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No Time to Lose:No Time to Lose: Closing the GapClosing the Gap
Between What We Know andBetween What We Know andWhat We DoWhat We Do
Jack P. Shonkoff, M.D.Chair of the National Scientific Council on the Developing Child
Presentation to Westchester Childrens Association
White Plains, New York March 24, 2006
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The Importance of Viewing the NeedsThe Importance of Viewing the Needs
of Children in a Broad Contextof Children in a Broad Context
The healthy development of all youngThe healthy development of all young
children benefits all of society by providingchildren benefits all of society by providing
a solid foundation for responsiblea solid foundation for responsible
citizenship, economic productivity,citizenship, economic productivity,lifelonglifelongphysical and mental health, strongphysical and mental health, strong
communities, and sustainable democracycommunities, and sustainable democracy
and prosperity.and prosperity.
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What We Know About Brain DevelopmentWhat We Know About Brain Development Brains are built over time, shaped by theBrains are built over time, shaped by theinteraction between genetics and experience.interaction between genetics and experience.
Social, emotional, and cognitive developmentSocial, emotional, and cognitive development
are highly interrelated.are highly interrelated.
Brain architecture and skills are built in aBrain architecture and skills are built in a
hierarchical bottom-up sequence.hierarchical bottom-up sequence.
Brain plasticity and the ability to changeBrain plasticity and the ability to change
behavior decrease over time.behavior decrease over time.
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Rethinking the Brain, Families and Work Institute, Rima Shore, 1997.
At Birth 6 Years Old 14 Years Old
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Relationships are the ActiveIngredients" of Early Experience
Nurturing and responsive relationships buildNurturing and responsive relationships build
healthy brain architecture that provides a stronghealthy brain architecture that provides a strong
foundation for learning, behavior, and health.foundation for learning, behavior, and health.
When protective relationships are not provided,When protective relationships are not provided,elevated levels of stress hormones (i.e., cortisol)elevated levels of stress hormones (i.e., cortisol)
disrupt brain architecture by impairing celldisrupt brain architecture by impairing cell
growth and interfering with the formation ofgrowth and interfering with the formation of
healthy neural circuits.healthy neural circuits.
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Early Childhood Adversity Can HaveEarly Childhood Adversity Can Have
Lifelong ConsequencesLifelong Consequences
Research on the biology of stress helpsResearch on the biology of stress helps
explain some of the underlying reasons forexplain some of the underlying reasons fordifferences in learning, behavior, anddifferences in learning, behavior, and
physical and mental health.physical and mental health.
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Positive StressPositive Stress Moderate, short-lived stress responses, suchModerate, short-lived stress responses, such
as brief increases in heart rate or mild changesas brief increases in heart rate or mild changes
in stress hormone levels.in stress hormone levels.
Precipitants include the challenges of meetingPrecipitants include the challenges of meeting
new people, dealing with frustration, gettingnew people, dealing with frustration, getting
an immunization, or adult limit-setting.an immunization, or adult limit-setting.
An important and necessary aspect of healthyAn important and necessary aspect of healthy
development that occurs in the context ofdevelopment that occurs in the context of
stable and supportive relationships.stable and supportive relationships.
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Tolerable StressTolerable Stress Stress responses that could disrupt brainStress responses that could disrupt brain
architecture, but are buffered by supportivearchitecture, but are buffered by supportive
relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.
Generally occurs within a time-limited period,Generally occurs within a time-limited period,
which gives the brain an opportunity to recoverwhich gives the brain an opportunity to recover
from potentially damaging effects.from potentially damaging effects.
Precipitants include death or serious illness ofPrecipitants include death or serious illness of
a loved one, a frightening injury, parent divorce,a loved one, a frightening injury, parent divorce,
terrorism,terrorism,a natural disaster,a natural disaster,or homelessness.or homelessness.
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Toxic StressToxic Stress Strong and prolonged activation of the bodysStrong and prolonged activation of the bodys
stress management systems in the absence ofstress management systems in the absence of
the buffering protection of adult support.the buffering protection of adult support.
Disrupts brain architecture and leads to stressDisrupts brain architecture and leads to stress
management systems that respond at relativelymanagement systems that respond at relatively
lower thresholds, thereby increasing the risk oflower thresholds, thereby increasing the risk of
stress-related physical and mental illness.stress-related physical and mental illness.
Precipitants include extreme poverty, physical orPrecipitants include extreme poverty, physical or
emotional abuse, chronic neglect, severe maternalemotional abuse, chronic neglect, severe maternal
depression, substance abuse, or family violence.depression, substance abuse, or family violence.
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Data To Think AboutData To Think About
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Adverse Childhood Events and
Adult Depression
0
.00
0
.00
0
.00
0
.00
0
.00
0
0
0
0
0
0
+0
OddsRatio
Adverse Events
Chapman et al, 2004
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Adverse Childhood Events and Adult
Ischemic Heart Disease
0
.00
0
.00
0
.00
0
.00
0
0
0
0
0
,00
,0
Dong et al,Adverse Events
OddsRatio
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Adverse Childhood Events and
Adult Substance Abuse
0
0
0
0
0
00
00
00
00
0 0 0 0 +0
0
0
00
00
00
00
00
00
00
0 0 0 0 0 +0
%
Self-Report: Alcoholism Self-Report: Illicit Drug Use
Dube et al, 2002 Dube et al, 2005
%
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Importance of Emotional DevelopmentImportance of Emotional Development In a study of 211 children under age 3 withIn a study of 211 children under age 3 with
newly opened child protection cases andnewly opened child protection cases and
completed developmental evaluations, 52% hadcompleted developmental evaluations, 52% haddocumented delays or established conditionsdocumented delays or established conditions
that met eligibility criteria for early interventionthat met eligibility criteria for early intervention
services in Massachusetts (MECLI, 2005).services in Massachusetts (MECLI, 2005).
In a survey of 119 preschool teachers, 39%In a survey of 119 preschool teachers, 39%
reported expelling at least one child from theirreported expelling at least one child from their
program in the preceding year (Gilliam, 2004).program in the preceding year (Gilliam, 2004).
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Economic Benefits of Early InterventionEconomic Benefits of Early Intervention
Perry Preschool Project follow-up data at agePerry Preschool Project follow-up data at age
40 indicate a total benefit-cost ratio of 17:1 (4:140 indicate a total benefit-cost ratio of 17:1 (4:1
for participants and 13:1 for the public), withfor participants and 13:1 for the public), with
annual internal rates of return of 18% (1%annual internal rates of return of 18% (1%participant gain and 17% public benefit).participant gain and 17% public benefit).
Public benefits include higher tax revenues andPublic benefits include higher tax revenues and
lower costs for special education, publiclower costs for special education, public
assistance, and incarceration.assistance, and incarceration.
Participant benefits are derived largely fromParticipant benefits are derived largely from
higher earned income.higher earned income.
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Implications for PolicyImplications for Policyand Practiceand Practice
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Human Capital FormationHuman Capital FormationRequires a Balanced ApproachRequires a Balanced Approach
If we really want to build a strong platform forIf we really want to build a strong platform forhealthy development and effective learning inhealthy development and effective learning in
the early childhood yearsthe early childhood years
then we must pay as much attention tothen we must pay as much attention tochildrens emotional well-being and socialchildrens emotional well-being and social
capacities as we do to their cognitive abilitiescapacities as we do to their cognitive abilities
and academic skills.and academic skills.
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Quality Interventions Make a DifferenceQuality Interventions Make a Difference
Services for vulnerable, young children canServices for vulnerable, young children can
have positive impacts on brain developmenthave positive impacts on brain development
that generate a significant return on investmentthat generate a significant return on investmentover a lifetime...over a lifetime...
but they require the quality and sustainabilitybut they require the quality and sustainability
that comes from low staff turnover and wellthat comes from low staff turnover and welltrained personnel withtrained personnel withexpertise that matchesexpertise that matches
the needs of the children and families served.the needs of the children and families served.
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Neuroscience Applies to PoliciesNeuroscience Applies to PoliciesBeyond Early Care and EducationBeyond Early Care and Education
If we really want to promote better outcomes forIf we really want to promote better outcomes forchildren, then we must apply the science ofchildren, then we must apply the science of
early childhood and early brain development toearly childhood and early brain development to
a broad array of policies a broad array of policies
including welfare reform, adult mental health,including welfare reform, adult mental health,
child welfare, family and medical leave,child welfare, family and medical leave,andand
environmental protection, among others.environmental protection, among others.
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Young Children and theirYoung Children and their
Families Need New ChampionsFamilies Need New Champions
Need for fresh leadership in both theNeed for fresh leadership in both thepublic and private sectors to addresspublic and private sectors to address
significant inequalities in opportunity forsignificant inequalities in opportunity for
children, beginning in the earliest yearschildren, beginning in the earliest years
of life, as both a moral responsibility andof life, as both a moral responsibility and
a critical investment in the nationsa critical investment in the nations
social and economic future.social and economic future.
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www.developingchild.net
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