My name is Mark Frankel. I am on staff here at AAAS, I direct a program
called Scientific Responsibility, Human Rights, and Law, so that means we deal with a lot
of issues from the point of view of ethics law and human rights and the issues that advances
in science and technology raise. This is the second event under the series
we called Neuroscience And Society and I'm delighted you're here. As you can see, the title is From Birth to
Two: Prepping For Life. We have an excellent group of speakers to
present on that topic. Unfortunately, none of the infants we invited
were able to attend. They had conflicting schedules as I understand
at about this time, but who among us is not infatuated by basis? Like me, you've probably taken a long hard
look at an infant and said to yourself, " I'd give much more than a penny for her thoughts." What are they thinking? What do they see? I think I expect us to gain some insight into
that question tonight and I wanna tell you a little bit about how we're going to proceed,
but I do wanna tell you and remind you that this is a partnership, these series between
AAAS and the Dana Foundation. I wanna thank and acknowledge the Dana Foundation
for its support and for its help in planning of the sessions that we have during the course
of the year. We will post on our website more information
about the next two in terms of dates and topics, but I can tell you at least this. The one in September will be on mental health
across the age spectrum, going from children, adolescents to midlife, to the elderly. Then, our final one of the season will be
on genius and creativity and I can't tell you much more than that at this point in time. We haven't been creative enough to put the
program together. So, since the infants are not well-represented
tonight, I want to speak for them by quoting from and even adding to something called the
Toddlers Creed. It was authored by a child psychologist, Burton
White. Anybody familiar with it? Does it resonate? Well, let me read it to you, maybe it'll resonate
as I read it, so it goes like this, " If I want it, it's mine. If I give it to you and change my mind, it's
mine. If I can take it away from you, it's mine. If I had it a little while ago, it's mine. If it's mine, it will never belong to anyone
else, no matter what. If we're building something together, all
the pieces are mine. If it looks like mine, it's mine." Here's my addition, "If you think it's yours,
think again. It's mine." So, having spoken for the toddlers, I do wanna
bring your attention to the photos here. These are not your ordinary internet photo
stock pics, these are members of the AAAS family. This young man over here, his name's Tyler,
he's obviously not a very happy boy at the moment, is the grandson of one of my colleagues
here, Debbie Runkle. Debbie is here. Raise your hand, Debbie. There she is. The proud grandmother of Tyler and this fellow,
who is smiling, and I wish I could tell you that the reason he's smiling is because I'm
standing in front of him, but that's my grandson, Max, who will be two years old this Sunday. So, this is a wonderful session and in one
sense I wish he were here. In another sense, I'm glad he isn't. Alright. Now, to our program for the evening. You have programs, so I'm not gonna go into
a lot of detail in introducing our speakers, so that we can get on with the substantive
issues. After each of them, after all three have spoken,
I'm gonna ask them to come back up, sit in those chairs over there. We'll have a little conversation. I'll moderate that and then, we'll open it
up to all of you. We have microphones on the sides, both aisles,
and invite your questions or reactions to what they have to say. Let's see. What else? I think, one other thing, after we're through
with the program, which will be 7:00 and 7:15, we'll go outside the auditorium. There'll be a reception and you'll have an
opportunity to talk again, maybe a one-on-one with the speakers. As they present, they'll be joining us as
well, so let's get on with our program. Our first speaker is Doctor Pat Levitt who's
the Simms/Mann Chair in Developmental Neurogenetics at the Institute for Developing Mind at Children's
Hospital Los Angeles and the W.M. Keck Provost Professor of Neurogenetics at
the Keck School of Medicine at the University of Souther California. Among his accomplishments, I'm most pleased
to highlight, given where we are and the sponsorship of this program, that he's an elected member
of the Dana Alliance for Brain Initiatives and also, an elected fellow of AAAS. So, he will set the stage for the evening
program by discussing some of the factors that influence postnatal infant development,
including the interaction of genetics and the environment. So, please join me in welcoming Doctor Levitt. Thank you, appreciate it. I've got them. Can you hear me? That's good? I'm not making a phone call, I'm just setting
my timer. It's 6:00. We're not gonna end at 7:00. I'm just pointing that out. Okay, so I gotta do this. Sorry about that and here we go. I took a video. Somebody's gonna switch that computer. I took a video of the rain, I live in Los
Angeles and I literally have forgotten what it actually looks like, but the taxi driver,
who drove me three blocks over here from the hotel, told me that's what it was. Okay, exactly. Okay, there we go. So, this is what the public sees, policymakers
see, and others, and the community see about how children develop. Now, see here are the factors. There's fate, there's free will, there's parents,
there's genes, but we don't really know what they do in terms of doing anything, the brain,
and the child developmental environment, they go into this thing that we typically identify
as a black box, that may be the case in terms of toddlers and adolescents. You either get a successful child or an unsuccessful
child and that's the narrative that is prominent, but I think things are changing because I
think that, in general, we've figured out much better ways of communicating the science. I'm part of the National Scientific Council
on the Developing Child. Essentially, it's a group of scientists, neuroscientists,
developmental psychologists, two pediatricians, economists figuring out how to talk about
early brain and child development. So, I'm gonna give you both common misconceptions
and the core story, which you're going to hear from the other speakers. So, here's some common misconceptions about
child development that I even heard this week. Okay, children are ... anybody wanna guess? Sponges. Does anyone believe that? Get out. Now. Okay, 80% of brain development occurs by three. No. Has anybody ever interacted with a preadolescent
or an adolescent? If you believe that 80% of brain development
is done before that time, right? We're in big, big, big, big trouble. Bad stuff happens. You just have to have rugged individualism,
that's actually a cultural narrative in the United States. It's problematic because resilience is not
about rugged individualism, being able to bounce back from adversity, but, actually,
skillsets that we'll talk about in a minute. Then, ready-to-learn is all about, right,
cognitive development, but you'll see that social, emotional, and cognitive development
are inexplicably intertwined. You're gonna hear more about that, so the
core story of development is the following: how development is the foundation of prosperous
communities, brains are built over time from the bottom up. So, skill begets skill. Basic skills beget more complex skills, that
means that basic circuits that underlie function are actually built first before more complex
circuits are laid down in the brain. The process starts prenatally, but I'm not
allowed to talk about prenatal development. But, I can only start at birth. Genes and experience together build brains
and, in particular, because humans [inaudible], which are social creatures. Humans are very, very social creatures, that
interactions that drive those experiences are so critical in terms of brain development
in all domains, not just in social behavior, but in cognitive development as well. I will re-mention this after inextricably
intertwined, that's hard for me to say. I'm from New Jersey. Toxic stress, I'll talk about a little bit,
damages brain architecture. There's real biological effects, which are
in my early adversity abuse and neglect and I won't mention this again, but neglect, according
to Health and Human Services and CDC, neglect, frankly, neglect is actually comprised of
what we define as early adversity for birth through five years of age, which surprise
a lot of people. Again, resilience is not an internal character
strength, but, rather, is built through combined impact of genes and environment. I'm building skillsets just like we build
skillsets for our sensory and motor functions. These are skillsets that can be built. For many functions, the brain capacity for
change decreases over time, but the brain doesn't develop synchronously. All skillsets don't come onboard at the same
time, right? So, some things are onboard very early, and
are patterned, and are gonna function just like they are in the adult, very, very early. Others take quite a long period of time to
develop, such as executive function, which I'll talk about in a minute as well. So, our genes and ultimately developing brain
architecture influence powerfully by positive early experiences and negative one as well. So, what the brain is fantastic at and it's
why I became a developmental neurobiologist is that it builds a structure with a lot of
genetic information. We have 22,000 genes in our genome and we
use all of them in the brain during development. They're literally all expressed at some point
period of time during brain development. The blueprint is laid down, but it uses experience
to further its own development, which is really quite remarkable when you think about it. So, it takes in information and utilizes that. It lays down circumstances to prepare the
organism to be able to deal with what it thinks the organism is gonna have to manage with
later on in life. I'll give you a few examples of why that is
the case and then, an analogy would be genes provide the hardware, but early experiences
is a software that drives the system. But, keep in mind that genes are not immutable. Genes are regulated by experience. They turn on and off based on the experiences
based off the individual and I think that's really an important concept to think about
in terms of development. So, if you look at the structure of the cerebral
cortex, which is where all the higher functions occur, it expands most dramatically in primates
compared to other vertebrates. Those are brain cells, beautiful drawings
of brain cells actually done by Dominick Purpura at Albert Einstein College of Medicine and
the same is for this display, how the brain changes over time, that's what it looks like
in a newborn. The same number of neurons are here in this
picture. It's an optical illusion. What happens is that the number of neurons
are not added. Those are all set by birth except for a few,
very limited areas that continue to add neurons. I'm not gonna talk about those, but almost
all the neurons we have are already there before birth, right? What happens is that the neurons grow and
they make connections to form the circuits that underlie the behaviors that we're interested
in. This is what it looks like at six months and
this is what it looks like at two years old, so the two-year-old who's quite obstinate
has a lot of brain cells to be able to do the kinds of things that you talked about,
Mark. So, if you look at what happens between birth
and puberty, this is what happens. Now, it's not a fourteen-year-old is in a
degenerative mode. Some people look at it and say, "Now, I understand
that teenager." But, it turns out that we make about 40% more
nerve connections than we end up with. We get rid off, just like in your garden. If you're at your garden, you get rid of the
connections that are not used through this experience-dependent process. We'll talk more about that. A child's experiences during the earliest
years of life have a lasting impact on the architecture of the developing brain. Genes provide the basic blueprint, but experiences
shape the process that determines whether a child's brain will provide a strong or weak
foundation for all future learning, behavior, and health. During this important period of brain development,
billions of brain cells called neurons send electrical signals to communicate with each
other. These connections form circuits that become
the basic foundation of brain architecture. Circuits and connections proliferate at a
rapid pace and are reinforced through repeated use. Our experiences and environment dictate which
circuits and connections get more use. Connections that are used more grow stronger
and more permanent. Meanwhile, connections that are used less
fade away through a normal process called pruning. Well-used circuits create lightning-fast pathways
for neuro-signals to travel across regions of the brain. Simple circuits form first, providing a foundation
for more complex circuits to build on later. Through this process, neurons form strong
circuits and connections for emotions, motor skills, behavioral control, logic, language,
and memory during the early critical period of development. With repeated use, these circuits become more
efficient and connect to other areas of the brain more rapidly. While they originate in specific areas of
the brain, the circuits are interconnected. You can't have one type of skill without the
others to support it. Like building a house, everything is connected
and what comes first forms a foundation for all that comes later. So, you just needed to hear that video. I didn't have to talk for the first set of
minutes, so remember the following. Development's not a blank slate. There's already a foundation laid at birth
and that foundation of brain connections are really established to be able to allow the
infant to begin to interact with its environment and have experiences in a very meaningful
way. So, you'll hear much more about specific milestones
of infant and toddler development, but, essentially, sensory systems are mapped and set up very
early. Why? Because, the only way for the infant to be
able to interact with its environment and understand experience and gain experience
is through using sensory modalities, so visual, auditory, tactile, somatosensory, olfactory,
all of those are established very early. There are critical periods of experience that
require in order to set up the auditory maps as well as the visual maps. For example, if a child is born with a lazy
eye amblyopia, there's a period of time during which we can correct that because the brain
is plastic enough to be able to change the connections. So, sensory circuits form first followed by
motor and language and then, higher cognitive function, you can see, take a much longer
period of time to develop. Something as complicated as executive function,
which you've heard about, and the components that make up executive function that are listed
here take a much longer period of time to develop through adolescence into early adulthood. Notice, because I'm older, I refuse to have
this line draw, so executive function takes a long time to build their skillsets that
have to do with this. In fact, education systems and other systems
are recognizing how important these elements are in terms of building the brain in a way
that allows an individual to be emotionally regulated, a problem solver, and somebody
who can be productive in society. So, here's the culprit. This is how nerve cells communicate with each
other. It's called the synapse and I'll show you
the curvable ... people think that brain development is done at about the age of two because about
80% of the synapses that we're gonna build end up being put together by the age of two,
that's what it looks like. Isn't this gorgeous? Isn't it amazing? These beautiful little circles here are vesicles
that contain little neurotransmitters. You've heard of some of them like dopamine,
the reward transmitter, serotonin, acetylcholine. The neurotransmitters are used to communicate
from one nerve cell to another. Over time, this is what the curve looks like
between the ages of ... starts in the third trimester between the ages of birth and about
two to three years of age. We get up to our plateau. If you count how long it takes to get here,
which is pretty fast, it's about 700 synapses that are being made in the cerebral cortex
of an infant per second. So, snap your fingers. Snap your fingers, that's seven ... okay,
so that's ... you're watching it in ... you're watching your grandson. He's about done, he's two years old, he's
got about three more days of these synapses. This plateau doesn't mean that nothing's going
on. It just means that the net change in the numbers
of those synapses is not changing, but they're maturing in ways that they could communicate
better and more efficiently. Then, there's a decrease and we really do
lose 40% to 50% of the synapses that we make and this occurs through the period of the
puberty. So, 80% of brain development does not occur
by the age of three, right? It just doesn't. The other thing that occurs is this process
that we call myelination. We wrap the nerve fibers in an insulated material
that allows information to flow much more dynamically and much more precisely. This begins just after birth and it continues,
fortunately, until about your fifth or sixth decade of life in certain parts of the brain. It's not synchronous to your frontal lobe,
which has to do with executive function and reasoning, that continues to myelinate until
your fifth or sixth decade, but there's a lot of myelin, a lot of its insulation is
laid down to allow information to be processed much more efficiently. So, when you see skillsets coming online,
that means that the information is being processed much more dynamically and efficiently by there
synapses that I showed. Part of the reason is this other really important
postnatal process called myelination. Nutrition has a major role in all of these
events in terms of providing what's necessary for healthy development. Remember, I told you no matter what kind of
experiences, positive or negative, if they're powerful, they will have a powerful impact
on the brain architecture that I talked about during this period of time. So, let me give you data from one experiment,
so this is the auditory map of a young rat, right? The colors just represent frequency that that
rat can hear, so this is while the rat's with it's mom. It's very young, hasn't gone through weaning. Puberty's a month away and the colors just
represent high and low frequencies, but you can see that the map is actually quite large. What happens over time, now that your expert
developmental neurosciences, is that a lot of these connections get pruned away. The rat here is all these different frequencies
and sets up this beautiful map. Look how precise this map is, blue, yellow,
and red segregated. It can hear all these different frequencies,
but if you raise that infant rat in hearing only one kind of frequency, let's say, the
red frequency, what's that map going to look like forever in that rat? As an adult, it's gonna look like this. There we go because the auditory system, while
it's being built, while it's creating its map, only hears that one frequency, that's
what it believes it's going to hear for the rest of its life. Why would it care about blue or yellow frequencies
if it's only hearing red frequencies? It would be a waste of time to build circuits
that would hear these others if it never experiences it. So, it's a really powerful example of why
experience is so important. So, as emotional cognitive skill building
are interconnected over ... The key to forming strong ...
Where are the children located in these frames? Where are they located? Close to the ...
Are they by themselves? No, close to their parents. They're on adults' laps. There's contact. It's a multisensory experience, it's auditory,
it's visual, it's somatosensory, all really important in terms of learning where complicated
skillsets. So, children are not sponges, not placed in
a room. They're not gonna learn that way. None of us learn that way and keep in mind
... yes, this is a neuroanatomy lesson, right? So, this is some of the circuitry that's involved
in memory and learning, the hippocampus, the amygdala, parts of the frontal lobe are shown
here. Watch carefully because I'm gonna show you
the circuitry that's evolved in fear and anxiety. It has to do with emotional regulation. There it is, okay? It's literally the same circuitry, right? It processes information differently, but
when something, when experiences come in and can damage those parts of brain architecture,
it's not just affecting emotional circuits. It's affecting the same circuits that has
to do with memory and learning as well. Learning to deal with stress is an important
part of healthy development. When experiencing stress, the stress responses
system is activated. The body and brain go on alert. There's an adrenaline rush, increased heart
rate, and an increase in stress hormone levels. When the stress is relieved after a short
time or a young child receives support from caring adults, the stress response winds down
and the body quickly returns to normal. In severe situations, such as ongoing abuse
and neglect, where there is no caring adult to act as a buffer against the stress, the
stress response stays activated. Even when there is no apparent physical harm,
the extended absence of response from adults can activate the stress response system. Constant activation of the stress response
overloads developing systems with serious, lifelong consequences for the child. This is known as toxic stress. Over time, this results in a stress response
system set permanently on a high alert. In the areas of the brain dedicated to learning
and reasoning, the neural connections that comprise brain architecture are weaker and
fewer in number. Science shows that the prolong activation
of stress hormones in early childhood can actually reduce neuro connections in these
important parts of the brain at just the time when they should be growing new ones. Toxic stress can be avoided if we ensure that
the environments in which children grow and develop are nurturing, stable, and engaging. So, remember what I told you, powerful experiences,
negative or positive, will have an impact on how the brain gets wired up. So, here's an amazing experiment that was
done by Seth Pollak, a student of his at the University of Wisconsin back in the early
2000s. They asked children, they're about three or
four years of age. I think four or five years of age, but they
look at a community sample of children who were physically abused. They said, "Tell me what you see in terms
of emotions and tell me what changes from one emotion to the next." For both groups, when they looked at happy
to sad or happy to fearful, they went about halfway across. They said, " This is where the transition
is." So, they had no problem with that, right? If you look at the community sample in terms
of being able to distinguish the transition from angry to fearful, angry to sad, it's
about right here. It's about 50%. If you look at the children who were physically
abused, it's about 80%, right? So, think about that in terms of what it means
and what the child is saying. We socially engage, we interact with our environment
based on how we read signals, social signals. They're seeing the faces differently. Why? Because, they've experienced this. It's just like that rat experience, that auditory
information and wired it up in a certain way. They over-represent anger, probably because
it's a survival mechanism, right? So, powerful experiences, positive or negative,
are really critical. Why does experience have a long-lasting effect? Well, we know, now, that the genome that we
inherit from mom and dad can be changed chemically over time, something that we call epigenetics. Those chemical signatures can actually change
how a gene is used during time in development, when and where it's expressed and also, which
I've already told you, that experiences can change, either in a positive way or negative
way, those synapses or nerve connections that actually change how circuitry is put together
and how it functions over time. Alright. So, what is neuroscience telling us? I'm almost done. Well, normal brain plasticity, which is influenced
by experience declines over time. It doesn't mean that it's eliminated because
many of us in this audience are still learning, but the amount of energy it takes for us to
do something completely new, like learning a language, for example, takes a lot more
energy. In the end, if we wait, we just don't acquire
that skillset as well, so these early years are really critical. The ages from zero to two lay down that foundation
for experience to have very positive effects in terms of wiring the brain up for a lifetime. So, I'm done. These are my granddaughters. This is my favorite shirt of all time. She never cries when I hold her, so thank
you very much. I'm done. Thank you very much. You're welcome. Well, I think we're off to a good start. Our next speaker will be Doctor Lisa Shulman
who is Associate Professor of Pediatrics and Director of the Infant/Toddler Team at the
Rose F. Kennedy Center Children's Evaluation and Rehabilitation Center at the Albert Einstein
College of Medicine. Since 2004, Doctor Shulman has been the Director
of the RELATE Program at Einstein, which is a state-of-the-art evaluation and treatment
program for toddlers through teens with autism spectrum disorders. She is going to focus on milestones for child
development, that is, what should we be looking for between birth and two years? So, please join me in welcoming Doctor Shulman. Okay, our outline for today is we're gonna
go through some principles of development. We're gonna look at the newborn's capabilities,
we're gonna start with motor milestones. Then, move onto communication milestones and
we'll finish up with when development does not unfold as expected. Okay, here are some principles of development. This builds nicely. I want you ... we're just hearing, I think. Skills build upon one another. When I'm teaching the residents, I usually
take out the growth curve that shows the height, and the weight, and how they increase over
time and that's what happens with development. Developmental milestones should unfold in
order. They shouldn't skip around. Development should always perceive forward
for young children. They should not take steps backward or regress. Development is influenced by experience. Thinking specifically about motor control
in young children, it should be symmetric and communication grows out of social awareness. Okay, here's our subject. Point A, the newborn, he doesn't look too
capable. He doesn't seem like he's gonna have too much
he can do, right? Here's point B. The toddler, this guy is busy. How does that happen? Okay, let's start off by looking at what the
newborn comes into the world with. The newborn is pre-programmed to grow, to
move, to vocalize, socialize, and learn. He comes out kicking his legs, batting his
arms, in seemingly uncoordinated random movements. Many of those initial movements are actually
governed by reflexes or involuntary responses. For example, the startle reflex. You drop a baby's head too quickly and the
arms come out as if to grab. It's pre-programmed, it will be present from
birth and gradually disappear and be gone by four months. The ATNR or Asymmetric Tonic Neck Reflex is
another reflex that when you turn the child's head to the side ... actually, oops. This is a fencing movement, it's called, when
you move the child's head to the side. The arm that's by the chin extends and the
one that's by the back of the head flexes as if they're fencing. So, the baby doesn't have total control of
his own body. These reflexes determine in certain ways how
he moves for those first four months. Grasps something touching the palms or the
soles will lead to the toes or fingers curling. Head riding, if you move the baby's head off-kilter,
he or she will make an effort to straighten it out, so that his world won't be crooked. Stepping, touch the baby's soles of the feet
to a surface and he'll make stepping movements. The newborn is also ready to learn. Much of that learning, as we were hearing,
comes through the senses. He comes out able to see and hear, but, for
seeing, he needs sharp contrasting patterns and he has a limited ability to track movement
or objects in an arc. He can best focus on objects that are seven
to 12 inches away and that happens to be the distance of his mother, or father's, or grandmother,
grandfather's face as they're feeding him. He's pre-programmed to have that social connection,
he likes to look at faces more than any other pattern or shape. Babies come out hearing at birth and they
seem to show a particular preference for the human voice over other sounds. In fact, they'll try to orient their head
toward voices. And in fact they'll try to orient their head
toward voices, and they'll imitate some facial expressions, simple things like yawning, smiling,
frowning after they've seen a parent do it over that next half hour. As the newborn experiences the world through
sensations his brain takes it all in and attempts to make sense of it. Connections, those same pictures you were
seeing develop and the more input he receives, the more connections born. Learning and fine tuning continue through
sensory mode or exploration and play during his first two years. Okay, so let's move on. Let's start with the motor milestones. Birth to four months. Okay, the baby came out, looking like a blob,
needing the parent to support their neck, and that first motor milestone, as those primitive
reflexes that are controlling the baby's movements are resolving volitional movements emerge. And the first volitional motor act is head
control. This is the pull to sit maneuver. And over time the baby goes from having a
completely lagging head to being able to keep the head not only even with the body but leading. That's gonna happen by four months. Now, head control is then followed by rolling
over. [inaudible]
And while baby's gross motor skills are developing, in those first couple of months baby's also
taking time to really explore her hands, bringing her hands and often her toes, to her mouth. Looking at her hands as if, "This is part
of my body, if I do things I can control it." And then being able to swipe at objects and
grab at objects by four months. Motor control develops from the neck downward. So, we saw that first, the neck control comes
into play. Then rolling over involves having control
over the upper torso. The next motor skill is sitting. Baby becomes more stable when placed in sitting. And it's actually very nicely illustrated
by this string of babies in sitting. Okay, this is a little baby. This is a four or five month old, she needs
her arms to maintain herself. Her back is not straight. She's like a complete C.
Now, what's gonna happen, her control of her back is gonna go down her back. And this baby is a little older and able to
sit with a straighter back. And this baby can completely control his spine,
he doesn't need to rely on his arms to basically protect him from falling. And so those hands are available to play. Moving on to five to nine months. At nine months, many babies are pulling to
stand. They may start to crawl as well. But this happens to be a skill that is actually
not considered a milestone because about 15% of babies don't crawl. And there are different crawling styles. [inaudible]
This baby's commando crawling, she's a very little crawler, she can't get her tummy off
the ground. This bigger boy, he's in the typical quadruped,
hands and legs are moving very, very symmetrically and this little girl as well. When baby's crawling like that, they're leaving
the room. They're really pursuing their own agenda and
interests. They're also now pulling erect, pulling to
stand initially in the crib, and then pulling to stand on the coffee table and walking holding
on or cruising. Experience and temperament will impact on
how quickly the baby moves now from that stage to walking. So for example, babies who are held and not
given an opportunity to be on the floor will often walk a little bit later. Babies who spend a lot of time in a baby walker
and aren't given free rein will also often walk a bit later. A timid baby, or a nervous baby, who has a
bad fall the first time they take their first step out, will probably take a step back and
need a little bit of time to try again. Between twelve and eighteen months though
most babies do start to walk. And the new walker has a very distinct gait
pattern. The legs are wide apart. Arms are up to help with balance and they
don't bend their knees much. [inaudible]
Now this boy, he's a little older. His legs are coming together, he's arms are
more under his control. And here's the little boy from the beginning. He's running, his feet are very close together
and he can use his arms for completely other tasks. Over time motor milestones include the ability
to have the balance to stoop and recover. And to, do my favorite toddler pose, stooping
and recover. And then babies like, toddlers like to squat
while they play. No one else can do this. Only little toddlers. Okay. And I like to refer to the phase of eighteen
to twenty-four months as being playground ready. The baby has gone from a lump to now walking. Walking turns to running. The baby is a toddler-
[inaudible] Able to go upstairs. We're gonna see some, there, going up. Going down. Kicking balls. Throwing things. And jumping. And again, the gait of a 24 month old is quite
mature. It really does look like a mature gait. It is narrow based. The feet are close together. The arms are swinging. And it's got a heel-toe pattern. Okay. So, boiling it down to what to look for. Head control, by four months. Sitting, by nine months. And by the way, we've watched sitting get
later since babies were put to sleep on their back. Another example of how experience impacts
on skill acquisition. And by 18 months baby should be walking. Okay, let's move on to communication. So I think when it comes to motor development
most people intuitively understand that skills build upon each other and the child isn't
going to walk before she can sit and these things need to occur in order and build upon
each other. But for whatever reason, after all these years
of doing this type of stuff with parents and in my social life, I'm amazed at how many
people don't apply that same logic to language. Even though the child is making no sounds,
making no efforts to communicate in any way, the parents often still think the child's
gonna open their mouth and talk in sentences possibly tomorrow. But we can gauge how communication is going
way before the first word ever appears by following the attainment of pre-language communication
skills. We can follow that process along, nurture
it, and anticipate difficulties so that we can intervene. Oops, hold on a second. Language is the use of words in structure
in conventional way. But I'm using the word communication here,
because it's a means of connection between people for the purpose of exchanging information. You need two people to communicate. Communication is the functional use of language
and in order to develop there must be social interest, social awareness, social interest
and social motivation. And it's actually that social component of
communication that we can look for and monitor and nurture long before that first word. Social awareness can be gauged through engagement. Attention to language and communicative efforts. So why don't we look at the different ages
and see how the baby manifest engagement, attention to language, and communicative efforts. Okay, I happen to love this video. Babies are born with social capability. As I had said, they prefer to look to at faces
and listen to voices over other stimuli. They match facial expressions. It is quite amazing what newborn babies can
do. But by two months, when parents often have
a sense that their child has like "woken up" and entered the real world. Look at everything a baby can bring to the
interaction. (baby gurgling) [inaudible]
This is an eight week old. You hear the conversation that's going on? That baby was so engaged with mom. Their eyes were locked. She's smiling, he's smiling. He's vocalizing, she's vocalizing back and
they're having a conversation. This is a two month old. By five to nine months babies are very attentive
to people around them. And they show that interest and attention
by where they're looking, their facial expressions, and their own actions, such as imitation. Again, it is amazing how early babies can
do some of this. (baby gurgling)
Okay, she's a ham. This girl loves attention. She is seven months old. She can imitate. Babies learn through imitation and this is
happening very, very early. Okay. Now in this same five to nine month age range,
baby is attentive to language. They're really paying attention to all the
language in their environment. And the biggest clues we get is that this
is an age where the baby, when you call the baby's name specifically, the baby should
turn to you. They're not just responding to a voice. They are responding to a word they hear frequently,
their name. So we can imagine that if you see a baby much
older, fifteen months, nineteen months, two years of age, who isn't responding when called,
it's really, it's gonna stand out, because this baby can do it much younger. And at the same time the baby's starting to
follow commands with gesture. Things they've been introduced to. Things they've practiced. (baby gurgling) Look, look at my eyes. Mom can direct her attention. [inaudible]
Babies this age, course they don't have any words yet in general, but they're using their
eye contact, they're vocalizing in gestures and they are building on the communication
we saw in the little baby. I'm sorry I can't find the, ah. (baby gurgling, squealing)
By nine to twelve months, babies are very socially engaged. They really want to have your attention all
the time. They are very, very attentive to language
and actually able to follow commands without gestures. Those initial commands are things they've
been introduced to through routines. So this is something a parent can do by establishing
routines. We're going bye-bye. Baby will hear, "Going bye-bye." "Going bye-bye." And the parent waving bye-bye, about a hundred
times before one day the parent says, "Okay, we gotta get ready, we're gonna go bye-bye." And then the baby without the mother's example,
it's not imitation anymore and the baby hears bye-bye and there they are, "Bye-bye." Whoops. Round 'n round. The people on the bus go up and down. Up and down. He's not watching her. He knows these words. Okay. He's nine months old. And the important communicative skill that
the baby acquires now, in this age range, is the all important point. [inaudible] Point to it. There it is. Took us a long time to get that baby [crosstalk]But
the pointing, is a very important, very specific gesture, "I want that." "Look at that interesting thing over there." You only do those things if you're communicating
with someone, and it is a two-way street. And it's also right around, after the point
that the first words typically emerge. In the twelve to eighteen month range baby
is socially engaged and more mobile and she is actively exploring her environment and
chasing after things of interest, following mom or dad around, curious about everything
and prime to imitate. Functional play emerges. Now at this age, baby's no longer putting
things in their mouth primarily, not banging things, not throwing things, now this is play
that incorporates language, and the parent being on hand to use that language is modeling
that language that the baby can then imitate and then call their own. [inaudible]
This is a very little baby, but the baby understands this doll is meant to be a baby and I'm gonna
feed this baby. That's symbolism that goes along with language
understanding in language production. The attention to language in this age group
is manifest by understanding more commands. [inaudible] "Look!" Look. And this is the age range in which most babies
begin to produce gradually a handful of words. Initially those first words are for wants. Baba, juice, mama, and then as part of routines,
the wheels on the bus go up and down, pick me up, mine. Between eighteen and twenty-four months, in
general, you have children who are very, very socially motivated. They're no longer needing to be wooed. They initiate the social interaction and the
showing behaviors. They want constant attention. They're constantly tapping mom, "Oh, look
at this." "I want that." "How come she got that." And more elaborate pretend play goes along
with that capability. mm-hmm (affirmative) Okay, it's your turn
[inaudible]. This is a complex series of events that this
child's been watching mother do, and now able to carry out. Okay. The toddler's attentive to language. Understanding a tremendous amount of language. Attentive to books and others' conversation. This is the age, which you have to be very,
very careful about what you say because this very nosy toddler is going to repeat it at
the most inopportune of times. Communicative intent is present with a vocabulary
of 200 words and growing. And language is used for a much wider variety
of purposes. No longer just to ask, not to label. I love this one. (baby chatter)
Mom: Yeah, what should I do? Baby: you need that. Mom: you need bubbles. Okay. So look how far the toddler has come in two
years. He's running, he's talking, he's socializing
and playing. In kind of thinking about communication milestones
to look for in terms of concerns, by nine months, a baby should be responding to names
specifically. By fourteen months, a baby should be pointing,
to indicate what they want and also to show things of interest. By eighteen months, a baby should have a handful
of words. And by 24 months, what's supposed to happen
between 18 and 24 months, is really amazing. There should be new words every day, and there
should be word combinations, which generally come when kids have 50 words. Okay, so. We have to start thinking about what happens
when skills don't exactly unfold as expected by remembering that there's a range of typical
development, especially in this age group. And on the other hand, the period of birth
to three years is a vital and critical developmental window and we don't want to miss that opportunity
to intervene. So if development has gone awry and a baby
or toddler is not demonstrating the skills expected we want to catch those difficulties
as soon as possible and initiate intervention. Delays in these skills can signal a variety
of issues. I actually think at the top of the list we
should put general health. Babies who are having problems with their
development, first and foremost we have to think about their health. Sick babies often do not develop appropriately. Then dividing things out into motor and communication. Motor delays can often be red signs for neuromuscular
problems, genetic or brain abnormalities, and cognitive impairment, significant cognitive
impairment. Communication delays, first and foremost we
have to think about hearing problems, specific language delays or more general developmental
delays or autism. Here's a few quick clinical scenarios: First
I'll say that babies traditionally walk upstairs erect before they walk downstairs. And you can picture the scenario that the
baby managed to get upstairs somehow and now he's stuck, as an example of that. But what happens if you see a 24 month old
toddler who can go downstairs erect but not up? What does that mean? We always take toddlers on the stairs to look
for just that, because if a baby can't go upstairs and can go down, going upstairs requires
a lot more strength of the proximal muscles and is generally a sign of weakness. It can be weakness due to general health problems
but it's also a very sensitive sign for muscular dystrophy, specifically Duchenne's muscular
dystrophy and probably in my career, and we've picked up about three cases by just this very
simple thing that development is happening out of order. Kids are supposed to be able to go upstairs
before they go downstairs. But if a baby or toddler can't, that is meaningful
information and suggests additional medical workup is needed. Okay, the next case. A 21 month old who does not respond when called
by name. Okay, now. We were looking at the videos. Nine month olds respond to name. Often six month olds respond to name, to be
honest. So it is really dramatic when I go out to
the waiting area to bring in a child to my office and I start calling their name. I call their name in the waiting area. I call them by name, all the way to the office. And if I don't get any reaction, of course
I confirm with the parent that I'm calling them the name that they actually use, but
I ask the parent, "Call him?" "How do you get his attention?" And it's not unusual that I'll have children
in my office, 21 months of age and older, who there is no way to get their attention
by calling their name. Initially parents come with a chief concern,
perhaps the child is deaf. Although then when you explore it further
they'll say, "Well, he hears the most minute electronic sound in the other room." It's a very concerning sign for autism because
children with autism often do not pay attention to language and if they don't pay attention
to language, they don't learn language. A 24 month old has many words. Has language. He can label oval, rectangle, alligator, tow
truck, but he doesn't point or use any words to let his parents know he wants food or anything
else, he only cries. Now, we were saying that that point's supposed
to come in 12 to 14 months. And using words for wants is going to be the
first thing words are used for. And that's certainly by 18 to 20 months. This boy has unusual first words. So he has a disconnect between language and
communication. He has language but he doesn't seem to have
communication. And that also would raise concerns regarding
the possibility of autism. So I think I'm gonna stop there, but that
was our introduction to our Amazing Infant to Toddler Years. You must have a lot of fun during the day
that you work. Okay, so our third and final speaker is Dr.
Lisa Freund, who is Chief of the Child Development and Behavior Branch at the Eunice Kennedy
Shriver National Institute of Child Health and Human Development at NIH. She's a developmental cognitive neuroscientist
known for her neuroimaging studies with children from different clinical populations and she's
going to present an overview of the NICHD investments and research priorities for children
between birth and two years old. So join me in welcoming Dr. Freund. Okay, so this is a mouthful, Eunice Kennedy
Shriver National Institute of Child Health and Human Development. And I'm the Chief of the Child Development
and Behavior Branch and it's, you know, we use acronyms in government. This is part of the NIH, so this, we usually
refer to it as NICHD, or the Child Health Institute. But you can call me Lisa. Okay, all right. So, and NICHD or the Child Health Institute
is part of the National Institutes of Health, which is the world's largest supporter of
biomedical behavioral and social science research and training. It has about a $30 billion budget. And it's comprised of 27 institutes and centers
of which NICHD is just one. So NICHD is a little different in that it
is not dedicated to one specific disorder or disease. For example, mental health is really focused
all, completely on mental health issues. It focuses on development. And it focuses on development from conception
through adulthood, and it also looks at when development goes awry or atypical development. So our research mandate is very broad, but
at NICHD we look at investigations and support research for all stages of human development. We're looking to improve the health and well-being
of children, families, and communities. Understanding intellectual and developmental
disabilities. In understanding all aspects of typical development,
which you've been hearing about today and social, physical and behavioral rehabilitation. We support both basic, meaning in the lab
type of research and applied in translational research the type of research where we're
trying to do interventions, when it looks like we need to help developmental. We have a website of course, and it's very
easy to get to. Kind of hard to move around in, but if you
click enough you'll find some interesting information. So particularly if you start looking at news
and media coverage of different things that we're involved in. Right here they're talking about, "Keep her
happy while she's up, and keep her safe while she sleeps." Part of the Back to Sleep campaign. It's been going on for quite a while, to put
infants on their backs when they sleep, to where we see that when we do this we see a
much, much lower incidence of SIDS, or unexplained crib death. This is a horrible slide that you can't really
read, but I just wanted to point out that when we're talking about the part of NICHD
that has to do with funding research, funding research for researchers out in other places,
in other universities and research centers not within the NIH but outside, [inaudible]
But we have these different branches. And these are the areas we're covering. Here's my branch, Child Development and Behavior
Branch. But we also have a branch on very basic research
and developmental biology. Gynecological health and disease. Contraceptive discovery or fertility and infertility. Intellectual and development disabilities
has a branch of its own. Maternal and pediatric infectious diseases. Pediatric growth and nutrition. Population dynamics. And we have a new branch, pediatric trauma
and critical illness. Looking at procedures in ERs and how to deal
with some very intense critical illnesses that young children can be subject to. And pregnancy and perinatology branch. So you can see we have this tremendously broad
and breadth of research that we support. And my branch alone, we have seven different
programs looking at many aspects of development, behavioral pediatrics, and health promotion. That's looking at working with parents with
their children and best practices for parenting. Looking at risky behaviors and also in keeping
children safe. My program's cognitive development and behavioral
neuroscience and psychobiology with an emphasis on looking at how brain function and behavior
are correlated and looking also at psychobiology, which involves animal models to help us look
more closely at brain development. We have a program in early learning and school
readiness. What do you need to do to help your child
at very early ages to be ready for a structured learning environment? We look at language, and this is typical language
development, bilingualism and biliteracy. Mathematics and science cognition and math
disabilities. Reading, writing and related learning disabilities. We support research there. And social and emotional development in child
and family processes. So you can see this is a lot to be covering. The level of research funding. I was asked to talk about what are our investments
for development? So overall in NICHD research funding, now
this is just for grants. Grants to outside universities or research
centers. It runs about 900 million a year, and it's
been pretty steady over the last five years. When we look at trying to see what are we
investing in research that targets the age range infants to two years old, that starts
to get a little hard. And one of the reasons is, the NIH doesn't
really categorize or collect data on the ages of the individuals being looked at in the
research in any kind of way where it's in a database. One has to go in to the grant and pick out
what ages are being looked at there. We know if they're children. We know if there's adults. But we don't know the ages. So we did a rough calculation, and we found
that maybe about 170 million, about 12% of the overall research funding, is going to
that age group. Okay. And that's in the fiscal year 2014, that's
our latest data. The number of grants is about 201, which is
about 10% of the overall number of grants that were awarded that year. It's probably an underestimate because I was
just looking to see if I could pick out infant or that age range to two years old quickly
and sometimes that's not easily determined. The types of things that we're funding. You can see that, most, oh I'm sorry, most
of our grants, the highest number of grants are really looking at particular physical
conditions in children or physical ailments and how that may be impacting development. Another area is language development. More grants are being there in 2014. Cognitive development, behavior development,
and social, emotional development, but also global health delivery in that age range. Looking at health practices in other countries
and helping to improve them. Growth and nutrition grants. You'll see that infant pharmacology is actually
quite low, but it's going to be growing, I think it's a fairly new program. Obesity and parenting. So you can see there's quite an array of areas
relevant to this age range focusing the research. So what are our research priorities for infants
to two years old. Well, there's a large initiative looking at
newborn screening and diagnosis. In particular, being able to screen for conditions,
genetic, congenital conditions that newborn, that we have an intervention for, that can
be treated. We have a strong emphasis in brain development,
and here again I put in parentheses, connectivity. We've been talking about that. It isn't just a matter of knowing the size
of the different areas of the brain necessarily, it's how they're connected and how does that
change over time and maturation, especially in this time, when and it's growing so rapidly
between infancy and two years old. And understanding as the brain changes how
is that associated with changes in behavior. That's a very thorny problem, that's very
difficult to do. We have a lot of interesting data that's come
from adults but with this age group, we're just touching the tip of what's there. There's a lot to understand about parenting
and healthy brain development, and I think that was talked about quite a bit by the other
two researchers, and I think this is an area that we want to explore more, but the environment
the caregivers create for their young infant and toddler has such an important impact on
the health of the brain and the success and competence of the child eventually. We're interested in very early number of quantity
sets and predictors of math difficulties. Yeah, there's research looking at that. Early language acquisition and communicative
gestures. We know a lot about the milestones. Communicative gestures. We know a lot about the milestones ... You
did a lovely job at pointing those out, but we need to understand more about how that's
achieved in development and what are the underlying brain structures and connectivity supporting
that. And of course the environmental caregiving
and neuro biological factors underlying the development of self regulation, which was
talked about by Dr. Levitt a little bit in terms of executive function. But self regulation we're talking about at
this age, the ability to begin to self soothe when you're an infant, be able to settle down,
initially the parent is doing that or the caregiver is doing that, eventually the child
will learn to do that him or herself or be able to modify some of that response. Other types of self regulation, being able
to inhibit touching something that they're told is dangerous, that type of thing. So self regulation starts developing and understanding
how caregiving impacts on that is very important. And of course we want to understand very early
predictors of autism spectrum disorders. If waiting until we can identify some of the
indicators, as you were mentioning at the last talk, maybe we could find earlier predictions. Are there biological factors or what we call
biological markers? Brain structure signatures. Are there other types of predictors? Maybe behavioral predictors very early on
for having us be able to intervene earlier. We're interested, of course, in much of the
developmental disabilities such as those associated with fragile 'x' syndrome, muscular dystrophy,
down syndrome. There's been a long history of focusing on
premature birth, both prevention and intervention. Prevention treatment and management of the
physical, and the psychological trauma for critically ill and injured infants and children. This is a part of that new branch that I was
telling you about, and a whole new focus for the research at NICHD. And finally, and this was mentioned by Dr.
Levitt, adversity, poverty, and by adversity I mean also the toxic stress that comes with
it, but poverty stigma, discrimination, exposure to violence or abuse or neglect, and it's
in an action with genetics, parenting, or the environment, and those effects of that
interaction with underlying brain development and function. Understanding that whole piece is of great
interest and we don't know enough yet. We also have a lot of resources we've developed
for research with infants and young children. For instance, I forgot to put in here some
existing data bases we have of neuroimaging of children, neuroimaging scans of infants
through, actually 18 years old, of both the structures of the brain as well as the connectivity
in the brain. The data bases we have available are available
to researchers to use and we have the, not only the MRI's or the brain scans of children
as young as infant to two years old available, but also a lot of assessment data on behaviors
and whether they've met developmental milestones et cetera. So that's available for other researchers
to use as well. And we have now, there's something called
the Human Connectome you may have heard about, this has been looking at adults with a very
special technique of looking at the brain with exclusive detail and beautiful resolution
in adults and now we're bringing this into a developmental focus and there's a call for
research now for looking at infants, and we're calling it the Baby Connectome and we're looking
for infants from newborn to five years old. We also have data base resources for other
types of researchers about language development, large data bases of samples of language development
across different periods of life. Early child care study we have that looks
at the effects of child care. We have a wonderful video tape library of
various different types of research protocols and also video taped data of social interactions
with infants and mothers, usually it's mothers, caregivers, as well as toddlers that were
done and are being stored by researchers who now are sharing with other researchers who
can then code that data as they like, or investigate the coding that was done by the researchers
originally with those video tapes. I just wanted to talk about one specific example,
just to show you the type of research. Remember this is where your money's going
for research and there's a lot of people who have wanted to hear more about where's that
research going for development. So here's an example that was a very interesting
launch tool, meaning that it really looked at children over time as they grew and started
very young at infancy and it was funded not only by NICHD but also the department of education,
another institute at NIH, the institute of deafness and communication disorders, and
also the center for diseases. I'm sorry, excuse me. And that's really important because this was
a huge project, it involved 20,000 children being followed. It required that kind of collaboration across
agencies and the government to be able to fund this for looking at development with
a real focus on language. And Amy Weatherbee is someone who is involved
in that, and one of the questions was instead of waiting to see if a child is delayed in
language and at risk for learning problems, is it possible to evaluate skills that are
early predictors of language development? And these are behavioral skills. We don't have the biological markers as I
mentioned or know what the biological brain configuration is to indicate a child who may
have a language development who appears to be developing normal in infancy but has a
language development problem. So what they came up with is they found that
if you look at gestures that a child can make between nine and sixteen months, these communicative
gestures, that it will predict language two years later. These gestures are things such as shaking
the head, or giving something, reaching, raising the arms, showing ... Again remember this
is all that interactive type of communication, points with the open hand, or taps, claps
or blows a kiss, points with the index finger, et cetera. These types of different gestures are really
important indicators of later language ability. And in fact, what they've found is that children
should use at least 16 gestures by 16 months. So what they came up with is a graph like
this that you should be seeing this progression that by 11 months you're getting waving 'bye-bye',
you know? That by 12 months that you're getting the
pointing, that you've got pointing with the index finger or like that, or other kinds
of symbolic gestures that you indicated in the last talk about feeding the baby with
a fork, pretend, that type of thing. Now these are something that would indicate
to a professional or a parent that, hey maybe we ought to check this out further. It is not a definitive diagnosis by any means
but it is a way of indicating maybe we should look at this further. And that's the type of research that is really
helpful by getting us in there earlier if there is a problem to be able to help and
intervene. Further research, again I just wanted to say
is the richest movements for early language learning are really when the child and the
caregiver are ... Whoops, I'm sorry, are sharing their attention, this joint attention. That they are really communicating with each
other, which we saw some beautiful examples of previously. And that the care giver talks about the child's
focus of attention. There's been a lot of emphasis on looking
further at speaking a lot with your baby to help with increasing language development,
or making sure that development in language is on track, cause many parents believe it
or not are not really used to talking to a baby. That they don't always back and parents sometimes
aren't sensitive to how a baby communicates back. But it isn't just how many words, its how
you do it, in what context, and that you are sensitive basically to what the child is attending
to. So that's another example of the type of research
that we look at and we have a website that can tell you more about our research findings,
the various topics that may be of interest to you, and its easy to find, NICHD.NIH.gov,
and that's it. I thank you very much. Thank you Dr. Freund. So I want to just start it off with a question,
and maybe two but maybe not, but I'll invite those of you who have comments or questions
to begin thinking about them. And there are microphones on both sides of
the auditorium. We'd like you to identify yourself and give
your affiliation, and maybe some of you have dual affiliations such as you're a scientist
and a parent and want to gain some insights from both perspectives. So before we then break for our receptions,
so I have lots of questions but let me start with Dr. Shulman. Is there any evidence that this developmental
track that you showed us is affected at all by the presence of an older sibling in cases
where the sibling may previously followed these steps, or one who has had difficulty
in following those steps? We talked a lot about parents, and caregivers,
what about older siblings? Does that effect the learning or the motor
skills of the younger child? There are some studies about language that
the overall level of language that the child's exposed to when there are many young siblings
that are immature language gives them less stimulation. And so sometimes kids who are one of several
kids [inaudible], kids who are close in age, may have some initial delays in speaking on
a bases of that theory and there's some data for that. But, you know, I answer in more practical
terms that I think having siblings around is great examples that kids then imitate,
its very motivating if your sibling has run off with your toy to go and get it. And so surely there's a lot of practical data
that having siblings is very good for children's development. Anyone else want to touch on that? There's a long history in, both in family
development and school development, pre school development that typically developing children
are not impacted negatively by being in the same environment as children who have a developmental
disability. It used to be a ... Back in the 50's and 60's
until Suzanne Gray did the practical experiment of demonstrating that typical development
is not impacted in a negative way. In fact, there are many positive factors that
emerge that she and hundreds of other scientists have shown now that occur in the development
of a typical child if they're in the environment of somebody who ... A child who might have
intellectual disability or some other issue. So I don't think there's any evidence that
there's a negative impact, in fact there are positive ones. Okay. Okay let me ask the audience if you'd go to
the microphones now those of you who have questions. I just have one other quick question and then
I'll step aside. For Dr. Freund, to what extent has your research
priorities or agenda been shaped by interaction with the community, the research community? And the advance in instrumentation, the technology? What we do is we try to get ... We don't just
come ourselves and just say, "Okay this is what we're going to do. This is what we're going to do". We get our experts, about five, to come to
conferences, scientific conferences, and we say, "Hey. In a certain area like language development
in this age range, what do we know? What don't we know?", and that's really important
for the experts to touch what we don't know. And so that we can then know how to go and
say, "Hey, we need research in this area because the experts are telling us now. We don't know enough". And what technology has helped us with is
in particular, I think we were talking about this a little bit before we all started, is
certainly neuro imaging has been a tremendous advantage for understanding the brain and
there are different aspects of neuro imaging that are useful for very young age range that
are being developed, not just the MRI machine. And also the eye tracking is a big boom for
early developmental research because eye tracking is a ... Basically, one of the things that
it does, it tells you where the child is attending. It also tells you somewhat about what the
child perceives as novel or something that it's seen before. It gives you an insight into, perhaps, memory. Okay, well I see we have a number of people
ready to ask questions so let's go to our audience. Again, if you would identify yourself and
your affiliation. We don't have lots of time but never the less
if you'll make your questions [inaudible] perhaps we can get through all the people
that are standing up now. Please go ahead. Good afternoon, my name is Felicity Crawford
associate professor at Wheelock College in Boston. My question is how, if at all, do hand held
devices impact children's cognitive development? Well, we don't know for sure, but we do know
that children, really before the age of two and most likely beyond, but that's what we
have data on that I'm aware of, they're not learning as well from the media, electronic
media. If they're sitting there with the electronic
media, with the parent, and they're on the lap, and they're looking at it together, well
then you're talking about something that's similar to reading a book. It's a social kind of learning situation,
perhaps. But if the child's isolated and sitting looking
at this electronic thing, or watching T.V, we're not seeing evidence that there's learning
occurring. Anybody else? Yeah, please. We have a large waiting area in our center,
and I used to go out into the waiting area and see the kids interacting with each other,
now it's not unusual that I'll go out to the waiting area and see each child beside their
parent with their own I-pad or on their parent's phone and nobodies interacting. There have been recommendations by the American
Academy of Pediatrics to limit use of these devices, along with T.V, for kids under two,
and they certainly should be limited because they end up competing with actual interaction. And as we know, actual interaction has a way
that captures kids abilities and promote them for real functional skills. So it's ... I've gotten myself in trouble
by saying this to a parenting magazine once, but I think it is important to limit these
devices and, as was said, to do them with a parent. Okay. Over here please. Yes, my name is Jessica Wyndham from AAAS. My questions about language acquisition and
brain development, particularly what the research might say about differences in children who
are raised in multi-lingual, bi-lingual, households as opposed to those that only one language? The bi-lingual research that we've seen and
has come into our institute indicates that there may be a benefit in cognition in the
ability to rapidly switch between ... Allows somewhat better executive function ability. The studies are small and more needs to be
done to understand that better, but that's where we are now with that. There does not appear to be any bi-lingual
deficit, or anything that delays cognitive development if one is bi-lingual or raised
in a bi-lingual home. What's interesting is there have been studies
that have shown that ... There was some though that there might be more limited vocabulary
that was being learned in a bi-lingual situation, but it turns out that vocabulary complexity
early on is identical to mono-lingual environments its just that the infant toddler ... The toddler
is learning two languages at the same time essentially splits the complexity between
the two languages and then sort of takes off from about the age of three and they exceed
mono-lingual individuals, obviously, because they're learning the same ... They're learning
vocabulary involved. So there seems to be a mechanism in the brain
to be able to handle the load, which I think is an interesting observation. And I think that it is another one of those
misconceptions to have on your list that coming from a bi-lingual household means you'll start
talking later. Yeah. That is a misconception. Yeah, that's not true. Okay, over here please. Hi, my name is Karen, I'm a scientist and
a parent of an eight month old. I'm interested in what research has been done
into how to reverse the course of the toxic stress that you talked about at later ages? And if anythings been ... There's protocols
as a scientific term for when kids have a better ability to control their own situations
in later teenagers or early twenties, where they maybe have some more control over their
situations. So it's been a challenging area to develop
in terms of developing ... In terms of new interventions that are really effective in
changing the course of development. I think, from my perspective over the last
ten years has been very exciting to recognize that interventions that have been developed
to target the child alone are less effective than when the interventions are multi dimensional. That is they're targeting both the child and
the primary care giver to learn skill sets, particularly in the area of social engagement,
which is so important. So there are lots of studies now, in the foster
care system for example, where what's called multi dimensional therapeutic foster care
has had a real positive impact in changing trajectories. So if you look at a child who has a history
of being moved from family to family, unstable, and they get into a program with their sixth
primary caregiver and they're in that program, the stability just kind of takes off. So it can have very positive effects. But I think the recognition that development
will take a positive trajectory with the recognition that there's a requirement for social engagement
and interaction in any kind of therapy is really see change in the field. Thank you. Please. I'm Ralph Hickman from the National Child
and Human Development, same place as Lisa, I'm here to keep an eye on her. [crosstalk] I'm actually [inaudible]. I'll talk about his stuff. But I think the talks that we had this evening
were very eloquent about the brain, and the role of early input from parents, and the
importance of those interactions. But having said that, it creates a certain
anxiety for parents because they figure, well the more I interact with my child, the better
they're going to be. And so how do you kind of strike the balance
that doesn't drive the parents crazy that tells them that this is enough? It's sufficient. And they don't try to be over achievers and
start piping in music in utero and so on? I'll answer that. I didn't say about, right? You notice I didn't say about because we don't
have a titration scale for that. I talked about an element of a child's environment,
of an infant and toddler's environment, which is do crucial for their development and the
development of milestones. We kind of, sometimes we tend to kind of silo
these things off where there's this, there's social development, there's emotional development,
there's cognitive development, and there's you know, and these ... The brain doesn't
work that way. I'm sorry, it just doesn't work that way. So it's not about titration, it's about recognizing
that this is a natural part of who we are as human beings. You saw the milestones and the remarkable
ability, even in infancy, of engaging. It happens so early and I think that element
is what needs to be recognized as being an important part of everything else that sort
of comes in terms of developmental milestones and development trajectory. I think the other thing, which gets at the
intervention issue ... It surprised me because I'm not an interventionist, but talking to
people who do intervention research, there's this idea that interaction or serve and return
is sort of the parent kind of directing everything. And if you think about your own experience,
if you play volleyball, or tennis, or whatever you do where ... Throwing and catching a baseball,
the game would get very boring very quickly if only you were throwing the ball to me. I would not be very happy with that. I like to share in those initiations and those
interactions. So some of the qualitative issues about, really
a skill set of how to do this, sometimes has to be discussed and taught as a skill set
for parents. So not necessarily the amount but understanding
what the qualities are. Dr. Freund, did you want to answer? Yeah, I think where some of this, especially
out in the popular press talking about amount of speaking came from research where they
were looking at some very toxic environments, very low SES environments where there was
a lot of stresses on the caregivers, a lot of stresses in the neighborhood, and there
wasn't a sense of even caregivers being able to spend much time interacting with their
child. So the amount of actual language and words
spoken to the child was so minimal that there was a lot of emphasis on that. So in homes that aren't so stressed, that
isn't an issue. But what we like to tell parents, and also
I think what many of the interventions have shown, it isn't a matter of sitting down and
then having time where you're going to interact with your kid and making sure you're doing
a lot of that. It's really making sure you engage child in
everyday activities, okay? You're folding the laundry, talk about what
you're doing. Talk about that towel and I fold it this way. Say the words to a very young infant, you
can always talk about the actions, or maybe have the child engage with you who's older. So it's really, look at your every day life
and how to engage your child. Okay, thank you. Jonathon. Hi, I'm Jonathon Drake, AAAS. I'm curious, given the profound and often
life long consequences of these very, very, early experiences be they positive or negative,
why do we not form conscious memories of them and moving forward in terms of developmental
stages, where along that line is there a correlation between the formation of permanent memories
and some of these developmental milestones that were discussed? That's an interesting question. That is an interesting question. I mean we can't answer it. No. Really interesting question. I'll take the first half of it, I think the
thoughts are that pre language, those experiences and memories, are coded differently and the
advent of language, they're kind of lost. Except for really traumatic ones. Well also we know that toxic or traumatic
types of experiences very early on affect parts of the brain that have to do with memory. And in fact, some of the receptors are not
functioning the way that they should and don't from then on. So, that could be part of it, that there's
a biological consequence of that in the brain. The other thing that ... I mean, I would argue
that our sensory systems have tremendous memories about what those systems experienced early
on. That's how those sensory maps form. If they don't have memory of those experiences
than the sensory map wouldn't form, right? You couldn't hear all the different frequencies
if there wasn't a memory trace that was held permanently in terms of being able to distinguish
between low, middle, and high frequencies. So in the sensory world I think that's exactly
what happens. In the social, emotional world I think those
circuits are developing over a longer period of time. Many of the experiences are happening earlier
are essentially in the sort of the erector set, building part of the process. And so, it's over time tuning the system. But my guess is that the requirement to maintain
those as specific memories just isn't ... That it would take too much energy, too many ATP,
to be able to withhold all those online when you don't really have to. Right, because you're building this structure
in a more gradual way. Okay, one final commenter question, please. This is [inaudible], how does one access the
neural imaging data base that you mentioned? I'm sorry, how does one access it? Yeah, where can one access the neural imaging
data base that you mentioned? Okay, there are websites that ... On our NICHD
website, we show you how you can click on a web link and it'll take you to the website
where you can find out how to access it. So it's there ... Usually most of these data
bases require that you're affiliated with either a university or research center or
some other kind of research foundation. That you sign a data use agreement, because
some of this data, even though it's de- identified, it needs to be used in a rigorous scientific
way and so they do have those kinds of things that you do to get access to that data. But it's not too bad a process to do that. So if you go to the NICHD website you should
be able to find resources for researchers and it's listed there. Otherwise, contact me please and I'll help
you find it. There's also a process now for scientific
papers that are published for many journals, not all journals, but many journals to be
made available freely to the public without having to have a subscription after a certain
period of time. You can go online and you can get those. It's through something called PubMed, which
is a government data base, essentially. So you can access the reports that scientists
publish about their findings. Sorry, question for the other two. A lot of information that a child gathers
is visual input. So how do you predict how the exposure to
different objects, different colors, and they're idea of objects actually impacts their development? I didn't understand the last part. How objects, different colors, et cetera ...
How exposure to different visual stimuli impacts development. So, I can't answer that directly but there's
a lot of work now that's being done, as we said, on using ... On looking at the development
of attentional systems. If you think about it, what we pay attention
to in this very complicated environment is going to do determine, in fact, what are next
response is within a certain context, right? What are we looking at? What are we hearing? If you're in a complex environment you have
to filter certain things out that are not important, you have to tend to certain things
that are going to be really important, and defining what you're going to do next. And it turns out you can do those measures
in infancy, you can sort of track them over time in terms of the kinds of things that
seems to be most salient to them, the things that they pay most attention to, you might
be shocked by this but Elmo turns out to be a really salient object for infants. We've done some tracking in one month olds
and it's really quite amazing, Elmo, I don't know what it is about Elmo but, Elmo's incredibly
salient. But there are other cartoon characters that
have no impact whatsoever. So the studies are more about trying to use
different objects, colors, movement, what are infants paying attention to, how long
they spend attending to something before they get distracted or attend to something else,
I think those are the kinds of developmental studies that are being done now. And it turns out that, from my perspective
at least, I'm a little bias, I think that this is a really exciting area because you
can do these things. Tracking attention really early, it's wireless
now, you don't have to attach an infant to all these wires, and we're going to gain a
lot of insight in terms ... Because infants don't have language, right? We're going to get a lot of insight in terms
of what they're paying attention to and what they're not paying attention to. It's a very exciting time.
I find that’s one of those really ‘unfair’ things about nature (not that nature can exactly be fair or unfair). It’s not bad enough that excessive childhood stress is terrible for its own sake but it leaves undoable damage long after. I teach kids and you always hope that the pressure some of them are under is just a storm that they have to temporarily weather.
There was probably a time in human history when it was advantageous to have more of these 'damaged' people to survive physical attacks and natural disasters -- this was a good strategy for when we merely needed to survive long enough to produce offspring. However, in the modern world (i.e. first world nations), we can largely guarantee survival of the individual but we do a poor job of ensuring survival of the species. What protects us from ourselves? Perhaps we need to shift our focus away from traditional labor and invest in child development instead. Forget education -- we need to start even earlier.
I need a tl;dr
Stress can change your DNA. The DNA sequence stay the same but it is marked by methyl. A methyl on your DNA can slghtly change it's role. This change can be transmtted to future generation.
Poverty has similar affects.
Welp...
This explains why I am how I am, lol.
Would this include ADHD-sufferers? My nephew is 8, diagnosed. He's been totally unhinged almost constantly since age 5. He doesn't get rage tantrums, but any time he's begrudged anything he wants, be it a soda at the store as we're already leaving the registers (45 minute screaming and crying all the way home, screaming that we should go back to the store and buy him that soda, as we are parking at home), or if it's his bed time and he wants to continue watching cartoons. Screaming for 20 minutes. He gets meds since a year back, but the stuff doesn't seem to do anything.
What I wonder is, can a child get brain damage or affected gene expression for stress that they themselves are the cause of? Or is the doctor in the vid only talking about outside stress factors?
Circumcision leads to autism.