First 1000 Days of Life – Window of Opportunity for Brain Development

1. First 1000 Days of Life – Window of Opportunity for Brain Development Sept 10, 2018 Karakoram International University, Gilgit– Baltistan Dr. Ghazala Rafique Aga Khan University

2. Situation of children – Under 5 In low and middle-income countries • 43% at risk of not achieving development potential • 75 million live in areas affected by conflict, exposed to toxic stress, potentially inhibiting brain cell connections • 155 million are stunted, which prevents brain development • 25% of 2-4 year olds (in 64 countries) do not have opportunities essential for brain development such as playing, reading and singing • 300 million live in areas with toxic air, which can damage their developing brains Early moments Matter –UNICEF for every child 2017

3. Why Early Child Development is Important? • What happens early affects all aspects of a child’s development • First 1,000 days of life have a profound impact on brain development • Nurturing relationships in the early years are critical • Toxic stress has a negative impact on a child’s development • Early interventions are critical for optimal life course outcomes

4. The First 1,000 Days of Life • The first 1000 days beginning at the time of conception on to a baby’s second birthday First Year 2 Pregnancy Year 1 1000 270 365 = 365 + + Days Days Days Days

5. Brain Development • Born with 100 billion brain cells • All the neurons have the same genetic potential • Our brain is Sensitive and Reactive and further development of connections is dependent on stimuli from the sensory pathways • Upto15,000 synaptic connections may be established for each cell • Signals can be sent to other cells at speeds of more than 200 mph • 70% of brain development occurs by age 1 and 80% by age 3

6. Brain Architecture Builds over Time Neural Circuits are Wired in a Bottom-Up Sequence (700 synapses formed per second in the early years) Language Higher Cognitive Function Sensory Pathways (Vision, Hearing) FIRST FIVE YEARS 1 2 3 4 5 6 7 8 9 10 111 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Years Months Source: C.A. Nelson (2000)

7. Experience shapes Brain Architecture (overproduction followed by pruning) Human Brain at Birth 14 Years Old 6 Years Old

8. Experiences shape Brain Architecture VideoExperiencesBuildBrainArchitecture.mp4

9. ‘Serve and Return’ Relationship • The interactive influences of genes and experience shape the developing brain • Brain development occurs through the brain’s active engagement in everyday experience • Major ingredient in the developmental process is the ‘Serve and Return’ interactions

10. Experience-based brain development genes brain learning health epigenetics behaviour experience physicalenvironment nurturing nutrition

11. The Plasticity of Brain Architecture Decreases over Time • Brain has more plasticity in early years and its capacity for change decreases with age • Accommodates a wide range of environments and interaction during early years • Early Plasticity makes the brain both more vulnerable to harm and more capable of recovery • Window of opportunity for different type of skills

12. `Sensitive Periods’ in Early Brain Development “Pre-school” years School years High `Numbers’ Peer social skills Sensitivity Symbol Language Habitual ways of responding Emotional control Vision Hearing Adapted from Nash, 1997; Early Years Study, 1999; Shonkoff, 2000 Low 1 2 3 4 5 6 7 0 Years

13. Neglect Impedes Brain Development • Limited exposure to language, touch or social interactions • Emotional or cognitive neglect • Physical Threat • Early, frequent and intense threat • Structural Changes • Lack of brain growth beyond effects of poor nutrition • Neuronal death beyond “pruning”

14. Disparities in Early Vocabulary Growth 1200 1000 Children of College Educated 800 Children of Lower Middle Class Cumulative Vocabulary (Words) 600 Children of Parents in Poverty 400 200 16 mos. 24 mos. 36 mos. Child’s Age (Months) Source: Hart & Risley (1995)

15. Stress and Development • Important to development & in the context of stable and supportive relationships • Potentially disruptive, but buffered by supportive relationships & safe environments • Disrupts brain architecture, increases the risk of stress-related physical and mental illness Positive Tolerable Toxic

16. Early Childhood Stress Influences Brain Development

17. Rates of Return to Human Development Investment Across all Ages ‘Policy makers should invest in young children where the return on investment is stronger than in low-skilled adults’ James Heckman, a Nobel-prize winning economist

18. A nation is only as good as its children – let us invest in our future by investing in Early Child Development

19. Thank you