Overcoming developmental risk: A biopsychosocial foundation for early interventions

1. Overcoming developmental risk:  A biopsychosocial foundation for early interventions Oslo—RBUP—June, 2009 Arnold Sameroffsameroff@umich.edu

2. Academic 2. Social 3. Political How do we understand children? How do we improve children? Who is responsible for children? Agendas for Intervention Professionals

3. Agendas for Intervention Professionals 2. Social Agenda How can we improve children’s lives?

4. Opportunities for Prevention or Intervention SOCIALECOLOGY SOCIALECOLOGY OTHER BIOLOGY SELF PSYCHOLOGY INFANCYCHILDHOODADOLESCENCEADULTHOOD

5. Improving Developmental Success 1) Make Children More Resilient 2) Make Environments Less Risky

6. Obstetrical Problems Newborn Pediatric Problems Newborn Brazelton Scores 4-Month Temperament 4-Month Development Scores 12-Month Development Scores Infant Competence

7. Infant Competence Predicting to 4-Year Mental Health Infant Competence

8. 4-Year Mental Health Predicting to 18-Year Mental Health 4-Year

9. 13-Year Mental Health Predicting to 18-Year Mental Health 13-Year (Y) Mental Health

10. 18-Year Mental Health Predicting to 30-Year Mental Health (PIRS) 4 18-Year MH High Low 3 30-Yr. Mental Health 2 0 1 2 3 4+ 18-Year Social Risk

11. 18-Year Mental Health Predicting to 30-Year Physical Health 18-Year Mental Health

12. PhiladelphiaAdolescent Development Study 500 11- to 14-year olds Urban Setting Examine Multiple Competencies Examine Multiple Risks Todd Bartko, Jacque Eccles Frank Furstenberg, Tom Cook, Glen Elder

13. GEOPOLITICAL COMMUNITY FAMILY PARENT CHILD SCHOOL PEERS CHILD Social Ecological Model

14. 20 NegativeEnvironmental Influences Proximal • Parent-Child Interaction • Parent Characteristics • Family Structure & Economy • Family Management • Peers • School • Community Distal

15. Psychological Adjustment Few Problem Behaviors Academic Competence DepressionAngerSelf-Esteem Substance UseEarly Sexuality DelinquencyViolence Grades Indicators of Adolescent Success

17. Resourcefulness High Low PsychologicalAdjustment Academic Performance Problem Behavior 1.0 1.0 1.0 .8 .6 .5 .5 .4 .2 0.0 .0 0.0 -.2 -.4 -.5 -.5 -.6 -.8 -1.0 -1.0 -1.0 LOW MED HIGH LOW MED HIGH LOW MED HIGH Multiple Risk Multiple Risk Multiple Risk Lines indicate means and 95% confidence intervals

18. Question:Can Personal ResilienceOvercome Environmental Adversity? Answer: Not for most people, For most of the time!

19. Improving Developmental Success 1) Make Children More Resilient 2) Make Environments Less Risky

20. Political Strategies for Social Intervention Conservatives-----Preserve the Family Liberals------------Eliminate Poverty

21. Preserve the Family Single Parent Two Parents

22. Eliminate Poverty Below Poverty Level 1 to 2 Times Poverty Level > 2 Times Poverty Level

23. Percent of Families in High and Low Risk Groups Risk Group Income Family Structure >$10,000 $10-30,000 >$30,000 Single Parent TwoParents Low (0-3) 13% 35% 60% 34% 54% High (8+) 44% 15% 6% 22% 7%

24. If single factors (money, parents)don’t change children’s lives,What about multiple factors?

25. Promotive Factors Changing Many Settings

26. Making Big Changes From Risk Factors to Promotive Factors

27. 20 Positive Environmental Influences Proximal • Parent-Child Interaction • Parent Characteristics • Family Structure & Economy • Family Management • Peers • School • Community Distal

29. Social Agenda What can be done to increase developmental success? Need to improve many settings

30. Making Small Changes Early Interventions and the Transactional Model

31. GEOPOLITICAL COMMUNITY FAMILY PARENT CHILD SCHOOL PEERS CHILD Social Ecological Model

32. Family Setting FAMILY PARENT CHILD CHILD

33. Regulation Model Development Other-Regulation Self-Regulation

34. Infant Parents Professionals Sleep, Feeding, Crying Stress, Depression Abuse and Neglect Who’s Suffering?

35. Who’s the Patient? • Infant • Parents • The Relationship

38. Themes Structural Model Motherhood Constellation Daniel Stern Nadia Bruschweiler-Stern Process Model Transactional Diagnosis Arnold Sameroff Barbara Fiese

39. Motherhood Constellation Bact Mact

40. Motherhood Constellation Brep Bact Mact Mrep

41. Motherhood Constellation Trep Tact Brep Bact Mact Mrep

42. Br Br Br Mr Mr Mr Ba Ma Ba Ma Ba Ma Motherhood Constellation

43. P2 P4 C1 C5 C3 Transactional Diagnosis Parent Child time

44. 3-R’s of Intervention Remediation Redefinition Reeducation

45. 3-R’s of Intervention Redefine Parent Parent Reeducate Remediate Child Child time 1 time 2

46. Parent Remediate Child Remediation • Indicated Child Conditions • Low Birth Weight • Malnourishment • Behavior/Emotional Problems

47. Parent Remediate Child Remediation Low Birth Weight Babies • Problem • Small, fragile appearance • Weak responses • Interventions • Gentle Stimulation • Deep Massage • Passive Limb Movement • Increases Activity/Alertness • Non-nutritive sucking • Accompanies Tube Feeding • Increases Weight Gain • Earlier Discharges

48. Parent Remediate Child Remediation Malnourished Infants • Problem • Unresponsive • Inactive • Feeding Intervention • Greater Responsiveness • Increased Energy Level • Provide Stronger Cues

49. Parent Remediate Child Remediation Medical Interventions • Surgery • Cleft Palate • Down Syndrome • Medication • Mood • Colic

50. Parent Parent Redefinition • Indicated Parent Conditions • Failure to adapt to exceptional child • Failure to distinguish mother perception from child behavior • “Ghosts in the Nursery” • Negative attributions