Hi I am Dr Mike Evans and Ill start todays visual lecture with a question. Did you know
1/3 of world’s children never reach their full potential? Ill talk about the science
behind this, but before I do I just want you to imagine for a moment – what if we could
unlock this potential? What if we could literally Save Brains?
You see, we used to see brain development as a fixed process--where a genetic blueprint
simply unfolds… BUT now we see a bigger picture …where genes are certainly important…
but that your brain actually physically and functionally changes with your experiences.
We call this brain plasticity, and though it begins prenatally and continues to death,
it has become clear that the first 1000 days, where the brain is in rapid growth mode, is
the most potent window to improve brains.
Understanding this developmental window is a bit like looking at the stock market and
saying to yourself, “Man, if I had just invested a little money in that company 20
years ago…” It turns out that supplying a few key elements at the beginning of a kid’s
life, when the genes are really listening, reaps massive rewards downstream…. their
brains become richer and more networked … and, unique to the brain, this has a ripple effect
by improving a persons academic performance, economic opportunity, health, resiliency,
and their capacity to navigate life, and avoid some of life’s more negative incidents and
pitfalls.
I will come to the positive things we can do to help young brains, but before I do...
I think we have to consider the reverse, when negative things happen to brains early in
life.
So let’s define negative. When we look at stress.. I think of 3 categories. Firstly
is the kind of positive stress experience we want for our kids, where stress happens
in the context of buffering stable and supportive relationships, and where the kids actually
build healthy responses to adversity. Even when they quote “fail”, hopefully their
social network, and I mean that in the old sense of the word, helps them fail well,,,
which in turn leads to resilience….
Next is when kids are exposed to extraordinary stress… such as unexpected death of a family
member, serious illness or injury, a contentious divorce, natural disaster, and so on. We call
this tolerable because if the child has these protective relationships… these create a
significant opportunity for kids to have a sense of control and adaptive coping.
Finally, we have Toxic stress by definition does not have this support system ..and is
more insidious. This would include child abuse, intimate partner or community violence, neglect…
sometimes due to maternal depression or parental substance abuse. These children have no buffer…
and when we measure their physiologic stress response … they exhibit strong, frequent,
or prolonged activation … which makes it harder for the early brain to prioritize growth
and learning.
SO your next question might be …so what …? Well ..when American kids with toxic
stress were followed in the Adverse Childhood Experiences Study .. those that scored the
worst had a 4 to 12-fold increased risk for alcoholism, drug abuse, depression, and suicide
attempts; a 2- to 4-fold increase in smoking, poor self-rated health, >50 sexual intercourse
partners, and 1 and a half times increase in physical inactivity and severe obesity.
So I think that's point #1, stress and adversity are part of life and if our children are engaged
and supported they can develop a healthy response regardless of where in the world they live…..
that’s even protective for those that have extraordinary stress. Children who suffer
toxic stress, who are abused or neglected at a very young age can have a much weaker
platform from which to launch …. This disadvantage can play out in multiple ways as life goes
on and these kids need child protection to prevent or limit damage.
OK so.. now we know what type of stressors that hold back the early brain, what can we
do to actually enrich our children’s brains?
Well the answer globally is twofold: Firstly providing a platform of health and Nutrition
and secondly creating a stronger focus on play-based responsive stimulation.
Let’s start in Jamaica.. with high risk kids 9 months to 2 years of age that had early
growth curves that were considerably lower than normal. Some kids were just followed,
others received an extra nutrition in the form of a kg of milk-based supplement … others
had stimulation, and still others had both stimulation and nutrition for 2 years..
Stimulation here consisted of weekly visits from community health workers that encouraged
mothers and children to interact in ways through play that develop cognitive and emotional
skills.
Let me just blow that out a bit for the average parent.. this is largely about responsiveness
.. When a parent responds quickly to a baby in a warm and loving way, the baby learns
that their needs will be met. She or he feels secure and loved. When a parent talks or sings
to their baby, encourages curiosity, and is consciously interactive …. They literally
enhance their kid’s brain and create a platform for more.
To get back to the Jamaican kids ….follow-up at the 2 year mark was published in the Lancet,
both the kids that got stimulation and those that received extra nutrition independently
improved their child development scores, but the group that got both did significantly
better than either alone…. And these kids actually caught up to their non-stunted peers,
which is remarkable.
The story gets even more interesting… When these kids were followed up at intervals between
the ages of 17 and 22 , the kids that got extra play were shown to have better vocabulary
and reading scores, less involvement in fights, less serious violent behaviour, and fewer
symptoms of depression and social inhibition. In fact, the drop out rates for school at
this age were 29% on average,, whereas kids that were engaged early had HALF the drop
out rate at 15%.
Remember, these were kids that had fallen off their growth curves at the beginning of
their lives.. This might seem like a rare problem to you … but in reality 1/3rd of
the world’s children under 5 falls in to this category of being stunted developmentally.
When the researchers wondered whether the intervention could actually help break the
cycle of poverty down the road… They found those that were stimulated actually generated
25% more income…
. If we go even earlier in the lives of kids,
another type of stimulation is simply skin to skin contact with newborns.. This was looked
at in babies born prematurely in Colombia… the newborns either went to an incubator,
which was usual care, or the Kangaroo Mother care program where the preemies were kept
in skin-to-skin contact around the clock with mom or dad until the infant showed they wanted
independence. The babies with the skin contact had shorter hospital stays, less death, better
growth, and improved cognitive development.
Breastfeeding is a great example of this contact where stimulation and nutrition go hand-in-hand
– and also evidence that if we can meet basic nutrition needs we can enhance a child’s
opportunity to benefit from stimulation.
So I think this is message #2. Making some early investments in nutrition and stimulation
to children can lead to less impoverished brains and hopefully break the complex cascades
that lead to impoverished communities … This may require some courage from policy-makers
as the return on investment tends to be farther down the road… when they have left office.
I have painted a picture here from the research but the reality is that there is lots we don’t
know. We certainly haven’t mapped all the nuances of brain development, We know more
about the extremes … so.. the effect on vulnerable families that are incredibly stretched
or kids that are neglected…rather than low risk kids… this tends to happen in research
as we can see outcomes with more definition in higher risk populations, but on the other
hand I do think we have a powerful signal to build on … that isnt complex and is intuitive
to parents: Food and Play. Re-imagining how to provide the right mix of nutrition, stimulation,
and protection - and most fundamentally… human love - needed to save brains seems a
grand challenge..
Now.. Ive focused on the early window of development …but it’s important to keep in mind that
it’s never too late.. Starting an earlier combo of play and early childhood education,
…. As well as responding, engaging, and nurturing the children, teenagers, and adults
in our lives can change brains for the better across the lifespan.
There is a Chinese proverb that says...”The best time to plant a tree is 20 years ago.
The second best time is now.” So… saving brains is about timely investment in resources
… but I think it’s also about resourcefulness, especially when it comes to us as parents,
friends, researchers or communities.
Saving brains… something to think about and thanks for listening.