Toxic Stress and its Impact on Early Learning and Health · Toxic Stress and its Impact on Early...
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Toxic Stress and its Impact on Early Learning and Health
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
National Conference of State LegislaturesJuly 22, 2009
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•Our genes, and ultimately our developing brain architecture, are influenced powerfully by positive early experiences—and negative ones, too.
Building Healthy Brain Architecture – The Ingredients
•Genes provide the hardware, but early experience is the software that drives the system.
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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.
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Experiences in childhood have a lasting impact on how our
fear and anxiety systems work
homeostasis
A balancing act
New homeostatic ‘set point’
early positive experiences
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Early Childhood Adversity Can Influence a Range of Lifelong Outcomes
Research on the biology of stress helps explain some of the underlying reasons for differences in learning, behavior, and high risk for physical (cancer, cardio, diabetes), and mental health disorders.
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35%
30%
25%
20%
15%
10%
5%
Institutionalization and Neglect of Young Children Disrupts Body Chemistry
Middle Class US Toddlersin Birth Families
Neglected/Maltreated ToddlersArriving from Orphanages Overseas
Percent of Children
with Abnormal
Stress Hormone
Regulation
Source: Gunnar & Fisher (2006)
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Disparities in Early Vocabulary Growth
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Experiences in childhood have a lasting impact on how our
fear and anxiety systems work
homeostasis
A balancing act
New homeostatic ‘set point’
early negative experiences
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The Brain Architecture of Anxiety and Fear
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The Brain Architecture of Memory and Learning
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Secure Relationships Calm Children’s Stress Hormone Response
Source: Nachmias et al. (1996)
Increase in Cortisol
Secure0
Insecure
-.1
.1
.2
.3
Attachment Relationship
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Sensitive Care Calms Children’s Stress Hormone Response in Parent’s Absence
Source: Nachmias et al. (1996)
Increase in Cortisol
High
0
Low
-.1
.1
.2
.3
Sensitivity/Responsiveness of Caregiver
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Concept:
Early Adverse Experiences (ACEs) contribute directly to the risk for long-term physical and mental health.
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Adverse Childhood Experiences
•Maternal rejection
•Harsh discipline
•>2 primary caregiver changes
•Physical abuse
•Sexual abuse
•Extreme social isolation
“epigenetics”
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Significant Adversity Impairs Developmentin the First Three Years
Number of Risk Factors Source: Barth et al. (2008)
Ch
ild
ren
wit
h
Develo
pm
en
tal
Dela
ys
1-2 3 54 6 7
20%
40%
60%
80%
100%
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Risk Factors for Adult Substance Abuse are Embedded in Adverse Childhood Experiences
0
2
4
6
8
10
12
14
16
0 1 2 3 4
Self-Report: Alcoholism Self-Report: Illicit Drugs
Source: Dube et al, 2002 Source: Dube et al, 2005
% %
ACEs
0
5
10
15
20
25
30
35
40
0 1 2 3 4 5+
Schilling et al, BMC Public Health 7 (2007)
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New Biological Evidence Links Maltreatment in Childhood to Greater Risk of Adult Heart Disease
Percent of adults with biological
marker for greater risk of heart disease
(increased blood level of CRP)
Source: Danese et al. (2008)
Control
10%
20%
40%
30%
50%
Depression(age 32)
Depression(age 32) +Maltreated (as a child)
Maltreated (as a child)
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ToxicProlonged activation of stress response systems
in the absence of protective relationships.
Three Levels of Stress
TolerableSerious, temporary stress responses, buffered by supportive relationships.
PositiveBrief increases in heart rate,
mild elevations in stress hormone levels.
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Source: Finkelhor et al. (2005)
U.S. Children Ages 2-5 (per 1,000)
Maltreatment Postpartum Depression
Sources of Toxic Stress in Young Children 130
98
Parental Substance Abuse
Source: SAMHSA (2002) Source: O-Hara & Swain (1996)
75
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Source: Pollok & Kistler (2002)
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Persistent Stress Changes Brain Architecture
Source: C. Nelson (2008)
Normal
Chronic stress
Prefrontal Cortex andHippocampus
Bock et al Cer Cort 15:802 (2005)
Typical -neuron with many
connections
Neuron damaged by toxic stress – fewer
connections
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Research Says that Remediation and Prevention
ARE Possible
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Source: Nelson et al. (2007)
“normal” range
100
90
70
60
Delayed Intervention Harms DevelopmentBucharest Early Intervention Program
80
0-18 18-24 24-30 30+
“normal” range
0-18 18-24 24-30 30+
IQ/DQ (Mean)
Age of placement in foster care (months)
Tested at 3 1/2 Years Old Tested at 4 1/2 Years Old
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How Should We Act On the Science?
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Building a New Science-Based Approach to Promoting Health and Preventing Disease
A healthier population begins with reducing toxic stress in early childhood, not just trying to change adult behavior.
Early childhood intervention programs can be a vehicle for enhancing lifelong health, not just preparing children to succeed in school.
A redesigned child welfare system could improve health outcomes by promoting positive relationships and adaptive development, not simply focusing on physical safety and custody.
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Conception Adulthood
EarlyChildhood
Middle Childhood
Adolescence
The Childhood Roots of Health Disparities: How Adversity is Built Into the Body
Low Income20%
Physiological Disruption• Neurodevelopmental• Immune• Metabolic• Neuroendocrine• Cardiovascular
Early Death
Early Adversity
Disease/Disorder
Health-Threatening Behavior
Low Educational Achievement
Biological Embedding during Sensitive Periods
Cumulative Burden over Time
Toxic Stress
Environmental Exposures
Malnutrition
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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.
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Think Broadly About Children’s Environment of Relationships
Plan from pregnancy to kindergarten, and look beyond education and health care.
Invest in the development and retention of a skilled early childhood workforce.
Make sure vulnerable children have access to stable, supportive relationships with adults—as early and as consistently as possible.
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Science Points Toward a 3-Tiered Approach to Ensuring
Healthy Development
2: Broadly targeted interventions for children in poverty (e.g., income supports and early enrichment) togive all the chance to succeed.
TIER 1: UNIVERSALLY AVAILABLE
TIER 2: BROADLY TARGETED
TIER 3: NARROWLY TARGETED
1: Basic health services and early care and education available to all children to help build and sustain strong brains and bodies.
3: Narrowly targeted, specialized services for children experiencing tolerable or toxic stress to prevent later problems.
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http://www.developingchild.nethttp://www.developingchild.harvard.edu
PRESENTED BY PAT LEVITT, PH.D.PROVOST PROFESSOR OF NEUROSCIENCE, PSYCHIATRY AND PHARMACYDIRECTOR, ZILKHA NEUROGENETIC INSTITUTEKECK SCHOOL OF MEDICINE OF USC