Fraser Mustard Presentación

These two programs which developed frameworks of understanding about the social
determinants of human development and health involved individuals from epidemiology,
medicine, education, psychology, neuroscience, economics, and child development. Both these
programs created new frameworks of understanding human development.

The evidence is growing that experienced-based brain development in the early years (including
in utero) influences risks for physical and mental health problems in early life. We can now
explore how the early stages of development affect the brain body interaction. Development
of the brain in the early years also affects learning and behavior. I will now review what we
know about brain development and how it can relate to health, learning and behavior. Including
motor, sensorial en socio emotional interaction. Cognitive area, moving area, emotional area
all interacting to make the human process.
The brain is composed of billions of neurons all of which have the same genetic coding as the
other cells in our bodies which raises the question: what causes nerve cells to differentiate for
their function as specialized neurons in different parts of the brain? We now know that their
differentiation is significantly influenced by the stimulation (experience) they are exposed to
particularly in early life. Experience also affects the development of the connections between
neurons. These are called synapses. One of the first pathways that was examined that
illustrates this point was the vision sensing pathway by Hubel and Weisel. They found that if
signals from the eye did not reach the vision neurons in the occipital cortex in the first years of
life, the child would not have normal vision.
This slide summarizes three of the key pathways in the brain that develop in the early years.
The sensing pathways as discussed are a key for language and cognition, but also play an
important role in sensing emotional stimuli. The stress HPA pathway influence host resistance,
cognition, emotion and behaviour. The third pathway on this slide is the autonomic nervous
system which has a strong influence on respiration and cardiovascular functions. It is closely
linked with the HPA stress pathway. We think these are the important pathways by which the
social economic environment in which you live and work gets under the skin.

Detailed analysis of the patterns of nerve connection that form from birth to age 14 have been
carried out. This slide which comes from the work of Huttenlocher shows the connections

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amongst the neurons at birth is not intense but that by the age of 6 the connection density is
considerable. By the age of 14, the connection pattern is still greater than at birth but is less
intense. The weak pathways have been cut out. This process is referred to as the wiring and
sculpting of the brain. The wiring of neurons in the brain is hugely influenced by stimulation
and the use of these neuron pathways. Thus, as you age, pathways that are not intensely used
will disappear (use it or lose it). What this evidence does show, is that the early period of life
has a significant effect on the wiring and sculpting of the brain.

Nelson, at the University of Minnesota, has outlined the wiring (synapse formation) and
sculpting of the brain in the early years in respect to the sensing pathways, language and
cognition. This shows you that the sensing pathways develop before language and this develops
before cognition. It is clear that the development of these pathways occurs in the early years
of life and is dependent on experiences in utero and in the early years of development. A
problem in the development of sensing pathways in early life will obviously influence language
development and cognitive development, which follows the development of the sensing
pathways.

The brain is composed of billions of neurons all of which have the same genetic coding as the
other cells in our bodies which raises the question: what causes nerve cells to differentiate for
their function as specialized neurons in different parts of the brain? We now know that their
differentiation is significantly influenced by the stimulation (experience) they are exposed to
particularly in early life. Experience also affects the development of the connections between
neurons. These are called synapses. One of the first pathways that was examined that
illustrates this point was the vision sensing pathway by Hubel and Weisel. They found that if
signals from the eye did not reach the vision neurons in the occipital cortex in the first years of
life, the child would not have normal vision.

There are two aspects of the stress pathway. The quick response, which is the autonomic
pathway, and the HPA pathway which acts for a longer period of time.

This is turning out to be a key pathway that affects m any aspects of how we function and it
looks as though experience in early life sets functions that seem to be embedded throughout
life.

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In the exploration of the development of the sensing pathways in the brain, it has become fairly
clear that the development and differentiation of neurons that interact with the signals from
the sensing pathway involves the turning on and off of genes which determine the function of
these parts of the brain. Thus, as Hyman states, “light impinging on the retina on the eye or the
mother’s voice on the auditory nerve, turns genes on/off, fine tuning those structures both
before and after birth”.
We know from the work of Tremblay and others that the conditions of early child development
influence the risks for antisocial behavior and violence in male children as they grow up and
become stronger. We also now know that children subject to physical or sexual abuse when
they are young, are at high risk for behavioral problems as teenagers or in adult life. Abuse
when the children are young produces significant changes in brain structure and function. These
changes are associated with the risk of drug and alcohol addiction. In effect, the trauma to the
brain produced by abusive family relationships leads to what can be considered as disease of
the brain which is manifested in drug and alcohol addiction.

The detailed work of Tremblay and his team has shown that the behavior problems can be
traced back to fetal development and infancy. High quality caregiving support – during the first
three years – reduces the seriousness of the behavior problems. These behavior problems
appear to be related to early child development and the setting and control of the HPA pathway.
Teicher has shown that severe stress (abuse) in early childhood produces structural changes in
the brain that affects function.

Teicher found, “the aftermath … can appear as depression, anxiety, suicidal thoughts, or post-
traumatic stress – or as aggression, impulsiveness, delinquency, hyperactivity”. This work has
shown the changes in brain structure as a result of these traumatic stimuli. Thus, adverse
circumstances in early life can produce what appear to be permanent alterations in brain
structure.

This slide illustrates some aspects of the pathways between the brain and immune system. The
pathways can inhibit or stimulate the brain immune system pathways. The orange arrows
indicate stimulation and the blue arrows inhibition. Immune cells can produce cytokines
(chemical signals) that can stimulate the hypothalamus either through the bloodstream or
nerves elsewhere in the body to produce cortico releasing factor. The cortico releasing factor
can activate the pituitary adrenal gland system leading to the release of cortisol, which can

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usually dampen down the immune system response. Cortico releasing factor can also act on
structures in the brain stem such as the locus ceruleus, to stimulate the sympathetic nervous
system, which innervates immune organs and tissues throughout the body and regulates
inflammatory responses throughout the body. In this complicated process, reduced sterol
output can be associated with an overactive immune system.
All of you will have had some experience with stress and vulnerability to colds.
We now better understand the dynamics between genes and experience. This slide shows you
the evidence concerning the serotonin transporter gene function in the hippocampus frontal
brain interaction and the risk for depression in adult life. These data are from the longitudinal
study of the Dunedin birth cohort in New Zealand. Similar observations have also been provided
from studies of rhesus macaque monkeys. Poor treatment of monkeys or humans when they
are young can lead to poor regulation of the sterol pathways with effects on the serotonin
pathway. For the humans with the short allele for the serotonin transporter gene, if they are
maltreated when they are young, their stress serotonin pathway in adult life is altered and their
risk of depression as adults is greatly increased. If they are not poorly treated when they are
young, their risk for depression in adult life is the same as those with the long allele. This is
concrete evidence about the effects of early experience on brain function and mental problems
in adult life and the interaction between experience and gene activation. Since mental health
problems such as depression are a significant cost to society, it is quite clear that public policy
to improve early child development in our society should be much stronger than it is at the
present moment. The costs of treating depression and its social costs are probably greater than
prevention measures through improving the conditions for early child development through
early child development and parenting centres. We know that maltreatment of young children
can affect brain development in the early years and that this can have long-term effects.

In my presentation today I will look at some of the historical evidence, epidemiology data, data
from longitudinal studies, data from intervention studies to improve early child development,
and recent information from the biological sciences, particularly the neurosciences, to
emphasize that the mind body interaction is a key field for research in the 21st century.
The detailed British study by Sir Donald Acheson and his team on inequalities in health for the
U.K. government in 1998 concluded, after having reviewed all of the evidence about early
childhood and health, “Follow up through life of successive samples of birth has pointed to the
crucial influence of early life on subsequent mental and physical health and development.” This
is from the 1998 report, Inequalities in Health.

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Tom McKeown concluded from his studies that the decline in mortality in the United Kingdom
during the 19th and 20th century was due to something other than medical care and that only
about 25% of the decline appeared to be due to public health measures. Through a process of
exclusion, he concluded that the main reason for the decline of mortality was the improvement
in the nutrition of the population resulting in part from improvements in the prosperity of
British society. Fogel in his detailed analysis a decade later also concluded that the decline of
mortality in Western countries in the last 250 years was largely related to social and economic
factors and not to improved medical care. He took the subject a step further than McKeown
and observed that the decline in mortality was associated with an increase in the mean height
of these populations. Since height is a product of the genetic characteristics of an individual
plus their nutrition in their early years, he concluded that a significant factor influencing
mortality in adult life could be related to the better quality of early childhood in which improved
nutrition was an important factor.
The detailed British study by Sir Donald Acheson and his team on inequalities in health for the
U.K. government in 1998 concluded, after having reviewed all of the evidence about early
childhood and health, “Follow up through life of successive samples of birth has pointed to the
crucial influence of early life on subsequent mental and physical health and development.” This
is from the 1998 report, Inequalities in Health.
Among the conditions that appear to be influenced by conditions in utero and early child
development that manifest themselves in adult life are; coronary heart disease, non insulin
dependent diabetes, obesity, blood pressure, aging and memory loss, and mental health
problems. There is now active exploration about how pathways in the brain affect the biological
pathways that affect physical and mental health. The hypothalamus pituitary adrenal gland
(stress pathway) appears to be a key pathway. Although not usually discussed, the quality of
early child development appears to have a significant effect on the chronic health problems of
adult life.

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