The First R: Relationships and Asset Building

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The First R Relationships.

• Jean Clinton BMus MD FRCP(C)
• McMaster Children's Hospital and University
• Council for ECD

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Guiding Principles

• Development of the whole child.
• The importance of belonging.
• Relationships as central.

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UNICEF REPORT CARD 2007

• The true measure of a nations standing is how
  well it attends to its children-their health and
  safety, their material security, their education
  and socialization, and their sense of being
  loved, valued and included in the families and
  societies into which they are born.

Unicef Innocenti Report 2007
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Canada

• Material Well Being
• Health and Safety
• Educational Well being
• Family and Peer Relationships
• Behaviours and Risks
• Subjective well being
• Overall

• 6 SWEDEN 1
• 13 SWEDEN 1
• 2 BELGIUM 1
• 18 ITALY 1
• 17 SWEDEN 1
• 15 NETHERLANDS 1
• 12/21

Unicef Innocenti Report 2007
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The Brain Matters

• The human brain is the organ responsible for
  everything we do. It allows us to laugh, walk,
  love, talk.
• For each of us, our brain is a reflection of our
  experiences.
• The brain is an environmental organ. It reflects
  our environment.

Adapted from Bruce Perry
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Time Magazine from the MEHRI Neuroscience lab
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03-080
The Founders Network
Experience-Based Brain Development in the early
years of life sets neurological and biological
pathways that affect
Health
Learning
Behaviour
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05-182
All the neurons (billions) have the same genetic
potential. Animals with brains have to activate
components of the genetic potential to produce
the diversity of cells in the animals body. The
differentiation of neurons is dependent on
stimuli from the sensory pathways.
Rosenzweig, Bennett, 1996.
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03-078
Experience and Brain Development
Stimuli in early life switch on genetic pathways
that differentiate neuron function sensitive
periods
Stimuli affect the formation of
the connections (synapses)
among the billions of neurons
From studies in humans, monkeys and rats
Founders Network
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04-212
Sound Vision Smell
Touch Proprioception Taste
Neal Halfon
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PLASTICITY

• Babies highly attuned to their environment
• Massive synaptic growth in first two years
• Pruning starts at 8months
• Pruning regulated by emotional interactions with
  caregivers
• From The First Idea Greenspan and Shanker

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The Critical Importance of Affect

• Babies reflexively seeks out those experiences
  that are positive and avoids those that are
  aversive
• i.e., an infant will only seek out dyadic
  interactions if she finds them pleasurable
• (Greenspan Shanker, The First Idea, chapters 1
  and 2)

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03-079
Vision - Hubel Wiesel
Eye cataracts at birth prevent
development of vision neurons
in the occipital cortex
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USE IT OR LOSE IT !

• The more a system, or set of brain cells is
  activated, the more that system changes in
  response. The stronger the repetitions the
  stronger the memory.

Bruce Perry MD
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03-013
The Hostage Brain
, Bruce S. McEwen and Harold M. Schmeck, Jr.,
1994.
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The nerve cell, or neuron resembles a miniature
tree (p. 21)
Diamond Hopson, 1998
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04-039
Two Neurons
RECIPIENT NEURON
Axon
Synapse
SIGNAL-SENDING NEURON
Dendrite
Founders Network
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03-012
Synaptic Density
At Birth
6 Years Old
14 Years Old
Rethinking the Brain, Families and Work
Institute, Rima Shore, 1997.
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02-002
Estimated Culmulative Difference in Language
Experiences by 4 Years of Age
Million
50
Professional
40
Working-class
30
Estimated cumulative words
addressed to child
20
10
Welfare
0
0
12
24
36
48
Age of child in months
From Hart and Risley
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02-001
Vocabulary Growth First 3 Years
Vocabulary
1200
High SES
Middle SES
600
Low SES
0
12
16
20
24
28
32
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Age - Months
B. Hart T. Risley, Meaningful Differences in
Everyday Experiences of Young American Children,
1995
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Sensitive periods in early brain development
Binocular vision
Central auditory system
Habitual ways of responding
Language
Emotional control
High
Symbol
Peer social skills
Relative quantity
Sensitivity
Low
0
1
2
3
7
6
5
4
Years
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01-040
Levels of Literacy A Reflection of ECD
Level 1
indicates persons with very poor skills.
Level 2
people can deal with material that is simple
Level 3
is considered a suitable minimum for coping with
the demands of everyday life
Level 4 and 5
describe people who demonstrate command of
higher-order processing skills
Founders Network
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02-061
Document Literacy
1994 1998, Ages 16 to 55
Level 1 and 2 Level 4 and 5

Sweden
23
34
Canada
42
23
Australia
43
17
United States
48
18
Chile
85
3
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01-008
"Longitudinal studies show most seriously
antisocial adolescents and adults who had
behavior problems during childhood showed as
antisocial behavior when they enter the school
systems."
Tremblay, R
. - Developmental Health and the
Wealth of Nations, 1999
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04-126
Physical Aggression Trajectories
4
Chronic (4)
High (28)
Physical Aggression
2
Moderate (53)
Low (14)
0
6
10
11
12
13
14
15
Age
Nagin Tremblay. 1999.
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04-127
High School Diploma
80
75.8
62.5
60

40
27.5
20
3.3
0
Never
Low
High
Chronic
Level of Aggression
Tremblay
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Developmental Trajectories Vulnerability is Not
Permanent
NLSCY 1994
NLSCY 1996
Not Vulnerable
Not Vulnerable
71.1
71.9
Vulnerable
Vulnerable
28.9
28.1
Source Human Resources Development Canada
Applied Research Branch (2000).
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03-063
HEALTH
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04-006
Swedish Longitudinal Study ECD and Adult Health
Number of Adverse ECD Circumstances
3
1
2
4
0
Adult Health
Odds - Ratios
2.08
General Physical
1
1.39
1.54
2.66
1
1.56
1.53
2.91
7.76
Circulatory
Mental
1
1.78
2.05
10.27
3.76
Economic, family size, broken family and family
dissention
Lundberg, Soc. Sci. Med, Vol. 36, No. 8, 1993
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04-161
VULNERABLE CHILDREN
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The Prevalence of Children with Difficulties by
Family Income
The Founders Network
QUARTILE
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Prevalence of Children With Difficulties by
Parenting Style
Wilms (1999)
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02-066
The Fear Response
Visual Thalamus
Visual Cortex
Amygdala
Scientific American
The Hidden Mind, 2002, Volume 12, Number 1
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Anterior Cingulate Cortex
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03-110
Interaction of the Brain and Immune System
CRF
Hypothalamus
Cortisol
Locus Ceruleus
CRF
Adrenal Gland
ACTH
Pituitary Gland
Vagus
Cortisol
Cytokines
Sympathetic Nervous system
Immune Cells
Nerve
Immune Organs
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Hippocampus
Amygdala
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03-002
Emotional Stimulus
Amygdala
Hippocampus
-

-

Hypothalamus PVN
Cortisol
Cortisol
CRF
PIT
ACTH
Adrenal Cortex
LeDoux, Synaptic Self
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Amygdala and Hippocampus
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00-058
Cortisol can be bad for the brain
Hippocampus
high sterol levels cause loss of dendrites
and cell death
Frontal brain
attention deficits
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Childrens Stress Pathway

• Childrens number one fear is PUBLIC
  HUMILIATION. They will do anything to belong.
• If a child is not sure if they are going to be
  embarrassed or humiliated they cant learn
  
• Mary
  Gordon

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00-046
Evening Cortisol Levels Increase with
Months of Orphanage Rearing
-0.2
-0.4
-0.6
Log10 Salivary Cortisol
-0.8
linear trendline
-1
-1.2
0
10
20
30
40
50
Months of Orphanage Rearing
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05-046
The Founders Network
Secure Attachment Buffers Cortisol Response to
Threatening Events
Secure Attachment Insecure Attachment
Change in Salivary Cortisol



HIGH
LOW
Fearful Responses to Stimuli
Gunnar (1996).
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02-050
Development and Cortisol Levels
1.3
Low SES
1.1
Medium SES
High SES
Salivary Cortisol (ug/dl)
0.9
0.7
0.5
6
8
10
Age
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05-047


Children in Poorer Quality Childcare Show Rises
in Cortisol Over the Day
2.0
1.0
Quality of Childcare
0.0
-1.0
-0.4
-0.2
0.4

0.0
0.2
Rise in Cortisol
Dettling (2000).
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05-063
Daycare Quality Cortisol Levels (Individual
Needs)
0.6
Unsatisfactory
0.5
Averaged Cortisol (log10)
High Quality
Satisfactory
0.4
AM
PM
Time of Sampling
Sims et al. 2005.
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05-064
Daycare Quality Cortisol Levels (Treat
Equitably)
0.6
Unsatisfactory
0.5
Averaged Cortisol (log10)
High Quality
Satisfactory
0.4
AM
PM
Time of Sampling
Sims et al. 2005.
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00-045
Cortisol Levels in Romanian Adopted
Children 6 Years Post Adoption
Adopted lt 4 months
in orphanage
1
Adopted gt 8 months
0.8
in orphanage
0.6
Canadian Control
0.4
0.2
0
AM
Noon
PM
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Dr Megan Gunnar

• Social Relationships control cortisol levels in
  infants and young children.
• Children with secure attachments to their
  caregivers show stable cortisol levels.
• The key ingredient to buffering stress is
  sensitive, responsive, individualized care.
• Its not separation from parents, but the
  experience in child care that triggers their
  stress responses.

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Research on Quality

• Treating children with respect
• Developing relationships with families
• Ensuring programmes focus on children feeling safe

Hutchins and SIMS 2000
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Research on Quality

• Meeting the individual needs of children
• Ensuring staff remain in their positions long
  enough to be able to develop and maintain
  relationships with children

All of these dimensions of quality are
fundamental to developing and maintaining strong
relationships between caregivers and children
(Hutchins Sims, 2000).
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Perry Preschool Project
17 saved for every 1 invested
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03-074
Rates of Return to Human Development Investment
Across all Ages
8
6
Pre-school Programs
Return Per Invested
School
4
R
Job Training
2
Pre- School
School
Post School
0
6
18
Age
Carneiro, Heckman, Human Capital Policy, 2003
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97-044
The Mismatch Between Opportunity and Investment
0
3
10
70
Age
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05-042
S. Suomi
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00-053
Non Human Primate Development
Poor Mothering First 6 Months of Life
Increased anxiety and depression as adults
Excessive alcohol consumption
Impulse aggression and violent behaviour
Females tend to be poor mothers
Highest risk genetically predisposed to high
cortisol levels during development
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00-054
Poorly Nurtured Rhesus Monkey Infants
Biological Changes
High cortisol levels to mild stress
Chronic deficits in serotonin metabolism
Disrupted circadian rhythms for cortisol
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00-054
Poorly Nurtured Rhesus Monkey Infants
Biological Changes
High cortisol levels to mild stress
Chronic deficits in serotonin metabolism
Disrupted circadian rhythms for cortisol
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00-055
Development of High Genetic Risk
Rhesus Monkey
Infants with Nurturant Mother
Precocious exploratory patterns
Females become very nurturant mothers
Rise to top of social groups - dominance hierarchy
Robust immune responsiveness
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EPIGENETICS

• Any Functional Change in the Genome that does not
  involve an alteration of sequence.
• Familial transmission of traits vulnerabilities)
  from parent(s) to offspring can occur through a
  nongenomic mechanism of inheritance

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05-056
Individual differences in stress reactivity of
the adult are determined by maternal behaviour
during infancy
HIGH LG
LOW LG
Development of Stress Reactivity
Increased Stress Reactivity Increased Risk for
Heart Disease, Type II Diabetes, Alcoholism,
Affective Disorders, Brain Aging, etc.
Modest Stress Reactivity Reduced Risk for
Disease
M. Szyf
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05-057
Is maternal care the mediator of these effects on
hippocampal (GR(17) promoter methylation?
ADOPTION/CROSS FOSTERING STUDIES
Adoptive Mother
Biological Mother
LOW
LOW
HIGH
HIGH
M. Szyf
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03-089
Serotonin Gene, Experience, and Depression Age 26
Depression Risk
.70
SS
S Short Allele L Long Allele
.50
SL
LL
.30
No Abuse
Moderate Abuse
Severe Abuse
Early Childhood
A. Caspi, Science, 18 July 2003, Vol 301.
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04-144
Epigenetics and Brain Plasticity
Experience and methylation of DNA Imprints
environmental experiences on the fixed
genome Maternal behaviour affects DNA
methylation Can be transmitted to offspring
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04-012
Summary Brain Plasticity
Sensing pathways set in early life
Vision Hearing Touch
HPA Pathway (stress) set in early life
(HPA-Immune Pathway)
Hippocampus - Memory
Plasticity sustained throughout life Affected by
HPA Pathway
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In the year of our Lord 2008

• Bowling Alone
• National Family Dinner Day
• Spending more time. studies
• If not our culture , then whose?

CLINTON
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A Sense of Urgency

• About breaking down the compartmentalization
• About how we communicate
• About where we put money
• About how we attack the problem

Dr Bruce Perry
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99-004
ECD and Experience-Based Brain Development
parent-oriented
child-oriented
1
2
3
4
5
6
- 0
age
Components of Early Childhood Development and
Parenting Centres
Universal available, accessible, affordable and
optional
Parental and non-parental care
Parent- and child-oriented
Quality early child development environments
Responsive relationships and parent
involvement Detect development problems early
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Slides available atwww.ascy.cawww.offordcentre.c
om

• clintonj_at_mcmaster.ca