The Enduring Influence of Child Temperament

Integrating Early Childhood Social Emotional Development into Early Childhood Systems Deborah F. Perry, PhD Georgetown University Center for Child & Human Development August 2010

Overview Define early childhood social emotional development Explore the role of early brain development on trajectories of development Describe policy implications for Part C systems

The Context Young children are: – Being kicked out of child care settings – Showing the impacts of maternal depression – Dealing with multiple family risks (parental substance abuse, domestic violence and mental illness)

School Readiness Skills

Estimated Prevalence No national epidemiological data Early Childhood Longitudinal Study: 10% of all kindergarten children show problematic behavior Rates are two to three times as high in low-income samples Clinical level problems are lower (4-10%)

Social Emotional Development Inter-relatedness of domains Intimately tied to caregivers’ mental health Core tasks: – Attachment – Behavior – Competence

Neurons to Neighborhoods …virtually every aspect of early human development, from the brain’s evolving circuitry to the child’s capacity for empathy is affected by the environments and experiences that are encountered in a cumulative fashion, beginning in the prenatal period and extending throughout the early childhood years.” Shonkoff and Phillips, 2000

Role of Early Experience Connections between neurons are strengthened through repeated exposure/use Connections that are not used often are pruned away Environmental influences shape the architecture of the brain

Quality and Quantity of Experiences Frequent, regular, predictable Occur in the context of warm, supportive relationships Are associated with positive emotions Involve several senses Are responsive to the child’s interests or initiative Early Childhood Resource Center, RTI

Early Childhood Mental Health The social, emotional and behavioral well-being of young children and their families The developing capacity to experience, regulate, express emotion Form close, secure relationships Explore the environment and learn Adapted from ZERO TO THREE

Experience and Regulate Emotions INFANT Behaviors:  Smiling

 Cooing and Babbling  Fussing when hungry or tired  Kicking legs when excited  Quieting when held by a familiar adult

TODDLER Behaviors:  Laughing

 Goes to familiar adult for comforting  Able to move from one activity to the next  Growing ability to focus  Calms with help from a familiar caregiver

Form Secure Relationships INFANT Behaviors:  Smile at and back to a familiar caregiver  Anticipates being held  Likes to look at and be near familiar caregiver  Shows preference for parent or caregivers face and voice  Stretches arms up to be held

TODDLER Behaviors:  Explores but checks in with familiar caregiver

 Shows affection for familiar caregivers  Responds to his/her name  Makes needs known to a familiar caregiver

Explore and Learn INFANT Behaviors:  Reaches for and grasps things  Enjoys simple games like peek-a-boo  Imitates others actions  Smiles or plays with self in the mirror

TODDLER Behaviors:  Keeps looking for a toy

 Tries new things  Shows interest in other people  Imitates others actions

Goodness of Fit Extent to which the temperament of the child is compatible with the environment, expectations and demands

Adversity in Early Childhood Can Have Long-Lasting Consequences Adverse Childhood Experiences Study (ACES) has documented the long term effects of earlier exposure to significant stressors Explains the link between early childhood brain development and long term health and mental health outcomes

Adverse Childhood Experiences Are Common Household dysfunction: Substance abuse Parental sep/divorce Mental illness Battered mother Criminal behavior

27% 23% 17% 13% 6%

Abuse: Psychological Physical Sexual

11% 28% 21%

Neglect: Emotional Physical

15% 10%

Adverse Childhood Events and Adult Depression 5

Odds Ratio

4.5 4 3.5

0 1 2 3 4 5+

3 2.5 2 1.5 1 0.5 0

Adverse Events Chapman et al, 2004

Adverse Childhood Events and Adult Substance Abuse 0

1

2

3

4+

0

2

3

4

5+

40

16

%

1

14

%

35

12

30

10

25

8

20

6

15

4

10

2

5

0

0

Self-Report: Alcoholism Dube et al, 2002

Self-Report: Illicit Drug Use Dube et al, 2005

Adverse Childhood Events and Adult Ischemic Heart Disease 3.5

Odds Ratio

3 0 1 2 3 4 5,6 7,8

2.5 2 1.5 1 0.5 0 Adverse Events

Dong et al, 2004

Levels of Stress Positive Stress: normative, helps in development Tolerable Stress: outside the normal range, one time events, buffered by caregivers Toxic Stress: prolonged activation of the stress response system, in absence of buffering adult Harvard Center for the Developing Child

Emotional Stimulus

HPA Pathway Control

Amygdala

Hippocampus Hypothalamus

PVN

Cortisol

Cortisol CRH

PIT ACTH

Adrenal Cortex Charles Zeanah PPT

LeDoux, Synaptic Self

Interaction of the Brain and Immune System CRF

Hypothalamus CRH

Adrenal Gland

ACTH

Immune Cells

Locus Ceruleus

Pituitary Gland Sympathetic Nervous system

Immune Organs

Impact of Stress on Development

How depression affects development Specific aspects of parenting behavior: – – – – – – –

Maternal responsivity Maternal sensitivity Emotional availability Negative mood (intrusive/hostile) Inconsistency in discipline Modeling negative affect Inability to assist with emotional regulation

Consequences of Maternal Depression Mothers’ well-being – Decreased Maternal Self-Efficacy Fathers’ well-being – Increased depression & marital stress – Increased concern of infants Infant development – Emotion dysregulation – Cognitive and language delays – Increased risk for psychopathology Mother-infant interaction – Mothers: understimulating or overstimulating – Infants: Less responsive, more gaze avoidant, more distress Field, 1997; Milgrom & McCloud, 1996; O’Hara, 1994

Challenges & Opportunities Address the mental health needs of young children and their caregivers in context of their network of services and supports

Integrate the best available science on what works for preventing and treating mental health needs of young children and their families

Challenges to Integration of ECMH into EC Systems-Building Need to address complex, multi-factorial problems that evolve over time and across settings – Focus on caregivers (parents and child care providers) Lack of fit between increasing specialization & real needs of young children & their caregivers Requires integration & adaptation of evidencebased practices (EBP)

An Early Childhood Systems’ Framework

Developed by Roxane Kaufmann, GUCCHD; design by: Lucia Foley, Hampshire Educational Collaborative

System of Care Values/Principles Infused Into Natural Settings and Services – Stand-alone early childhood mental health systems won’t work

Grounded in Developmental Knowledge – Lifespan approach, different approaches needed for infants, toddlers, preschoolers

Risk & Resilience – Building family and community assets

Need for Focus on RelationshipBased Strategies Dyadic interventions Two-generation models Family systems framework Relationships between MH and other service systems Relationships with stakeholders in systems building

Best Scientific Evidence Growing number of evidence-based prevention and treatment models – Developed through rigorous scientific experiments – Need for adaptation for local context, but with eye to fidelity – Difficulties in bringing these to scale

How to value “practice-based evidence” and “family wisdom”

Pyramid Model

Promotion Developmental and social-emotional screening in primary care and early care and education programs High quality training on social-emotional development for Part C providers and child care community Dissemination of information promoting healthy social-emotional development

Prevention Screening for caregiver depression Mental health consultation in child care and integration of MH into Part C systems Social skills curricula (i.e., Second Step)

Intervention Positive Behavioral Support Intensive mental health consultation in homes and child care settings to support children with IFSPs Relationship-based therapy (e.g., PCIT) In-home treatment for children with mental health diagnoses and depressed caregivers

Moving Forward Consider how current eligibility criteria and procedures for Part C reflect the fundamentals of early childhood social-emotional development Broaden networks of providers who are screening families (caregivers and children) for social-emotional risks Establish cross-sector competencies for all providers working with young children and families Support integration of mental health consultants in Part C systems