Social Emotional Development:Nurturing Brain, Mind, Child, and Relationship for Lifelong Health

Sherri L. Alderman, MD, MPH, IMH-E, FAAPDevelopmental Behavioral Pediatrician

OCCYSHN Coffee Time Consultations

December 10, 2013

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 Health

OBJECTIVES1. Name one fundamental social emotional developmental skill characteristic of typical early childhood development2. Name one intermediate step linking brain architecture to learning in the Emotional Regulation Theoretical Model.

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)

0200400600800

100012001400

Conception

Birth

12m36m 12y

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 Infant brains have neuroplasticity. Babies are born learning. Starting at birth, babies seek out human

connections. Children learn in relationship.

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 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 Emotional Regulation Social Referencing Joint Attention

Social Emotional CapacityEmotional 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

Relationships

Behavior

Brain architecture

Environment-------random events-------temperament(nurture) (nature)

Learning Genetic expression

Long vs. Short Route

Click icon to add picture

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

Joseph 2000

Long vs. Short Route

Click icon to add picture

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

Joseph 2000

Long vs. Short Route

Click icon to add picture

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

Joseph 2000

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

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 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 ExperiencesNational Survey of Children Exposed to Violence (n=4549 + caregivers) 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

Finkelhor 2009Conception

Early Death

Adverse Childhood Experience

Disruptive Neurodevelopment

SE & Cog Development

Health Risk Behaviors

Morbidity/Social Problems

Social Emotional CapacitySocial Referencing

Social Emotional CapacitySocial ReferencingUse of another’s perception of a particular situation when developing one’s own understanding of the situation

Babies seek human connections

Richter 2004 Perry

Visual Cliff

Campos Perry

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 CapacityJoint Attention

Social Emotional CapacityJoint AttentionCoordinating 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

Left-Brain “Assertive”

Motivational state Cooing Language

Joint AttentionShared focus in relationship

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 AttentionShared focus in relationship

Emotionally available adult PPD Maternal affect

disregulation Unhealthful

externalizing behaviors

Chronic stress (emotional, financial, other)

Parental self-efficacy

Joint AttentionShared focus in relationship

Kim 2012; Fulton 2012

Joint Attention

“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 AttentionShared focus in relationship

Shonkoff 2012

What a Child NeedsFor Optimal Health and Development

Home environment:• Healthy• Loving• Safe• Emotionally-balanced

The Child needs to:• Know they are special• Feel safe• Have confidence in

themselves and their world• freedom• limits• experiences

A Child’s Perspective:• I am loveable• I am held in my

parents’ thoughts• The world is safe

Summary Brain neuroplasticity is both potentiality and

vulnerability highly determined by environment.

Summary Healthy social emotional development is critical

for lifelong well-being and success.

Summary Biological and environmental factors determine

brain architecture and development of emotional regulation.

Summary Adverse childhood experiences are neurotoxic and

negatively impact health across the lifespan.

Summary Social emotional relationships are the means for

protection, survival, and learning.

Thank you

References Briggs-Gowan MJ, 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.

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.

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.

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.