"Connect now, or Correct later": four points on early brain development
At a charity event I once introduced myself to someone as an executive recruiter and she to me as a child psychiatrist, with the fabulous comment: "I see the children of the people you see” ! She explained that many loving, well-intended, successful parents fail to provide sufficient attuned and sensitive attention to their infants - many of whom later struggle to correct the far-reaching effects of that lack of connection.
During a decade as an executive recruiter with a global firm, I had the privilege of observing a sliver of human nature across several cultures. Solving searches requires careful analysis of the tip of the iceberg, i.e. executives’ career trajectories and most recent professional experiences. Curiosity sometimes led me to dive into their diverse upbringings, in an effort to identify common traits that might have contributed to their becoming impactful leaders in their fields. Asking what hopes and expectations their families, teachers and communities had of them while they were growing up, I looked for hints at what gives some people a turbo that propels them confidently forward in life, while others are saddled with hand-breaks that hold them back (an earlier post on this topic is linked here).
Mindsets and values are undoubtedly in great part shaped by education, a key driver of growth and potential in both individuals and nations. We have all seen how certain countries’ economies have benefited from deliberately building competent and confident young generations through quality schooling, while others still struggle to dedicate appropriate attention and resources to education, with catastrophic consequences. But we only need to look at the divergence of behavior and development in infants and pre-schoolers to see that differences exist even before education kicks in. What makes some toddlers explore creatively, rather than fear the unknown? What makes them see obstacles optimistically as challenges to be surmounted rather than as roadblocks they cannot face? What makes some connect confidently with others, and not with fear or aggression? These questions have to do with how we feel, and the organ with which we feel is our brain - before it even becomes the organ with which we think. So getting to the heart of the question requires a step further back in time to brain formation at the beginning of life - in whose mysterious waters one never ventures as a recruiter: it is as an amateur anthropologist and interested parent that I dove into early brain development.
The last two decades’ advances in non-intrusive brain imagery have given neuroscientists and psychiatrists powerful tools to visualize the brain in action. They are building evidence that the pre-cognitive development in the first three years of life significantly determines a person’s health, resilience, and potential. This understanding is slow to disseminate to the rest of us. As a result, the choices we make as individuals and as a society in how we care for infants remain sometimes at odds with what science would advise. In writing this summary of the current state of research my goal is to join the efforts of the professors and doctors whose work aims to demonstrate to parents, caretakers, and policy-makers why we, as a society, need to continue to be so very attentive to the relationships we forge with infants, the budding next generation, and encourage us to invest more in them.
Point 1: The human brain grows from 25% of its adult weight at birth to 90% by age three
While practically all of our 86 billion neurons are present at birth, almost all of the axons, dendrites and synapses (the “circuitry”) are built in the first 1,000 days. Our most important organ’s functional competence is almost entirely built after birth! There is a sociological theory as to why primate brains are so unformed at the outset of life: ”Being born earlier is better if you’re a cultural animal” wrote Adolf Portman, a Swiss zoologist. Indeed, sitting at the top of the food chain by the strength of our clans’ collective ingenuity rather than our individual physical force, we humans are each other’s only salvation as well as our fiercest predators: connecting with each other is our number one survival strategy. According to this theory, our brains need to be customized to the environment we will encounter.
Point 2: The brain grows in phases of blossoming and pruning, keeping the circuits that are used.
Imagine watching a fast-forward animation of a forest growing over decades, tree trunks lengthening, branches extending and breaking, leaves growing and falling, the whole dynamic resulting in sunlit canopies across which monkeys run, swing, and jump. The brain similarly forms in an iterative ‘blossom and prune’ process. From our existing neurons, dendrites and synapses first extend in many directions and are then left to connect and compete for nutrients. The connections that “fire together, wire together”, and in becoming part of a system they are better fed. Those that are less used are starved to make room for the next growth spurt. This results in custom-developing the most efficient brain to handle our environments. The brain is expensive in terms of energy needs (60% of newborns’ metabolism, 25% of adults’), so we must either “use it or lose it.” That the brain develops in a use-dependent way isn’t widely known nor universally accepted. It negates the more common misconception that “it’s all in the genes”. Science demonstrates that in the “nature versus nurture” debate, both a genetic blueprint and experience play a concurrent, determinant role - especially in the first months of life.
Point 3: The neural circuitry is shaped by the constant stream of direct exchanges between infant and caregivers
The brain matures in the context of attachment relationships. In other words, the brain is a social organ which pairs up with and tunes into more mature brains to develop. The caregivers’ brains serve as emotional models to the baby, which show it how to cope with the world, what to focus attention to, whether to fear or trust, how to calm down. Infants are not “sponges” that passively absorb all input and react to all external stimuli, as is commonly thought. For better or for worse, they are more selective and more demanding than that: they are active learners, “sonars” that are programmed to constantly trigger their caregivers for a reaction, register outcomes, and etch them into their neural networks. It is through this iterative “serve and return” dynamic that brain circuitry is established, some pathways strengthened and others atrophied. The key ingredient is a live, responding human brain to be in continuous interaction with.
Point 4: The quality of interactions between infant and caregivers is critical: care has to be attuned and responsive to the child’s needs, in order to optimize brain circuitry and minimize toxic stress.
As if constant personal presence wasn’t hard enough! For healthy brain development caregivers are attuned to properly hear and respond to the infants’ needs. This comes naturally to most parents, and requires both self-awareness, to make the difference between a baby’s needs and one’s own; and empathy, to properly assess and appropriately prioritize the baby’s needs. The way a caregiver responds time after time determines the type of attachment the infant develops with them: if its needs are consistently heard and met, the infant is likely to continue to turn to that caregiver for nurturance, comfort and stimulation. It is said to have a “secure” attachment. Studies estimate that two thirds of infants have secure attachments. The rest do not feel this sense of security and comfort with their caregivers, and are said to develop forms of attachment that are “avoidant”, “anxious” or “disorganized”. These result in high daily levels of stress as they cope with the world without having someone they can reliably turn to for comfort. Such stress experienced over sustained periods of time negatively affects brain circuitry. Many of these infants exhibit concerning behaviors in childhood, (chronic anxiety, aggression, attention deficit, self-harming or compulsive self-soothing habits) and may later be diagnosed as having mental health disorders in childhood, adolescence and adulthood (depression, borderline personality, bipolar, eating disorders, etc.) This idea that psychiatric disorders are frequently the outcome of early relational trauma’s impact on brain’s circuitry is still fighting for broad acceptance. Despite compelling emerging evidence in the scientific and academic community, the dominant hypothesis in the broader population remains that of genetically determined chemical imbalances or neural deficiencies.
Conclusion: When ‘Connect Now’ goes wrong, ‘Correct Later’ remains a difficult and imperfect option
Children, who can be our greatest assets, can instead become our greatest liabilities. John Bowlby, the British pioneer of attachment theory, wrote: “Engaging in parenthood is playing for high stakes”. David Winnicott, another eminent British pediatrician and psychiatrist had written that in cases of the babies’ environment not adapting appropriately while they are utterly dependent, "they come through in life needing to spend their time and energy building a fortress around themselves to keep away an enemy that truly dwells within the fortress walls.”
I am reminded of a poignant lunch conversation with a non-profit executive in London a couple of years ago. His parents had fostered children in England through most of their life. They had been dealt very difficult cases, including refugee children who had crossed the world in traumatic conditions, as well as British kids severely neglected or abused by addict parents who had also been exposed to traumatic experiences. When I asked him how these children had turned out, he said that the refugee children generally ended up doing far better. He explained: “The difference is that someone had nurtured and believed in them at the start. No matter what they endured afterwards, it kept them going.”
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The situation in the US is concerning. The Adverse Childhood Experiences (ACE) studies since the 1980ies show a high prevalence of traumatic experience in youth, as well as a strong correlation between maltreatment in childhood and serious health issues in adults (cancer, heart disease, obesity, depression). More alarmingly, a 2013 World Health Organization report shows that the rate of death from maltreatment of children in the US is over seven times that of its OECD peers (except Mexico). What do we do about this? Three policies seem critical:
1- Access to family planning services: a woman who wishes to have two children will spend five years of her life trying to conceive, being pregnant, and recovering from childbirth... and another thirty trying to avoid pregnancy! Restricted access to family planning in the US means that over half humans born are unintended, and many unwanted. In many States this rate is similar to developing countries'. The starting point in engaging in the high stakes endeavor of parenting is to have children when we are ready to have them.
2 - Paid parental leave: the US is the only country in the OECD that gives no paid maternity leave except in three States (California, Rhode Island and New Jersey). Newborns need to bond with parents, and denying them both this opportunity is a serious obstacle to the healthy development of the next generation.
3 - Quality daycare infrastructure: Early Child Development is the lowest paying College degree in the US, according to a recent Forbes study. Daycares are scarce and only 10% are deemed of sufficient quality.
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The above notes summarize lectures, talks and readings by several medical doctors and academics. The below stood out:
Pr. David J Anderson, professor at CalTech, focuses on the neurobiology of emotion (January 2013 TEDxCalTech Talk)
Dr. Anne Fernald, Stanford biology professor, focuses on the early development of communication and language (August 2014 TEDxMonterey talk)
Dr Alison Gopnik, professor of psychology and affiliate professor of philosophy at Berkeley. She is known for her work in the areas of cognitive and language development
Dr. Daniel Hughes, founder of Dyadic Developmental Psychotherapy, focuses on attachment disorders in foster children - but applicable to all children
Dr Bessel van der Kolk - Boston-based Dutch psychiatrist and author, has focused on the effects of developmental trauma
Pr. Patricia Kuhl, Co-Director of the University of Washington’s Institute for Learning & Brain Sciences
Dr. Chaya Kulkarni - Director of Infant Mental Health Promotion (IMHP) at The Hospital for Sick Children in Toronto
Dr Gabor Mate, Canadian physician focuses on developmental psychology and addictions. My favorite talk of his links very compellingly childhood trauma with adult addictions.
Pr James J McKenna, anthropologist and Professor at Notre Dame, expert in sleep, SIDS, breastfeeding.
Dr Bruce D. Perry, psychiatrist, clinician and researcher in children's mental health, Senior Fellow of the Child Trauma Academy in Texas, Adjunct Professor of Psychiatry and Behavioral Sciences at the School of Medicine in Chicago.
Dr Terrie Rose, psychologist, entrepreneur and Ashoka fellow, founder of Baby’s Space (TEDxTC talk, January 2011)
Dr Jack P. Schonkoff - Professor of Child Health and Development at Harvard; Professor of Pediatrics at Harvard Medical School and Boston Children’s Hospital; and Director of the Center on the Developing Child at Harvard University.
Pr Allan Schore, neuropsychologist and researcher, UCLA School of Medicine, and UCLA Center for Culture, Brain, and Development
Pr. Daniel J. Siegel, clinical professor of psychiatry at UCLA School of Medicine, and UCLA Center for Culture, Brain, and Development
Pr J Alan Sroufe, Professor Emeritus at the University of Wisconsin, focuses on socio-emotional development and developmental psychopathology
Dr Jill Stamm - cofounder of New Directions Institute for Infant Brain Development (NDI) in Arizona’s Children Association family of agencies, and associate clinical professor at Arizona State’s Department of Psychology in Education
Pr Joan Stiles - Professor Emeritus of Cognitive Science at the University of California, San Diego