The First R Relationships: How Love Builds Brains

Transcription

1

2 The First R Relationships: How Love Builds Brains Jean Clinton BMus MD FRCP(C) McMaster University and Children s Hospital Department of Psychiatry and Behavioural Neurosciences Offord Centre for Child Studies

3 Presentation objectives: Presentation objectives: 1) To outline the optimal environment for healthy infant development using the knowledge from neuroscience and biology as a foundation 2) The role Breastfeeding and affective attunement play in attachment, healthy infant mental development and maternal well being. 3) The crucial role touch plays in development.

4 Disclaimer These are my sponsors

5

6 The Wisdom of the Elders Consider the interest of the next 7 generations when decisions are being made

7 Masai Greeting: How are the children?

8 What is our VALUES DRIVEN question and conversation?

9 The Child To the doctor, the child is a typhoid patient; to the playground supervisor, a first baseman; to the teacher, a learner of arithmetic. At times, he may be different things to each of these specialists, but too rarely is he a whole child to any of them. From the 1930 report of The White House Conference on Children and Youth

10 What is the world we want to see? What we believe about children informs our view and our language. Child as empty vessel? Or Child as Powerful,resourceful, creative co-learner and creator Develop normally or function to the best of ability? Fix the problem..or promote activity and what can be? WHAT IS OUR IMAGE OF THE CHILD? Adapted from Loris Malaguzzi

11 How are the Children?

12 UNICEF REPORT CARD 2007 The true measure of a nation s standing is how well it attends to its children-their health and safety, their material security, their education and socialization, and their sense of being loved, valued and included in the families and societies into which they are born. Unicef Innocenti Report 2007

13 Unicef Report :Canada Material Well Being Health and Safety Educational Well being Family and Peer Relationships Behaviours and Risks Subjective well being Overall 6 SWEDEN 1 13 SWEDEN 1 2 BELGIUM 1 18 ITALY 1 17 SWEDEN 1 15 NETHERLANDS 1 12/21 Unicef Innocenti Report 2007

14 Reaching For the Top Report. We are doing poorly compared to other OECD countries(29 total) 21 st in child well being, including mental health 22 nd in PREVENTABLE childhood injury and deaths 27 th in childhood obesity National Advisor Report March 2008

15 Families OR Society 15

16 Kolb 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.

17 No longer a debate Nature/ Nurture 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 Hamilton CERPS Regional Conference Child Nov 2010 Wefare Conference September 2010 Dr Robin Gibb U of Lethbridge

18 Breastfeeding and the Brain The Brain is a social organ Breastfeeding wires the brain Breastfeeding is more than nutrition Breastfeeding is brain building

19 BRAIN PLASTICITY Connections are formed and altered by experience But, not done until at least age 24+years 19

20 Proliferation- how cells grow Migration- where cells go Subtle changes in the neurotransmittershow the cells communicate Many parts of the brain are affected The Hamilton Task Force on FASD x267 20

21 13 weeks

22 Dr Robin Gibb U of Lethbridge

23 Two Neurons Axon RECIPIENT NEURON Synapse SIGNAL- SENDING NEURON Dendrite Founders Network

24 Graphic courtesy of Center on the Developing Child at Harvard University. Originally published in Nelson, C.A. (1999) Change and continuity in neurobehavioral development: lessons from the study of neurobiology and neural plasticity. Infant Behavior and Development, Volume 22(4) Cited in InBrief: The Science of Early Childhood Development, presentation summary from the National Symposium on Early Childhood Science and Policy, Cambridge, MA, June 2008.

25 Vision and Hearing Critical Period Eye cataracts at birth prevent normal development of vision neurons in the occipital cortex (Hubel and Wiesel) Cochlear defects at birth impair hearing development (Rauschecker and O Donoghue)

26 SERVE AND RETURN Sound Vision Smell Touch Proprioception Taste Neal Halfon From Aitken and Trevarthen

27 The Importance of Touch

28 The external Womb Bipedalism- the pelvis narrowed and flattened--- what to do about the head???? The growing brain comes out before it is too big but not fully mature yet The external environment needs to recreate the womb

29 What s a Baby to do? Stimulate prolactin ensures nutrition Stimulate oxytocin- ensures protection Stimulate cholecystokinin-ensures well being and bonding

30 What happens during breastfeeding?

31 What is Breastfeeding? A place dependant brain-based behaviour of the newborn It is more than eating!! THE PRIMARY PURPOSE IS BRAIN WIRING Dr Nils Bergman

32 PLASTICITY Babies highly attuned to their environment Massive synaptic growth in first two years Pruning starts at 8months Pruning regulated by emotional interactions with caregivers From The First Idea Greenspan and Shanker

33 Breastfeeding and the Brain The Brain is a social organ Breastfeeding wires the brain Breastfeeding is more than nutrition Breastfeeding is brain building

34 Ontario Collaborative Law Federation September

35 A Citizen and Competent from Birth Amazing Talents of the Newborn ; Johnson & Johnson Paediatric Institute

36 Brain Cells develop connections over the first 2 years Conference Nov 2010 Then they are sculptedcerps actively for the rest of your life!

37 USE IT OR LOSE IT! The more a system, or set of brain cells is activated, the more that system changes in response. The stronger the repetitions the stronger the memory.

38 Children s Mental Health Is Developing the capacity to: Experience, regulate, and express emotions Form close interpersonal relationships Explore the environment and learn Child mental health = healthy social and emotional development. Zero to Three

39 Harvard Centre on the Developing Child

40 The Fear Response Visual Thalamus Visual Cortex Amygdala Scientific American The Hidden Mind, 2002, Volume 12, Number 1

41 Hippocampus Amygdala

42

43 Stress is NUTS Novelty, Unpredictability, Threat to the ego, Sense of loss of control Dr Sonia Lupien Centre for Studies on Human Stress

44 Emotional Stimulus Amygdala Cortisol CRF PIT Hippocampus Hypothalamus PVN Cortisol ACTH Adrenal Cortex LeDoux, Synaptic Self

45 Amygdala and Hippocampus

46 Cortisol can be bad for the brain Hippocampus high sterol levels cause loss of dendrites and cell death Frontal brain attention deficits

47 Limbic HPA Pathway - Stress Cortisol Over Production Behaviour (ADHD, violence), depression, diabetes, malnutrition, cardiovascular disease, memory, immune system, drug and alcohol addiction Cortisol Under Production Chronic fatigue syndrome, fibromyalgia, immune system (autoimmune disorders) rheumatoid arthritis, allergies, asthma

48 Maternal Stress Affects HPA axis in offspring Can alter susceptibilty to later disease/ drug taking Affects males more than females

49 Maternal style Mothering has a lifelong influence on health of offspring Passed on from generation to generation via epigenetics

50 Individual differences in stress reactivity of the adult are determined by maternal behaviour during infancy HIGH LG LOW LG Development of Stress Reactivity Modest Stress Reactivity Reduced Risk for Disease Increased Stress Reactivity Increased Risk for Heart Disease, Type II Diabetes, Alcoholism, Affective Disorders, Brain Aging, etc. M. Szyf

51 Is maternal care the mediator of these effects on hippocampal (GR(1 7 ) promoter methylation? ADOPTION/CROSS FOSTERING STUDIES Biological Mother LOW Adoptive Mother LOW HIGH HIGH M. Szyf

52 Rats Gene Methylation 1.2 Cytosine-Methylation Licking Low Licking High 0 Embryo Day 20 Birth Day 1 Pup Day 6 Age Weaning Day 21 Adult Day 90 M. Szyf

53 Serotonin Gene, Experience, Depression Risk and Depression Age 26 S = Short Allele L = Long Allele SS SL.30 LL No Abuse Moderate Abuse Severe Abuse Early Childhood A. Caspi, Science, 18 July 2003, Vol 301.

54 Change in Salivary Cortisol The Founders Network Secure Attachment Buffers Cortisol Response to Threatening Events Secure Attachment Insecure Attachment LOW HIGH Fearful Responses to Stimuli Gunnar (1996).

55 Still Face Experiment

56

57 PFC AMYGDALA A: Positive emotional state, flow through amygdala to PFC and better memory test results. B: Stressed state: No passage of information to PFC & lower memory testing short and long-term. (Hamman,et al. Cognitive Neuroscience.) Hamilton CERPS Regional Conference Child Nov 2010 Wefare Conference September 2010

58 Ontario s Enhanced 18-month well baby visit Getting it right at 18- months..making it right for a lifetime

59 No longer a debate Nature/ Nurture 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 Hamilton CERPS Regional Conference Child Nov 2010 Wefare Conference September 2010 Dr Robin Gibb U of Lethbridge

60 Human aggression and the MAO-A gene Buckholtz & Meyer Lindenberg, 2008 Nature Nuture

61 No longer a debate Nature/ Nurture 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 Hamilton CERPS Regional Conference Child Nov 2010 Wefare Conference September 2010 Dr Robin Gibb U of Lethbridge

62 Life Course Problems Related to Early Life 2 nd Decade 3 rd /4 th Decade 5 th /6 th Decade Old Age School Failure Teen Pregnancy Criminality Obesity Elevated Blood Pressure Depression Coronary Heart Disease Diabetes Premature Aging Memory Loss

63 Change in Salivary Cortisol The Founders Network Secure Attachment Buffers Cortisol Response to Threatening Events Secure Attachment Insecure Attachment LOW HIGH Fearful Responses to Stimuli Gunnar (1996).

64 Depressed Mother John S T Chung depressed mother

65 What is Attachment? An affectional bond or tie between an infant and his/her mother figure

66 What is Attachment? Bowlby s Attachment Theory proximity-maintaining behaviours for protection in balance with exploration system secure base Attachment & Loss (1969)

67 Internal Working Models Early relationship experiences create internal representations of the self in relation to the attachment figure and the world Influence expectations of significant others (Bowlby, 1988)

68 What s a parent to do? Get peer support! - family, friends, join a group or early years centre Get rid of the ghosts in the nursery -get counseling (family doctor, local infant development program, hospital or mental health centre, or Employee Assistance Program) - books (e.g., Sears, Leach) videos (e.g., A Simple Gift) - - home study (e.g., the Parent Kit) courses (e.g., Right from the Start) - Education Have fun!

69 Paternal Depression it is important to also be wary of mood disorders in expecting and new fathers (especially if the mother has mood problems), but these mood disorders in fathers may need to be addressed.

70 Impact on child paternal depression may have substantial emotional, behavioral and developmental effects on the infant. prevention, screening and interventions for depression should likely be focused on the couple rather than on the individual parent.

71 SCENARIOS What we THINK. Affects what we FEEL Affects how we ACT. 71

72 The Power of One Collected all together is Massive

73