Fr om risk to resilience in human br ain dev elopmentsiteresources.worldbank.org/INTECD/Resources/... · Fr om risk to resilience in human br ain dev elopment: A framework for planning

Courtney Stevens, PhD

Brain Development Laboratory

University of Oregon &

Sarah Lawrence College

From risk to resilience in human brain development: A framework for planning early childhood interventions

World Bank May 2008

Broad Framework

1.! Some neural systems and subsystems are highly modifiable (neuroplastic), with the potential for either enhancement or vulnerability.

2.! The most plastic neural systems are also vulnerable among individuals from lower socioeconomic backgrounds.

3.! Early environmental enrichment in the form of interventions can protect and enhance the plastic and thus potentially vulnerable neurocognitive systems in children with, or at risk for, developmental deficits.

Neville, H., & Bavelier, D. (2000), Specificity and Plasticity in Neurocognitive Development in Humans, in The New Cognitive Neurosciences Stevens, C., & Neville, H. (2006). Journal of Cognitive Neuroscience

A Human Brain

Birth! 6 years! 14 years"

Old!

Human Brain Development Conel (1939~1963)

Synapse Development Human Brain

Adapted from P. Huttenlocher et. al. (1979-1997)

Motor

control!

Vision!

Faces!Social skills!

Emotions!

Language!

Hearing!

Approaches to studying brain plasticity

Specialized Adult Brain

Retrospective studies: adults with different sensory or language experience

Prospective studies: Children of different ages

Structure Function Connectivity

MRI Images

Event-related Brain Potentials (ERPs)

1.!Constrained

2.!Modifiable by and dependent on experience during particular time periods (multiple)

3. Modifiable throughout life

Different Profiles of Plasticity

Low High

Low

High

CUBA

SWE

NL,G

CAN

US

IRE

GB NZ NI

Language

Literacy Numeracy

Health Longevity

Western Society Socio-economic status (SES) gradients

SES (parents’ education and occupation)

Pakulak E, Harris AM, Yamada Y, Coch D, Schachter J & Neville H (2002) Cognitive Neuroscience Society

Vulnerability of Syntax: Adults with lower language proficiency

Vulnerability of Syntax: Adults from lower SES backgrounds

Pakulak E, Harris AM, Yamada Y, Coch D, Schachter J & Neville H (2002) Cognitive Neuroscience Society

Sanders, L., Stevens, C., Coch, D., & Neville, H. (2006). Neuropsychologia

Attention in typically developing children

Story 1unattended! Story 2 attended!

ba! buzz ! buzz! buzz! ba! buzz!

Blue Kangaroo !Harry the Dog!

ERP to probes in Blue Kangaroo story!

Attend Blue Kangaroo Story!

Attend Harry the Dog Story!

Attention vulnerability: Children from lower SES backgrounds

Stevens, C., Lauinger, L., & Neville, H. (In press). Developmental Science

Difficulty suppressing response to unattended stimuli.

High SES*

Low SES*

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Low SES

Unpacking SES

Prenatal care Nutrition

Depression Nurturance/neglect

$ SCHOOLS!

Cortisol Perception of inequality

Parental Attitudes/education

Social support Books

not

talkative

moderately

talkative

talkative

Differences in Amount of Language from Parent to Child

Hart B & Risley T (1995) Meaningful Differences in the Everyday Experience

of Young American Children

children talkative families

children moderately talkative families

children families not talkative

Differences in Growth of Child Language

Hart B & Risley T (1995) Meaningful Differences in the Everyday Experience

of Young American Children

Sorting Out Genes and Environment

Correlation ! Causation

Attention only modulated early sensorineural processing in the TD group

(group x attn, P < .005; see figure) TD SLI

P > .4

Specific Language Impairment (SLI)

Stevens, Sanders, & Neville (2006). Brain Research

Stevens C, Fanning J, Coch, D., Sanders L & Neville H (2008) Brain Research

Building an intervention framework

•! Using neuroimaging techniques, we observe differences in brain function among children and adults from different socioeconomic backgrounds

•! However, vulnerable neural systems can also be enhanced

•! Could an early intervention serve to buffer and protect these vulnerable neural systems?

Neville, H. & Lawson, D. (1987). Brain Research Roder, B.,Teder-Salejarvi, W., Sterr, A., Rosler, F., Hillyard, S., & Neville, H. (2001). Nature Stevens, C., Fanning, J., Coch, D., Sanders, L., Neville, H. (2008). Brain Research

Intervention Overview: Collaborations with Head Start

•! All children living at or below the poverty level

•! Participating families randomly assigned to a control group or one of several training programs

•! Over 100 participants to date

Today’s focus: Parent training model

Parent Training

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

•! Identified known risk factors for children –!Stress

–! Language

–!Behavioral control/ emotional regulation

•! Identified evidence-based strategies / approaches for targeting each domain

•! Examined literature for existing programs using these strategies / approaches

Reduce child stress: Patterson et al., 1975; Deater-Deckard, 2005; Kazden & Whitley, 2003

Enhance language: Bruner, 1983; Maccoby & Martin, 1983; Hart & Risley, 1995

Support behavioral control / emotional regulation: Patterson et al., 1973, 1982

Success in Parenting: Fischer et al, 1997

INteREActive Language training program (INREAL): Weiss et al, 1981

Parent Training

Reduce family stress

Enhance language &

cognitive development

Promote pro-social

behavior & self-regulation

!!Eight weekly, 2 hour sessions

!!Food, childcare, transportation, and prizes provided as attendance and participation incentives

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Adapted elements of existing programs to target parents of typically developing preschool children.

Parent Training: Key Components

•! Provide high levels of positive reinforcement and specific praise

•! Use consistent discipline with clear expectations

& natural consequences

•! Use language differently to encourage high-

quality interactions

•! Provide frequent opportunities for the children to

Choose, Think, Solve Problems

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Hypothesis

Training parents in these strategies will change their parenting behaviors and stress levels.

These parenting changes will have a “trickle down” effect on children such that children’s increased emotional regulation & decreased stress " will lead to improved cognition, language, & brain

organization

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Participants

•! 28 children, randomly assigned –! 14 children’s parents receive training

–! 14 children in control group

•! No differences between groups in: –! Children’s age, gender, receptive language, or nonverbal

intelligence

–! Parents’ age, marital/partnered status, or education level

–! Family’s socioeconomic background

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

•! Primary caregiver’s language use and interaction behaviors during 10-minute free-play with child (SALT-8 transcription)

•! Primary caregiver’s self-reported parenting stress levels

(Parent Daily Report)

•! Child’s language and cognition (standardized

assessments)

All testers/raters blind to intervention condition

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Parent Interaction Behaviors

Parent Interaction Behaviors (SALT-8)

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Therapeutic Gain

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Balanced Turn Taking Language Modeling

Parent Interaction Behaviors (SALT-8)

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Bal. Trn. Bal. Trn. Ch. Dir. Ch. Dir. Lang. Mod. Lang. Mod.

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Bal. Trn. Bal. Trn. Ch. Dir. Ch. Dir. Lang. Mod. Lang. Mod.

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Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Parent Stress

*

*

Direction: Optimal

Therapeutic Gain

Perceived Stress

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Child Conduct Problems

*

*

Direction: Optimal

Therapeutic Gain

Conduct Problems

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Child Language

* *

Receptive Language Direction: Optimal

Therapeutic Gain

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Child Nonverbal IQ

* *

Nonverbal IQ Direction: Optimal

Therapeutic Gain

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Child Attention

*

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Sustained Attention Direction: Optimal

Therapeutic Gain

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

Changes in Child Memory

*

*

Associative Memory Direction: Optimal

Therapeutic Gain

Fanning, J., Sundborg, S., Neville, H. (2007). Cognitive Neuroscience Society Fanning, J. (2007). Doctoral dissertation, University of Oregon.

•! Following short-term parent training,

#! Parents changed their behaviors

#! Parents reported reduced stress

#! Children’s language, cognition, and attention improved

•! Ongoing studies #! Examining effects on electrophysiological measures of brain

organization

#! Following children longitudinally as they enter the K-12 school system

#! Replicating study with a larger sample

#! Contrasting parent-focused training with child-focused, pull-out training during the school day

Future Research

1. Determine time periods of plasticity of other brain systems.

2. Determine the mechanisms that confer plasticity.

3. Determine the interventions that can enhance plasticity.

**4. Convince the public and policy makers to be guided by evidence from brain research.

5. Design and implement evidence-based educational and support programs that optimize human development.

Research Associates Ted Bell Jessica Fanning Christina Karns Courtney Stevens Yoshiko Yamada

Graduate Students Annika Andersson Jeff Currin Justin Hulbert Eric Pakulak Stephanie Sundborg

Collaborators Bavelier, Daphne (U of Rochester) Coch, Donna (Dartmouth) Corina, David (UC Davis) Mills, Debra (Emory University) Roeder, Brigitte (U of Hamburg, Germany) Sanders, Lisa (U Mass Amherst) Weber-Fox, Chris (Purdue)

Research Assistants Olivia Bagdade Mark Dow Scott Klein David Paulsen

Technical Staff Paul Compton Linda Heidenreich Ray Vukcevich

Funding: NIH, IES