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Adverse childhood experiences (ACEs) are categorized into three groups: abuse, neglect, and household challenges. Each category is further divided into multiple subcategories. Participant demographic information is available by gender, race, age, and education. The prevalence of ACEs is organized by category.

ACEs Definitions

All ACE questions refer to the respondent's first 18 years of life.

Abuse

Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt.

Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured.

Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.

Household Challenges

Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother's boyfriend.

Substance abuse in the household: A household member was a problem drinker or alcoholic or a household member used street drugs.

Mental illness in the household: A household member was depressed or mentally ill or a household member attempted suicide.

Parental separation or divorce: Your parents were ever separated or divorced.

Incarcerated household member: A household member went to prison.

Neglect

Emotional neglect: Someone in your family never or rarely helped you feel important or special, you never or rarely felt loved, people in your family never or rarely looked out for each other and felt close to each other, or your family was never or rarely a source of strength and support.

Physical neglect: There was never or rarely someone to take care of you, protect you, or take you to the doctor if you needed it, you didn't have enough to eat, your parents were too drunk or too high to take care of you, or you had to wear dirty clothes.

¹Collected during Wave 2 only.
Items were reverse scored to reflect the framing of the question.

Participant Demographics

Demographic information is from the entire ACE Study sample (n=17,337).
Note: Research papers that use Wave 1 and/or Wave 2 data may contain slightly different reports of participants' demographic information.
ACEs Prevalence

The prevalence estimates reported below are from the entire ACE Study sample (n=17,337).
Note: ³Collected during Wave 2 only (N=8,629). Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.
Note: Research papers that use Wave 1 and/or Wave 2 data may contain slightly different prevalence estimates.
Source: Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.

# data[].attributes.attachment_link.description
Adverse childhood experiences (ACEs) are categorized into three groups: abuse, neglect, and household challenges. Each category is further divided into multiple subcategories. Participant demographic information is available by gender, race, age, and education. The prevalence of ACEs is organized by category. All ACE questions refer to the respondent's first 18 years of life.

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Adverse Childhood Experiences: Expanding the Concept of Adversity

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Adverse Childhood Experiences: Expanding the Concept of Adversity

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doi: 10.1016/j.amepre.2015.02.001.

Affiliations

¹ Department of Family Medicine and Community Health, University of Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania. Electronic address: peter.cronholm@uphs.upenn.edu.

² Department of Epidemiology and Biostatistics, University of Pennsylvania; Violence Prevention Initiative, Center for Injury Research Prevention.

³ Department of Pediatrics, The Children's Hospital of Philadelphia.

⁴ Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.

⁵ Robert Wood Johnson Foundation, Princeton, New Jersey.

⁶ Philadelphia Health Management Corporation, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

⁷ Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

⁸ Violence Prevention Initiative, Center for Injury Research Prevention; Department of Emergency Medicine, The Children's Hospital of Philadelphia.

doi: 10.1016/j.amepre.2015.02.001.

Affiliations

¹ Department of Family Medicine and Community Health, University of Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania. Electronic address: peter.cronholm@uphs.upenn.edu.

² Department of Epidemiology and Biostatistics, University of Pennsylvania; Violence Prevention Initiative, Center for Injury Research Prevention.

³ Department of Pediatrics, The Children's Hospital of Philadelphia.

⁴ Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.

⁵ Robert Wood Johnson Foundation, Princeton, New Jersey.

⁶ Philadelphia Health Management Corporation, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

⁷ Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

⁸ Violence Prevention Initiative, Center for Injury Research Prevention; Department of Emergency Medicine, The Children's Hospital of Philadelphia.

Abstract

Introduction: Current knowledge of Adverse Childhood Experiences (ACEs) relies on data predominantly collected from white, middle- / upper-middle-class participants and focuses on experiences within the home. Using a more socioeconomically and racially diverse urban population, Conventional and Expanded (community-level) ACEs were measured to help understand whether Conventional ACEs alone can sufficiently measure adversity, particularly among various subgroups.

Methods: Participants from a previous large, representative, community-based health survey in Southeast Pennsylvania who were aged ≥18 years were contacted between November 2012 and January 2013 to complete another phone survey measuring ACEs. Ordinal logistic regression models were used to test associations between Conventional and Expanded ACEs scores and demographic characteristics. Analysis was conducted in 2013 and 2014.

Results: Of 1,784 respondents, 72.9% had at least one Conventional ACE, 63.4% at least one Expanded ACE, and 49.3% experienced both. A total of 13.9% experienced only Expanded ACEs and would have gone unrecognized if only Conventional ACEs were assessed. Certain demographic characteristics were associated with higher risk for Conventional ACEs but were not predictive of Expanded ACEs, and vice versa. Few adversities were associated with both Conventional and Expanded ACEs.

Conclusions: To more accurately represent the level of adversity experienced across various sociodemographic groups, these data support extending the Conventional ACEs measure.

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Cited by

Exploring Social Impairment in Those with Opioid Use Disorder: Linking Impulsivity, Childhood Trauma, and the Prefrontal Cortex.

Arruda T, Sinko L, Regier P, Tufanoglu A, Curtin A, Teitelman A, Ayaz H, Cronholm P, Childress AR. Arruda T, et al. Res Sq [Preprint]. 2024 Apr 8:rs.3.rs-4202009. doi: 10.21203/rs.3.rs-4202009/v1. Res Sq. 2024. PMID: 38659778 Free PMC article. Preprint.

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adult survivors of child abuse / statistics & numerical data*

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adult survivors of child adverse events / statistics & numerical data*

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racial groups / statistics & numerical data

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urban population / statistics & numerical data*

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national center for biotechnology information

# data[].attributes.attachment_link.title
Adverse Childhood Experiences: Expanding the Concept of Adversity - PubMed

# data[].attributes.attachment_link.description
To more accurately represent the level of adversity experienced across various sociodemographic groups, these data support extending the Conventional ACEs measure.

# data[].attributes.attachment_link.authors[].name
Office of the California Surgeon General

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Understanding ACEs with Dr. Nadine Burke Harris

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Literacy in School-Aged Children & ACEs Risk - Canadian Paediatric Society

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Literacy in School-Aged Children & ACEs Risk - Canadian Paediatric Society

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The Canadian Paediatric Society gives permission to print single copies of this document from our website. For permission to reprint or reproduce multiple copies, please see our copyright policy.

Principal author(s)

Anne Kawamura MD, Angela Orsino MD, Scott McLeod MD, Mark Handley-Derry MD, Linda Siegel PhD, Jocelyn Vine RN BN MHS CHE, Nicola Jones-Stokreef MD; Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee

Abstract

Literacy is a key social determinant of health that affects the daily socioemotional lives of children and their economic prospects later in life. Being able to read, write, and understand written text is essential to participating in society, achieving goals, developing knowledge, and fulfilling potential. Yet a significant proportion of adults in Canada do not have the literacy skills they need to meet and manage increasingly complex workforce demands. Paediatric care providers play a pivotal role in identifying children and families at risk for low literacy. This statement offers approaches for assessing children and counselling families to improve reading skills, while advocating for their right to access evidence-based reading instruction.
Keywords: Evidence-based reading instruction; Literacy; Screening
Literacy is a human right

The United Nations Educational, Scientific and Cultural Organization (UNESCO) recognized literacy as both a human right and an essential prerequisite for a healthy, just, and prosperous world in 2013. An association between having strong literacy skills and higher economic success in adulthood has been well established in the literature. That low literacy skills correlate with lower academic, economic, social, and health outcomes is also well known⁻, and the effects of Canada's rate of low literacy, which has increased over the past two decades, is being felt even in Alberta and Ontario, provinces with higher literacy scores overall. According to the Programme for the International Assessment of Adult Competencies (PIAAC), level 3 literacy is typically required to complete high school and do most jobs in Canada. However, recent statistics have shown that 48% of adults have literacy skills falling below this level, while 17% of adult Canadians function at or below the lowest skills level (level 1, or being unable to read a prescription on a medication bottle). Lower literacy scores are also found in specific populations (e.g., newcomers to Canada, racialized Canadians, and First Nations, Métis and Inuit peoples), and otherwise marginalized groups (e.g., incarcerated individuals)⁻.

Reading performance among 15-year-olds in Canada has declined since year 2000, with 1 in 7 students scoring at the lowest reading level, as measured in the Organization for Economic Co-operation and Development (OECD's) Programme for International Student Assessment (PISA). Territories did not participate in 2018 PISA testing and provincial results varied: New Brunswick, Saskatchewan, and Manitoba had lower literacy scores than the national average. Reading difficulties often persist throughout the school years and 1 in 4 children entering grade 1 show significant learning delays compared with their peers. Students from disadvantaged socioeconomic backgrounds or living in households where languages other than English or French are spoken, or who are living with a speech and language delay or a learning difficulty (e.g., a specific learning disorder with impairment in reading), are at highest risk for experiencing low literacy without early, evidence-based instruction and interventions⁻. The Ontario Human Rights Commission (OHRC's) 2022 Right to Read Inquiry Report made 157 recommendations to address inequities related to reading instruction in Ontario.

Early literacy development begins in infancy and spans the toddler years. Parents and caregivers promote literacy by reading, speaking, singing, and storytelling with children as part of everyday interactions. Book sharing and storytelling nurture language and literacy while promoting attachment, bonding, and relational skills. Attention on written text intensifies after entering grade school, and children who are not reading proficiently by the end of grade 3 are less likely to experience success in all academic areas than more literate peers.

Paediatric care providers are well positioned to help ensure that all children in Canada benefit from in-class reading instruction and literacy skill-building. They can advocate for literacy by collaborating with teachers and other school authorities, child psychologists, and speech-language pathologists to identify children at risk for low literacy, intervene early when needed, and recommend supports at school such that children in their communities achieve optimal, equitable reading achievement.

The science of reading

Accurate and efficient word reading is the basis for skilled reading and critical to comprehending what is read. Research has identified the kind of classroom instruction needed to build optimal, efficient word reading skills in children. Meta-analyses of this research by the National Reading Panel (NRP) in the United States identified the five pillars of classroom reading instruction: phonemic awareness, phonics, fluency, vocabulary, and reading comprehension. (For basic terms and definitions, see Box 1). The first three pillars focus on children's foundational word reading accuracy and fluency skills.

Whole language or 'balanced literacy'

An instructional approach focusing on the whole word and its meaning. For example, teachers facilitate reading development by providing "rich and authentic reading experiences through immersion in age-appropriate literature" rather than explicit or systematic phonics instruction

Phonics instruction allows children to learn the sounds associated with letters, which is essential to decoding words. Children also need to learn phonemic awareness, which involves understanding how the smallest units of sound distinguish one word from another, and phonological awareness involves identifying phonemes, blending them together to make words, and segmenting spoken words into constituent phonemes (e.g., the word "sat" is made up of three phonemes: "s", "ӕ", and "t").

The NRP report found that systematic phonics instruction yielded better reading gains than non-systematic or non-phonics instructional approaches (e.g., whole language or balanced literacy approaches, or curriculum using cueing systems). Systematic phonics instruction teaches the alphabetic code and how to use it to read words, starting with simple words and sounds and progressing to more complex words and sounds. Systematic phonics instruction is effective when taught through individual tutoring, in small groups, or to whole classes. Similar findings in the UK led to national adoption of systematic phonics instruction in 2007.

The OHRC's report recommended integrating teaching approaches to bring the science of reading into practice for teaching foundational word reading skills. Systematic phonics instruction appears to work best when initiated early, specifically before rather than following grade 1, and phonemic awareness instruction works best when integrated with phonics programming. Children learn both to blend the sounds represented by letters to decode words and to segment words into sounds to spell words. One study has shown that a systematic phonics program produced better reading, spelling, and phoneme awareness, with gains being maintained over a 7-year period. Follow-up reviews of research have supported the NRP's conclusions: that children from all SES levels make better reading gains when provided with systematic phonics instruction.

In Canada, there is a high prevalence of students who are learning English as a second language, and current data have shown that over half of students from low SES backgrounds and minority groups are not reading at a basic level by the end of grade 4. Phonics and phonemic awareness instruction has proven effective for improving their decoding abilities, especially when implemented in primary school⁻.

In-class quality reading programs must include phonemic awareness, phonics, and reading practice to improve word-reading accuracy and speed. Structured literacy resources are available on the Dyslexia Digital Library page at the International Dyslexia Association website. Early reading interventions are needed for children struggling with foundational skills in kindergarten or grade 1 to prevent their falling further behind. The OHRC recommends that "interventions should be evidence-based and include systemic, explicit instruction in phonemic awareness, phonics and building word-reading accuracy and fluency". Intervening early with a core reading skills program could significantly reduce the number of children experiencing low literacy by the end of grade 2.

At the time of writing, provincial ministries of education in Alberta, Manitoba, New Brunswick, and Ontario were adjusting their early literacy curriculums to prioritize phonics and phonological and phonemic awareness instruction using integrated approaches. Early screening for reading difficulties, monitoring children's reading skills, intervening appropriately, and ensuring equitable access to evidence-based reading instruction will be required.

What can paediatric care providers do?

Parents seek advice from physicians when children are struggling in school or when they suspect a child's reading development is not progressing at the same rate as their siblings or peers. Paediatric care providers are in a unique position to identify, support, and advocate for children experiencing or at-risk for reading difficulties because they can provide developmental surveillance and respond early to parents' concerns.

The research recognizes that both risk and protective factors influence a child's ability to read. Children with language or articulation disorders, attentional deficits, vision problems, and adverse childhood experiences are at higher risk of having a specific learning disorder with impairment in reading, and therefore require special attention to their literacy development. In early environments that lack rich language and literacy experiences or resources, or where children are learning English as a second or third language, learning to read can be especially challenging. An interaction-rich home environment and early, systematic phonics- and phoneme-based instruction in school can mitigate risk for many children. Paediatric care providers are well-positioned to help children and families who are at-risk for or already struggling to read through screening, intervening, support, and advocacy.

Screening
Table 1. Identifying early risks for reading difficulties Information drawn from references 31,32
When seeing young children for a regular health visit or who have been referred regarding a reading concern, screen initially for risk by asking a few targeted questions and completing a 2- to 3-minute office-based assessment of reading ability (e.g., DIBELS, Acadience Reading, Table 1). Informal and validated screens that only take a minute to administer are freely available to download online and can be administered to children in almost any office setting ( Table 1). At present, tools with adequate validity evidence to screen for reading ability in French are lacking. Current practice is to conduct a detailed history including risk factors for reading difficulties and refer for standardized assessments of reading ability when indicated. Ontario's Right to Read Inquiry recommends screening for reading difficulties twice a year between kindergarten and grade 2 to identify children with or at risk for reading difficulties and ensuring earlier interventions when required. Paediatric care providers can support families and liaise with a child's school to recommend interventions, accommodations, and resources. Incorporating screening for reading difficulties into health maintenance guides, such as the Rourke Baby Record or Greig Health Record, could enhance system capacity to identify children at risk for a reading difficulty early on.

Examples of targeted questions for parents, depending on the child's age

Is your child ...

Learning to speak more slowly or later than other children around the same age?

Having trouble recognizing or identifying letters of the alphabet?

Having difficulty recognizing letters in her or his own name?

Having difficulty with:

knowing the sound associated with a letter (e.g., B makes a "buh" sound)?

sounding out words

rhyming (cat, hat, mat, rat)

identifying which spoken words begin with the same sound (e.g., Night and Nest - yes; Night and Dog - no)

Needing to rely on pictures in a book to guess words on the same page? (e.g., Says "dog" when the written word is "puppy")

Does anyone in your family have difficulty reading or spelling? Has anyone in your family been diagnosed with dyslexia or a specific learning disorder with impairment in reading?

Office-based assessments

Refer to the CPS book Children with School Problems: A Physician's Manual

Visit these reputable websites for informal screening tools (with focus on dyslexia) :

https://www.dyslexiacanada.org/en/diagnosis https://www.idaontario.com/assessment-resources/

Standardized screening tools with validity evidence

of specific learning disorder with impairment in reading

Classroom reading curriculums focused on explicit and systematic instruction in phonemic awareness, phonics, and foundational word reading skills, combined with the early identification of risk and prompt and appropriate interventions and support, can prevent or resolve reading difficulties in an estimated 95% of children.

Paediatric care providers commonly recommend a psychoeducational assessment to diagnose a specific learning disorder with impairment in reading or dyslexia in children who struggle with reading. However, the practice may be premature for children in kindergarten and grade 1 (K-1), especially in educational settings where universal (or tier 1) systematic instruction in phonics and foundational word-reading skills is being taught, routine screening occurs, and children have access to timely interventions and support⁻. It may be more appropriate to refer older students (beyond grade 1) who are not responding to instruction or intervention according to standardized reading test scores for a psychoeducational assessment.

Supporting literacy as part of mental health and developmental care

Literacy is a key social determinant of health that affects the daily socioemotional lives of children, and paediatric care providers must consider the mental health needs of children who struggle with reading. Children and adolescents with low literacy skills are known to be at greater risk of experiencing anxiety, low self-esteem, substance misuse, and negative, even aggressive behaviours, but when care providers encourage them to develop their strengths, while acknowledging how hard they are working to become better readers, it builds confidence and trust, and supports resilience. Paediatric care providers also have essential roles to play in detecting, managing, and monitoring conditions that often co-exist with a specific learning disorder with impairment in reading, such as attention-deficit hyperactivity disorder and developmental coordination disorder⁻.

Resources to support literacy development

Educating parents on optimal reading practices and about dyslexia and specific learning disabilities when these conditions are present helps families understand children's specific needs and how best to support them. Parents may have dyslexia themselves, but encouraging them to read with young children, listen to audiobooks together, and share their own experiences with children when appropriate can promote both literacy and relational health. Online resources for parents that support phonemic awareness and phonics-based approaches can be downloaded at no cost, including the following:

Ontario-based support groups, agencies, school policies, terminology, and other resources can be found in the Physicians of Ontario Neurodevelopmental Advocacy ( PONDA) Advocacy Toolkit for Students Struggling to Read. Comparable repositories may need to be developed in other provinces/territories.

Recommendations:

Literacy is a human right, and low literacy in Canada is a serious public health concern. However, paediatic care providers are well-positioned and equipped to improve literacy in young people by:

Screening regularly at well-child visits between the ages of 4 to 7 years to identify children at risk for reading difficulties and dyslexia.

Incorporating screening for reading difficulties into health maintenance guides, such as the Rourke Baby Record and Greig Health Record, to enhance system capacity in identifying children at risk.

Assessing for conditions that commonly co-occur with a specific learning disorder with impairment in reading (e.g., attention-deficit hyperactivity disorder and developmental coordination disorder), and monitoring and managing these conditions when present.

Advocating for enhanced medical training for paediatric and family medicine residents and other paediatric care providers around early literacy, reading difficulties, and learning disabilities.

Encouraging parents and allied caregivers to read, speak, and sing with infants and young children.

Educating parents about resources and programs that promote phonemic awareness and phonics-based reading approaches.

Liaising with schools on behalf of children and families to support their access to reading interventions for children with reading difficulties or a specific learning disorder with impairment in reading.

Advocating to government, and specifically to provincial/territorial ministries of education, to integrate evidence-based curricular changes, especially phonemic awareness and systematic phonics instruction, into classroom reading curriculums, starting in kindergarten.

Calling for improved access to classroom instruction and school-based reading interventions that include and benefit children with special needs and other equity-deserving populations: First Nations, Métis, and Inuit peoples, racialized communities, newcomers to Canada, and children living with poverty.

Supporting government investment in teacher training programs that foster literacy and language in the early years and throughout school life.

Acknowledgements

This position statement was reviewed by the Community Paediatrics Committee, Early Years Task Force, and Developmental Paediatrics Section Executive of the Canadian Paediatric Society.
Potential Conflict of Interest
CANADIAN PAEDIATRIC SOCIETY MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES COMMITTEE (March 2023)

Members: Anne Kawamura MD (Chair), Johanne Harvey MD, MPH (Board Representative), Natasha Saunders MD, Megan Thomas MBCHB, Scott McLeod MD, Ripudaman Minhas MD, Alexandra Nieuwesteeg MD (Resident Member)
Liaisons: Olivia MacLeod MD (Canadian Academy of Child and Adolescent Psychiatry), Angela Orsino MD (CPS Developmental Paediatrics Section), Leigh Wincott MD, FRCPC (CPS Mental Health Section)
Principal authors: Anne Kawamura MD, Angela Orsino MD, Scott McLeod MD, Mark Handley-Derry MD, Linda Siegel PhD, Jocelyn Vine RN BN MHS CHE, Nicola Jones-Stokreef MD

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35. Shaywitz SE, Shaywitz JE, Shaywitz BA. Dyslexia in the 21st century. Curr Opin Psychiatry 2020;34(2):80-86. doi: 10.1097/YCO.0000000000000670

36. Francis DA, Caruana N, Hudson JL, McArthur GM. The association between poor reading and internalising problems: A systematic review and meta-analysis. Clin Psychol Rev 2019;67:45-60. doi: 10.1016/j.cpr.2018.09.002

37. Cohen-Silver J, van den Heuvel M, Freeman S, Ogilvie J, Chobotuk T; Canadian Paediatric Society, Community Paediatrics Committee. (in press).

38. Belanger S, Andrews D, Gray C, Korczak D; Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee. . Paediatr Child Health 2018;23(7):447-53.

39. Ip A, Mickelson ECR, Zwicker JG; Canadian Paediatric Society, Developmental Paediatrics Section. . Paediatr Child Health 2021;26(6):366-78.

40. Physicians of Ontario Neurodevelopmental Advocacy (PONDA), Jones-Stokreef N. Advocacy Toolkit for Children Struggling to Read 7.0. 2021. https://pondaca.files.wordpress.com/2021/08/advocacy-toolkit-7.08.pdf (Accessed June 6, 2024).

Dr. Anne Kawamura reported receiving funding from the Bloorview Research Institute and the Academic Health Sciences Innovation Fund. She is also a member on the Ontario Ministry Advisory Committee for Special Education. Dr. Scott McLeod reported receiving speaker fees from Elvium Pharmaceuticals for a talk on ADHD/ASD. Linda Siegel PhD is a paid consultant to the Ontario Human Rights Commission and unpaid Board member of Play Roly. Jocelyn Vine is a volunteer member of Everyone Reads NS. Dr. Nicola Jones-Stokreef is a past chair of PONDA and a current member of the Physicians of Ontario Neurodevelopmental Disabilities Advocacy and Literacy Alliance of Ontario. Dr. Angela Orsino and Dr. Mark Handley-Derry had no reported conflicts of interest.

References

Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.

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Literacy in school-aged children: A paediatric approach to advocacy and assessment | Canadian Paediatric Society

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Literacy is a key social determinant of health that affects the daily socioemotional lives of children and their economic prospects later in life. Being able to read, write, and understand written text is essential to participating in society, achieving goals, developing knowledge, and fulfilling potential.

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Three Principles to Improve Outcomes for Children

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Three Principles to Improve Outcomes for Children

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Center on the Developing Child at Harvard University

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Science X Design: Three Principles to Improve Outcomes for Children

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Brain Story - Toxic Stress, Brain Development, Addictions, Interventions & Strategies - Certification

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Brain Story - Toxic Stress, Brain Development, Addictions, Interventions & Strategies - Certification

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The core story of brain development, mental health, and addiction: Find out how experiences shape brain development and impact lifelong health.

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Identity-Affirming SEL - School Mental Health Ontario

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Identity-Affirming SEL - School Mental Health Ontario

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Social-emotional learning and equity

Culturally responsive social-emotional learning considers students' lived experiences, as well as racial and other disparities that exist within the school, school system and society.

An August 2020 report from The Collaborative for Academic, Social and Emotional Learning (CASEL) explains the potential for social-emotional learning to cultivate knowledge, beliefs, practices, and relationships that:

Help individuals, groups, and institutions examine and interrupt inequitable policies and practices

Create opportunities for students, families, and educators to co-construct more inclusive, student-centred school environments

Reveal and nurture the interests, talents and contributions of children, youth, and adults from diverse backgrounds

Create more fertile learning environments and improved developmental outcomes for all individuals

How to implement culturally-responsive social-emotional learning

As the CASEL report mentioned above highlights, there's an opportunity for social-emotional learning to help us dismantle oppressive structures and create a more equitable school system and society.

Be a learner first

While there's evidence that social-emotional learning has the most significant benefits when introduced early in a child's development, the learning doesn't stop. We develop our social and emotional skills throughout life, and so, you're both a learner and a guide.

Be gentle with yourself as you acquire knowledge and skills. Remain humble and curious, remembering to examine your biases along the way. Look for opportunities to learn from and build on the strengths of students and families, peers and other professionals in your system, including the equity team and members of your mental health leadership team.

Tips for implementing culturally-responsive social-emotional learning

Social-emotional learning is only effective when introduced within safe, welcoming and inclusive classrooms and schools. A culturally-responsive approach to social-emotional learning demonstrates awareness of and respect for the social and cultural identities of all students. Understand that racism, oppression and disparity exist, and students' experiences with racism and oppression at school can affect the way social-emotional learning is perceived.

There are many resources available, including our resources mentioned below, that will help you implement social-emotional learning. As with other areas of the curriculum, it's essential to consider your students' strengths and experiences when planning how to use the resources.

Here are some factors to keep in mind to implement impactful, supportive, anti-racist, and anti-oppressive social-emotional learning:

Understand that there are nuances across and within cultural groups; one statement or idea does not apply to everyone. Allow opportunities for cultural self-expression and ways of knowing.

Make sure your examples are inclusive. For instance, be sensitive about using a heteronormative stance (e.g. referring to families as having a mom and a dad).

Be sure to provide students with support and tools to challenge oppression and be careful not to blame or place the onus on students to navigate oppressive, racist and discriminatory spaces. For example, research shows using positive thoughts can influence our emotions and behaviours in helpful ways and can support reframing negative events. While it's helpful to learn about positive thinking and reframing, they are not the solutions to oppressive practices and shouldn't be presented to students in that way.

Take a strengths-based, co-learning approach. Social-emotional learning is a co-learning process where student ideas and strengths are honoured, and new ideas are explored together.

Six common elements of social-emotional learning

Six common elements were identified through a review process of existing evidence-based programs. Learn more about this process.

Resources to support social-emotional learning

Benefits of social-emotional learning

When all students in a class or school learn and practise social and emotional skills, their sense of belonging within the classroom, school and community improves. Everyone tends to communicate in more positive and thoughtful ways, and they show respect for diversity of thought, culture, language, faith, identities and expression.

CASEL provides an overview of research on the outcomes of social-emotional learning. In general, supporting social-emotional learning can

increase academic achievement

improve behaviour

yield impressive return-on-investment, in terms of educational as well as health/justice outcomes

support equity and inclusion

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Identity-affirming social-emotional learning - School Mental Health Ontario

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Social-emotional learning and equity Culturally responsive social-emotional learning considers students' lived experiences, as well as racial and other disparities that exist within the school, school system and society. An August 2020 report from The Collaborative for Academic, Social and Emotional Learning (CASEL) explains the potential for social-emotional learning to cultivate knowledge, beliefs, practices, and relationships [...]

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Attach (TM) Program - Connecting with your Child - Building healthy relationships through reflection and mentalization

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Attach (TM) Program - Connecting with your Child - Building healthy relationships through reflection and mentalization

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Building healthy relationships through reflection and mentalization

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NB Student Wellness Survey - NB Health Council

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NB Student Wellness Survey - NB Health Council

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2024-2025 Student Wellness and Education Survey

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The New Brunswick Student Wellness and Education Survey is conducted in all public schools across the province. It aims to evaluate several aspects of students’ wellness, including their social and emotional development, physical health, substance use, and experiences at school and in the community.

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California Surgeon General - Adverse Childhood Experiences

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California Surgeon General - Adverse Childhood Experiences

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Office of the California Surgeon General

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Understanding ACEs: What are Adverse Childhood Experiences (ACEs)?

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Center on the Developing Child at Harvard University

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New scientific research shows that environmental influences can actually affect whether and how genes are expressed. In fact, scientists have discovered that early experiences can determine how genes are turned on and off and even whether some are expressed at all. Thus, the old ideas that genes are "set in stone" or that they alone determine development have been disproven. Nature vs. Nurture is no longer a debate-it's nearly always both!

More Information on Epigenetics

Deep Dive: Gene-Environment Interaction
Learn more about the physical and chemical processes that take place as part of the creation of the epigenome.

Working Paper 10: Early Experiences Can Alter Gene Expression and Affect Long-Term Development
This in-depth working paper explains how genes and the environment interact, and gives recommendations for ways that caregivers and policymakers can effectively respond to the science.

During development, the DNA that makes up our genes accumulates chemical marks that determine how much or little of the genes is expressed. This collection of chemical marks is known as the " epigenome." The different experiences children have rearrange those chemical marks. This explains why genetically identical twins can exhibit different behaviors, skills, health, and achievement.

Correcting Popular Misrepresentations of Science

Until recently, the influences of genes were thought to be set, and the effects of children's experiences and environments on brain architecture and long-term physical and mental health outcomes remained a mystery. That lack of understanding led to several misleading conclusions about the degree to which negative and positive environmental factors and experiences can affect the developing fetus and young child. The following misconceptions are particularly important to set straight.

Contrary to popular belief, the genes inherited from one's parents do not set a child's future development in stone.
Variations in DNA sequences between individuals certainly influence the way in which genes are expressed and how the proteins encoded by those genes will function. But that is only part of the story-theenvironment in which one develops, before and soon after birth, provides powerful experiences that chemically modify certain genes which, in turn, define how much and when they are expressed. Thus, while genetic factors exert potent influences, environmental factors have the ability to alter the genes that were inherited.

Although frequently misunderstood, adverse fetal and early childhood experiences can-and do-lead to physical and chemical changes in the brain that can last a lifetime.
Injurious experiences, such as malnutrition, exposure to chemical toxins or drugs, and toxic stress before birth or in early childhood are not "forgotten," but rather are built into the architecture of the developing brain through the epigenome. The "biological memories" associated with these epigenetic changes can affect multiple organ systems and increase the risk not only for poor physical and mental health outcomes but also for impairments in future learning capacity and behavior.

Despite some marketing claims to the contrary, the ability of so-called enrichment programs to enhance otherwise healthy brain development is not known.
While parents and policymakers might hope that playing Mozart recordings to newborns will produce epigenetic changes that enhance cognitive development, there is absolutely no scientific evidence that such exposure will shape the epigenome or enhance brain function. What research has shown is that specific epigenetic modifications do occur in brain cells as cognitive skills like learning and memory develop, and that repeated activation of brain circuits dedicated to learning and memory through interaction with the environment, such as reciprocal "serve and return" interaction with adults, facilitates these positive epigenetic modifications. We also know that sound maternal and fetal nutrition, combined with positive social-emotional support of children through their family and community environments, will reduce the likelihood of negative epigenetic modifications that increase the risk of later physical and mental health impairments.

The epigenome can be affected by positive experiences, such as supportive relationships and opportunities for learning, or negative influences, such as environmental toxins or stressful life circumstances, which leave a unique epigenetic "signature" on the genes. These signatures can be temporary or permanent and both types affect how easily the genes are switched on or off. Recent research demonstrates that there may be ways to reverse certain negative changes and restore healthy functioning, but that takes a lot more effort, may not be successful at changing all aspects of the signatures, and is costly. Thus, the very best strategy is to support responsive relationships and reduce stress to build strong brains from the beginning, helping children grow up to be healthy, productive members of society.

For more information: Early Experiences Can Alter Gene Expression and Affect Long-Term Development: Working Paper No. 10.

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What is Epigenetics? The Answer to the Nature vs. Nurture Debate

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Scientific research shows that experiences can affect whether and how genes are expressed. Nature vs. Nurture is no longer a debate-it's nearly always both!

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Next Deep Diversity Course
"Honest and disarming...this book's framework is both original and needed."
- Mahzarin R. Banaji, Harvard University

In Deep Diversity, award-winning racial justice educator Shakil Choudhury explores the emotionally loaded topic of racism using a compassionate, scientific approach that everyone can easily understand.

With clear language and engaging stories that will appeal to readers of Brené Brown and Malcom Gladwell, Choudhury explains how and why well-intentioned people can perpetuate systems of oppression, often unconsciously. Using a trauma-informed approach that removes shame or blame, he offers us the tools to recognize, take authentic responsibility, and enact deep change. In easy-to-absorb chapters, Choudhury interweaves research into the brain and studies on human behavior with hard-won lessons from his career of helping organizations and CEOs create more inclusive environments. He models vulnerability and mistake-making, sharing examples of his own bias-missteps so readers are encouraged into their own racial justice journey without judgment.

Many are calling Deep Diversity a "breakthrough book" on race, meeting you where you're at, regardless of your identity, class, ability, or belief system, and inviting you to come along on a journey of self-discovery, social awareness, and lifelong learning. Read what others are saying and order now.

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What if our interactions with those different than us are strongly influenced by things happening below the radar of awareness, hidden even from ourselves? Deep Diversity explores this question and argues that "Us-versus-Them" is an unfortunate but normal part of the human experience due to reasons

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Epigenetics is how your behaviors and environment change how your genes work.

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Understanding the Root Causes of Inequities Activity

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Understanding the Root Causes of Inequities Activity

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Complete this activity from an education/school perspective.

https://www.countyhealthrankings.org/sites/default/files/UnderstandandIdentifyRootCauses_Worksheet.pdf

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Adverse Childhood Experiences & Impact on Brain, Body and Behaviour - Video

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Adverse Childhood Experiences & Impact on Brain, Body and Behaviour - Video

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ACEs & Impact on Brain, Body, & Behaviour

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Adverse Childhood Experiences (ACEs): Impact on brain, body and behaviour

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Why Do Some Children Respond to an Intervention & Others Don't - Video

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Why Do Some Children Respond to an Intervention & Others Don't - Video

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Why Do Some Children Respond to an Intervention & Others Don't

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Center on the Developing Child at Harvard University

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In this science talk, formally titled "Beyond Main Effects: Individual Variation in Vulnerability and Resilience," Nathan A. Fox, of the University of Maryland, talks about the limitations of traditional early childhood intervention studies, which examine the effects of programs on large groups of children with the hope that one size fits all. But, because children (and adults) differ in terms of reactivity and self-regulation, new interventions must take into account these individual differences and incorporate individual approaches. Nathan Fox is the Distinguished University Professor, Department of Human Development; and Director, Child Development Laboratory, at the University of Maryland. He is also Science Co-Director of the National Scientific Council on the Developing Child.

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Why Do Some Children Respond to an Intervention and Others Don't?

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Nathan A. Fox talks about the limitations of traditional early childhood intervention studies, which examine the effects of programs on large groups of children with the hope that one size fits all.

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ACEs & Resilience w/Dr. Kelly Fradin Podcast

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ACEs & Resilience w/Dr. Kelly Fradin Podcast

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ACEs & Resilience w/Dr. Kelly Fradin

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‎The Nourished Child: Adverse Childhood Experiences (ACES) and Resilience with Dr. Kelly Fradin on Apple Podcasts

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‎Show The Nourished Child, Ep Adverse Childhood Experiences (ACES) and Resilience with Dr. Kelly Fradin - Oct 14, 2021

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Stress, Trauma, and the Brain: Insights for Educators--The Power of Connection

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Building the Core Skills Youth Need for Life - Article

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Building the Core Skills Youth Need for Life - Article

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Building the Core Skills Youth Need for Life

Building the Core Skills Youth Need for Life: A Guide for Practitioners (harvard.edu)

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Harvard Impacts of Racism on Child Development (Community ACEs)

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Harvard Impacts of Racism on Child Development (Community ACEs)

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Center on the Developing Child at Harvard University

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What could our society look like if racial disparities in health and learning outcomes didn't exist? According to extensive studies, the U.S. would save billions in health care costs alone. The value of realizing the potential contributions of so many people around the world who are impaired by-or die from-preventable chronic illnesses is enormous, and the human costs are incalculable.

Advances in science are presenting an increasingly clear picture of how significant adversity in the lives of young children can disrupt the development of the brain and other biological systems. These early disruptions can undermine young children's opportunities to achieve their full potential. And, while they may be invisible to those who do not experience them, there is no doubt that both systemic racism and interpersonal discrimination can lead to chronic stress activation that imposes significant hardships on families raising young children.

It's time to connect these dots. This infographic explains in basic terms how racism in particular gets "under the skin" and affects learning, behavior, and lifelong health. There is much more to say, but by starting with a shared understanding, we can work together toward creative strategies to address these long-standing inequities.

Sources
Panel 1
Forde, A.T., Crookes, D.M., Suglia, S.F., & Demmer, R.T. (2019). The weathering hypothesis as an explanation for racial disparities in health: a systematic review. Annals of Epidemiology, 33, 1-18.e3
Panel 2
Geronimus, A.T., Hicken, M., Keene, D., & Bound, J. (2006). "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. American Journal of Public Health, 96(5), 826-833.

McEwen, B.S. (1998.) Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171-9.
Panel 3
Williams, D.R., & Wyatt, R. (2015). Racial Bias in Health Care and Health: Challenges and Opportunities. JAMA 314(6): 555-556.

Williams, D.R., Mohammed, S.A., Leavell, J., & Collins, C. (2010). Race, socioeconomic status and health: Complexities, ongoing challenges and research opportunities. Annals of the New York Academy of Sciences, 1186, 69.

Panel 4
Agency for Healthcare Research and Quality (2019). 2018 National Healthcare Quality and Disparities Report. Rockville, MD. AHRQ Pub. No. 19-0070-EF https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-final-es.pdf

Manuel J. I. (2018). Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health Services Research, 53(3), 1407-1429.
Panel 5
Heard-Garris, N.J., Cale, M., Camaj, L., Hamati, M.C., & Dominguez, T.P. (2018). Transmitting trauma: A systematic review of vicarious racism and child health. Social Science & Medicine, 199, 230-240.

Pachter, L.M., & Coll, C.G. (2009). Racism and child health: a review of the literature and future directions. Journal of Developmental and Behavioral Pediatrics, 30(3), 255-263.

Clark, R., Anderson, N.B., Clark, V.R., & Williams, D.R. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54(10), 805- 816.
Panel 6
Trent, M., Dooley, D.G., & Dougé, J. (2019). The impact of racism on child and adolescent health. Pediatrics, 144(2), e20191765.

Williams, D. R., & Cooper, L. A. (2019). Reducing Racial Inequities in Health: Using What We Already Know to Take Action. International Journal of Environmental Research and Public Health, 16(4), 606.
Panel 7
Collins, C., Asante-Muhammed, D., Hoxie, J., & Nieves, E. (2017). The road to zero wealth: How the racial wealth divide is hollowing out America's middle class. Washington, DC: Prosperity Now and Institute for Policy Studies.

Weir, K. (2016). Policing in Black & White. Monitor on Psychology, 47(11). Retrieved from http://www.apa.org/monitor/2016/12/cover-policing
Panel 8
National Scientific Council on the Developing Child. (2020). Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined: Working Paper No. 15. Retrieved from www.developingchild.harvard.edu

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How Racism Can Affect Child Development - Center on the Developing Child at Harvard University

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What could our society look like if racial disparities in health and learning outcomes didn't exist? According to extensive studies, the U.S. would save billions in health care costs alone. The value of realizing the potential contributions of so many people around the world who are impaired by-or die from-preventable chronic illnesses is enormous, and [...]

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Child Development & Epigenetics

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Understanding the Teenage Brain - Speaking of Psychology Podcast

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Understanding the Teenage Brain - Speaking of Psychology Podcast

# data[].attributes.body
Understanding the Teenage Brain

Speaking of Psychology: Encore - Understanding the teenage brain, with Eva Telzer, PhD on Apple Podcasts

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‎Speaking of Psychology: Encore - Understanding the teenage brain, with Eva Telzer, PhD on Apple Podcasts

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‎Show Speaking of Psychology, Ep Encore - Understanding the teenage brain, with Eva Telzer, PhD - 9 Aug 2023

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Building Resilience Through Responsive Relationships - Video

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Building Resilience Through Responsive Relationships - Video

# data[].attributes.body
Building Resilience Through Responsive Relationships

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Center on the Developing Child at Harvard University

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Responsive Relationships in Early Childhood & Beyond - Webpage

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Responsive Relationships in Early Childhood & Beyond - Webpage

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Responsive Relationships in Early Childhood and Beyond

An introduction to serve and return in early childhood education - THE EDUCATION HUB

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Responsive interactions have been identified as a vital element in supporting all children to thrive. Serve and return describes what we see and do in the back and forth of these responsive interactions. Serve and return interactions are critical for all children, but they are particularly important for infants and toddlers in the first two years. It seems intuitive that playing with infants, responding to them and building relationships matters, but the benefit of focusing in on a specific approach like serve and return is that it can help teachers and caregivers to take concrete action and notice things that make a significant difference to the lifelong wellbeing of children. This guide sets out:

A short introduction to serve and return - what it is and why it matters

The challenges of serve and return

How to increase the quantity and quality of serve and return interactions with infants and toddlers

What is serve and return and why does it matter?

Serve and return is a short-hand term coined by researchers at Harvard University in 2005. It synthesises a number of complex ideas around the love and nurturing of infants and helps make those ideas more accessible and practically useful in everyday settings by using the image of a rally in a tennis match or game of ping-pong. Serve and return is the focused, back and forth, two-way interaction between an infant and an adult when both the infant and adult are trying to communicate, to understand each other, to relate, and to show care and interest.

Serve and return uses the image of a tennis rally to make it clear that the infant is an equal partner with agency, feelings and ideas of their own: infants serve as well as return. Serve and return requires adults to act in a relational way that recognises the mana of children and genuinely 'see' and get to know the infant in order for rallies to grow and develop. The activity itself doesn't really matter - what matters most is the relational intention, the common interest, and the 'rally space' of mutual back and forth. While words or sounds are often involved, a lot of serve and return is non-verbal. Infants and adults don't only 'serve' (or return) words and sounds: tone, touch, feeling, gestures, eye-contact, smiles, squirming, reaching, swaying and patting are all part of what can be served to and received back from an infant. Serve and return is two way - the adult is physically and emotionally affected during the process and so is the infant. When an adult is connected with an infant in the rhythm of a mutually engaged rally, the infant and the adult are co-regulating and often sharing heart beats, hormones, emotions, and breathing patterns.

Serve and return interactions are important for all children, but especially critical for infants. The value of serve and return interactions in the first 1000 days cannot be over-stated. Infants are born wanting and expecting to connect and, from the very start, they seek out connection with the people around them. Getting a caring and attuned response often enough from the adults around them is essential for all aspects of their holistic development. A wealth of neuroscientific research produced since the 1990s has confirmed that the loving, in-tune, back and forth serve and return interactions that adults have with infants build the foundations for all later brain development, learning, and emotional, mental and physical health. Infants that receive enough love and responsive attention feel safe and soothed, and build brains that are ready to play, explore and learn. Infants who don't receive enough love and responsive attention miss out on the positive brain building stimulation that comes from interacting with a loving and responsive adult but, much more than this, they feel unsafe and highly stressed. Their bodies are often flooded with potentially harmful stress hormones and their brains are more likely to be wired to be ready to react, defend themselves and survive. This can make it much harder for children to do many of the things we want them to be able to do later on - to make and keep friends, to accept comfort, to regulate their emotions, and to pay attention.

Serve and return interactions have additional value for children with complex and stressful lives. Relationally-focused, loving and attuned serve and return interactions are exceptionally valuable because, in addition to building strong foundations for lifelong resilience, they also help to repair the impacts of trauma and stress experienced during pregnancy, at birth or during the first few months (including the impacts of family violence, substance misuse, chronic illness, and poverty). Focusing on serve and return may be a significant contribution that teachers and caregivers can make to breaking cycles of intergenerational disadvantage. Growing a network of adults who are focused on providing lots of high quality serve and return interactions in the lives of infants and toddlers can be a crucial harm prevention and reduction intervention to support healing and resilience, particularly within the context of external wraparound support from infant mental health professionals and other experts.

The challenge of serve and return

Serve and return is often presented as 'just playing' with an infant, and because serve and return is a simple image, it can be easy to think 'we do all that already'. However, serve and return interactions can often be harder to do than they first appear. A significant challenge of serve and return is to ask how much, and how well, teachers and caregivers are able to engage in uninterrupted, relationally responsive rallies with infants and toddlers. There are a number of factors that are likely to impact on this.

How adults feel matters. Serve and return can feel tiring, draining and frustrating for adults. It needs patience, persistence and focus, and draws on executive function skills. This is because the adult needs to put lots of effort into regulating their own feelings and responses. An adult has to be sufficiently calm and regulated but also open before they can engage, connect, and help to regulate an infant or toddler. While all positive interaction supports the development of children, high quality serve and return requires an adult to be deeply interested in forming a relationship with the child, to have enough uninterrupted one-on-one time to focus in on them, to 'linger lovingly' and to notice the small things, rather than just performing tasks like reading, singing, talking, feeding and so on. This is much more than having a 'key worker' identified for each child. The quality and quantity of interactions are dependent on how the adult feels about the child with whom they are interacting and how committed they are to the child.

The setting matters. The environment plays an important role in supporting teachers to engage in high quality serve and return interactions. Calm, peer support, respite, respect, belonging, community and connection are all important enabling factors for teachers. By contrast, noise, distraction, administrative workload, long hours, high ratios, staff turn-over, or a negative team culture can undermine the ability of teachers to engage fully and deeply in serve and return. Even small things, like an expectation to regularly stop and take a photo or video, can break the flow and ability to extend and deepen the rally of interaction between a teacher and infant.

Teachers' and caregivers' own histories and mental wellbeing matter. Stress, depression, boredom, isolation, exhaustion and their own personal history all impact on their ability of any adult to give infants and toddlers the open, positive, emotionally regulated and focused care they need. An adult's own childhood experiences can have an (often unconscious) impact on the way they interact with the children in their care. This is recognised for parents, but the same is also true for teachers. It is important to find ways to acknowledge and respond to this as part of teacher selection, training, support and day-to-day practice.

The challenges posed by serve and return can raise some difficult but important questions for early childhood teachers and caregivers to ask about the limits of what can be provided in an institutional setting to support the loving responsive care that is so important to infants. It is not necessary to have all the answers. ECE settings are only one part of a network of whānau, community and specialist providers who all play a part in creating the loving network of relationships around infants. But the more that teachers can engage in serve and return interactions and take time to grapple with the challenges it poses, the more they are likely to find ways of helping children to thrive.

How to support more and better serve and return interactions with infants and toddlers

Be conscious. Serve and return is an action, and the image of a tennis rally is a simple reminder of the goal that teachers are seeking to achieve. Serve and return interactions don't have to be constant or perfect, but the more that teachers can consciously try to engage in one-on-one, uninterrupted, reciprocal interactions with infants and young toddlers the better. Because serve and return is a relational activity, adults get better with practice as they learn more about each infant and give infants time to get to know them. The aim is to find ways to start building longer and better rallies with individual infants and children. This video provides some useful ideas and tips.

Slow down. Serve and return is more about 'being' with an infant than 'doing' with an infant. It helps to slow down, focus in on what an infant is 'serving', and be conscious of trying to create a rally of mutual interest and emotional connection. When teachers slow down and focus in, they are more likely to notice the little things and to genuinely respond to the particular infant with whom they are interacting. It takes time and patience (for both the adult and the infant) to learn how to respond and interact. Slowing down and tuning in also helps adults to notice when an infant wants to engage and when they want to rest or be alone.

Be curious. To increase the quality and quantity of the responsive interactions that are happening for infants and toddlers, it can be useful for teachers as individuals and as a team to be open to seeing and noticing more about how, when and for whom serve and return occurs in their setting. Notice how much uninterrupted and focused time adults are able to spend engaging in serve and return with particular children. Consider how the environment or the norms and policies in place may be supporting or hindering serve and return interactions. It helps for teachers to pay attention to their own feelings by noticing when they feel bored, frustrated or as though they are just 'going through the motions', as well as when they are more genuinely open and engaged. It is very likely that it feels easier to do serve and return with some infants and harder to do with others. Noticing patterns of what is working well and what isn't can help the teaching team to identify and try out small changes, access extra resources or expert help, or have new conversations.

Talk about serve and return. Serve and return is reminder of the long-standing cross-cultural wisdom that love, time and attention are essential for all infants. It is not exclusive knowledge only for those who are qualified or highly skilled. Serve and return is also a practical and concrete action rather than a theory. Using the image of serve and return may be a useful way to talk more in ECE teams and communities about nurturing infants by having a common language and clear image of what you are trying to achieve. It can be difficult to talk together about love, attachment, attunement or dyadic interactions, particularly when there are important cultural differences and personal stories that impact the meaning that individuals bring to these ideas. It is vital that whānau, teachers and caregivers talk honestly and openly about relationships in the lives of infants, and serve and return may be a useful doorway to help start deeper conversations about the quantity and quality of relational interactions that are happening for infants in ECE settings and at home.Being open and curious and speaking up about the hard parts of serve and return requires courage and vulnerability. Creating a space and a team culture where teachers and caregivers feel safe enough to reflect and talk about the real and often deeply personal challenges of providing responsive, emotionally attuned interactions with children is a skilled and important task for leaders.

Use serve and return as a touchstone. Relationships are at the heart of Te Whāriki, and the importance of relationships for learning and the holistic wellbeing of children is well established. However, it is easy to get distracted by lots of competing priorities and immediate demands, to be overwhelmed by the difficult issues in children's lives, or to find it hard to say exactly what you are doing to build responsive and attuned relationships. Serve and return can be a helpful anchor point for good practice and purpose among the complexities of early childhood education. In the same way that focusing on breathing can calm and centre us when we get anxious, focusing on doing the simple actions of serve and return can be of immediate benefit to children and help teachers and caregivers to notice and think about what matters.
References
Conkbayir, M. (2017). Early childhood and neuroscience. Theory, research and implications for practice. London and New York: Bloomsbury Academic.

Dalli, C., White, E. J., Rockel, J., & Duhn, I.(2011). Quality early childhood education for under-two-year-olds: What should it look like? A literature review. Wellington: Victoria University of Wellington. Retrieved from https://www.educationcounts.govt.nz/publications/ECE/Quality_ECE_for_under-two-year-olds/executive-summary

Centre on the Developing Child at Harvard University. Resources library: Serve and return (2004-2020). https://developingchild.harvard.edu/resourcetag/serve-and-return/

Hughes, D. A., & Baylin, J. (2012). Brain-based parenting: The neuroscience of caregiving for healthy attachment. New York: Norton and Co.

National Scientific Council on the Developing Child (2004). Young children develop in an environment of relationships: Working paper No. 1. Retrieved from www.developingchild.harvard.edu.

Siegal, D., & Hartsell, M. (2003). Parenting from the inside out. New York: Penguin Putnam.

By Thalia Wright

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An introduction to serve and return in early childhood education - THE EDUCATION HUB

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Responsive interactions have been identified as a vital element in supporting all children to thrive. Serve and return describes what we see and do in the back and forth of these responsive interactions. Serve and return interactions are critical for all children, but they are particularly important for infants and toddlers in the first two years.

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Let's Get Healthy Epigenetics Game

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The 7 C's of Resilience

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Building Resilience

Our parental instincts drive us to protect our children. Given a choice we'd bubble wrap them. But we can't. We can, however, prepare them to navigate the world. We can support them to develop the character strengths and human connections that allow them to thrive in good times and rebound (maybe even grow) in challenging times. In other words, we can build their resilience.

No Bubble Wrap Needed

Resilience is better than bubble wrap because it is about developing internal strength rather than relying on an external shield. Think of resilience as a process of bouncing back - of rising above adversity. And to do so ideally, with lessons that enable you to better handle the next bump in the road.

It is a mistake, however, to only think of resilience as something that enables us to respond to adversity. The very same characteristics that allow someone to rebound from difficult times will position them to get the most out of life. We want our children to become their best selves, to experience healthy relationships, to make their unique contributions to our communities - to succeed.

Think of resilience as a process of bouncing back -- of rising above adversity. And to do so ideally, with lessons that enable you to better handle the next bump in the road.

Ordinary Magic

Some people are more likely to be resilient in the face of adversity. But resilience is not something you are born with. Instead, it is something that can be built and nurtured as a part of development. Dr. Ann Masten, one of the nation's leading thinkers on resilience, describes it as " ordinary magic." She underscores resilience is not about extraordinary events or heroic measures. Rather, resilience is built when we're offered meaningful support and love from others.

Why Love Matters

Love is seeing someone as they deserve to be seen, as they really are, not based on a behavior they might be displaying or what they might be producing. When you express love, you are helping your children understand that they are worthy of being loved and that has lifelong implications.

Decades of research point to factors that build resilient children and adolescents, and the results are empowering to parents! Young people grow to be resilient when there's at least one adult (more is better!) loving them unconditionally and supporting them to be their best selves by holding them to high expectations.

What does it mean to love without condition? It means that your presence has to be unwavering and reliable. It does not mean approving of every decision or saying, "Good job for trying those drugs!" Instead, when you communicate with your consistent presence, "I'm not going anywhere," that assurance allows your children to take needed (safe!) leaps of development. They leap because they know they have somebody who will have their back.

The fact that our loving presence itself is so vitally important should help parents draw a deep breath. We worry so much about finding the perfect words (and words can matter). But what we say is less important than how we listen, or that our kids know we stand by their sides no matter what. We communicate with our presence a solid commitment to making sure they'll get through challenges.

Have High Expectations

What does it mean to support our children to be their best selves by holding them to high expectations? It does not mean demanding high grades, scores, or trophies, though we certainly can expect effort. The roots of our high expectations stem from knowing our children's character. You know best those strengths they have shown from a young age. Honesty, commitment to fairness, sense of humor. Strength and stick-to-it-ive-ness.

These traits you have noticed from the time your child was small develop further during adolescence. When you celebrate their strengths and see them for who they are, they will have a highly protective grounding. If they stray, hold them accountable and they will return to their better selves.

We're not saying, "Expect an A, they'll get an A," or "Demand a goal, they'll score one." Those kinds of expectations backfire by making young people feel like they're never good enough even though these measures are often out of our their control. Your support, however, can help your children reach their unique potential.

Resilience Doesn't Mean Invulnerability

As we build resilient children, we mustn't believe resilience means invulnerability. Everyone has limits. And we actually don't want to build invulnerable beings. Why? Because we want our youth to be passionate and compassionate. We want them to experience joy. To be committed to lifting others up and building a better world. To do so, they must have emotions - even though feelings set them up to experience pain.

Our goal is not to suppress or deny emotions. Rather it's to help them learn to benefit from emotions, while knowing which ones may undermine their well-being. With that said, we must fully protect our children from " toxic" stressors, those challenges that can be threatening to developing brains and bodies, such as drugs, abuse, neglect, and violence.

Resilience is Uneven

We want our children to be able to bounce back in every setting, but realistically, they'll be able to handle different settings with varied levels of resilience. That's because resilience is uneven. In fact, it might be that precisely because they are showing extraordinary resilience in one setting, that they will "let go" in another. For example, school may present so many challenges that it takes all your children's energy to keep it together there. That may make things more fragile or explosive at home. In this case, take it as a sign of security and trust in the reliability of your love and support that home is where they can display vulnerabilities.

Teach and Nurture Resilience

We can nurture and teach resilience in a variety of ways, including when we demonstrate positive coping strategies to manage stress. Or when we teach skills that help our children navigate their world. We model resilience when we choose healthy coping strategies. Or when we keep things in perspective, and grow from life's challenges.

But some elements of resilience can best be learned through experience. Resilience is solidified when people learn for themselves how to rebound from a bump in the road and how to grow stronger and wiser by drawing lessons from overcoming challenges. We support resilience when we allow for mistakes and recovery within safe boundaries. And when we act as a non-judgmental sounding board as our children learn through experiences.

The Seven C's Model of Resilience

The seven C's model of resilience was first published by the American Academy of Pediatrics in 2006. It draws from a framework originally presented by some of the great leaders of the positive youth development movement. It adds to their model by emphasizing "coping" which prepares one to recover, and "control" which gives one the sense that choices make a real difference.

Each "C" is a critical element that parents, schools, communities, youth programs, and professionals can support in youth. The C's are all interrelated - forming almost a net of resilience-building strategies. To learn more about each "C", follow the links provided.

Confidence

Young people with confidence will have the belief in themselves that they will ultimately succeed. They'll be more likely to take the chances needed to learn about themselves. They may be willing to try harder and have less fear of failure. More importantly, they'll rebound from failure, seeing it as an opportunity for growth rather than a catastrophe. Confidence is not gained from an abundance of unearned praise. Rather, it comes from adults authentically noticing effort and nurturing and supporting skills (or competence).

Competence

Youth need to possess real skill sets to be able to navigate the world. Those include communication skills, self-advocacy skills, peer negotiation skills, and academic skills to name a few. Young people also need to be able to make wise decisions if they are going to make the kind of choices that will contribute to, versus undermine, their health and well-being.

Adults can teach and model effective competencies. We can listen to them as they work through solutions to problems. Support their ability to manage school and peers. Talk with them instead of at them. On the other hand, we undermine competence by telling our children what to do, or by talking to them in a way that shuts down their ability to come up with their own solutions. In other words, lectures backfire! Similarly, saying "Let me do that for you," says, "I don't think you are capable of doing it yourself."

Connection

Human connection allows us to more fully celebrate during joyous times and to recover during challenging times. It is the connection with your children - based on knowing who they really are - that is the most protective force in their lives. Hopefully, your adolescent will develop amongst many other protective connections as well. The more, the better.

Character

Young people with strong core values make the strongest contributions, have the best sense of self, and have the most secure and healthy relationships. Think of character strengths as those things that ensure we do the right thing - even if nobody is watching. We need people who know how to do the right thing!

Adults must notice and nurture children's inherent character strengths and teach and reinforce others. We also must never forget that our actions speak so loudly that sometimes our kids can't hear a word that we are saying. In other words, they are watching what we do. We must uphold those character strengths that we hope to see in them.

Contribution

Young people want to matter. Ultimately, they want to have a sense of meaning and purpose in their lives. When children and adolescents are given an opportunity to make a difference they also gain strong protections for themselves. They learn firsthand of the joy of giving. This means that ultimately when they need to receive from others they can do so without shame. Why? Because they'll understand that the person supporting them does so out of pleasure not pity. When they contribute to other lives they gain appreciation. Youth surrounded by gratitude rather than condemnation thrive. Plus, they earn an extra set of protective eyes to watch over them.

Coping

Life is about making choices. Stress is a part of life - an uncomfortable reality. We do what we can to minimize discomfort. The choices we make to cope with our discomfort can be negative or positive. Negative ones can work in the short run, but bring great harm to us and our communities in the long run. So many of the quick-fix behaviors we hope our children never choose are negative coping strategies. Telling our children what not to do barely makes an impact and sometimes backfires. Instead, when we raise them with a range of healthy coping strategies (and model them as well), they make wiser, healthier choices during challenging times.

Control

Core to resilience is knowing that your actions matter. Without a sense of control we cannot possess hope. And without hope, we crumble in challenging times. How we parent makes a large difference in our children's sense of control. Young people who know that their parents are pro-development - supporting all stages of their growth - understand privileges are earned with demonstrated responsibility. Young people raised being told, "You'll do what I say, because I said so!" do not learn how to make their own choices. We must let tweens and teens understand that they have control over their lives.

The protective forces that allow us to recover after difficult times are the same ones that prepare us to flourish in the best of times. They challenge us and enable us to get the most out of every opportunity.

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The 7 essential ingredients supporting teens to thrive.

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Fostering Supportive & Responsive Spaces for Student Engagement & Leadership - Ontario School Mental Health

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Fostering Supportive & Responsive Spaces for Student Engagement & Leadership - Ontario School Mental Health

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Fostering Supportive and Responsive Spaces for Student Engagement and Leadership – Building mentally healthy spaces through co-created agreements - School Mental Health Ontario

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Why are group agreements important? Connectedness is a powerful protective factor in mental health and is essential in creating mentally healthy schools. One way to build connection while supporting student engagement and leadership is to co-create group agreements. Building agreements with both staff and students signals to young people that their voices matter and that they […]

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The Teen Brain: How Schools Can Help Students Manage Emotions & Make Better Decisions - Article

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The Teen Brain: How Schools Can Help Students Manage Emotions & Make Better Decisions - Article

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Teen Brain & How Schools Can Support Development

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The Teen Brain: How Schools Can Help Students Manage Emotions and Make Better Decisions

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Cognitive and neuroscience research points out ways schools can help leverage teenagers’ strengths in this unique developmental period.

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The Brain Architects Podcast - Laying the Foundation

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The Brain Architects Podcast - Laying the Foundation

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The Brain Architects Podcast - Laying the Foundation

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Center on the Developing Child at Harvard University

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Transcript

Sally: Welcome to The Brain Architects, the new podcast from the Center on the Developing Child at Harvard University. I'm your host, Sally Pfitzer. Our center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children, and take what you're hearing from our experts and panels and apply it to your everyday work. In today's episode, we're going to dive into the concept of brain architecture and learn a little bit more about the science behind it. We'll learn why the early years are really important for brain development, and think about how connections are built in the brain, and what a strong or weak foundation in the brain can mean for a child's future health and development. Here to help us explain brain architecture is Dr. Jack Shonkoff, professor of child health and development, and director of the Center on the Developing Child at Harvard University. Welcome, Jack.

Jack: Hey, Sally. Good to be here.

Sally: We have a lot of questions to dive into today, but first, can you explain where the idea of brain architecture came from? I've heard you use the metaphor of a house before, which I've found to be really helpful in really thinking about that foundation that's set in the early years.

Jack: Almost 20 years ago, the National Scientific Council on the Developing Child realized that we needed metaphors to take very complicated science and present it with a phrase that would capture what it was about, and would be remembered. What came from our early conversations was this very simple fact that brains are built over time. We latched onto this concept of brain architecture, and any building begins with a strong foundation. If the foundation is strong, the building will last a long time, and if the foundation has a crack in it, or it's weak, the building may not fall apart, but you won't be able to build on it very much over time without having to deal with some of the weaknesses. Think of the building communities where multiple houses are built, that they're all exactly the same. But then people move in, and they bring their own decoration, and they're own style to it, and every house that's built with the same basic design ends up looking very different. The more we got into the architecture metaphor, the more we realized how powerful it is in terms of understanding this process of brains being built over time.

Sally: As I'm listening to you, it's making me think about the nature/nurture argument. I know that the current science has a lot to say around that. Is brain architecture determined solely by our genes?

Jack: I love this question. This whole idea of how much is genetic and how much is the result of experience used to be a very fierce argument among scientists. We now know that there's a very strong genetic and a very strong experience influence. To stick with the architecture metaphor, think of the genetic contribution as the architect's blueprint, before you begin to build a building. That's the way genetics contributes. It's why most children, they sit up at a certain age, walk at a certain age. But how those skills develop, how they're built, how strong they are, what the design looks like, very little of that is influenced by genetics. It's influenced by, it's the world in which kids live, the experiences they have, the environment of relationships they live in, that shape the development of the blueprint for that individual. Genes determine when circuits get built. Experience, individual differences in people's life experiences determine how those circuits get built. Together, they both explain the development of brain architecture.

Sally: That's so fascinating. I know a lot of our listeners are folks who are working directly with kids. I'm wondering if you can give them some examples what that building responsive relationships looks like, and also how that actually goes into building brain architecture.

Jack: Another great question. The key feature of what we mean by "environment," and what we mean by "experiences" that shape brain development really come down to the nature of the interaction between very young children and the adults who care for them. The brain is wired to expect interaction with other people. It's not looking for interaction with tablets, or mobile phones, mainly because those stimulus sources are not interactive. This need for interaction is built into our biology, into our genes. It comes from eons and eons of evolution. If there wasn't a reason for it, it wouldn't appear over and over again over eons. From a developmental point-of-view, somebody has to be there engaging and interacting, and providing experiences from which you can learn, in order for your brain to build strong circuits. If the brain is getting bad input, the brain struggles to learn how to deal with it. If the brain is getting no input, it's an all-signal alert that the world is crashing down on you, not because it's harming you, but because it's ignoring you. Positive experiences strengthen brain circuits. Threatening negative experiences weaken brain circuits, at the time that they're being made.

Sally: One last question. I can't help but ask, given what you've just described about how detrimental some of these things can be to a developing brain, and I'm thinking about listeners who have either experienced this themselves, or have had children that have experienced this, and that sense that they might have of "This is a doomed situation. My foundation is crumbling and completely weak, and from there on, I'm not able to continue to build my house." I just wondered if you could address that.

Jack: I'm really so glad you asked that question, Sally, because there are no perfect brains. The best parents in the world do a dozen things wrong every day. There's a lot of science about brain development, but raising healthy, competent children is much more a bumbling art than it is a precise science, right? There's a core concept in biology about adaptation and resilience over time, so that it is never too late to strengthen the brain's capacity to do things. Anybody who says, "Past a certain age, there's nothing you can do," is ignorant of what science has to say. On the other hand, it's not true that early doesn't matter. It's a balance. Having problems early on, perhaps having a weaker foundation, is not a doomsday scenario at all. It just means that some things are going to have to be worked on a little bit harder. They would have been easier if we had gotten it right the first time, but it's not too late. The take-home messages here are earlier is always better than later, prevention of difficulties is better than trying to remediate difficulties later. But it is never, ever too late to strengthen capacities. The brain is always trying to get things right. If it goes off-track, it's always trying to get back on-track. That's the beauty of the science. It's also the beauty of the magic of human development.

Sally: Thank you so much. I'll leave you with that. "Earlier is better, but it's never too late." Thank you so much.

Jack: Thank you, Sally. I appreciate it.

Sally: When we come back, we'll welcome a few special guests.
Musical interlude
Sally: Here to discuss the implications of the science of brain architecture, we have Judy Cameron, Ph.D. Judy is a professor psychiatry, University of Pittsburgh, and the CEO of Working for Kids: Building Skills, LLC. Welcome to the podcast, Judy.

Judy: Thank you. I'm really happy to be here.

Sally: We also have Debbie LeeKeenan joining us. Debbie's an early childhood consultant and former director of the Eliot-Pearson Children's School at Tufts University. Hi, Debbie.

Debbie: Hi. It's an honor to be here. I'm looking forward to the conversation.

Sally: Also joining us on the podcast, we have Pia Rebello Britto, Ph.D. She's the global chief and senior advisor, Early Childhood Development Program Division, at UNICEF. Welcome, Pia.

Pia: It's a pleasure to be on. Thank you for inviting me.

Sally: I'd like to start by asking why is it critical for parents, teachers, and even policy makers to understand the importance of brain architecture?

Judy: It's important that people, all people who interact with children, understand brain architecture, and how brain architecture is made. Because experiences play a really strong role. The brain is genetically programmed to make connections, but whether those connections stay, become strong, and are permanent and there for the child to use their whole lifetime, depends on having experiences that strengthen them. You want parents to strengthen children's brain circuits. You want teachers to do that. At the policy level, you want policy makers to vote for things that will give all children that opportunity.

Pia: To complement Judy, I want to focus a bit on the policy makers, in terms of their understanding of brain architecture. Ultimately, as we know, for these positive experiences to occur between children and their caregivers or parents, these adults in the child's life need time. They need resources. They need services. All of that enables them, then, to be able to engage with their children in a meaningful manner. Policy makers, employers in the business sector, all of them create the right policies and enabling environment to then give the parents that time, that space, the resources they need. Their understanding of brain architecture, and the value it holds and how it occurs, is very important, then, to enable parents to engage in what they love the most, to engage and interact with their children.

Sally: Great. Debbie, I know you've been in the field for quite some time, in a variety of roles. I think our listeners would like to know what are some specific things that teachers, parents, and caregivers can do to actually help build a healthy brain?

Debbie: We know that young children learn through everyday play and exploration in safe and stimulating environments, and with relationships with their families, teachers, and caregivers. Young children learn when they're using their whole body and senses. Giving opportunity for young children to explore open-ended materials that can be manipulated and combined in different ways, these provide unlimited play and learning opportunities. We're talking about blocks, little figures, animals, toy cars, balls, spoons, buckets, pans, baskets, or recycled materials. Through all of that, the early childhood brains are opened to new experiences, and children are testing new theories, and changing old theories when they learn something new. This kind of constructive play allows experimentation, problem solving, higher-order thinking, and as well as language development and social skills. They develop new ideas and schema. It helps them with language development, cognitive skills, problem solving, and taking on other perspectives and self-regulation. All of these things are a way that teachers, parents, and caregivers can help the brain develop from very young ages.

Judy: I think that what Debbie has said is exactly right, and one thing parents are always asking is "How can we fit this into our everyday life?" Giving them examples of what they can do while they're cooking dinner, what they can do while they're driving in the car, what they can do when they're just hanging out with their kids, so that they can begin to be creative. They have ideas that anytime can be a learning time for a child.

Sally: Great. Judy, you were part of a team that created a whole game around the concept of brain architecture. Could you tell us a little bit more about that game? Who plays it? What do you think people actually learn from it?

Judy: The Brain Architecture Game, people work in small groups. They have a task of building a brain. They roll the dice to get their genetic background. That gives you the structure of the base of the brain. And then, they draw Life Experience cards, and the Life Experience cards might be a good experience, a really bad stress, which we would call a toxic stress, or a tolerable stress, a stress that can be good for the growth of the brain or not, that it could be toxic, and it really depends on how much social support. A key issue in the game was to get people to understand that social supports are really important. They build their brain out of pipe cleaners with the supports being straws, and they debate with each other, "Okay. Where am I going to use this support? How tall can we get it? Do we need a little bit more of a sturdy base?"

Sally: Yeah, Judy, I've facilitated that game a few times, and I'm always struck by how many times I hear the term " that's not fair" when people are watching their brains collapse.

Judy: That's true. I've played it with over 12,000 people. I remember playing it at a legislature at one point where the whole legislature decided to take an hour out of their day. One legislator came in the room, and he said, "I'm going to build a fantastic brain. I really care about children, and I'm a good architect." And I said, "Excellent." And then, his brain collapsed. And when I asked him what happened, he said, "Oh. It wasn't my fault," and I didn't say anything. I just looked right at him, and he said, "Oh, my gosh. That's what you're trying to teach us. It's not children's fault."

Sally: I always think that's such an interesting concept that, of course, that's part of what you're trying to teach throughout these experiences. Pia, I'm wondering from your perspective, if you can share why the concept of brain architecture is so important for us to consider internationally, and do you have some examples of how this concept is being used all around the world?

Pia: Yeah. This is actually a very seminal concept for us to build on internationally and build on globally because the situation of children really calls us to take serious actions. So, I'm not sure if you're familiar with but a few numbers to help you contextualize how important this is. The first is that over 250 million children around the world, especially in low- and middle-income countries, are at risk of not achieving that developmental potential. And when we look further into that number and understand what's going on, we know that in 2018, 29 million babies were born into conflict affected areas where they're born into these areas where they are exposed to high degrees of toxic stress. We know that over 300 million children live in areas with toxic air that we know can damage the developing brain. So, we know there's a lot of risk factors in the environment. Okay so, that's the broad environment. So, what's going on in the daily lives of children? We find out across sort of our work that only about 60% of children receive that sort of early stimulation and responsive care from their parents and caregivers on a consistent basis. So really, it's just about over half are receiving that type of care that we know is so integral for brain architecture. So, the case for why we need to bring this, this concept, globally is really important. The whole world community aims to achieve certain goals and targets, and in 2014, to have a very powerful seminar at UNICEF. Judy was there. Jack was there. The world's leading neuroscientists were there, and they very clearly laid out a case for what happens when you build this brain architecture and what happens when it gets derailed. Now, for the first time in history, there was a goal that looked at child development. There was an indicator and a target that all countries now are accountable for, that they are supporting children to make this happen, and that's super powerful. We never had that at a population level before. Another example I can throw out really quickly is most parents around the world do not have access to this information of why their engagement with their child matters, why responding to their baby's cues matter so much. They don't have access to this information. So at UNICEF, we launched Early Moments Matter. It's now the largest global campaign. The essence of Early Moments Matter is that babies' brains are built and they need the active ingredients. They need eat, play love. They need care. They need protection. And we were actually through the Early Moments Matter, we're able to reach over 2 billion people with these messages.

Debbie: I loved hearing those examples, Pia, with the UNICEF program and those Early Moments. I could give an example locally here in Seattle. I'm involved with a program called PEPS, Programs for Early Parent Support, and the concept here is that the first thousand days of a baby's life are the most important, and yet many families, many parents feel isolated or have all these other negative experiences. So, this program tries to connect families with other families, creates kind of a small community learning group for parents where they get together maybe a group of 10 to 12 families in different settings, partnering with different agencies to really provide access to all kinds of families. Another point that I thought was important: one of these toxic stress factors is also about the racism and community violence that families and children experience. And one of the things in my work that we've found is that as adults in children's lives, we have an opportunity to choose materials for children, whether they're books, whether they're toys, that provide both mirrors and windows for children. This really helps them build their positive social identity development, which happens to begin at birth. And I like this metaphor of mirrors and windows meaning we want to expose children with materials with experiences that reflect who they are, that help them feel good about their identity. And at the same time, you want opportunities to provide materials, books, that may provide windows for children and families to see people that are different than them.

Judy: I also had something that might be worth thinking about. We have been collecting data from communities that we work with, and most of these are very impoverished communities, about child development. We're checking development of children over a one-year period, so measurements of the stress exposure of the parents and the children, poverty level, education level, as well as videotaping them with their parents and scoring parent-child interactions. And a really interesting finding is that parent-child interactions can be very strong no matter how much family stress is experienced. So, you have parents living in really stressed environments, but if they have very good serve and return interactions, if those are strong from the parents, the child will be doing better even in the face of stress.

Pia: And just building on Judy's point, one such context we haven't discussed too much is families who are on the move, migration, refugee status, families who are living through protracted crisis, conflict, and those who are suffering sort of links of humanitarian or climate change-related emergencies. And what we're finding when we are working with families with young children in these areas is that caring for the caregiver is as important as giving messages to the caregiver about their young child. And in order for parents to feel sort of on top of the game, in order for them to be able to care for children in the manner that's most suitable for their kids, they need caring as well for their own emotional wellbeing.

Sally: Judy, I'm wondering if you could also weigh in on that question on how to build social-emotional skills, in particular in how it relates to regulation.

Judy: Happy to. So, in the communities we're working in, there often is a lot of disruption in the family setting, and so we've put a lot of emphasis on getting adults in a community to think more broadly about who can provide kids with the skills that they need and with learning environments. And we think of this as charging stations. We talk about the fact that you need to plug the phone in in order to function. Each of us needs to have a support in order to function, and we start by talking to adults about, "What is your charging station? What do you do when you really need to feel better?" This connects very closely to what Pia said earlier about taking care of the parents and making sure that the adults that are interacting with children are taken care of also. But then, we expand it to, "What are the charging stations in your communities that can work to help children?" And that gets people to think much more broadly about the fact that it's not just parents. It's not just childcare providers. It's not just teachers that have an impact on children in children's development. Everybody in the community can play a role. The matter is getting everybody in the community to realize that they can play an important role in helping children learn skills.

Sally: Excellent. Up next, our panelists are going to answer some of your social media questions.
Musical interlude
Sally: Since our panelists have answered all of my questions, let's move on to some of yours. So, haleyraepearce from Instagram asks, "How do we make sure young children are successful in their transition to school?"

Debbie: Preparation is always important, but I also like to say not too early because typically in the early childhood years, children don't have a good concept of time. So when we talk about preparing children, we're not talking about months in advance but maybe a week in advance what's going to happen, and you want to do it in a very concrete way, maybe visiting the school, reading stories about going to school. I also think always bringing something from home to school is also a good strategy that helps with transitions. I think that a key idea is preparation but doing it in a concrete way and kind of figuring out the when to start that preparation, not too early and not too late.

Pia: Just adding to that. The model we use at UNICEF is children ready for school, parents ready for school, but school's ready for children. So, I want to build on what Debbie presented. Preparation is key, and preparation is key on the part of the school as well to be able to receive children in. And in many of the contexts in which we work, we have a lot of different issues linked to school readiness, for example, multiculturalism, multilingualism. So many of our children are for the first time coming into schools where maybe the language spoken at home is not the language that is being spoken in the classroom or part of the curriculum. So, a lot of the focus and emphasis is also on preparing these teachers and the school administration to be able to receive children to sort of smooth and ease their transition.

Judy: I can also comment on this from a much broader perspective. So, Debbie and Pia have talked about the literal transition from living at home in your family to starting to go to school. But what's really important to remember is how well children do in that transition, and in school is going to be very dependent on brain development earlier in life. So throughout their time growing up. And so it really behooves parents and those who are interacting with children to try to help them build strong social-emotional skills, strong problem-solving skills, a strong image of themselves so that they are ready to make that transition.

Sally: I love the variety of perspectives there. We had sort of some really concrete specific examples, and then zoomed out to more global and then thinking about how that all relates to brain architecture will be really helpful for our listeners. So attipay61 from Instagram asks, "I'm a teacher of one -to two- year-olds, and in your opinion, what is a good timeframe to expect children of that age to grasp, understand and remember a concept? Simple examples, hands are not for hitting, or food goes in your mouth. Some days things are a little challenging because it feels like this is what we say all day." I bet some listeners will relate to that.

Debbie: And I'm chuckling here too, as I take care of my grandchildren this age. I'm thinking about that. First of all, there's these first two years of life, is what we call the sensory motor stage. And often infants are busy discovering relationships between their bodies and the environment, and this is actually how they're learning. When we say don't put things in your mouth, yet, that's how they learn through sensory experiences. Through their seeing, hearing, smelling, tasting, touching, et cetera. I think we can also through simple words, repetition, signs, gestures, a 12-month-old can understand the concept, what we put in our mouth, food goes in our mouth, toys we put in the bucket or in the basket. But instead of saying, "No toys in the mouth", we'll often say, "Put the toys here, we'll eat our snack in our mouth." Things like that. So being concrete and yet understanding that this is where they are developmentally, what their brain understands, so it's not like it's a misbehavior I always say, but a typical behavior.

Judy: I would have a different perspective, that is that what we really have to remember is the way brain development happens is that the genetic program tells neurons, brain cells to make connections. And what causes those connections to be strengthened and become a stable brain circuit is experiences that use the connections. I get asked many times, "How many times do you have to use a connection to increase the probability of it being permanent, and really strong?" And the answer is thousands and thousands of times. And so you have a teacher or a parent who's working with one- and two-year-olds who says, "I've told them over and over again about this. Why do they still not get it?" They really have to have used that part of their brain thousands of times. And we need to understand that it really takes a lot of work on the part of the growing brain to form a strong, stable pathway.

Sally: Thanks to our panel for offering that expertise and thank you to our social media followers for submitting some great questions. Up next, Dr. Shonkoff is back to debunk an early childhood myth that may have actually heard.
Musical interlude
Sally: And we're back with Dr. Jack Shonkoff, and we're going to talk about a myth that exists in the early childhood field. This is a segment I'm particularly excited about, because I think there are a lot of myths out there. I know you are particularly passionate about, and it is that 90% of a child's brain is formed by the age of three. So could you tell us a little bit about that myth and why it is not a correct fact?

Jack: Should I start with why this drives neuroscientists insane? Let me just start with something simple, which is why that's wrong. To say that 90% of the brain is completed by age three, or age four or age five is to completely misunderstand the very basic concept of a developing brain. Is there anybody out there who could make some sense of the idea that a three-year-old now has 90% of all of the competence and skills and knowledge that you'll have for the rest of your life? From a common-sense point of view, that's just ridiculous. If we're talking about brain development, we're not talking about how big your brain is, or how much it weighs. We're talking about its circuitry. You don't have to be a neuroscientist. Ask anybody who knows anything about kids, how much of a difference is there between what a two-month-old can do and what a five-year-old can do? But here's why it's damaging. If 90% of your brain development is completed by age three or four, what does that tell us? What it tells us is not only to get hysterical about the first three or four years of life and drive yourself crazy, it also tells you, okay, you're four, you're five years old now, you're there, it's done. It implies it's too late to do anything. It implies there's not a whole lot you need to do to promote healthy brain development afterwards, because most of it is over.

Sally: It also implies that at some point you get to 100%, which contradicts exactly what you just said earlier, that we're still developing.

Jack: Exactly. It creates a lot of misperceptions and misunderstandings that could affect the way we think about how much of an impact can adults have on children? But let me tell you why it's continued. I was speaking at a conference once, and I was on a panel with some people, one of whom who got up there who made this comment about how 90% of the brain, and I said, you know that's wrong, right? You know what he or she said to me? That person said, "I know, you've told me that, but do you see the look on the audience's face when I say that? Do you see how jazzed they get? Do you see how much they understand the importance of the early years? I know it's wrong, but it's effective." And perpetuating that myth is terrible. Not only because it's wrong, it creates ideas in people's heads that end up being damaging to how we can help children all through their lives to be who they can be. Sally, to your point about it never reaches 100%, this is the other side of the coin. People ask this question about how flexible and adaptive is the brain? We know that resilience also is something that's built over time. If you have a weak foundation early on because you hadn't had time to develop resilience, you can develop resilience later, and you can get better and things can be better. So then the question becomes, is it ever too late? It gets harder the older you get. But if there's anyone out there listening to this podcast who's 103 years old, who learned one thing from this podcast, goes to sleep and tomorrow wakes up and remembers it, a new connection was made in the brain.

Sally: Thanks Jack. Up next, how can we take the science of brain architecture and apply it to everyday situations?
Musical interlude
Sally: We've learned about the science of brain architecture, and its implications, and we've learned that your brain is never fully developed. We're always learning. Now we'll leave you with something that you can do today, tomorrow, or even next week to promote healthy brain architecture. Do you have to go pick up groceries this week, for example, while your little ones tag along? Well, when you're searching for ripe apples, ask your child if they can point out all of the green ones. While you're picking out cereal, maybe ask them if they can find all the cereals that start with C. Simple games like these require children to understand rules, hold those rules in mind and then follow them. So while you're shopping for groceries, they're actually building their brain. I'd like to, once again thank our guests, Dr. Judy Cameron, Professor Debbie LeeKeenan, Dr. Pia Britto, and Dr. Jack Shonkoff. I'm your host Sally Pfitzer, and we'll see you next time. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we'll post any resources that were discussed in this episode. We're also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas, Charley Gibney, and Kristen Holmstrand are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. The podcast is recorded at PRX Podcast Garage in Allston, Massachusetts.

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The Brain Architects Podcast: Brain Architecture: Laying the Foundation

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Why are the early years of a child's life so important for brain development? How are connections built in the brain, and how can early brain development affect a child's future health? This episode of The Brain Architects dives into all these questions and more.

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FROM THE AMERICAN ACADEMY OF PEDIATRICS| POLICY STATEMENT| AUGUST 01, 2019

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FROM THE AMERICAN ACADEMY OF PEDIATRICS| POLICY STATEMENT| AUGUST 01, 2019

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The Impact of Racism on Child and Adolescent Health

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Maria Trent, Danielle G. Dooley, Jacqueline Dougé, SECTION ON ADOLESCENT HEALTH, COUNCIL ON COMMUNITY PEDIATRICS, COMMITTEE ON ADOLESCENCE, Robert M. Cavanaugh, Amy E. Lacroix, Jonathon Fanburg, Maria H. Rahmandar, Laurie L. Hornberger, Marcie B. Schneider, Sophia Yen, Lance Alix Chilton, Andrea E. Green, Kimberley Jo Dilley, Juan Raul Gutierrez, James H. Duffee, Virginia A. Keane, Scott Daniel Krugman, Carla Dawn McKelvey, Julie Michelle Linton, Jacqueline Lee Nelson, Gerri Mattson, Cora C. Breuner, Elizabeth M. Alderman, Laura K. Grubb, Janet Lee, Makia E. Powers, Maria H. Rahmandar, Krishna K. Upadhya, Stephenie B. Wallace; The Impact of Racism on Child and Adolescent Health. Pediatrics August 2019; 144 (2): e20191765. 10.1542/peds.2019-1765

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The Impact of Racism on Child and Adolescent Health

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The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families.

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Breaking Cycles of Inequity - Supporting Family Responsiveness

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Breaking Cycles of Inequity - Supporting Family Responsiveness

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This is a First Person column by Alexander Redhead, a father from York Factory First Nation who lives in Ste. Anne, Man. For more information about CBC's First Person stories, please see . WARNING: This story contains details of experiences at residential schools.
My son is six years old and he's my world. He's never been to daycare or kindergarten, so last year was his first real experience with school. Every morning is hard, but that one day in October was something else entirely.

When we got to the school doors, he froze. He wouldn't climb the stairs. He cried, begged and held onto me with everything he had.

"Please, Dad ... don't make me."

I took him to the office hoping someone could help, but it only got worse. He cried harder when the teachers came. He fought, screamed, reached for me and tried to run back into my arms while they held him. My gentle, sweet boy was terrified - and seeing him like that shattered something in me I didn't even know was still breakable.

This wasn't a child who didn't feel like going to school.

This was fear. Deep, real fear.

And I knew exactly where it came from.

Last summer in Calgary, a man tried to grab my son. Right in front of me.

It happened in seconds - the kind of seconds that I'll replay in my mind for the rest of my life. We were on a family trip, trying to salvage a day after the zoo turned us away due to overcrowding, so we went to explore a local park instead. My son was walking just a few steps ahead of me when a man approached from the opposite direction. I thought nothing of it.

Then he suddenly reached out and grabbed my boy by the shoulders.

I can't tell you what his intentions were - I'll never know. But I can tell you what I felt: pure instinct. Fear. A wave of protective panic I had never experienced before. My body moved before my mind did. I grabbed my son back immediately. The look the man gave me afterward still sits heavy in my stomach. It felt wrong. It felt dangerous. And it's stayed with me ever since.

After that, all I cared about was getting my family out of Calgary safely.

We didn't speak much on the drive back to our home in Ste. Anne, Man.

None of us felt right.

It changed my son.

It changed me.

Since that day, my son hasn't been the same. He holds on tighter. He's nervous around strangers. He checks for me constantly. And, truthfully, I haven't been the same either. I get anxious when he's out of my sight. I scan every room, every door. That one moment - that one man - stole something from both of us. And this morning, it all rushed back like it never left.

As I stood in the school office, watching my boy cry and reach for me while adults held him back, something else hit me - something I didn't expect.

I saw my late father.

The same age my son is now.

Being taken from his family.

Terrified.

Reaching for someone who couldn't save him.

My father was a Sixties Scoop survivor who was taken to residential school in Manitoba. Like so many survivors, he carried trauma he never asked for. Some of that pain followed him into adulthood - moments where he struggled silently with things he never fully healed from.

Even then, those struggles never defined him in my eyes. He still became a chief, a musician, a father and a man I admired deeply. He taught me pride, humour and resilience even when love cost him more effort than it should have.

I sometimes felt a quiet emotional distance between us - not because he didn't love me, but because he had grown up in residential school without consistent safety or affection.

There were times when he would physically shut down, especially in stressful or emotional situations. It wasn't anger or cruelty - it was a kind of bracing, like his body was protecting itself. As a child, I didn't always understand it, but as an adult I can see it as a survival response from someone who learned very young that the world was not safe.

Becoming a parent myself helped me see him not just as a man who struggled at times to show me affection, but as a child who never got what he needed. A boy who was never given safety, gentleness or comfort when he needed it most. A boy whose fear was never met with love. It made me feel more compassion for him, and it softened how I understood our relationship.

And now, my youngest son carries his name - a connection that means everything to me.

So when I watched my boy reaching for me in that school office, terrified and shaking, generations of pain rose up. Generations of children who didn't get to choose safety. Generations of parents who couldn't do anything to stop their babies from being taken.

My father didn't have a choice.

But I do.

So I took my son home.

Not to spoil him.

Not to avoid hard days.

But because I refuse to let fear, shame or force be what he remembers from childhood. I refuse to let his body store fear the way my father's did. I refuse to repeat the cycle - even in small ways.

At home, I held my son until he finally relaxed.

And then I cried - for him, for myself and for my father, who never had someone to bring him back home when he was afraid.

If I could speak to my dad today, I would tell him that I see him now - not just as my dad, but as the little boy he once was - and that I understand how much he carried. I'd thank him for the love he gave me, even when it wasn't always easy for him to show it. And I'd tell him that I'm trying to honour him by giving my children the safety and gentleness he was never given.

That day wasn't about skipping school.

It was about breaking a cycle.

Choosing love over fear.

Gentleness over shame.

Safety over silence.

It was about listening to the child in front of me, and the child my father once was.
A national 24-hour Indian Residential School Crisis Line is available at 1-866-925-4419 for emotional and crisis referral services for survivors and those affected. Mental health counselling and crisis support are also available 24 hours a day, seven days a week through the Hope for Wellness hotline at 1-855-242-3310 or by online chat.
I'm grateful that I get to be the kind of father who listens - the kind who brings his child home when the world feels too big.

That's something my father never had. And it's something I'll never take for granted.

Do you have a compelling personal story that can bring understanding or help others? We want to hear from you. Here's more info on how to pitch to us.

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FIRST PERSON | When my son cried, I listened. My father never had that when he was in residential school | CBC News

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What started as a school drop-off turned into a deeply emotional moment for Alexander Redhead that connected to his late father's experience in residential school - and to what it means to be an Indigenous parent trying to break cycles through love and compassion.

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Deep Diversity with Shakil Choudry & Sharon Salzberg – Metta Hour Podcast Ep. 198

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JUMP TO: VIEW THE ILLUSTRATIONS | DOWNLOAD THE PDF | TAKE THE QUIZ

In 2019, researchers at Johns Hopkins University published results of the first large-scale study that sought to identify "Positive Childhood Experiences," which help protect kids from the adverse effects of traumatic experiences¹ (read the full-text journal article here). The Seven Positive Childhood Experiences (PCEs) they identified (illustrated below) are categories of childhood/adolescent experiences that are connected to improved mental health and social connectedness in adults.

Most counselors, pediatricians, teachers, and other people who work with children know about ACES: The "Adverse Childhood Experiences" scale. Based on measuring the number of traumatic or adverse events experienced, ACEs predict which kids are likely to struggle developmentally and emotionally as they mature. (You can take the ACES quiz here).

New results from a survey based on a study of 6188 adults at Johns Hopkins show that there are 7 childhood experiences that can be statistically linked to good mental health in adults.

What has been less well understood is why a small percentage of kids with high ACE scores have normal development and good adult emotional health. What factors created a level of resiliency in these kids that helped them to survive and thrive despite difficult childhoods?

Supporting Kids through COVID using PCEs

This PCE study inspired my book Covid Kid's Activity Book - A Workbook for Kids and Families to Build Community and Resilience through Quarantine and Beyond, available now in print and instant digital download. This workbook for ages 4-11 is designed to help kids process, understand, and integrate the PCEs they are experiencing, even amid a pandemic. This may help kids grow resilience to current and future adversity.
Or get All-Access as a $5/mo Patron
Even before researchers defined ACEs and demonstrated the link between high ACE scores and lower high school graduation rates, increased mental health diagnoses, higher rates of incarceration, and other poor outcomes, there has been an enormous focus on decreasing adverse childhood experiences. Research shows that these positive childhood experiences can help promote lifelong health, even for kids who've had multiple adverse childhood experiences (four or less).

This study helps shape research moving in an additional direction: How to support kids who have experienced one or more traumatic events and kids who have not yet experienced a traumatic event but will in the future. Could PCEs help researchers identify ways to help grow resilience in kids who are then able to become healthier adults?

Kids who experience many PCEs learn to trust the support of social connections, and social connectedness is linked to adult mental health. Adult survey respondents who reported high levels of adulthood social and emotional support (i.e., family, partners, and friend circles they trusted, were open with, and looked to for support) were more likely to have experienced a high number of PCEs during their childhood.

Kids who experience many PCE's during childhood become adults who can seek support and get care- and adults who can seek support and get care have improved symptoms even if mental illness is present.

Get a Print Copy of this Art to Share + Support Sustainable Educational Illustrations

To learn more about PCEs, you can read the full-text journal article of this study for free on JAMA Pediatric's website. To purchase a copy of this poster, choose an option below. Please note that the purchase price paid is compensation for artistic work only and does not include rights to republish.
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The relationship between PCEs in childhood and good mental health in adults is dose-responsive. That means: the more PCEs a child gets, the better their adult mental health is likely to be.

Take My PCE Quiz to Learn Your Score:

1. Ability to talk with family about feelings.

Thoughts, feelings, and experiences are shared openly and honestly, and dialogue around feelings is welcomed. This could be through a parent checking in every so often or even sharing their own feelings (in an appropriate way) to encourage the child to share. Sharing emotions also promotes emotional intelligence in growing minds by identifying and expressing a felt experience.

2. Felt experience that family is supportive in difficult times.

When a difficult experience occurs in a child's life, a parent offers support through presence and/or expresses support through words. Taking the time to notice and be with the child through this helps them to feel as though the parent is by their side and on their side. It doesn't have to be much, but even just a little moment can go a long way in teaching the child that they matter.

3. Enjoyment in participation in community traditions.

Traditions generally allow us to feel part of a greater whole. Having traditions in childhood creates a rhythm that binds us to the greater whole and connects us to our families. Celebrating traditions allow for meaningful moments to be had within families and among communities. This can help a child feel connected, garner a greater sense of community, and promote life-long (positive) memories.

4. Feeling of belonging in high school.

High school can be a challenging experience, but belonging can be found in many places. This sense of belonging can come from participation in extracurricular activities, joining clubs or groups that share a similar interest, or simply finding peers to connect with in a meaningful way. Feeling connected and having positive relationships is key to feeling like they belong.

5. Feeling of being supported by friends.

Similar to feeling supported by family - it is important that children feel that support from their friends. A parent is essential here because they are the model for a child's first understanding of relationships. A parent can model what it looks like to have healthy, supportive relationships with friends, and encourage their children to find the same qualities in the friends they choose.

6. Having at least two non-parent adults who genuinely care.

While it is vital for a child to feel supported by their family, it is also essential that they have supportive adults outside the home. These adults could be teachers, counselors, coaches, mentors, a friend's parent, etc. It is an adult who is a positive influence with whom they have a healthy attachment, a person they feel they can talk to or turn to besides their parent(s).

7. Feeling safe and protected by an adult at home.

Feeling safe and protected can look like many different things: It can look like being physically cared for - protected from physical danger. It can also look like being kept safe from overwhelming experiences. Whatever it may be, it is crucial that a child feels that the parent(s) in their life are available and doing what they can to keep the child safe and healthy. This allows the child to focus on things beyond basic needs being met.

Original summary of this illustration posted on social media: Until now, research on the impact that childhood experiences have on adult mental health has focused on adverse experiences. This week, Johns Hopkins researchers published significant new research demonstrating 7 positive experiences, that, when experienced regularly in childhood, correlate to adults who are less likely to experience depression and poor mental health.

Study authored by: Christina Bethell et. al. " Positive Childhood Experiences (Free Full Text Article) "

In summary, Identified PCEs in the Johns Hopkins Study include (in my words):

Being able to talk about feelings with family

Feeling supported by family in difficult times

Participating in community traditions

Feeling as though one belongs in high school

Feeling supported by friends

Feeling as though at least two non-parent adults truly care

Feeling safe and protected by adults at home

PCES:
Resources
Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr. 2019;173(11):e193007. doi:10.1001/jamapediatrics.2019.3007 jamanetwork.com/journals/jamapediatrics/fullarticle/2749336

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7 Positive Childhood Experiences (PCEs) that Shape Adult Health and Resiliency - Illustrated - LindsayBraman.com

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Positive Childhood Experiences can build resilience to trauma and mental illness. This illustrated printable contains a breakdown of all 7 Protective Childhood Experiences (PCE's) identified by researchers.

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How Schools, Families, and Communities Build Children's Resilience - Michael Unger

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How Schools, Families, and Communities Build Children's Resilience - Michael Unger

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Trauma & Behaviour - Trauma-Informed Practices in Early Childhood Education

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Trauma & Behaviour - Trauma-Informed Practices in Early Childhood Education

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Trauma-Informed Practices in Early Childhood Education

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Implementing trauma-informed care in early childhood education can increase the chances that young traumatized children recover, thrive, and enter kindergarten ready to learn.

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Queen's Family Medicine Article - Pages 2-4

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Queen's Family Medicine Article - Pages 2-4

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Reading (pp. 2-4)

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Canadian Paediatric Society Position Statement on Moving from ACEs to Relational Action

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From ACEs to early relational health: Implications for clinical practice | Canadian Paediatric Society

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Children grow and develop in an environment of relationships. Safe, stable, nurturing relationships help build resilience and buffer the negative impact of adverse experiences. Promoting relational health in clinical practice shifts the focus from adverse childhood experiences (ACEs) to positive childhood experiences (PCEs). This approach evaluates a family’s strengths and assets, and can be incorporated into both well-child and subspecialty care. While the optimal window for such interventions is in the prenatal period or as early…

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Core Skills Building & Windows of Development

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Core Skills Building & Windows of Development

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The Adolescent Brain: A second window of opportunity - Unicef

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The Adolescent Brain: A second window of opportunity - Unicef

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UNICEF Executive Director, Anthony Lake

Few things irritate adolescents more than being told what to do - or how to think.
Their need for independence is not only emotional. Adolescence is a critical developmental phase of life, a time during which children acquire the social skills they need to thrive as adults.

Just as critically, it is also the time in which their brains develop - or fail to develop - in a way that enables them to reach their full potential in life.

We already know that in the earliest years of childhood, children's brains form neural connections at a rate never to be repeated. This is the first window of opportunity to influence the development of children's brains through nutrition, stimulation and protection from violence and other harms.

But a growing body of scientific knowledge shows that experience and environment also combine with genetics to shape the brains of adolescents. This presents a second, crucially important window of opportunity to influence the development of children's brains - and thus, their futures.

In 2016, UNICEF hosted The Adolescent Brain: A second window of opportunity, a symposium that brought together experts in adolescent neuroscience to discuss this emerging science and how we can apply it to support all adolescents - but especially those already facing risks to their well-being, including poverty, deprivation, conflict and crisis.

The articles in this compendium elaborate on some of the ideas shared at the symposium. Together, they provide a broad view of the dynamic interactions among physical, sexual and brain development that take place during adolescence. They highlight some of the risks to optimal development - including toxic stress, which can interfere with the formation of brain connections, and other vulnerabilities unique to the onset of puberty and independence.

They also point to the opportunities for developing interventions that can build on earlier investments in child development - consolidating gains and even offsetting the effects of deficits and traumas experienced earlier in childhood. Evidence shows that practical approaches - including safe and secure environments, or the presence of a caring adult - can help counteract the effects of trauma and lay a better foundation for optimal development.

The symposium also highlighted the importance of greater collaboration between the scientific research community and development professionals to develop and implement policies and programmes that apply the new science - something we at UNICEF will explore more concretely with partners in the months and years ahead.
With 1.2 billion adolescents in the world today, all of us have a stake in helping them to reach their full potential. For today's independence-seeking adolescent is tomorrow's doctor. Tomorrow's teacher. Tomorrow's worker. Tomorrow's leader.

Their future is the future of our world.

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The Adolescent Brain: A second window of opportunity - A Compendium - World

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Analysis in English on World about Health and Protection and Human Rights; published on 31 Dec 2017 by UNICEF

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What Neuroscience Tells Us About the Teenage Brain

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What Neuroscience Tells Us About the Teenage Brain

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Developmental cognitive neuroscientists are at the frontier of this new outlook, using updated methodology, larger and more diverse samples, and experimental tasks with real-world relevance to answer questions about adolescents in the context of society. They're also supporting developmentally informed policy and practice on everything from mental health care to juvenile justice. "The adolescent brain was long portrayed as broken, immature, or contributing to problematic behaviors," said Eva Telzer, PhD, an associate professor of psychology and director of the Developmental Social Neuroscience Lab at the University of North Carolina, Chapel Hill. "But in the last five years, there's been a huge shift toward seeing the developing brain as malleable, flexible, and promoting many positive aspects of development in adolescence."

Heightened sensitivity to rewards, for example, which is partly driven by increased activity in a part of the brain called the ventral striatum, has been implicated in behaviors such as substance use and unprotected sex among teens. But research now shows that in different settings, that same neural circuitry can also promote positive peer influence and behaviors, Telzer said, such as wearing a seat belt or joining a peaceful protest.

As the field of developmental neuroscience matures, so too do the questions researchers ask. Studies are increasingly considering the influence not just of peers but also of parents. Researchers are also looking closely at how social media use may affect young brains, as concerns mount about teens' online activity. As a result, research on the teenage brain is finally starting to catch up with studies of other age groups, complete with the level of detail it deserves.

"The shift from childhood to adulthood is not a linear one. Adolescence is a time of wonderfully dynamic change in the brain," said BJ Casey, PhD, a professor of psychology who directs the Fundamentals of the Adolescent Brain Lab at Yale University. "Too often, we've superimposed an adult model onto a developing brain, but now we're starting to see more nuanced findings."

Embracing new approaches

Adolescence-spanning from puberty until the mid-20s-describes the transitional period between childhood and adulthood, according to the National Academies of Sciences, Engineering, and Medicine. During this period, the brain grows and changes in a number of ways. Gray matter in the cerebral cortex tends to thin, while white matter that connects various regions of the brain generally increases in volume. Functional connections between regions, which researchers measure with brain scans that track oxygen usage in blood, also undergo widespread changes during adolescence.

Beyond that, things get a little more complicated-and recent replication efforts indicate that some findings considered fundamental to the field may not hold up in larger samples. For example, early research suggested that brain volume increases peaked earlier in adolescent girls (Lenroot, R. K., & Giedd, J. N., Brain and Cognition, Vol. 72, No. 1, 2010), but more recent studies of large, international samples have shown it's not that simple. Instead, boys' brains tend to change at similar rates regardless of variability in other brain metrics, while changes in girls' brains can be predicted based on certain measurements, such as the thickness of the cortex (Mills, K. L., et al., NeuroImage, Vol. 242, 2021).

"This kind of finding is emblematic of a bigger shift in the field as to how we're approaching our science, what techniques we use, and what information we consider valuable," said Jennifer Pfeifer, PhD, a professor of psychology and director of the University of Oregon's Developmental Social Neuroscience Lab. "It's become clear that if we want to understand developmental processes within individuals, we need to use some different tactics."

More sophisticated methodology is a big part of that shift, she added. Instead of merely comparing brain structure or activity between two age groups (12- and 18-year-olds, for instance), researchers are increasingly relying on a variety of experimental approaches that follow the same youth over time.

"Many people may not realize that our early insights about adolescent brain development were based on cross-sectional approaches, which can sometimes lead to the wrong conclusions," said Pfeifer, who also codirects the National Scientific Council on Adolescence.

Now, researchers use other techniques, such as accelerated longitudinal designs, where participants are sampled a handful of times at a range of ages (starting at ages 12 to 15, for instance, and then annually for three years), which can paint a more comprehensive picture of neurodevelopment.

Large collaborative consortia, in particular the Adolescent Brain Cognitive Development (ABCD) Study, a decade-long effort that follows a nationally representative sample of nearly 12,000 teens, are also providing richer data that can power more rigorous studies of the developing brain. The ABCD Study shares its brain scans measuring neurological development, clinical tests of mental and physical health, and behavioral data on substance use, academic achievement, and more with researchers around the world; of about 250 papers published using the survey's data so far, half were from investigators outside the consortium. Fittingly, one of the study's early insights is that very large samples-with thousands of individual brain scans-are needed to detect reproducible differences between individuals at the whole-brain level (Marek, S., et al., Nature, Vol. 603, 2022).

"On the other hand, there is still a need for innovative, smaller-scale studies," said Eveline Crone, PhD, a professor of neurocognitive developmental psychology and director of the Society, Youth, and Neuroscience Connected (SYNC) Lab at Erasmus University Rotterdam in the Netherlands. "If we only ran the big consortia, we would miss out on a lot of novelty in terms of our methods and research questions."

Some questions-for instance, how adolescents' brains respond, on average, to winning money for themselves, a family member, or a stranger-can be examined effectively in much smaller samples, pointing to the importance of a balance between large and small efforts (Developmental Cognitive Neuroscience, Vol. 51, 2021). (Crone and her colleagues who conducted this research have found that teen brains show activation in the nucleus accumbens, part of the brain's reward system, when achieving gains for themselves or their parents but not for strangers. Those findings point to the development of ingroup-outgroup distinctions during adolescence.) Like others in the field, Crone employs a mixed-methods approach, combining brain imaging with behavioral measures, youth panels, and large-scale surveys to contextualize development alongside behavior, relationships, and society.

Another major advance is the creation and use of "ecologically valid" experimental tasks, or those that more accurately mimic teens' experiences outside the lab.

"If we really want to understand how the adolescent brain works, we need to use stimuli-things like social media and video games-that they actually care about," said Jennifer Silk, PhD, a professor of psychology at the University of Pittsburgh who runs the Families, Emotions, Neuroscience, and Development Lab.

Silk and her colleagues have developed one such activity, called the Chatroom Interact Task, which simulates acceptance and rejection from peers. Teenage girls participating in the task are either "chosen" or "rejected" by other girls their age while undergoing an fMRI scan, which maps brain activity by measuring changes in blood flow and oxygen levels. Other tasks monitor teens while they use platforms similar to Instagram and Facebook, including how their brains respond to receiving "likes."

Researchers are even collecting data that may redefine the meaning of "adolescence," with an eye on the juvenile justice system.

"We're expanding the age ranges we're looking at because the field is recognizing that significant neurocognitive changes continue into the 20s," said Casey. "Those changes have consequences with regard to decision-making," and research in this area may ultimately inform more scientifically aligned approaches to reward, punishment, justice reform, and other areas.

Optimizing mental health

Teens are famous for their heightened emotional sensitivity, especially in social interactions. Researchers are starting to pin down brain circuitry linked to that sensitivity-and differentiate between cases where it's an asset that helps teens reach emotional maturity versus a risk factor that may predict mental health problems (Casey, B. J., et al., Neuroscience Letters, Vol. 693, 2019).

Research by Silk, Telzer, Casey, and others has identified several areas of the brain that underlie emotional responses in teens, including the subgenual cingulate cortex, anterior insula, and amygdala. For example, teens who had more activity in those regions during the rejection phase of Silk's Chatroom Interact Task, compared with the acceptance phase, were more likely to experience depression and suicidality down the line (Journal of Clinical Child & Adolescent Psychology, online first publication, 2022; Child Psychiatry & Human Development, Vol. 51, 2020). "There seems to be some sensitivity to rejection in this brain network that's related to the development of internalizing disorders," Silk said.

Because mental health problems increase sharply during adolescence-affecting an estimated 1 in 4 teens-there's an urgent need to determine who is at risk and what treatments may be most effective (Silva, S. A., et al., PLOS ONE, Vol. 15, No. 4, 2020).

In animal models, stressful experiences during adolescence appear to alter the development of emotion-focused regions such as the amygdala and hippocampus, as well as the prefrontal cortex (Eiland, L., & Romeo, R. D., Neuroscience, Vol. 249, 2013). Early findings from the ABCD Study have found different patterns of activation in the amygdala, anterior cingulate cortex, and other reward-associated brain regions among preteens with disruptive behavior disorders, as well as brain differences that may underlie attention-deficit/hyperactivity disorder (ADHD) (Hawes, S. W., et al., The American Journal of Psychiatry, Vol. 178, No. 4, 2021; Bernanke, J., et al., The Lancet Psychiatry, Vol. 9, No. 3, 2022).

Rather than searching for a drug or mechanism that can address the entirety of depression, anxiety, or ADHD, researchers are increasingly studying specific symptoms-anhedonia or inattention, for instance-as well as subtypes of various disorders and seeking solutions for each.

"We are now looking at specific behaviors for which we can identify a neural circuit, mechanisms, and sometimes even genes," said Pradeep Bhide, PhD, a professor of developmental neuroscience and director of the Center for Brain Repair at the Florida State University College of Medicine. "That is a newer, better, and likely more successful approach to treating complex human psychiatric and developmental disorders."

For example, adolescents tend to benefit less from fear extinction efforts than adults (Pattwell, S. S., et al., PNAS, Vol. 109, No. 40, 2012). According to Casey, this suggests that they may respond poorly to exposure therapy, a key component of cognitive behavioral therapy (CBT) for anxiety, which recruits the prefrontal cortex to reprogram fear memories. It may therefore be possible to optimize CBT to work better for adolescents by using strategies that bypass the prefrontal cortex, instead working to alter memories using other circuitry, including emotion- and memory-focused regions such as the hippocampus and amygdala (Scientific Reports, Vol. 5, No. 8863, 2015; Nature Communications, Vol. 7, No. 11475, 2016). This process is often referred to as "memory reconsolidation" or "reconsolidation update."

"Thus, there appear to be developmental windows in which we can optimize treatments in specific ways," Casey said.

Parents and peers

When it comes to teens' relationships, both the scientific community and the lay public have long embraced the assumption that adolescence triggers a shift away from parents and toward peers, particularly when it comes to risk-taking.

New findings are challenging that assumption, which was pervasive but difficult to test directly, Pfeifer said (Nelson, E. E., et al., Psychological Medicine, Vol. 35, No. 2, 2005). Early data from Project NeuroTeen, Telzer's 5-year longitudinal study of how parent and peer relationships influence adolescent decision-making and development, show that teens shift their behavior to align with the risky choices of parents more than the risky choices of peers. This shift is supported by increased activation in regions of the brain related to reward, including the ventral striatum and ventromedial prefrontal cortex (Journal of Research on Adolescence, Vol. 31, No. 1, 2021).

Silk, Amanda Morris, PhD, of Oklahoma State University, and their colleagues have started to document the synchrony between teens and their parents in real time, using a new simultaneous scanning technique to measure how one brain responds to another during an interaction. They have found that adolescent brain activity tends to mirror parent brain activity, especially in emotion-processing regions such as the amygdala and anterior insula (Child Development, Vol. 92, No. 6, 2021).

"I think a lot of parents believe that it's too late, that by adolescence, peers have all the power," Silk said. "But this research is showing that parents shouldn't give up, that they still do have the power to help their adolescents learn how to process and regulate their emotions."

Pfeifer's lab also recently explored the claim that changes in the brain during adolescence make teens more sensitive to social information related to acceptance by peers, but their findings did not clearly support that idea. Instead, they found that activity in regions such as the ventromedial prefrontal cortex-a brain area related to evaluation of the self-tended to peak during mid-adolescence, especially for information related to status (Cosme, D., et al., Developmental Cognitive Neuroscience, Vol. 54, 2022). These findings may suggest that "identity is an important source of value to adolescents, and this could be leveraged to promote healthy decision-making," she said (Child Development Perspectives, Vol. 12, No. 3, 2018).

Peer interactions are still important, of course, and they're increasingly happening online. Parents, researchers, and policymakers have plenty of unanswered questions about how social media use may affect the developing brain. For example, do certain neural profiles among teens predict riskier online behavior, such as the tendency to compare one's appearance and social status to others?

Silk and Cecile Ladouceur, PhD, of the University of Pittsburgh, have launched new research to bring more nuance to that conversation. They are collecting information about social media use from teens' phones, along with fMRI data on their neurological responses to acceptance and rejection, for instance during the Chatroom Interact Task. Telzer has also launched a new effort, with Mitch Prinstein, PhD, APA's chief science officer, to study whether brain development in regions responsible for reward, emotion, and cognitive control relates to how frequently teens check their social media apps.

"Undoubtedly there's a link between teens' social experiences online and the way their brains respond to the environment, but it's something we're slowly working to unpack," Telzer said.

Challenging assumptions about teens

The malleability of the adolescent brain may make it vulnerable at times, but teen brains are also highly capable of prosocial growth under the right circumstances, Pfeifer said. Teens' biological need for social connection, combined with their heightened sensitivity to rewards, likely underlies teen-led activism, for instance on climate change, racial justice, and gun control.

Research by Crone and others shows that the ventral striatum is linked to prosocial behavior, responding to rewards not just for oneself but also for others (Nature Communications, Vol. 12, No. 313, 2021). Among teens serving time in youth detention centers, both the ability to spontaneously take the perspective of others and activity in the temporoparietal junction-an associated region of the brain-differed significantly from a control group. The temporoparietal junction is more malleable by environmental influence than other social brain regions, according to studies by Crone among twin populations. This suggests that interventions in perspective-taking, which target this area, may be helpful for justice-involved teens (Social Cognitive and Affective Neuroscience, Vol. 9, No. 12, 2014).

Based on ongoing research by Casey and others about the trajectory of development in regions related to cognitive control, including the prefrontal cortex, APA has launched a task force to review new findings that may inform extending Roper v. Simmons, a Supreme Court decision that abolished the use of the death penalty for those under 18, to cover individuals into their early 20s.

Looking forward, researchers in the field emphasize the importance of continuing to challenge assumptions about adolescence-around risk-taking, emotionality, and more-to ensure that the science remains robust and can ultimately support interventions for healthy development.

"We're not going to change adolescents' brains, nor should we want to," Telzer said. "What we can do is optimize what we know to create social contexts and environments that provide the most enriching experiences for them."

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What neuroscience tells us about the teenage brain

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New research now turns an old assumption on its head, as psychologists seek to optimize social contexts and environments for developing minds.

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Introduction to Trauma-Informed Practice - Centre for Addiction and Mental Health

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Introduction to Trauma-Informed Practice - Centre for Addiction and Mental Health

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An introduction to trauma informed practice

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Presenter: Jenn Corbiell, Family Counsellor, Alberta Health Services
Date: July 23rd, 2019