Early brain development: Implications and understandings when assessing cognitive functioning and brain injury

JCA Provider Team ANA ALT PRESENTATION

Outline of presentation
Brain development - what the research tells us Early childhood and the life course The developmental trajectory - risk and protective factors

The science of brain development

Convergence of research from neurosciences, developmental psychology, economics of human capital formation New imaging techniques MRI and fMRI (Functional Magnetic Resonance Imaging) PET scans (Positron Emission Tomography) - maps brain metabolism (uptake of glucose) with cognitive activity, so localising where brain activity is taking place Chemistry and physiology

Neuroscience of brain development

Brain is not mature at birth Brain is changed by experiences - the early years of life impacts on long term outcomes (life course) Relationships program social emotional function Adversity impacts on brain development

The importance of genes

Genes provide the initial map for development of brain Guide individual cells to become different parts of the nervous system Genes guide the connections (synapses) between different parts of the brain to develop the neural circuits

Nature biological dispositions that were born with (genes)

The human genome contains 30,000 genes!

The importance of the environment

Genes provides the substrate but after birth nurture is the dominant force Optimal development dependent on good environment nutrition, good health, nourishing and stimulating parenting The experiences an infant has determine function and then structure of brain - environment largely determines which synapses will survive and which will be pruned development of the neural circuits Experience literally sculpts the brain

Nurture our surroundings, upbringing, social influences Example: Rats in a deprived environment had less brain development

Core concepts of development

Human development shaped by a dynamic and continuous interaction between biology and experience (the transactional model of development) Developmental outcome is the result of complex, dynamic transactions between biological factors and the environment.

Influencing outcomes
Biology - at present state of knowledge we cannot do much to change biology (except in the antenatal period) - although we can reduce the risk to the fetus and infant - eg avoid substance abuse during pregnancy Environment - there is much we can do to change the environment in which young children grow and develop

The early years

Rapid period of change Physical Neurological Cognitive Language Social-emotional All programmed by brain development

Plasticity
The ability of the brain tissue to take on new functions Greatest in childhood Important if parts of the brain are damaged or destroyed

Brains are built over time

Brain architecture and skills are built in a hierarchical bottom-up sequence Neural circuits that process basic information are wired earlier than those that process more complex information Foundations important - higher level circuits are built on lower level circuits Skills beget skills - the development of higher order skills is much more difficult if the lower level circuits are not wired properly

Brain organisation
At birth, brainstem (regulates respiratory and cardiovascular function) must be intact Different areas of brain develop, and become fully functional at different different stages during childhood. As more complex higher areas organise they begin to modulate and control lower areas. At birth, cortical areas responsible for abstract cognition have many years before they are required to be fully functional

Brain organised hierarchically

Cortex Limbic system Midbrain Brainstem
Over time, cortical areas can inhibit lower areas frustration, anger, aggression - and impulses are controlled Abstract thought, logic Modulation of behaviour Attachment Motor regulation Arousal Appetite Sleep Blood pressure Heart rate Body temperature

Human brain development synapse formation

Sensing Pathways (vision, hearing) Language Higher Cognitive Function

-6

-3

12

16

Months
not pec no C i

AGE

Years
C. Nelson, in From Neurons to Neighborhoods, 2000.

Brain architecture
The brain is sculpted by early experiences this determines the development of neural circuits Plasticity of the brain decreases over time and brain circuits stabilises, so it is much harder to alter later It is biologically and economically more efficient to get things right the first time

Relationships
Of all the factors that operate in a young childs environment, the single most important determinant is the quality of the childs relationships with parents and caregivers It is the relationship that the young child has with their caregiver(s) that literally sculpts the brain and determines the development of circuits

Early experience is all about relationships

Nurturing and responsive relationships build healthy brain architecture that provides a strong foundation for learning, behaviour and health Human infants are the most dependent of species need nurturing and protective relationship for survival as well as optimal development When protective relationships are not provided, levels of stress hormones increase - this impairs cell growth, interferes with formation of healthy neural circuits, and disrupts brain architecture

Positive stress
Moderate and transient stress responses results in mild increases in stress hormone levels and short lived increases in heart rate Precipitated include the challenges of new people and situations, dealing with frustration, adult limit setting, the pain of a fall or injection Important part of healthy development as it occurs in the context of stable and supportive relationships

Tolerable stress
Stress responses that can disrupt brain architecture, but are buffered by supportive relationships that facilitate adaptive coping Precipitants include death or serious illness of a loved one, parent divorce, witnessing a frightening event, major trauma or illness, a natural disaster, homelessness Generally time limited, so gives the brain opportunity to recover from potentially damaging effects

Toxic stress
Strong and prolonged activation of bodys stress response in absence of buffering protection of adult support Precipitants include extreme poverty, physical or emotional abuse, chronic neglect, severe maternal depression, substance abuse, family violence Disrupts brain architecture and leads to stress management systems that have lower threshold of activation - increases risk of stress related physical and mental illness

The importance of social and emotional development

Social, emotional and cognitive development are highly interrelated - they are not separate constructs Emotional wellbeing and social competence provide a strong foundation for emerging cognitive abilities Social skills, emotional health and cognitive abilities are all important prerequisites for success in school and later in the workplace

Depressed mothers: response patterns to their infants

Express less positive and more negative affect Less attentive and more disengaged When engaged are more intrusive and controlling Fail to respond adaptively to infant emotional signals - non-responsive parenting

Infants of depressed mothers

Shorter attention spans Less motivation to master new tasks Elevated heart rates Elevated cortisol Reduce EEG activity right frontal cortex

Ecological factors impacting on child development and life course

Proximal
Family stress - less stable attachments Pressure on parents - tiredness, anxiety, poor parenting skills Poor quality child care Poor connectedness - extended family, community, work colleagues Lack of support in difficult transitions

Ecological factors impacting on child development and life course

Distal
Market deregulation Increased mobility Increased hours of work; casual/PT work Job insecurity Erosion of social capital Poverty and social inequalities

The impact of social change on children and families

Divorce, single parents, blended families, shared custody arrangements Both parents working, child care Working longer hours, part time/shift work, more casual work Job insecurity, unemployment, homelessness Increase in poverty and increased social gradient (health inequalities)

Sub-optimal developmental trajectory

Problems in childhood Beginning of pathways to problems later in life Evidence that many problems in adult life have their origins in pathways that begin in childhood

Risk and protective factors

Child Parents Parenting style Family environment Community and cultural School Life events

Poverty and health (0-4 years)

Less likely to: Be breast fed Be fully immunised Receive well child care Have regular and consistent access to health services More likely to have: Low birth weight Developmental delay Higher incidence of SIDS Higher injury rate Suboptimal growth More frequent hospitalisations Behavioural disorders

Double jeopardy for children living in poverty

Experience most health problems, and more likely to be unimmunised, live in unhealthy environments and have fragmented access to health care Highest risk of academic failure, but often attend the most disadvantaged schools Families experience the most stress but have fewest social supports

Vocabulary Growth - First 3 Years

Vocabulary 1200 High SES

Middle SES 600 Low SES

12

16

20 24 Age - Months

28

32

36

B Hart & T Risley Meaningful Differences in Everyday Experiences of Young American Children 1995

What we know from research: start early

100

Literacy divide
Typical middle class child enters first grade with up to 1,700 hours of one on one picture book reading, whereas a child from a low income family averages just 25 hours (Adams 1990) 47% of welfare dependent parents had no alphabet books in the home, compared to 3% of professional parents (McCormick & Mason 1986)

Literacy standards in Australia

Year 3 reading standard
% meeting % not meeting the standard the standard Main Sample 66 Males 77 Females High SES 88 Medium SES Low SES 62 Indigenous 19 73 34 23 12 72 38 81

(ACER, 1997)
27

28

Literacy standards in Australia

Year 5 reading standard
(ACER, 1997)
% meeting the standard Main Sample Males Females High SES Medium SES Low SES Indigenous % not meeting the standard 71 65 76 87 71 47 23 29 (+ 2%) 35 (+ 1%) 24 (+ 1%) 13 (+ 1%) 29 (+ 1%) 53 (+ 15%) 77

Literacy As children move from year 3 to year 5, the

disparity among those meeting literacy standards grows
Proportion Meeting Standard (%)

100 90 80 70 60 50 40 30 20 10 0 Y 3 ear Y 5 ear

T W he idening G ap
Socioeconom ic Status: H igh Low

Adverse childhood events and adult depression

5 4.5 4
Odds Ratio

3.5 3 2.5 2 1.5 1 0.5 0

Adverse Events

0 1 2 3 4 5+

Chapman et al, 2004

Adverse childhood events and adult ischemic heart disease

3 .5 3 2 .5
Odds Ratio

2 1 .5 1 0 .5 0
Adverse Events

0 1 2 3 4 5,6 7,8

Dong et al, 2004

Adverse childhood events and adult substance abuse

0 16 14 12 10 % 8 6 4 2 0 1 2 3 4+

0 40 35 30 25 20 15 10 5 0

5+

Self-Report: Alcoholism

Dube et al, 2002 2005

Dube et al,

Self-Report: Illicit Drug Use

Adversity
Any adversity that impacts on the parents or caregivers has the potential to have a negative impact on brain development in the young child