Pediatrics August 2021; 148 (2): e2021052582. Eco-bio-developmental model of emergent literacy helps identify risk These varied adversities share the potential to trigger toxic stress responses and inhibit the formation of SSNRs. Immediate Past Chairperson, David O. Childers, Jr, MD, FAAP, Program Chairperson, John Takayama, MD, MPH, FAAP, Website Editor, Robert G. Voigt, MD, FAAP, Newsletter Editor, Rebecca A. Baum, MD, FAAP Society for Developmental and Behavioral Pediatrics, Lynn Davidson, MD, FAAP Council on Children with Disabilities, Yekaterina Kokidko, DO Section on Pediatric Trainees, Sherri Louise Alderman, MD, MPH, IMH-E, FAAP, Chairperson, Jill M. Sells, MD, FAAP, Immediate Past Chairperson, Alan L. Mendelsohn, MD, FAAP, Abstract Chairperson, Ami Gadhia, JD Child Care Aware of America, Michelle Lee Section on Pediatric Trainees, Dina Joy Lieser, MD, FAAP Maternal and Child Health Bureau, Lucy Recio National Association for the Education of Young Children. Bronfenbrenner's ecological theory of development. PHIL 101 Notes - Society - Social Contract Theory: The social - Studocu Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health. In short, a public health approach to prevent childhood toxic stress is a public health approach to promote relational health. Toxic stress explains how many of our societys most intractable problems (disparities in health, education, and economic stability) are rooted in our shared biology but divergent experiences and opportunities. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. Acronym for Parent-Child Interaction Therapy; PCIT is an evidence-based intervention to change the patterns of parent-child interactions to improve the parent-child relationship. ecobiodevelopmental framework new morbidity toxic stress social Emphasizing that the vertical integration of this public health approach or the layering of primary, secondary, and tertiary preventions and/or interventions is necessary because the heterogeneity of responses to adversity seen at the population level will need to be addressed through a menu of programs that are layered and matched to specific levels of individual need (universal preventions, plus targeted interventions for those at risk, plus indicated therapies for those with symptoms or diagnoses). Importance: Literacy has been described as an important social determinant of health. Part 1 - Overview of Developmental Domains, Periods, and Theories a. Domains of Development b. However, FCPMHs are also called to advocate for policies at the federal, state, and local levels that promote safe, stable, and nurturing communities. Dara's child care center is close to her parents . This emphasis on universal primary preventions is congruent with the fact that more children are mentally and socially well and flourish as adults, regardless of their level of childhood adversity, if they also are afforded positive relational experiences and high family resilience and connection during childhood.59,121 Relational health includes more than nurturing in its traditional, spoken sense (eg, verbal warmth or responsivity); it also includes the activities that support the relationship more broadly (eg, reading aloud and a prescription to play), and research has documented that nurturing words and actions are inextricably linked.137 Although there are both practice-based (eg, Reach Out and Read [ROR],129,138,139 the Video Interaction Project [VIP],66,72 HealthySteps84,85) and community-based programs (eg, positive parenting programs,140,141 home visiting programs,142,143 quality early child care settings69,71) that promote these early positive relational experiences, they are not funded at levels that would make them universally accessible. The 3 principles described above, each of which is grounded in the research literature, provide a science-based framework for developing innovative strategies to promote SSNRs at the dyadic level, family level, and community level. A multigenerational perspective is fundamental. All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. Biological Sensitivity to Context/Adaptive Calibration Model. Other investigators have applied the term ACEs to additional adversities known to affect child health, such as poverty, neighborhood violence, and exposure to racism. Educate residents about the many different facets of a fractured early childhood system of care (eg, Medicaid, Individuals with Disabilities Education Act Parts C and B, Child Care and Development Block Grants, Head Start, etc), as there is little collaboration or communication between the systems, funders, and programs that address child health, out-of-home child care, education, special education, protective services, or public health. Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. Childhood trauma can alter developing brain, creates lifetime of risk An integrated, biodevelopmental framework is offered to promote greater understanding of the antecedents and causal pathways that lead to disparities in health, learning, and behavior in order to inform the development of enhanced theories of change to drive innovation in policies and programs. In the presence of SSNRs, a limited degree of childhood adversity (eg, normative childhood frustrations and setbacks) can lead to the positive stress responses that build the rudiments of resilience: a set of social and emotional skills that allow children to adapt to future adversity in a healthy manner. To prevent childhood toxic stress responses and support optimal development across the life span, the promotion of relational health needs to become an integral component of pediatric care and a primary objective for pediatric research and advocacy. Fortunately, adversity in childhood is only half the story, as positive experiences in childhood are associated with improved outcomes later in life. According to studies, how a human brain is structured shares connections to various subsequent behaviors. The challenge, then, is not only to prevent adversity but also (for mothers, fathers, and other engaged adults) to actively promote positive relational experiences throughout infancy and childhood. Adapted with permission from Garner AS, Saul RA. The currently ascendant Ecobiodevelopmental Theory argues that severe childhood stressors (known as Adverse Childhood Experiences or ACEs) affect children's genetic predispositions, brain. Toxic stress explains how a wide range of ACEs become biologically embedded and alter life-course trajectories in a negative manner. Similarly, symptomatic children need to be referred to evidence-based treatment programs (eg, ABC, PCIT, CPP, TF-CBT), but these are supplemental to and do not replace either targeted interventions for potential barriers to SSNRs or the aforementioned universal primary preventions. Primary preventions in the toxic stress framework are focused on how to prevent the wide array of adversities that might precipitate a toxic stress response. 3. Foremost on the advocacy agenda will be the need for serious payment reforms that consider the complexity of care attributable to adverse family and community contexts and include financial supports that incentivize families to engage with an FCPMH.204 Payment reforms need to be sufficient to allow FCPMHs to spend more time with families, function as interdisciplinary teams, integrate into their communitys initiatives and services to support children and families (horizontal integration), and anchor medical neighborhoods that not only foster wellness in childhood but promote positive outcomes across the life span. The biological response to frequent, prolonged, or severe adversities in the absence of at least one safe stable and nurturing relationship; these biological responses might be beneficial or adaptive initially, but they often become health harming or maladaptive or toxic over time or in different contexts. Society is currently trending toward division, marginalization, alienation, and social isolation.177 In opposing this trend and calling for a public health approach that builds SSNRs, the AAP is working to translate the latest developmental science into practices and public policies (see Table 2) that build healthy, resilient children. A public health approach that includes primary universal preventions to promote wellness (like promoting positive parenting practices), secondary targeted interventions for those deemed to be at risk for poor outcomes (like using biomarkers both to identify those at higher risk and to monitor the effectiveness of various interventions), and tertiary evidence-based treatments for the symptomatic (like referring to providers trained in TF-CBT). Acronym for Attachment and Biobehavioral Catch-up; ABC is an evidence-based program of interventions to assist foster parents in nurturing children who have experienced disruptions in care. For example, expanding family leave policies154 could reduce family stress and promote positive childhood experiences. Rather, an integrated public health approach (see Fig 1) is needed to support all children, including those with delays in development and special health care needs.8082 The foundation for any public health approach is universal primary prevention. HealthySteps is an evidence-based, interdisciplinary pediatric primary care program that promotes positive parenting and healthy development for infants and toddlers, with an emphasis on families living in low-income communities. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. These techniques come from family therapy, cognitive therapy, motivational interviewing, family engagement, family-focused pediatrics, and solution-focused therapy. Chp 2- evolutionary theories Theories of development Theories give a certain perspective Advantages: narrows down way to look at things Negatives: disadvantages to see everything around that one theory (it filters out too many things) Depending on what you are looking at may add different theories NOT JUST 1 5 theories will be seen (removing evolutionary)-Psychoanalytic theories-Humanistic . Efforts to repair strained or compromised relationships are likely to be more effective if other potential barriers to SSNRs are being addressed (eg, parental mental illness and basic needs) and additional efforts are being made to actively promote SSNRs (eg, the provision of developmentally appropriate play). To determine an individuals ACE score, see http://acestoohigh.com/got-your-ace-score. Be it child labor laws, federal grants to states to promote maternal-child health, support for paid parental leave after childbirth, required immunizations to attend school, the use of car safety seats, the adoption of children by same-sex parents, the harms of corporal punishment, the safe storage of firearms, the care of immigrant children in federal custody, the negative effect of toxins and global warming on child health, or the importance of nutrition and income support for healthy families, pediatric professionals have been a powerful force for bringing a scientifically grounded, evidence-based perspective to public debates. The first one is the Transactional of Development Model, proposed by Sameroff (Sameroff & Chandler, 1975; Sameroff & Fiese, 2000). ecobiodevelopmental theory asserts that: The concept of childhood toxic stress taps into a rich literature on the biology of adversity and explains the danger in overlooking significant adversity in childhood. Toxic stress responses are known to alter multiple systems that interact in a reciprocal and dynamic manner: genomic function, brain structure and connectivity, metabolism, neuroendocrine-immune function, the inflammatory cascade, and the microbiome.13,14 Toxic stress-induced alterations also influence the adoption of maladaptive coping behaviors decades later.3740. Just another site. Although intensive, capacity-building efforts for parents and other caregivers with limited executive function skills is beyond the scope of most pediatric settings, providing information and support around basic child-rearing practices and establishing daily routines is a cornerstone of traditional primary care. 2022 avalon exterior colors. Reciprocal experiences with engaged and attuned adults (like those that occur during developmentally appropriate play) that build SSNRs; they are warm, affirming, and inclusive, and they promote early relational health. Consequently, the challenge is not only to prevent a broad spectrum of adversities from occurring but also to prevent them from becoming barriers to the SSNRs that allow individuals from across the spectrum of adversity to be resilient and flourish despite the adversity.17,58,59. One expert has written that this synchronous biobehavioral matrix builds the childs lifelong capacity for intimacy, socio-affective skills, adaptation to the social group, and the ability to use social relationships to manage stress.117 Early relational experiences with engaged and attuned adults have a profound influence on early brain and child development. 1, Center on the Developing Child at Harvard University, Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics, The lifelong effects of early childhood adversity and toxic stress, Associations between early life stress and gene methylation in children, Differential glucocorticoid receptor exon 1(B), 1(C), and 1(H) expression and methylation in suicide completers with a history of childhood abuse, Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse, Annual research review: childhood maltreatment, latent vulnerability and the shift to preventative psychiatry - the contribution of functional brain imaging, Childhood trauma exposure disrupts the automatic regulation of emotional processing, Enhanced amygdala reactivity to emotional faces in adults reporting childhood emotional maltreatment, Childhood maltreatment is associated with increased neural response to ambiguous threatening facial expressions in adulthood: evidence from the late positive potential, Adverse childhood experiences, allostasis, allostatic load, and age-related disease, Child maltreatment and allostatic load: consequences for physical and mental health in children from low-income families, Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health, Genes, environments, and time: the biology of adversity and resilience, Leveraging the biology of adversity and resilience to transform pediatric practice, Building Relationships: Framing Early Relational Health, Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper No. Identify and address potential barriers to SSNRs. Children with known adversity but no overt symptoms,18 children with parents who experienced significant adversity as a child,86 and families struggling with the social determinants of health (SDoHs) (eg, poverty leading to food or housing insecurity,87,88 language barriers, or acculturation leading to conflicts within immigrant families89) may benefit from an array of interventions that mitigate specific risk factors. Ecobiodevelopmental theory asserts that: (a)early experiences create the structure of the brain (b)genes are the dominant determinant of brain development (c)early interventions cannot overcome the power of poverty in brain development (d)improving early nutrition could break the cycle of poverty 4. Advocate that health systems, payers, and policy makers at all levels of government align incentives and provide funding to promote the universal primary prevention work discussed in this policy statement. Many of the components of a public health approach to prevent, mitigate, and treat toxic stress responses (see examples) are also components of a public health approach to promote, identify barriers to, and repair SSNRs. A Comparison of the Toxic Stress and Relational Health Frameworks. An ecobiodevelopmental framework sheds new light on the biological basis for persistent disparities in education, poverty, and health. ecobiodevelopmental (EBD) framework to stimulate fresh thinking about the promotion of health and prevention of disease across the lifespan. Identify and address sources of inequity, isolation, and social discord (poverty and racism). Such an approach will require pediatricians, other pediatric health care professionals, and FCPMHs in general to partner with families and communities in practical and innovative ways to universally promote SSNRs, address potential barriers to SSNRs in a targeted manner, and afford indicated treatments that repair relationships that have been strained or compromised (see Table 2). If nothing else, pandemic-mandated stay-at-home orders should increase our collective awareness of the distress associated with being socially isolated or vulnerable. The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. The capacity to develop and maintain SSNRs with others; relational health is an important predictor of wellness across the life span. For many resource-poor families and older children, overall relational health is dependent not only on dyadic serve and return interactions with family members but also on trusted, SSNRs with others in the community through interactions at the medical clinic, school, recreation leagues, faith-based and civic organizations, community improvement efforts, and employment opportunities. Feminist theory asserts that gender is a social construct and that the unequal treatment of women is a result of patriarchal norms and values. Typically, restorative justice allows the victims and the offenders to mediate a restitution agreement that is satisfactory to both parties. Biological sensitivity to context is a theory with emerging evidence that children differ in their susceptibility to environmental influence in a for better and for worse manner, depending on their psychobiologic reactivity to stress. As a consequence, the very characteristics that are often thought of as childrens frailties (eg, high stress reactivity) can also be their strengths, given the right context.*,91,131,134,206. Relational health, in the form of at least one SSNR, is a universal, biological imperative for children to fulfill their potential; to be healthy and resilient; to be successful academically, economically, and socially; and, perhaps most importantly, to be the caregivers that value and build SSNRs with subsequent generations. Embrace an ecobiodevelopmental model for understanding how both adverse and positive relational experiences in childhood become biologically embedded and impact both negative and positive outcomes across the life course. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. Bronfenbrenner's Ecological Theory Of Development intel director salary. ACE = Events/Incidents which harm social, cognitive, and emotional functioning causing a dramatic upset in the safe, nurturing environments children require to thrive. Acronym for the family-centered pediatric medical home; in an FCPMH, the pediatrician leads an interdisciplinary team of professionals providing care that is: family-centered: the family is recognized and acknowledged as the primary caregiver and support for the child, ensuring that all medical decisions are made in true partnership with the family; accessible: care is easy for the child and family to obtain, including geographic access and insurance accommodation; continuous: the same primary care clinician cares for the child from infancy through young adulthood, providing assistance and support to transition to adult care; comprehensive: preventive, primary, and specialty care are provided to the child and family; coordinated: a care plan is created in partnership with the family and communicated with all health care clinicians and necessary community agencies and organizations; compassionate: genuine concern for the well-being of a child and family are emphasized and addressed; and. Taken together, these diverse lines of inquiry suggest that it may not actually be the wide spectrum of childhood adversity that drives poor outcomes but the degree to which that adversity drives shame, guilt, anger, alienation, disenfranchisement, and degree of social isolation.181,182 If so, the proposed public health approach toward the promotion of SSNRs is needed, not only to buffer adversity and promote resilience but also to begin bridging political, religious, economic, geographic, identity-based, and ideological divides that increase social isolation, encourage tribalism, diminish empathy, and, ultimately, drive poor outcomes in the medical, educational, social service, and justice systems. Other common-factors techniques target feelings of anger, ambivalence, and hopelessness, family conflicts, and barriers to behavior change and help seeking. More importantly, they are rarely integrated vertically with other programs that layer on additional efforts to address barriers to relational health (eg, SDoHs) or already strained or compromised relationships (eg, PCIT) when needed. See the Appendix for full descriptions of the abbreviations. This wide spectrum of adversity underscores the fact that ACE scores and other epidemiologically derived risk factors at the population level are not valid or reliable predictors of outcomes at the individual level.56 Toxic stress, by contrast, refers to an individuals physiologic response to these adversities, and biomarkers of this physiologic response have the potential to be more sensitive and specific measures of experienced adversity at the individual level.37 Validated biomarkers also offer transformational potential as measures of responsiveness to specific interventions.37,57 With these applications in mind, the pediatric research community is hoping to develop clinic-friendly, noninvasive biomarkers for different forms and degrees of adversity. Acronym for child-parent psychotherapy; CPP is an evidence-based, psychoanalytic approach for treating dysfunctional parent-child relationships based on the theory that the parent has unresolved conflicts with previous relationships. Conversely, a solution-focused approach would focus on relational health15 (see the Appendix for a glossary of terms, concepts, and abbreviations) by promoting the safe, stable, and nurturing relationships (SSNRs) that turn off the bodys stress machinery in a timely manner.1,16,17 Even more importantly, a strengths-based, relational health framework leverages those SSNRs to proactively promote the skills needed to respond to future adversity in a healthy, adaptive manner.16,18,19 The power of relational health is that it not only buffers adversity when it occurs but also proactively promotes future resilience. Contributors and Attributions. The medical home recognizes the family as a constant in a child's life and emphasizes partnership between health care professionals and families (as per the National Resource Center for the Patient/Family-Centered Medical Home at the AAP). Scientists now theorize that toxic stress causes epigenetic changes that allow trauma to be transmitted over the generations. Based on the EBD model, The Ecobiodevelopmental Theory model of toxic stress experiences provoke these memories, Shonkoff is associated directly to other theoretical which are essentially created by interactions models of human development. Acronym for Trauma-Focused Cognitive Behavioral Therapy; TF-CBT is an evidence-based, manualized, skills-based therapy that allows parents and children to better process emotions and thoughts related to traumatic experiences. Relational health refers to the capacity to develop and sustain SSNRs, which in turn prevent the extreme or prolonged activation of the bodys stress response systems. This guide asserts Without strong therapeutic alliances with patients, caregivers, and families, few of the recommended universal primary preventions will be implemented, few of the targeted interventions will be used, and few of the indicated treatments will be sought. ACEs are common stressful traumatic experiences which affect children's neurodevelopment. Understanding, practicing, and reinforcing executive functions and self-regulation skills (eg, managing strong emotions, ensuring adequate sleep, and getting regular exercise) is essential because all caregivers need these skills to create the kinds of environments in which children thrive.16,37,59 Whether an adult coaching or skill-building component is incorporated within a FCPMH or connected to it in a collaborative manner, the essential role that these programs play in promoting the healthy development of children is clear, especially for those who are the most disadvantaged.1,16. Available at: https://psych.utah.edu/research/labs/biological-sensitivity.php. This toxic stress framework is powerful, because it taps into a rich and increasingly sophisticated literature describing how early childhood experiences are biologically embedded and influence developmental outcomes across the life course.1214 This was the focus of the original technical report on toxic stress from the American Academy of Pediatrics (AAP) in 2012.2 Current threats to child well-being and long-term health, such as widening economic inequities, deeply embedded structural racism, the separation of immigrant children from their parents, and a socially isolating global pandemic, make the toxic stress framework as relevant as ever. Unfortunately, the two theories are very much at odds regarding what is "right." Shareholder theory asserts that shareholders advance capital to a company's managers, who are supposed to spend corporate funds only in ways that have been authorized by the shareholders. Module 3 Understanding & Using Theories - HDFS 501 - Studocu Tertiary preventions in the toxic stress framework are focused on the evidence-based practices that treat toxic stress-related morbidities such as anxiety, depression, oppositional defiant disorder, posttraumatic stress disorder, and substance abuse disorder. With almost a century of service to children, families, and communities, the field of pediatrics has made critical contributions at the interface of science and public policy. Biobehavioral synchrony refers to the matching of nonverbal behaviors (eg, eye contact), coupling autonomic functions (eg, heart rate), coordination of hormone release (eg, oxytocin), and alignment of brainwaves between a parent and an infant.