Jean M Clinton B.Mus MD FRCP(C)

1. Jean M Clinton B.Mus MD FRCP(C) McMaster University and Children’s Hospital Offord Centre for Child Studies

2. Disclaimer… No drug company sponsorship

3. 03-013 THE BRAIN FAIRY The Hostage Brain , Bruce S. McEwen and Harold M. Schmeck, Jr., 1994.

4. Why do we care about brain?YOU ARE YOUR BRAIN. • BUT- Your brain is not just produced by your genes • Your brain is sculpted by a lifetime of experiences. • The most important time in brain development is the first few years of life. Dr Robin Gibb U of Lethbridge

5. Cortical Neuron Brain Plasticity: Connections are formed and altered by experience Dr Robin Gibb U of Lethbridge

6. What is experience? • Everything that you encounter both pre and postnatally, as well as in adulthood • Examples: Light, touch, sound, food, thoughts, injury, drugs, disease Dr Robin Gibb U of Lethbridge

7. Our genetic determinants: Nature 22 prs of autosomal chromosomes are passed from parents to offspring Dr Robin Gibb U of Lethbridge

8. Nature/ Nurture • No longer a debate • Environment leaves its mark on our genome and can modulate future gene expression in a sometimes heritable fashion • The study of how environment leaves its footprint on the genome falls into the domain of Epigenetics Dr Robin Gibb U of Lethbridge

9. Dr Robin Gibb U of Lethbridge

10. In Utero and during lactation maternalexperience has a major influence on baby Dr Robin Gibb U of Lethbridge

11. But, not done until at least age 20 years… Dr Robin Gibb U of Lethbridge

12. Dr Robin Gibb U of Lethbridge

13. SYNAPSE

14. Brain Cells develop connections over the first 2 years Then they are sculpted actively for 20 yrs

18. Some brain areas are very slow to mature - and thus are vulnerable to many experiences… This is especially true of the lighter areas Dr Robin Gibb U of Lethbridge

19. The Frontal Lobe is Very Sensitive to early Experience Frontal lobe development is a long process beginning prenatally and continuing until early adulthood. It Is altered by a wide range of positive and negative experiences. -Frontal lobe functions include: -Short-term memory -Associative learning -Strategy formation -Social/emotional behavior -Response inhibition -Behavioural spontaneity Experiences that alter frontal development will alter these functions. e.g., parent-infant interactions; drugs;stress Dr Robin Gibb U of Lethbridge

20. The Frontal Lobes “Executive Functions” • Governing emotions • Judgment • Planning • Organization • Problem Solving • Impulse Inhibition • Abstraction • Analysis/synthesis • Self-awareness* • Self-concept* • Identity and • Spirituality *Self- “everything” Williamsgroup, 2003: Please credit Protecting You/Protecting Me (PY/PM)

21. Touch Touch and Experience can alter the production of chemicals in the skin, which in turn can alter the brain. Thus, skin may provide a unique route to the brain Think about parent-infant interactions. At 6 weeks there is a difference of 6+ hours at the two ends of the human parenting spectrum. Dr Robin Gibb U of Lethbridge

22. Does experience have the same effects at different times in life? NO! There are qualitative differences at different stages of life. There is something fundamentally different prenatally vs infancy vs juvenile vs adult Dr Robin Gibb U of Lethbridge

23. Psychoactive Drugs Also Alter the Brain Drugs include: nicotine caffeine cocaine antidepressants valium marijuana morphine antipsychotics and more… Dr Robin Gibb U of Lethbridge

24. Drugs and Frontal Lobe Development Psychoactive drugs selectively alter cells in the frontal lobe. A variety of disorders are related to frontal lobe abnormalities: depression, schizophrenia, addiction… Dr Robin Gibb U of Lethbridge

25. Parents change us too… Dr Robin Gibb U of Lethbridge

26. Epigenetics • refers to changes in gene expression often mediated by environmental influences that are stable between cell divisions, and sometimes between generations, but do not involve changes in the underlying DNA sequence of the organism. Dr Robin Gibb U of Lethbridge

27. Early Experience alters stress axis Chronic stress OR high stress Acute, mild stress Development of Stress Reactivity Increased Stress Reactivity Increased Risk for Heart Disease, Type II Diabetes, Alcoholism, Affective Disorders, Brain Aging etc. Modest Stress Reactivity Reduced Risk for Disease

28. Consequences? The mom’s behaviour affects the lifelong health of the infants via later stress reactivity. The mom’s behaviour is transferred to the pups in an epigenetic manner. The gene involved has been located. This epigenetic effect is reversible. Dr Robin Gibb U of Lethbridge

29. Parenting by role-modeling begins as soon as baby arrives • Much of what we learn about “normal” behaviour occurs before we can speak • Parents don’t realize their actions are teaching their children-they think they are just “living” Dr Robin Gibb U of Lethbridge

30. Paternal Care • Dads are spending more time with kids (6.5 hrs/week -2.6 hrs/week 30 yrs ago-<1 hr/week 50 yrs ago) • Dads parentdifferent than Moms: Play more-rough and tumble Dr Robin Gibb U of Lethbridge

31. Factors influencing brain development The developing cortex is altered by many pre- and postnatal events including: 1. sensory & motor experience 2. hormones (gonadal) 3. psychoactive drugs (e.g., nicotine, caffeine, antidepressants and more) 4. parent-child relationships 5. stress Dr Robin Gibb U of Lethbridge

32. The Fear Response: Fight or Flight and Stress Visual Thalamus Visual Cortex Amygdala Scientific American The Hidden Mind, 2002, Volume 12, Number 1

33. Hippocampus Amygdala

34. 03-002 Emotional Stimulus Amygdala Hippocampus - + - + Hypothalamus PVN Cortisol Cortisol CRF PIT ACTH Adrenal Cortex LeDoux, Synaptic Self

35. Amygdala and Hippocampus

36. 00-058 Cortisol can be bad for the brain Hippocampus high sterol levels cause loss of dendrites and cell death Frontal brain attention deficits

37. Maternal depression both pre and post partum affects up to 25% of moms • Higher rates of spontaneous abortion • Placental abnormalities • Premature delivery with low birth weight babies • Fetal growth retardation - 2nd leading cause of neonatal mortality • Associated with childhood depression and other mental health issues Dr Robin Gibb U of Lethbridge

38. Paternal Depression is higher after the birth of baby • Rates of depression are estimated to be as high as 30% in Dads • Father depression puts marital status at risk • Reduced attachment to kids • More problems with self -regulation and executive function in offspring Dr Robin Gibb U of Lethbridge

39. Felletti : Turning Gold into Lead • ACE (adverse childhood experience) study • >170,000 middle aged adults in California • ACE’s are more common than previously thought and have a powerful effect on mental and physical health later in life • Frontal lobe development is particularly sensitive Dr Robin Gibb U of Lethbridge

40. Child Maltreatment • Maltreatment in young kids results in • Changes to Stress axis, reduced development of left cortex and limbic system. Many present with psychiatric disorders. (Teicher et al., 2003) Left Frontal cortex associated with resilience and emotional regulation • At 30 months of age, maltreated children show heightened recognition of angry faces using ERP whereas controls showed heightened recognition of happy faces (Cicchetti & Curtis, 2005) • Maltreated kids become aggressive themselves. May be linked to overactivation of certain cognitive processes leading to biased perceptions (Hoaken, 2007) Dr Robin Gibb U of Lethbridge

41. Modifying Developmental Trajectories Early experience alters developmental trajectories & can lead to many later problems (e.g., addiction) There is no easy fix. Treating an adult symptom will not work. Treatment must be of the whole package…Educate parents and provide support. The best treatment is prevention… Dr Robin Gibb U of Lethbridge

42. Adolescents: Why DO they do the things they do?

43. Kids Today "The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in placeof exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. Theycontradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers." PLATO

44. Pre-Test: 1. Most behavior changes in adolescence are due to hormones T F 2. The brain is fully developed in the first three years of life T F 3. The average teen needs 9.25 hours of sleep each night T F 4. Nicotine affects adults and teens in the same way T F 5. After age 12, parents don’t have much influence on their child’s development T F

45. Defining Adolescence • The period between the onset of sexual maturation & the attainment of adult roles & responsibilities • Involves psychological, social, legal, and biological changes • The transition from: • “child” status (requires adult monitoring) to • “adult” status (self-responsibility for behavior)

46. Key Messages ‘UNDER CONSTRUCTION” • Teens need MORE of our time, not less. • What we THINK, affects how we FEEL, affects how we ACT (TAFFY) • The majority of adolescents do well YET

47. Adolescent Tasks • Peer group formation • Increased academic demands • Pressure to be self-reliant (especially in two income families) • Increased responsibility • Money • Romantic desires • Identity formation

48. What Changes in Adolescence? • Memory and planning • Responsibility • Self-regulation or control of emotion • Mood Lability • Risk taking • Sleep

49. The Paradox • Measures of most abilities indicate that adolescence is the healthiest and most resilient period of the lifespan. • Yet overall morbidity and mortality increases 200-300 times from childhood to late adolescence. • Primary causes of death and disability related to Problems with control of behaviour and emotions

50. Key Messages ‘UNDER CONSTRUCTION” (MUC to some) which explains much of the challenge!!