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

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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 Children Quality Preschool 8 hrs/ day birth to 5 years Health care Nutrition: 2 meals, 1 snack Cognitive & Social stimulation 54 Children Controls Medicaid, WIC, Food Stamps No 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 active

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

Campbell 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

Biology

Physiologic Adaptations and Disruptions

Life Course

shapes and together they drive across the lifespan

Source: Andrew Garner, MD, PhD, FAAP 6

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

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The First 1000 Days are Crucial

Emotional Outbursts Fear Anxiety Impulsive Stressed Reactive

The Mid Brain Develops First & Fast

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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

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The Frontal Cortex Develops

Slowly

Calculating Plans Ahead Thinks First Multi-tasks Logical Organized

The Front Brain

“The Air Traffic Control Center of the Brain”

Pre-Frontal Cortex

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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

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“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

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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

Metabolism Changes Function 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 Cichlid Astatotilapia burtoni

Within 12 hours changes in gene expression caused florid 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) elicited different gene expression patterns in the Finch forebrain -- 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.

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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

• 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

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

Experiences

Set the Stage

• 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 al U of Illinois

Expression of genes for aggression increased with repeated exposures Regulatory genes (transcription factors) triggered a cascade

• f gene networks

increasing aggressiveness

• ver time

Apis mellifera scutellata Killer Bees Apis mellifera ligustica European Honey Bees Gene Robinson et al University of Illinois

Social experiences alter gene expression, which alters behavior

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– 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

• verwhel

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

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

Early Death

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-EM EMOTIO TIONAL AL BUFFE FERS

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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Ignore distractions Control emotions Stay focused

Flexible Thinking

Switch perspectives Overcome barriers Consider “what if…” Assess different strategies

Working Memory

Manipulate Information Perform 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 determined whether parents read to their child was 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 family experiences 45 million words, a child from a working class family 26 million words, and a child in poverty 13 million words

The 30 Million Word Gap

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Childhood Language Experiences are 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 way Mother & Child share a way of looking at the world”

Snow, 1986

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Language Literacy

Years 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)

Reality Make-believe

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How to Read to a Child: Serve-and-Return with Books*

AAP Reading Promotion for Parents https://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
• f social stimulation

Amoeba

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Enjoyable Freely chosen An end in itself * Social Basis of cognition

P L A Y 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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QUESTIONS 30, 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 through sensory-motor exploration

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Experiences in a Stimulating 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
• f their environment
• Safe settings
• Limit times of restricted

movement

• Actively promote

movement skills Year 2-5

• 30-60 minutes of structured

activity

• 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 Practice Themes

“The Magic of Everyday Moments” Serve-and-return parenting Match talk & support to development Promote executive function Establish routines Play, with affect Play, while reading Play, with muscle skills