Social Emotional Development:

1. 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

2. 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.

3. 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.

4. 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)

5. 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

6. 4 IMH Principles • Infant brains have neuroplasticity. • Babies are born learning. • Starting at birth, babies seek out human connections. • Children learn in relationship.

7. 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)

8. 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)

9. Critical Social Emotional Capacities • Emotional Regulation • Social Referencing • Joint Attention

10. Social Emotional Capacity Emotional Regulation

11. 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)

12. Emotional Regulation—Theoretical Model Genetic expression Learning Relationships Behavior Brain architecture Environment-------random events-------temperament (nurture) (nature)

13. Long vs. Short Route Hormonal regulation, temperament, circumstances, and experiences determine which pathway Joseph 2000

14. Long vs. Short Route Cortisol impedes hippocampal functioning, blocks explicit memory processing, and inhibits hippocampal-medial PFC neural connections Joseph 2000

15. Long vs. Short Route Catecholamines increase implicit encoding of fear by the amygdala, enhances implicit memory processing (bodily sensation, emotion), & amygdala hypertrophy Joseph 2000

16. 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

17. 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

18. 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

19. 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

20. Social Emotional Capacity Social Referencing

21. Social Emotional Capacity Social Referencing Use of another’s perception of a particular situation when developing one’s own understanding of the situation

22. Babies seek human connections Richter 2004 Perry

23. Visual Cliff Campos Perry

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

25. Social Emotional Capacity Joint Attention

26. 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

27. Left-Brain • “Assertive” • Motivational state • Cooing • Language Joint Attention Shared focus in relationship

28. 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

29. 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

30. Joint Attention

31. “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

32. 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

33. Summary • Brain neuroplasticity is both potentiality and vulnerability highly determined by environment.

34. Summary • Healthy social emotional development is critical for lifelong well-being and success.

35. Summary • Biological and environmental factors determine brain architecture and development of emotional regulation.

36. Summary • Adverse childhood experiences are neurotoxic and negatively impact health across the lifespan.

37. Summary • Social emotional relationships are the means for protection, survival, and learning.

38. Thank you

39. 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.

40. 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.

41. 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.

42. 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.