Developing Mentally Healthy Children Stuart G. Shanker Distinguished Research Professor Director, Milton & Ethel Harris Research Initiative Taking Stock:

Developing Mentally Healthy Children

Stuart G. Shanker

Distinguished Research Professor Director, Milton & Ethel Harris Research Initiative

Taking Stock: New Perspectives on Parenting. Sept 29, 2008

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Secondary Altriciality

• Early plasticity enables the child’s brain to be highly attuned to the environment in which she is born

• Synaptic growth in the first 2 years is massive• There is huge over-production of synapses that, at

8 months, will start to be ‘pruned’ back• Synaptic pruning is regulated by baby’s emotional

interactions with her caregivers

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Neal Halfon

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SoundVisionSmell

TouchProprioceptionTaste

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The Role of the Primary Caregiver in Early Brain Growth

•The primary caregiver serves as an ‘external brain’, regulating and stimulating the baby’s brain•Dyadic experiences are vital for:

–Sensory integration–Emotion-regulation–Self-Regulation

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Development of Self-Regulation

•Infant is born with limited capacity to regulate her own arousal states and emotions•This function performed in early months by caregivers•Infant develops the capacity to self-regulate (SR) by experiencing regulation in these dyadic interactions•Similarly, the caregiver has to woo the infant into paying attention to the world around her

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Problems in Self-Regulation at Core of Many Disorders

Basic biological challenges include:–Sensory regulation and integration–Information processing and motor control–Hypo- and hyper-functioning neural systems

•Child with such challenges may avoid interactions essential for development of self-regulation•Deprivation and abuse can lead to similar result

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How Pervasive are Problems in Self-regulation?

•In 2005 CMHO reported that 20% of children in Ontario have a mental illness impairing day-to-day functioning•2007 US Surgeon General’s Mental Health Report: 30% of children 9-17 have a diagnosable mental disorder•Difficult to gather this kind of population data; problems in

–diagnostic categories and practice –factoring in co-morbidities –estimating # of diagnosable children not seen by doctor

Concern is that this is still only telling a small part of the story in regards to self-regulation in children

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Neither Mentally Ill nor Mentally Healthy

•How many children present behaviours similar to CMHO symptoms but not at a level that would warrant a DSM-IV diagnosis?•Is a child getting a C- grade, with no close friends, no interests besides tv and video games, unhappy and overweight, easily bored or distracted, has trouble sticking to a task, but is not difficult to handle at home or in the classroom, thriving?

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The Long Reach of Problems in Self-Regulation

•Our concern is with large and growing number of children who are not fully developing these core capacities as a result of poor self-regulation when they enter school•These are the qualities that:

–lead to great learners–help protect a teenager from harmful practices–help an adult form a lasting deep relationship, enjoy a meaningful career, adopt a healthy lifestyle, and be active in the community

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Why are so many Children entering Kindergarten with poor

self-Regulation?

•Approximately 83% of Canadians live in cities•Now rare for children to be raised in extended family•Children exposed to vast amounts of stimuli and stressors in excess of evolutionary environment•Children spending on average 4 hrs/day in front of screen•Sharp declines in exercise, time in nature, or just playing with other children

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Effects on Early Brain Development

•Environmental toxins (lead, dioxin, passive exposure to tobacco) have all been shown to affect growth of prefrontal cortex

–Has a negative effect on stress response of HPA pathway –Negative effect on self-regulation

•October 2008 issue of Brain and Cognition reports link between air pollution and inflammatory and/or neurotoxic effect on early brain growth

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Epigenetic Effects

•Early experiences control switches that turn genes on or off•This can have a significant effect on development child’s prefrontal cortex•ADHD, autism, aggression, depression are all downstream disorders: result of initial neurogenetic factors that impair the child’s capacity to engage in the experiences necessary for the development of ‘higher-order’ brain systems

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Pathways Model of Autism

•A child who is hyper-sensitive to visual/auditory stimuli may find interactions aversive and withdraw•Such children are born with a neurological deficit that leads to a reduced input of information necessary for the development of the neural areas involved in social behavior (e.g., fusiform gyrus)

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Pathways Model of Agression

•Children who have difficulty processing nonverbal cues may respond by withdrawal or agression•Similar in children who have trouble regulating their emotions due to over-aroused limbic system and/or under-developed regulatory systems•These children don’t have a ‘violence gene’; rather, as Tremblay has shown, they don’t develop strong enough regulatory mechanisms

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Development of the Mind Governs the Development of the Brain

•Child’s motivation, interest, curiosity, pleasure, support effort required for next step in development, which forces the brain to develop new connections needed for the task at hand•Even a child with serious biological impairments can, if wooed into interactions, go through the stages of healthy mental development

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The Ongoing Development of Self-Regulation

•SR develops throughout childhood, adolescence, and young adulthood as challenges to which child is exposed increase•Programs with greatest long-term physical and psychological benefit are those that promote SR•The more developed the child’s SR, the more receptive and able they are to adopting healthy behaviors

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Back to Basics

•We’re just starting to understand what enhances and what constricts development of SR•The most important early experiences are the child’s interactions with her caregivers•The most effective activities for children growing up are the simplest: e.g., sports, nature, arts, social interest groups

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Living in Challenging Times

•See evidence of the possible negative effects of excessive tv and video games on development of SR •These activities also inhibit family and peer interactions•Growing number of families with both parents working, single parent-families with working parent

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The Critical Role of Emotion

•If strong positive affect is critical for development of SR in child, it only stands to reason that it is equally important for parental development•Parents need to continue developing SR just as much as their children, to deal with the added stresses of parenting (including financial)•Just as with the interactions that promote SR in children, the most successful parenting programs are those that individuals enjoy

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Key Principles

1.We need to identify biological and/or social problems early and intervene immediately

2.We need to focus on the emotional and physical experiences that promote strong SR

3.Parents also need to continue developing SR

4.The same principles that apply to the development of SR in children apply to parents and communities

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Six Important Policy Initiatives

1.Highly trained and motivated workforce: ECE, School, Medical

2.Programs to enhance Father Involvement

3.Sports and music programs

4.School Based Health Clinics

5.Community Development

6.Data Collection

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Highly Trained ECD Workforce

•Recognize critical role of ECEs, primary teachers, working with parents:

– Full training in developmental model– Appropriate remuneration, status– Ongoing mentoring and support

•This applies to anyone working with young children: e.g., doctors, nurses, social workers, coaches

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Father Involvement

•FI a crucial social determinant of health for children•Number of families lacking active FI is rising (particularly for some Canadian sub-populations and lower-income households) •Lack of FI increases risks of: poor health; lower education, social-emotional problems, aggression

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Sports and Music Programs

•Involvement in sport promotes:–self-regulation–self-esteem and sense of fairness –Rule-following and frustration-tolerance–ability to form friendships–Protection from addiction, mental illness

•El sistema Nacional de las Orquestas Juveniles e Infantiles de Venezuela has had dramatic effects on preventing aggression and criminal behavior

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School Based Health Clinics

•Access to health services in school increases use and overall health among children•Parent use also increased: particularly among those who don’t receive regular medical attention•SBHCs reduce emergency department use•largest improvement was for psychosocial HRQOL, especially in regards to counseling

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Community Development:New Horizons Model

•Designed to get seniors involved in communities, maintain mental and physical well-being•Seniors identified needs in their own communities and developed/directed the projects •Successful programs are pitched at community’s developmental level, whatever that might be•Communities need to be engaged in design, directing, and evaluating their own programs

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Data

•We need universal screening (18 or 24 months)•We need to start tracking children’s social-emotional development•We need integrated databases (health, social, and education)

No data. No problem. No action.

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Reading

•Diamond, A et. al (2008) Preschool program improves cognitive control Science November 30th•Fogel, A, King, B & Shanker, S (2007) Human Development in the 21st Century (Cambridge UP)•Greenspan, S & Shanker, S (2004) The First Idea (Perseus)•McCain, M, JF Mustard & SG Shanker (2007) Early Years Study II: Putting Science into Action.•Smith-Chant, B.L. (2008) Early Learning and heath. In D Rahpael (ed), Social determinants of health. (Canadian Scholars Press)

Wade, T et al. (2007) Improvements in Health-Related Quality of Life

Among School-Based Health Center Users in Elementary and Middle School. Ambulatory Pediatrics 8,4