HS 1111 post midterm

Who wrote “Adversity in childhood is linked to mental and physical health throughout life”

Nelson et. al

Who wrote “Epidemiology, genes and the environment: lessons learned from the Helsinki Birth Cohort Study”

Eriksson

Understanding the ACE’s video

Dr. Nadine Burke Harris

Sensitive Windows

These are periods in early life where an organism’s nervous system has increased sensitivity to certain environmental stimuli, where such stimuli assists in the development of certain abilities, traits, and functions

Critical Windows

Critical windows are period of development when certain environmental stimuli or inputs are crucial for normal development of abilities, traits, and functions

Developmental periods for children

prenatal period, infant attachment, early childhood, mid-childhood, puberty, adolescence

prenatal period

maternal stress or exposure to trauma

Infant attachment (0-2 years)

attachment between infants and primary caregivers

early childhood (2-6 years)

• development of emotional regulation and social skills

• importance of imaginary play

mid-childhood (6-12 years)

cognitive development, and formation of self-identity

Puberty (varies around 10-14 years)

development of secondary sex characteristics

adolescence (12-18 years)

development of autonomy and identity

Nelson et al: “Growing evidence indicates that in the first ___ years of life, a host of ____ (e.g. malnutrition, infectious disease) and ____ (e.g., maltreatment, witnessing violence, extreme poverty) _____ can affect a child’s developmental trajectory and lead to increased risk of adverse _____ and psychological health conditions”

three, biological, psychological, hazards, physical

Toxic stressors

adverse/traumatic experiences refer to adverse events that happen to a person

toxic stress response

the prolonged activation of our bodies stress response

Adverse childhood experiences (ACEs) Felitti, study objective

examine the relationship between adverse childhood experiences and health risk behaviours and disease adulthood

ACE Felitti study methods:

• a questionnaire about adverse childhood experiences was mailed to 13,494 adults

• questionnaire asked about 7 categories of ACEs

• compared the number of ACEs to measures of adult risk behaviour, health status, and disease

What are adverse childhood experiences (ACEs)

highly stressful and potentially traumatic events or situations that occur during childhood

ACEs can range from relatively commonplace or horrific events

acute or complex

What kind of experiences are adverse?

• maltreatment

• violence & coercion

• adjustment

• prejudice

• household or family adversity

• inhuman treatment

• adult responsibilities 

• bereavement & survivorship

The original ACEs study by Felitti et al (1998) had the following findings:

• ACEs are common

• ACEs often occur together

• ACEs are risk factors for various health issues and diseases throughout the lifespan

ACEs are common: top 5

physical abuse, substance abuse, parental separation/divorce, sexual abuse, mental illness

One meta-analysis (Madigan et al 2023) that surveyed total of 206 studies published between January 1st, 1998 and August 5 2021, from 22 countries with a a total of over half a million adult participants, found that:

overall average:

0 ACE- 40%

1 ACE- 22%

2 ACE- 13%

3 ACE- 9%

4 ACE-16%

Every demographic group experiences ACEs, but vulnerable communities are at a _____ risk of having higher ACE scores

higher

ACE score

the number of ACEs a person has experience; 5 levels

In the original study results, almost ___ of the original sample reported two or more ACEs and ____ experienced four or more

40%, 12.5%

There is a direct ___-____ _____ between ACEs and some of the health-related impacts of ACE exposure (Burke Harris 2022)

dose-response relationship

dose-response relationship

a relationship where increased levels of exposure are associated with either an increasing or decreasing risk of a defined outcome

The impacts of ACEs

___ times more likely to binge drink and have a poor diet

___times more likely to be a current smoker

____times more likely to have low levels of mental wellbeing & life satisfaction

____times more likely to have had underage sex

____times more likely to have an unplanned teenage pregnancy

___times more likely to have been involved in violence

____times more likely to have used illicit drugs

____times more likely to have been incarcerated

2, 3, 4, 5, 6, 7, 11, 11

Impact of ACEs from preconception to death

• historical trauma/ intergenerational adversity

• adverse childhood experience

• social, emotional & cognitive functioning

• health risks & behaviours

• disease disability, & social problems

• early death

Neurodevelopment & epigenetic influences…

impact of ACEs

Health risks and behaviours as adaptations: “… behaviours such as smoking, alcohol or drug abuse, overeating, or sexual behaviours that may be consciously or unconsciously used because they have ____ _____ or psychological benefit as ____ devices in the face of the stress of abuse, domestic violence, or other forms of family and household dysfunction

immediate pharmacological, coping

What is our bodies stress response?

• stress activates the ___

• When the brain perceives a threat, the ____ releases corticotropin- releasing hormone (CRH), which signals the ____ _____ to produce adrenocorticotropic hormone (ACTH). This is sent to the ___ ____, which prompts the release of cortisol

• Cortisol keeps the body’s _____ nervous system (flight or fight) response engaged

• When threats subside, cortisol levels drop, and our ______ nervous system works to calm the body and restore balance

hypothalamic-pituitary-adrenal (HPA) axis

hypothalamus, adrenal glands

sympathetic

parasympathetic

In children a toxic stress can occur when a child experiences strong, frequent, and/or prolonged _____(Nelson et al 2020)

adversity

Prolonged activation of stress response systems like the HPA Axis can disrupt the development of brain ______, other organ systems, and increase risk of related disease and/or lead to cognitive _____

architecture, impairement

epigenetic definition

refers to the study of and mechanisms involved in heritable changes involved in heritable changes in gene expression that do not involve alterations to the underlying DNA sequence

• epigenetic changes involve chemical modifications to DNA and associated proteins, such as _____, that act like “tags” or “marks” the influence gene regulation

• epigenetic changes can be ____: the modifications in gene expression can be passed onto offspring, which impacts subsequent generations

histones, heritable

Epigenetic ____serve important functions regarding gene regulation, cell identity, environment response, and more

changes

Genetic influences

nature, stability, immutable

Epigenetic influences

nurture, dynamic, reversible

immutable

DNA sequence changes are typically permanent

reversible 

many epigenetic changes can be reversible

Fetal programming hypothesis

the theory that environmental cues experienced during fetal development in utero plays a seminal role in determining health trajectories across the lifespan

Three forms this kind of development can take:

• Change in development that leads to greater disease risk

• genetic changes that alter disease risk

• epigenetic changes that alter disease risk not only for the child, but also for the next generation

developmental stage: preconception health

Factor/influence:

poor nutrition, obesity, stress, drug/medication use 

development stage: maternal/paternal health

Factor/influence:

impaired nutrient sensing/transfer, impaired hormonal function

developmental stage: infancy

factor/influence:

size at birth

developmental stage: childhood

factor/ influence:

growth impairment, catch-up growth

development stage: childhood

factor/influence: 

growth impairment, catch-up growth

developmental stage: adult

Factor/influence:

body composition, cardiovascular disease, type 2 diabetes

Is it just the mother’s health and maternal context that matters?

no

• Epigenetic changes in a father’s ____ cells can also be inherited

• One researcher at McGill University, Dr. Bernard Robaire, has spent his career studying male ____

• Dr. Robaire an early developer of the field of _______, which studies sperm quality and the health effects that may be transmitted by fathers to their offspring through DNA mutations or epigenetic modifications

germine

reproduction

male-mediated developmental toxicity

parental environment, to alterations in then paternal germline epigenome, to preservation epigenetic changes equals

epigenetic transmission

Dutch Hunger Winter

• In 1944-1945, Germany blockaded the Netherlands, leading to a lack of food supplies

• This caused the Dutch famine of 1944-1945, affecting millions

• This caused severe malnutrition among the population, including women who were pregnant

• Unintended experiment that allowed for the study of the long-term effects of prenatal malnutrition

Results:

• higher risk of chronic diseases among famine-exposed individuals

• some second-generation descendants showed increased risk of cardiovascular disease as well

Helsinki Birth Cohort:

• Two birth cohort of children born between 1924-1933 and 1934-1944

• Some studies, including Eriikkson’s research, evaluated the relationship between growth in early childhood and later ___ ____

health outcomes

Results of the Helsinki Birth Cohort (Erickson)

• increased risk for cardiovascular disease

• including coronary heart disease, due to small body size at birth plus nonoptimal growth during infancy and an approximate average body mass index (BMI) during childhood

Female intergenerational

parent to grandchild

female transgenerational

parent to great-grandchild

intergenerational male

parent to child

transgenerational male

parent to grandchild

Dutch Famine impacts 3 generations, "'Violent experiences alter the genome in ways that persist for generations”

a first of its kind study shows that experiencing violence and trauma leaves a heritable imprint on the human genome

Social and Political problems: Most people wish for a world that is safe and conductive to the healthy development of children

What do we have to do to create such a world?

What protects against adversity and toxic stress response?

Dr. Nadine Burke Harris: regulate stress response through things like… mindfulness, spending time in nature, mental health interventions, nutrition, healthy relationships

Wolcott (2022): Research suggests that most healthcare providers and medical educators are _____ from the trauma of COVID-19

depleted

During the the height of the pandemic, when asked how he was doing, Walcott used the analogy of a gas tank. Is it full or empty?

empty

Why did healthcare providers and medical educators feel depleted?

Wolcott: “An area of respite may be an emphasis on our mindset” (2022, 477)

“research in non-healthcare contexts suggests that supporting a growth mindset can be deeply impactful on individual optimism, well-being and ____” (Wolcott)

resiliency

A caution about mindset:

mindsets may not be resistant to all adversity

We need to disrupt the expectation that responsibility of well-being rests ______ with the individual

exclusively

“It is paramount to understand our mindset, well-being and resilience are largely a product of our _____ and experiences, including those that may be forced upon us” (Wolcott 2022)

contexts

The Renaissance and Prior

Can attributes be learned?

The Renaissance

humans are the only species with the ability to transform ourselves

• previous views held that talent and ability were fixed and ability were fixed and predetermined

History of mindset Research

The Renaissance and Prior, Behaviourism vs. Cognitive Psychology, Current Research

Behaviourism

behaviour is a consequence of environmental stimuli

cognitivism

internal cognitive processes and systems are essential for explanations of behaviour and the processing of environmental stimuli

Current Research: Dweck and Yeager”s research

• Dweck’s work on mindsets as evolving from earlier work on learned helplessness, attribution theory, positive psychology, etc.

• Yeager’s work on implementing mindset research

Research on mindsets is one area of…

positive psychology

“The aim of Positive Psychology is to catalyze a change in psychology from a preoccupation only with repairing the worst things in life to also building the best qualities in life.”

As this quote indicates, it is the scientific study of conditions and process that contribute to positive psychological states, well-being, positive relationships, and positive institutions

____ _____ is a behaviour exhibited by a subject after experience adverse stimuli out of their control

learned helplessness

Research by American psychological _____ _____ in the late 1960s- early 1970s

Martin Seligman

A sense of control _____ be learned. It can also be _____, especially through prolonged exposure to adversity (Maier and Seligman 2016)

can, unlearned

_______ ______ suggests that people try to find explanations for what happens to themselves (and others), and that the explanations they develop go on to then shape their reactions to stimuli (Dweck and Yaeger 2020, 482-483)

attribution theory

Internal. External

Stable

Unstable

Ability Task difficulty

Motivation luck

____ research has shown that the attributions people make to their successes or setbacks can predict their responses to future success/setbacks 

Dweck’s

Question: Why would students of roughly equal ____ show such different attributions and reactions to a challenge?

ability

• How the goals of performance are framed- whether they reflect a fixed or growth mindset- also shape reactions to future performance

_______ are sets of beliefs, attitudes, perspectives, and inclinations. They are states of mind that influence how people think and act

Mindsets (as meaning system)

Growth mindset

the belief that human capacities are not fixed but can be developed over time

Fixed minset

the belief that human capacities are fixed, innate and cannot be learned or developed 

Impact of mindsets on meaning:

“when people view ability as ____, then validating their ability… can take on more importance, high effort may more readily be seen as indicating low ability, and setbacks are more easily attributed to low ability… in contrast, when people view ability as something that can be improved, then developing that ability… can become more important, ____ may be seen as a tool in this process, and setbacks can be more readily be seen as information about the learning process (Dweck and Yeager 2019)

fixed, efforts

Fixed minsets

“Either I’m naturally good at something or I’m not”

“I can either do something, or I can’t”

“Failure is the limit of my abilities”

“My abilities are fixed and unchanging”

“My potential is predetermined”

“Feedback and criticism is personal”

“I’ll stick to what I know”

“I’m afraid of mistakes”

Growth mindset

“My effort and attitude determine my abilities”

“I can learn anything I want”

“Failure is an opportunity to grow”

“Challenges help me grow”

“Feedback is constructive and meant to help me”

“I like to try new things, and sometimes trying new things is difficult, but I can do difficult things”

Question: Where do we get our mindsets? Do we get our mindsets from our parents? It isn’t so simple…

Instead, what predicted a child’s mindset was parents’ beliefs about failure and parents’ reactions to their child’s failure (Haimovitz and Dweck 2016)

A failure-as-enhancing mindset

where failure is something that motivates learning, performance, and growth

A failure-is-debilitating mindset

where failure is something that inhabits learning, performance, and growth

Person praise 

praise directed at a person’s traits like intelligence 

process praise

praise directed at effort or outcome

Person praise implies that success is due to fixed traits that a person possesses but ____ control

cannot

Process praise implies that success if due to their effort and strategies used, which they ______

control

Some cautions

• false growth mindsets (Dweck and Yaeger 2019, 490). Growth =/= ___ _____

mere effort

Child achievement event (success, failures)

Activates adult’s Activates adult’s theory

intelligence mindset of how to motivate children

Activates adult process-or person-oriented practices 

promotes child growth or fixed mindset