Transcript Antisocial Behaviour – Bullying Family Violence and Young

Vanier Children’s Services
London, Ontario
Equity in Early Human Development
and Mental Health
By J. Fraser Mustard
The Founders’ Network
Founding Chairman
Council for Early Child Development
Sept 30, 2009
09-029
History
Early Human Development
1. Population Health – Bob Evans
Hertzman
2. Human Development – Dan Keating
Hertzman
3. Experience-based Brain and Biological
Development – Ron Barr
Hertzman
4. Canadian Council for ECD
Hertzman
04-015
140
Socio-Economic Gradient and
Mortality – Men UK
SMR
120
100
SMR – Standardized
Mortality Rate
80
60
I
II
III
Social Class
IV
V
91-068
Cumulative Mortality
U.K. CIVIL SERVICE
Mortality - All Causes
16
Other
12
Clerical
Professional/
Executive
8
4
Administrative
0
0
2
4
6
Year of Follow-up
8
10
96-076
Literacy and SES Gradients for Youth by Province 1994
1
0.5
literacy
score
(adjusted)
MN
AB
SK
QC
0
ON
NS
NB
NF PE
BC
-0.5
-2
-1
0
1
2
socioeconomic status
J. Douglas Willms, "Literacy Skills of Canadian Youth"
Atlantic Centre for Policy Reseach in Education, University
of New Brunswick, October 21, 1996. Prepared for Statistics Canada.
09-087
Mental Health
Prevention vs Treatment
Michael Kirby’s report was
on diagnosis and treatment
This presentation will focus
on prevention.
09-069
Poor neurobiological
development in the first
stages of life affects
development in the later
stages.
09-068
Stages of Human Development
1. Conception to ages 6 to 8
2. Age 8 to age 14
3. Age 14 to age 18
Each stage affects the next stage
of the life course.
09-070
The development of the architecture and
function of the brain in the first stage
affects throughout the life course:
Health (physical and mental)
Learning (literacy)
Behaviour
08-039
Why do we care about brains?
The function of the billions of neurons
in your brain are differentiated by a
lifetime of experience.
Your brain affects health, learning, and
behaviour throughout the life course.
The most important time in experience
based brain development is in utero
and the first few years of life.
Kolb, U Lethbridge
08-026
What is experience?
The stimuli that you encounter both
pre- and post-natally as well as in later
stages…
Examples: sound, touch, vision, smell,
food, thoughts, drugs, injury, disease
etc.
Experience stimulates the neurons in
the brain through the different sensing
pathways and sets their functions.
Kolb, U Lethbridge
Does Experience have the Same Effects on
Neuron Development at Different Times in
Life?
08-029
No !
There are qualitative differences at different
stages of life.
There is something fundamentally different
prenatally vs infancy vs juvenile vs adult
(plasticity).
One difference is gene expression at different
stages of development (genotype [nature] vs
phenotype [nurture]).
Kolb, U Lethbridge
03-079
Vision and Hearing
Critical Period
Eye cataracts at birth prevent normal
development of vision neurons in the
occipital cortex.
Cochlear defects at birth and repeated
middle ear infections during infancy
impair hearing development.
09-085
Expression of Genes
How does experience get
under the skin to affect gene
function and neural
pathways?
07-169
Environment Affects Gene Function
(genotype [nature] versus phenotype [nurture])
Stimuli from environment affects biological
pathways that influence normal gene
function.
Epigenetics Methylation of cytosine in DNA
affects normal gene function
MicroRNAs affect gene messenger
RNA (mRNA) expression
07-123
Brain (neural) Pathways
“Higher levels of brain circuits depend on
precise, reliable information from lower
levels in order to accomplish their function.
Sensitive periods for development of lower
level circuits ends early in life (e.g. vision,
sound, etc).
High level circuits remain plastic for a
longer period.”
Knudsen 2004
07-001 Experience and Brain Architecture and Function
Early
Affects gene expression and neural pathways
Shapes emotion, regulates temperament and
social development
Shapes perceptual and cognitive ability
Shapes physical and mental health and behaviour
in adult life
Shapes physical activity (e.g. skiing, swimming,
etc.)
Shapes language and literacy capability
09-083
Language and Literacy
The development of language
is affected by language
exposure during early
development.
04-200
Early Child Development and Language
Starts early – first 7 months –
neurons differentiate language
sounds (e.g. English, Japanese)
Sets capability for mastering
multiple languages
Sets literacy and language learning
trajectory for the second and third
stages of development
02-001
Vocabulary Growth – First 3 Years
Word Exposure
Vocabulary
1200
High (SES)
Middle (SES)
600
Low (SES)
0
12
16
20 24
28 32 36
B. Hart & T. Risley, Meaningful Differences in Everyday
Age - Months Experiences of Young American Children, 1995
04-146
Test of Language Development
(TOLD) at Age 9
Correlation between vocabulary
growth at Age 3 and TOLD at
Age 9.
0.74
01-003
Human Brain Development –
Language and Cognition
Language
Sensing
Pathways
(vision, hearing)
-6
-3
3
0
Months
6
9
Higher
Cognitive Function
1
4
8
12
Years
16
AGE
C. Nelson, in From Neurons to Neighborhoods, 2000.
Math Scores, Ages 5-14
08-090
standardised mathematics score
(Low SES)
2
0
medians
-2
-4
5
6
8
10
12
14
Students’ age
Mean Score
NZ Council for Educational Research
Math Scores, Ages 5-14
08-089
standardised mathematics score
(High SES)
2
0
median
s
-2
5
6
8
10
12
14
Students’ age
Mean Score
NZ Council for Educational Research
New Zealand Education Study
Student Performance at Age 14
Highest Quartile
Lowest Quartile
at Age 5
at Age 5
Age 14
Above Median
Age 14
Below Median
Mathematics
87
91
Reading
94
85
NZ Council for Educational Research
07-105
Health, Behaviour and Limbic
HPA Pathway
Allostasis & Allostatic Load
(Stress)
03-002
Sensory
Stimuli
Prefrontal
Cortex
Amygdala
+
+
Hippocampus
Hypothalamus
-
-
PVN
Cortisol
Cortisol
CRF
PIT
ACTH
Adrenal
Cortex
LeDoux, Synaptic Self
05-212
Limbic HPA Pathway - Stress
Cortisol – Over Production
Behaviour (ADHD, violence), depression,
diabetes, malnutrition, cardiovascular disease,
obesity, memory, immune system, drug and
alcohol addiction
Cortisol – Under Production
Chronic fatigue syndrome, fibromyalgia, immune
system (autoimmune disorders) rheumatoid
arthritis, allergies, asthma
09-089
Poor Early Human Development
Depression
Cardiovascular disease
Inflammation
Danese 2008
05-056
Differences in stress reactivity of adult rats are
determined by maternal licking and grooming (LG)
during infancy
HIGH LG
LOW LG
Development of
Stress Reactivity
Modest Stress
Reactivity
Reduced Risk for Poor
Development & Disease
Increased Stress
Reactivity
Increased Risk for Heart
Disease, Type II Diabetes,
Alcoholism, Affective
Disorders, Brain Aging, etc.
M. Szyf
05-059
Methylation of Glucocorticoid Receptor
(GR) Gene in Hippocampus of Rats
Mean Methylation
1.2
0.8
Low (LG)
0.4
High (LG)
0
Embryo
Birth
Pup
Weaning
Adult
Day 20
Day 1
Day 6
Day 21
Day 90
Age
M. Szyf
05-213
Limbic HPA Pathway and Sensory
Experience in Early Life
Touch and other experiences in
the early period are critical
Rats – Mothers licking pups
Epigenetic effect
Monkeys – Peer vs mother rearing
Humans – Holding infants & talking
to them has an epigenetic effect
03-089
5-HTT Gene and Depression
Age 26
Depression
Risk
Length of normal gene
.70
S = Short Allele
L = Long Allele
SS
.50
SL
.30
LL
No Abuse
Moderate Abuse Severe Abuse
Early Childhood
A. Caspi, Science, 18 July 2003, Vol 301.
08-005
Mental Disorders
- Monozygotic Twins
For many mental disorders,
monozygotic twins (same
genotype) who are reared in the
same family are discordant
(different phenotype) as adults in
20% to 30% of the cases –
epigenetic effect.
Caspi, A. et al. & others. 2004.
09-084
Literacy, Poverty, Behaviour
and Health
08-022
Levels of Literacy:
A Reflection of ECD
Level 1: indicates persons with very poor skills.
Level 2: people can deal with material that
is simple.
Level 3: is considered a suitable minimum for
coping with the demands of everyday life.
Level 4: people who demonstrate command of
higher-order processing skills.
Level 5: competence in sophisticated reading
tasks, managing information and
critical thinking skills.
05-178
Literacy Levels for the Population
Ages 16 to 65 – USA
35
Prose
30
Document
25
Quantitative
20
15
10
5
0
1
2
3
Level
4
5
NALS, p. 17, 2002
05-173
Literacy Levels (Quantitative) and Physical,
Mental or Other Health Conditions – USA
60
Health Problems
50
Mental or Emotional
Problems
40
Long-term Illness
30
20
10
0
1
2
3
Level
4
5
NALS, p. 44, 2002
05-170
Percentages of Adults in Poverty,
by Literacy Level – USA (Prose)
1
Level
2
3
4
5
0
10
20
30
40
50
Percent
NALS, p. 61, 2002
03-116
THE EVIDENCE
ABOUT EARLY
CHILD
DEVELOPMENT
PROGRAMS
93-040
Mental Development of Undersized Children
(Low Height for Age) : The Jamaican Study
110
children of
normal height
105
development
quotient
stimulation &
supplement
stimulation
100
supplement
95
control
90
baseline 6 mo
12 mo
18 mo 24 mo
08-031
A “Natural” Experiment:
Romanian Orphan Adoption
Children adopted into middle class homes
after 8 months in the orphanages show at
11 years in contrast to children adopted
early within 4 months of birth:
1. Abnormal brain development (small brain,
low metabolic activity, abnormal EEG)
2. Social and cognitive problems (IQ loss)
3. High vulnerability to behavioural problems
(ADHD, aggression, quasi-autism)
Kolb, U Lethbridge
09-009
Bucharest Early Intervention Project
Foster parent care vs orphanage care
The children who were
youngest when placed in
foster parent care are
approaching normal, a
recovery that sadly does not
seem to be occurring in
children first placed in foster
care well after the age of 2.
C. Nelson, The Bucharest Early Intervention Project
04-153
Abecedarian Study – Reading
Effect Size
1.2
Special
Primary
Grades
Preschool
(4 mths to
School)
Preschool &
Special
Primary Grades
0.8
0.4
0
Age 8
Age 12
Age 15
Age at Testing
Age 21
Campbell & Ramey, 2002
COUNTRIES AND
HUMAN DEVELOPMENT
05-066
Grade 3 Language Scores
Argentina _ _ _ _ _ _ _ _
Brazil _ _ _ _ _ _ _ _ _ _
Chile _ _ _ _ _ _ _ _ _
Cuba _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mexico _ _ _ _ _ _ _
100
150
200
250
300
350
400
UNESCO, 1998
00-042
Sociocultural
Gradients for
Language
Scores
By Country
360
Cuba
320
Chile
280
Argentina
Brazil
Colombia
240
Mexico
200
1
4
8
12
Parents' Education (Years)
Willms & Somers, 2000
16
09-055
Cuban Early Development Programs
Polyclinics started 1970.
Daycare for working mothers –
about 20%
Program Educate Your Child
started 1993.
09-072
Health status in life is a measure
of brain development
09-033
1958 Birth Cohort
Birthweight and IQ
0.2
Mean IQ
0.1
0
-0.1
-0.2
-0.3
-0.4
<2.5
2.5-3.0
3.01-3.5
Birthweight (kg)
3.51-4.0
>4.0
Jefferis et al. 2002
09-073
Association Between Health and Education
Under 5 Mortality
rate
UNICEFyear 1990
Cuba
13
Chile
21
Argentina
29
Venezuela
33
Colombia
35
Paraguay
41
Mexico
46
Honduras
59
Brazil
60
65
Dominican
Rep.
Bolivia
125
1st UNESCO Study
study
4th
grade-Language
year 1998
349 Cuba
286 Chile
282 Argentina
277 Brazil
265 Colombia
252 Mexico
251 Paraguay
249 Venezuela
238 Honduras
233 Bolivia
232 Dominican
Socioeconomic Gradients for Adult
Document Literacy Scores (16 to 65)
06-114
Mean Scores
350
310
Intern’l Mean
U.S.
270
Canada
Australia
230
Sweden
Finland
190
Chile
0
3
5
7
9
11
13
15
Parents’ Education (years)
17
19
OECD, 2000
02-061
Document Literacy
1994 – 1998, Ages 16 to 65
Level 1 and 2
Sweden
Finland
Canada
Australia
United States
Chile
23%
37%
42%
43%
48%
85%
Level 4 and 5
34.0%
25.0%
23.0%
17.0%
18.0%
3.0%
OECD
09-078
“Mothers and Others” – Sarah Hrdy
“Unsettling is the finding that
15 percent of children in
normal middle class families
exhibit symptoms of
disorganized attachment.”
Hrdy, p. 289
04-230
Early Child Development
and Parenting Centres
Available from pregnancy to school entry
Provide support for parents
Learning parenting by doing
Provide non-parental care
Linked to Children’s Services as needed
Integrate with Education (human
development)
08-067
Creating Infrastructure for Early Child
Development and Parenting Centres
Support and fund high quality early
child development centres
Provide relevant education and training
for staff
Establish outcome measures
Establish whole-of-government
approach
Centres should be accessible,
available, and affordable for all families
08-066
Integration of Early Child Development
and Education (Human Development)
Sweden
Cuba
South Australia
Saskatchewan
09-035
Public Expenditure
Families with Children under 15
% GDP/capita
Sweden
Denmark
Finland
U.K.
Canada
USA
22.9
19.4
18.0
11.8
3.41
2.43
J. Lynch, 2006
09-037
Sweden GDP/capita US$28,100
Use of 0-6 program:
45% age 1-2 years
86-96% age 2-6 years
Canada GDP/capita US$30,700
Use of 0-6 program:
24% age 0-5 years have
access to regulated daycare
08-044
Sweden ECD (Preschool) and
Education Expenditure
Cost/Child
Preschool*
(age 1-6)
$15,000
Enrollment
2+ yrs >86%
(not compulsory)
Compulsory
Education
$10,500
Compulsory
(age 7-16)
* Maternal and parental paid leave 1-1/2 years
Skolverket 2006
07-157
Cost of Universal ECD-P Centres
Canada (0 to Grade 1)
Age 0 to 6 Population
Universal (2,100,000 children)
Not compulsory
Cost about $20.0 Billion per year (1.5%
of GDP)
(80 to 90% participation)
Present Expenditure 0.25% of GDP
07-158
Cost to Individuals and
Canadian Society of
Poor Early Child Development (estimates)
Crime and Violence
$120 Billion/year
Mental Health
Behaviour and
Drug Use
$100 Billion/year
World Health Organization
Michael Marmot
Inequalities in Health and
Development
Closing the Gap in a Generation
WHO, August 2008
WHO – Marmot Commission on
Social Determinants of Health
08-151
Chapter 5 – Equity from the Start
Recommendation 5.1:
WHO and UN Children’s Fund
(UNICEF) set up an interagency
mechanism to ensure policy coherence
for early child development such that,
across agencies, a comprehensive
approach to early child development is
acted on.
Recommendation 5.2
The Commission recommends that:
Governments build universal
coverage of a comprehensive
package of quality early child
development programmes and
services for children, mothers, and
other caregivers, regardless of ability
to pay.
WHO, August 2008
09-012
How can we persuade
Canadian society during this
economic change to invest in
the future quality of
Canadians to achieve equity
in human development and be
competitive in the new
knowledge based global
economy?
We know what to do and we
can afford it.
09-079
With Our Best Future in Mind
– Pascal report
Recommendation 1:
The province should create a
continuum of early learning, child
care, and family supports for
children from the prenatal period
through to adolescence, under the
leadership of the Minister of
Education.
Pascal, 2009
01-039
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