Leveraging an Integrated Science of Early Brain and Child Development: Strengthening Foundations of Health, Learning and Behavior PAT LEVITT, PH.D.

Transcription

1 Leveraging an Integrated Science of Early Brain and Child Development: Strengthening Foundations of Health, Learning and Behavior PAT LEVITT, PH.D. PROVOST PROFESSOR OF NEUROSCIENCE, PSYCHIATRY AND PHARMACY DIRECTOR, ZILKHA NEUROGENETIC INSTITUTE CHAIRMAN, DEPT. CELL AND NEUROBIOLOGY KECK SCHOOL OF MEDICINE OF USC DIRECTOR, USC NEUROSCIENCE GRADUATE PROGRAM

2 The Foundations of Prosperity and Sustainability Begin in Early Childhood The healthy development of young children provides a strong foundation for healthy and competent adulthood, responsible citizenship, economic productivity, strong communities, and a just and fair society.

3 The Core Story Child development is the foundation of prosperous communities Brains are built over time, from the bottom up (skill begets skill) Genes and experiences together build brains (serve and return relationships) Cognitive, social and emotion development are inextricably intertwined Toxic stress damages brain architecture The brain s capacity for change decreases over time (cost-effectiveness)

4 Building Healthy Brain Architecture: The Blueprint

5 Four Numbers to Remember 700 per second 18 months percent 3:1 odds

6 Four Numbers to Remember 700 per second 18 months percent 3:1 odds

7 Experience Shapes Brain Architecture by Over-Production Followed by Pruning (700 synapses formed per second in the early years) birth 6 years 14 years

8 Neural Circuits are Wired in a Bottom-Up Sequence Sensory Pathways (Vision, Hearing) FIRST YEAR Birth (Months) (Years) Source: C.A. Nelson (2000)

9 Extreme Early Experiences Can Dramatically Disrupt How Senses Form 16 days 50 days 50 days: exposed to early noise Source: Chang & Merzenich (2003)

10 Neural Circuits are Wired in a Bottom-Up Sequence Sensory Pathways (Vision, Hearing) Language Higher Cognitive Function FIRST YEAR Birth (Months) (Years) Source: C.A. Nelson (2000)

11 The Changing Brain - Childhood through Adolescence Giedd et al Neuropsychol Rev, 2010

12 Rate of Change - Correspondence with IQ Shaw et al, Nature, 2006

13 Interaction as Serve and Return Healthy development of brain architecture depends a lot on a kind of interaction experts call Serve and Return, based on an analogy from games like tennis and volleyball. Serve and Return happens when young children instinctively reach out for interaction, through babbling, facial expressions, words, gestures, cries, etc. and adults respond by getting in sync and doing the same kind of babbling, gesturing, and so forth. Serve and Return is that it works best with adults who are familiar to the child, like familiar partners. Effects on everything from the chemicals in the brain to physical structures and connections there.

14 Luby et al, Proc. Nat. Acad. Sci. (2012)

15 Remember. Development is not a blank slate (children are not sponges) Skill begets skill

16 Four Numbers to Remember 700 per second 18 months percent 3:1 odds

17 Cumulative Vocabulary (Words) Barriers to Educational Achievement Emerge at a Very Young Age College Educated Parents Working Class Parents Welfare Parents mos. 24 mos. 36 mos. Child s Age (Months) Source: Hart & Risley (1995)

18 Remember From 18 months to 4 years, our brains are gaining the basic skills necessary to learn From 4 years to 7 years, our brains are using these skills to learn how to read..the essential proficiency for future success If you can t read, you can t learn..and we know this early on in a child s earliest school years

19 Executive Function Our Air Traffic Control System (Top-down) Volitional Control Over: Attention (selective attention, interference suppression) Working memory representations (our file drawer of information) Long-term memory (controlled retrieval) Actions (response inhibition; response selection) Emotions (emotional suppression; reappraisal)

20 Early Executive Function Disruption - Predictor of At- Risk Adolescents and Adults The Dunedin Study Moffitt et al PNAS 2011

21 Early Executive Function Disruption - Predictor of At-Risk Adolescents and Adults Moffitt et al PNAS 2011

22 Beyond Learning, Our Emotional Development Depends Upon Early Experiences Fear and anxiety are essential to facilitate the detection of danger in the environment. Threatening stimuli receive more attention than non-threatening stimuli.

23 Experiences in childhood have a lasting impact on how our fear and anxiety systems work early positive experiences A balancing act New homeostatic set point homeostasis

24 Experiences in childhood have a lasting impact on how our fear and anxiety systems work early negative experiences A balancing act New homeostatic set point homeostasis

25 Toddler Behavioral Inhibition - Manifest in Teens as Stimulus Bias Perez-Edgar et al, Emotion, 2010

26 Toddler Behavioral Inhibition and Adolescent Social Withdrawal - Manifest in Teens with Large Threat Bias Perez-Edgar et al, Emotion, 2010

27 Source: Pollok & Kistler (2002)

28 Three Levels of Stress Positive Brief increases in heart rate, mild elevations in stress hormone levels. Tolerable Serious, temporary stress responses, buffered by supportive relationships. Toxic Prolonged activation of stress response systems in the absence of protective relationships.

29 The Brain Architecture of Anxiety and Fear

30 The Brain Architecture of Memory and Learning

31 Concept: Early Adverse Experiences (ACEs) contribute directly to the risk for longterm physical and mental health.

32 Sources of Toxic Stress in Young Children U.S. Children Ages 2-5 (per 1,000) Maltreatment Parental Substance Abuse Postpartum Depression Source: Finkelhor et al. (2005) Source: SAMHSA (2002) Source: O-Hara & Swain (1996)

33 Four Numbers to Remember 700 per second 18 months percent 3:1 odds

34 Children with Developmental Delays Significant Adversity Impairs Development in the First Three Years 100% 80% 60% 40% 20% Number of Risk Factors Source: Barth et al. (2008)

35 A Major Challenge: How do early developmental disturbances have long-lasting effects?

36 Creation of Chemical Signatures Our Epigenome Experiences Malnutrition Emotional stressors Oxidative stressors Immune challenges Frameworks Institute The Signature Can Control When and Where Genes are Expressed

37 Early Experiences Leave Lasting Chemical Signatures on Genes External Experience Gene Regulatory Proteins Epigenetic Signature Turns Gene On or Off National Scientific Council on the Developing Child

38 Four Numbers to Remember 700 per second 18 months percent 3:1 odds

39 New Biological Evidence Links Maltreatment in Childhood to Greater Risk of Adult Heart Disease 50% Percent of adults with biological marker for 40% greater risk of heart disease (increased blood level 30% of CRP) 20% 10% Source: Danese et al. (2008) Control Depression (age 32) Maltreated (as a child) Depression (age 32) + Maltreated (as a child)

40 Risk Factors for Adult Substance Abuse are Embedded in Adverse Childhood Experiences 4:1 Odds Increase Self-Report: Alcoholism Self-Report: Illicit Drugs % % ACEs Source: Dube et al, 2002 Source: Dube et al, 2005

41 RESILIENCE

42 So How Should We Act On the Science?

43 The Ultimate Disconnect Brain's "Malleability" Spending on Health, Education and Welfare $$ Age

44 Maximizing Return on Investment The basic principles of neuroscience indicate that later remediation will be more costly than preventive intervention in the first years of life. Brains: more physiological energy needed to compensate for poorly formed neural circuits. Society: higher cost of remedial education, clinical treatment, crime.

45 Preventive Intervention is More Efficient and Produces More Favorable Outcomes Than Later Remediation Programs targeting the earliest years Rates of return to human capital investment Preschool programs K-12 schooling College, job training B Age Heckman, J. (2007)

46 data from Heckman, Res. in Economics (2000) Graph from Howard-Jones et al, Dev. Cogn. Neurosci. (2012)

47 Think Broadly About Children s Environment of Relationships Plan from pregnancy, and look beyond education and health care. Invest in the development and retention of a skilled workforce in early childhood and public education. Make sure vulnerable children have access to stable, supportive relationships with adults as early and as consistently as possible.

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49 Placement Instability Breeds More Instability But Brain Plasticity Means Interventions Can Help Probability of a Stable Permanent Placement Multidimensional Therapeutic Foster Care (MTFC) Standard Foster Care Foster Care Placements Prior to Study Source: Fisher, Burraston & Pears (2005)

50 Executive Function Interventions The Recipe of Programs that Work (4-12 yr old in clinical studies) computerized training (CogMed) for working memory reasoning and speed training - domain-specific aerobic exercise (high dose min daily) martial arts (inhibitory control, mindfulness) curricula (Tools of the Mind - planning, inhibitory control) Diamond and Lee, Science, 2011

51 Policy Changes Now Reduce special needs populations; increase emotionally sound, learning-ready children with sound Executive Function Invest Early Major increase human capital via ready workforce It s Patriotic

52 67:689 (2010)

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