1 neuroscience of early childhood development & role of … · · 2017-01-04wiring the brain...

Neuroscience of Early Childhood

Development & Role of Parenting

Dr Patrick Ip

ICP 21

20 Oct 2016

1

Neuroscience of Brain Development

•Brain is changed by

experiences - early years

of life impacts on long

term outcomes (life course)

•Relationships program

socio-emotional function

development

2

Transactional model - Child Development

CONSTITUTION C1 C2 C3 C4 C5 etc

ENVIRONMENT E1 E2 E3 E4 E5 etc

How children (and adults) turn out is the outcome of

the transaction between biology and environment

3

Bio-ecological model of Development

• Children are shaped by their interactions with their parents, relatives, peers, teachers and other community members

•

• Critical periods during the

• course of brain development

• that differentially influence

• development of the body and

• mind

4

Critical Periods

• In the 1st year of life, the brain grows at a pace of 700-1000 new neural connections per second.

• By age 3, a child’s brain is twice as active as an adult brain

• It is Early Life Experiences that determine the capacity of the brain – its structure and function

5

What science is telling us ?

Our earliest experiences are responsible for literally wiring the brain for future use, therefore building its basic architecture

During its period of greatest growth - from before birth to ~ three - the cerebral cortex is adding an astounding 40,000 synaptic connections every sec

Dendrites Nucleus

Axon

Electrical

signal

Neurotransmitter

chemical contained

in vesicles

Synap

se

Brain Facts

You are born with 100

billion neurons, but

these are largely

unconnected and not

networked

Synapses are produced at the rate of 1.8 million per second between 2 months and

2 years!

Each neuron forms about 1,500 synapses

You have more

than 2 million miles

of neuronal fibres

By the age of 2 a child has as many synapses as an adult but this has doubled by the age of 3

By late adolescence half the

synapses in the brain have

been discarded

Stress induced

neurochemicals lead to

cell death in a tender brain Neglect may cause

unused regions to

atrophy - apopsis

When signal transmission reaches a

certain threshold the synapses

involved become exempt from future

elimination

Myelination begins in the brain

stem and cortex and progresses

to higher order regions of

thought, memories & feelings

By the age of 3, the brain

has reached 90% of adult

size

The brain continues to

grow & develop until mid

20’s but remember

plasticity

Plasticity –the ability to adopt and adapt to stimulus

Neuronal networks are continuously shaped by genetic, environmental and experiential stimulus and strengthened

through repetition

* Brain plasticity reduces as we age

Our Brains

• During the first few years of life the brain becomes organised i.e. the brain changes in response to stimulation.

• Neurons which were unconnected at birth become connected

• Neurons which are not stimulated are lost

• Lack of stimulation and profound neglect alters and reduces the brain’s functioning

• Assaults and toxins can damage brains cells, resulting in difficulties associated with the area affected.

26 November 2013 Masters BSU

海馬體

下視丘

杏仁核

新皮層

基底核

Brain Functions by Region

Brain Region

Age of Greatest

Developmental

activity

Age of

Functional

Maturity

key Functions

Neocortex

(Forebrain)

Childhood

Adult

Reasoning, problem-

solving, abstraction,

secondary sensory

integration

Limbic

(Forebrain)

邊緣系統

Early

childhood

Puberty

Memory, emotional

regulation, attachment,

affect regulation, primary

sensory integration

Diencephalon(Forebrain)

Infancy

Childhood

Motor control, secondary

sensory processing

Brainstem.

(Mid and

Hindbrain)

In utero

Infancy

Core physiological

reflexes and state

regulation, primary

sensory processing

Synaptogenesis & Apoptosis – developing, tuning and pruning our neuronal networks

• We are born with many more neurons than

we will ever need • Genes, environment & experience effect the

density of the neuronal networks • As we develop and grow some networks are

pruned e.g. babies are tuned into every human sound but gradually

“prune” out the ones not needed or used for their “mother tongue”

‘Use it or loose it’, ‘Neurons that fire together wire together’

Parental-Infant Attachment

• Children form emotional attachments to parents and caregivers in early life

• When caregivers are sensitive and responsive to child’s needs, they provide a secure base to explore the world

• Contributes to later emotional and cognitive development and future interpersonal relationships

14

Early Years Matter

• Windows of opportunity

• Patterns of early caregiving matters

• Across species similar bio-behavioural systems are involved in parenting

15

Oxytocin System

• Oxytocin (催產素) and vasopressin (升壓素): • two neuropeptides that are synthesized and

released from the hypothalamus (下視丘)

• Key elements in the neurobiology of attachment and bonding

16

Biology of Parent-Child Bonding

• High levels of oxytocin are associated with responsive affectionate caregiving

• More securely attached individuals as adults show an increased reward response to being with their child, and less of an averse reaction to hearing the baby’s cries

• Parenting begets parenting

17

Adverse Childhood Experience (ACE)

• An ACE is a traumatic experience in a person’s life as a child and adolescent

• Child abuse (emotional, physical, or sexual), child neglect (emotional or physical), and household dysfunction (domestic violence, substance abuse, mental illness, teenage pregnancy)

18

Number of Risk Factors

Source: Barth et al. (2008)

Ch

ild

ren

wit

h

Develo

pm

en

tal D

ela

ys

1-2 3 5 4 6 7

20%

40%

60%

80%

100%

損害智能發展

Significant Adversity Impairs Development in first 3 years

19

Risk Factors for Adult Depression are Embedded in Adverse Childhood Experiences

Od

ds R

ati

o

ACEs Source: Chapman et al, 2004

0 1 2 3 4 5+

1

2

4

3

5

Elevated risk for Depression

20

Adverse Experiences Source: Dong et al, 2004

Od

ds R

ato

0 1 2 3 4 5,6 7,8

0.5

1

1.5

2

2.5

3

3.5

增加心臟病風險

Risk Factors for Adult Heart Disease Are Embedded in Adverse Childhood Experience

21

(Published on 4 Oct 2016)

A Better Brain and Body

• Parenting provides a legacy that transcends genes

• It has a direct impact on: • Brain

(interconnectedness of brain regions, epigenetics)

• Physical health (metabolism, telomere length)

23

Better Brains and Bodies

• Early Child Development programs aimed at enhancing responsive parenting can:

• Reduce the number of adverse childhood experiences

• Positively impact:

• Brain structure and function,

• Hormonal and immune systems

• DNA is read and transcribed

24

Generation to Generation

Parenting Begets Parenting:

• Growing body of scientific literature that

indicates that an important predictor of

parenting behaviour is how parents were

parented themselves

• This reality has the potential to create

vicious or virtuous cycles

25

Responsive Parenting

• Responsive Parenting occurs when:

• parents do their best to invest in their children

• meet children’s physical, nutritional, emotional and cognitive needs during pregnancy and the early years

26

Resilience

• Early childhood adversity and poor parenting can set

the stage for a vicious cycle

• Intergenerational transmission of poor parenting

• Resilience: in many cases, parents who experienced adversity as a child, including physical abuse, will not adopt the same pattern of behaviour with their child

27

The Economic Dimension

• Positive results of prospective longitudinal studies

• Economic benefits also support the value to society of parent-child interventions in the early preschool years

28

年齡

人類資本投資回報

學前計劃

學校教育

職業訓練

Interpreting the Evidence on Life Cycle Skill Formation Heckman et al 2005,

30

Parental & Societal Expectation

What do we want from our children?

•Excellent academic performance

•Good career prospect

•Good health

•Positive holistic development

(physical, mental, emotional)

31

Early Child Development in Hong Kong

32

Early Development Instrument (EDI)

• A population measure of school readiness and holistic development of young children:

• (a) Physical health and well-being

• (b) Social competence

• (c) Emotional maturity

• (d) Language and cognitive development

• (e) Communication skills and general knowledge

33

(Hong Kong)

34

Objectives

• to adapt and validate the Chinese Early Development Instrument (CEDI), which would serve as a useful tool for studying school readiness among Chinese children population

• to investigate the socioeconomic gradients in school readiness of Chinese preschool children

in relation to family SES, contextual effect, and

family processes

35

Training of Teachers

• In the main study, the validated Chinese version of Early

Development Instruments (CEDI) were collected from

567 kindergarten children of 21 kindergartens located in

two districts with dramatically different socioeconomic

characteristics in Hong Kong, Yuen Long & HK Island

38

Main study findings

• Existence of socioeconomic gradient

• On average, for one unit increment in SES

(one standard deviation) would increase the

total CEDI scores by 0.69

• The evidence provided support to the inequalities within kindergarten classes associated with family SES

40

The Early Development of Children

from Different Socioeconomic

Backgrounds in Hong Kong

Socioeconomic Gradients p<0.01 p<0.05

41

Family SES School Readiness

Parent-child

Interaction

Teachers’ Average

Teaching Experience

Number of

Special Facilities

0.22 (0.04) *** 0.77 (0.25) **

0.14 (0.24)

0.20 (0.05) ***

0.33 (0.11) **

0.49 (0.20) *

0.23 (0.09) **

Family-level

Indirect effect = 0.17 (0.07)

p-value = 0.01

Mediation proportion = 35.6%

Kindergarten-level

Indirect effect = 0.18 (0.06)

p-value = 0.004

Mediation proportion = 36.3%

42

Mediating effects of Family and Kindergarten

• Mediating effect of

Family processes (i.e.

frequency of parent-

child interactions and

management of child

digital use at home) in

explaining

socioeconomic gradients

in child developmental

outcomes

• Kindergarten level

variables (annual school

fees, teacher education

background and

working experience) as

important mediators

which accounted for

significant proportion of

variance in the total

CEDI score

Double jeopardy !!

43

The importance of parent-child interaction

• Collaborative study with Prof James Heckman

• Aims to show the importance of parent-child interaction relative to family income and other SES indicators

44

The importance of parent-child interaction

45

Recreation-based parent-child interaction has better

predictive performance than SES

Sleep & Early Child Development

• Sleep has been identified as the most important period of a day affecting growth and development

• Detrimental effects of insufficient sleep on adolescent health well documented (AAP 2005)

46

Knowledge Gap

• Would sleep affects the early development of children?

• The first study of such on the relationship between sleep duration and school readiness of preschool children

• 567 K3 Chinese children (~5 year old) recruited

48

Sleep duration categorisation

• Age-Specific Recommendations: • NHS: 11 hours

• NIH: 11-12 hours

• Sleep duration was categorized into:

n %

<9 hours 100 18.0

9-10 hours 390 70.1

11-12 hours 61 11.0

>12 hours 2 .4

Effective total 553 (out 556 samples) 99.5

50

Sleep Duration of Hong Kong Preschool Children

51

School Readiness vs Insufficient Sleep

52

Adjusted for family SES

School Readiness vs Sleep Deprivation


53

Prosocial Behaviour

54


Hyperactivity and inattention

55


Sleep duration of children

• Associated with better family functioning • more parent-child activities

• higher family SES

• Negatively associated with the use of electronic devices

56

Sleep and Child Development

• Children are most ready for school when they have optimal sleep duration

• The less hours children sleep, the lower are their school readiness; this is particularly true for children from wealthy families

• Sleep deprivation in children increases risk of vulnerability in school readiness

57

Longitudinal Association between Sleep and Risk of ADHD

58

ADHD risk and early sleep deprivation

59

Adjusted for baseline SES, OSA diagnosis, frequent snoring, and methylphenidate use

ADHD risk and sleep deprivation at P3

60

Adjusted for baseline SES, OSA diagnosis, frequent snoring, and methylphenidate use

ADHD symptom severity

ADHD symptom score

β (95% CI) P

Sleep duration in K3

<8 hours 0.76 ( 0.10, 1.41) *

8 to <9 hours 0.41 ( 0.04, 0.79) *

9 to <11 hours 0.23 (-0.08, 0.54)

11 to 12 hours 0 (Reference)

Sleep duration in P3

<8 hours 0.20 (-0.07, 0.46)

8 to <10 hours 0.11 (-0.11, 0.33)

≥10 hours 0 (Reference)

Days with regular sleep pattern in P3

0–3 days/week 0.39 ( 0.03, 0.74) *

4–5 days/week 0.30 (-0.03, 0.64)

6–7 days/week 0 (Reference)

Days with good quality sleep in P3

0–3 days/week 0.34 ( 0.10, 0.58) **

4–5 days/week 0.04 (-0.18, 0.26)

6–7 days/week 0 (Reference)

61

Gender differences

ADHD symptom severity

Female (n=204) Male (n=197)

β (95% CI) P β (95% CI) P


<8 hours 0.63 (-0.20, 1.47) 0.83 (-0.17, 1.83)

8 to <9 hours 0.12 (-0.38, 0.62) 0.66 ( 0.11, 1.22) *

9 to <11 hours 0.04 (-0.35, 0.44) 0.49 ( 0.02, 0.96) *

11 to 12 hours 0 (Reference) 0 (Reference)


≤8 hours 0.27 (-0.07, 0.60) 0.11 (-0.31, 0.52)

>8 to <10 hours 0.08 (-0.19, 0.35) 0.14 (-0.20, 0.48)

≥10 hours 0 (Reference) 0 (Reference)

Days with regular sleep pattern in P3

0–3 days/week 0.32 (-0.17, 0.80) 0.64 ( 0.13, 1.14) *

4–5 days/week 0.25 (-0.23, 0.72) 0.49 ( 0.01, 0.96) *

6–7 days/week 0 (Reference) 0 (Reference)

Days with good quality sleep in P3

0–3 days/week 0.39 ( 0.09, 0.69) * 0.32 (-0.05, 0.69)

62

Longitudinal Association between Sleep and Risk of Mental Disorder

63

Risk of mental disorder and sleep deprivation in K3

64

Adjusted for baseline SES, gender, and socio-emotional development at K3

Potential mental disorder screened using SDQ with 53% sensitivity and 89% specificity against clinical diagnosis

Risk of mental disorder and sleep deprivation in P3

65

Adjusted for baseline SES, gender, and socio-emotional development at K3

Potential mental disorder screened using SDQ with 53% sensitivity and 89% specificity against clinical diagnosis

Subdomain problems

66

β (95% CI) P β (95% CI) P β (95% CI) P β (95% CI) P β (95% CI) P


<8 hours/day 4.60 (1.19, 17.82) * 3.26 (0.72, 14.70) 4.44 (1.10, 17.90) * 1.99 (0.54, 7.43) 4.36 (1.11, 17.10) *

8 to < 9 hours/day 2.78 (0.89, 8.65) 1.97 (0.58, 6.63) 1.65 (0.48, 5.65) 1.35 (0.51, 3.57) 2.31 (0.72, 7.41)

9 to <11 hours/day 3.37 (1.19, 9.59) * 1.70 (0.56, 5.15) 2.08 (0.70, 6.16) 1.35 (0.58, 3.17) 1.95 (0.66, 5.71)

11 to 12 hours/day 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)


≤8 hours/day 1.89 (1.10, 3.26) * 1.20 (0.55, 2.61) 1.79 (0.92, 3.50) 1.89 (1.02, 3.50) * 1.57 (0.74, 3.34)

>8 to <10 hours/day 1.47 (0.90, 2.39) 1.51 (0.81, 2.79) 1.30 (0.72, 2.37) 1.21 (0.69, 2.13) 1.91 (1.04, 3.53) *

≥10 hours/day 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)

Regular sleep pattern in P3

0-3 days/week 3.19 (1.10, 9.27) * 2.20 (0.71, 6.77) 1.89 (0.61, 5.83) 6.60 (1.10, 39.55) * 3.01 (0.79, 11.38)

4-5 days/week 2.87 (1.00, 8.19) 1.14 (0.36, 3.56) 1.56 (0.51, 4.75) 5.73 (0.96, 34.08) 2.10 (0.56, 7.92)

6-7 days/week 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)

Good quality sleep in P3

0-3 days/week 1.07 (0.67, 1.71) 2.75 (1.46, 5.18) ** 3.53 (1.83, 6.81) *** 2.33 (1.35, 4.01) ** 2.51 (1.43, 4.40) **

4-5 days/week 0.94 (0.59, 1.48) 1.43 (0.72, 2.87) 2.21 (1.12, 4.38) * 1.29 (0.71, 2.34) 0.97 (0.49, 1.91)

6-7 days/week 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)

Prosocial Peer problems Emotional problems Conduct problems Hyperactivity

Mental well-being and sleep deprivation in K3

67

Adjusted for baseline SES, gender, and early childhood socio-emotional development at K3

Prosocial, internalising, and externalising behaviours

68

β (95% CI) P β (95% CI) P β (95% CI) P


<9 hours/day -1.10 (-1.88, -0.33) ** 1.48 ( 0.22, 2.73) * 1.23 (-0.13, 2.58)

9 to <11 hours/day -0.89 (-1.54, -0.24) ** 1.08 ( 0.01, 2.16) * 0.66 (-0.50, 1.81)

11 to 12 hours/day 0 (Reference) 0 (Reference) 0 (Reference)


≤8 hours/day -0.95 (-1.50, -0.39) *** 0.74 (-0.18, 1.65) 1.43 ( 0.44, 2.41) **

>8 to <10 hours/day -0.48 (-0.93, -0.02) * -0.09 (-0.83, 0.66) 0.54 (-0.26, 1.34)

≥10 hours/day 0 (Reference) 0 (Reference) 0 (Reference)

Regular sleep pattern in P3

0-3 days/week -0.74 (-1.47, -0.01) * 1.27 ( 0.10, 2.45) * 2.24 ( 0.96, 3.52) ***

4-5 days/week -0.50 (-1.21, 0.20) 0.11 (-1.01, 1.24) 1.61 ( 0.38, 2.84) *

6-7 days/week 0 (Reference) 0 (Reference) 0 (Reference)

Good quality sleep in P3

0-3 days/week -0.44 (-0.95, 0.06) 1.92 ( 1.12, 2.72) *** 1.99 ( 1.13, 2.85) ***

4-5 days/week -0.07 (-0.54, 0.39) 1.11 ( 0.38, 1.85) ** 0.36 (-0.44, 1.15)

6-7 days/week 0 (Reference) 0 (Reference) 0 (Reference)

Prosocial behaviors Internalising behaviours Externalising behaviours

Adjusted for baseline SES, gender, and early childhood socio-emotional development at K3

Summary

• Sleep deprivation in early childhood (~5 years) is a prominent risk factor for early child development • Lowered school readiness

• More symptoms in inattention and hyperactivity

• Less prosocial behaviour

• Even more alarming is the potential impact in middle childhood (~9 years) • Elevated risk in ADHD

• Poorer mental health

• Less prosocial behaviour

69

Ownership of Electronic Devices – Hong Kong Children (Preschool K3)

70

Time spent on Electronic Devices

71

ED in bedroom and School Readiness

Any ED in bedroom

β (95% CI) P

Physical -0.12 (-0.26, 0.01)

Social -0.29 (-0.50, -0.08) **

Emotional -0.19 (-0.35, -0.03) *

Language / Cognitive -0.24 (-0.39, -0.10) **

Communication / General -0.26 (-0.50, -0.03) *

Total -1.11 (-1.80, -0.42) **

72

Effect of Electronic Device in bedroom influenced by SES

73

Effect of ED in bedroom influenced by parental mediation

74

The Gap Between the Rich and the Poor -

From School Readiness to School Success

Longitudinal study

(CEDI Cohort)

75

Time spent on Electronic Device

76

Academic performance and ED

77

Adjusted for baseline SES, age, and gender

ED placed in bedroom and time spent on ED

SES and time spent on ED

78

Time spent on ED and academic performance

79

Academic performance and ED

80

Adjusted for baseline SES, age, and gender

Parental mediation

Academic performance and parental mediation

81

Psychosocial wellbeing and ED

82

Physical activity in preschool improves ADHD risk in middle childhood

83

Adjusted for gender and family SES

Physical activity in preschool improves Psychosocial well-being in middle childhood

84

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

Re

lati

ve

z-s

co

re

Parent-child Physical Activity (Time/week)

Conduct problems Peer problems Prosocial behaviours

0-2 3-4 >4 0-2 3-4 >4 0-2 3-4 >4

Adjusted for gender and family SES

The Gap Between the Rich and the Poor -

From School Readiness to School Success

Longitudinal study

(CEDI Cohort)

85

Cohort studies

Pros

• Reverse causation unlikely (compared to cross-sectional study)

• Ethical issues unlikely (compared to RCT)

86

Well-designed cohort studies are regarded as the most rigourous and useful among observational studies.

Gordis, L. (2009). Epidemiology (4th Ed.). Philadelphia: Saunders.

Objectives

• To study the existence and magnitude of the socioeconomic gap in school success (academic achievement and psychosocial outcomes) in primary school (P3)

• To study the extent to which the school readiness of preschoolers (K3) predicts their school success in P3

87

Objectives

• To examine the extent to which the socioeconomic gap observed in K3 is attenuated or intensified during formal schooling

• To investigate the dynamic of changes in gaps at the two time points in relation to family process related factors (e.g., parenting styles and the home learning environment)

88

First study in Hong Kong to provide longitudinal data on: (i) the link between school readiness at kindergarten and academic success in primary school; (ii) the changes in achievement gap between the rich and poor

89

Academic Performance by District

Hong Kong Island Yuen Long Comparison

Mean SD Mean SD Difference p

Mathematics Total 92.4 4.9 81.3 16.6 11.1 <0.001

Chinese Total 82.5 8.9 71.3 17.8 11.2 <0.001 Reading 87.2 10.8 80.0 16.6 7.2 0.013

Writing 80.4 9.9 67.5 20.2 12.9 <0.001

0

10

20

30

40

50

60

70

80

90

100

Mathematics Total

Chinese Total Reading Writing

Hong Kong Island

Yuen Long

90

Academic Performance by Family SES

p<0.0001 p<0.0001

Family SES index = composite index of family income,

paternal/maternal occupation and education

91

Psychosocial wellbeing by Family SES

92

P=0.0008

The widening socioeconomic gap in

Cognitive Performance

93

The consistent socioeconomic gap in

Psychosocial Development

94

Mechanism of longitudinal cognitive disparity

95

Low SES Cognitive function

Early prolonged exposure to ED

Learning Environment

+

-

-

+

Optimal Learning Environment

• An optimal learning environment not just include academic tutorials, but also: • Reading extra-curricular books

• Playing musical instruments

• Visiting museums

• Freeplay in park/playground

• Outdoor activities, etc.

• Parental activities: reading together, discussing school matters, etc.

• Overemphasis of academic performance does not lead to a better academic performance

96

Mechanism of longitudinal psychosocial disparity

97

K3 SES Cognitive function

Early prolonged exposure to ED

Authoritarian parenting

Sleep quality

Regular sleep pattern

Physical activity

+ -

+ -

- +

- +

- +

Authoritative parenting - +

Two traits of parenting styles for Chinese

• Authoritarian (專制) • Authoritarian parents value obedience, favour punitive and

forceful measures, believe children should accept their parents’ word for what is right, and do not encourage verbal give and take (Baumrind, 1989).

• Authoritative (權威) • Authoritative parents (Baumrind, 1971, 1989, 1996) attempt to

direct children’s activities in a rational, issue-oriented manner. They reason with their children, facilitate verbal give and take (Baumrind, 1989), and encourage children to think independently and to respond in prosocial ways (Baumrind, 1996).

98

Wu et al (2002)

Authoritarian parenting and child development

Academic performance Psychosocial well-being

99

P=0.02 P<0.001


Authoritative parenting and child development

Academic performance Psychosocial well-being

100

P=0.52 P=0.004


Summary

• Both neuroscience and epidemiological studies tell us the importance of parenting, particularly in early childhood

• Both parenting style (positive & non-authoritarian) and parent-child activities (recreation & multi-exposure) are essential for academic performance and psychosocial well-being

• Parents need to be cautious of other behavioural risk factors: • Early exposure of electronic devices

• Sleep deprivation

101

Inter-discipline

Collaboration

Parents

HA MCHC

Child

Development

School

Community

Health

DH

102

1 neuroscience of early childhood development & role of … · · 2017-01-04wiring the brain...

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