TSBVI Coffee Hour: The Impact of Stress on Brain Development and Brain Resiliency Ð Part 1 Ð 9-30-21
>> Dr. Cameron: What are we going to talk about today? What we're really going to talk about is the impact of experiences on brain development. Now, you often hear about experiences having negative impacts on brain development but what we're going to focus on today is how do you help children build brain resilience? How do you help them deal with life's stresses, particularly children that have problems with seeing, with hearing, with sensory perception.  How can we work with these kids to make them as resilient as possible so that their trajectory through life is as positive as possible. That's what we're going to focus our attention on. So, we're going to talk about this in early childhood and there's a good reason for doing that.  Your brain is building circuits that control everything you do but it's building them from before birth until age 25. It takes a quarter of a century to build the circuits that you use when you say I'm thinking, my brain is working, takes a long time to build those circuits. But a lot of the foundational circuits are built in the first years of life and so paying attention to this information early and setting a sturdy foundation can make a huge difference for children. So we're going to talk about the early years. We'll talk some about later years. And I think when we're thinking about resilience, an important thing to remember is that even if there has been stress and you might not have done everything you wish you'd done in the early years, the brain's still developing all the way to age 25. And so you have time to strengthen circuits. You have time to build circuits that can help those circuits that maybe didn't have the opportunity to grow as much in their early years.  But let's get started and see how this works. Now, I am a neuroscientist. I study brain development and I study specifically how experiences impact brain development. But for the last 20 years I've done a lot of work translating this to groups of people so that not just scientists know about the science, but everybody else knows about the science too. I'm a member of the national scientific council on the developing child and you may be familiar with that, some of you. It is run out of Harvard University. You might know it as the center for the developing child. Many of the videos, almost all the written resources I've helped create.  So that's a really good website to go to if you want to read information about child development or for professionals who want to use a video. Almost everything we've developed is free. But for regular people, it might not be the best place to send them.  And what I'm going to use today is a number of materials that have been developed in my lab in a program called working for kids building skills.  And you'll be introduced to these as we go. These are materials that are activities, they're games.  They're ways to get people to have hands-on experience using information so that they don't have to read a lot of things to learn how to help their children have sturdy brain development. And I urge you to use these resources. I'll mention them as I go. I'll show them to you and I'll give you the websites, one in particular, the First Pathways Game is freely available to everybody and it's 250 activities or games for adults to do with children from zero to age 8 to strengthen brain development.  So I hope we not only convey some information today, but we do a good job of giving you a sense of how brain development works and what are some resources that you can use. So, working for kids works in communities. It teaches all sorts of adults, not just parents but grandparents, doctors, older children, teachers, policemen, everybody in a community is an adult who can help your children have sturdy brain development. Sometimes parents are incredibly busy and they're not as available as they wish they could be. Good mentoring by adults within your community can play a really important role in helping your children with brain development. So one thing we're going to urge you to do today is to make use of your community. Think about resources that are available to you and are available to your child. And we'll talk a lot more about this. So, let's get started with the basics.  How do experiences build the brain? How exactly does that work? I often use this -- what looks like a graph to you -- from working for kids. What are we looking at here? We're looking at how mother's speech influences how children's vocabulary increases. So you have on this axis -- I'm just going to move this over here. You have vocabulary size and you have age in months. Now, most children start talking somewhere around 12 months of age.  That's pretty consistent. They may say a word or two earlier than that. They may initiate a little later but it's at about 12 months of age. But what this is paying attention to is the fact that their trajectory, their increase in how big their vocabulary is and how much they're talking can differ a great deal and it differs, depending on the experiences they have. So working for kids uses activities and stories to teach people. So let's talk about this little boil up here. This little boy is Darren and Darren's mom is a hairdresser.  Now, I don't know about you but when I go to the hairdresser the fellow who cuts my hair -- his name is Gary -- talks and talks and talks. One day I asked him, how many other neuroscientist's hairdo you cut? He said, Judy, I don't cut any other neuroscientist's hair. I said that's amazing you know what to say. You know what to talk about all the time. He said I just enjoy talking. I enjoy getting to know people. And he talks all the time.  Well, so does Darren's mom. When Darren's born, he can't answer, of course. He's just a little baby.  He's gurgling. He's sleeping most of the time but she talks to him nonstop and it turns out that talking is having an influence on his brain way before he's able to answer and talk. The circuits in his brain that can hear words and start to understand that they're a form of communication, start hearing and paying attention to the words. A child is exposed to a lot of vocabulary, especially directed right at that child so that it's meaningful. Well, not necessarily start to talk earlier but when they start talking, their rate of increase in vocabulary is going to be at a high level. Not only did Darren hear a lot of talking before he started talking, he heard a ton of talking once he did start talking. You can imagine that as soon as he said a word, his mom got all excited, told everybody at the house, all their friends, everybody whose hair she cuts. There was a lot of talking. He got lots and lots of positive feedback for talking. And so by the time he's 2 years old and he's been talking for a year, a child like Darren will have about 600 words in his vocabulary.  Now, these are real graphs. How do people get them?  Large population studies were done and the level of mothers' vocabulary and communication was measured and then the child's trajectory of increase in speech was measured. So we're telling you a story about Darren but this is real data. Now, here is another little boy. We're going to call him Brian.  Brian lives right next door to Darren and his moms went to the same high school, they're good friends.  What does Brian's mom do? She's a dental hygienist so it's hard to have a conversation with your dental hygienist. You're there in the dentist chair. Your mouth is wide open and you can't talk back. She's a much quieter person. She did not start talking to Brian when he was born. She figured when he starts talking, I'll talk back to him. And because she isn't as talkative a person, Brian wasn't exposed to all the vocabulary and communication going on. What happened is by the time he gets to be 2 -- now, look, he started talking right about the same time Darren started talking but when he's 2 he's expected to have about 150 words in his vocabulary. So there's a big difference. Now, you might be thinking, hmm, who cares how many words a child has when they're 2 years old? They're going to go to school, probably preschool, day care. They're going to be exposed to lots of people. They're all going to have an increase in vocabulary. And that's absolutely true. They will. But this difference in trajectory stays with them so that for the rest of his life Darren will be much more comfortable vocally communicating with people and Brian will be quieter and he won't talk as much. You can have a medium level of speech and the line, the trajectory, is right in the middle. So I always start with this because it's hard to convince people that experiences really matter in brain development.  Your average parent says that can't be right.  They're born with a brain. Their head grows. Their brain grows. It just unfolds naturally. Genetics are what are determining brain development. So by starting with this, what I'm telling you is that the capability to use language is really influenced by the experiences these children had. Now, it turns out that producing an action, like talking, has to be governed by the brain. You build brain circuits and what we're going to find out is that Darren is going to have more brain circuits for verbal communication than Brian. Let's look at how this happens. So, this is a complex graph and this little part here is incredibly important. And you know you've invited a neuroscientist when this is their favorite part of a slide. It may look a little boring to you but I think that you're going to really be amazed at how it shows you how experiences work. So, right here you're looking at a part of the brain. It could be any part of the brain. And it's a part of the brain that hasn't really done much development before birth. So at birth there are lots of brain cells here but there are not a lot of connections between the brain cells. By the time a baby is born, they have almost all the brain cells they're ever going to have. But in many parts of the brain there are not a lot of connections. And then look what happens. In this brain area they are forming connections over the first three years of life or so. So at three years of age, if we took a snapshot of that brain area, the same cells are there. There's no more cells but there's tons of connections. I often use my hands to model this with people. I say, okay, let's pretend my hands are brain cells. Right here in my brain. Now, they haven't done much development before birth and so they're just sitting there being brain cells. What genetics does is genetic programming says, ooh, reach out connections and start to connect to each other. And that's what's been going on here during the first three years of life. But then look at this. This is the same brain area at 14 years of age. It is much less connected than it was at 3 years. Now, I've had people say, oh, that looks worrisome. Does that mean my 14-year-old isn't as smart as my 3-year-old?  I'm, no, that's not how you interpret it. The normal process of brain development is genetics, they reach out extensions, connect to each other and tons of connections are made. But they don't all last. The normal process of brain development is that some of these connections are going to get pruned away and other connections are going to become really, really strong and permanent. And neuroscientists call that period where you're making connections and pruning connections the period of plasticity. So that's the period of plasticity in that brain circuit. Now, you have millions of brain circuits in your brain. You have thousands of brain areas and the period of plasticity is different for different circuits. So, we're going to look here at -- do we have a question? 

>> Kaycee: We do. A great question. Someone asked if a child who is left behind begins to then receive more opportunities to communicate, can they catch up to the other child who had opportunities from the beginning or will the gap always stay the same? 

>> Dr. Cameron: So I'm going to finish talking to you about this and then I'll come back to that question. So I'm going to answer your question but I'm going to go a little bit further so that it makes sense to you. So we're going to look at this schematic diagram and the upward swing of each of these lines is making connections. The downward swing is pruning and when the pruning process is finished, then the plastic period is over. The period where you have lots of connections made and if they get used a lot the connections will become really strong. So we haven't talked yet about what causes some connections to become strong and permanent and other connections to get pruned. And this is 100% experience. You're thinking, well, genetics did do something. Genetics said make connections. And that's right but which connections you're left with is completely experiences. If you use a connection a lot, you increase the probability of the connection staying there and being permanent.  So let's look at some of these different brain pathways. The yellow line here shows you that connections in sensory systems. Vision, hearing that we're going to be talking about a lot today are being made before the baby is born. Now, you actually know that because if a baby can do something at the time they're born, they must have made connections. So babies can see at the time they're born. They can hear at the time they're born. They can taste. They can smell. They can feel touch. Those are all senses and it means the connections were being built. But what's really important in the first years of life is that those connections get used a lot. Because the plastic period for sensory systems is early in life. Now, vision has one of the fastest-developing sensory systems there is. It's making connections before birth and then in the first year of life that I've colored here in this pink square. The pruning process is going on. And that means it's really important to give children the ability to see things, to see in all directions, to see near, to see far. And if they have visual impairment, to try to optimize visual function at that time because the plastic period for the visual system is early. Now, you asked a question, what if they didn't have a lot of visual experience? What if they were born with an impairment in the visual system and they didn't get a lot of experience in this first year? Well, the pruning is going to be very robust and after that you're past the plastic period. But the good news is that you can still make connections and you still have pruning but you have it in a much, much slower rate than during the plastic period. So the answer to your question is, yes, later experiences can build strong circuits but you have to give much more experience. So on average we think to have a really strong circuit that doesn't get pruned, you need to use it -- let's say 10,000 times. That's a lot of times but you have to use it 10,000 times.  What about after the plastic period? You may have to use it 100,000 times to get it to be strong and permanent. And you'll never make as many connections or have as many connections if the use has been after the plastic period. So knowing when the plastic period is really, really important.  Now, I don't have hearing on this but hearing would be a sensory function that connections are being made prenatally and the pruning process goes on for about the first three years of life. Hearing is a complex function. You know that you can hear quiet and loud. You can also hear different sounds. The ta sound versus the da sound. They're very closely related but you can distinguish them. That ability to distinguish different sounds and the ability to hear loud and soft develop at different times. And so we think of hearing as having the plastic period that lasts for the first three years and parts of it until the first seven years of life. But it's still early and it's why, if you have a child born with problems hearing, it's very good to have as much done as possible to remediate those problems early so that they're still in the plastic period. Do we have another question? 

>> Kaycee: We do. Someone asked if there is a link between lack of experience and cortico visual impairment or cerebral vision impairment? 

>> Dr. Cameron: There can be an effective experience but there are many, many things that lead to impairment. So there can be genetic issues. There can be wiring issues, things genetically don't wire to the right thing. There can be exposure to toxins in the environment. So each child needs to see a physician and have a workup. No matter what, the experiences play an important role. So if you have a child that's born with a deficit in a sensory function, you can strengthen it by getting them to use that circuit as much as possible. That is a general developmental principle that always works.  Will you totally remediate genetic problems or other developmental problems? No. Experience won't completely get rid of those but experiences will always strengthen circuits. So it's a good thing to remember because no matter what the baseline is for your child, they're able to strengthen it if you get them to use the circuit. Another question? 

>> Kaycee: This one is a clarifying question and asks if they're reading the chart correctly to make sure the plastic period for vision, is it ending at the three-year mark? 

>> Dr. Cameron: It does but most the vision ends at about one year. It's really early. So we think of vision as being the fastest developing sensory system and it's incredibly important that children have visual experiences as early as possible so that you have those experiences during the time where that system is very plastic. It will be a . 

>> Dr. Cameron: It's a positive message, not a negative message.  What we're doing is giving you information that allows you to help your child the best you can of knowing when to use circuits for different things so that it is as easy as possible for them. Nevertheless, you still are able to do it afterwards. So let's talk about other circuits because I said different parts of the brain are different. The blue line here is for language and children are building connections over the first year of life, in the circuits that will allow them to use language. Now, remember we talked about detainer and Brian. And detainer was hearing language from his mother, a lot, very early before he was talking. So that means that while the genetics were telling that circuit to make connections, they were getting used the minute they were being made, and so they're strengthening. And that is going to play a role in why he has such a high vocabulary development. The pruning period goes on till about age 7. So getting children, as soon as they start talking, to talk and express themselves and be verbal -- I happen to have a grandson now who's ten months old, and he now can say one word. And his mom and dad were pretty upset. His first word was "kitty." He has two cats, he loves those kitties, but that's the only word he says. Nevertheless, he babbles non-stop. He understands lots of words, but using the circuits and allowing the child to use the circuits is really important for building strong circuits for language. Now I give lots of talks to people who are multilingual. They wonder should they be teaching children other languages early in life, or later. Well, languages have different sounds that you make. Not every sound made in every language is present in English. So if you want to be very good at speaking something like Mandarin Chinese, there are some sounds that are not in English. If you teach Chinese to a child before age 7, they're going to build neurocircuits for making those sounds. And they'll be able to sound like a native speaker the rest of their life. They can learn the language after age 7. I learned languages after age 7. I had years and years of Spanish. But if you were to hear me speak Spanish, you'd say, um, she must have had Spanish after the plastic period. And I did. I started in high school. So there are some sounds I make that will not sound like a native speaker. I'm capable of learning the language, but I'm not building circuits that underlie the language. So getting children to talk and to communicate in general -- because there's lots of other ways to communicate than just to talk. During the first seven years, is very important. Now, we have other circuits in our brain that develop on a very different time course. And what you see here is that for higher cognitive function -- that's things like thinking, reasoning, problem solving -- You're building circuits for the first 11 or 12 years of life, and pruning goes on until age 25. So it's really important during that period of pruning that you're able to use those circuits. That means the teenage years are incredibly important for things like reasoning and problem solving. Another question? 

>> Kaycee: Yes, ma'am. This person asked if you would talk about how the brain makers circuits in different ways for a child who's blind. For example, circuits that are made for learning through touch. 

>> Dr. Cameron: Yeah. I am absolutely going to do that. I have a poster here behind me and I'm going to do exactly that. I'll really try to talk about how do you build circuits when you have a deficit in a certain area? So we'll get to that very quickly. I'm now going to show you a short video, it's just a little over a minute. But it's going to reinforce what we've talked about here. The process of making connections and pruning connections. [Video playing] 

>> 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 architect. 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 useful -- More 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 neurosignals to travel across regions of the brain. Simple circumstances provide 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. This is 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 circumstances 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. Cameron: Okay. So you learned the basic process of brain development. Cells are there at the time of birth. At different times during development, they're genetically programmed to form extensions and make connections. And then the connections go through a period of pruning. And that period of pruning happens at different times for different circuits. But it's really important for circumstances to get used during the period of pruning or the plastic period. Then you'll have lots of circuits to underlie that skill. That is a concept that we can teach with writing. We can teach with little videos like what you just saw. But to getting people to really be able to think about how does this work and how am I going to be able to increase my child using circuits... Working for kids has developed a different strategy of teaching this.  And we have a poster of the brain. I have this poster right here behind me, and I'll use it in a couple of minutes. But I'm going to talk about what we do. So what we do is, we have pictures of different things. So here is a picture of a baby's face, with the eyes. And we use this picture to represent vision. We stick it on the brain, and we tell people... "Well, vision is important for human beings, and human beings develop a large part of the back of the brain to vision." This part is developed really early in life. It's one of the first parts of the brain to develop. We also have areas for emotion regulation, shown here with this face. And those formerly, too. You know that because babies are able to show emotions at the time they're born. It means they must have some circuitry for being able to do that. It's making connections before birth. And then they're being pruned for about the first five years of life. Now, lots of people say, wait a minute. That can't be right. Because you have emotions later in life that you don't have during the first five years. And that's right. You do. But, you're using the circuits that were built in the first five years of life. So it may make you rethink things like is that temper tantrum okay. I look at a child expressing emotion and I say, awesome! This is great. You want them to express emotion in the first five years. They're building strong circuits for making emotions and for understanding emotions. Emotion production, seeing different people express emotions, very, very important so that these circuits get used in the first five y years. The communication pathways, we already talked about. They're located in the middle of the brain, a little above where emotions are regulated. They're making connections, and they start making them before birth. A baby can make noises. They can't talk, but they can make noises at the time they're born. They are finished pruning at about year 7 which we just talked about. And there's a part of the brain up here at the top that are the motor pathways. And this he is pathways, the motor pathways are here, there's some sensory pathways here. And they are making connections before birth. Babies can move at the time they're born. And they finish pruning at about age 5. Now, you can learn lots of motor skills. I learned to ride a bike after age five. I learned to play tennis after age five. I learned to play the saxophone age five. But if I had learned before age five, I would be much letter at these things. Because I would have customized brain pathways. For shooting a basketball; for playing a violin. So the general principle is, you can learn skills after the plastic period. But if you want to be really good at that skill and have customized brain pathways for it, you want to get experience during the plastic period. Then we have this part of the brain. It takes the whole front part of the brain. When you say you're thinking, you mean you're using the front part of your brain. It is forming connections for the first 11 or 12 years of life. And it's pruning to age 25. It is connected to every other part of the brain. We then use yarn to explain how you make connections. And to get people to try to use this scientific information and apply it to their own lives. So this blue piece of yarn is talking about connections used to start talking. So -- and reading, for reading. When you read, you have to be able to see words. And you have to understand that they have a meaning. And so you have to know what that is. And that's in your communication part of your brain. So you need to connect the visual part of the brain to the communication part of the brain, to read really well. This part has its plastic period in the first year. This in the first seven years. Children will build really strong pathways for reading if you start reading early. And what I do when I'm teaching this is, I hold up my piece of blue yarn -- I've got it right here. And I say, okay, I'll make a loop if you give me an idea of what I can do with my child that would strengthen reading stills. reading skills. Frequently, people say, well, I would read to my child. Awesome. That's great. You'll read to your child. Make one loop with the blue yarn for reading. But remember, you have to use a circuit thousands and thousands of times. Sometimes I have parents say, I'm going to read to my child every night for seven years, so that they get that experience every night. And I say, hmm, well, there's 365 days in a year. And 7 times 365 is about 2,500. That's not nearly enough use. So even if you read to your child and you do that every night, they need to use that circuit much, much more. In order to really have strong circuitry. So you really need to think of other things you're going to do. You see there are several loops of blue yarn. This audience probably said, well, I'm going to read. Maybe you're going to take your child to the library so they can pick out books they really like. Maybe you're going to have them read while you're cooking dinner. They'll read the recipes. Maybe you'll have them read while you're driving in the car. They'll read road signs and advertisements. My dad used to always have us play the license plate game where you tried to spell a word and you had to find the letters in license plates. You need to work hard to get children to read enough. I remember when my eldest daughter was about four years old, she lined all her teddy bears up on her bear, and she would read to them at night. She would also reprimand them, and I wondered, is she learning that from me too? But I was very pleased to see her reading to her teddy bears. Because she's using those circuits, again and again. When you give people an activity, like using this yarn and getting them to think about what's really going to work in their own life to strengthen a particular skill... That's great. So what we're going to do is, we're going to put these pictures up on the brain I have right here. And we're going to talk about what if your child is born with some impairments in their visual system? What if they're born with impairments in hearing? But you want them to do as well as possible in terms of communicating. What can you do to do that? In order to give you an idea of, how can you help your child strengthen brain development. Okay. So we have this picture of eyes. You've already learned that eyes -- vision takes the whole back part of the brain. It's developing early, making connections before birth, through the first year of age. We have an ear here. And the part of the brain that controls hearing is this part that's actually right by the ear. The temporal cortex. So it's making connections before birth. And the pruning process, much of it goes on the first three years of life. There's a little more pruning till about age 7. And we're going to put our other pictures up, too. Emotion regulation got right here. It's being developed during the first three -- five years of life. Communication, the first seven. Motor skills, the first five. And cognitive function until you're 25. Now, let's take yarn and we're going to use our blue piece of yarn. And we're going to say, well, we want to have good communication skills. But we have trouble hearing. And we're not going to be able to talk to the child a lot in order to get them to communicate more. What can you do? Well, you should go see the doctor as soon as possible. In many states lately, laws have been passed so that children have to have hearing tests as early as possible. And a huge effort has been made by the hearing impaired community to advocate for this. And it's a really good thing because now that you know about plastic periods, you know you want to optimize hearing as early as possible. This is so that they can hear even a little bit during the plastic period, and those circuits can get used. So having cochlear implants put in, doing things that will optimize hearing is a good idea. You can also have hearing aids put in. And another thing that you want to think about is having this done early. So you want them to be able to hear things from you and then be able to communicate back to you. Sorry, my yarn is getting tangled here. Well, I don't know how that happened, but the -- okay. So, hear and communicate. And that will help. But, what if they really have a serious problem with hearing and you still want them to learn communication skills? The deaf community knows how to work with this. Okay? So there are other ways of communicating with children. You can communicate visually. You can communicate through sensory input, through touch. You want to use every strategy you can so that you're communicating through touch. That would be these motor pathways connecting to communication pathways. You'll have vision pathways connecting to communication pathways. What we're trying to give you a sense of here is that if one avenue of building strong pathways isn't available to you, you want to use another avenue for building those pathways. I think I'll pause for a minute here and see if there are questions about this. Because I'm suspecting there well may be. 

>> Kaycee: The question that came right before you started talking, I think you covered quite a bit of it, John asked, if a child is born blind, is there a different part of the brain that is developing instead of the part that is devoted to vision? 

>> Dr. Cameron: So the brain is very plastic. And if you are born blind and this part of the brain that we see here -- I'm trying to get my pointer to work. The back part of the brain would normally be devoted to seeing. But those brain cells will start to be used by other circuits that the child is using a lot. So let's say that you have a lot of sensory input. You're using touch and feel as a really important way of communicating with your child. Those areas are going to expand. And they can expand into this area that normally is controlled by the visual field. And that part can become dedicated to more sensory perception. So if there's no input through one circuit, and connections are made, but they're pretty much all pruned... Then those brain cells are available and they can be used for different things. And that is another part of how you have brain plasticity. A child that has lots of sensory input and touch will become super good at detecting the meanings in touch. And they'll have an expanded brain area that pays attention to these. Does that make sense? Okay. Do we have another question? 

>> Kaycee: No, not a question. The visual cortex lights up when the child is reading Braille. So like you were describing, that portion of the brain is being used through that tactile input through Braille. 

>> Dr. Cameron: Yeah. Wonderful. Okay. So let's talk a little bit about stress. And COVID-19 has been a huge stress for everyone. And it's been a stress for children that have impairments, for reasons that are different than most of the population. All the population has been afraid of their health. All of the population has undergone a lot of anxiety about having to socially distance. Not be able to go to work. But children that have impairments are really dependent on a community of providers. Having the people who work with them and help them with various things that they are trying to learn that they need extra attention for. Come to their house, work with them, or take the child to the taxpayerist's office. -- take the child to the therapist's office, that's been hugely impacted by COVID. So we're very aware that the situation over the last year and a half has been very difficult for the children you are working with. So let's talk a little bit about how stress exposure changes what children are doing, and, therefore, it impacts neurocircuits that are plastic when the stress is experienced. And that's a key phrase. What we want you to take away from this is that the circuits that are going to be most impacted by a stress... ...are the circuits that are plastic, right at the time that the stress has been experience wanted. But you just saw these pictures on the brain. And you know there's a huge amount of development and lots of different systems going on in the first few years of life. And those systems are the systems that are going to be sensitive to a change in the child's behavior or change in the experiences. And so we're going to be impacted by stress. Let's talk about how this happens. . So, here we have stress impacting circuits that are developing when the stress is experienced. You can see in this circle starting at the top... We're going from preconception to the prenatal period, early childhood, middle childhood, adolescence, adulthood. So we've got the whole arc of life. What we know is that stresses have an impact at the time they're experienced on the circuits that are plastic at that time. So if you experience a stress at 6 months of age, it's going to influence the circuits that are developing at 6 months. If you experience another stress at five years of age, well, you'll have two sets of circuits impacted by stress. The set at 6 months, and the set at 5 years. And because of that, the general principle that stresses accumulate over time, they're cumulative, is true. Because different parts of the brain are going to be impacted by stresses that are experienced at different times. So we come back to this again and we think, ooh, how exactly does that work? This red yarn that you see on this diagram is an example of a child facing a particular stress. Now, this isn't a stress due to COVID-19. The example shown here is the stress due to going up in a hustle with an adult that has trouble controlling their anger. And they get angry a lot. The child perceives anger quite often. Most children will get out of the way when they perceive anger. They'll run away. And that's a good thing. Because they're not going to take the brunt of the anger. How often will they experience anger if they're living in a house with somebody who has trouble controlling their anger? A huge amount of the time. So they'll have many, many exposures. And they'll develop a very strong brain pathway for sensing anger and getting out of the way. And the brain is building a circuit that it knows that child needs. It's great. It protects them when they're young. It's probably a really good thing. The brain builds circuits that it needs that are getting a lot of use. However, later in life, you can imagine that this wouldn't be so good. What if the child is now in 8th great, and the teacher gets mad because they didn't turn in their smoker. homework? You don't want the child to run away or leave, but they have a really strong brain circuit for doing that. What if they're 17 and the police pull them over for speeding? You don't want them to get out of the car and run away. But you have to understand that they have a really strong circuit for doing that. And so we need to work against circuits that were built kind of inadvertently. Nobody tried to help that child build a strong brain circuit for running away when they see anger. They did it on their own. So things that children do, whether you encourage them to do it or they just do it on their own, build brain circuits. And that's the take-home message you want to get. Now, the good thing is, we have these organ brain circuits. -- we have these orange brain circuits, that are being built all the way to age 25. So let's think about this child who runs away when they see anger. You could teach them that the teacher -- let's take the child in 8th grade that didn't turn in their homework. The teacher is not mad at them as a person. They're trying to tell them that they really need to do their homework for their own good. And so you want this cognitive part of the brain to communicate with the emotion perception. Oh, I know they don't hate me. They're just trying to get me to do my homework. And then you want that cognitive part of the brain to inhibit running away so you want to build circuits here and circuits there. And if you do a really good job doing that, the child then will go through the rest of their life. They'll rethink what they have to do when they see somebody that's angry. So you can change the trajectory. And you can do it by building circuits in the teenage and early adult years. The key that you have to remember is that you still have to do something about 10,000 times in order to build strong circuits. And that's the hard part. It may be hard to get kids to read and use reading circuits thousands of times. But that's nothing compared to getting teenagers to rethink things and reorganize what they do. You have to be a very clever adult to get them engaged. So, how do we apply that to children who have impairment in the visual and the hearing circuitry? Think of other ways of communicating. Not just early, but later in life. Now, they can use the front part of their brain as they're getting to the teenage years, the early adult years. And they can come up with many ways of communicating. They can use Braille. They can use a number of different communication strategies. But they need to think about doing it. And then they need to do it a lot. And as a community, we need to give them lots and lots of positive feedback to do that. So that we're strengthening these orange pathways and building new pathways that are going to allow them to communicate using different parts of their brain. I'd be happy to take questions, if there's questions at this point. 

>> Kaycee: Yes, ma'am, we have one. It says what about stress exposure for adults? Would that have an impact on neural circuits? Certainly our staff members are experiencing significant effects of the pandemic at work now. 

>> Dr. Cameron: Yes. Stress has influence on the brain through many mechanisms. So we've spent this morning talking about building brain circuits because that's the main way stress impacts children. --...impacts children's brains, they're right in the middle of building all these circuits, that's the main thing going on. Now, in adulthood, you are building circuits, but you're building them at a much slower rate. And there's other things that get activated by stress that will have an impact on your brain. People think about genes. And they think, okay, you're born with all the genes you have. But stress can change gene expression. So what is gene expression? If you're born with all the genes you have, what exactly does that mean? I think about it like I think about cooking and my cookbooks. I love to cook. I have a ton of cookbooks on a book shelf in my kitchen. Does that mean that I can make anything that's in those cookbooks? Or when you come to my house, you can eat anything in those cookbooks? No. You can only eat what I chose to cook. So I have all the recipes for lots of things. But I choose to express one of the recipes. Let's say I choose to make pizza when you come. That's what you have a choice of. You have pizza. I'm expressing that recipe. That's how gene expression works. All your cells have genes in them. They're all there. They're all available. But they don't get used to direct the business of your cells unless they get activated. And things like stress can activate very different genes than things like feeling pleasure or being happy or being peaceful. And so you can have an impact on stress that isn't caused by changing circuitry. It's caused by changing gene expression. This happens in children, too, but again, it's not as big of an impact as the changes in circuitry. Because that's what the child's brain is very busy doing. You also can release hormones with stress. So stress-related hormones. Many people have heard about cortisol.  It's a stress-related hormone that mobilizes fuel, it causes the liver to release fuel so you have lots of fuel to deal with things. That's great. But if you release cortisol over and over and over again, you can start to have an impairment in immune function. Again, it's not that this can't happen in children, but the main way that stresses influence children is by a rewiring. Because that's what their brain is so busy doing. So, yes, you, as an adult, will have an effect on your brain by other mechanisms. We wiring won't be the main mechanism. Okay. I'm happy to take questions. Keep on asking them. We're now going to really get to the heart of what we want to talk about. We wanted to talk about how to make kids resilient. How do we put in protective interventions that strengthen brain development? So many of us have this current conceptual framework. We think there's all sorts of things pushing up the trajectory of development of our children. And some of them are listed here. Parenting education. Sound nutrition. Stimulating experiences. Health-promoting environments. All of these things are good. But, significant adversity and stress pushes down on development. And it leads to an impairment in health and development. Now, what we really want is, we want to develop new protective interventions. So we'll still have all of these things helping children develop. But we have a buffer in there so that significant adverse didty doesn't have such an impact on your child. Now, this may seem golden and out of attainment, but it's not. All of us, all of you, with your own children, can put in these protective interventions. Because neuroscientists know a lot about what protects the brain. . So I am going to talk now about capabilities that help with stress management. If children can be taught to focus their attention, to problem-solve when they see a problem... ...to plan ahead so they can work around problems that occur... To...to regulate their behavior, to control their impulses and to adjust to new circumstances... ...then stresses that they experience will have much less of an impact on their brain. What part of the brain is controlling all these things? We call these executive function and self-regulation skills. And it's that front part of the brain. Now, that part is developing until age 25. So you have the ability to help kids really become much better at focusing attention, at problem solving, at behavior regulation, until they're 25 years of age. And if you can come up with creative ways to make those processes and using them, getting an experience doing these things, really fun... ...then you'll help them build brains that provide resilience against stress. They'll do much better with stress. They'll be much more protected. So we have help. Now, the first thing to understand is that all of these skills are conveyed to children by stable, caring relationships. -- relationships with adults. So a really important factor is helping children build stable, caring relationships within their family. But also stable, caring relationships with adults in many other parts of their lives. Adults are the ones who teach children the first things about communication. They share what's going on in the world. So the child learns skills. And if you do that really well, the child starts to share with other children. They're taking what they learn and they're using it with each other. They're using it in school. So adults that they come in contact with in school environments in community environments, can play really important roles, helping foster children to use skills that are developing. We're going to watch another short video that shows that. [Video playing] 

>> The key to forming strong brain architecture is what's known as serve and return interaction with adults. In this developmental game, new neuroconnections 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 interacts with a face or hand. This interaction forms the foundation of brain architecture upon which all future development will be built. It helps create neuroconnections 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 objects. 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 and serve in interaction, beginning in infancy, builds a foundation in the brain for all learning, behavior, and health that follow. [End of video] 

>> Dr. Cameron: Okay. So we're going to spend a few minutes now talking about how to interact with children. If interactions with kids are really important, how you interact really matters. And we're going to use some diagrams here that were developed by June Lee at the Fred Rogers center. If you're somebody my age, you remember watching before Rogers on PBS when you were a little kid. The center that was instituted by Mr. Rogers has done a lot of work on how to do a really good job communicating with children. And working for kids has worked with the Fred Rogers center to develop some diagrams that help teach that. So the first way to interact with a child is to pay attention to connection. How well you connect to a child. Now, what is meant by that is, if the child is happy when you're starting to do something together... ...you want to show that you're happy too, and that you recognize that they're happy, and they're in a good mood, by showing to them that you're in a good mood also. This turns out to be really easy for parents to do. They just naturally, when their child is looking happy, connect to them and show a similar emotion. The difficulty comes when the child is looking not as happy. Maybe they're not looking mad or sad, but they're looking very n neutral. You don't know, are they worried about something? Are they concerned about something? And many, many adults the tendency to use a happy face like this to try to cheer a child up. And that is not a good way to connect to the child. It's much more effective in developing good communication skills with children if the adult recognizes that the child is not happy right then. And the adult says, you look a little worried. Are you worried about something? Or you look a little concerned. Or you look a little unhappy. What's going on? And usually, if an adult shows that they recognize what the child is looking like, and cares about them, and is asking bit, this child will feel like you're connected to them. You're paying attention. You understand. You want to help them. It's a way more effective strategy than just trying to cheer them up. And so it's the first step in really good communication between adults and children. Always look at what -- where the child is, and connect to them at the place that they're at. Don't start by trying to change them. Now, I spend a lot of time talking to adults about this. And many adults are like, nooo, that's not what I do. I try to cheer them up. That's going to work. And I say, think about yourself. Think about it from an adult perspective. Maybe this is an easier way to think about whether that really works. So sometimes I'm at work and I'm really busy, and I have a lot of deadlines to meet. But I always leave the door to my office open so that people know I'm there, and they can get me if they really need me. If I have a student, a college student, that comes in and says, Dr. Cameron, I'm all excited about this... And I say, hmm, I am swamped and I'm on a deadline; let's talk about it later. I'm expecting that they'll see that I'm not in a receptive mood right now, and they'll come back later. Or they'll say, oh, I'm sorry. If they don't do that, if they say, no, I want to tell you about this, if it's going to make you really happy, do I get really happy? No! I get more irritated, because they're not realizing where I'm at. They're not recognizing my emotion. So seeing them be happy, even if they're going to tell me something that would make me happy, does not make me happy at that time. It makes me more annoyed because I feel like they don't care about me. They're not paying attention to me. Sometimes it's easier to get adults to hear this when they're thinking from the adult perspective. But then they can transfer that understanding to their children. Their children are just the same. They're people. And they want the adults in their life to recognize what emotional state they're in, what they feel like, and care about them, and ask about what's going on. So we put this first because we always want adults to rethink connection, and think about how to really effectively connect to your child. It's the basis of all communication. Now, the next real key part of communicating well with children is what's called serve and return. And this terminology was developed by the child council that I told you I'd been a member of for the last 20 years. You might think, oh, it's in the vernacular, you hear it all the time.  And you do. But you didn't hear it all the time 20 years ago. A lot of effort went to developing this nomenclature. Who's doing the serving? Well, the child is doing the serving. The child shows what they're interested in. The child shows how they want to communicate. And the adult gets that served from the child and returns it. So the child is serving; the result is recognizing what the child is doing, and is returning the serve. In really good communication between children and parents, children are serving, adults are building on that. They may be introducing new ideas of things to do or things to try. But they're building on what the child serves. They're not starting the interaction themselves. So this serve and return notion takes some thinking about for most adults. Many adults feel that they're the authority. They've grown up and gone through childhood. They know what to do that is successful. When you're thinking about communication skills for children that have trouble with vision, have trouble with hearing, the adult may think they're the most knowledgeable. To be most effective for that child, they need to pay attention to what the child wants to do. I've had many really interesting conversations with families of hearing impaired children. The parent may be feeling like we really want you to try, we're going to have cochlear implants, we're going to have hearing aids. We really want you to try to use hearing. The child is really interested in Braille. And the parent says, no, don't do that. But the child is serving. The child is showing what they're interested in. What an adult who's a really good communicator will do is build on that. Oh, you're interested in that. Let's look into it. And they may get them to use hearing more, but they don't ignore what the child is showing an interest in. So serve and return, with the child doing the serving. And the last really important piece of good communication skills is maybe the most difficult for adults. It's progression. Or opportunity to grow. So when children are very young, no matter what they're doing, they're learning to walk, learning to talk, they're learning to do anything, we give them little baby steps. And we help them each step of the way. We wouldn't have a child climb upstairs by themselves for the first time. Adults are right there, right behind them, making sure they don't fall, they don't go backwards. But at some point, in order for a child to be able to function independently, adults have to be willing to let children make a leap on their own. And this is really, really hard. And it's true not just for physical things, it's true for any skill a child is trying. When they're very young and they're learning, you help them each step of the way. But you have to pull back and give them room to try things on their own. It doesn't mean you walk away. They're not able to do things all by themselves anymore. The adult still needs to be right there, encouraging them, giving them lots of positive feedback, in order for them to succeed in starting to do things on their own. So they need that adult there. But they need some independence, too. So you're allowing them to progress. This is often called opportunity to grow. You're pulling back your help, but you're not going away. You're staying right there. You're being very supportive. These three skills in communication are incredibly important. The connection, the serve and return, and the progression. Now, working for kids makes lots and lots of educational tools. You back familiar with this brain poster where you can make your own circuits for thinking about how are you going to get your child to do anything. You can use this poster, and if you want to talk about other skills, we said the skills that we have in these pictures, you can contact us, and we're happy to make customized brain pictures and posters. Like I showed you for hearing, that's there. A number of you may have played a game we developed called the brain architecture game. It teaches how life experiences help build the brain. But what I want to focus on here is the first pathways game. This is really available to everybody. It's at firstpathwaysgame.com. You can get it on your phone, you just go to a server, is a father or Chrome, whatever server you like using. Put in the firstpathwaysgame.com and the game will come up. It'll ask you a couple questions. It'll ask you the age of your c child. And eventually you'll get to a wheel that spins. There are eight age brackets, 0 to 6 months, 6 months to 12, and so o on. And we actually now have 6 to 8 years of age. So there's games for children all the way from 0 to 8 years of age. When you land on a game, you can say play. Very frequently a little video clip will come up that shows an adult playing the activity with the child, so you can see what it's like. A narrator will tell you about the game, how to play it, and what skills you're helping strengthen by playing that game. There are also games available for children that were born prematurely, or children born on the autism spectrum. So we have kids with special developmental issues. And we have kids with regular developmental issues. If you find a game that you don't like or you don't want to play, just spin the wheel again and another game will come up. This is a fun way to get ideas for activities you can do with your child that will really use those brain circuits, at times, at ages where they're plastic. So first pathways game focuses on improving parent-child interactions. Getting parents and children to do things together. Because there's a very strong body of data, it's a very large body of data, that says the stronger the relationships, the children have with adults in their life... ...the faster they're going to improve in cognitive skills, things like problem-solving, reading skills, math skills. And the faster they're going to improve in social-emotional skills. So learning to recognize emotions and expectations. Learning to control their impulses and their behaviors. We think of those as social-emotional skills. Again, we know that the better the relationship between adults and children, the more likely the child is to have a really good growth trajectory on both cognitive skills and social-emotional skills. So working with kids has gains for adults and children to do together. Now, children can strengthen brain pathways by doing things on their own. We talked about that earlier. But there's lots of games out there that do that. So what we're trying to do is strengthen relationships and skills at the same time. Do we have a question? 

>> Kaycee: We have a few questions about the games. One of the questions is about the questions regarding the child when you first log into the first pathways game. If you're an educator and you're checking them out to see which ones might be appropriate for which students, does it matter what information you put in on the child? 

>> Dr. Cameron: No. It just asks you for an age. But -- to take people to the age of their child so they don't get frustrated. But if you want to look at all of them, as soon as you hit the play button, you can pick different ages every time you spin the wheel. 

>> Kaycee: Perfect. And then when you enter the age of the child, would you use their chronological age or developmental age? Adjusted age for premature? 

>> Dr. Cameron: So if you are talking about children born prematurely, you would use the adjusted age, especially for very young children. We think of children born prematurely as you really want to use the adjusted age during the first two years of development. After that, most people just use their actual age. If you're talking about children with other neurodevelopmental issues, we suggest that you go to the games for the diverse learner. So when you have the wheel and you have the age categories, there's a bar at the bottom that says games for the diverse learner. Those are not by age. They're by Level I, 2, and 3. And try some games at level 1 and see how they work for your child. If they're able to do those very easily, you might try level. Sometimes children are really good with one skill, but not so good with another. So take a child on the autism spectrum. They may be terrific at motor development. And so they'll be playing motor games, you know, running, kicking a ball, doing things like that, at level. -- at Level III, but they're not as good at communication skills and may be at level 1 for that. So you can adjust how you may the game to your child. 

>> Kaycee: And then one more question on the games, someone asked if they work with a switch interface, if the children can activate the games using a switch? 

>> Dr. Cameron: Not that I know of. So right now, they work this w way. In the next couple weeks, we will be releasing the game as an app, both for Android phones and IOS phones, so that you will no longer have to go to a website. You'll be able to download the app and then you'll have it on your phone. But it skill will need to be played very similarly. Anyway, that is a resource that's available to you. The last topic I want to talk about today, before we finish up, is helping communities develop charging stations, to support families in strengthening children's brain development. Now, what do I mean by charging stations? Well, this is a picture from working for kids. And we've put some charging stations here in the environment around this little child. This is a child, and they're surrounded by a circle of learning. And you've already thought about this as we've talked today. In order to learn any new skill, a child has to first get interested in learning it. And that can be a really hard part. It's a lot of why you want to use serve and return interactions. You want to see what the child is interested in, and then build on that. Because in order for them to use a circuit, thousands and thousands of times, to strengthen it, they have to be interested in learning the skill. They then have to engage their own brain circuits in doing the skill. They can't just watch an adult do it. They can't hear about how to do it. They're not going to strengthen that skill unless they use their own brain circuits to do it. So the child has to be interested in learning a new skill. They have to engage in the skill. And then they have to develop self-confidence. And they have to do this for two reasons. One, if you're going to use a skill thousands of times in order to build strong brain pathways, you have to have the self-confidence that you can do it. And then secondly, most skills require learning things in a stepwise manner. So think about learning to ride a bicycle. You didn't just get on a bicycle and go riding down the street. You probably learned to ride tricycle first, so you knew you had to pedal, and that was what made it go forward. Then you might have got a bicycle with training wheels, so you didn't have to have stability but you had to have a little more stability than you do on a tricycle. And finally, and I'm the oldest in my family so I remember this, someone older runs along with the bicycle and kind of holds the seat so you really are learning to balance. But you're not left on your own to fall over. And then you go out and do it on your own. So all learning is a stepwise process. You need to develop self-confidence with the early stages of learning in order to be interested in trying the next stage. So if you didn't develop self-confidence with training wheels, you're not going to be interested in riding a bicycle without training w wheels. So self-confidence is incredibly important. And this diagram shows things in the environment, attitudes you have adults, that improve the circle of learning. So the black words -- and we have tons of these, and when we're running a session to train people, we put all of them up -- Things like support and encouragement are very important. But, the red words represent attitudes that will work against this cycle of learning. Now, what are these charging stations doing here? Adults get overwhelmed. They're -- "I can't provide all of those positive supports. It's just me. I can't do everything the child needs." And what we tell people is, you don't have to. There are charging stations for you. Why do we use charging stations? Well, we use telephones. People's cell phones, as an example of -- as an example of something that needs to be charged. All of us use cell phones nowadays, it's one of the main ways we communicate. And we know it works really well in our lives, but it needs to be charged. If it runs out of charge, it won't work at all. And so we have to plug in that cell phone to get it to work or give it a charging station. People are the same way. You can't work when you're running out of energy. You'll be no use to your child if you're running out of energy. You need a charging station. Now, all of us have our own personal charging stations. I always say my sister is my personal charging station. If I'm in a really great mood, I call my sister and I tell her what happened today. And she is in a good mood too. If I'm in a terrible mood and horrible things happen, I call my s sister. And she gives me a hard time. She's my younger sister. And she tells me I'm worrying too much. But she cares and we talk about it. And by the time I get off the phone, I feel much better. So she's my charging station. She allows me to have reserve so that I can do difficult things, like help a child who's having problems. What can be charging stations? Other people can be charging stations. Your pet can be a charging station. Something that you do to feel good. Maybe you go for a walk. Maybe you take a warm bath. Maybe you go have your nails done. Whatever kind of helps you regroup and refresh is a charging station. Children have charging stations, too. So I told you I have a little grandson who's ten months old. Having his bottle is a charging station. Snuggling up in a blanket is a charging station. Just knowing that you'll pick him up when he gets frustrated is a charging station. So make use of the charging stations in your environment. We find lots of families that think they have to do everything perfectly and everything on their own. Be gentle with yourself. Let your children be gentle with themselves. Make use of charging stations. And then this is a charging station that is in a community, that can help lots of adults or lots of children. So maybe the therapist that works with your child is this kind of charging station. They're helping your child, but they're also helping lots of other children. If you take advantage that they're in the community, then that lifts that burden from you as an adult. Schools can be charging stations. Churches can be charging stations. Play groups or sports teams can be charging stations. Think of the charging stations that are in your community. And make use of your personal charging stations and your community charging stations, so that you don't feel overly burdened. And you have the strength and you're fresh and can help your child as much as possible. So we hope we've given you lots of tools, lots of ways of thinking about things. I think I'm going to turn it back over to. At this time, and I'm going to be very happy to join you for a discussion in just a little while. Thank you.