Dr. Pat Levitt - Why Early Matters for Healthy Brain and Child Development

Why Early Matters for Healthy Brain and Child Development

Dr. Pat Levitt discusses the research showing that early life experiences influence social, emotional and learning skills, and how these skills come together to help children succeed in the real world and how healthy brain architecture provides the resilience to deal with adversity experienced during the first years of life.

Full Transcript

Dr. Pat Levitt: Thanks for the very kind introduction. It's great to be back here at the Urban Child Institute.

So part of the time I spend away from the laboratory or the training program is in the policy arena, and in particular, how to communicate the science of brain and child development to people who are in positions to make decisions. So that's policy makers, that's business leaders, that's families, that's service providers, that's the community in general.

And so I've been part of the National Scientific Council on the Developing Child, which is up there since 2003, and it's group of scientists who got together, who knew nothing about how to communicate, but knew a lot about the science. And so what I'm going to talk about tonight is the basics of brain and child development that will then lead, I think hopefully will, into a talk that's going to focus on the kinds of programs and interventions that can enhance child development and families and the community in general. So there's my title.

So let's start with common misconceptions about child development, what I call the myths. You like that, Dan?

Dr. Dan Goldowitz: Yeah.

Dr. Pat Levitt: It's good. Okay. So far so good. So children are, you have to shout out what the picture is, okay? This is participation for Brain Awareness Week in Tennessee.

[Audience]: Sponges.

Dr. Pat Levitt: Misconception. Children are not sponges. Children are children. Right there, there's a child, right there. They are not sponges. You can't drop them in the middle of a room and say, "Learn. I'll be back in 10 years." It doesn't work that way, okay?' Common misconception, there are more. Eighty percent of brain development occurs by?

[Audience]: Four? Three?

Dr. Pat Levitt: Wrong. In terms of size and structure, the brain is 80% of the size that it's going to attain in adulthood. But raise your hand if you think a 3-year old has basically 80% of the functions of an adult. Raise your hand. Good job.

Because there's so much more that goes on in terms of brain development besides the size of it, right? And so I've even heard some political candidates talking about this. Their heart's in the right place, but their brain is in the wrong place. There's a lot of development that occurs before birth, after, all the way through, believe it or not, through adolescence. We'll talk about that in a minute.

Bad stuff happens. You just have to be tough. Strong. Arnold, right, Arnold. You just have to be strong. So that's the narrative that we have in this country about rugged individualism, that being tough, being resilient, which you're going to hear about in the next talk, is simply about whether you got it or you don't got it, and that's not the case at all, that in fact, resilience is comprised of skills, just like other skills that we think about, reading and sports or whatever, and you can build those in children. You're going to hear about that. And then ready to learn is all about numbers or letters or whatever.

So learning is all about how the brain puts together social and emotional and cognitive functions that really further the development in terms of learning skill sets for a lifetime, and you cannot separate those out. And programs that focus on one component don't work, and that's what the science says.

So here's the core story of brain and child development that the council developed over the last 10 or 12 years. And the first is that child development is the foundation of prosperous communities. I think everyone who I've gone around to about 40 states to talk about this, and I think it's pretty clear that everybody embraces this for a whole bunch of different reasons, but they recognize this. Brains are built over time from the bottom up.

Think about anything that a child learns. Basic skills start first. In fact, simple circuits are built first in the brain, and then more complex circuits follow. So skill begets skill. And so if you don't have the basic skills, are you going to ever be able to learn the more complex skills? Everybody? No, okay. Great.

Genes and experience together build brains. So it's not which one is at work, but it's both genes and environment. Scientists don't argue about this anymore. We embrace both. We love our genes and we love our experiences, hopefully. And I'll talk about serve and return relationships.

Because humans are social. We're social, and that everything that I'm going to talk about really revolves around that component of our behavior that's critical for emotional behavior, and learning how to regulate our emotions under all different kinds of circumstances, and our cognitive development. Our education is done and needs to continue to be done in a social setting, positive social settings, and if they're not, they really are tremendous liabilities in terms of being able to learn.

Cognitive social-emotional development are inextricably intertwined. They're not separate. Toxic stress damages brain architecture. You'll hear more about that. That's early, profound adversity that occurs in a chronic way that sets off a chronic stress response system that affects both brain health and body health, both, mental health and physical health. I'll show that in a minute. And then resilience is not an internal character strength, I've already talked about that.

Then finally, for many functions, the brain's capacity for change decreases over time. So it's not that we can't learn as we get older. It's not that we can't change a little bit as we get older. You just have to expend a lot more energy, and it's much more expensive, quite frankly, to do interventions later on or to do programs that focus much later on. The brain's plasticity decreases over time.

So what do these have in common? Early child care and education, positive psychology, speech language, positive exposure, primary care, physical exercise, occupational therapy, spiritual, physical therapy, child-parent counseling – what do they have in common? They have the brain in common.

They're all targeting brain architecture. They're all targeting how the brain is developing in these periods of time that are sensitive to those kinds of experiences. And, of course, that's the adult brain. This is the typical toddler brain there. This region right here, my wife says, "Never leaves adult men." Oh yeah, everyone's agreeing with that.

So this is what the brain looks like from a developmental perspective, when you look at the principal brain cells, which are called neurons. This is a newborn, and you can see the number of neurons. And they have these little processes that receive information called dendrites, and they have another process that allows them to connect to other neurons to pass information along, and those are axons. So this is a newborn, and this is at one month. Are there more nerve cells?

[Audience]: Definitely. Yes.

Dr. Pat Levitt: No. It's an optical delusion. They're bigger and they have more...like your garden, they have more processes, as your garden is growing, but you haven't increased the number of plants in your garden. In fact, the number of neurons is the same.

Same here. That's at six months. Incredible amount of growth that occurred. Rob is counting. Go away, Rob. Get out of here. I got to get through this. Look at two years! Look at two years! It's unbelievable, the amount of growth. No more neurons, lots of process growth. They're making connections, and those connections are occurring at about 700 per second during this period of time. From the third trimester of pregnancy all the way through the first two years of life, all these connections are being made.

Oops, I don't know why that happened. I hit the button, actually. I'm sorry.

And this is what happens birth, 6 years, and 14 years. This is not evidence that the adolescent brain is in degeneration. It doesn't mean that the adolescent brain is falling apart, though it seems. It turns out that we overproduce nerve connections, and we basically solidify the ones that we use through experience, and we get rid of the ones that we don't need because it's not cost-efficient.

And so actually our brains grow, they get to a maximum size, and then over time, the brain actually reduces in size, and it's pruning or getting rid of those connections. Just like if you have a garden that overgrow a little bit, but then you prune it back and the plants are actually healthier and they produce more fruits or vegetables. Same concept.

[Video Narration]: A child's experiences during the earliest years of life have a lasting impact on the architecture of the developing brain. Genes provide the basic blueprint, but experiences shape the process that determines whether a child's brain will provide a strong or weak foundation for all future learning, behavior, and health.

During this important period of brain development, billions of brain cells called neurons send electrical signals to communicate with each other. These connections form circuits that become the basic foundation of brain architecture. Circuits and connections proliferate at a rapid pace, and are reinforced through repeated use.

Our experiences and environment dictate which circuits and connections get more use. Connections that are used more grow stronger and more permanent. Meanwhile, connections that are used less fade away through a normal process called pruning. Well-used circuits create lightning-fast pathways for neuro signals to travel across regions of the brain. Simple circuits form first, providing a foundation for more complex circuits to build on later.

Through this process, neurons form strong circuits and connections for emotions, motor skills, behavioral control, logic, language, and memory during the early critical period of development. With repeated use, these circuits become more efficient and connect to other areas of the brain more rapidly. While they originate in specific areas of the brain, the circuits are interconnected. You can't have one type of skill without the others to support it. Like building a house, everything is connected, and what comes first forms a foundation for all that comes later.

Dr. Pat Levitt: So that took about a minute and twenty. I took 10 minutes to describe this. I just should have shown the video. By the way, the videos, most of the time I'll show you, you can go to the Center for the Developing Child, and you can get these videos and download them. There's all sorts of PDFs or papers that have been written.

So here's the deal. Experiences are really important. They drive development of the brain. So there's a blueprint that's set up prenatally to get the basic connections to form them, then experience drives further development through infancy, toddlerhood, childhood, and well past adolescence.

But what the brain doesn't do is decide that it's only going to focus on the powerful positive experiences. Powerful negative experiences, like neglect and abuse, witnessing violence, trauma in one's life, those are powerful as well, and so if those are chronic, those are going to have an effect on how the brain gets wired up, and I'll give some examples of that.

So here's an example. This is an experiment. This is a rat experiment. You guys okay with that? I didn't do it. It was done here by Chang and Merzenich. So the red, yellow, and blue colors represent different frequencies of sounds that a rat can hear when it's young. And so it's kind of sloppy. There's red, and there's yellow, and then they're kind of intermixed with each other.

And then after they go through puberty, here we go, there it goes, it looks like that. So it gets smaller, but more compact, more efficient. You see how the colors have sorted out? So those are different frequencies that the rat can hear, and it wires itself up that way because it hurdled those frequencies of sounds from below which is blue, to high which is red. Now what happens if the rat is raised before this map gets produced? It gets raised only in the red frequency. What do you think the map is going to look like? Anybody? Dan?

Dr. Dan Goldowitz: Yeah, it'll be red.

Dr. Pat Levitt: There it is. He read the study. So here's a great example. Why did the rat not just say, "Well, I'm just going to wire myself up to hear these frequencies based on red, yellow, and blue?" Why did it just create this large map where it's overwhelmed with red?

Because that's what – I mean, I'm anthropomorphizing – but that's what it thought it was going to have to deal with, with the rest of his life, red frequencies. Why should I wire myself up for blue or yellow if all I'm going to deal with is red? In fact, what the brain is doing is preparing itself through wiring of circuits to deal with what it thinks it's going to have to endure for the rest of his life. So that's the trick.

So negative experiences are going to wire the brain up in a way that's going to...for example, if a young child is in a situation where there are either severe neglect or abuse, let's take abuse for example, they're going to be on high vigilance all the time. They're going to wire their circuits up to see any change in emotion, in faces, which is what we use to figure out whether somebody's angry at us or happy with us or joyful with us or whatever. They're going to wire themselves up to become expert. In fact, even over-representing anger. So it's changing brain architecture.

So, language. We know that complex language spoken to a child in a social setting is directly correlated with the language that the child develops in terms of the numbers of words. So this is what it looks like, studies that have been done in the mid-'90s, and in 2012. This is why there are programs now all around the country talking about talking to your child, doing it, not playing an audio tape for them and leaving the room, but actually talking to them and interacting with them.

And it has a positive effect. At 16 months, there's no difference when you look at education level or at income. If you look at 24 months, the gap starts, and by 36 months, it's a pretty significant gap.

Again, this is not genetic. This is experience. So that means that you can shift that and change that by simply using language in a way, in your social interactions, that are going to shift that curve to go from here to here.

So the key component of this developmental period of time, which language is being acquired and social skills are being acquired, is what we call serve and return. This interaction between parent or primary caregiver and child, we call it serve and return because there is an initiator of the interaction.

Now the mistake that most people make is they believe that the interaction obviously must be initiated by the adult because, of course, it's the adult. But in fact, in serve and return, think about it, if you were standing on one side of a net on a tennis court and there's a person on the other side, and they get to serve all the time, or you're a one-sided, a net with the ball and there's nobody on the other side. So it gets very boring very quickly. That would be neglect. But if you don't give the child that opportunity, the infant or toddler to initiate, it's not really that interaction.

And look at what the child is looking at here. What are they looking at? What is the thing they look... face most of the time. They're looking at the eyes. They're looking at the mouth. Mouth, they see, there are sounds coming out. I hear these sounds, but I'm seeing this mouth move, and they have to put together these vocalizations in a way where they can actually learn what the motor skills is to actually form the sounds themselves.

The sounds, phonemes are put together to form words. Words, then are associated with objects. We used to take our kids shopping all the time in wide aisle stores where they couldn't grab all the stuff and throw it on the floor.

Every setting, it changes over time in terms of the skill set that they're learning. This is basic discriminating sounds. This is putting sounds together with objects, and then this is putting symbols together with sounds and words, but it's all done in the context of serve and return, of an interaction, that you can see here. And by the way, it changes. So, it's initially primary caregivers. It's teachers and educators, and it becomes peers. All of which are all part of this process.

This is conserved in evolution, you guys. There's a great story about bird song and how they learn. So there are lots of different species of songbirds. They each have their own special mating song, and teaches the juvenile male songbird their specific species' song. Raise your hand, shout it out. Who teaches it? Anybody?

[Audience]: The father.

Dr. Pat Levitt: The male, the adult male. So it's clear that in order to learn this correct song, there has to be a live tutor presence in order for them to become expert at doing a song. If you just record the song and play it to the juvenile without the adult being there, it doesn't work at all. Similar to what I talked about in terms of serve and return.

[Video Narration]: The key to forming strong brain architecture is what's known as serve and return interaction with adults. In this developmental game, new neural connections form in the brain as young children instinctively serve through babbling, facial expressions, and gestures, and adults return the serve responding in a very directed, meaningful way.

It starts very early in life when a baby coos and the adult interacts and directs the baby's attention to a face or a hand. This interaction forms the foundation of brain architecture upon which all future development will be built. It helps create neural connections between all the different areas of the brain, building the emotional and cognitive skills children need in life.

For example, here's how it works for literacy and language skills. When the baby sees an object, the adult says its name. This makes connections in the baby's brain between particular sounds and their corresponding object. Later, adults show young children that those objects and sounds can also be represented by marks on a page. With continued support from adults, children then learn how to decipher writing and eventually to write themselves. Each stage builds on what came before. Ensuring that children have adult caregivers who consistently engage in serve and return interaction beginning in infancy builds a foundation in the brain for all the learning, behavior, and health that follow.

Dr. Pat Levitt: There's one thing you take from what I talked about it's that serve and return is so central to everything that a child is going to learn in terms of social engagement, in terms of emotional regulation, and in terms of learning and being comfortable in those interactions, from my perspective, and it's evolutionary conserve. There's nothing more important than that.

So the absence of serve and return, when the neglect is severe, in the United States is the most severe form of what we call toxic stress. It's not abuse. It's not physical abuse. That's a toxic stressor, but in terms of the numbers, when you look at the numbers, it's neglect.

[Video Interview]: Built into our biology is the need to have responsive interactions with adults.

Neglect for children is when they don't get what the brain is expecting to get, what the child is expecting to get, what we are biologically prepared and waiting for, which is input from those around us.

It's this back and forth serve and return interaction that literally shapes the architecture of the brain.

Serve and return begins when a child looks at something, or observes something, makes an utterance, and that represents the serve, and return is when the parent...

Dr. Pat Levitt: The child initiating.

[Video Interview]: ...notices the child doing these things...

Dr. Pat Levitt: Watch the dad.

[Video Interview]: ...and responds to the child.

Under conditions where serve and return is broken, you literally are pulling away what is the essential ingredient of the development of human brain architecture.

It was really compelling series of experiments, where they started by videotaping the mother and the baby engaging and cooing and smiling, and then they asked the mother to basically put on a blank face and not respond at all. When a baby is not attended to, that is a sign of danger to the baby biologically. So the stress systems become activated.

In a brain that is constantly bathed in stress hormones, not that's up and down that comes with normal development, certain key synapses, the connections between nerves fail to form in critical regions of the brain. So neglect both fails to provide the stimulation that's needed to develop the basic architecture. And when it's at a certain level, is one of the most potent activators of the stress biology of a young child. So you get a double whammy.

Dr. Pat Levitt: You get a double whammy. So a child like that not responding, not interacting, and they're very upset, that's not making them stronger. It's not making their brain architecture stronger. Built into that architecture early on is the desire to interact.

[Video Narration]: Learning to deal with stress is an important part of healthy development. When experiencing stress, the stress response system is activated. The body and brain go on alert. There's an adrenaline rush, increased heart rate, and an increase in stress hormone levels.

When the stress is relieved after a short time, or a young child receives support from caring adults, the stress response winds down and the body quickly returns to normal. In severe situations such as ongoing abuse and neglect, where there is no caring adult to act as a buffer against the stress, the stress response stays activated. Even when there is no apparent physical harm, the extended absence of response from adults can activate the stress response system.

Constant activation of the stress response overloads developing systems with serious life-long consequences for the child. This is known as toxic stress. Over time, this results in a stress response system set permanently on a high alert. In the areas of the brain dedicated to learning and reasoning, the neural connections that comprise brain architecture are weaker and fewer in number.

Science shows that the prolonged activation of stress hormones in early childhood can actually reduce neural connections in these important areas of the brain at just the time when they should be growing new ones. Toxic stress can be avoided if we ensure that the environments in which children grow and develop are nurturing, stable, and engaging.

Dr. Pat Levitt: So that doesn't mean that all stress is bad. So when you think about all sorts of stressors that an older infant or a toddler will go through, when I was...I hated, dreaded circle time because I stuttered, and so when I was a child, I stuttered terribly. I had no fluent speech.

So that was incredibly stressful for me to go through. It was intermittent. I had siblings and parents and then occasionally a really good teacher, who provided me with the scaffold of interaction to give me the confidence to be able to do it, even though I didn't have fluent speech. So it was stressful. I learned how to modulate my emotion.

So not all stress is bad, and in fact, it's good to have children have to deal with certain issues and challenges and problems. So it's not about wrapping them up in cotton and putting them to an [inaudible 00:27:43]. But here we're talking about chronic abuse, chronic neglect that lasts for long periods of time. I do want to make that clear.

So it's also about health for a lifetime. There was a study that was done back in the late '50s, early '60s looking at some of the first studies. Perry Preschool and Abecedarian, at that time the question was does high-quality preschool matter compared to those children in the community who were not getting any?

And there are all sorts of things that happened in that study. They measured IQ, nothing happened. But then they started to measure all these other outcomes, like high school graduation rates and income and all sorts of stuff, and they could see that there were big effects. Nobody had really thought about the fact that high stress or these kinds of really positive programs early on could actually have an effect on the whole child for a lifetime.

So this is a story that came out in 2014 where they looked at the health of individuals as adults who were in this program as four year olds. So they're looking like, whatever, 40, 50 years later. And so they looked at a lot of things, but the thing that was most impressive to me was they looked at blood pressure. Are you hypertensive or not?

So if you were in low-quality or no early child care at all, your average mean blood, your average blood pressure is 143/92. Not great, not good. You go to the doctor, they're putting you on a low-salt diet and no more ribs. I'm looking at my friend, Dan. High-quality childhood...

And this study, this was done by Economist, by the way. 126/78. It's amazing. This is like 40 years later, 40 years later. But it's an accumulation of the fact that that high-quality program started to create a support system and experiences in a positive way that allowed the stress response system to react appropriately to stressors during childhood and into young adulthood, and then come back down to restart again. It wasn't chronically activated. I think this is pretty amazing.

And then we know in the immune system, it's the same thing, and I'm going to skip because I'm going to run out of time, so I'm going to skip that.

So one of the problems in talking about this, the policy makers and the other people is there's always this, well, you're talking about all these bad things, but I know somebody, I know somebody like me, I know somebody who is okay after a traumatic childhood. So if they fall back to this idea of you're either strong or you're not, there's nothing we can do about it, so why are you talking to me about programs or community settings or families or anything else like that?

So resilience is what we call the ability to endure adversity. And so is it about this idea of rugged individualism. So here's the video that's going to talk about this.

[Video Narration]: You can think of child development as a scale that has two sides. A child scale is placed in a community, and has spaces on either side where experiences and environmental influences stack up over the course of development. One side gets stacked with negative factors, like stress, violence, and neglect. While the other side gets loaded with positive factors, like supportive relationships, skill building opportunities, and community resources. In the same way that the weight on a teeter-totter affects the direction it tips, the factors that a child is exposed to affect how they turn out, the outcomes of their development.

But the way the scale tips and the outcomes a child experiences are also a function of the position of the scale's fulcrum, which is like the genetic makeup of the child. The position of the fulcrum affects how the scale responds to factors that get stacked on either side and how easily it tips.

We know that fulcrums start in different places for different children, and that this genetic starting point is an important factor in how a child responds to experiences and how they turn out. We also know that the position of the fulcrum isn't fixed. It's a sliding set point. Over time, the things that load and tip the scale can actually shift the position of the fulcrum.

There are points in human development when this fulcrum is easier to shift. During these shiftable periods, our biology can be changed, making us more or less able to withstand negative weight that gets stacked on the scale. One of these shiftable periods is early childhood, and another is adolescence. That's why it's so important to make sure that children have positive experiences, especially early on, and a continued positive support throughout development.

By providing positive experiences during these sensitive periods of development and offloading negative weight, we can shift the fulcrum, making children more able to bear the weight of negative experiences later on, making them more resilient.

So resilience isn't just about individual children. It's about the environments and experiences that gets stacked under resilience scale. Resilient societies are those that figure out how to stack more positives than negatives onto the children who will become workers and citizens.

Dr. Pat Levitt: So there's a really important concept in there, that we are not the same. We inherit genes from our mom and dad, creates a different biology, but the biology, because the genes are influential in that, are not super glue. That fulcrum is not super-glued to the board. It can move, and it can move through negative or positive experiences.

There's great examples that I don't have time to go through, where we know that there are genes, there are variants of genes that increase risk, let's say, for adult depression. I want to play that game. Genes that are increased risk for adult depression, when combined with early adverse childhood experiences. But if that individual who has that risk factor doesn't have early adverse childhood experiences, their risk for depression is no different than somebody who does not have that risk gene. So just because somebody says genetics, it doesn't mean that it's immutable. That's really important.

So here's a neural system that's key to resilience, and there are lots of programs, and you're going to hear about some of them, incorporating some of these skill sets and something that we call executive function. It's not about IQ. It's about a combination of skills that we use to solve problems, to be able to shift from one thing that we're doing to another, all sorts of things that you think about as a child and a young adult, and then finally as you are an adult, have to go through on a daily basis.

[Video Narration]: Science tells us that brains, minds are built, not born, and at the center of this dynamic architecture are a set of skills called executive function and self-regulation.

[Video Interview]: Children's self-regulation and executive function are key ingredients in their lifetime performance. It's not just about learning language or learning numbers or learning colors.

We have to be able to work effectively with others, with distractions, with multiple demands. These actually are skills that contribute to the productivity of the American workforce.

[Child on video]: You don't do that! You don't do that!

[Teacher on video]: Just look at your shapes. What should you have done next?

[Video Interview]: Educators, I think, are looking for just this sort of thing, and when we describe what we mean by executive function, they say, "Yes, that's it. That's exactly the problem. These kids, they can tell me these rules, but they can actually use them."

[Teacher on video]: What's this?

[Child on video]: A toolbox.

[Teacher on video]: A toolbox.

[Video Narration]: What is executive function?

[Child on video]: Safety goggles.

[Teacher on video]: Safety goggles.

[Video Interview]: Probably the best way to think about it is sort of like an air traffic control system in the brain. Just like an air traffic control system has to manage lots of airplanes going on, lots of runways, and really exquisite timing and so on, a child has to manage a lot of information and avoid distractions. We really think of it as an involving working memory and inhibitory control and mental flexibility. Take a situation where a child is having to take turns. So first of all, the child has to have inhibitory control.

Dr. Pat Levitt: See the child like that and then...that was great regulation.

[Video Interview]: The child has to be able to stop whatever he or she is doing and let the other child take a turn. But when it's your turn again, you also have to remember what it is you're supposed to be doing. So that pulls on working memory. If the children who are taking the turns after you do something unpredictable, you have to be able to adjust what you're going to do next, and that requires mental flexibility. Children who are struggling with these capacities often look like children who just aren't paying attention, or children who are deliberately not controlling themselves.

[Video Interview]: If you don't have self-regulation, you act out, and the teacher puts you in timeout, so then you miss part of the learning that's going on, and then you are more upset because you're behind, and so you act out. So you get this downward spiral.

[Video Narration]: How does executive function develop?

[Child on video]: ...six, seven. Seven. And plus four.

[Video Interview]: In little children and even in the infant and toddler years, you begin to see the roots of executive functioning skills. What's going on in our brains is unbelievably intricate and complicated.

[Video Interview]: The prefrontal cortex or the front third of the brain is important for executive function. But it's more than just prefrontal cortex. This region doesn't act alone. It's involved in controlling your behavior through its interactions with all other parts of the brain. The brain goes from a situation where you've got nearest neurons communicating very strongly with each other and ignoring the rest of the brain, to this widespread networks that are connecting these different areas.

Executive function changes over the life course. It improves radically over the first few years. It continues to improve throughout adolescence. It's not until early adulthood that you have the adult type networks that are very strongly activated, that connect different brain regions together.

[Child on video]: Just take notes.

[Video Interview]: Also, we believe that executive functions can be trained.

It's just like going to the gym. So the more you practice in these areas, the stronger the capacity is likely to become because you're helping to strengthen those neural connections.

Dr. Pat Levitt: So let's watch an example. I'm sort of on time. I'm not late yet. So you've seen my watch? Okay. So this is a great example. This is like a three year old, I think. So everything you heard about mental flexibility, impulse control, focus, perseverance. There's no sound.

So he's in the classroom. I think it's a Montessori, I don't know, but he's in a classroom. So there are kids walking around and...okay, that was 40 minutes.

So he gets that point. He figures that. He's getting to his working memory. That block's bigger. It's not going to stay. No way. He's got that, right? And he's not getting upset. This would not be me, by the way, at the age of three. I would have kicked that thing over.

This kid's unbelievable. It's unbelievable. This kid's watching him. Watch this.

Now that child's so great impulse control. Unbelievable, right? But it wasn't just that child. It wasn't just him who was showing all these incredible...that's executive function, all the component parts. He's three. But there are other children, the same age, who are in that room showing impulse control, watching. They were probably doing other things not distracted by what he was doing, etc.

It's a great example. So this is all about, from my perspective, building these strong relationships, give the skill sets to be able to deal with different challenges over time because the challenges change from being one to two to three. I'm going to skip the Dunedin study.

We know from lots of longitudinal studies, and you're going to hear about one, that when you measure early on science of executive function disruption, low persistence, impulsiveness, inattention, that's increases risk for those children to developing what we call behavioral disinhibition, the ability to not control your behavior under a variety of conditions, which child disruptive disorders, externalizing behaviors.

And these are all the things that increase that will turn out in terms of increased risk. Not every child, but surely it increases risk for expressing all of these problems. Of course, your ratio rates are up, drug use. These are longitudinal studies over 40 years. This is New Zealand by the way, but it's been seen in longitudinal studies over and over and over again.

Physical illness, cardiovascular disease, cancer, obesity, diabetes, just like I showed blood pressure. This affects physical health, too. Mental illness, low adult income, etc. Oops. This is the last video, then I'm done.

[Video Interview]: Resilience, it's not some magical quality. It's something that really can be built even in difficult circumstances.

A key active core ingredient to building resilience are the relationships that kids have to others who care about them.

Of course, families play a very important role, but nobody raises children in isolation. We have a huge amount of research that show the powerful impacts of teachers, coaches, other adults in the community with whom children have a chance to develop relationships, who play that critical supportive role of building resilience as a result of responsive interaction. Children build simple skills of coping and adapting, how to stop crying, how to regulate your behavior, being able to defer gratification.

They have an adaptive toolkit that allows you at moments of stress or challenge to bring up a number of potential skills that allow you to get through it.

As children get older, the sophistication of those skills increases. Being able to monitor situations, solve problems. The way we as a society can nurture the development of resilience is to help communities provide the families and adults who are important in the lives of young children, the capacities and the supports they need.

And our community's saying, we want to be impacted part of crafting the solution to really understand what's necessary to produce the resilience. That that's when the ball gets rolling.

Resilience building, capacity building is really in everyone's interest, and everyone reaps the benefits when we do that well.

Dr. Pat Levitt: It's a team sport. It really is a team sport. So remember development is not a blank slate. This is an active process, and skill begets skill for the whole child and all of her or his future. They're two of my granddaughters, and they want to thank you for allowing me to come here and talk today. Thank you very much.

Dr. Dan Goldowitz: Thanks very much, Pat. We have time for questions, just comments like, I don't know.

[Audience]: Have you seen if there's any connection between diet and some of your research?

Dr. Pat Levitt: So is there a connection between diet and some of the things that I talked about today, and the answer is nutrition, early nutrition. The nutrition through childhood has been shown over and over again in basic research and in clinical studies to be incredibly important in terms of building healthy brain architecture. There's incontrovertible evidence.

And there's variations on diets in terms of...there's not one that somebody can say, "Well, that's the absolute best one." But we know in terms of balanced diets and we know in terms of nutrition, the brain uses the largest part of the energy that's taken in through food, and there are many essential amino acids that turn into proteins that are important for how nerve cells communicate with each other, called neurotransmitters, and they have to get produced through nutrition and food.

There was work that was done in the late '60s and early '70s that will probably never get done again. We now have incredible technologies to be able to measure changes to the brain so precisely. And these studies were done by Richard Workman at MIT, where he showed really profound effects of malnutrition during pregnancy or early on. So this is a really important point that I didn't talk about, but I think it's a great question. It speaks to this issue of attending to the whole child both mentally and physically.

[Audience]: So I was wondering since environment is so critical for brain development, and the way you presented it is many of the perception of children, babies, young toddlers and so forth, maybe instinctive perception, or was that experiences. Is that true?

Dr. Pat Levitt: Well, so there's always been this conversation about when do somebody's skills come online. So there's a very famous study that Andy Meltzoff did, I think in 1976, where he wanted to see whether an infant, when would an infant imitate? Which is a sign that they're socially, that they're actually paying attention to what's happening.

And the answer is, and this doesn't...I mean, the interpretation is a little complicated I think. I don't quite understand it, but the day of birth, he stuck his tongue out and the infant went back at him and that's...so some people would argue that, prenatally parts of the brain, the sensory parts, because our sensory systems are basically wired up for us to do what? To take in information from our environment and then respond to it.

Now an infant's sensory systems are much more mature than their motor systems. They can't walk. Have you ever watched an infant try to grab objects? Awful. It's embarrassing. Not until around seven or eight months.

But you know what else happens at seven, eight months when they start to grab those objects and they realize, "Oh, I can do this better than chance." They actually start to socially interact, and there's this amazing study that was done to show you that it's not just instinct. So the brain is wired up early on to be able to take the sensory information.

But there's this great study that was done by a developmental psychologist, Amanda Woodward. She brought children into her laboratory to see, well, this motor skill of grabbing seems to correlate in time with when they started, because they grab, "Ah, I want to share with Rob. See what I got?"

And so when she put Velcro mittens on three month olds and have them grab for Velcro objects, she actually increased their hand-eye coordination by three or four months, where they were grabbing...and what happened? They started to socially reference what they had just grabbed. So it's movable, right?

[Audience]: Right. My follow-up question because if a kid can't, a baby can't change the parents, they can't change their environment and the flexibility of their perception of what's parent and environment, could you alter their perception by giving them different experiences, even though it doesn't come from their parents and their environment?

Dr. Pat Levitt: Yes. So family's important, but you heard Jacques Jean Claude say this is a team sport. That high quality programs in the community support systems that involve lots of different adults can really help. And I'll tell you that there are programs now in which it's very clear that the old school of thought was there's a problem with a child, you target...the intervention's all about the child.

And it turns out that programs that are understanding that they're serve and return, that there's this interaction, and providing new skill sets for young adults for those adults, will change the environment for the child in a positive way.

So those interventions are turning out to be, you may talk of that, that those interactions, those interventions, are turning out to be much more effective than we ever thought that we could do in terms of changing the environment for the child. But there's no doubt that that's part of the goal is to figure out what those interventions are and to incorporate as much high-quality as we can. Yeah?

Dr. Dan Goldowitz: A question right here.

Dr. Pat Levitt: Oh, right here. Sorry. I'm sorry.

[Audience]: It's all right.

Dr. Pat Levitt: Boy, you guys are so hostile in Tennessee. I've lived here for seven years.

[Audience]: I'm really not. If you came upon a child, say a four year old in a pre-K school setting, can you overcome that lack of connection that they may have had from birth to three or four?

Dr. Pat Levitt: Yeah. So the question is if a child has really struggled in the first three or four years of life in terms of these interactions and there've been absence, and there are some issues that you can see, are they still in the sensitive period of time where you can change brain architecture?

And the answer for many things that have been studied, like emotional regulation and social engagement, the answer is yes. Is it better to start early? Absolutely. And so some of the concepts that are going around, particularly among policy makers like in California, we have...everything is focused on four and five year olds.

And I wouldn't say it's too late, but it's silly to start at the age of four when you can start prenatally or at the age of zero because brain development doesn't start at the age of four. You're convinced of that, right? But the sensitivity is there and the ability to intervene is there, and there are programs that have been developed. Again, it's targeting both the adults and the child's life as well as the child, and it can change. Yes?

[Audience]: Okay. You talked about the toxic stress, and then it could be chronic neglect, abuse, something that's going on for a long time. What about poverty? What's the effects of poverty as far as toxic stress?

Dr. Pat Levitt: So there are a number of studies that have come out since 2012 or 2013 that have looked at poverty and its impact on brain growth. Poverty and this lack of resources in terms of child skill development, all of those are negative, all of those are lack of resources that come with poverty, which may also come with witnessing violence, are all part of the ingredients of really challenging since that changes brain architecture in a negative way.

So there's no doubt about that. The problem with interpreting...poverty has so many different elements to it. It has nutritional issues. It has health issues. Children in poverty endure more infections. They have more emergency room visits. There's all sorts of physical health challenges that go along with this as well. So interpreting it as a single element gets complicated, but we know it's bad. We know it's bad.

[Audience]: My question is adults who are arrested in their development, do the extreme chronic abuse, neglect, sexual abuse, whatever, whatever, whatever, through positive community programs, can they overcome the emotional behavior?

Dr. Pat Levitt: I sort of talked about it in this way. There's no absolute. Different individuals have different degrees of ability to change, what we call plasticity. We know that it takes a lot more to change a brain of an adult, but we also know you heard from Sylvia Bunge, who is an expert in executive function, that that skill set, which is really important, continues to develop, we think into the late '20s, early '30s.

So there's opportunities there, and their programs...she's actually involved in a program in California in Oakland, where they're looking at interventions in mid-20s, to provide skill sets that speak to this issue of emotional control, shifting attention, skill sets for memory and learning. And by the way, one of the simplest things that improves executive function skills from an early age and through adulthood is the first thing that went at a public education. Can anybody guess?

[Audience]: Recess.

Dr. Pat Levitt: Recess, exercise. We know that there's brain science now about this. It's not just, and it's in development. It's also in rehabilitation now that's being used, but we know that exercise changes brain chemistry in a really positive way, and of course, what took it out of public education is...that's a long conversation. Probably because it is very straightforward to incorporate, and really helps. And Sylvia's program, I think, does incorporate that.

[Audience]: Yeah, I have a question. From personal experience, by reading case, I found out the interactions with kids, it seems like from parents, it's more important than the grandparents or neighbors. Are there...

Dr. Pat Levitt: No.

[Audience]: No?

Dr. Pat Levitt: No.

[Audience]: No?

Dr. Pat Levitt: I'm a grandparent, and I'm just as important enough. I would say this. The science really says that children grow up in an environment of relationships, and so those relationships, each and every one of them are important. Are parent-child relationships very important? Absolutely, and in most instances, in most families, that's the relationship that flourishes and that's the relationship that needs to be positive.

But neighbors of community, programs with an educator, grandparents, aunts, uncles, those are all part of the environment of relationships, which also drives brain development in a very positive way. So we don't tend to rank order and say which is most important, which is least important. I know that my grandchildren think that I'm the most important interaction, in their...is that it? One...any...

Dr. Pat Levitt: Oh, one more.

[Audience]: And I actually have two questions.

Dr. Pat Levitt: Oh, wait. Is that allowed?

[Audience]: Well, the first one is a follow-up to the question I asked before. It was really a more pointed question about being on a vegan gluten-free, casein-free diet, especially as now there's some thought that that might be linked to supporting some autism recovery. And then just how would that benefit all kids in general because, of course, the connection between your body using that energy to break down meat products versus vegetable-based products.

Dr. Pat Levitt: So my disclaimer is I'm not a nutritionist, but my research on autism happens to be on children with autism who also have gastrointestinal disorder. So we actually looked at diet. And there is a subset of children with GI problems that actually benefit from restricted diets in autism, but it's not a panacea. The majority of children don't, and so what we saw in our studies is that parents move from one diet to another.

In terms of this topic that we're talking about today, I think it's pretty clear that processed carbohydrates, sugars, high-fat diet, all those things that we know were leading to early childhood propensity for obesity. What's that doing, that food is actually having an impact on how the brain is getting wired. It's called the hypothalamus, and there's lots of evidence of the people who are working on the development of those parts of the brain that have to do with appetite control and other things.

Just like the study I told you about with the rat and the hearing and the red frequencies and all that, these systems get wired up based on experience as well. And so those nutritional elements are going to wire the system up to crave sugars and high fats. And it's much more difficult to deal with that later on. That's clear as well.

[Audience]: Is there a follow-up to it?

Dr. Pat Levitt: There's a follow up to it?

[Audience]: No. My second question was about is there a new research related to using the brain to identify autism? I've read what I think is the most recent, but is there something else that's going to come out soon about using the brain...

Dr. Pat Levitt: You mean the brain structure?

[Audience]: Yeah.

Dr. Pat Levitt: So autism and other neuro developmental disorders, some of them are defined, if they're rare syndromes or chromosomal abnormalities or defined genetically, most autism is not as defined behaviorally. We don't have a road map for what the brain looks like exactly. There are some differences, but there's huge overlap between children who have autism and children who don't have autism in terms of their brain structure.

So we're just not there yet. So the diagnosis for something like autism is done behaviorally. And Fred Palmers here, and his University Center of Excellence on Developmental Disabilities, does a lot of work in that area. So we're not there yet. Most of this is still going to be behavioral. Are we done?

Dr. Dan Goldowitz: Thank you very much, Pat.