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Toxic Stress and the Science of Child Development: Implications for Early Childhood Professionals The 2013 Annual Early Childhood Conference of the Bennington.

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Presentation on theme: "Toxic Stress and the Science of Child Development: Implications for Early Childhood Professionals The 2013 Annual Early Childhood Conference of the Bennington."— Presentation transcript:

1 Toxic Stress and the Science of Child Development: Implications for Early Childhood Professionals
The 2013 Annual Early Childhood Conference of the Bennington County Child Care Association & Partners November 2nd , 2013 Todd Grindal, Abt Associates Julius B. Richmond Dissertation Fellow Harvard Center on the Developing Child Thank yous find out who they 1 Next slide: ECE supports 2 national priorities

2 Elementary School Teacher
( ) Preschool Teacher ( , 2007) Discuss background. -Teaching experience. Why I went to grad school. Understand how and why preschool seems to be such a great thing for kids. I would to being by explain a bit about my background. I spent the first part of my carrer as I teacher of young children at the elementary and preschool level- now, as a dissertation fellow at the center of the developing child, I study how how public policies impact children and their families . Now, early on in this work I found that I describe what was happening as a result of public policies but could say very little about why. I discovered that to get at the mechanisms by which policies impact young children and their families it was essential to understand the science of child development. I became a student of Dr. Shonkoff and am now dissertation fellow at HCDC. Recently , I coauthored a book chapter with Dr. Shonkoff a pediatrician and Christina Hinton a neuroscience student on the lessons of this science for parents and caregivers. This is what I will present today. Reminder, I am neither a pediatrician nor a neuroscientist so my depth of knowledge does not extend to the minutia of brain science public health. Rather, like many of you I'm interested in the application of this knowledge to real-world problems. It is therefore possible that you may have specific questions I'm unable to answer. If that's the case, I will do my best to point you to someone who can. I'd also like to note that all of the materials presented today were prepared by the Harvard center of the developing child and happy to share these and other similar resources for anyone who's interested.

3 Outline of Today’s Activities
Core concepts of early development Research on the impact of early childhood programs Discuss how this material is relevant to your work

4 My objectives for this workshop
Help each of you develop a deeper understanding of the science of child development its implications for you work with children & families. Lean about issues related to early childhood policy and practice in Vermont

5 What are your objectives for today?
(please share with the person sitting next to you) Why might it be useful for early childhood professionals to understand the underlying science of child development? Discuss with your nieghtbor.

6 Core Concept 1: Experiences Build Brain Architecture

7 Looking inside the brain
Brief nueroanalotomy

8 (700 synapses formed per second in the early years)
Experience Shapes Brain Architecture by Over-Production Followed by Pruning (700 synapses formed per second in the early years) re we can this process of proliferation and pruning at work. The first panel shows a sketch of neural connections at birth. We see here on handful of neurons connecting with one another to form synapses. In the next panel, we see that same area of a child’s brain at age 6. Here we see the evidence of the proliferation of neural connections- a dense connection of multiple synapses. Finally we see this region at age 14. Now we see that neural connections have been reduced through experience. The pathways that we worn through repeated use have been retained, connection that were used less often have faded away. This use or lose it phonon is bit of a double-edged sword. On the one hand, positive, healthy, growth-promoting experiences help to develop brains that are efficient and sophisticated. But for some young children, their developing brains are incorporating experiences that are abusive and neglectful. birth years years

9 Neural Circuits are Wired in a Bottom-Up Sequence
Language Higher Cognitive Function Sensory Pathways (Vision, Hearing) FIRST YEAR process beings even before birth. Neural circuits are built from the bottom up with simple circuits developing 1st and more complex circuits built on top. Here we see this displayed graphically. Y axis’s here represents the number of new circuits. The x axis represents time. We see that the sensory pathways come first reaching their peak of proliferation on a few months after birth. Language development also begins early with the development higher cognitive functions extending into adolescence. What is notable for is the number of connections being created here in the first year of life. Birth (Months) (Years) Source: Nelson (2000)

10 The Ability to Change Brains
Decreases Over Time Normal Brain Plasticity Influenced by Experience Physiological “Effort” Required to Enhance Neural Connections Last February, I presented this work to the “senior Academy” the University of South Florida. As you imagine, there was some consternation about these data among the audience. So let me be clear does not mean that our brains cease making connections after early childhood . Our brains continue o forms new synapses throughout life. But, as the maturing brain becomes more specialized to assume more complex functions, it is less capable of reorganizing and adapting. For example, by the first year, the parts of the brain that differentiate vocal sounds are becoming specialized to the language the baby has been exposed to and are already starting to lose the ability to recognize important sound distinctions found in other languages. As the brain prunes away the circuits that are not used, those that are used become stronger and increasingly difficult to alter over time. Declining plasticity means it’s easier and more effective to influence a baby’s developing brain architecture than it is to rewire parts of its circuitry in the adult years. In other words, we can invest now by ensuring positive conditions for healthy development, or pay more later in the form of costly remediation, health care, mental health services, and increased rates of incarceration. Birth 10 20 30 40 50 60 70 Age (Years) Source: Levitt (2009) 10

11 Experiences Build Brain Architecture
Reviewing Key Terms Neuron Synapse Pruning Sensitive periods Plasticity 11 11

12 Experiences Build Brain Architecture
Activity Based on the information on brain architecture, why might attending a high quality childcare program be beneficial for young children? 12 12

13 Core Concept 2: Interactions Shape Brain Circuitry

14 Brains and Skills are Shaped by the “Serve and Return”
Nature of Human Interaction Here's a quick overview of how that serve and return interaction supports process of skill development, in this case the ability to read and write : interactive sound play (leads to the ability to differentiate the sounds of one’s native language) ---> pointing and labeling ---> exposure to books and reading ---> ability to read independently ---> ability to write. Circuits build on circuits --- and skills beget skills. Development never starts with a clean slate. it always builds on what happened earlier.

15 Language environment impacts children’s language development
1200 College Educated Parents Working Class Parents 600 Cumulative Vocabulary (Words) Welfare Parents 200 EXAMPLE 2 Differences in development appear very early -- in this instance, differences in vocabulary growth between children in low socio-economic households and high socio-economic households begin to appear as early as 18 months. And as the children grow toward school age, and enter school, the differences only get larger in the absence of intervention. 16 mos. 24 mos. 36 mos. Child’s Age (Months) Source: Hart & Risley (1995) 15

16 Early Experiences Alter Gene Expression and Shape Development
Neuron 16

17 Genes Carry Instructions that Tell Our Bodies How to Work
DNA Nucleus Chromosome 17

18 Early Experiences Leave Lasting Chemical “Signatures” on Genes
External Experience Epigenetic “Signature” Turns Gene On or Off Gene Regulatory Proteins 18

19 Early Experience Affects Differences in Adult Anxiety in Mice
Example 1: Early Experience Affects Differences in Adult Anxiety in Mice Neuroscience basis for individual differences High care Low Low care High Source: Gross & Hen, 2004

20 Gene/Environment Interaction An Example

21 Interactions Shape Brain Circuitry
Reviewing Key Terms Serve and Return Gene-Environment Interaction 21 21

22 Experiences Build Brain Architecture
Activity Imagine you are preparing to share some information on children's brain development at a preschool back-to-school night. What of 3 ways children engage in serve and return behaviors while in the classroom? & What are 3 ways parents could engage in serve and return behaviors with parents outside of school? 22 22

23 Core Concept 3: Early Life Experiences are Built Into Our Brains and Bodies ( for better or for worse)

24 Three Levels of Stress Response
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. We all know that stress is a part of life. Learning how to cope with stress is an important part of a child’s healthy development, whether it’s the stress of meeting new people, learning to walk, or dealing with problems. There is a range of physiological responses to stress, which most of us are familiar with: increased heart rate and fluctuations in stress hormone levels, such as cortisol. When stress occurs to a young child within an environment of supportive relationships with adults, these physiological effects are buffered and brought back down to baseline. The result is a healthy stress response system. For larger stressors -- such as the death or serious illness of a loved one, a frightening injury, the divorce of one’s parents, or a natural disaster -- these physiological responses are sustained for a longer period of time. But still, the buffering effects of supportive adult relationships allow the brain to recover from what might otherwise be damaging effects. It’s when situations of extreme stress are prolonged and unrelenting, in the absence of supportive adults, that a child is affected by toxic stress. These situations can include extreme poverty, physical or emotional abuse, chronic neglect, severe maternal depression, substance abuse, or family violence. Without the support of a caring network of adults, toxic stress can disrupt brain architecture and lead to stress management systems that respond at relatively lower thresholds, thereby increasing the risk of stress-related physical and mental illness. 24

25 Toxic Stress Changes Brain Architecture
Typical neuron— many connections Normal Toxic stress Damaged neuron— fewer connections Brain architecture is created by the formation of connections between neurons as a result of interactions with one’s environment, and then the pruning of connections that aren’t used. Neural connections in different areas of the brain are responsible for different kinds of activities. For example, the prefrontal cortex and hippocampus house activities related to memory and decision-making (executive function). As you can see from these depictions of neurons, brains subjected to chronic stress have underdeveloped connections in the areas of the brain most critical for success in school, work, and behavior. Prefrontal Cortex and Hippocampus Sources: Radley et al. (2004); Bock et al (2005) 25

26 Severe Neglect Affects Brain Power
Positive Relationships Extreme Neglect Just as positive early experiences build healthy brain architecture, adverse early experiences can weaken it. Helping all children have supportive environments to learn and grow levels the playing field, so even those children who do not have advantages at home or whose families can’t afford expensive child care can start school with the same opportunities as their neighbors. This slide shows one measure of brain activity in two children. One had a normal family upbringing, and the other spent the early years of life in extremely neglectful conditions, in an orphanage in Romania. Brain activity is measured in terms of electrical impulses, using EEGs (electroencephalograms). The more electrical power, the more brain activity. Here we see the EEG translated into a color spectrum -- the more color, the more electrical activity in the brain. If you look at these circled areas, the differences become clear. Put simply, chronic neglect of very young children diminishes their brain power well beyond the period when they were neglected. If healthy brain architecture is the equivalent of a 100 watt bulb, by seriously neglecting children in their earliest years, we give them a 40 watt bulb. Source: C.A. Nelson (2008) and Marshall P.J., Fox N.A., & the BEIP Core Group (2004). Journal of Cognitive Neuroscience, 16, 1327–1338. Source: C.A. Nelson (2008); Marshall, Fox & BEIP (2004) 26

27 Significant Adversity Impairs Development in the First Three Years
100% 80% Children with Developmental Delays 60% 40% 20% Descrtibe study born in Duedin New Zealand in people. Children ages birth to 36 months who have been maltreated are at substantial risk of experiencing subsequent developmental problems. Specific domains potentially affected include cognitive, social, emotional, and physical health in addition to the potential for subsequent development of psychopathology. Moreover, negative developmental effects are typically seen in at least one domain regardless of the type of maltreatment experienced. Effects are similar to poverty, but may be more severe. Specific risk factors that were examined are shown below, with the percentage of children with that risk factor in parentheses: Child Maltreatment (100%) Caregiver Mental Health Problem (30%) Minority Status (58%) Low Caregiver Education (29%) Single Caregiver (48%) Biomedical Risk Condition (22%) Poverty (46%) Teen-aged Caregiver (19%) Domestic Violence (40%) 4 or More Children in Home (14%) Caregiver Substance Abuse (39%) Young children from birth to three years of age are most at risk of experiencing maltreatment. Children birth to three years have the highest rate of victimization, 16.1 per 1,000. 1-2 3 4 5 6 7 Number of Risk Factors Source: Barth, et al. (2008) 27

28 Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood Experiences
3.5 3 2.5 Odds Ratio 2 1.5 1 And it’s not just cognitive development that is affected by early experiences--it’s also social-emotional behaviors and physical health. This study investigated adults with a history of early Adverse Childhood Experiences to determine whether these experiences increase the odds that they would experience alcoholism, drug abuse, and a range of unhealthy behaviors later in life. Perhaps not unexpectedly, all of these behaviors increased dramatically in adults who had higher numbers and prevalence of Adverse Childhood Experiences in their early years. But this graph shows that these experiences also lead to dramatically increased odds of having a range of physical health problems as adults -- in this case, cardiovascular disease. And these trends also appeared for diabetes, hypertension, stroke, obesity, and cancer. arly experiences actually get into the body, with lifelong effects—not just on cognitive and emotional development, but on long term physical health as well. A growing body of evidence now links significant adversity in childhood to increased risk of a range of adult health problems, including diabetes, hypertension, stroke, obesity, and some forms of cancer. This graph shows that adults who recall having 7 or 8 serious adverse experiences in childhood are 3 times more likely to have cardiovascular disease as an adult. first 18 years of life. Longtudinal reaserch out of new Zealand is making a more definatelive connection - And children between birth and three years of age are the most likely age group to experience some form of maltreatment–16 out of every thousand children experience it.  Source: Dong et al. (2004) Emotional abuse. Physical abuse. Sexual abuse. Emotional neglect. Physical neglect. Domestic violence Household substance abuse.. Mental illness in household. Parental separation or divorce.. Criminal household member. It is worth noting that risk for smoking increases risk for cV desiesae by a factor of 2 to 4. 0.5 1 2 3 4 5,6 7,8 Adverse Experiences Source: Dong, et al. (2004)

29 Caregivers Depression Can Have a Profound Impact on Young Children
Still Face Experiment EXAMPLE 4 On the first point: We can’t provide evidence-based services if the service provider doesn’t know the evidence, or can’t afford to stay on the job once they do know the evidence. On the second point: We have seen that supporting the healthy development of children from their earliest years benefits all of us -- so all of us need to work together to get it done. 29 29

30 Early Abuse Affects Later Behavior
Example 3: Early Abuse Affects Later Behavior Source: Pollak & Kistler (2002)

31 Profound Neglect Impairs Physical Growth
11-Year-Old Girl (height-for-age = 48 month old) Source: Johnson et al. (2000)

32 Positive early experiences yield positive long-term outcomes

33 As a result of this study,
Bucharest Early Intervention Project Children randomly assigned to leave the institution and be placed and high quality foster care environment Children placed in foster care before age 2 appear to catch up with typical children on measures of cognitive development These children had lower rates of ADHD, disruptive behaviors, and depression when compared to children who stayed in the institution As a result of this study, The Romanian government passed a law forbidding the institutionalization of non-handicapped children under age 2. Over 27,000 foster homes have been created. Next slide: School readiness and later achievement effect sizes

34 Long-term effects of Head Start
Head Start closes one-third of the gap between median and low income family income on a summary of young adult outcomes: High school graduation College attendance Idleness (not in high school, no wages) Crime Teen parenthood Health status Source: Deming, 2009 Next slide: School readiness and later achievement effect sizes

35 Chicago Child-Parent Center (2004)
Preschools in the Public Schools Chicago Child-Parent Center (2004) Children who did not receive a strong education from PK through 3rd grade were three times more likely to be held back and more likely to be placed in special education than those who had a strong PK-3 foundation. Preparing to Succeed-Boston (2011) Attending preschool erased the Latino/white test score gap and significant reduced the African American/White test score gap Source: Reynolds, et al., 2004 Next slide: Deming

36 The impact of attending high quality early childhood education can be observed nearly four decades later These figures show some of the impacts at age 40 of attending a high quality preschool program. Another program know as the Abecedarain project yeilded similar impacts including Higher scores on tests of cognitive skills, and reading and math achievement, More years of education, Children More likely to attend a 4-year college Reduced levels of depressive symptoms Reduced rates of cigarette and marijuana use

37 Rates of return to human capital investment
We all know about Heckman’s ground breaking research about the value of $1 invested at varying points in the life cycle Source: Heckman, 2006 p.1902 37 Next slide: Heckman, gaps are more costly to correct later

38 Cost/Benefit Analyses Show Positive Returns
Early Childhood Programs Demonstrate Range of Benefits to Society $10 $9.20 $8 $5.70 Total Return per $1 Invested $6 $3.23 $4 $2 Break-Even Point There have been several rigorous longitudinal studies that have looked at long-term outcomes of participants in early childhood programs and their benefits to the individuals and to society. Perry Preschool's returns consist of increased earnings for individuals and, to the public, savings in welfare, special ed, and the costs of crime, as well as increased income tax revenues. All have shown clearly that there IS a big return on investment -- ranging from $3 to more than $9 for every dollar invested in the program. The three shown here represent different kinds of interventions, populations, and goals, yet all of them yielded significant return on investment. And in each case, the majority of those returns are to society -- not to the individual. So while the individuals who participate do have better jobs, better education, and better lives, in terms of dollars returned from the investment, it’s society that is the big winner, primarily through savings in crime and justice, health care, and educational remediation costs. Sources: Early Childhood Interventions: Proven Results, Future Promise. Lynn A. Karoly, M. Rebecca Kilburn, Jill S. Cannon. RAND Corporation The Rate of Return to the High/Scope Perry Preschool Program; James J. Heckmana, Seong Hyeok Moona, Rodrigo Pintoa, Peter A.Savelyeva, Adam Yavitz. April 17, 2009 Abecedarian Project (through age 21) Nurse Family Partnership (High Risk Group) Perry Preschool (through age 40) Sources: Karoly et al. (2005) Heckman et al. (2009) 38

39 36 months: Adjusted means for child outcome by quality
Source: NICHD ECCRN, 2000 Next slide: Prim grades: CC quality as a predictor of children’s achievement

40 The best of what we do is still not good enough
These figures show some of the impacts at age 40 of attending a high quality preschool program. Another program know as the Abecedarain project yeilded similar impacts including Higher scores on tests of cognitive skills, and reading and math achievement, More years of education, Children More likely to attend a 4-year college Reduced levels of depressive symptoms Reduced rates of cigarette and marijuana use

41 Program Evaluation Research Helps Identify Effectiveness Factors
Not all programs are effective. Effectiveness factors are key to distinguishing those programs that work from those that do not. Our goal: to provide clearer guidance than the usual calls for “quality.” Introduces the FrameWorks-approved idea of effectiveness factors: rather than recommend specific programs, effectiveness factors allow us to use research to identify the components of programs that are most important to their effectiveness. Source: Center on the Developing Child at Harvard University (2007). A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children. Source: Center on the Developing Child at Harvard University (2007)

42 Effectiveness Factors for Early Care and Education Programs
Skilled and well-compensated personnel Small group sizes and high adult-child ratios Language-rich environment Developmentally appropriate “curriculum” Safe physical setting Warm and responsive adult-child interactions These effectiveness factors for ECE programs come from the Council/Forum Policy Framework paper. Evidence from 40 years of program evaluation data shows that effective, high-quality programs have a cluster of characteristics in common, from skilled staff and high adult-child ratios to language-rich environments and safe physical settings. Ensuring that all programs have these characteristics will maximize the possibilities of favorable outcomes and positive return on investment. Source: Center on the Developing Child at Harvard University (2007). A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children. Source: Center on the Developing Child at Harvard University (2007)

43 Grindal et. al. (under review)
Effectiveness Factors for Parenting Education Programs: Parenting education with modeling and/or opportunities for practice Grindal et. al. (under review)

44 Four Targets for Professional Development
Educator Education, ECE Training, Well-Being Institutional/ Organizational Practices Classroom/Group Setting Quality Practices Related to Specific Child Outcomes Four targets: Strengthening Early Educator Practices Related to Specific Child Outcomes; A: Specific curricula/methods for teaching Math, Lang & EF B: Ability to conduct and respond to assessments to support student learning Strengthening ECE training and well being A: Training and certification B: Voice –valuable experience that can help inform policy –Seat at the table C: Health care –in particular dealing with the fatigue/depression that many ECE providers experience 3) Strengthening Overall Quality in Classroom or Group Setting A: Use of the comprehensive curricula/pedagogical approach – don’t want each adult using a different curricula, set of guidelines for learning and behavior, B: clear consistent goals for teachers and students C: Regular support from peers and expert teachers 4) Strengthening Practices at Institution or Organization & Providing Professional Development A: B: teachers, teachers assistants and administrators should participate jointly in PD. Adapted from Figure 1: Targets of Early Childhood Professional Development Initiatives, in report written by by Martha Zaslow, Kathryn Tout, Tamara Halle, Jessica Vick Whittaker, Bridget Lavelle — Child Trends, Washington, D.C. Source: U.S. Department of Education, Office of Planning, Evaluation and Policy Development, Policy and Program Studies Service. (2010). Toward the identification of features of effective professional development for early childhood educators, literature review. Washington, D.C. Retrieved from Source: U.S. Department of Education (2010)

45 Current Conceptual Framework for Early Childhood Policy and Practice
Sources of Toxic Stress Healthy Developmental Trajectory Delayed Development Key point – our theory of change. This is the state of the field currently. Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

46 Designing an Enhanced Framework that Balances Enrichment and Protection
Protective Interventions Sources of Toxic Stress Healthy Developmental Trajectory Key point – theory of change – this is where the field needs to go in order to dramatically increase impact Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

47 An Integrated, Science-Based Logic Model Could Inform More Effective
Early Childhood Policies and Programs Preconception Prenatal Policy & Program Levers for Innovation Biological Adaptations or Disruptions Early Childhood Caregiver & Community Capacities Foundations of Healthy Development Health & Development Across the Lifespan Middle Childhood Adolescence 1. Biological Adaptations or Disruptions - The biology of health explains how experiences and environmental influences “get under the skin” and interact with genetic predispositions, which then result in physiological adaptations or disruptions that affect lifelong outcomes in learning, behavior, and both physical and mental well-being. EX: Prenatal screenings, basic health care, lead removal. 2. Foundations of Healthy Development - The foundations of health establish a context within which the early roots of physical and mental well-being are nourished. These include a stable and responsive environment of relationships, Safe and supportive physical, chemical, and built environments, and sound and appropriate nutrition. EX:--Differential response to CPS claims to include so that case workers are not simply identifiying vitictms and perpetrators but assesing What underlying conditions and factors may jeopardize the child’s safety?What strengths and resources exist within the family and community? What areas of family functioning need to be strengthened? 3. Caregiver & Community Capacities – Caregiver and community capacities to promote health and prevent disease and disability refers to the ability of family members, early childhood program staff, neighborhoods, voluntary associations, and the parents’ workplaces to support and strengthen the foundations of child health. These capacities can be grouped into three categories: time and commitment; financial, psychological, and institutional resources; and skills and knowledge.- EX: WA online PD initiate focused on kids EF development. 4. Policy & Program Levers for Innovation - Public and private sector policies and programs can strengthen the foundations of health by enhancing the capacities of caregivers and communities in the multiple settings in which children develop. Relevant policies include legislative and administrative actions that affect public health, child care and early education, child welfare, early intervention, family economic stability, community development, housing, environmental protection, and primary health care. -QRS RTT ELC, HCZ. Adulthood Source: Center on the Developing Child (2010) 47

48 Brain Hero! 48 48

49 Thank you ! 49 49

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