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OCCYSHN Coffee Time Consultations . December 10, 2013 . Social Emotional Development:. Nurturing Brain, Mind, Child, and Relationship for Lifelong Health Sherri L. Alderman, MD, MPH, IMH-E, FAAP Developmental Behavioral Pediatrician.

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social emotional development

OCCYSHN Coffee Time Consultations

December 10, 2013

Social Emotional Development:

Nurturing Brain, Mind, Child, and Relationship for Lifelong Health

Sherri L. Alderman, MD, MPH, IMH-E, FAAP

Developmental Behavioral Pediatrician

se development nurturing brain mind child and relationship for lifelong health
SE Development:Nurturing Brain, Mind, Child, and Relationship For Lifelong Health
  • I have no financial interests to disclose.
  • I do not intend to discuss any unapproved or investigational use of commercial products or devices.
se development nurturing brain mind child and relationship for lifelong health1
SE Development:Nurturing Brain, Mind, Child, and Relationship For Lifelong Health
  • OBJECTIVES

1. Name one fundamental social emotional developmental skill characteristic of typical early childhood development

2. Name one intermediate step linking brain architecture to learning in the Emotional Regulation Theoretical Model.

the human brain
The human brain
  • Fetal brain development begins at 3 wks gestation and continues throughout the pregnancy.
  • At birth, the infant’s brain is the most undifferentiated organ in the body.
  • The brain continues to grow after birth more than doubling in mass in the first year. (400 g to 1000 g)
the human brain1
The human brain
  • Estimated one hundred billion neurons
  • Two million miles long
  • Each neuron with an average of 10,000 synapses
  • The most complex structure, natural or artificial, on earth
4 imh principles
4 IMH Principles
  • Infant brains have neuroplasticity.
  • Babies are born learning.
  • Starting at birth, babies seek out human connections.
  • Children learn in relationship.
scope of the importance
Scope of the Importance
  • An estimated 21% of pediatric population meet diagnostic criteria for a mental health disorder causing impairment (Foy 2010)
  • 9-14% of children birth to 5 experience social-emotional problems that cause suffering to the child and family and interfere with functioning (Egger 2006)
scope of the importance1
Scope of the Importance
  • Healthy social emotional development is highly predictive of school readiness and academic performance (Briggs-Gowan 2008, National Scientific Council on the Dev Child 2007 & 2010)
  • Healthy social emotional development increases family & community success(Knudsen 2006, National Research Council & IOM 2009)
critical social emotional capacities
Critical Social Emotional Capacities
  • Emotional Regulation
  • Social Referencing
  • Joint Attention
social emotional capacity
Social Emotional Capacity

Emotional Regulation

emotional regulation
Emotional Regulation
  • The ability to maintain flexibly organized behavior in the face of high levels of arousal or tension (Sroufe 1996)
  • Top-down PFC—Limbic connections
  • Secure attachment cultivates sense of comfort and buffers the child from stress (Lieberman 2008)
emotional regulation theoretical model
Emotional Regulation—Theoretical Model

Genetic expression

Learning

Relationships

Behavior

Brain architecture

Environment-------random events-------temperament

(nurture) (nature)

long vs short route
Long vs. Short Route

Hormonal regulation, temperament, circumstances, and experiences determine which pathway

Joseph 2000

long vs short route1
Long vs. Short Route

Cortisol impedes hippocampal functioning, blocks explicit memory processing, and inhibits hippocampal-medial PFC neural connections

Joseph 2000

long vs short route2
Long vs. Short Route

Catecholamines increase implicit encoding of fear by the amygdala, enhances implicit memory processing (bodily sensation, emotion), & amygdala hypertrophy

Joseph 2000

temperament b iologically rooted individual differences in behavior tendencies 2 major dimensions
TemperamentBiologically rooted individual differences in behavior tendencies—2 Major Dimensions
  • Reactivity (high or low)
    • Speed of reaction
    • Quality (+ or -)
  • Self-regulation capacity
    • Actively direct attention away
    • Respond to adult’s attempts to soothe

Wachs 2004

temperament b iologically rooted individual differences in behavior tendencies right brain
TemperamentBiologically rooted individual differences in behavior tendencies—Right-Brain
  • “Acceptive”
  • Responsive to prosody of “motherese”
    • Nonverbal sing-song tone of voice
  • Impaired regulation leads to externalizing behavioral challenges

Siegel 1999

toxic stress allostatic load c umulative stress induced burden on physiology at a physiologic cost
Toxic Stress & Allostatic LoadCumulative, stress-induced burden on physiology at a physiologic cost
  • Adaptive behaviors become ‘maladaptive’
  • Amygdala hyperactivity increases anxiety
  • PFC atrophy causes loss of top-down control
  • Hippocampal reduction causes impaired memory & mood control
  • Insecure attachment & trauma produce affect disregulation

Shonkoff 2012

adverse childhood experiences national survey of children exposed to violence n 4549 caregivers
Adverse Childhood ExperiencesNational Survey of Children Exposed to Violence (n=4549 + caregivers)

Early Death

Morbidity/

Social Problems

  • 60% had experienced some kind of violence in the last year
  • 10.9% had experienced 5 or more types of violence
    • CAN
    • Community crime exposure
    • Family abuse exposure

Health Risk

Behaviors

SE & Cog Development

Disruptive Neurodevelopment

Adverse Childhood Experience

Conception

Finkelhor 2009

social emotional capacity1
Social Emotional Capacity

Social Referencing

social emotional capacity2
Social Emotional Capacity

Social Referencing

Use of another’s perception of a particular situation when developing one’s own understanding of the situation

visual cliff
Visual Cliff

Campos

Perry

serve and return
Serve and Return

“The more mature adult brain’s state of mind will tend to recruit similar processes in the child.” (Siegel 1999)

social emotional capacity4
Social Emotional Capacity

Joint Attention

Coordinating attention to an event or object with another individual, sharing interest and social engagement, and showing an understanding that the partner is sharing the same focus

joint attention

Left-Brain

  • “Assertive”
    • Motivational state
    • Cooing
    • Language
Joint Attention

Shared focus in relationship

joint attention1

Co-regulation

  • The mature adult brain acts as the PFC for the young child
  • Time-in
  • Cortico-limbic neural pathways of the immature brain are primed in the presence of the mature adult
Joint Attention

Shared focus in relationship

joint attention2

Emotionally available adult

    • PPD
    • Maternal affect disregulation
    • Unhealthful externalizing behaviors
    • Chronic stress (emotional, financial, other)
  • Parental self-efficacy
Joint Attention

Shared focus in relationship

Kim 2012; Fulton 2012

joint attention4

“Tolerable stress”

  • Relationship buffers effects of chronic stress
  • Naturally occurring transient stressful experiences in the presence of an emotionally available and regulated adult teach coping mechanisms
Joint Attention

Shared focus in relationship

Shonkoff 2012

what a child needs

Home environment:

    • Healthy
    • Loving
    • Safe
    • Emotionally-balanced
  • A Child’s Perspective:
    • I am loveable
    • I am held in my parents’ thoughts
    • The world is safe
What a Child Needs
  • The Child needs to:
    • Know they are special
    • Feel safe
    • Have confidence in themselves and their world
      • freedom
      • limits
      • experiences

For Optimal Health and Development

summary
Summary
  • Brain neuroplasticity is both potentiality and vulnerability highly determined by environment.
summary1
Summary
  • Healthy social emotional development is critical for lifelong well-being and success.
summary2
Summary
  • Biological and environmental factors determine brain architecture and development of emotional regulation.
summary3
Summary
  • Adverse childhood experiences are neurotoxic and negatively impact health across the lifespan.
summary4
Summary
  • Social emotional relationships are the means for protection, survival, and learning.
references
References
  • Briggs-GowanMJ, Carter AS, (2008). “Social-Emotional Screening Status in Early Childhood Predicts Elementary School Outcomes,” Pediatrics 212(5):957-962.
  • Egger HL, Angold A, (2006). “Common Emotional and Behavioral Disorders in Preschool Children: Representation, Nosology, and Epidemiology,” Journal of Child Psychology and Psychiatry 47(3-4):313-337.
  • Finkelhor D, Turner H, Ormrod R, et al., (2009). “Violence, Abuse, and Crime Exposure in a National Sample of Children and Youth,” Pediatrics 124(5):1411-1423.
  • Foy JM, Perrin, J, et al., (2010) “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community,” Pediatrics 125(3):S69-S160.
  • Fulton JM, Mastergeorge AN, Steele JS, et al., “Maternal Perceptions of the Infant: Relationship to Maternal Self-Efficacy During the First Six Weeks Postpartum,” Infant Mental Health Journal 33(4):329-338.
references1
References
  • Joseph R, (2000). Neuropsychiatry, Neuropsychology, Clinical Nueroscience, New Your: Academic Press.
  • Kim B-R, Teti DM, Cole PM, (2012). “Mother’s Affect Dysregulation, Depressive Symptoms, and Emotional Availability During Mother-Infant Interaction,” Infant Mental Health Journal 33(5):469-476.
  • Knudsen EI, Heckman JJ, et al. (2006). Economic, Neurobiological, and Behavioral Perspectives on Building America’s Future Workforce, Proc National Academy of Science USA 203(27):10155-10162.
  • Lieberman AF, Van Horn P, (2008). Psychotherapy with Infants and Young Children: Repairing the Effects of Stress and Trauma on Early Attachment, New York: The Guilford Press.
  • National Research Council and Institute of Medicine, Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions, (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, Washington, D.C.: The National Academies Press.
references2
References
  • National Science Council on the Developing Child, (2007). The Science of Early Childhood Development: Closing the Gap Between What We Know and What We Do. Cambridge, Massachusetts: Harvard Press.
  • National Scientific Council on the Developing Child, (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development, Cambridge, Massachusetts: Harvard Press.
  • Richter L, (2004). The Importance of Caregiver-Child Interaction for the Survival and Healthy Development of Young Children—A Review. Geneva, Switzerland: World Health Organization.
  • Shonkoff JP, Garner A, et al., (2012). “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” Pediatrics 129(1):e232-e246.
  • Siegel DJ, (1999). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are, New York: The Guilford Press.
references3
References
  • Sroufe LA, (1996). Emotional Development: The Organization of Emotional Life in the Early Years. New York: Cambridge University Press.
  • Wachs TD, (2004). “Temperament and Development: The Role of Context in a Biologically Based System,” Zero to Three 24(4):12-21.