Taking Stock: New Perspectives on Parenting. Sept 29, 2008

1. Developing Mentally Healthy ChildrenStuart G. ShankerDistinguished Research Professor Director, Milton & Ethel Harris Research Initiative Taking Stock: New Perspectives on Parenting. Sept 29, 2008

2. Secondary Altriciality • Early plasticity enables the child’s brain to be highly attuned to the environment in which she is born • Synaptic growth in the first 2 years is massive • There is huge over-production of synapses that, at 8 months, will start to be ‘pruned’ back • Synaptic pruning is regulated by baby’s emotional interactions with her caregivers

3. 04-212 Sound Vision Smell Touch Proprioception Taste Neal Halfon

4. The Role of the Primary Caregiver in Early Brain Growth • The primary caregiver serves as an ‘external brain’, regulating and stimulating the baby’s brain • Dyadic experiences are vital for: • Sensory integration • Emotion-regulation • Self-Regulation

5. Development of Self-Regulation • Infant is born with limited capacity to regulate her own arousal states and emotions • This function performed in early months by caregivers • Infant develops the capacity to self-regulate (SR) by experiencing regulation in these dyadic interactions • Similarly, the caregiver has to woo the infant into paying attention to the world around her

6. Problems in Self-Regulation at Core of Many Disorders • Basic biological challenges include: • Sensory regulation and integration • Information processing and motor control • Hypo- and hyper-functioning neural systems • Child with such challenges may avoid interactions essential for development of self-regulation • Deprivation and abuse can lead to similar result

7. How Pervasive are Problems in Self-regulation? • In 2005 CMHO reported that 20% of children in Ontario have a mental illness impairing day-to-day functioning • 2007 US Surgeon General’s Mental Health Report: 30% of children 9-17 have a diagnosable mental disorder • Difficult to gather this kind of population data; problems in • diagnostic categories and practice • factoring in co-morbidities • estimating # of diagnosable children not seen by doctor • Concern is that this is still only telling a small part of the story in regards to self-regulation in children

8. Neither Mentally Ill nor Mentally Healthy • How many children present behaviours similar to CMHO symptoms but not at a level that would warrant a DSM-IV diagnosis? • Is a child getting a C- grade, with no close friends, no interests besides tv and video games, unhappy and overweight, easily bored or distracted, has trouble sticking to a task, but is not difficult to handle at home or in the classroom, thriving?

9. The Long Reach of Problems in Self-Regulation • Our concern is with large and growing number of children who are not fully developing these core capacities as a result of poor self-regulation when they enter school • These are the qualities that: • lead to great learners • help protect a teenager from harmful practices • help an adult form a lasting deep relationship, enjoy a meaningful career, adopt a healthy lifestyle, and be active in the community

10. Why are so many Children entering Kindergarten with poor self-Regulation? • Approximately 83% of Canadians live in cities • Now rare for children to be raised in extended family • Children exposed to vast amounts of stimuli and stressors in excess of evolutionary environment • Children spending on average 4 hrs/day in front of screen • Sharp declines in exercise, time in nature, or just playing with other children

11. Effects on Early Brain Development • Environmental toxins (lead, dioxin, passive exposure to tobacco) have all been shown to affect growth of prefrontal cortex • Has a negative effect on stress response of HPA pathway • Negative effect on self-regulation • October 2008 issue of Brain and Cognition reports link between air pollution and inflammatory and/or neurotoxic effect on early brain growth

12. Epigenetic Effects • Early experiences control switches that turn genes on or off • This can have a significant effect on development child’s prefrontal cortex • ADHD, autism, aggression, depression are all downstream disorders: result of initial neurogenetic factors that impair the child’s capacity to engage in the experiences necessary for the development of ‘higher-order’ brain systems

13. Pathways Model of Autism • A child who is hyper-sensitive to visual/auditory stimuli may find interactions aversive and withdraw • Such children are born with a neurological deficit that leads to a reduced input of information necessary for the development of the neural areas involved in social behavior (e.g., fusiform gyrus)

14. Pathways Model of Agression • Children who have difficulty processing nonverbal cues may respond by withdrawal or agression • Similar in children who have trouble regulating their emotions due to over-aroused limbic system and/or under-developed regulatory systems • These children don’t have a ‘violence gene’; rather, as Tremblay has shown, they don’t develop strong enough regulatory mechanisms

15. Development of the Mind Governs the Development of the Brain • Child’s motivation, interest, curiosity, pleasure, support effort required for next step in development, which forces the brain to develop new connections needed for the task at hand • Even a child with serious biological impairments can, if wooed into interactions, go through the stages of healthy mental development

16. The Ongoing Development of Self-Regulation • SR develops throughout childhood, adolescence, and young adulthood as challenges to which child is exposed increase • Programs with greatest long-term physical and psychological benefit are those that promote SR • The more developed the child’s SR, the more receptive and able they are to adopting healthy behaviors

17. Back to Basics • We’re just starting to understand what enhances and what constricts development of SR • The most important early experiences are the child’s interactions with her caregivers • The most effective activities for children growing up are the simplest: e.g., sports, nature, arts, social interest groups

18. Living in Challenging Times • See evidence of the possible negative effects of excessive tv and video games on development of SR • These activities also inhibit family and peer interactions • Growing number of families with both parents working, single parent-families with working parent

19. The Critical Role of Emotion • If strong positive affect is critical for development of SR in child, it only stands to reason that it is equally important for parental development • Parents need to continue developing SR just as much as their children, to deal with the added stresses of parenting (including financial) • Just as with the interactions that promote SR in children, the most successful parenting programs are those that individuals enjoy

20. Key Principles • We need to identify biological and/or social problems early and intervene immediately • We need to focus on the emotional and physical experiences that promote strong SR • Parents also need to continue developing SR • The same principles that apply to the development of SR in children apply to parents and communities

21. Six Important Policy Initiatives • Highly trained and motivated workforce: ECE, School, Medical • Programs to enhance Father Involvement • Sports and music programs • School Based Health Clinics • Community Development • Data Collection

22. Highly Trained ECD Workforce • Recognize critical role of ECEs, primary teachers, working with parents: • Full training in developmental model • Appropriate remuneration, status • Ongoing mentoring and support • This applies to anyone working with young children: e.g., doctors, nurses, social workers, coaches

23. Father Involvement • FI a crucial social determinant of health for children • Number of families lacking active FI is rising (particularly for some Canadian sub-populations and lower-income households) • Lack of FI increases risks of: poor health; lower education, social-emotional problems, aggression

24. Sports and Music Programs • Involvement in sport promotes: • self-regulation • self-esteem and sense of fairness • Rule-following and frustration-tolerance • ability to form friendships • Protection from addiction, mental illness • El sistema Nacional de las Orquestas Juveniles e Infantiles de Venezuela has had dramatic effects on preventing aggression and criminal behavior

25. School Based Health Clinics • Access to health services in school increases use and overall health among children • Parent use also increased: particularly among those who don’t receive regular medical attention • SBHCs reduce emergency department use • largest improvement was for psychosocial HRQOL, especially in regards to counseling

26. Community Development:New Horizons Model • Designed to get seniors involved in communities, maintain mental and physical well-being • Seniors identified needs in their own communities and developed/directed the projects • Successful programs are pitched at community’s developmental level, whatever that might be • Communities need to be engaged in design, directing, and evaluating their own programs

27. Data • We need universal screening (18 or 24 months) • We need to start tracking children’s social-emotional development • We need integrated databases (health, social, and education) • No data. No problem. No action.

28. Reading • Diamond, A et. al (2008) Preschool program improves cognitive control Science November 30th • Fogel, A, King, B & Shanker, S (2007) Human Development in the 21st Century (Cambridge UP) • Greenspan, S & Shanker, S (2004) The First Idea (Perseus) • McCain, M, JF Mustard & SG Shanker (2007) Early Years Study II: Putting Science into Action. • Smith-Chant, B.L. (2008) Early Learning and heath. In D Rahpael (ed), Social determinants of health. (Canadian Scholars Press) • Wade, T et al. (2007) Improvements in Health-Related Quality of Life • Among School-Based Health Center Users in Elementary and Middle School. Ambulatory Pediatrics 8,4