

• Muscle movements

• Body position

• Build on skills

Babies Seek Novelty

What Does It Take to Walk?

• Motivation

• Trials of body movements

• Coordinate and control motion

• Perception-action-consequence cycles

• Practiced and refined

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“Fundamental Motor Skills”• Object Control –

manipulate an object:– Bottle, cup, spoon, fork

– Self-feeding

– Throw, bounce

– Kick/Punt

– Catch, roll, strike

– Stack, sequence

– Puzzle-solving

– Draw, color, finger paint

• Locomotor –

body in space:– Run

– Hop

– Skip

– Gallop

– Slide

– Leap

– Jump

* Failure to Master FMS = “A Negative Spiral of Engagement”

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NASPE Active Start Guidelines

Year 1

• Promote active exploration of their environment

• Safe settings

• Limit times of restricted movement

• Actively promote movement skills

Year 2-5

• 30-60 minutes of structuredactivity

• 60 minutes or more of unstructured play

• Promote motor skills

• Indoor & outdoor time

• Not sedentary for more than 60 minutes

We Are All Different

• Prior experiences

• Expectations & Culture

• Stresses

• Depression

• Anxieties

• Support system

• Response to baby

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The New Health Supervision Model

Promoting Relationships in PracticeThemes

“The Magic of Everyday Moments”Serve-and-return parenting

Match talk & support to developmentPromote executive function

Establish routinesPlay, with affect

Play, while readingPlay, with muscle skills