Presentation on theme: "The Crisis in Youth Mental Health: Experience Matters Hiram E"— Presentation transcript:
1 The Crisis in Youth Mental Health: Experience Matters Hiram E The Crisis in Youth Mental Health: Experience Matters Hiram E. Fitzgerald, Ph.D. Michigan State University ODMHSAS Children’s Mental Health State of the State January, 2008 Tulsa, OklahomaRelationship between Brain Development and Experience Provide Conditions for a Great StartInterconnectedness of ExperiencesBarriers to a Great Start: Risk and Risk CumulationPrevention: The key to overcoming Risk and Promoting pathways to a great finish.
10 Organizational Periods During Prenatal Development: Vulnerability to Environmental Teratogens Adapted from: (K. L. Moore (1977). The developing human: Clinically oriented embryology. (2nd edition, p. 136). Philadelphia: W. B. Saunders.
11 Postnatal Sensitive Periods Developmental ProcessMaximum Period of OrganizationSystemMotor developmentPrenatal to age 4ExplorationEmotion regulationBirth to age 2-3Self controlVisual processingOrienting in spaceEmotional attachmentBirth to age 2Emotional and social systemsLanguage acquisitionBirth to age 4CommunicationCognition/thoughtSecond language1 year to age 4Math/logical thinkingCognitive processingMusic and rhythm3 years to age 5Creative expression
12 Experiences have Multiple Origins and are Interconnected
13 Roles of Experience in Neural, Biological, and Behavioral Development Induction: If experience does not occur, endpoints are not achievedFacilitation: Hastens the appearance of endpointsMaintenance: Keep achieved endpoints functional
14 Factors Highly Related to Positive Early Organizational Processes Ongoing nurturing relationships with the same adultsPhysical protection, safety, and regulation of daily routineExperiences responsive to individual differences in such characteristics as temperamentDevelopmentally appropriate practices related to perceptual-motor, cognitive, social stimulation, and language exposureLimit-setting (discipline), structure (rules and routines), and expectations (for positive outcomes)Stable, supportive communities (violence free) and culture (a sense of rootedness, connectedness, identity)These are the factors that are highly predictive of normative development or of development that exceeds the norm.
15 Possible Transactional Linkages in a Primary Family System BoundariesStoriesExogenous InfluencesFatherMotherCodesRitualsTransitionsThe influences on the developing individual include parental and sibling relationships, but also go beyond the family and include relatives, neighborhoods, friends. They also include all of the external factors that may have an impact on parents, factors such as the workplace, religious institutions, child care settings.Sibling 1Sibling 2Source: Loukas, A., Twitchell, G. R., Piejak, L. A., Fitzgerald, H. E., & Zucker, R. A. (1998). The family as a unity of interacting personalities. In L. L’Abate (Ed.), Family psychopathology: The relational roots of dysfunctional behavior (pp ). New York: Guilford.Roles
17 Establishing Risk Through family characteristics Through individual characteristicsThrough social environments
18 Establishing Risk Through family characteristics Children of alcoholicsChildren of drug abusing or drug addicted parentsChildren of parents with antisocial personality disorder
19 Establishing Risk Through family characteristics Through individual characteristicsExternalizing behavior, aggression, behavioral undercontrol, oppositional defiant disorderNegative emotionality, depressionAttention problems, ADHDShyness, social withdrawal, social phobia
20 Establishing Risk Through family characteristics Through individual characteristicsThrough social environmentsHigh drug use environmentsHigh stress environments (violence, poverty, unemployment)
21 Etiology of Alcohol Use Disorders Illustrating the Impact of Early Experience Developmental life course perspectiveSystemic organization and probabilisticMultiple pathways
22 Family Risk: Marital Conflict Higher marital conflict is a significant longitudinal predictor of quality of parenting in the infant and toddler years.Buffalo Longitudinal Study(Fitzgerald & Das Eiden, 2007)
23 Parenting Risk: Alcoholic fathers display higher levels of aggravation with their 12 month old infants (Eiden & Leonard, 1999).display lower levels of sensitivity, positive engagement, and verbalizations toward their 12 month old infants (Eiden, Chavez & Leonard, 1999)perceive their infants as having more difficult temperaments, and higher rates of behavior programs as early as 18 months of age (Edwards, Leonard & Eiden, 2001)have children who do not show normative declines in aggression between 3 and 4 years of age (Edwards, Eiden, Colder & Leonard, 2006)Buffalo Longitudinal Study
24 Parenting Risk: Protective Factors Children with alcoholic fathers who have a secure attachment relationship with their mothers have significantly lower externalizing behavior problems, compared with those who have an insecure attachment relationship with their mothers.Buffalo Longitudinal Study(Fitzgerald & Das Eiden, 2007)
25 Risk Cumulation Predicts Poor Outcomes PovertyLow birth weightTransiencePoor nutritionLack of quality child careUnemployed parentsLack of access to health and medical careLow parent education levels
26 Understanding Etiology of Alcoholism From a Risk Development Perspective
27 Primary Onset of Substance Use Occurs Between Ages 12 and 20 100-80-60-40-20-0-AgeAlcoholTobaccoAny DrugsCannabisSource: Anthony, J.C., & Arria, A.M. (1999). Epidemiology of substance abuse in adulthood. In P.J. Ott, R.E. Tarter, & R.T. Amerman (Eds). Sourcebook on substance abuse. Etiology, epidemiology, assessment and treatment. Boston, MA: Allyn and Bacon.
28 Percent First Use among High School Students Less than Age 13 in Oklahoma and US Alcohol MarijuanaOklahoma 25.2% 9.4%US % 8.7%Adapted from: Focus on Children’s Behavioral Health, Oklahoma Institute for Child Advocacy 2007
29 Course of the Comorbid and Primary Alcoholisms Age StagesPrenatalInfancyPreschool YearsMiddle ChildhoodAdolescenceYoung AdulthoodMiddle AdulthoodLate AdulthoodA: The Comorbid AlcoholismsB: The Primary AlcoholismsAntisocial AlcoholismDevelopmentally Limited AlcoholismNegative Affect Alcoholism(Alcoholisms without initial continuity or comorbidity)Isolated Alcohol AbuseDevelopmentally Cumulative AlcoholismEpisodic Alcoholism> > > >> > > > > >>Source: Figure 17.6, p. 639, in Zucker, R. A. (2006). Alcohol use and the alcohol use disorders: A developmental-biopsychosocial systems formulation covering the life course. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation (2nd ed., pp ). New York: Wiley.
30 What Predicts Early Alcohol and Other Drug Use?
31 Mental Representations (Cognitive Schemas/Motor Neuron Networks/Expectancies/Contingency Awareness) Schemas for Alcohol use Disorders Organize during Infancy and Early ChildhoodSchemas are Social Constructions, Representations, Autobiographical Memory
32 Components of an Organizing Schema for Alcohol Abuse/Dependence and Co-active Psychopathology Sensory-PerceptualSensory identification of substancesPerceptual discrimination of substancesCognitive-MotivationalAttributions about who are appropriate usersExpectancies related to outcomes based on useAffectiveSelf-regulatory, self-control processesInterpersonal relationshipsSocialRole modelsPeer relationshipsDominance hierarchies/powerBiologicalFamilial historyCongenital history
33 Structure of Common and Disorder-Specific Genetic Risk for Common Psychiatric and Substance Use DisordersInternalizingCommon FactorExternalizingMajorDepressionGeneralizedAnxietyDisorderPhobiasOtherDrug UseDisordersAdultAntisocialBehaviorConductAlcoholDependenceSpecificRiskKey: Width of arrows is an indicator of relative strength of the relationship.Source: Figure 17.6, p. 639, in Zucker, R. A. (2006). Alcohol use and the alcohol use disorders: A developmental-biopsychosocial systems formulation covering the life course. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation (2nd ed., pp ). New York: Wiley.
34 Moos Family Environment Scale scores Relation of Preschool Family Environment Indicators to Early First Drink ExperienceMoos Family Environment Scale scores
35 The combination of both early child risk (individual risk) and family environment (social risk) structures differences in life course from early childhood to adolescence…..
36 The Different Adaptation Groups During the Preschool Years Child PsychopathologyNormal RangeHighFamily AdversityLowNon-ChallengedTroubledResilientVulnerable
37 Externalizing Symptoms During Early Childhood and the Elementary School Years
38 Stability and Change in Externalizing Symptoms During the Transition Into High School
40 Indicators of High Risk: UC (under control) and NA (negative affect). The most damaged children (and those at highest risk) are those who temperamentally have behavioral indicators of undercontrol, roughness, irritability, early mood dysregulation, sadness, depression, sleep problems, and who show higher levels of antisocial behavior early.They also are growing up in highly adverse, very difficult environments.Michigan Longitudinal Study, Zucker & Fitzgerald
41 Three Developmental Pathways Into Substance Use Disorder
42 Strong Continuity Pathway Infancy and early childhoodDifficult temperament, poor parenting, insecure to disorganized attachment, regulatory difficultiesPreschool to kindergartenLower self-regulation, externalizing behavior problems, social withdrawal, poor school readinessChildhoodBehavioral problems, oppositional behavior, impulsivity, social withdrawal, poor school performanceLate middle childhoodFamily disorganization (divorce/separation, loss of job, health or social problems or other family members), poorer parent monitoringAdolescenceEarlier onset of alcohol and other drug involvement, heavier alcohol and other drug problems, delinquency, depression.AdulthoodAntisocial personality disorder, mood disorder, substance abuse disorderAdapted from Fitzgerald, Zucker, Puttler, Caplan & Mun, (2000) and Fitzgerald and Das Eiden (2007)
43 Social Costs of the Strong Continuity Trajectory Academic difficulty and failureDate rape/sexual assaultOther kinds of physical injury to self and others (e.g. automobile accidents)Impaired social relationshipsLoss of human and social capital; foreclosure of future opportunities, higher poverty risk, incarceration
44 Two Discontinuity Pathways Suggesting Differentiation Occurring During the Transition from Elementary to Middle SchoolDiscontinuity Pathway 1Discontinuity Pathway 2Infancy and Early ChildhoodNormative patterns of development during infancyPreschoolSchool readiness, behavior within normal limits, adaptive temperament.ChildhoodGood school adaptation and performance; good friendship network.Late Middle ChildhoodFamily disorganization (divorce/separation, loss of job, health or social problems of other family member); poorer parent monitoring; shift in more deviant peer network; increasing emergence of externalizing behavior, developing pattern of internalizing problems.Family disorganization (divorce/separation, loss of job, health or social problems of other family member); shift in peer network; increasing emergence of externalizing behavior.AdolescenceAlcohol and other drug involvement, minor delinquency. Poor or adverse outsider or parent response: undependability of both parents, less available prosocial network; difficulties self-correcting.Alcohol and other drug involvement, minor delinquency. Poor or adverse outsider or parent response and/or personal concern moving back on track; shorter clinical course.Adapted from: Zucker, Chermack, & Curran (2000)
45 Identifying Best Times for Prevention and Intervention We now can identify risk for substance abuse during infancy and early childhood.We now understand that there are multiple life course pathways of risk and resilience for alcohol use disorders.These findings inform us about when preventive-intervention programs may be most effective.
46 Traditional Approach to Change: Linear Modeling, Linear Thinking OUTCOMEINTERVENTION
47 When in reality, things are not linear… InterventionOutcomeFoster-Fishman, 2007
48 SummaryNormative development occurs in a minimal risk environment with strong familial and social supportsSustained exposure to cumulative risk factors minimizes chances for a great finish because it organizes dysfunctionEarly experiences influence later outcomes and depending on the nature of maintenance processes may determine outcomesHigh quality, sustained and systemic prevention programs can help children overcome bad startsEarly prevention programs are cost effective, later remediation programs are not (nor is incarceration).
49 The work reported here was supported by National Institute on Alcohol Abuse and Alcoholism grants R37 AA 07065, R01 AA 12217, and T32 AA 07477, Michigan State University Biomedical Sciences Support Grant
50 Collaborators Robert A. Zucker, Ph.D. Hiram E. Fitzgerald, Ph.D. Leon I. Puttler, Ph.D.Susan Refior, M.S.W.Maria M. Wong, Ph.D.Ann Buu, Ph.D.Margit Burmeister, Ph.D.Scott F. Stoltenberg, Ph.D.Andrea Hussong, Ph.D.Kirk J. Brower, M.D.Frank Floyd, Ph.D.Joel Nigg, Ph.D.Susan Nolen-Hoeksema, Ph.D.Deborah A. Ellis, Ph.D.Jennie Jester, Ph.D.Kenneth M. Adams, Ph.D.Jennifer Glass, Ph.D.James Cranford, Ph.D.Mary J. McAweeney, Ph.D.Colleen Corte, R.N., Ph.D.Edwin Poon, Ph.D.Laura Sheridan Pierce, Ph.D.Michelle Martel, Ph.D.
51 Past Collaborators Eve E. Reider, Ph.D. Alexandra Loukas, Ph.D. Fernando E. Gonzalez, Ph.D.Roseanne D. Brower, Ph.D.Lucilla Nerenberg, M.D.Michael A. Ichiyama, Ph.D.Sondra Wallen, Ph.D.Michelle Klotz Dougherty, M.A.Helene M. Caplan, Ph.D.Gregory Hanna, M.D.Ed Cook, M.D.Gregory S. Greenberg, Ph.D.William J. Curtis, Ph.D.Robert R. Mueller, Ph.D.Diane M. Pallas, Psy.D.Marcel Montenez, Ph.D.Robert B. Noll, Ph.D.C. Raymond Bingham, Ph.D.Roni Mayzer, Ph.D.Cynthia L. Nye, Ph.D.Eun-Young Mun, Ph..D.Eugene T. Maguin, Ph.D.W. Hobart Davies, Ph.D.Steven Kincaid, Ph.D.Roger Jansen, Ph.D.Lisa Piejack, Ph.D.Geoffrey Twitchell, Ph.D.Karley Y. Little, M.D.Ellen E. Whipple, Ph.D.Hae-Young Yang, Ph.D.Hazen P. Ham, Ph.D.Keith P. Sanford, Ph.D.