dvances in the basic sciences of development are
forcing a paradigm shift in our understanding of the early childhood
origins of lifelong health and prosperity (versus disease and poverty). E
arly social and environmental experiences (the ecology) and the genetic predispositions (the biology) influence the development of adaptive behaviors, learning capacities, lifelong physical and mental health, and future economic productivity. The new integrated approach is referred to as the ecobiodevelopmental framework.
Life-course studies, like the Adverse Childhood Experiences (or ACE) Study and others, have demonstrated strong associations between various forms of early childhood adversity (e.g., abuse, neglect, parental mental illness or substance abuse) and a wide array of less than optimal adult outcomes in health (obesity, hypertension, diabetes, cancer), mental health (depression, suicide, substance abuse), and prosperity (financial woes or difficulties at work). Despite these well-established associations between the early childhood ecology and lifelong developmental trajectories, the biology underlying these associations remained unclear – until recently (See below).
AAP Policy Statement on Toxic Stress
The burgeoning field of epigenetics suggests that clues from the ecology – the physical, social, and emotional milieu – literally alter the way the inherited genetic blueprint is read. The term epigenetics refers to those mechanisms that change gene expression without altering the DNA sequence. We now know that many epigenetic mechanisms (like DNA methylation and histone deacetylation) are activated by the physiologic mediators of the stress response (like cortisol and adrenaline). In this way, the early childhood ecology is biologically embedded – altering the way the blueprint is utilized in this generation as well as the next.
After NIH designated the 1990’s as the “Decade of the Brain,” advances in neuroscience revealed the critical role that experiences (and the neural activity generated by experience) play both in determining how the brain wires itself during development (the foundational architecture) and in how it re-wires itself in response to changes in the environment (plasticity). Rudimentary neuronal pathways lay the foundation for more complex circuits, just like rudimentary developmental skills pave the way for more sophisticated skills. Because the brain’s overall cellular plasticity declines with age, it is essential that early childhood experiences lay a sturdy foundation for a lifetime of learning, healthy behaviors, and wellness. The figure below is from the AAP Technical Report on Toxic Stress.
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policy statement discusses how pediatricians are ideally positioned to
inform science-based policies and programs that prevent or mitigate the
damage associated with such health-threatening adversities as poverty,
maltreatment, parental depression, and exposure to violence.
AAP Technical Report on Toxic Stress
technical report proposes an instructive framework that helps us
understand how the biological consequences of psychosocial adversity are
no less real than the damaging physical effects of poor nutrition or
exposure to lead. AAP News Article:
A New Science of Early Childhood Reveals Urgency of Protecting
Developing Brains: This article provides background information on the
AAP policy statement and technical report on toxic stress.
AAP Clinical Report on Psychological Maltreatment
clinical report supports the need for pediatricians to be alert to the
occurrence of psychological maltreatment and identifies ways to support
families who have risk indicators for, or evidence of, this problem.
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