1. Early Brain and Child Development: The Impact of Toxic Stress and Adverse Childhood Experiences

2. Objectives

3. Strategic Initiatives Urgent child health and member priorities and initiatives that are national in scope. Each priority moves through 3 phases of AAP commitment (planning, implementation, and integration) over a 3-5 year period.

8. The New Caledonian Crow Science Magazine, 2010

10. CHILDHOOD IS FOR LEARNING

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14. The first 1,000 days offer a critical window for social and emotional attachment, with rapid brain development that does not occur at any other time and sets humans apart

15. MEG: Magnetoencephalogram

16. http://developingchild.harvard.edu/resource s/multimedia/videos/three_core_concepts/ brain_architecture/ http://developingchild.harvard.edu/resource s/multimedia/videos/three_core_concepts/ brain_architecture/

17. 700 New Neural Connections Every Second Image source: Conel, JL. The postnatal development of the human cerebral cortex. Cambridge, Mass: Harvard University Press, 1959 17

19. Free play Learning how their actions affect their immediate physical environment Serve and return interaction, or interactive face-to-face time with dependable adults 19

20. 20 There is no app for this

21. Still Face Experiment https://www.youtube.com/watch?v=apzXGEbZh t0

22. Stress

23. Toxic Stress http://developingchild.harvard.edu/resources /multimedia/videos/three_core_concepts/toxi c_stress/ http://developingchild.harvard.edu/resources /multimedia/videos/three_core_concepts/toxi c_stress/

24. ACE Study WomenMenTotal Abuse(n=9,367)(n=7,970)(17,337) – Emotional13.1%7.6%10.6% – Physical27.0%29.9%28.3% – Sexual24.7%16.0%20.7% Household Dysfunction – Mother Treated Violently13.7%11.5%12.7% – Household Substance Abuse29.5%23.8%26.9% – Household Mental Illness23.3%14.8%19.4% – Parental Separation or Divorce24.5%21.8%23.3% – Incarcerated Household Member 5.2% 4.1% 4.7% Neglect* – Emotional16.7%12.4%14.8% – Physical 9.2%10.7% 9.9% * Wave 2 data only (n=8,667) Data from www.cdc.gov/nccdphp/ace/demographics 1:4!

25. 90-100% Chance of Developmental Delays When Children Experience 6-7 Risk Factors Number of Risk Factors Data Source: Barth, et al. (2008) Children with Developmental Delays 1-235467 20% 40% 60% 80% 100% Graphic adapted from 2011, Center on the Developing Child at Harvard University 25

26. 3:1 Odds of Adult Heart Disease After 7-8 Adverse Childhood Experiences Adverse Experiences Source: Dong, et al. (2004) via Center on the Developing Child at Harvard University Odds Ratio 012345,67,8 0.5 1 1.5 2 2.5 3 3.5 26

27. Childhood AdversityPoor Adult Outcomes Toxic Stress Epigenetic Modifications Disruptions in Brain Architecture Behavioral Allostasis Linking Childhood Experiences and Adult Outcomes

28. Epigenetics Genes are NOT destiny! You can nurture nature… 28

29. TOXIC STRESS disrupts brain architecture… Increases neural connections dedicated to fear and anger, and prunes connections dedicated to reasoning, learning, memory and emotional regulation

30. Behavioral Allostasis Acute causes of death are the exception, not the rule

31. Unhealthy behaviors,Unhealthy Lifestyles Unhealthy behaviors, Unhealthy Lifestyles FUNDAMENTALTOXIC STRESS If these unhealthy lifestyles are manifestations of behavioral allostasis, a FUNDAMENTAL cause of death is TOXIC STRESS!

32. How do those automatic processes form in the first place!?

33. Childhood AdversityPoor Adult Outcomes Linking Childhood Experiences and Adult Outcomes Toxic Stress Epigenetic Modifications Disruptions in Brain Architecture Behavioral Allostasis Maladaptive behaviors Non-communicable Diseases Improve caregiver/community capacity to prevent or minimize toxic stress (e.g. – efforts to promote the safe, stable and nurturing relationships that turn off the physiologic stress response) Improve caregiver/community capacity to promote healthy, adaptive coping skills (e.g. - efforts to encourage rudimentary but foundational SE, language, and cognitive skills )

35. Adverse Childhood Experiences Social, Emotional, and Cognitive Impairment Adoption of Health-Risk Behaviors Disease & Disability Early Death Conception Freely reproducible slide from the Centers for Disease Control and Prevention. Understanding Impact of Adverse Childhood Experiences 35

36. But wait, there’s more (bad news) We’ve just learned that adverse childhood experiences (ACEs) can lead to toxic stress and poor lifestyle choices and ultimately disease and premature death. Not paying attention to the critical 1,000 days can lead to poor Kindergarten preparedness, decreased literacy, poor graduation rates, and failure to supply our future workforce

37. Discourage screen time for any child less than 2 years old!!!!!!!!!!!! Promote the 5 R’s Educate your parents, yourself and your lawmakers about the importance of the first 1,000 days and the role early education plays

38. #dirtydiaper

39. Read together every day with your child Rhyme, play and cuddle with your child every day Develop routines, particularly around meals, sleep and family fun Reward your child with praise for successes to build self-esteem and promote positive behavior Develop a strong and nurturing relationship with your child as the foundation for their healthy development

40. Educate Families and Lawmakers Eric Knudsen, James Heckman, Judy Cameron and Jack Shonkoff Proceedings of National Academy of Sciences (PNAS), July 5, 2006 Return Per $ Invested Carneiro, Heckman, Human Capital Policy, 2003 Age 1860 “The most effective strategy for strengthening the future workforce, both economically and neurobiologically, and improving its quality of life is to invest in the environment of disadvantaged children during the early childhood years.” 15% Return on Investment 40

41. BOOKS 16 mos.24 mos.36 mos. Cumulative Vocabulary (Words) College Educated Parents Working Class Parents Welfare Parents Child’s Age (Months) 200 600 1200 400 800 1000 Data Source: Hart & Risley (1995) Slide Source: © 2011, Center on the Developing Child at Harvard University 41

43. The Foundation of a Successful Society is Built in Early Childhood Educational Achievement Economic Productivity Responsible Citizenship Lifelong Health Strong Communities Healthy Economy Successful Parenting of Next Generation © 2011, Center on the Developing Child at Harvard University 43

44. YOU make the difference “It is easier to build strong children than to repair broken men.“ Frederick Douglass

45. Or in other words… http://www.youtube.com/wat ch?v=WkWbu54LJ_8