Dr Shonkoff "NO TIME TO LOSE" Power Point 2006

7/31/2019 Dr Shonkoff "NO TIME TO LOSE" Power Point 2006

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No Time to Lose:No Time to Lose: Closing the GapClosing the Gap

Between What We Know andBetween What We Know andWhat We DoWhat We Do

Jack P. Shonkoff, M.D.Chair of the National Scientific Council on the Developing Child

Presentation to Westchester Childrens Association

White Plains, New York March 24, 2006


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The Importance of Viewing the NeedsThe Importance of Viewing the Needs

of Children in a Broad Contextof Children in a Broad Context

The healthy development of all youngThe healthy development of all young

children benefits all of society by providingchildren benefits all of society by providing

a solid foundation for responsiblea solid foundation for responsible

citizenship, economic productivity,citizenship, economic productivity,lifelonglifelongphysical and mental health, strongphysical and mental health, strong

communities, and sustainable democracycommunities, and sustainable democracy

and prosperity.and prosperity.


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What We Know About Brain DevelopmentWhat We Know About Brain Development Brains are built over time, shaped by theBrains are built over time, shaped by theinteraction between genetics and experience.interaction between genetics and experience.

Social, emotional, and cognitive developmentSocial, emotional, and cognitive development

are highly interrelated.are highly interrelated.

Brain architecture and skills are built in aBrain architecture and skills are built in a

hierarchical bottom-up sequence.hierarchical bottom-up sequence.

Brain plasticity and the ability to changeBrain plasticity and the ability to change

behavior decrease over time.behavior decrease over time.


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Rethinking the Brain, Families and Work Institute, Rima Shore, 1997.

At Birth 6 Years Old 14 Years Old


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Relationships are the ActiveIngredients" of Early Experience

Nurturing and responsive relationships buildNurturing and responsive relationships build

healthy brain architecture that provides a stronghealthy brain architecture that provides a strong

foundation for learning, behavior, and health.foundation for learning, behavior, and health.

When protective relationships are not provided,When protective relationships are not provided,elevated levels of stress hormones (i.e., cortisol)elevated levels of stress hormones (i.e., cortisol)

disrupt brain architecture by impairing celldisrupt brain architecture by impairing cell

growth and interfering with the formation ofgrowth and interfering with the formation of

healthy neural circuits.healthy neural circuits.


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Early Childhood Adversity Can HaveEarly Childhood Adversity Can Have

Lifelong ConsequencesLifelong Consequences

Research on the biology of stress helpsResearch on the biology of stress helps

explain some of the underlying reasons forexplain some of the underlying reasons fordifferences in learning, behavior, anddifferences in learning, behavior, and

physical and mental health.physical and mental health.


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Positive StressPositive Stress Moderate, short-lived stress responses, suchModerate, short-lived stress responses, such

as brief increases in heart rate or mild changesas brief increases in heart rate or mild changes

in stress hormone levels.in stress hormone levels.

Precipitants include the challenges of meetingPrecipitants include the challenges of meeting

new people, dealing with frustration, gettingnew people, dealing with frustration, getting

an immunization, or adult limit-setting.an immunization, or adult limit-setting.

An important and necessary aspect of healthyAn important and necessary aspect of healthy

development that occurs in the context ofdevelopment that occurs in the context of

stable and supportive relationships.stable and supportive relationships.


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Tolerable StressTolerable Stress Stress responses that could disrupt brainStress responses that could disrupt brain

architecture, but are buffered by supportivearchitecture, but are buffered by supportive

relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.

Generally occurs within a time-limited period,Generally occurs within a time-limited period,

which gives the brain an opportunity to recoverwhich gives the brain an opportunity to recover

from potentially damaging effects.from potentially damaging effects.

Precipitants include death or serious illness ofPrecipitants include death or serious illness of

a loved one, a frightening injury, parent divorce,a loved one, a frightening injury, parent divorce,

terrorism,terrorism,a natural disaster,a natural disaster,or homelessness.or homelessness.


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Toxic StressToxic Stress Strong and prolonged activation of the bodysStrong and prolonged activation of the bodys

stress management systems in the absence ofstress management systems in the absence of

the buffering protection of adult support.the buffering protection of adult support.

Disrupts brain architecture and leads to stressDisrupts brain architecture and leads to stress

management systems that respond at relativelymanagement systems that respond at relatively

lower thresholds, thereby increasing the risk oflower thresholds, thereby increasing the risk of

stress-related physical and mental illness.stress-related physical and mental illness.

Precipitants include extreme poverty, physical orPrecipitants include extreme poverty, physical or

emotional abuse, chronic neglect, severe maternalemotional abuse, chronic neglect, severe maternal

depression, substance abuse, or family violence.depression, substance abuse, or family violence.


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Data To Think AboutData To Think About


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Adverse Childhood Events and

Adult Depression

0

.00

0

.00

0

.00

0

.00

0

.00

0

0

0

0

0

0

+0

OddsRatio

Adverse Events

Chapman et al, 2004


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Adverse Childhood Events and Adult

Ischemic Heart Disease

0

.00

0

.00

0

.00

0

.00

0

0

0

0

0

,00

,0

Dong et al,Adverse Events

OddsRatio


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Adverse Childhood Events and

Adult Substance Abuse

0

0

0

0

0

00

00

00

00

0 0 0 0 +0

0

0

00

00

00

00

00

00

00

0 0 0 0 0 +0

%

Self-Report: Alcoholism Self-Report: Illicit Drug Use

Dube et al, 2002 Dube et al, 2005

%


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Importance of Emotional DevelopmentImportance of Emotional Development In a study of 211 children under age 3 withIn a study of 211 children under age 3 with

newly opened child protection cases andnewly opened child protection cases and

completed developmental evaluations, 52% hadcompleted developmental evaluations, 52% haddocumented delays or established conditionsdocumented delays or established conditions

that met eligibility criteria for early interventionthat met eligibility criteria for early intervention

services in Massachusetts (MECLI, 2005).services in Massachusetts (MECLI, 2005).

In a survey of 119 preschool teachers, 39%In a survey of 119 preschool teachers, 39%

reported expelling at least one child from theirreported expelling at least one child from their

program in the preceding year (Gilliam, 2004).program in the preceding year (Gilliam, 2004).


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Economic Benefits of Early InterventionEconomic Benefits of Early Intervention

Perry Preschool Project follow-up data at agePerry Preschool Project follow-up data at age

40 indicate a total benefit-cost ratio of 17:1 (4:140 indicate a total benefit-cost ratio of 17:1 (4:1

for participants and 13:1 for the public), withfor participants and 13:1 for the public), with

annual internal rates of return of 18% (1%annual internal rates of return of 18% (1%participant gain and 17% public benefit).participant gain and 17% public benefit).

Public benefits include higher tax revenues andPublic benefits include higher tax revenues and

lower costs for special education, publiclower costs for special education, public

assistance, and incarceration.assistance, and incarceration.

Participant benefits are derived largely fromParticipant benefits are derived largely from

higher earned income.higher earned income.


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Implications for PolicyImplications for Policyand Practiceand Practice


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Human Capital FormationHuman Capital FormationRequires a Balanced ApproachRequires a Balanced Approach

If we really want to build a strong platform forIf we really want to build a strong platform forhealthy development and effective learning inhealthy development and effective learning in

the early childhood yearsthe early childhood years

then we must pay as much attention tothen we must pay as much attention tochildrens emotional well-being and socialchildrens emotional well-being and social

capacities as we do to their cognitive abilitiescapacities as we do to their cognitive abilities

and academic skills.and academic skills.


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Quality Interventions Make a DifferenceQuality Interventions Make a Difference

Services for vulnerable, young children canServices for vulnerable, young children can

have positive impacts on brain developmenthave positive impacts on brain development

that generate a significant return on investmentthat generate a significant return on investmentover a lifetime...over a lifetime...

but they require the quality and sustainabilitybut they require the quality and sustainability

that comes from low staff turnover and wellthat comes from low staff turnover and welltrained personnel withtrained personnel withexpertise that matchesexpertise that matches

the needs of the children and families served.the needs of the children and families served.


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Neuroscience Applies to PoliciesNeuroscience Applies to PoliciesBeyond Early Care and EducationBeyond Early Care and Education

If we really want to promote better outcomes forIf we really want to promote better outcomes forchildren, then we must apply the science ofchildren, then we must apply the science of

early childhood and early brain development toearly childhood and early brain development to

a broad array of policies a broad array of policies

including welfare reform, adult mental health,including welfare reform, adult mental health,

child welfare, family and medical leave,child welfare, family and medical leave,andand

environmental protection, among others.environmental protection, among others.


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Young Children and theirYoung Children and their

Families Need New ChampionsFamilies Need New Champions

Need for fresh leadership in both theNeed for fresh leadership in both thepublic and private sectors to addresspublic and private sectors to address

significant inequalities in opportunity forsignificant inequalities in opportunity for

children, beginning in the earliest yearschildren, beginning in the earliest years

of life, as both a moral responsibility andof life, as both a moral responsibility and

a critical investment in the nationsa critical investment in the nations

social and economic future.social and economic future.


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www.developingchild.net

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Dr Shonkoff "NO TIME TO LOSE" Power Point 2006