The Effect of Early Adversity on Brain Development, Learning, and Health: Mobilizing Brain Science to Improve Children’s Mental Health and Catalyse Positive System Change CMHO Conference November 21, 2016

A Science-Based Theory of Change Informs More Effective Policies and Programs Preconception Prenatal Policy & Program Levers for Innovation 1. Biological Adaptations or Disruptions - The biology of health explains how experiences and environmental influences “get under the skin” and interact with genetic predispositions, which then result in physiological adaptations or disruptions that affect lifelong outcomes in learning, behavior, and both physical and mental well-being. 2. Foundations of Healthy Development - The foundations of health establish a context within which the early roots of physical and mental well-being are nourished. These include a stable and responsive environment of relationships, Safe and supportive physical, chemical, and built environments, and sound and appropriate nutrition. 3. Caregiver & Community Capacities – Caregiver and community capacities to promote health and prevent disease and disability refers to the ability of family members, early childhood program staff, neighborhoods, voluntary associations, and the parents’ workplaces to support and strengthen the foundations of child health. These capacities can be grouped into three categories: time and commitment; financial, psychological, and institutional resources; and skills and knowledge. 4. Policy & Program Levers for Innovation - Public and private sector policies and programs can strengthen the foundations of health by enhancing the capacities of caregivers and communities in the multiple settings in which children develop. Relevant policies include legislative and administrative actions that affect public health, child care and early education, child welfare, early intervention, family economic stability, community development, housing, environmental protection, and primary health care. Biological Adaptations or Disruptions Early Childhood Caregiver & Community Capacities Foundations of Healthy Development Health & Development Across the Lifespan Middle Childhood Adolescence Adulthood Source: Center on the Developing Child (2010) 2

National Scientific Council Working Papers

FrameWorks Institute Nonprofit think tank that conducts communications research to advance the resolution of social problems. http://www.frameworksinstitute.org/ FW has worked on a host of social problems in the US, Canada and Europe, from early childhood development and children’s mental health to climate change and immigration. Methods: Map the gaps between lay and expert understanding. Develop simplifying models that explain an important scientific concept and channel public thinking about a topic in ways consistent with the science. Test effectiveness of the models with the general public. Simplifying models are concrete, familiar, mechanistic metaphors that help explain an expert concept so that it fits into the way the public thinks. When expert information does not fit into existing cultural models it has nowhere to go, and can entrench negative beliefs about the issue. The Simplifying Model fills this cognitive hole and allows the public to use expert information in thinking about and understanding the issue. Allows experts and the public to talk to each other in a meaningful way.

Bridging the gap between science, policy and practice through: Knowledge mobilization Professional development and training Supporting research with impact

AFWI Δ in systems AFWI Theory of Action Δ in change agents Improved health & wellness outcomes for individuals & families AFWI Theory of Action Knowledge base Identification of change agents Δ in change agents Relationships Narrative & language Understanding & beliefs Behaviors & practices Knowledge mobilization activities Research on ECD & A/MH* Media & communications Presentations & convenings Networking Symposia Relationship building Program development Education & training Broad adoption of approaches to ECD & A/MH* rooted in the knowledge Δ in systems Resource allocation Institutions & organizations Government policy Professional practice Assumptions Understanding how the brain works and develops will overcome existing misperceptions and underlying beliefs and will support changes in individual behavior and systems related to ECD & A/MH* Change agents identified by AFWI will act as drivers of systems change by spreading knowledge throughout systems (“ripple effect”) * Early Childhood Development & Addiction/Mental Health

Change Agents are Working Across the Province

Findings: Overall Summary AFWI Is Contributing to Changes in Individuals, Organizations, and Systems, but the Amount of Change Varies Some Change Significant Change Efficacy and role in creating change Changing behaviors Increasing understanding Forming or deepening relationships Individual Change Adopting new practices Increasing sense of priority Institutionalizing the core story Changing in activities Increasing conversation Discussing changes to activities Sharing the core story Organizational Change Funding reallocation Changing policy or strategy Ownership over policy implementation Increasing cross-sector work Approving high-visibility policy documents Increasing cross-sector dialogue Systems Change Changing professional practice standards Funding reallocation

In Summary Common language + Common understanding + Community and relationships + Increased confidence + Ripple effect - distributed leadership = Emerging change initiatives in Alberta

The Core Story of Brain Development

How Do Brains Get Built?

Neural Circuits are Wired in a Bottom-Up Sequence Source: C.A. Nelson (2000)

Experience-Based Pruning of Synapses During Childhood and Adolescence Birth 3 years 14 years

What Kind of Experiences Shape Development?

Infants are Hard Wired for Social Interactions

Serve and Return Interactions With Adults Build Cognitive, Social, and Emotional Skills in Children Serve and return interactions with adults help build basic social, emotional, and cognitive skills that are important for healthy development, like paying attention, sharing and having empathy for others, and emotional regulation. These skills provide a solid foundation for more complex behaviours that are grouped together under the label of “executive function”.

Executive Function is Like Air Traffic Control: Helps Children Navigate Their World and Succeed in Life EF skill set is based on cognitive, social and emotional competencies: Attention Working memory Self-regulation Delayed gratification Planning and organization Perseverance Reasoning and evaluation Problem solving Cognitive flexibility

Serve and Return Interactions Alter Neural Circuits and Gene Expression

The Biology of Early Adversity

Stress Also Shapes Brain Architecture Toxic Stress: Prolonged activation of the stress response system in the absence of supportive adult relationships; e.g., abuse, neglect, living with an addicted or depressed parent. Tolerable Stress: Serious but temporary activation of stress response, can damage brain architecture if not buffered by supportive adult relationships; e.g., death in the family. Positive Stress: Brief activation of stress response system, required for healthy development; e.g., immunization, first day of school.

Anatomy of the Stress Response Effect of Catecholamines (Adrenalin): Increased heart rate, blood pressure Decrease in non-essential functions (e.g., digestion, reproduction) Blood clotting Mobilization of glucose stores Effect of Glucocorticoids (Cortisol): Glucose metabolism Insulin production Immunosuppression Negative feedback on HPA axis

Early Life Stress Affects Biology, Behaviour, and Impacts Lifelong Health

Short and Long Term Outcomes Associated with Early Adversity

Significant Adversity Impairs Development in the First Three Years 100% 80% Children with Developmental Delays 60% 40% 20% 1-2 3 4 5 6 7 Number of Risk Factors Source: Barth, et al. (2008)

Sensitivity to Anger in Abused Children Pollak S D , and Kistler D J PNAS 2002;99:9072-9076 ©2002 by National Academy of Sciences

Early Adversity Increases Risk for Substance Use Disorders in Adulthood Self-Report: Alcoholism Self-Report: Illicit Drugs 16 40 % 14 % 35 12 30 10 25 8 20 6 15 4 10 2 5 ACEs 1 2 3 4 1 2 3 4 5+ Source: Dube et al. (2002) Source: Dube et al. (2003)

Early Adversity Increases Risk for Depressive Disorders in Adulthood 5 4 3 Odds Ratio 2 1 1 2 3 4 5+ ACEs Source: Chapman et al. (2004)

Early Adversity Increases Risk for Adult Heart Disease 3.5 3 2.5 Odds Ratio 2 1.5 1 0.5 1 2 3 4 5,6 7,8 ACEs Source: Dong et al. (2004)

Where Do We Go From Here?

What Determines Whether a Child’s Outcomes Will Be Good or Bad? Resilience is a product of our genes and experiences, like a scale that can be tipped to one side or the other.

It’s NOT All Over By Age 6: Brain Still Maturing Until ~ 25 Years Source: Gotgay, Giedd, et al., 2004

Brain Builders Video

Alberta Family Wellness Initiative WHERE SCIENCE MEETS REAL LIFE www Alberta Family Wellness Initiative WHERE SCIENCE MEETS REAL LIFE www.albertafamilywellness.org