Integrating Early Childhood
Social Emotional Development
into Early Childhood Systems
Deborah F. Perry, PhD
Georgetown University
Center for Child & Human Development
August 2010
Overview
Define early childhood social emotional
development
Explore the role of early brain
development on trajectories of
development
Describe policy implications for Part C
systems
The Context
Young children are:
– Being kicked out of child care settings
– Showing the impacts of maternal depression
– Dealing with multiple family risks (parental
substance abuse, domestic violence and
mental illness)
School Readiness Skills
Estimated Prevalence
No national epidemiological data
Early Childhood Longitudinal Study: 10%
of all kindergarten children show
problematic behavior
Rates are two to three times as high in
low-income samples
Clinical level problems are lower (4-10%)
Social Emotional Development
Inter-relatedness of
domains
Intimately tied to
caregivers’ mental
health
Core tasks:
– Attachment
– Behavior
– Competence
Neurons to Neighborhoods
…virtually every aspect of early human
development, from the brain’s evolving
circuitry to the child’s capacity for
empathy is affected by the
environments and experiences that are
encountered in a cumulative fashion,
beginning in the prenatal period and
extending throughout
the early childhood years.”
Shonkoff and Phillips, 2000
Role of Early Experience
Connections between neurons are
strengthened through repeated
exposure/use
Connections that are not used often are
pruned away
Environmental influences shape the
architecture of the brain
Quality and Quantity of
Experiences
Frequent, regular, predictable
Occur in the context of warm, supportive
relationships
Are associated with positive emotions
Involve several senses
Are responsive to the child’s interests or
initiative
Early Childhood Resource Center, RTI
Early Childhood Mental Health
The social, emotional and
behavioral well-being of
young children and their
families
The developing capacity
to experience, regulate,
express emotion
Form close, secure
relationships
Explore the environment
and learn
Adapted from ZERO TO THREE
Experience and Regulate Emotions
INFANT Behaviors:
 Smiling
 Cooing and Babbling
 Fussing when hungry or tired
 Kicking legs when excited
 Quieting when held by a familiar adult
TODDLER Behaviors:
 Laughing
 Goes to familiar adult for comforting
 Able to move from one activity to the next
 Growing ability to focus
 Calms with help from a familiar caregiver
Form Secure Relationships
INFANT Behaviors:
 Smile at and back to a familiar caregiver
 Anticipates being held
 Likes to look at and be near familiar caregiver
 Shows preference for parent or caregivers face and voice
 Stretches arms up to be held
TODDLER Behaviors:
 Explores but checks in with familiar caregiver
 Shows affection for familiar caregivers
 Responds to his/her name
 Makes needs known to a familiar caregiver
Explore and Learn
INFANT Behaviors:
 Reaches for and grasps things
 Enjoys simple games like peek-a-boo
 Imitates others actions
 Smiles or plays with self in the mirror
TODDLER Behaviors:
 Keeps looking for a toy
 Tries new things
 Shows interest in other people
 Imitates others actions
Goodness of Fit
Extent to
which the
temperament
of the child is
compatible
with the
environment,
expectations
and demands
Adversity in Early Childhood Can Have
Long-Lasting Consequences
Adverse Childhood Experiences Study (ACES)
has documented the long term effects of earlier
exposure to significant stressors
Explains the link between early childhood brain
development and long term health and mental
health outcomes
Adverse Childhood Experiences Are Common
Household dysfunction:
Substance abuse
Parental sep/divorce
Mental illness
Battered mother
Criminal behavior
27%
23%
17%
13%
6%
Abuse:
Psychological
Physical
Sexual
11%
28%
21%
Neglect:
Emotional
Physical
15%
10%
Adverse Childhood Events
and Adult Depression
5
Odds Ratio
4.5
4
3.5
0
1
2
3
4
5+
3
2.5
2
1.5
1
0.5
0
Adverse Events
Chapman et al, 2004
Adverse Childhood Events
and Adult Substance Abuse
0
1
2
3
4+
0
2
3
4
5+
40
16
%
1
14
%
35
12
30
10
25
8
20
6
15
4
10
2
5
0
0
Self-Report: Alcoholism
Dube et al, 2002
Self-Report: Illicit Drug Use
Dube et al, 2005
Adverse Childhood Events and
Adult Ischemic Heart Disease
3.5
Odds Ratio
3
0
1
2
3
4
5,6
7,8
2.5
2
1.5
1
0.5
0
Adverse Events
Dong et al, 2004
Levels of Stress
Positive Stress: normative, helps in
development
Tolerable Stress: outside the normal
range, one time events, buffered by
caregivers
Toxic Stress: prolonged activation of the
stress response system, in absence of
buffering adult
Harvard Center for the Developing Child
Emotional
Stimulus
HPA Pathway Control
Amygdala
Hippocampus
Hypothalamus
PVN
Cortisol
Cortisol
CRH
PIT
ACTH
Adrenal
Cortex
Charles Zeanah PPT
LeDoux, Synaptic Self
Interaction of the Brain and
Immune System
CRF
Hypothalamus
CRH
Adrenal
Gland
ACTH
Immune
Cells
Locus
Ceruleus
Pituitary
Gland
Sympathetic
Nervous system
Immune
Organs
Impact of Stress on
Development
How depression affects
development
Specific aspects of parenting behavior:
–
–
–
–
–
–
–
Maternal responsivity
Maternal sensitivity
Emotional availability
Negative mood (intrusive/hostile)
Inconsistency in discipline
Modeling negative affect
Inability to assist with emotional regulation
Consequences of Maternal
Depression
Mothers’ well-being
– Decreased Maternal Self-Efficacy
Fathers’ well-being
– Increased depression & marital stress
– Increased concern of infants
Infant development
– Emotion dysregulation
– Cognitive and language delays
– Increased risk for psychopathology
Mother-infant interaction
– Mothers: understimulating or overstimulating
– Infants: Less responsive, more gaze avoidant, more
distress
Field, 1997; Milgrom & McCloud, 1996; O’Hara, 1994
Challenges & Opportunities
Address the mental
health needs of young
children and their
caregivers in context
of their network of
services and supports
Integrate the best
available science on
what works for
preventing and
treating mental health
needs of young
children and their
families
Challenges to Integration of ECMH
into EC Systems-Building
Need to address complex, multi-factorial
problems that evolve over time and across
settings
– Focus on caregivers (parents and child care
providers)
Lack of fit between increasing specialization &
real needs of young children & their caregivers
Requires integration & adaptation of evidencebased practices (EBP)
An Early Childhood
Systems’ Framework
Developed by Roxane Kaufmann, GUCCHD; design by: Lucia Foley, Hampshire Educational Collaborative
System of Care Values/Principles
Infused Into Natural Settings and Services
– Stand-alone early childhood mental health
systems won’t work
Grounded in Developmental Knowledge
– Lifespan approach, different approaches
needed for infants, toddlers, preschoolers
Risk & Resilience
– Building family and community assets
Need for Focus on RelationshipBased Strategies
Dyadic interventions
Two-generation models
Family systems framework
Relationships between MH and other
service systems
Relationships with stakeholders in
systems building
Best Scientific Evidence
Growing number of evidence-based
prevention and treatment models
– Developed through rigorous scientific
experiments
– Need for adaptation for local context, but with
eye to fidelity
– Difficulties in bringing these to scale
How to value “practice-based evidence”
and “family wisdom”
Pyramid Model
Promotion
Developmental and social-emotional screening
in primary care and early care and education
programs
High quality training on social-emotional
development for Part C providers and child
care community
Dissemination of information promoting
healthy social-emotional development
Prevention
Screening for caregiver depression
Mental health consultation in child care
and integration of MH into Part C systems
Social skills curricula (i.e., Second Step)
Intervention
Positive Behavioral Support
Intensive mental health consultation in homes
and child care settings to support children with
IFSPs
Relationship-based therapy (e.g., PCIT)
In-home treatment for children with mental
health diagnoses and depressed caregivers
Moving Forward
Consider how current eligibility criteria and
procedures for Part C reflect the fundamentals of
early childhood social-emotional development
Broaden networks of providers who are
screening families (caregivers and children) for
social-emotional risks
Establish cross-sector competencies for all
providers working with young children and
families
Support integration of mental health consultants
in Part C systems