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Dr Nils BergmanDr Nils Bergman
PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT
Dr Nils BergmanDr Nils Bergman
MB MB ChBChB, DCH, MPH, MD, DCH, MPH, MD
(USA equiv: MD, MPH ,PhD)(USA equiv: MD, MPH ,PhD)
Cape Town, RSACape Town, RSA
www.skintoskincontact.comwww.skintoskincontact.com
Speaker Disclosure
PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT
Under ACCME guidelines:Under ACCME guidelines:
a)a) I am the South African distributor ofI am the South African distributor ofMIRIS : Human Milk AnalyzerMIRIS : Human Milk Analyzer
b)b) My My wife markets educational materials and shirts related wife markets educational materials and shirts related to the talk content to the talk content
Kangaroo Mother Care Kangaroo Mother Care PromotionsPromotions
NEUROSCIENCE
PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT
NEUROSCIENCEEVOLUTIONARY
BIOLOGY,EPIGENETICS
PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT
600gr,600gr, 26 26 w w GA, 48 GA, 48 hrshrs
SkinSkin--toto--skin contactskin contact
What is going on in that What is going on in that brain?brain?
PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT
What is going on in that What is going on in that brain?brain?
PERINATAL NEUROSCIENCE PERINATAL NEUROSCIENCE and SKINand SKIN--TOTO--SKIN SKIN CONTACTCONTACT
What is going on in that What is going on in that brain?brain?
Evolutionary Biology and Evolutionary Biology and Modern Neuroscience Modern Neuroscience ––
What Mothers Always KnewWhat Mothers Always Knew
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
THE HUNTER GATHERER (cont)THE HUNTER GATHERER (cont)
Infant care patterns in such societies Infant care patterns in such societies (which are closest to our origins):(which are closest to our origins):
11 Infant carried most of timeInfant carried most of time11 Infant carried most of timeInfant carried most of time22 Mother sleeps with infant same bedMother sleeps with infant same bed33 Immediate feeding response to cryingImmediate feeding response to crying44 Breastfeeding 24 months or moreBreastfeeding 24 months or more55 Father frequently and closely involved ...Father frequently and closely involved ...
“For species such as “For species such as primates, the mother primates, the mother ISIS the environment.”the environment.”Sarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.
Sarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)
“For species such as “For species such as primates, the mother primates, the mother ISIS the environment.”the environment.”Sarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONSarah Sarah BlafferBlaffer HrdyHrdy, , Mother NatureMother Nature (1999)(1999)The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
Nothing an infant can or Nothing an infant can or
cannot do makes sense, cannot do makes sense,
except in light of mother’s bodyexcept in light of mother’s body
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“except in the light of “except in the light of
mother’s body.”mother’s body.”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SkinSkin--toto--skin contact skin contact
For the human newborn For the human newborn –– this this place / environment is place / environment is
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
Skin-to-skin contact
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
Skin-to-skin contact
CENTRAL DOGMA CENTRAL DOGMA –– all biological processesall biological processes
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SkinSkin--toto--skin = key that skin = key that unlocks the neuroscience !unlocks the neuroscience !
NEUROSCIENCE NEUROSCIENCE SUMMARYSUMMARY
90% of what we know90% of what we knowabout the brain has about the brain has been discovered inbeen discovered inbeen discovered inbeen discovered in
the last 15 yearsthe last 15 years
Society of Neuroscience estimateSociety of Neuroscience estimateDr Sandra Witelson, McMasterDr Sandra Witelson, McMaster
Dr Stanley Graven (2004)
“Cells which
FIRE TOGETHER, FIRE TOGETHER, WIRE TOGETHERWIRE TOGETHERFIRE TOGETHER, FIRE TOGETHER, WIRE TOGETHERWIRE TOGETHER,,and those which
don’t, won’t.”Carla Shatz
NEUROGENESIS
Myelination
Arborisation
SYNAPTOGENESIS
NEURONAL NEURONAL PLASTICITYPLASTICITYMIGRATION
0 10 20 30 40w 6m 2y 10y 60yBirth
Myelination
Programmed cell deathCOMPETITIVEELIMINATION
MAXIMAL O
CCURRENCE
Synapses
0 10 20 30 40w 1y 3y 13y 50y 80y28 Birth Puberty
MAXIMAL O
CCURRENCE
Synapses
Dendrification:peak 2m & 6m
MAXIMAL O
CCURRENCE
RELATIVE BRAIN ACTIVITY
METABOLIC ACTIVITY
peaks3 years
NEW SYNAPSE FORMATION
0 10 20 30 40w 1y 3y 13y 50y 80y28 Birth Puberty
MAXIMAL O
CCURRENCE
3 years
Impulse
Presynaptic neuron
VesicleVesicle
Transmitters
Synaptic cleft
ReceptorsPostsynapticneuron
Postsynaptic activity
SENSORY STIMULUS SENSORY STIMULUS
synapse store chemical signalsynapse store chemical signal
chemical signal strongerchemical signal stronger
THRESHOLD THRESHOLD ��EXEMPT from eliminationEXEMPT from elimination
(synapse stabilised)(synapse stabilised)PATHWAYPATHWAY
(Rima Shore 1997)(Rima Shore 1997)
fetal REM sleepfetal REM sleep(or active sleep) seems to be(or active sleep) seems to be
particularly importantparticularly importantto the developing organism to the developing organism
... spontaneous ... spontaneous synchronous firingsynchronous firing
Marks et al 1995
AS (20 mins) QS (40 mins)
REMREM
BRAIN CYCLINGBRAIN CYCLING
REMREMNR1NR1NR2NR2NR3NR3SWSSWS
Stanley Graven 2006
REMREMNR1NR1NR2NR2NR3NR3SWSSWS
ACQUISITIONACQUISITION
RAMRAMNR3NR3SWSSWS
ACQUISITIONACQUISITION
polypoly--sensory inputsensory inputshortshort--term memory term memory stored cortex stored cortex
Awake and REMAwake and REM
NeocortexNeocortexconsciousnessconsciousnessshort term memoryshort term memory
CPUCPU
AMYGDALA:AMYGDALA:
GPSGPS
Amodio 2008
AMYGDALA:AMYGDALA:
EmotionalEmotionalProcessing Processing UnitUnit
HIPPOCAMPUSHIPPOCAMPUSMemory functionMemory functionand spatial codeand spatial code
REMREMNR1NR1NR2NR2NR3NR3SWSSWS
CONSOLIDATIONCONSOLIDATION
SWSSWSACQUISITIONACQUISITION CONSOLIDATIONCONSOLIDATION
polypoly--sensory inputsensory input transfer informationtransfer informationshortshort--term memory term memory “SNR” strong signals“SNR” strong signalsstored cortex stored cortex amygdala / amygdala /
hippocampus hippocampus Awake and REMAwake and REM NREM stage 4NREM stage 4
REMREMNR1NR1NR2NR2NR3NR3SWSSWS
MEMORY FORMATIONMEMORY FORMATION
NR3NR3SWSSWS
ACQUISITIONACQUISITION CONSOLIDATIONCONSOLIDATION MEMORYMEMORYFORMATIONFORMATION
polypoly--sensory inputsensory input transfer informationtransfer information P wavesP wavesshortshort--term memory term memory “SNR” strong signals“SNR” strong signals returns inforeturns infostored cortex stored cortex amygdala / amygdala / to neocortex:to neocortex:
hippocampus hippocampus organizedorganizedAwake and REMAwake and REM NREM stage 4NREM stage 4 REMREM
Stanley Graven 2006
REMREMNR1NR1NR2NR2NR3NR3SWSSWS
BRAIN WIRINGBRAIN WIRING
SWSSWS
ACQUISITIONACQUISITION CONSOLIDATIONCONSOLIDATION MEMORYMEMORYFORMATIONFORMATION
polypoly--sensory inputsensory input transfer informationtransfer information P wavesP wavesshortshort--term memory term memory “SNR” strong signals“SNR” strong signals returns inforeturns infostored cortex stored cortex amygdala / amygdala / to neocortex:to neocortex:
hippocampus hippocampus organizedorganizedAwake and REMAwake and REM NREM stage 4NREM stage 4 REMREM
Stanley Graven 2006
EARLY DEVELOPMENTEARLY DEVELOPMENT
Gestational ageGestational age20w20w all structures completedall structures completed
parallel development parallel development of structure & functionof structure & functionof structure & functionof structure & function
(Hugo Lagercrantz 2004)(Hugo Lagercrantz 2004)
Brain growth Brain growth depends on experiences !!depends on experiences !!
NEURO DEVELOPMENTNEURO DEVELOPMENT
NEURO PHYSIOLOGYNEURO PHYSIOLOGY
NEURO BEHAVIOURNEURO BEHAVIOUR
NEURO DEVELOPMENTNEURO DEVELOPMENT
NEURO BEHAVIOURNEURO BEHAVIOUR
Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”
Sequence•• Neural circuits that process basic information Neural circuits that process basic information are wired earlier than those that process more are wired earlier than those that process more are wired earlier than those that process more are wired earlier than those that process more complex information.complex information.
•• Higher circuits build on lower circuits, and Higher circuits build on lower circuits, and skill development at higher levels is more skill development at higher levels is more difficult if lower level circuits are not wired difficult if lower level circuits are not wired properly.properly.
Slide by: Jack P. Shonkoff, M.D.
R ShoreR Shore
Critical period concept :Critical period concept :
“Windows of opportunity in early “Windows of opportunity in early “Windows of opportunity in early “Windows of opportunity in early life when a child’s brain is life when a child’s brain is exquisitely primed to receive exquisitely primed to receive sensory input in order to develop sensory input in order to develop more advanced neural systems.”more advanced neural systems.”
SchoreSchore
Critical period :Critical period :
“Early interpersonal events “Early interpersonal events positively positively and negativelyand negativelypositively positively and negativelyand negativelyimpact the impact the
structural organisationstructural organisationof the brain.”of the brain.”
“The perinatal sensorium “The perinatal sensorium is never in chaos ….is never in chaos ….DEVELOPMENT IS DEVELOPMENT IS ��
EVER MORE ORDEREDEVER MORE ORDERED
11stst 28w unmyelinated28w unmyelinated11 28w unmyelinated28w unmyelinated
22ndnd 2 m sympathetic2 m sympathetic
33rdrd 6 m myelinated vagus6 m myelinated vagus
AUTONOMIC NERVOUS SYSTEMAUTONOMIC NERVOUS SYSTEM
“The perinatal sensorium “The perinatal sensorium is never in chaos ….is never in chaos ….DEVELOPMENT IS DEVELOPMENT IS ��
EVER MORE ORDEREDEVER MORE ORDERED
11stst 28w unmyelinated28w unmyelinated
MOREMORECOMPLEXCOMPLEX
MORE FLEXIBLEMORE FLEXIBLE
11 28w unmyelinated28w unmyelinated
immobiliseimmobilise
22ndnd 2 m sympathetic2 m sympathetic
fight or flightfight or flight
33rdrd 6 m myelinated vagus6 m myelinated vagus
engage/disengageengage/disengage
“The perinatal sensorium “The perinatal sensorium is never in chaos …. is never in chaos …. DEVELOPMENT IS DEVELOPMENT IS ��
EVER MORE ORDEREDEVER MORE ORDERED
COMPETENTCOMPETENT 11stst 28w unmyelinated28w unmyelinated
Laughlin 1991
COMPETENTCOMPETENT
COMPETENTCOMPETENT MOREMORECOMPLEXCOMPLEX
COMPETENTCOMPETENT
ALWAYS!ALWAYS! MORE FLEXIBLEMORE FLEXIBLE
11 28w unmyelinated28w unmyelinated
immobiliseimmobilise
22ndnd 2 m sympathetic2 m sympathetic
fight or flightfight or flight
33rdrd 6 m myelinated vagus6 m myelinated vagus
engage/disengageengage/disengage
100%100%
OLD vagus (dorsal vagal complex)OLD vagus (dorsal vagal complex)
Sympathetic nervous system)Sympathetic nervous system)
Social vagus (ventral vagal complex)Social vagus (ventral vagal complex)
DVC
VVC
SNS
28w PMA28w PMA
From Porges, Schore, others…
•• Higher circuits build Higher circuits build on lower circuits, on lower circuits, development more difficult ifdevelopment more difficult if
lower circuits not wired properly.lower circuits not wired properly.
100%100%
DVC
VVC
SNS
DVC
VVC
SNS
DVC
VVC
SNS
28w PMA28w PMA 48w PMA48w PMA2 months2 months 6 months 6 months ��������
Jacksonian DissolutionJacksonian Dissolution
The more threatened the individual,The more threatened the individual,the more 'primitive' (or regressed) the more 'primitive' (or regressed) becomes the style of becomes the style of thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995)
DVC
VVC
SNS
JacksonianJacksonian Dissolution Dissolution -- BERGMANBERGMAN
The more threatened the The more threatened the PREMATUREPREMATURE,,the the SOONERSOONER 'primitive'primitive' (or regressed) ' (or regressed) becomesbecomes the style of the style of thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995) thinking and behaving. (Perry 1995)
DVC
VVC
SNS
Basic neuroscienceBasic neuroscience::neurons, synapsesneurons, synapsesfire and wire,fire and wire,
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
fire and wire,fire and wire,two kinds of two kinds of sleepsleepcritical periods,critical periods,
hierarchy of layershierarchy of layers
CENTRAL DOGMA CENTRAL DOGMA –– all biological processesall biological processes
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SkinSkin--toto--skin = key that skin = key that unlocks the neuroscience !unlocks the neuroscience !
CENTRAL DOGMA CENTRAL DOGMA –– all biological processesall biological processes
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SkinSkin--toto--skin = key that skin = key that unlocks the neuroscience !unlocks the neuroscience !
YOU DON’T THINK HUMANS EVOLVED FROM
I SURE DON’T SEE ANY THINK HUMANS
EVOLVED FROM MONKEYS?
SEE ANY DIFFERENCE.
Our cortex distinguishes us from
other animals …
BUTThe “primitive”The “primitive”hindbrain is similar …
Our cortex distinguishes us from
other animals …
BUTThe “primitive”The “primitive”hindbrain is vital We can learn
about ourselves from animals, and mammals!
THE “OLD” BRAIN HAS THE “OLD” BRAIN HAS
3 PROGRAMMES3 PROGRAMMES
EVOLUTIONARY BIOLOGYEVOLUTIONARY BIOLOGY
3 PROGRAMMES3 PROGRAMMES
DEFENCE NUTRITION REPRODUCTION
DEFENCE NUTRITION REPRODUCTION
HIGHLY CONSERVED HIGHLY CONSERVED NEURONEURO--ENDOCRINEENDOCRINE
BEHAVIORBEHAVIOR
HORMONESHORMONES NERVESNERVES MUSCLESMUSCLES
endocrineendocrine autonomic NS autonomic NS somaticsomatic
DEFENCE NUTRITION REPRODUCTION
HIGHLY CONSERVED HIGHLY CONSERVED NEURONEURO--ENDOCRINEENDOCRINE
BEHAVIORBEHAVIOR
DEFENCE NUTRITION REPRODUCTION
HORMONESHORMONES NERVESNERVES MUSCLESMUSCLES
REPRODUCTIONNUTRITIONDEFENCE
HIGHLY CONSERVED HIGHLY CONSERVED NEURONEURO--ENDOCRINEENDOCRINE
BEHAVIORBEHAVIOR
REPRODUCTIONNUTRITIONDEFENCE
HORMONESHORMONES NERVESNERVES MUSCLESMUSCLES
DEFENCE NUTRITION REPRODUCTION
HIGHLY CONSERVED HIGHLY CONSERVED NEURONEURO--ENDOCRINEENDOCRINE
BEHAVIORBEHAVIOR
DEFENCE NUTRITION REPRODUCTION
HORMONESHORMONES NERVESNERVES MUSCLESMUSCLES
Clinics in Clinics in PerinatologyPerinatology,,June 2004, June 2004, VolVol 31(2) page 21031(2) page 210
Stanley GravenStanley GravenEarly Early neurosensoryneurosensory visual visual development of fetus and newborn.development of fetus and newborn.
“It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the principles derived from careful animal studies principles derived from careful animal studies do not apply to human infants. do not apply to human infants.
All mammals have set sequence All mammals have set sequence of behaviours at birth ………….of behaviours at birth ………….
……. ……. All with a All with a ……. ……. All with a All with a single purpose : tosingle purpose : to
BREASTFEEDBREASTFEED
After birth, events are determined … … by the neonate … by the neonate stimulating the mother!
(Rosenblatt 1994)
Breast-feeding is “establishedthrough a set of mutual,complex sensory stimulations complex sensory stimulations in mother and child.”
(Kjellmer & Winberg 1994)
Warming, feeding andWarming, feeding andprotectionprotection behavioursbehavioursare intricately, inseparablyare intricately, inseparablylinked to the right place.linked to the right place.linked to the right place.linked to the right place.
((AlbertsAlberts 1994)1994)
= NUTRITION PROGRAMME= NUTRITION PROGRAMME
Warming, feeding andWarming, feeding andprotectionprotection behavioursbehavioursare intricately, inseparablyare intricately, inseparablylinked to the right place.linked to the right place.linked to the right place.linked to the right place.
((AlbertsAlberts 1994)1994)
= NUTRITION PROGRAMME= NUTRITION PROGRAMME“Habitat “Habitat –– niche” niche” �� place determineplace determinebehaviors that ensure basic needs.behaviors that ensure basic needs.
ALBERTS “habitat ALBERTS “habitat –– niche”niche”
“Each state of development“Each state of development
is a form of completeness, is a form of completeness,
rather than an approximation rather than an approximation
In the right habitat, developing In the right habitat, developing organism behaves competently.organism behaves competently.
rather than an approximation rather than an approximation
the final adult goal”the final adult goal”
ALBERTS “habitat ALBERTS “habitat –– niche”niche”
Fetus Fetus �� ““fetallyfetally mature” mature” �� competent in uteruscompetent in uterus
NewbornNewborn �� ““neonatallyneonatally” mature” mature �� competent on mothercompetent on mother
InfantInfant �� �� competent in the attachment environmentcompetent in the attachment environment
AdultAdult �� mature mature �� competent in worldcompetent in world
All mammals have set sequence All mammals have set sequence of behaviours at birth ………….of behaviours at birth ………….
……. ……. All with a All with a ……. ……. All with a All with a single purpose : tosingle purpose : to
BREASTFEEDBREASTFEED
In all mammals …….
….. the newborn is responsible for initiating initiating breastfeeding,
not the mother !!
In all mammals …….
….. the newborn is responsible for initiating initiating breastfeeding,
not the mother !!
EXCEPT IN HUMAN ???
Sequence human newborn breastSequence human newborn breast--feedingfeedingPrePre--requisite = habitatrequisite = habitat
hand to mouthhand to mouthtongue movestongue movesmouth movesmouth moveseye focuses nippleeye focuses nippleeye focuses nippleeye focuses nipplecrawls to nipplecrawls to nipplelatches to nipplelatches to nipplesuckles suckles
(Widstrom et al 1994)(Widstrom et al 1994)
“The newborn may appear helpless, but displays an impressive and purposeful motor activity which, without maternal assistance, brings the baby to the nipple.
(Michelson et al 1996)
“The newborn may appear helpless, but
raises its own temperature,raises its own temperature,raises its own temperature,raises its own temperature,has a higher blood glucose,has a higher blood glucose,metabolic adaptation faster.metabolic adaptation faster.
(Widstrom 1987)
METABOLIC ADAPTATIONMETABOLIC ADAPTATION
SSC started in the first SSC started in the first 20 minutes after birth20 minutes after birth
SSC SSC CotCotSSC SSC CotCotBlood glucoseBlood glucose (1 hr)(1 hr) 3.173.17 2.562.56Base excess dropBase excess drop 3.43.4 1.81.8
(Christenson 1992)(Christenson 1992)
Warming, Warming, feeding andfeeding andprotection protection
behavioursbehaviours arearebehavioursbehaviours areareintricately, inseparablyintricately, inseparablylinked to the right place.linked to the right place.
(Alberts 1994)(Alberts 1994)
“The perinatal sensorium “The perinatal sensorium is never in chaos ….is never in chaos ….DEVELOPMENT IS DEVELOPMENT IS ��
EVER MORE ORDEREDEVER MORE ORDERED
COMPETENTCOMPETENT 11stst 28w unmyelinated28w unmyelinatedCOMPETENTCOMPETENT
COMPETENTCOMPETENT MOREMORECOMPLEXCOMPLEX
COMPETENTCOMPETENT
ALWAYS!ALWAYS! MORE FLEXIBLEMORE FLEXIBLE
11 28w unmyelinated28w unmyelinated
immobiliseimmobilise
22ndnd 2 m sympathetic2 m sympathetic
fight or flightfight or flight
33rdrd 6 m myelinated vagus6 m myelinated vagus
engage/disengageengage/disengage
BIRTH SKINBIRTH SKIN--TOTO--SKIN CONTACTSKIN CONTACTPLACE DEPENDENT COMPETENCEPLACE DEPENDENT COMPETENCE
ALBERTS “habitat ALBERTS “habitat –– niche”niche”
“Each state of development“Each state of development
is a form of completeness, is a form of completeness,
rather than an approximation rather than an approximation
In the right habitat, developing In the right habitat, developing organism behaves competently.organism behaves competently.
rather than an approximation rather than an approximation
the final adult goal”the final adult goal”
BIRTH SKINBIRTH SKIN--TOTO--SKIN CONTACTSKIN CONTACTPLACE DEPENDENT COMPETENCEPLACE DEPENDENT COMPETENCE
In the right habitat, developing In the right habitat, developing organism behaves competently.organism behaves competently.
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“except in the light of “except in the light of
mother’s body.”mother’s body.”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
AT BIRTH,AT BIRTH,
the brain has the brain has TWO TWO CRITICAL CRITICAL SENSORY SENSORY SENSORY SENSORY NEEDSNEEDS::
SMELL & CONTACTSMELL & CONTACT
AT BIRTH,AT BIRTH,
the brain has the brain has TWO TWO CRITICAL CRITICAL SENSORY SENSORY SENSORY SENSORY NEEDSNEEDS::
SMELL & CONTACTSMELL & CONTACTconnect direct to the amygdala connect direct to the amygdala
THE THE NEWBORNNEWBORN
BRAINBRAIN
SKINSKIN--TOTO--SKINSKINCONTACTCONTACTCONTACTCONTACT
fires and wiresfires and wires
the the amygdalaamygdala--prefrontoprefronto--orbital orbital cortical pathway cortical pathway (PFOC)(PFOC)
AMYGDALAAMYGDALA::Prefrontal Prefrontal cortexcortex AMYGDALAAMYGDALA::EmotionalEmotionalProcessingProcessingUnit CPU Unit CPU
Prefrontal Prefrontal cortexcortexExecutive Executive functionfunction
approach / avoidapproach / avoid
AMYGDALAAMYGDALA::Prefrontal Prefrontal cortexcortex AMYGDALAAMYGDALA::EmotionalEmotionalProcessingProcessingUnit CPU Unit CPU
Prefrontal Prefrontal cortexcortexExecutive Executive functionfunction
SOCIAL and EMOTIONALSOCIAL and EMOTIONAL
INTELLIGENCEINTELLIGENCE
SOCIAL SOCIAL EMOTIONALEMOTIONALINTELLIGENCEINTELLIGENCE INTELLIGENCEINTELLIGENCE
Behavioural Behavioural activation systemactivation systemrewardreward--basedbased(dopamine)(dopamine)
Frontal alpha EEG asymmetryFrontal alpha EEG asymmetry= a measure of temperament = a measure of temperament
( i.e. ( i.e. traittrait emotion). emotion).
an index of potential risk for an index of potential risk for emotionemotion--related psychopathology.related psychopathology.emotionemotion--related psychopathology.related psychopathology.
a sizable literature ( +/a sizable literature ( +/-- 100 studies ) embeds the 100 studies ) embeds the measure in a network of psychological and behavioural measure in a network of psychological and behavioural constructs, thus bestowing frontal EEG asymmetry with constructs, thus bestowing frontal EEG asymmetry with sizable construct validity as a measure of an underlying sizable construct validity as a measure of an underlying approachapproach--related or withdrawalrelated or withdrawal--related motivational style,related motivational style,or as an index of potential risk for or as an index of potential risk for
emotionemotion--related psychopathology. related psychopathology.
Frontal alpha EEG asymmetryFrontal alpha EEG asymmetry
Greater LeftGreater Left--sided EEG asymmetrysided EEG asymmetry�� greater positive affect and greater positive affect and �� greater psychological and greater psychological and �� greater physiological resilience greater physiological resilience �� greater physiological resilience greater physiological resilience
Greater RightGreater Right--sided EEG asymmetry sided EEG asymmetry �� greater negative affect and greater negative affect and �� poorer psychological and poorer psychological and �� poorer physiological resiliencepoorer physiological resilience
Thibodeau 2006
Aaron Jones et al. (2004)Aaron Jones et al. (2004)conducted a study of four groups conducted a study of four groups
of mother of mother –– infant dyads:infant dyads:EEG done on baby at 1 month of ageEEG done on baby at 1 month of age
The first group wasThe first group wasThe first group wasThe first group wasDepressedDepressed--BottlefedBottlefed
EEG asymmetryEEG asymmetrycorrelates ascorrelates as
expected ...expected ...Aaron Jones 2004
SchoreSchore
In early postnatal life, In early postnatal life, maintenance of critical maintenance of critical levels of tactile input … levels of tactile input … is important for normal is important for normal is important for normal is important for normal brain maturation. brain maturation.
Areas of the amygdala …. Areas of the amygdala …. are in a critical period of maturation,are in a critical period of maturation,… in the first two months of life… in the first two months of life
BrainBrain--to brainto brainFaceFace--toto--facefaceEyeEye--toto--eyeeye
Interpersonal awareness
Emotions
EyeEye--toto--eyeeyevoice,voice,hands, hands, movementsmovements
CarlyCarly & Ethan, 12h& Ethan, 12h
Interpersonal awareness
Emotions
Kerstin
In humans, oxytocinincreases gaze to the eye region of human faces and enhances interpersonal trust and the ability to inferthe emotions of others from facial cues.
Kerstin Uvnas-Moberg
Ross 2009
SchoreSchoreIn early postnatal life,In early postnatal life,maintenance of maintenance of critical levels of critical levels of tactile input … is tactile input … is important for normal important for normal important for normal important for normal brain maturation. brain maturation.
Areas of the Areas of the amygdalaamygdala …. …. are in a critical period of maturation,are in a critical period of maturation,… in the … in the first two months first two months of lifeof life
Basic neuroscienceBasic neuroscience::neurons, synapsesneurons, synapsesfire and wire,fire and wire,
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
fire and wire,fire and wire,PATHWAYSPATHWAYSCIRCUITSCIRCUITSNETWORKSNETWORKS
Clinics in Clinics in PerinatologyPerinatology,,June 2004, June 2004, VolVol 31(2) page 21031(2) page 210
Stanley GravenStanley GravenEarly Early neurosensoryneurosensory visual visual development of fetus and newborn.development of fetus and newborn.
“It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the “It is a serious mistake to assume that the principles derived from careful animal studies principles derived from careful animal studies do not apply to human infants. do not apply to human infants. The risk of suppression or disruption of The risk of suppression or disruption of
needed neural processes ... needed neural processes ...
is very significant and potentially lasts a life time.is very significant and potentially lasts a life time.
STANLEY GRAVENSTANLEY GRAVEN
“ … NEEDED “ … NEEDED “ … NEEDED “ … NEEDED
NEURALNEURAL
PROCESSES” PROCESSES”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“needed neural “needed neural
processes” processes”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SOCIAL SOCIAL EMOTIONALEMOTIONALINTELLIGENCEINTELLIGENCE INTELLIGENCEINTELLIGENCE
Behavioural Behavioural activation systemactivation systemrewardreward--basedbased(dopamine)(dopamine)
R R ShoreShore
Critical period concept :Critical period concept :Critical period concept :Critical period concept :
“Windows of opportunity in early “Windows of opportunity in early life when a child’s brain is life when a child’s brain is exquisitely primed to receive exquisitely primed to receive sensory input in order to develop sensory input in order to develop more advanced neural systems.”more advanced neural systems.”
a kind of invisible hothouse
“the wiring of the brain’s pathways “the wiring of the brain’s pathways is best supported when it can integrate quality sensory input through several pathways at once, particularly during critical periods of development.” (McCain 1999)
“... creates“... createsa kind of a kind of invisible hothouseinvisible hothouseinvisible hothouseinvisible hothousein which the infant’s in which the infant’s development can unfold.”development can unfold.”
(Hofer in Gallagher 1992)(Hofer in Gallagher 1992) aa
SEESSEESMum’s eyesMum’s eyes
SENSATIONS THAT WIRE BRAINSENSATIONS THAT WIRE BRAIN
Ear HEARS Ear HEARS Mum’s voiceMum’s voice
SMELLS SMELLS Mum’s milkMum’s milk MOVES MOVES
with Mum’swith Mum’s
Hand TOUCHHand TOUCHMum’s skinMum’s skin
SkinSkin--toto--skinskinCONTACTCONTACT
Back FEELSBack FEELSMum’s armMum’s armholdingholding
TASTES TASTES Mum’s milkMum’s milk
WARMED on WARMED on Mum’s front Mum’s front
with Mum’swith Mum’s
Slide from JILL BERGMAN Slide from JILL BERGMAN
SEESSEESMum’s eyesMum’s eyes
SENSATIONS THAT WIRE BRAINSENSATIONS THAT WIRE BRAIN
Ear HEARS Ear HEARS Mum’s voiceMum’s voice
SMELLS SMELLS Mum’s milkMum’s milk MOVES MOVES
with Mumwith Mum
Hand TOUCHHand TOUCHMum’s skinMum’s skin
SkinSkin--toto--skinskinCONTACTCONTACT
Back FEELSBack FEELSMum’s armMum’s armholdingholding
TASTES TASTES Mum’s milkMum’s milk
WARMED on WARMED on Mum’s front Mum’s front
with Mumwith Mum
Slide from JILL BERGMAN Slide from JILL BERGMAN
NEWBORN DEVELOPMENT
skinskin--toto--skin contactskin contactTactile stimulations build the amygdala - preorbital cortical tract during the first 8 weeks during the first 8 weeks
The next pathway requires eyeeye--toto--eye contacteye contact
This is the basis of healthyright brain development!
NEWBORN DEVELOPMENTNEWBORN DEVELOPMENT
Tactile stimulationsTactile stimulations facilitate facilitate “the flow of “the flow of affective informationaffective information
from the infant … to the mother”from the infant … to the mother”“the “the language of mother and infantlanguage of mother and infant“the “the language of mother and infantlanguage of mother and infantconsists of signals produced by the consists of signals produced by the autonomic nervous systemautonomic nervous systemof both parties”.of both parties”.
This is the basis of healthy development!This is the basis of healthy development!Schore 2001a
Myron Hofer Myron Hofer
… the private realm of… the private realm of… the private realm of… the private realm ofsensory stimulation constructed sensory stimulation constructed by the mother and infant from by the mother and infant from numberless exchanges of numberless exchanges of subtle clues.subtle clues.
(Gallagher 1992)(Gallagher 1992)
The BOND The BOND
REGULATIONREGULATION
The BOND The BOND is made up of the is made up of the sensory inputs sensory inputs from the parent from the parent to the infantto the infant
Bowlby 1969, 1973, 1980
Through “hidden maternal regulators” ... Through “hidden maternal regulators” ...
warmth warmth �� activity levelactivity levelwarmth warmth �� activity levelactivity levelmilkmilk �� heart rateheart rate
“ “ physiological set points physiological set points ““internal internal working modelsworking modelsscripts scripts –– templatestemplates
Through Through “hidden maternal regulators” ... “hidden maternal regulators” ...
a mother precisely controls everya mother precisely controls everyelement of her infant’s physiologyelement of her infant’s physiology,,
from its heart rate to its from its heart rate to its from its heart rate to its from its heart rate to its release of hormonesrelease of hormones
from its appetite to the from its appetite to the intensity of its activityintensity of its activity
(Gallagher 1992)(Gallagher 1992)
Through Through “hidden maternal regulators” ... “hidden maternal regulators” ...
“ physiological set points ““ physiological set points “
“ internal working models’“ internal working models’“ scripts “ scripts –– templates”templates”
REGULATIONREGULATION
the objective is to achieve thethe objective is to achieve theability to establish:ability to establish:ability to establish:ability to establish:
‘STABILITY THROUGH CHANGE’‘STABILITY THROUGH CHANGE’
The foundation for The foundation for INFANT MENTAL HEALTHINFANT MENTAL HEALTH
Scientific model:Scientific model:
“simplified “simplified
abstract viewabstract viewabstract viewabstract viewof complex of complex
reality”reality”
SENSORY STIMULATIONSENSORY STIMULATION
AUTONOMICAUTONOMIC
EMOTIONAL EXCHANGESEMOTIONAL EXCHANGES
AUTONOMICAUTONOMICBODY CONTROLBODY CONTROL
WELLWELL--BEINGBEING
HEALTHHEALTH
SENSORY STIMULATIONSENSORY STIMULATION
AUTONOMICAUTONOMIC
EMOTIONAL EXCHANGESEMOTIONAL EXCHANGES
AUTONOMICAUTONOMICBODY CONTROLBODY CONTROL
WELLWELL--BEINGBEING
HEALTHHEALTH
The First Idea: How Symbols, Language, and Intelligence Evolved from our Primate Ancestors to Modern HumansStanley I. Greenspan & Stuart G. Shanker
The First Idea The First Idea
“It is necessary for a child to be “It is necessary for a child to be engaged in a series of affective engaged in a series of affective (emotional) interactions that give (emotional) interactions that give rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor sensory and social capacities,sensory and social capacities,which, when combined with symbol which, when combined with symbol formation, lead to language. formation, lead to language.
Greenspan & Shanker 2006, p39
The First Idea The First Idea
“It is necessary for a child to be “It is necessary for a child to be engaged in a series of affective engaged in a series of affective (emotional) interactions that give (emotional) interactions that give rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor rise to the developmentof motor sensory and social capacities,sensory and social capacities,which, when combined with symbol which, when combined with symbol formation, lead to language. formation, lead to language.
Greenspan & Shanker 2006, p39
The First Idea The First Idea
“It is necessary for a child to be “It is necessary for a child to be engaged in a series of affective engaged in a series of affective (emotional) interactions that give (emotional) interactions that give rise to the developmentof motor rise to the developmentof motor
Peek a boo … from Peek a boo … from FritziFritzi DrostenDrosten
rise to the developmentof motor rise to the developmentof motor sensory and social capacities,sensory and social capacities,which, when combined with symbol which, when combined with symbol formation, lead to language. formation, lead to language.
Greenspan & Shanker 2006, p39
The First Idea (p39)The First Idea (p39)
“The symbolic use of language, “The symbolic use of language, in turn, creates the foundationin turn, creates the foundationfor more advanced social and for more advanced social and intellectual capacities, including intellectual capacities, including intellectual capacities, including intellectual capacities, including higher and higher levelshigher and higher levelsof reflective thinking.of reflective thinking.
Greenspan & Shanker 2006, p39
SENSORY STIMULATIONSENSORY STIMULATION
BODYBODYAUTONOMICAUTONOMIC
EMOTIONAL EXCHANGESEMOTIONAL EXCHANGES
BODYBODYLANGUAGELANGUAGE
AUTONOMICAUTONOMICBODY CONTROLBODY CONTROL
COMMUNICATIONCOMMUNICATIONWELLWELL--BEINGBEING
SPEECHSPEECHHEALTHHEALTH
ATTACHMENT ATTACHMENT -- REGULATIONREGULATION
the objective is to achieve thethe objective is to achieve theability to establish an ability to establish an efficiently regulated right brain:efficiently regulated right brain:
‘STABILITY THROUGH CHANGE‘STABILITY THROUGH CHANGE
The foundation for The foundation for INFANT MENTAL HEALTHINFANT MENTAL HEALTHSchore 2001a
RESILIENCERESILIENCE(= STRESS RESISTANCE)(= STRESS RESISTANCE)
“capacity to maintain healthy “capacity to maintain healthy emotional functioning in the afteremotional functioning in the after--emotional functioning in the afteremotional functioning in the after--math of stressful experiences”math of stressful experiences”
Scientific model:Scientific model:
“simplified “simplified
abstract viewabstract viewabstract viewabstract viewof complex of complex
reality”reality”
SENSORY STIMULATIONSENSORY STIMULATION
BODYBODYAUTONOMICAUTONOMIC
EMOTIONAL EXCHANGESEMOTIONAL EXCHANGES
BODYBODYLANGUAGELANGUAGE
AUTONOMICAUTONOMICBODY CONTROLBODY CONTROL
COMMUNICATIONCOMMUNICATIONWELLWELL--BEINGBEING
SPEECHSPEECHHEALTHHEALTH
Basic neuroscienceBasic neuroscience::neurons, synapsesneurons, synapsesfire and wire,fire and wire,
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
fire and wire,fire and wire,two kinds of two kinds of sleepsleepcritical periods,critical periods,
hierarchy of layershierarchy of layers
Basic neuroscienceBasic neuroscience::neurons, synapsesneurons, synapsesfire and wire,fire and wire,
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
fire and wire,fire and wire,PATHWAYSPATHWAYSCIRCUITSCIRCUITSNETWORKSNETWORKS
PERINATAL PERINATAL neuroscienceneuroscience::
Birth is critical periodBirth is critical period
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
Birth is critical periodBirth is critical periodEarly experience:Early experience:
-- Physical regulationPhysical regulation-- Emotional regulationEmotional regulation
Maternal presenceMaternal presence
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
The BOND The BOND
REGULATIONREGULATION
The BOND The BOND is made up of the is made up of the sensory inputs sensory inputs from the parent from the parent to the infantto the infant
Bowlby 1969, 1973, 1980
Positive StressPositive Stress•• Moderate, shortModerate, short--lived stress responses, such lived stress responses, such as brief increases in heart rate or mild changes as brief increases in heart rate or mild changes in stress hormone levels.in stress hormone levels.in stress hormone levels.in stress hormone levels.
•• An important and necessary aspect of healthy An important and necessary aspect of healthy development that occurs in the context of development that occurs in the context of stable and supportive relationships.stable and supportive relationships.
Slide by: Jack P. Shonkoff, M.D.
Positive Stress= Eustress UnderUnder--
activityactivity
EUSTRESSEUSTRESS
OverOver--activityactivity
= Eustress
•• An important and necessaryAn important and necessaryaspect of healthy developmentaspect of healthy developmentthat occurs in the context of that occurs in the context of stable and supportive relationships.stable and supportive relationships.
Through Through “hidden maternal regulators” ... “hidden maternal regulators” ...
a mother precisely controls everya mother precisely controls everyelement of her infant’s physiologyelement of her infant’s physiology,,
from its heart rate to its from its heart rate to its from its heart rate to its from its heart rate to its release of hormonesrelease of hormones
from its appetite to the from its appetite to the intensity of its activityintensity of its activity
(Gallagher 1992)(Gallagher 1992)
RESILIENCERESILIENCE(= STRESS RESISTANCE)(= STRESS RESISTANCE)
“capacity to maintain healthy “capacity to maintain healthy emotional functioning in the afteremotional functioning in the after--emotional functioning in the afteremotional functioning in the after--math of stressful experiences”math of stressful experiences”
Tolerable StressTolerable Stress
•• Stress responses that could disrupt brain Stress responses that could disrupt brain architecture, but are buffered by supportive architecture, but are buffered by supportive relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.relationships that facilitate adaptive coping.
•• Generally occurs within a timeGenerally occurs within a time--limited period, limited period, which gives the brain an opportunity to recover which gives the brain an opportunity to recover from potentially damaging effects.from potentially damaging effects.
Slide by: Jack P. Shonkoff, M.D.
Toxic StressToxic Stress
•• Strong and prolonged activation of the body’s Strong and prolonged activation of the body’s stress management systems in the absence of stress management systems in the absence of the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.
JACK SHONKOFFJACK SHONKOFF
“Buffering protection “Buffering protection “Buffering protection “Buffering protection
of adult support” of adult support”
Toxic StressToxic Stress
•• Strong and prolonged activation of the body’s Strong and prolonged activation of the body’s stress management systems in the absence of stress management systems in the absence of the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.
•• Disrupts brain architecture and leads to stress Disrupts brain architecture and leads to stress management systems that respond at relatively management systems that respond at relatively lower thresholds, therebylower thresholds, thereby increasing the risk of increasing the risk of stressstress--related physical and mental illnessrelated physical and mental illness ..
Slide by: Jack P. Shonkoff, M.D.
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“buffering protection “buffering protection
of adult support” of adult support”
Jacksonian DissolutionJacksonian Dissolution
The more threatened the individual,The more threatened the individual,the more 'primitive' (or regressed) the more 'primitive' (or regressed) becomes the style of becomes the style of becomes the style of becomes the style of thinking and behaving.thinking and behaving.
Perry 1995 Perry 1995
DVC
VVC
SNS
SEESSEESMum’s eyesMum’s eyes
Ear HEARS Ear HEARS Mum’s voiceMum’s voice
SMELLS SMELLS Mum’s milkMum’s milk MOVES MOVES
with Mum’swith Mum’s
Hand TOUCHHand TOUCHMum’s skinMum’s skin
SkinSkin--toto--skinskinCONTACTCONTACT
Back FEELSBack FEELSMum’s armMum’s armholdingholding
TASTES TASTES Mum’s milkMum’s milk
WARMED on WARMED on Mum’s front Mum’s front
with Mum’swith Mum’s
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“buffering protection “buffering protection
of adult support” of adult support”
Toxic StressToxic Stress
•• Strong and prolonged activation of the body’s Strong and prolonged activation of the body’s stress management systems in the absence of stress management systems in the absence of the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.
•• Disrupts brain architecture and leads to stress Disrupts brain architecture and leads to stress management systems that respond at relatively management systems that respond at relatively lower thresholds, therebylower thresholds, thereby increasing the risk of increasing the risk of stressstress--related physical and mental illnessrelated physical and mental illness ..
Slide by: Jack P. Shonkoff, M.D.
“Genome” “Genome” –– genes of speciesgenes of species
“Genotype” “Genotype” -- genes in specimengenes in specimen
… highly conserved … highly conserved neuroneuro--endocrine behaviorsendocrine behaviors
INKINK
“Genome” “Genome” –– genes of speciesgenes of species
“Genotype” “Genotype” -- genes in specimengenes in specimen
… highly conserved … highly conserved neuroneuro--endocrine behaviorsendocrine behaviors
INK
“Phenotype” “Phenotype” –– specimen specimen resulting fromresulting from
gene gene –– environment interactionenvironment interaction
INK
Pencil
Toxic StressToxic Stress
•• Strong and prolonged activation of the body’s Strong and prolonged activation of the body’s stress management systems in the absence of stress management systems in the absence of the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.the buffering protection of adult support.
•• Disrupts brain architecture and leads to stress Disrupts brain architecture and leads to stress management systems that respond at relatively management systems that respond at relatively lower thresholds, therebylower thresholds, thereby increasing the risk of increasing the risk of stressstress--related physical and mental illnessrelated physical and mental illness ..
Slide by: Jack P. Shonkoff, M.D. CORTISOL
MICHAEL MEANEYMICHAEL MEANEY
“In response to stress, CRF“In response to stress, CRF
… and vasopressin are … and vasopressin are
released … anterior pituitaryreleased … anterior pituitary
Unsafe environment activates HPAUnsafe environment activates HPAaxis axis (autonomic nervous system, ANS)(autonomic nervous system, ANS). .
released … anterior pituitaryreleased … anterior pituitary
… synthesis release ACTH… synthesis release ACTH
……glucocorticoidsglucocorticoids �� ””CORTISOL
LG Low Grooming High Grooming HGLG Low Grooming High Grooming HG
LG BABY LG BABY HG BABYHG BABY
MOTHER MOTHER MOTHERMOTHER
UnhealthyUnhealthy HEALTHYHEALTHY
adult adult adultadultMakes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
LG Low Grooming LG Low Grooming High Grooming HGHigh Grooming HG
Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
LG Low Grooming High Grooming HGLG Low Grooming High Grooming HG
LG BABY LG BABY HG BABYHG BABY
MOTHER MOTHER MOTHERMOTHER
UnhealthyUnhealthy HEALTHYHEALTHY
adult adult adultadultMakes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
LG BABYLG BABY LG BABYLG BABY
High grooming careHigh grooming care
LG Low Grooming LG Low Grooming High Grooming HGHigh Grooming HG
Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
HEALTHYHEALTHY
adultadultLG Low Grooming High Grooming HGLG Low Grooming High Grooming HG
Makes MOTHER Makes MOTHERMakes MOTHER Makes MOTHER
LG Low Grooming High Grooming HGLG Low Grooming High Grooming HG
LG BABY LG BABY HG BABYHG BABY
MOTHER MOTHER MOTHERMOTHER
UnhealthyUnhealthy HEALTHYHEALTHY
adult adult adultadultMakes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
LG Low Grooming LG Low Grooming High Grooming HGHigh Grooming HG
Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
LG Low Grooming High Grooming HGLG Low Grooming High Grooming HG
LG BABYLG BABY HG BABYHG BABY
MOTHER MOTHER MOTHERMOTHER
UnhealthyUnhealthy HEALTHYHEALTHY
adult adult adultadultMakes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
HG BABY HG BABY HG BABYHG BABY
LOW grooming careLOW grooming care
LG Low Grooming LG Low Grooming High Grooming HGHigh Grooming HG
Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
UN UN -- HEALTHYHEALTHY
adultadultLG Low Grooming LG Low Grooming
Makes MOTHER Makes MOTHER
Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
Earliest care Earliest care at birth mattersat birth matters
Same gene Same gene �� switchedswitched
HG BABY HG BABY HG BABYHG BABY
LOW grooming careLOW grooming care
LG Low Grooming LG Low Grooming High Grooming HGHigh Grooming HG
Makes MOTHER Makes MOTHER Makes MOTHERMakes MOTHER
UN UN -- HEALTHYHEALTHY
adultadultLG Low Grooming LG Low Grooming
Makes MOTHER Makes MOTHER
CORTISOL
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
Earliest care Earliest care at birth mattersat birth matters
Same gene Same gene �� switchedswitchedThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
Earliest care Earliest care at birth mattersat birth matters
Same gene Same gene �� switchedswitchedThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“BIRTH” “BIRTH” –– earliest environmentearliest environment
Primate separation studiesPrimate separation studies
Maternal Separation ParadigmMaternal Separation Paradigm0w0w 1w1w 2w2w 3w3w 4w4w 5w5w 6w 6w �� �� 12w12w
n 4n 4 Mat Mat MNSMNS ��group reared no mothergroup reared no mothern 4 n 4 Mat Mat �� �� �� MNSMNS �� group as abovegroup as aboven 4n 4 Mat Mat �� �� �� �� �� �� ((controlcontrol))
Gene specific for the AMYGDALAGene specific for the AMYGDALA( GUYC1A3)( GUYC1A3)
Separated at 1 week:Separated at 1 week:
LOW gene expressionLOW gene expression
Increased self soothingIncreased self soothing�� AnxietyAnxiety
Decreased socialityDecreased sociality�� DepressionDepression
Primate separation studiesPrimate separation studies
Maternal Separation ParadigmMaternal Separation ParadigmEarly Deprivation (ED) vs control (CON)Early Deprivation (ED) vs control (CON)
0d0d 2d2d �������� ��������28d28d �� �� 48w48wED n 11ED n 11 Mat Mat 30 30 --120 min daily120 min daily ��
CON n 4 CON n 4 Mat Mat �� �� �� �� �� �� 48w48w
Repeated shortRepeated shortRepeated shortRepeated shortseparations:separations:
LOW gene expressionLOW gene expression
Correlate to human adult depressionCorrelate to human adult depression
SEPARATION causesSEPARATION causes
PROTEST PROTEST –– DESPAIRDESPAIR(hyperactivity (hyperactivity �������� depression)depression)
Social deprivation Social deprivation alters neurobiological systems. alters neurobiological systems.
This pathology ... cannot be cured ...This pathology ... cannot be cured ...Scientific Committee 2002
3-day separation:
induces physiological changes (immune,system, heart rate, sleep, cortisol, loss of body temperature..
anaclitic depression:anaclitic depression:•hyperactivity•conservation- withdrawal;•death or recovery
Slide & photo fromJames McKenna
CONCLUSIONSCONCLUSIONSScientific findings do not support the Scientific findings do not support the perceived benefits of permanent, perceived benefits of permanent, preweaningpreweaningmothermother––infant separation.infant separation.
(similar to earlier … )(similar to earlier … )
REGULATIONREGULATION
the objective is to achieve thethe objective is to achieve theability to establish:ability to establish:ability to establish:ability to establish:
‘STABILITY THROUGH CHANGE’‘STABILITY THROUGH CHANGE’
The foundation for The foundation for INFANT MENTAL HEALTHINFANT MENTAL HEALTH
VocabularyVocabulary
Homeostasis the coordinated operation of Homeostasis the coordinated operation of physiological processes that maintain physiological processes that maintain the steady state required to sustain lifethe steady state required to sustain life
AllostasisAllostasis the mechanism by whichthe mechanism by whichAllostasisAllostasis the mechanism by whichthe mechanism by whichhomeostatic systems are maintained in balancehomeostatic systems are maintained in balanceas life cycle and environment changesas life cycle and environment changes
AllostaticAllostatic state state elevated activity of elevated activity of mediators, with returnmediators, with returnto baseline and no impact on health.to baseline and no impact on health.
AllostasisAllostasis the mechanism by whichthe mechanism by whichhomeostatic systems are maintained in balance …homeostatic systems are maintained in balance …
AllostaticAllostatic state state elevated activity of mediators,elevated activity of mediators,with return to baseline and no impact on health.with return to baseline and no impact on health.
AllostaticAllostatic load load elevated activity elevated activity ––AllostaticAllostatic load load elevated activity elevated activity ––sustained over time, or severe …sustained over time, or severe …�� changes target cells of mediators,changes target cells of mediators,and so changes the “set points” for homeostasisand so changes the “set points” for homeostasis(e.g. increasing blood pressure, (e.g. increasing blood pressure,
change in cholesterol level)change in cholesterol level)
�������� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��������
PERCEPTIONSPERCEPTIONS
“NEUROCEPTION”“NEUROCEPTION”
RESPONSERESPONSESTRESSSTRESS
ALLOSTASIS ALLOSTASIS
PsychologicalPsychological
NeurologicalNeurological
EndocrineEndocrine
Immune Immune
�������� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��������
ALLOSTATIC STATEALLOSTATIC STATE
HEALTHHEALTH DISEASEDISEASE
ALLOSTATIC LOADALLOSTATIC LOAD
ALLOSTATIC OVERLOADALLOSTATIC OVERLOAD
WELLWELL--BEING BEING �������� SUSCEPTIBILITY SUSCEPTIBILITY �������� MORBIDITY MORBIDITY �������� MORTALITYMORTALITY
ALLOSTATIC LOAD:ALLOSTATIC LOAD:
TOXICSTRESS
SensitivityHIGH
2ND
KNOCK
ALLOSTATIC LOAD:ALLOSTATIC LOAD:“wear and tear that results from “wear and tear that results from chronic chronic overactivityoveractivity
(or (or underactivityunderactivity))of of allostaticallostatic systems.”systems.”
(McEwen 1998, 1999)(McEwen 1998, 1999)
RESILIENCERESILIENCE(= STRESS RESISTANCE)(= STRESS RESISTANCE)
“capacity to maintain healthy “capacity to maintain healthy emotional functioning in the afteremotional functioning in the after--emotional functioning in the afteremotional functioning in the after--math of stressful experiences”math of stressful experiences”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
CORTISOL
�������� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��������
PERCEPTIONSPERCEPTIONS
“NEUROCEPTION”“NEUROCEPTION”
RESPONSERESPONSESTRESSSTRESS
ALLOSTASIS ALLOSTASIS
PsychologicalPsychological
NeurologicalNeurological
EndocrineEndocrine
Immune Immune
�������� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��������
ALLOSTATIC STATEALLOSTATIC STATE
HEALTHHEALTH DISEASEDISEASE
ALLOSTATIC LOADALLOSTATIC LOAD
ALLOSTATIC OVERLOADALLOSTATIC OVERLOAD
WELLWELL--BEING BEING �������� SUSCEPTIBILITY SUSCEPTIBILITY �������� MORBIDITY MORBIDITY �������� MORTALITYMORTALITY
ALLOSTATIC LOAD:ALLOSTATIC LOAD:
TOXICSTRESS
SensitivityHIGH
2ND
KNOCK
ALLOSTATIC LOAD:ALLOSTATIC LOAD:“wear and tear that results ….“wear and tear that results ….
SPECTRUM of expression in SPECTRUM of expression in POPULATIONPOPULATION
HEALTHHEALTH DISEASEDISEASE
The Fetal Matrix: The Fetal Matrix:
PREDICTIVEPREDICTIVEADAPTIVEADAPTIVEADAPTIVEADAPTIVERESPONSESRESPONSES
(PARs)(PARs)Gluckman &Hanson 2005
BARKER ‘thrifty phenotype’BARKER ‘thrifty phenotype’
“Fetal programming hypothesis”“Fetal programming hypothesis”
Developmental Origins of Developmental Origins of
Health and DiseaseHealth and DiseaseHealth and DiseaseHealth and Disease
DOHaDDOHaD
Epigenetic processes operate Epigenetic processes operate in the human fetus, and beyond.in the human fetus, and beyond.
CENTRAL DOGMA CENTRAL DOGMA –– all biological processesall biological processes
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATIONThe PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
Adaptation and Adaptation and MALADAPTATION …MALADAPTATION …
Developing Developing Brain Brain (1)(1)
NeurogenesisNeurogenesis
Neural morphologyNeural morphology
SynaptogenesisSynaptogenesis
MyelinationMyelination
Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain
Fewer dendritic spinesFewer dendritic spines
Poorer connectionsPoorer connections
Fewer glial cells, less myelinFewer glial cells, less myelin
TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL
Developing Developing Brain Brain (1)(1)
NeurogenesisNeurogenesis
Neural morphologyNeural morphology
SynaptogenesisSynaptogenesis
MyelinationMyelination
Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain
Fewer dendritic spinesFewer dendritic spines
Poorer connectionsPoorer connections
Fewer glial cells, less myelinFewer glial cells, less myelin
Enduring (4)Enduring (4)consequencesconsequences
TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL
consequencesconsequencesAttenuated L brain devlopmentAttenuated L brain devlopment
Poor R / L integrationPoor R / L integration
Irritability limbic systemIrritability limbic system
Poorer function vermisPoorer function vermis
Developing Developing Brain Brain (1)(1)
NeurogenesisNeurogenesis
Neural morphologyNeural morphology
SynaptogenesisSynaptogenesis
MyelinationMyelination
Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain
Fewer dendritic spinesFewer dendritic spines
Poorer connectionsPoorer connections
Fewer glial cells, less myelinFewer glial cells, less myelin
Sensitivity (3)Sensitivity (3)GeneticGenetic
GenderGender
Enduring (4)Enduring (4)consequencesconsequences
TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL
GenderGender
TimingTiming
Developmental rateDevelopmental rate
GCR densityGCR density
consequencesconsequencesAttenuated L brain devlopmentAttenuated L brain devlopment
Poor R / L integrationPoor R / L integration
Irritability limbic systemIrritability limbic system
Poorer function vermisPoorer function vermis
Developing Developing Brain Brain (1)(1)
NeurogenesisNeurogenesis
Neural morphologyNeural morphology
SynaptogenesisSynaptogenesis
MyelinationMyelination
Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain
Fewer dendritic spinesFewer dendritic spines
Poorer connectionsPoorer connections
Fewer glial cells, less myelinFewer glial cells, less myelin
Sensitivity (3)Sensitivity (3)GeneticGenetic
GenderGender
Enduring (4)Enduring (4)consequencesconsequences
TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL
GenderGender
TimingTiming
Developmental rateDevelopmental rate
GCR densityGCR density
consequencesconsequencesAttenuated L brain devlopmentAttenuated L brain devlopment
Poor R / L integrationPoor R / L integration
Irritability limbic systemIrritability limbic system
Poorer function vermisPoorer function vermis
Neuropsychiatric Neuropsychiatric vulnerabilitiesvulnerabilities (5)(5)
Dissociative identity disorderDissociative identity disorder
DepressionDepression Personality disorderPersonality disorder
Substance abuseSubstance abuse
Post Traumatic Stress DisorderPost Traumatic Stress Disorder
Developing Developing Brain Brain (1)(1)
NeurogenesisNeurogenesis
Neural morphologyNeural morphology
SynaptogenesisSynaptogenesis
MyelinationMyelination
Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain
Fewer dendritic spinesFewer dendritic spines
Poorer connectionsPoorer connections
Fewer glial cells, less myelinFewer glial cells, less myelin
Sensitivity (3)Sensitivity (3)GeneticGenetic
GenderGender
Enduring (4)Enduring (4)consequencesconsequences
TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL
GenderGender
TimingTiming
Developmental rateDevelopmental rate
GCR densityGCR density
consequencesconsequencesAttenuated L brain devlopmentAttenuated L brain devlopment
Poor R / L integrationPoor R / L integration
Irritability limbic systemIrritability limbic system
Poorer function vermisPoorer function vermis
Neuropsychiatric Neuropsychiatric vulnerabilitiesvulnerabilities (5)(5)
Dissociative identity disorderDissociative identity disorder
DepressionDepression Personality disorderPersonality disorder
Substance abuseSubstance abuse
Post Traumatic Stress DisorderPost Traumatic Stress Disorder
Developing Developing Brain Brain (1)(1)
NeurogenesisNeurogenesis
Neural morphologyNeural morphology
SynaptogenesisSynaptogenesis
MyelinationMyelination
Early Early Stress Stress (2)(2)Neuronal death, smaller brainNeuronal death, smaller brain
Fewer dendritic spinesFewer dendritic spines
Poorer connectionsPoorer connections
Fewer glial cells, less myelinFewer glial cells, less myelin
Sensitivity (3)Sensitivity (3)GeneticGenetic
GenderGender
Enduring (4)Enduring (4)consequencesconsequences
TEICHER’STEICHER’SEARLY STRESSEARLY STRESSCASCADE MODELCASCADE MODEL
GenderGender
TimingTiming
Developmental rateDevelopmental rate
GCR densityGCR density
consequencesconsequencesAttenuated L brain devlopmentAttenuated L brain devlopment
Poor R / L integrationPoor R / L integration
Irritability limbic systemIrritability limbic system
Poorer function vermisPoorer function vermis
Neuropsychiatric Neuropsychiatric vulnerabilitiesvulnerabilities (5)(5)
Dissociative identity disorderDissociative identity disorder
DepressionDepression Personality disorderPersonality disorder
Substance abuseSubstance abuse
Post Traumatic Stress DisorderPost Traumatic Stress Disorder
StimulationStimulation
ResilienceResilience
MENTAL HEALTHMENTAL HEALTH
Schore: Schore:
“Infant trauma will interfere with“Infant trauma will interfere withcritical period limbic organisation ...critical period limbic organisation ...
future capacity to adapt ...future capacity to adapt ...correlated with maladaptive correlated with maladaptive adult mental health”adult mental health”
SchoreSchore: :
“long term alterations brain function“long term alterations brain function
“risk for developing severe psycho“risk for developing severe psycho--pathologies at later stages of life.”pathologies at later stages of life.”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“risk for developing severe psycho“risk for developing severe psycho--pathologies at later stages of life.”pathologies at later stages of life.”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
HEALTHHEALTH DISEASEDISEASE
EXPECTED UNEXPECTED EXPECTED UNEXPECTED
“risk for developing severe psycho“risk for developing severe psycho--pathologies at later stages of life.”pathologies at later stages of life.”
�������� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��������
PERCEPTIONSPERCEPTIONS
“NEUROCEPTION”“NEUROCEPTION”
RESPONSERESPONSESTRESSSTRESS
ALLOSTASIS ALLOSTASIS
PsychologicalPsychological
NeurologicalNeurological
EndocrineEndocrine
Immune Immune
�������� RESILIENCE / SENSITIVITY RESILIENCE / SENSITIVITY ��������
ALLOSTATIC STATEALLOSTATIC STATE
HEALTHHEALTH DISEASEDISEASE
ALLOSTATIC LOADALLOSTATIC LOAD
ALLOSTATIC OVERLOADALLOSTATIC OVERLOAD
WELLWELL--BEING BEING �������� SUSCEPTIBILITY SUSCEPTIBILITY �������� MORBIDITY MORBIDITY �������� MORTALITYMORTALITY
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SPECTRUM of expression in SPECTRUM of expression in POPULATIONPOPULATION
HEALTHHEALTH DISEASEDISEASE
EXPECTED UNEXPECTED EXPECTED UNEXPECTED
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
SPECTRUM of expression in SPECTRUM of expression in POPULATIONPOPULATION
HEALTHHEALTH DISEASEDISEASE
Platform for better understanding of Platform for better understanding of PUBLIC HEALTHPUBLIC HEALTH..
… policy and practice that impacts the care of mothers and babies.… policy and practice that impacts the care of mothers and babies.
EXPECTED UNEXPECTED EXPECTED UNEXPECTED
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“except in the light of “except in the light of
mother’s body.”mother’s body.”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“needed neural “needed neural
processes” processes”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“buffering protection “buffering protection
of adult support” of adult support”
NEUROSCIENCENEUROSCIENCE
The DNAThe DNAEverything elseEverything else
EVOLUTIONARYEVOLUTIONARY
BIOLOGYBIOLOGY
The BrainThe Brain
EPIGENETICSEPIGENETICS
The PlaceThe Place EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
“Scientific foundation” … a synthesis “Scientific foundation” … a synthesis
The PlaceThe Place
ENVIRONMENTENVIRONMENT
EXPERIENCEEXPERIENCEFITNESSFITNESS ADAPTATIONADAPTATION
ZERO ZERO
SEPARATIONSEPARATION
ZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZEROZERO
SEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATIONSEPARATION
MOTHERMOTHERis the key tois the key toneurodevelopment …neurodevelopment …neurodevelopment …neurodevelopment …
… because she is the … because she is the
RIGHT PLACE !!RIGHT PLACE !!
MOTHERMOTHERis the key tois the key toneurodevelopment …neurodevelopment …neurodevelopment …neurodevelopment …
EEnvironment ofnvironment ofEEvolutionary volutionary AAdaptednessdaptedness
“EEA”“EEA”EEnvironment ofnvironment ofEEnvironment ofnvironment ofEEvolutionary volutionary AAdaptednessdaptedness
PERINATAL PERINATAL neuroscienceneuroscience::
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
FIRST: socioFIRST: socio--emotionalemotionalTHEN: sensory inputsTHEN: sensory inputsNEXT: regulationNEXT: regulationLATER: resilienceLATER: resilience
Primate neurosciencePrimate neuroscience::Stress Stress �������� cortisolcortisol
brain alterations brain alterations ��������
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
brain alterations brain alterations ��������MALMAL--adaptationadaptation
Social / EmotionalSocial / Emotional
MATERNALMATERNAL--INFANTINFANTSEPARATIONSEPARATION
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
SEPARATIONSEPARATION
HAS HAS NONO SCIENTIFIC SCIENTIFIC
FOUNDATION.FOUNDATION.
HUMAN neuroscienceHUMAN neuroscience::Stress Stress �������� cortisolcortisol
brain alterations brain alterations ��������
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
brain alterations brain alterations ��������MALMAL--adaptationadaptation
Social / EmotionalSocial / Emotional
SEPARATIONSEPARATIONDYSDYS--REGULATESREGULATES
(short(short--term)term)
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
(short(short--term)term)
LongLong--termtermmaladaptationmaladaptation &&susceptibilitysusceptibility
For the human newborn, it is the habitat which determines which brain determines which brain programme is operating, which then determines the behaviour (niche).
HABITAT
MATERNALMOTHER
MATERNAL DEPENDENCE
OTHERALTERNATE
There are only these two habitat choices available
HABITAT NICHE
BREAST-MOTHER FEEDING
SAFESAFE ? ? �������� YESYES
OTHER PROTEST-DESPAIR
SAFESAFE ? ? �������� NONO
HABITAT NICHE MEANS RESULT
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
SKIN-TO-SKIN CONTACT
OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)
SEPARATION
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
SKIN-TO-SKIN CONTACT
THE PLACE MODELPLACE MODEL
OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)
SEPARATION
Relationships are the “Active Ingredients" of Early Experience
•• Nurturing and responsive interactions build Nurturing and responsive interactions build healthy brain architecture that provides a strong healthy brain architecture that provides a strong foundation for later learning, behavior, health.foundation for later learning, behavior, health.foundation for later learning, behavior, health.foundation for later learning, behavior, health.
•• When protective relationships are not provided, When protective relationships are not provided, persistent stresspersistent stress results in elevated cortisol results in elevated cortisol levels that disrupt brain architecture by levels that disrupt brain architecture by impairing cell growth and interfering with the impairing cell growth and interfering with the formation of healthy neural circuits.formation of healthy neural circuits.
Jack P. Shonkoff, M.D.
BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH
•• Nurturing and responsive interactions build Nurturing and responsive interactions build healthy brain architecture that provides a strong healthy brain architecture that provides a strong foundation for later learning, behavior, health.foundation for later learning, behavior, health.
OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)
•• When protective relationships are not provided, When protective relationships are not provided, persistent stresspersistent stress results in elevated cortisol results in elevated cortisol levels that disrupt brain architecture by levels that disrupt brain architecture by impairing cell growth and interfering with the impairing cell growth and interfering with the formation of healthy neural circuits.formation of healthy neural circuits.
SCIENTIFIC BASIS SCIENTIFIC BASIS For SkinFor Skin--toto--Skin ContactSkin Contact
The PLACE MODELThe PLACE MODEL
�� scientifically derived scientifically derived �� alternative approach alternative approach �� falsifiable/testable hypothesisfalsifiable/testable hypothesis
NeuroscienceNeuroscienceEvolutionary biologyEvolutionary biology
NeuroscienceNeuroscienceEvolutionary biologyEvolutionary biology
primatologyprimatologyEpigeneticsEpigeneticsTOXIC STRESSTOXIC STRESS
DOHADDOHAD
... the newborn child ... the newborn child ... the newborn child ... the newborn child is a small human being, is a small human being, with all its senses developed, with all its senses developed,
open and receptive.open and receptive.(John Lind, 1979)(John Lind, 1979)