MOC II: Good 4 Growth - New Jersey AAP – American...
Transcript of MOC II: Good 4 Growth - New Jersey AAP – American...
5/12/2016
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MOC II: Good 4 Growth
Counseling Parents
for
Optimal Development
Does Early Child Care Make a Difference? Carolina Abecedarian Study
1972-77: 111 Impoverished Children Randomized
57 ChildrenQuality Preschool8 hrs/ day birth to 5 yearsHealth careNutrition: 2 meals, 1 snackCognitive & Social stimulation
54 ChildrenControls
Medicaid, WIC, Food StampsNo child care
Campbell et al, Science 343:1478. 2014
•Survey: children, parents, teachers•Demographics•Health evaluation•Lab tests•Personality & Behavior•Cognition & Achievement
Follow-up years:12, 15, 21, 30 and mid-30s
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Every $1Spent at least a $7 Return
• Less likely to fail or repeat a grade
• 4 x more likely to graduate from college
• 4.4 x more likely to hold a skilled job
• Stronger social and emotional skills
• Less drinking, run-ins with the law
• More physically activeCampbell et al, Science 343:1478. 2014Campbell et al, Early Child Res Q, 23:452, 2008
Abecedarian Kids at 40 years: Health
Physical Health at 40
• Blood pressure
– Systolic: lower by 17.5 mm Hg
– Diastolic: lower by 13.5 mm Hg
• Lipids
– Good cholesterol 11 mg/dL higher
– Bad Lipids: 31% less (males)
• Obesity
– Fewer obese or severely obese
• Metabolic syndrome
– ¼ of Controls (typical);
– None from child care group
• Cardiovascular risk score
– 2 fold lower
Campbell et al, Science 343:1478. 2014Campbell et al, Science 343:1478. 2014
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What Made the Difference?4 THINGS
• Quality nutrition
• Health care
• Play-focused child care
• Social and emotional support
The Eco-Bio-Developmental Model
BiologyPhysiologic Adaptations
and Disruptions
Life Course
shapes
and together they drive
across the lifespan
Source: Andrew Garner, MD, PhD, FAAP
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Objectives for MOC II
• How the brain develops
• Executive function of the pre-frontal cortex
• Experiences alter gene expression
• Stress and how it shapes the child
• Scaffolding social-emotional skills
• Promoting parent-child relationships through talk, play, reading, routines, & discipline
• The role of play in learning
How the Brain Develops
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We are born with…Potential
•
Ready:
Brain cells, the spine, nerves and blood vessels form and grow during pregnancy
The Big Bang: Birth
Information floods the brain from
all 5 senses
muscles
movement & balance
The Developing Brain
Brain doubles in size in first yearTriples in size by the third yearMassive synaptic connections
Strengthened by use, lost if unused
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The First 1000 Days are Crucial
Emotional OutburstsFear Anxiety
ImpulsiveStressedReactive
The Mid BrainDevelops
First & Fast
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Behavior &
Discipline
A unique form ofServe-and-Volley
You Can’t Stop a Child’s Emotions
• Model healthy emotional self-management– Take a parent “time out” and speak respectfully
• Rely on your nurturing relationship– Reconnect, soothe and calm them
• Accept your child’s feelings as real (and normal)– You understand why they feel upset
• Shape your child’s behavior without punishment– Punishments don’t help deal with emotions
• Emotions are okay, but hurting others is not– Give them limits and words to describe their feelings
Laura Markham, PhD, Psychology Todaywww.ZerotoThree.org 2015
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The Frontal CortexDevelops
Slowly
Calculating
Plans AheadThinks FirstMulti-tasks
LogicalOrganized
The Front Brain
“The Air Traffic Control Center of the Brain”
Pre-Frontal Cortex
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DevelopmentCompleted
Executive Function Development
The Memory Center
• Synthesizes information• Encodes memories
– Spatial– Relational
• Highly metabolic• Regulates
stress response
Very responsive to lifestyle
Monti et al, Adv Nutr, 2014; 5:337s
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“Scaffolding”Adult support throughout everyday routines:highly responsive, encouraging, interactive,
and playful
www.EarlyLiteracyLearning.org
What Happens to the MotherHappens to the Baby
• Poor diet & inactivity
• Under- or over-weight
• Blood pressure and flow
• Corticosteroids
• Smoking, alcohol
• Physical, mental stress
• Toxins, drugs
• Chronic diseases
• Blood sugar
Mother’s stress affects baby’s stress response
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Fetal Experiences “Program” Future Disease
• Growth
• Obesity
• Hypertension
• Abnormal Lipids
• Cardiovascular Ds
• Diabetes
• Metabolic Syndrome
• Mental Health*
Epigenetics
Diet QualityPre-pregnancy/ Pregnancy/ Postnatal
Too little/ Imbalance/ Too Much
Metabolism ChangesFunction Changes
DEVELOPMENT IS CHANGED
Body composition Heart & Blood vessels
Appetite and energy control
Structure and Function Changes
Cells Dysfunction
Tissues Remodel
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Epigenetics: Which, When, & How Much
Genetics: What Proteins DNA Makes
When #2 Male Suddenly Becomes #1
Russell Fernald et al, Stanford U
#1 Male Coloring Typical African CichlidAstatotilapia burtoni
Within 12 hours changes in gene expression causedflorid color changes and an increase of 20% in size
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The Zenk Gene: an immediate response to social situations
Zebra Finch
Different types of songs(mating vs territorial calls)
eliciteddifferent gene expression patterns
in the Finch forebrain --within minutes --
adapting their behavior
David Clayton, et alU of Illinois
Social experience changesGene expression, which changes
Biology, which changesBehavior, which changes
who we are.
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How?
Histones are Changed by Events
“Stresses” modify DNA
* cytosine methylation
“Stresses” modify Histones
* acetylation
* methylation
* phosphorylation
* ubiquitilation
* histone types
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One board
Limited squares
Set number of pieces
Specific movements
. . .
Infinite possibilities
• Positive Stress
– Is brief, infrequent, mild or moderate
– Is normal in everyday life
– Motivates, builds exploration and curiosity,
and teaches the child to adapt
The child’s social and emotional support
Helps to manage stress
and allow a return to normal
Stress Shapes the Brain
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The Stress Response
Aversive Stimuli
Endocrine
Nervous
Immune/ Inflammatory
Systems
Hypothalamus: Homeostasis Central
•Light: daylength and circadian rhythms
•Olfactory stimuli
•Steroids and corticosteroids
•Neurally transmitted information
•Autonomic system input
•Blood-chemical-hormonal-homeostatic stimuli
•Invading microorganisms and body temperature
Stress is a real or perceived threat to homeostasis
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PFC, Amygdala, & Hippocampus
•Executive, emotion, memory•Regulate HPA axis•Affect glucocorticoid
& catecholamine release•Affect behaviors after stress•Terminate the stress response
ExperiencesSet theStage
• Hunger & Malnutrition
• Illness or Chronic disease
• Injury or trauma
• Neglect
• Violence & Abuse
• Family chaos
• Environmental stress
Severe Stress can Harm a Child
http://www.cdc.gov/violenceprevention/acestudy/
Tolerable? Toxic?
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Pheromones Signaling “Danger!”
Cedric Alaux, et alU of Illinois
Expression of genes for aggression increased
with repeated exposures
Regulatory genes (transcription factors)triggered a cascade of gene networks increasing aggressivenessover time
Apis mellifera scutellataKiller Bees
Apis mellifera ligusticaEuropean Honey Bees
Gene Robinson et alUniversity of Illinois
Social experiences alter gene expression, which alters behavior
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– Adverse childhood events (ACEs)
– Long lasting, frequent, or intense
– Perceived by the child as overwhelming
– Results in
• Anxiety
• Anger
• Emotional outbursts
• Fear
• Withdrawal
Damaging if the child does not have sufficient
social and emotional buffers
Toxic Stress Damages the Brain
Toxic Stress Impacts Life Long Health
Adverse Childhood Experiences
Social, Emotional, and
Cognitive Impairment
Adoption of
Health-Risk Behaviors
Disease &Disability
EarlyDeath
Death
Birth
Slide modified from V. J. Felitti
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Isolation is a Powerful Stress
Social vs Lonely People
• White blood cell DNA• Gene Expression differed in
> 200 genes (1% of genes)• Most controlled
inflammatory processes• 78 were hyper-active and
131 were sub-active
Same gene expression pattern in:
• Healthy adults
• Troubled teen females
• Poor children
• Depressed cancer patients
• Spouses of people dying of cancer
S Cole et al, Curr Directions Psych Sci, 2009; 18:132
Lickers & Groomers• Handling rat pups caused
anxiety & stress
• Maternal behavior*– High L&G
– Low L&G
• High = greater exploration, curiosity, socialization, healthier, less anxious, less aggressive
• Biochemical changes in brain: stress hormones
Series: M Meany et al, McGill University
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We Can Build
SOCIAL-EMOTIONAL BUFFERS
Self-Regulation
Coping, Persistence
Organization, Planning
Relief of anxiety and stress
Curiosity, Exploration
• Learned through experiences
• Modeled & reinforced
• Turn off stress hormones
• Lead to resilience, self-control, and social success
Shonkoff et al, Pediatrics. 2012 Jan;129(1):e232
www.CASEL.org
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Self-ControlIgnore distractions Control emotions
Stay focused
Flexible ThinkingSwitch perspectivesOvercome barriers
Consider “what if…”Assess different strategies
Working MemoryManipulate InformationPerform multiple steps
Remember and connect
Executive Function needs Practice
“The Magic of Everyday Moments”
T Berry Brazelton, MD
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Mealtime is Playtime
• Sight
• Smell
• Taste
• Texture
• Sound
• Food qualities
• Fine motor skills
• Exploration
• Independence
• Communication“The magic of everyday moments”
A Structured Day
• Morning
• Meals & Snacks
• Nap or “quiet time”
• Play times
• Bedtime steps
• Reading
• Sleep
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The #1 Factor
that determinedwhether parents read
to their childwas
a structured daily life
Sleep Should Anchor the Day
Sleep recommendations by age
– Infants
• Birth-2 months 12-18 hours
• 3-11 months 14-15 hours
– Toddlers/Children
• 1-3 years 12-14 hours
• 3-5 years old 11-13 hours
• 5-10 years old 10-11 hours
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The Language Gap
The Study
• 42 families
• Video 1 hour/ month x 2.5 years in home
• 1,318 hours analyzed
• Families: – 13 = upper SES
– 10 = middle SES
– 13 = lower SES
– 6 = poverty (welfare)
Drs. Betty Hart & Todd Risley
A dramatic difference in words addressed to the child per hour
By age 4 years…
a child from a professional familyexperiences
45 million words, a child from
a working class family26 million words,
and a child in poverty13 million words
The 30 Million Word Gap
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Childhood Language Experiencesare Not the Same
Affirmations/ hr Prohibitions/ hr Ratio
Professional 32 5 6:1
Working Class 12 7 2:1
Impoverished 5 11 1:2
• Early language experiences are build on one another
• Brain development depends on stimulation
• Language experiences occur one-on-one --with emotion and expression
Hart & Risley, 1995
What Happened to Those Kids?
The Risley/ Hart Study: Now 3rd graders 9-10 yrs
• Restudied 29 of 42 families
• Age 3 experiences predicted:
• Peabody Picture Vocabulary Test of receptive language r = 0.58
• Test of Language Development & its subsets
r = 0.74
• Comprehensive Test of Basic Skills
r = 0.56
Dale Walker, et al
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A Critical Finding
“The relation between socioeconomic status and child-directed speech is
mediated by parental knowledge of
child development” *
*and that’s simple to fix
Rowe ML. J Child Lang, 2008; 35:185
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Specific Baby Talk
Mothers who…
• Pointed, described and affirmed the child’s object attentions (0-12 months) -- Exploration
• Practiced vocal imitations, expanded on child speech, and asked questions back (1-2 years) -- Elaboration
Had a child who learned…
• Sound imitations and first words
• Affect with words
• 50 words, combination speech, and talk about the past (memory)
• Pretend and symbolic play
Tamis-LeMonda, et al 2001
Focus on the Child’s Object of Attention
Add words and affect to the child’s exploration
“In this wayMother & Child
share a way of looking at the world”
Snow, 1986
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Language LiteracyYears Play Skills
1 Play with sounds Social communication
2 Play with words Grammar,communication
2-4 Play with songs, rhymes & chants
Literacy, expression
3-5 Play with grammar Cognitive, social, language
The Second Year
Play (Pretend)
Symbolism (Language)
RealityMake-believe
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How to Read to a Child:
Serve-and-Return with Books*
AAP Reading Promotion for Parentshttps://littoolkit.aap.org/Pages/home.aspx
Retelling the Story
Expressive Language&
Comprehension
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Story Retelling Strategies
• Story related to child’s interests/ experiences
• Reread stories
• Introduce story
• Review story
• Child elaborates the story
• Prompting questions & predictions
• Using visual aids or manipulatives
• Role playing
www.EarlyLiteracyLearning.org
Humans need
Social & Stimulating ENVIRONMENTS
• Boredom is a form of stress
• Chronic boredom causes depression & attention deficits
• Child neglect = an absence of social stimulation
Amoeba
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Language is Play
0-12 mo: Plays with sounds
1-2 yrs: Plays with words
3-5 yrs: Songs, rhymes, chants
2-5 yrs: Plays with grammar
Play Pays Off
• Free play: brain connections, social-emotional, language, creative, symbolic thinking, curiosity, exploration
• Purposeful play: self-control, fundamental motor skills, communication, social-emotional learning, rules, peer relations, executive function, memory
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Socio-Dramatic Play
Pretend Play
• Represents perceived reality
• Asks “What if…”
• Executive functions: – Cognitive skills
– Communication
– Planning, organization
• Peer interaction
• Negotiation
• Creativity
“between reality & make-believe”
“Vital for Self-Regulation”
Play & Problem-Solving
Convergent
• Single Solution
• Self-control, persistence
Divergent
• Many possibilities
• Creative thinking
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The Benefits of Rough-and-Tumble Play
* Serve-and-Return with Screens
Cell phone, TV, video games, computers
The Magic of Everyday Moments
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QUESTIONS30, 31, 33, 34, 36, 37, 38
39, 40, 41, 43, 44, 45
A Neonate’s “Birthday Kit”
• Startle reflex (Moro)
• Palmar & plantar grasp
• Suck, swallow, gag
• Rooting reflex
• Stepping (placing) reflex
• Fencing posture
• Trunk curvature Skills will be expanded throughsensory-motor exploration
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Experiences in aStimulating Environment
• Lips, taste, smell
• All 5 senses
• Muscle movements
• Body position
• Build on skills
Babies Seek Novelty
What Does It Take to Walk?
• Motivation
• Trials of body movements
• Coordinate and control motion
• Perception-action-consequence cycles
• Practiced and refined
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“Fundamental Motor Skills”• Object Control –
manipulate an object:– Bottle, cup, spoon, fork
– Self-feeding
– Throw, bounce
– Kick/Punt
– Catch, roll, strike
– Stack, sequence
– Puzzle-solving
– Draw, color, finger paint
• Locomotor –
body in space:– Run
– Hop
– Skip
– Gallop
– Slide
– Leap
– Jump
* Failure to Master FMS = “A Negative Spiral of Engagement”
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NASPE Active Start Guidelines
Year 1
• Promote active exploration of their environment
• Safe settings
• Limit times of restricted movement
• Actively promote movement skills
Year 2-5
• 30-60 minutes of structuredactivity
• 60 minutes or more of unstructured play
• Promote motor skills
• Indoor & outdoor time
• Not sedentary for more than 60 minutes
We Are All Different
• Prior experiences
• Expectations & Culture
• Stresses
• Depression
• Anxieties
• Support system
• Response to baby