MOC II: Good 4 Growth Counseling Parents for Optimal Development - PDF document

5/12/2016 MOC II: Good 4 Growth Counseling Parents for Optimal Development Does Early Child Care Make a Difference? Carolina Abecedarian Study Campbell et al, Science 343:1478. 2014 1972-77: 111 Impoverished Children Randomized 57 Children 54 Children Quality Preschool Controls 8 hrs/ day birth to 5 years Medicaid, WIC, Food Stamps Health care No child care Nutrition: 2 meals, 1 snack • Survey: children, parents, teachers Cognitive & Social stimulation • Demographics • Health evaluation • Lab tests • Personality & Behavior • Cognition & Achievement Follow-up years: 12, 15, 21, 30 and mid-30s 1

5/12/2016 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 active Campbell et al, Science 343:1478. 2014 Campbell et al, Early Child Res Q, 23:452, 2008 Abecedarian Kids at 40 years: Health • 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 Physical Health at 40 Campbell et al, Science 343:1478. 2014 Campbell et al, Science 343:1478. 2014 2

5/12/2016 What Made the Difference? 4 THINGS • Quality nutrition • Health care • Play-focused child care • Social and emotional support The Eco-Bio-Developmental Model Biology shapes Physiologic Adaptations and Disruptions and together they drive across the lifespan Life Course 6 Source: Andrew Garner, MD, PhD, FAAP 3

5/12/2016 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 4

5/12/2016 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 year Triples in size by the third year Massive synaptic connections Strengthened by use, lost if unused 5

5/12/2016 The First 1000 Days are Crucial The Mid Brain Develops First & Fast Emotional Outbursts Fear Anxiety Impulsive Stressed Reactive 6

5/12/2016 Behavior & Discipline A unique form of Serve-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 Today www.ZerotoThree.org 2015 7

5/12/2016 The Frontal Cortex Develops The Front Brain Slowly Calculating Plans Ahead Thinks First Multi-tasks Logical Organized Pre-Frontal Cortex “The Air Traffic Control Center of the Brain” 8

5/12/2016 Development Completed 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 9

5/12/2016 “Scaffolding” Adult support throughout everyday routines: highly responsive, encouraging, interactive, and playful www.EarlyLiteracyLearning.org What Happens to the Mother Happens 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 10

5/12/2016 Fetal Experiences “Program” Future Disease • Growth • Obesity • Hypertension • Abnormal Lipids • Cardiovascular Ds • Diabetes • Metabolic Syndrome • Mental Health* Epigenetics Diet Quality Pre-pregnancy/ Pregnancy/ Postnatal Too little/ Imbalance/ Too Much Tissues Function Cells Metabolism Changes Remodel Changes Dysfunction DEVELOPMENT IS CHANGED Structure and Function Changes Heart & Appetite and energy control Body composition Blood vessels 11

5/12/2016 Genetics : What Proteins DNA Makes Epigenetics: Which, When, & How Much When #2 Male Suddenly Becomes #1 #1 Male Coloring Typical African Cichlid Astatotilapia burtoni Within 12 hours changes in gene expression caused florid color changes and an increase of 20% in size Russell Fernald et al, Stanford U 12

5/12/2016 The Zenk Gene: an immediate response to social situations Different types of songs (mating vs territorial calls) elicited different gene expression patterns Zebra in the Finch forebrain -- Finch within minutes -- adapting their behavior David Clayton, et al U of Illinois Social experience changes Gene expression, which changes Biology, which changes Behavior, which changes who we are. 13

5/12/2016 How? Histones are Changed by Events “ Stresses ” modify DNA * cytosine methylation “ Stresses ” modify Histones * acetylation * methylation * phosphorylation * ubiquitilation * histone types 14

5/12/2016 One board Limited squares Set number of pieces Specific movements . . . Infinite possibilities Stress Shapes the Brain • Po Posit sitiv ive St Stress s – Is brief, ef, infrequ quen ent, t, mild or moder erate – Is normal al in ever everyd yday y life fe – 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 15

5/12/2016 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 16

5/12/2016 PFC, Amygdala, & Hippocampus • Executive, emotion, memory • Regulate HPA axis • Affect glucocorticoid & catecholamine release • Affect behaviors after stress • Terminate the stress response Experiences Set the Stage Severe Stress can Harm a Child • Hunger & Malnutrition • Illness or Chronic disease • Injury or trauma • Neglect Tolerable? Toxic? • Violence & Abuse • Family chaos • Environmental stress http://www.cdc.gov/violenceprevention/acestudy/ 17

5/12/2016 Pheromones Signaling “Danger!” Expression of genes for aggression increased with repeated exposures Regulatory genes (transcription factors) triggered a cascade of gene networks increasing aggressiveness over time Cedric Alaux, et al U of Illinois Apis mellifera ligustica Apis mellifera scutellata European Honey Bees Killer Bees Social experiences alter gene expression, which alters behavior Gene Robinson et al University of Illinois 18

5/12/2016 Toxic Stress Damages the Brain – Adver erse childhood hood events events (ACEs Es) – Long lastin ing, freque uent, t, or intense – Pe Percei eived ed by by the e child as over overwhel helming – Results ts in • Anxiety • Anger • Emotional outbursts • Fear • Withdrawal Damagin ging g if the child d does not t hav ave suffi ficient cient social al and emotional al buffe fers Death Early Death Disease & Disability Adoption of Health-Risk Behaviors Social, Emotional, and Cognitive Impairment Adverse Childhood Experiences Birth Toxic Stress Impacts Life Long Health Slide modified from V. J. Felitti 19

5/12/2016 Isolation is a Powerful Stress Social vs Lonely People Same gene expression pattern in: • Healthy adults • White blood cell DNA • Troubled teen females • Gene Expression differed in • Poor children > 200 genes (1% of genes) • Most controlled • Depressed cancer patients inflammatory processes • Spouses of people dying of • 78 were hyper-active and cancer 131 were sub-active 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 20