Promoting School Readiness: Early Brain and Child Development

1. Pamela C. High, MD, FAAP Professor of Pediatrics (Clinical) W Alpert Medical School Brown University October 3, 2010 Promoting School Readiness:Early Brain and Child Development

2. Learning objectives: participants should be able to: • Describe the importance of both genetic and environmental influences on developmental trajectories that begin in early childhood • Define and describe school readiness in children, schools and communities • Identify ways to promote school readiness at home, in care and as child advocates

3. Disclosure • I have no relevant financial disclosures – nothing to hide…..

4. Early Brain and Child Development • Popular interest in coordinating neurosciences research with developmental pediatric research • Nature versus nurture question • Newest AAP “pizza box” Strategic Priority

5. Early Brain and Child Development • Child development and behavior depend upon brain development which begins within weeks of conception • The first 3 years of life are very important and provide a foundation • Development (and CNS maturation) continue throughout life • Brain development is dependent upon bothgenetics and experience

6. Brain growth is sequential and proportional Courtesy of Bruce Perry MD PhD

7. Structural Brain Development:Proliferation and Differentiation • Brain development begins when the neural tube forms - 18th to 24th day of gestation • By the 6th prenatal week, primitive neuroblasts and glialblasts begin migrating outward

8. Brain Development:Migration and Differentiation Orchestrated by Monoamine Systems • In the cerebral cortex the neuroblasts are carried along radial glial fibers (target destinations in higher centers) • Brainstem monoamine systems (noradrenergic, dopaminergic, serotonergic & adrenergic) orchestrate this migration and differentiation Courtesy of Bruce Perry MD PhD

9. Neurons and Glial Cells: Building Blocks • At birth, the human brain has 100 billion neurons and 10 times more glial cells than neurons • These glial cells and neurons organize, move, connect and specialize to create the amazing brain of the newborn

10. Structural Hierarchy of the Brain • The brain is organized from bottom to top -brainstem to cortex (simple functions in the brainstem; complex ones in cortex) • 6 layers of cortex • Deepest layer is oldest • Cortex has 40% of the neurons in the brain Cortex Limbic area Diencephalon Brainstem Courtesy of Bruce Perry MD PhD

11. Abstract Thought Concrete Thought Affiliation Neocortex Attachment Sexual Behavior Emotional Reactivity Limbic Motor Regulation "Arousal" Appetite/Satiety Diencephalon Sleep Blood Pressure Heart Rate Brainstem Body Temperature Functional Hierarchy of the Brain C O M P L E X I T Y Courtsey of Bruce Perry MD PhD

12. Myelination • Myelinization - increases speed of conduction • Motor and sensory regions begin myelinization before birth; completed before the first birthday • Prefrontal cortex is not fully myelinated until almost adolescence Courtesy of Bruce Perry MD PhD

13. Synaptogensis - Branching • Mature neurons develop axons and dendrites forming connections/synapses • This synaptogenesis occurs sequentially within the brain, by region Courtesy of Bruce Perry MD PhD

14. Synaptic Sculpting • Explosive increase in synapses in the first 8 months • Highest density & number of synapses are in 1st year • “Overproduction” is followed by “Pruning” phase • Visual areas peak at 4 months- decline until preschool age • Prefrontal cortex peaks at 1 yr- decline stabilizes in adolescence Courtesy of Bruce Perry MD PhD

15. The brain is the ultimate “Use-it-or-Lose-it” Machine Synapses: • At birth - 50 trillion • At 1 year - 1000 trillion Pruning: • At age 20 - 500 trillion

16. Critical (Experience-expectant) Periods of Development • Critical periods of development are times during which a set of signals must be present for neural systems to differentiate normally • This is a process whereby synapses are formed after only minimal experience has been obtained

17. Critical Period of Experience Dependant Development: Vision • Stereoscopic vision depends on regions in the visual cortex receiving separate inputs from each eye • These inputs result in separate columns of cells that are distinct for each eye • If 1 eye is deprived of input (cataract, hemangioma, ptosis), these ocular dominance columns fail to develop; stereoscopic vision is compromised – If not corrected very early –irreversible damage.

18. The Role of Experience in Brain Development • All sensory information is “transduced” by the nervous system into changes in nerve cells at a molecular level • This repetitive sensory input (patterned neuronal changes) allows the brain to make internal representations, which how a child learns about the world: • The sound of parent’s voice • A feeling of mastery and self worth

19. Experience - Dependent Development:Learning • In this way, during development, patterns of experience define patterns of synaptic connectivity • This process optimizes the individual’s adaptation to specific environmental factors • In adults, experience can alter pre-existing neural organization (e.g. when exposed to new information, we modify old synapses and make new ones) - learning has no critical period

20. Experience - DependentTemplates & Development • Early Childhood is a “Sensitive” (not “Critical”) time in a child’s life when experiences directly mold neuronal circuits (brain architecture) and influence that child’s developmental trajectory - their lifecourse

21. Meaningful Differences in the Everyday Experiences of Young American Children 30 Million Word Gap • Hart and Risely studied the language environment of 42 children in their homes monthly from 7 to 36 months of age in professional, working class and welfare families

22. Meaningful Differences in the Everyday Experiences of Young American Children • Some families talked a lot, others talked a little • “Business talk” – gets things done (‘stop,’ ‘come here,’ ‘bring me ___,’ ‘put on your shoes’) • “Non-business talk” – extra chit chat, praise, restatements, active listening, reciprocal • Amount of business talk was constant across families, the amount of non-business talk varied considerably between more and less talkative families

23. Parent Talkativeness (not SES or race) predicts IQ & languageHart and Risely • Talkative families had 5 to 6 times more “praise and chats” than “prohibitions” • Taciturn families had more “prohibitions” than “praise” • IQ (Stanford Binet) at 3 years correlated highly with “non-business” talk at 1 & 2 yo - explaining 61% of the variance in IQ • PPVT (Receptive Language) at 3rd grade correlated highly with “non-business” talk at 1 & 2 yo– explaining 59 % of variance

24. Adverse Childhood Experiences (ACE) Model • 17,000 Adults in Kaiser-Permanente San Diego 1995-7

25. Number of Adverse Childhood Experiences – ACE Scores (0-10)Childhood Stress • Physical, sexual or emotional abuse • Physical or emotional neglect • Household mental illness, substance abuse, divorce, domestic violence or incarceration

26. Alcoholism/alcohol abuse STDs COPD Depression Fetal death Health related QOL Liver disease Smoking Unintended pregnancy Suicide attempts Intimate partner violence Ischemic heart disease “as ACE Score (childhood stress) increases, the risk of the following health problems increases in a strong and graded fashion” Centers for Disease Control and Prevention

27. Household Routines and ObesityHow experience influences health – Anderson & Whitaker 2010 • Early Childhood Longitudinal Study – 8,550 preschoolers in 2005 • 18% obese ( >95th % BMI ) • Controlling maternal BMI, education, race, poverty and single parent status, 4 yo with 3 household routines (<2 hours TV daily, Family dinner > 5X weekly, sleeping > 10.5 hours nightly) were 40% less likely to be obese

28. Child Development 100% Nature and 100% Nurture James Jebusa Shannon

29. Brain Plasticity • The brain is constantly changing • Plasticity varies across all brain areas • It takes less time, intensity and repetition to organize developing neural systems than to reorganize the developed neural systems • Opportunity exists to overcome early adversity

30. Early Experience Matters Virtually every aspect of early human development - from the brain’s evolving circuitry to the child capacity for empathy, is affected by the environment and experiences that are encountered in a cumulative fashion, beginning in the prenatal period and extending throughout the early childhood years. Neurons to Neighborhoods, IOM, 2002

31. Definition: School Readiness National Educational Goals Panel 1991 GOAL: By 2000 all children will enter school “ready to learn” • Readiness within the child (domains) • Physical well being and motor development • health, growth, vision, hearing, disability • Social and emotional development • empathy, turn taking • Approach to learning • enthusiasm, curiosity, culture, and values • Language development • listening, emergent literacy • General knowledge and cognition • sound/letter association and numeric concepts

32. Definition: School Readiness National Educational Goals Panel 1991 • School’s readiness for all children • Commitment to the success of every child and every teacher • Smooth home and school transitions • Continuity between early care and elementary ed • High quality instruction • Integrating parent involvement • Serving children within their communities • Having strong leadership • Taking responsibility for results

33. Definition: School Readiness National Educational goals Panel 1991 • Family and community supports contributing to child readiness including: • Excellent prenatal care for mothers • Health care, nutrition, and physical activity for children • Access to high quality preschool for all • As their child’s first teacher, every parent should devote time daily, helping their child learn, and should have access to training and support to accomplish this goal

34. 5-6 Year Old: Pre-Kindergarten Assessment - School Readiness (Bright Futures) MOTOR (GROSS & FINE) • Balances on 1 foot, hops, skips • Draws a person > 6 parts, copies  ∆, ties knot, mature grasp, prints some letters and numbers LANGUAGE • Full sentences – appropriate tenses/pronouns • Tells stories – good articulation SOCIAL/COGNITIVE • Counts to 10; names 4 colors • Listens & follows directions; dresses self • Able to separate from parents for several hours • Takes turns; plays well with other kids Steven Scott Young

35. State Early Learning Guidelines • All states + DC have Early Learning Guidelines for Preschoolers (3 to 5 yo) • Voluntary (mostly) • Domains: language and literacy, early math, early science, physical health & social emotional health – some also address creative arts and approach to learning • Almost half the states have ELG for birth to 3 yo Child Trends: Early Childhood Highlights June 17, 2010

36. Statewide Kindergarten Entry Testing • > 50% of state assess children in Kindergarten • Only 7 track aggregate data on children “ready” “in progress” or “not ready” for school • Tests mainly rely on teacher observations in multiple domains at kindergarten entry • Assessments are mostly state-designed or adapted from existing measures Child Trends: Early Childhood Highlights June 17, 2010

37. Early Childhood Assessment:Why, What and How? • Assessment may be used for purposes as diverse as determining the level of function of an individual child, guiding instruction or measuring functioning at the program, community or state level • The purpose of the assessment should guide assessment decisions within a coherent system of medical, educational and family supports • Tools must be psychometrically sound, test the domain targeted and be appropriate to the age, culture, race and language of the child • National Research Council of National Academy of Sciences - 2008

38. Early Childhood Assessment:Why, What and How? • Parents should be informed in advance of assessment’s purpose and focus and be promptly informed of screening results and whether follow-up diagnostics are indicated • Medical professional should screen for maternal and family factors impacting child outcome, such as maternal depression and abuse • Domains should be expanded from literacy, math and language, to include approaches to learning, social emotional function, creativity and interpersonal skills • National Research Council of National Academy of Sciences - 2008

39. Early Childhood Assessment:Why, What and How? • For children with disabilities and special needs, domain-based assessment may need to be replaced or supplemented by more functional approaches • Implementation of a system-level approach requires having services to meet the needs of all children identified through screening, including follow-up in-depth assessment • If services are not available, the results of screening may be used to argue for expansion of services- failure to screen may lead to underestimation of need for services • National Research Council of National Academy of Sciences - 2008

40. Recognizes All Letters3 to 6 yo – National Household Education Surveys -1993, 1999, 2007 • www.childtrendsdatabank.org

41. Writes Name 3 to 6 yo – 1993, 1999, 2007 • www.childtrendsdatabank.org

42. Counts to 20 or Higher 3 to 6 yo – 1993, 1999, 2007 • www.childtrendsdatabank.org

43. School Readiness Skills in 3-6 yo by Poverty Status 2007 • www.childtrendsdatabank.org

44. School Readiness Skills in 3-6 yo by Race and Ethnicity 2007 • www.childtrendsdatabank.org

45. School Readiness Skills in 3-6 yo by English Spoken in Home 2007 • www.childtrendsdatabank.org

46. Three Landmark Studies of Preschoolfor at risk children • High/Scope-Perry Preschool Project (Ypsilanti, MI), Abecedarian Project (North Carolina), Chicago Child-Parent Centers • Center-based programs that served children at risk for school failure • Randomized control group design or matched comparison group • Longitudinal research into adulthood (age 40 and beyond)

47. Benefits of High-quality Pre-K – Early outcomes • Educational • Lower special education and grade retention • Increased high school completion • Increased test scores • Social-Emotional • Fewer behavior problems • More self-control • Improved peer relations • Child well-being • Less child maltreatment and neglect

48. Benefits of High-quality Pre-K – Later outcomes • Increased Earnings and Tax Revenues • Decreased Reliance on Social Services • Decreased Criminal Activity • Juvenile and Adult • Improved Health Behaviors • Better health outcomes • Less reliance on health services • More Skilled Workforce • Increased productivity • Increased earnings • Stops cycle of poverty

49. Access: Preschool Education by Income, NHES 2005 Source: National Association for Early Education Research, Rutgers

50. Public Investment in Children by Age