CREATIVE VICTORIA Growing Audiences: Engaging Children & Families Summit 21 st November 2017

1. CREATIVE VICTORIAGrowing Audiences: Engaging Children & Families Summit21st November 2017 HOW CHILDREN DEVELOP AND LEARN Tim Moore Centre for Community Child Health Murdoch Childrens Research Institute The Royal Children’s Hospital

2. OUTLINE • New learnings about child development • How children develop • How children learn • What children need • Readings and resources • Conclusions

3. NEW LEARNINGS ABOUT CHILD DEVELOPMENT AND WELL-BEING

4. NEW LEARNINGS ABOUT CHILD DEVELOPMENT AND WELL-BEING There is new evidence to support three key concepts regarding how children develop: • Developmental plasticity and the developmental origins of health and disease (DOHaD) hypothesis • Social climate change and the ‘mismatch’ hypothesis • Ecological impacts on development and the social determinants of health and disease. Collectively, evidence relating to these key concepts transforms our understanding of how children develop and highlights the critical role of the very earliest stages of development – the first 1000 days

5. PRENATAL AND POSTNATAL DEVELOPMENT

6. Tim Moore, Noushin Arefadib, Alana Deery, and Sue West (2017). The First Thousand Days: An Evidence Paper. Parkville, Victoria: Centre for Community Child Health, Murdoch Children’s Research Institute. Full paper: http://www.rch.org.au/uploadedFiles/Main/Content/ccchdev/CCCH-The-First-Thousand-Days-An-Evidence-Paper-September-2017.pdf Summary: http://www.rch.org.au/uploadedFiles/Main/Content/ccchdev/CCCH-The-First-Thousand-Days-An-Evidence-Paper-Summary-September-2017.pdf

7. RELATIONSHIP BETWEEN MIND, BRAIN AND BODY • Recent accounts of early development have focused on neurological development at the expense of other aspects of development. • Thus, efforts to disseminate new research knowledge have used the metaphor of ‘brain architecture’ to convey the sense of the importance of early neurological development • This way of framing early development reflects an underlying belief in the importance of the brain as the seat of personhood and learning. • However, this fails to capture the fact that brain functioning is not purely cognitive, that ‘learning’ is not purely conscious, that the brain is not purely skull-based, and that the brain is closely linked with other key bodily systems.

8. MIND, BRAIN AND BODY (cont) • First, the brain is not purely cognitive, but is also profoundly emotional– our emotions directly influence the functions of the entire brain and body, from physiological regulation to abstract reasoning. • Emotion serves as a central organising process within the brain, and our ability to organise our emotions directly shapes the ability of the mind to integrate experience and adapt to future stress • Emotional development begins early in life, is a critical aspect of the development of overall brain architecture, and has enormous consequences over the course of a lifetime. • Children's early abilities to deal with their emotions are important not only for the foundation these capacities provide for the future, but also for the children's current social functioning with their parents, teachers and peers.

9. There are many well-trodden pathways to misery. People may choose to eat too much or too little, drink too much alcohol, react to other people without thinking, fail to have empathy for others, fall ill, make unreasonable emotional demands, become depressed, attack others physically, and so on, largely because their capacity to manage their own feelings has been impaired by their poorly developed emotional systems. Sue Gerhardt (2014). Why Love Matters: How affection shapes a baby's brain (2nd Ed.). London, UK: Routledge.

10. MIND, BRAIN AND BODY (cont) • Second, learning is not a purely conscious process: much of our most important emotional and interpersonal learning during the first few years occurs before we have developed the neurological capacities for conscious awareness and memory • Thus, many of the most important aspects of our lives are controlled by reflexes, behaviours, and emotions learned and organised outside our awareness. • Third, the brain is not just skull-based, but ‘embodied’, being shaped by messages from all over the body via the central and peripheral nervous systems. • This embodied brain shapes and is shaped by both its external and internal environments.

11. THE NERVOUS SYSTEM • The nervous system controls and coordinates all bodily systems. • It has two main parts: • The central nervous system, which consists of the brain and the spinal cord • The peripheral nervous system, which forms a network through the body • Properly understood, the brain is not just skull-based but ‘embodied’, being shaped by messages from all over the body.

12. MIND, BRAIN AND BODY (cont) • Fourth, the brain is not a stand-alone bodily system, but is intricately connected to other major bodily systems, including the immune, endocrinal, metabolic, cardiovascular, and muscular and skeletal systems • These systems shape and are shaped by each other, and function as an integrated mind-brain-body system. • This means is that what is ‘learned’ in the prenatal and first two to three years of life affects not only the neurological system but also the other bodily systems to which the brain is connected, with potentially profound consequences over the life course • Biological embedding involves the whole mind-brain-body system.

13. Contact between a microglial immune cell (purple) and a neuron (yellow), with signaling particles being interchanged Mueller, K.L., Hines, P.J. and Travis, J. (2016). Neuroimmunology. Science, 353 (6301), 760-761. DOI: 10.1126/science.353.6301.760 CREDIT: V. ALTOUNIAN/SCIENCE

14. 1. DEVELOPMENTAL PLASTICITY AND THE DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE (DOHaD) HYPOTHESIS • Developmental plasticity – the capacity to adapt to different physical and social environments – a double-edged sword • Adaptation involves a process known as biological embedding, underpinned by two central mechanisms: • epigenetic effects and • synaptic pruning • Epigenetic effects shape our telomeres, repeating segments of noncoding DNA that live on the ends of our chromosomes

15. EPIGENETICS Nessa Carey (2011). The Epigenetics Revolution: How Modern Biology is Rewriting Our Understanding of Genetics, Disease and Inheritance. London, UK: Icon Books. David S. Moore (2015). The Developing Genome: An Introduction to Behavioral Epigenetics. New York: Oxford University Press. Richard C. Francis (2011). Epigenetics: The Ultimate Mystery of Inheritance. New York: W.W. Norton.

16. EPIGENETICS • Parents shape their children’s health and development through genetic transmission, but genes do not determine development or behaviour • The way that genes are ‘expressed’ depends upon their interaction with environmental factors: these interactions alter the expression or function of genes without altering their DNA sequence – these are known as epigenetic effects • Epigenetic changes may also be inherited, so that the experiences of mothers or even grandmothers can be transmitted across generations • Even the health and physiology of parents prior to conceiving a child can affect the child’s health and development • While these changes may, in time, be rectified, in the short term they contribute to non-genomic transmission of risk

17. SYNAPTIC PRUNING • The rapid expansion of synaptic connections between brain neurons that occurs after birth results in an overproduction of connections – those that a least used are progressively ‘pruned’ and removed from the network • The proximal or immediate environments in which young children spend their time play a fundamental role in deciding which synapses are ‘pruned’, and can ultimately shape their lifelong development and well-being. • Children come out of the womb primed to engage with their environment and caregivers, and the parents are primed to engage with them • Learning starts from birth and learning and development are cumulative, with later development building upon earlier development • Children's early social experiences shape their developing neurological and biological systems for good or for ill

18. DOHaD: DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE Gluckman, P. & Hanson, M. (2005). The Fetal Matrix: Evolution, Development and Disease. Cambridge, UK: Cambridge University Press. Barker, D.J.P. (1998). Mothers, Babies, and Health in Later Life (2nd Ed.). Churchill Livingstone Prescott, S. (2015). Origins: An early life solution to the modern health crisis. Perth, Western Australia: The University of Western Australia Publishing. Newnham, J.P. & Ross, M.G. (Eds.) (2009). Early Life Origins of Human Health and Disease. Basel, Switzerland: Karger AG

19. DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE (DOHAD) HYPOTHESIS • According to this hypothesis, environmental exposures such as stress or undernutrition during critical periods of development can have long-term effects on chronic disease risk by ‘programming’ organs, tissues, or body system structures or functions • Rather than being a passive passenger in the womb during the pregnancy journey, the foetus actively responds to changes within the intrauterine environment, and makes adaptations based on the nutritional and hormonal signals that cross the placenta • If the conditions are suboptimal, these adaptations can result in permanent alteration of the structure, physiology and metabolism of the offspring, laying a physiological basis for adult-onset disease, such as cardiovascular disease, type-2 diabetes, obesity and metabolic syndrome, and fertility • As a result, adult conditions that were regarded solelyas products of adult behavior and lifestyles are now seen as being linked to processes and experiences occurring decades before

20. 2. SOCIAL CLIMATE CHANGE AND THE ‘MISMATCH’ HYPOTHESIS • Social climate change and the ‘Great Acceleration’ • Evolutionary mismatch resulting epidemics of non-communicable diseases • Mismatch conditions – allergies and obesity • Role of the microbiome – humans as ‘superorganisms’

21. SOCIAL CLIMATE CHANGE • Over the last 50 or so years, developed nations have experienced dramatic societal changes as the result of a range of interconnected factors – economic, demographic, social and technological – at globalised, national and local levels. • These changes are the result of the same factors that have contributed to climate change, and they have dramatically altered the conditions under which families are raising young children • These changes have been so rapid, dramatic and unprecedented as to constitute a form of social climate change paralleling environmental climate change • While the impact of social climate change on child development and family functioning does not appear to be as dramatic as the impact of climate change on the health of the earth, that may be because we have not fully understood what is happening

22. MISMATCH - Evolution and modern environments Peter Gluckman and Mark Hanson (2006). Mismatch: Why Our World No Longer Fits Our Bodies. Oxford, UK: Oxford University Press Daniel Lieberman (2013). The Story of the Human Body: Evolution, Health and Disease. London, UK: Allen Lane. Greg Gibson (2009). It Takes a Genome: How a Clash Between Our Genes and Modern Life Is Making Us Sick. Upper Saddle River, New Jersey: FT Press Science.

23. MISMATCH DISEASES (Lieberman 2013) • Thanks to the genes you inherited, you are adapted to varying extents for certain activities, foods, climatic conditions, and other aspects of your environment. • At the same time, because of changes to your environment, you are sometimes (but not always) inadequately or poorly adapted for other activities, foods, climatic conditions, and so on. • These maladaptive responses can sometimes (but again, not always) make you sick. • There are many mismatch diseases, but all of them are caused by environmental changes that alter how the body functions.

24. USE IT OR LOSE IT (Lieberman, 2013) • Some mismatch diseases result from too much of a formerly rare stimulus (such as sugar), while others result from too little of a formerly common stimulus • We evolved to ‘use it or lose it’: because bodies are not engineered but instead grow and evolve, your body expects and requires certain stresses when you’re maturing to develop appropriately • Many mismatch diseases occur when growing bodies fail to experience as much stress as evolution geared them to expect • Necessary stresses may be neurological, musculoskeletal, immunological, dietary, and metabolic • We have created environments that deprive us of necessary stresses during development

25. 3. ECOLOGICAL IMPACTS ON DEVELOPMENT AND THE SOCIAL DETERMINANTS OF HEALTH AND DISEASE • Social determinants of health – our health and broader life outcomes are strongly shaped by the social, economic and environmental conditions into which we are born, grow, live, and age • Social gradient effects in health and well-being– the lower one’s social standing in life, the worse their health (and other) outcomes are likely to be • Role of poverty – sustained poverty in the first 1000 days is associated with adverse health and social outcomes in later life, including physical health; social and emotional well-being; cognitive functioning; educational attainment and employment; and mortality • Social determinants of Aboriginal health and well-being

26. The conditions in which people lead their lives … are the main influences on their health. Good conditions of daily life, the things that really count, are unequally distributed, much more so than is good for anything, whether for our children’s future, for a just society, for the economy and, crucially, for health. The result of unequal distribution of life chances is that health is unequally distributed. Being at the wrong end of inequality is disempowering, it deprives people of control over their lives - their health is damaged as a result. And the effect is graded – the greater the disadvantage the worse the health. Michael Marmot (2015). The Health Gap: The Challenge of an Unequal World. London, UK: Bloomsbury Publishing.

27. INTERGENERATIONAL TRANSMISSIONS • Epigenetic changes may be inherited - the experiences of mothers or even grandmothers can be transmitted across generations and contribute to non-genomic transmission of disease risk across generations • When parents have been exposed to adverse experiences that have produced changes to their epigenome, these changes can be passed on to their children • In effect, children receive genes that are in an active or ‘switched on’ state rather than a dormant or latent state. • Thus, the long-term consequences of adverse environmental conditions during the first 1000 days may not be limited to one generation, but may lead to poor health in the generations to follow, even if these individuals develop in normal conditions themselves • Environments are also transmitted generationally

28. HOW CHILDREN LEARN

29. HOW CHILDREN LEARN • What happens in the prenatal and early years has profound implications for later development – this is the time when developmental plasticity is at its greatest • Adaptation and learning start in the womb and are continuous • Learning and development are cumulative, with later development building upon earlier development • Relationships are the medium through which young children learn the skills that enable them to become fully participating members of society • Every environment in which young children spend their time provides opportunities and experiences that shape development – there is no such thing as a neutral or non-learning environment

30. NEUROBIOLOGY OF INTERPERSONAL RELATIONSHIPS

31. NEUROBIOLOGY OF INTERPERSONAL RELATIONSHIPS • Healthy development depends on the quality and reliability of a young child’s relationships with the important people in his or her life, both within and outside the family • Relationships are the medium through which young children learn the skills that enable them to become fully participating members of society – in effect, children use the brains of adults to develop their own • Sensitive and responsive care giving is a requirement for the healthy neurophysiological, physical and psychological development of a child • The key qualities of effective relationships are attunement, responsiveness and respect • Brains are changed by relationships – they can do this because our brains constantly communicate with each other through unconscious or subconscious neurobiological pathways of which we are unaware.

32. NEUROBIOLOGY OF INTERPERSONAL RELATIONSHIPS • Our brains are designed to respond to and be influenced by others: we are wired to be social • The brain has a network devoted to mindreading others: we have an unparalleled ability to understand the actions and thoughts of those around us, enhancing our ability to stay connected and interact strategically • When human being experience threats or damage to their social bonds, the brain responds in much the same way as it responds to physical pain Matthew Lieberman (2013). Social: Why Our Brains are Wired to Connect. Oxford, UK: Oxford University Press.

33. NEUROBIOLOGY OF INTERPERSONAL RELATIONSHIPS • Research on the neurobiology of interpersonal relationships has shown that our brains constantly communicate with other people’s brains via subconscious high-speed pathways • These enable us to register others’ feelings and states of mind, and enables them to register our’s, which is why we cannot fake being interested, caring or empathetic • We are intensely social creatures, and our brains are shaped by relationships, for good or otherwise • This is particularly true for children, but relationships continue to play an important role in shaping our health and well-being throughout our lives

34. THE POWER OF A SMILE (Gerhardt, 2004) • When the baby looks at the mother (or father), he/she reads their dilated pupils as indicating that their sympathetic nervous system is pleasurably aroused • In response, the baby’s own nervous system gets pleasurably aroused and his/her heart rate goes up • These processes trigger off a biochemical response: a pleasure neuropeptide (called beta-endorphin) is released into the orbitofrontal region of the brain • Natural opioids like beta-endorphin help neurons grow, by regulating glucose and insulin, as well as making you feel good • At the same time, another neurotransmitter called dopamine is released from the brainstem and also makes its way to the prefrontal cortex - this also enhances the uptake of glucose there, helping new tissue to grow

35. THE SOCIAL SYNAPSE • The subconscious pathways enable our brains to read the body and facial signals of others, and detect their intentions and emotional states. • In effect, our (right) brains are able to communicate directly with other people’s (right) brains independently of conscious communication processes or awareness. • The right brain limbic areas that enable this to occur grow rapidly in the first two years of life and the nature of their development can have long-term implications. • The growth of a baby’s brain literally requires brain–brain interaction, and occurs in the context of a positive affective relationship. • These interactions constitute a ‘social synapse’ that resembles the synaptic connections between the neurons in our brains Cozolino (2006)

36. When we smile, wave, and say hello, these behaviours are sent through the space between us via sight and sound. These electrical and mechanical messages are received by our senses, converted into electrochemical signals within our nervous systems, and sent to our brains. The electrochemical signals generate chemical changes, electrical activation, and new behaviors, which in turn transmit messages back across the social synapse. The social synapse is the space between us – a space filled with seen and unseen messages through which we are combined into larger organisms such as families, tribes, societies, and the human species as a whole. Because our experience as individual selves is lived at the border of this synapse and because so much communication occurs below conscious awareness, this linkage is mostly invisible to us. Louis Cozolino (2014). The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2nd. Ed.). New York: W.W. Norton.

37. Secure attachment and right brain development (Allan Schore, adapted from Trevarthen, 1993)

38. INTER-BRAIN SYNCHRONISATION Inter-brain synchronization in alpha (blue), beta (orange) and gamma (red) frequency bands related to interactional synchrony during spontaneous imitation of hand movements (Dumas, 2011)

39. WHAT CHILDREN NEED

40. WHAT ARE THE CONDITIONS THAT INFANTS AND CHILDREN NEED FOR THEIR OPTIMAL WELLBEING? • Responsive caregiving – attunement, responsiveness • Attachment – developing secure attachments to a small number of caregivers • Emotional functioning – experiencing range of emotions / acknowledging emotions / listening to the body • Self-regulation and executive functioning – importance of co-regulation • Meaningful participation – experiencing agency • Social relationships – experience with a range of adults and other children • Safety - protection from social, physical, environmental harms • Security - providing a safe place for exploration

41. CONDITIONS THAT INFANTS AND CHILDREN NEED FOR THEIR OPTIMAL WELLBEING (cont) • Resilience – learning that relationship ruptures / failures / accidents can be overcome and how they can do this • Children do not need cotton wool environments where they are never stressed and are totally protected from failure • Instead, they need moderate stress in the form of freedom to explore and sometimes fail, as well as in the form of high expectations • However, children also need some caregiver with whom they have a secure relationship who provides them with support whenever they face challenges or experience failures or temporary breakdowns in relationships • ‘Good-enough’ parenting – children don’t need perfect parenting, but they do need a threshold-level of responsive caregiving

42. Daniel Hughes and Jonathan Baylin (2012). Brain-Based Parenting: The Neuroscience of Caregiving for Healthy Attachment. New York: W.W. Norton. Daniel Hughes (2009). Attachment-Focused Parenting New York: W.W. Norton.

43. ESTABLISHING SAFETY Key features for ensuring children’s felt sense of safety: • Ensure the habitual presence of an attachment figure • Maintain predictability • Enhance safety when disciplining • Plan in advance for changes and separations • Avoid isolation • Be deliberate with surprises • Repair the sense of safety whenever it gets broken Hughes (2009)

45. Alison Gopnik contrasts two ways of being a parent: • In one, being a parent is like being a carpenter: the job is to shape the raw material of the child into a final product that will fit what you had in mind to begin with. • In the second approach, caring for children is like tending a garden, and being a parent is like being a gardener; when we garden, we create a protected and nurturing space for plants to flourish. Alison Gopnik (2016). The Gardener and the Carpenter: What the New Science of Child Development Tells Us About the Relationship Between Parents and Children. London, UK: The Bodley Head.

46. THE CARPENTER APPROACH TO PARENTING • The prescriptive parenting model is fundamentally misguided, from a scientific, philosophical, political and personal point of view. • Even if we humans could precisely shape our children's behaviour to suit our own goals and ideals, it would be counterproductive to do it. • We can't know beforehand what unprecedented challenges the children of the future will face: shaping them in our own image, or in the image of our current ideals, might actually keep them from adapting to changes in the future. Gopnik (2016)

47. TEACHING AND SCAFFOLDING • Teaching is a double-edged sword. Children are remarkably sensitive to the fact that they are being taught. For example, preschoolers respond differently when you say ‘Let’s see what this does‘, rather than ' Let me show you what this does.' • Direct teaching seems to discourage children from discovering all the possibilities that things have to offer – the children become more eager to imitate the teacher then to discover things themselves. • Rather than direct teaching, guided play or scaffolding can serve as a model for teachers and educators. It's not that the grown-up builds knowledge for the child: instead the grown-up builds a scaffold, and the scaffold helps the child to build knowledge for themselves. Gopnik (2016)

48. TEACHING AND SCAFFOLDING (cont) • Children are acutely sensitive to the unconscious messages we adults give, and actively interpret these messages to try and understand what people do and why they do it • For example, preschoolers notice whether you say ‘Let’s see what this does' rather than 'Let me show you what this does' – and respond differently to the implied message: - Let’s see what this does is interpreted by the child as an invitation to explore and lead to more actively engaged learning - Let me show you what this does implies that the adult is going to take the lead and causes children to become much less actively involved in learning

49. TEACHING AND SCAFFOLDING (cont) • The kinds of interactions that best support and extend children’s thinking involve sustained shared thinking – which is when children and adults work together in conversations which provide opportunities to discuss and think about problems or challenges in a serious, extended way Conversations that support sustained, shared thinking involve: •  genuine, open-ended to-and-fro inquiry • creative and collaborative problem solving • children having the chance to elaborate, recap and review ideas • suggesting and wondering • scaffolding children’s understanding of what is being discussed • summarising and reflecting.

50. TEACHING AND SCAFFOLDING (cont) Good questions for extending open-ended conversations include: • ‘What do you think?’ • ‘I wonder what would happen if …?’ • ‘How do you know?’ • ‘How could we find out?’ • ‘What else do we need?’ • ‘I wonder why …?’ • ‘What happened when …?’ • ‘Can you tell me more about that?’ • ‘What else do you know about …?’ Touhill (2012)