Building a Foundation

for Achievement How Early Experiences Shape Brain

Architecture and the Skills We Need to Thrive

AL RACE Deputy Director Director, Communications and Public Engagement Center on the Developing Child at Harvard University

NCSL Early Learning Fellows Denver, CO | May 1, 2013

Educational Achievement

Economic Productivity

Responsible Citizenship

Lifelong Health

Strong Communities Healthy Economy Successful Parenting of Next Generation

The Foundation of a Successful Society is Built in Early Childhood

Experiences Build Brain Architecture

The Ability to Change Brains Decreases Over Time

Source: Levitt (2009)

Birth 10 20 30

Physiological ““Effort”” Required to Enhance Neural Connections

Normal Brain Plasticity Influenced by Experience

Age (Years)

40 50 60 70

““Serve and Return”” Interaction Builds Brain Architecture

Barriers to Educational Achievement Emerge at a Very Young Age

16 mos. 24 mos. 36 mos.

Cu

mu

lati

ve V

ocab

ula

ry (

Wor

ds)

College Educated Parents Working Class Parents Welfare Parents

Child’’s Age (Months)

200

600

1200

Source: Hart & Risley (1995)

400

800

1000

Significant Adversity Impairs Development in the First Three Years

Number of Risk Factors Source: Barth, et al. (2008)

Ch

ildre

n w

ith

D

evel

opm

enta

l Del

ays

1-2 3 5 4 6 7

20%

40%

60%

80%

100%

Toxic Stress Derails Healthy Development

Toxic Prolonged activation of stress response systems

in the absence of protective relationships.

Tolerable Serious, temporary stress responses, buffered by supportive relationships.

Positive Brief increases in heart rate,

mild elevations in stress hormone levels.

The Biology of Adversity: Three Levels of Stress

Source: C.A. Nelson (2008); Marshall, Fox & BEIP (2004).

Extreme Neglect Positive Relationships

Profound Neglect Can Reduce Brain Power

Source: Egeland, et al. (1983)

Neglect Can Be a Greater Threat to Development than Abuse

  More likely to have anxiety, depression, personality disorders   More academic problems and special education referrals   Lower IQ, poorer reading skills, less likely to graduate high school   Poorer responses to frustrating situations

Creativity Confidence/Assertiveness

No Maltreatment

Verbal Abuse

Physical Abuse

Neglect No Maltreatment

Verbal Abuse

Physical Abuse

Neglect

Source: U.S. Department of Health and Human Services (2010b).

Neglect is the Most Prevalent Form of Child Maltreatment

Neglect

Physical Abuse

Sexual Abuse

Psychological Maltreatment

20% 40% 60% 80%

Risk Factors for Adult Depression are Embedded in Adverse Childhood Experiences

O

dd

s R

atio

ACEs Source: Chapman et al, 2004

0 1 2 3 4 5+

1

2

4

3

5

Biological ““Memories”” Link Maltreatment in Childhood to Greater Risk of Adult Heart Disease

Percent of adults with biological

marker for greater risk of

heart disease

Source: Danese et al. (2008)

Control

10%

20%

40%

30%

50%

Depression (age 32)

Depression (age 32) + Maltreated (as a child)

Maltreated (as a child)

Chronic Diseases Associated With Childhood Adversity Dominate U.S. Health Care Costs

Source:  Agency  for  Healthcare  Research  and  Quality  (2008)

An

nu

al C

ost

$20 billion

$40 billion

$60 billion

$80 billion

$100 billion

Diabetes #8

Mental Disorders

#4

Trauma-Related Disorders

#2

Hypertension #7

Heart Disease

#1

Five of Top Ten Diagnoses for Direct Health Expenditures = $335 billion

Cancer #3 $72 billion

$96 billion

$74 billion

$72 billion

$47 billon

$46 billion

Significant Adversity

Parenting Education, Sound Nutrition, Stimulating Experiences, and Health-Promoting Environments

Readiness to Succeed in School

Impaired Development

Early Childhood Policy and Practice: The Current Model

Address Sources and Effects of Toxic Stress Significant Adversity

Healthy Developmental Trajectory

Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

Science Points to the Need to Balance Enrichment, Prevention, and Protection

Source: Finkelhor et al. (2005)

U.S. Children Ages 2-5 (per 1,000)

Sources of Toxic Stress in Young Children

130

Source: O-Hara & Swain (1996)

75

136

Parental Substance Abuse

Source: SAMHSA (2009)

Maltreatment Postpartum Depression

Instability Disrupts the Stress Response System — But Relationships Reverse the Effect

Source: Fisher, Stoolmiller & Gunnar (2007)

Therapeutic Foster Care

Standard Foster Care

2 4 6 8 10 12

Months in Foster Care

Morning Cortisol Levels

.35

.4

.45

.5

Typical (Community Control Group)

The Brain Architecture of Memory and Learning

The Brain Architecture of Anxiety and Fear

50%  

40%  

30%  

20%  

10%  

High

5  4  3  2  1  

Low

Childhood [Mystery Skill]

Source: Moffitt, et al. (2011)

Higher Childhood [Mystery Skill] Predicts Less Adult Crime

Adult Criminal

Convictions

Higher Childhood [Mystery Skill] Predicts Better Adult Health

0.4  

0.2  

0  

-­‐0.2  

-­‐0.4  

Adult Health

Outcomes

Childhood [Mystery Skill]

5  4  3  2  1  

High Low

Poor Physical Health Index

Substance Dependence Index

Source: Moffitt, et al. (2011)

0.4  

0.2  

0  

-­‐0.2  

-­‐0.4  

Income

Socioeconomic Status

High

5  4  3  2  1  

Low

Source: Moffitt, et al. (2011)

Adult Wealth

Outcomes

Higher Childhood Self-Control Predicts Greater Adult Wealth

Childhood Self-Control

The Pencil Tap Test

Source: Blair, C. (2012)

What Are Essential Skills for Success?

An ““Air Traffic Control System”” in the Brain

Ø  A key biological foundation of school readiness as well as outcomes in health and employability

Executive functioning is a group of skills that help us to focus on multiple streams of information at the same time, set goals and make plans, make decisions in light of available information, revise plans, and resist hasty actions.

Three Types of Executive Function Skills

Inhibitory Control — filter thoughts and impulses to resist temptations and distractions

Mental flexibility — adjust to changed demands, priorities, or perspectives

Working Memory — hold and manipulate information in our heads over short periods of time

What Do These Skills Look Like in Adults? Inhibitory Control — filter thoughts and impulses to resist temptations and distractions

Mental Flexibility — adjust to changed demands, priorities, or perspectives

Working Memory — hold and manipulate information in our heads over short periods of time

How Does Executive Function Develop?

Circuits for Executive Function Skills Are Located in Brain Regions that Exhibit

an Extended Period of Plasticity

Weintraub, et al., (2011)

Birth

Age (Years) 50 70 80

Ski

ll p

rofi

cien

cy

3 5 15 25 30 10

Public Health Tobacco cessation program Consultation with local health jurisdictions

How Executive Function Is Being Applied Across Multiple Agencies in WA

Economic Services Administration WorkFirst assessment redesign

Juvenile Rehabilitation Administration Building adolescent executive function through mindfulness training

Training for Managers mid-level managers in Economic Services, Vocational Rehabilitation, Children’s Administration, Aging & Disability Services Medicaid Incorporate EF information into contractually obligated training for managed care organizations

Childhaven (therapeutic child care) and Children’s Home Society (Head Start, EHS, home visiting, foster care)

Co-creation and weekly collaboration with researchers: initial focus on games

Building EF capacities in children and caregivers combined with strategies for reducing toxic stress in families

WA Department of Early Learning

Pilot Sites

Assessment Consultation with researchers on using NIH Toolbox EF assessment tools

Professional Development

Guidelines, online modules, coaching, learning communities

WA Early Learning Guidelines

http://www.del.wa.gov/development/guidelines/

Working memory Remember and follow directions in one or two steps.

—3-4 years Listen to others and respond in a group discussion for a short period. Remember what was said and gain information through listening.

— 4-5 years

WA Early Learning Guidelines

http://www.del.wa.gov/development/guidelines/

Inhibitory Control Enjoy turn-taking games with caregivers and may direct adult in his or her role.

—16-36 months Will sometimes turn down a treat now if a better treat will be available later (one cookie now or two cookies later).

—3-4 years

WA Early Learning Guidelines

http://www.del.wa.gov/development/guidelines/

Cognitive/Mental Flexibility Adjust behavior to different settings (such as using an outdoor or an indoor voice), sometimes with reminders. —4-5 years

Begin to enjoy games like Simon Says, where a child has to adjust behavior in response to changing rules. —4-5 years

DEL Professional Development Module

http://www.deltraining.com/courses/Executive_Function/content-frame.htm

What Is Inhibitory Control?

How Can Early Learning Practitioners Support its Development?

Supporting the Development of EF Skills Supporters Strategies Capacities

Address external causes of stress

Teach & use stress coping techniques

Foster social interaction

Encourage physical exercise

Progressively increase complexity

Practice, practice, practice

Working Memory Flexibility Self-control

Environments Safe Creative Explorable Stable

>Economically >Emotionally

Parents, Caregivers, Teachers & Other Professionals Support Model Engage Be Reliable Guide Protect

Learning & Work ü  Follow multi-step

instructions ü  Avoid distractions ü  Plan & execute ü  Manage long-term

assignments ü  Adjust to new rules ü  Seek alternate

solutions Behavior ü  Teamwork ü  Leadership ü  Foresight ü  Goal-directed ü  Aware of self &

others ü  Adaptable

Health ü  Stress Reduction ü  Nutrition & Exercise ü  Resist Pressure to

Take Risks

Life Course Outcomes

Skills

Remember

Filter

Focus

Plan

Monitor

Adjust

Resist

Persevere

Source: Diamond, et al. (2011)

www.developingchild.harvard.edu

Public Health Tobacco cessation program Consultation with local health jurisdictions

How Executive Function Is Being Applied Across Multiple Agencies in WA

Economic Services Administration WorkFirst assessment redesign

Juvenile Rehabilitation Administration Building adolescent executive function through mindfulness training

Training for Managers mid-level managers in Economic Services, Vocational Rehabilitation, Children’s Administration, Aging & Disability Services Medicaid Incorporate EF information into contractually obligated training for managed care organizations