From Birth to Two: the Neuroscience of Infant Development

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 WM 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, NICHDNIH

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 TV, 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 TV, 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


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