Mark Attridge, PhD, MA1 and Laura Ghali, PhD2,3
Monitoring Editor: Margaret Clarke, MD and Laura Ghali, PhD
1Attridge Consulting, Inc., Minneapolis, Minnesota
2Fraser Mustard Chair in Child Development, University of Calgary, Department of Paediatrics, Calgary, Alberta
3Alberta Children’s Hospital, Calgary, Alberta
Received May 16, 2011; Accepted July 29, 2011.
This paper introduces the special issue of the Journal of the Canadian Academy of Child and Adolescent Psychiatry on the theme of how multiple factors in early brain and biological development can influence a variety of outcomes in mental health and addictions in childhood, adolescence and adulthood.
In Part 1, we preview three papers in this issue. In Part 2, we highlight two recent innovative knowledge-transfer symposia featuring the application of the science in early development and addictions.
The papers focus on the subtopics of brain plasticity, mood disorders, and comparative research with monkeys on gene-environment interactions and parent-child attachment. In addition, the research presented at the Early Brain and Biological Development Symposium and the Recovery from Addiction Symposium is also reviewed. Held in 2010 in Banff, Alberta, each five-day program was intended to bridge the gap between scientific and clinical experts and those in the province responsible for policy, programs, and services.
The science now links common neurobiological maturation processes, adverse early childhood experiences, and key aspects of the social environment with risks for mental health disorders and addictions later in life. The final paper in this issue examines the clinical and policy implications of this research knowledge.
Keywords: addiction, brain, development, knowledge-transfer, symposium
Présenter le numéro spécial du Journal de l’Académie canadienne de psychiatrie de l’enfant et de l’adolescent qui explique qu’au moment du développement cérébral et biologique certains facteurs peuvent avoir une incidence sur la santé mentale et les addictions pendant l’enfance, l’adolescence et à l’âge adulte.
Dans la première partie nous présentons trois articles tirés de ce numéro; dans la deuxième, nous nous concentrons sur deux symposiums récents et novateurs qui ont pour thème le transfert des connaissances et qui traitent de l’application des méthodes scientifiques à l’étude du développement du cerveau et des addictions.
Ces articles se concentrent sur la plasticité du cerveau et les troubles de l’humeur; ils analysent les interactions gène-environnement et l’attachement parent-enfant à partir d’une étude comparative menée sur des singes. En outre, ces articles portent sur les travaux de recherche présentés lors de deux symposiums, le Early Brain and Biological Development Symposium et le Recovery from Addiction Symposium. Ces symposiums de cinq jours chacun, qui se sont tenus en 2010 à Banff (Alberta), visaient à créer un lien entre scientifiques et cliniciens, et entre les responsables, au niveau provincial, des politiques, programmes et services.
Les scientifiques reconnaissent maintenant le lien entre la maturation neurobiologique courante, les expériences négatives vécues dans la petite enfance, les principaux aspects de l’environnement social et les risques de maladie mentale ou d’addiction. L’article final de ce numéro du Journal de l’Académie canadienne de psychiatrie de l’enfant et de l’adolescent analyse les implications cliniques et politiques découlant des résultats de ces études.
Mots-clés : addiction, cerveau, développement, transfert de connaissances, symposium
This paper serves as an introduction to this special issue of the Journal of the Canadian Academy of Child and Adolescent Psychiatry on the theme of how multiple factors in early brain and biological development can influence a variety of outcomes in mental health and addictions in childhood, adolescence and adulthood. Early childhood is a time of great opportunity for positive growth and a period of considerable risk as well. What is done – or not done – during this early part of life can have profound implications for the individual and also for society. As a demonstration of practical value of this research, we also highlight two recent innovative symposia featuring the application of science in this area to research, training, and clinical services in the province of Alberta.
Early brain and biological development is influenced by the effects of the interplay of experiences occurring before and after birth on a child’s genetic code. Emerging research across a wide range of disciplines provides compelling evidence that what happens during the first few years of life influences health outcomes, behaviour, social adjustment, and learning over the long term. Early development thus sets the course for health and well-being over the lifespan. A research-based understanding of epigenetics, developmental neuroscience, and behavioural neuroscience is shifting the way we approach support for development in childhood and adolescence and the way we must begin to redirect clinical treatment and prevention activities for many diseases including mental health and addictions. Full appreciation of these scientific facts is leading to important opportunities for clinical and policy innovations for child and adolescent mental health in Canada (Kutcher, Hampton, & Wilson, 2010).
PART 1: Introduction to the Special Issue
The theme of the special issue concerns how multiple factors in early brain and biological development can influence a variety of outcomes in mental health and addictions in youth and adulthood. This article provides a brief overview of each paper in the issue and notes why this information is relevant to research and clinical services for child and adolescent psychiatry.
Preview of the Papers in this Issue
The first paper: “Brain Plasticity and Behaviour in the Developing Brain” was prepared by Bryan Kolb and Robbin Gibb. It reviews ways the developing brain is sculpted by a wide range of pre- and postnatal factors. The paper begins with an overview of brain development, is followed by a brief review of the principles of brain plasticity and concludes by considering how certain factors influence brain development and adult behaviour. Brain structure and function are altered by the experience of a wide range of factors during pregnancy and after birth (Kolb & Whishaw, 2011). Brain development starts before birth and continues into early adulthood. The development of the brain reflects more than the simple unfolding of a genetic blueprint; rather it reflects a complex dance of genetic and experiential factors that shape the emerging brain. Brains develop in ways that reflect the influence of exposure to environmental events such as sensory stimuli, drugs, diet, hormones, and stress. Plasticity refers to the brain’s capacity to change in response to external influences and experiences, particularly during the first few years of life. Research in epigenetics suggests that early interpersonal experiences (e.g., caregiver-child relationships) influence both gene expression and brain architecture, which then influence a wide range of behaviour in adulthood.
The second paper is called “Psychological and Neurobiological Mechanisms by Which Early Negative Experiences Increase Risk of Mood Disorders” by Stefanie Hassel, Margaret McKinnon, Andrée Cusi, and Glenda MacQueen. This paper examines how early life experiences can have severe and long-lasting effects on behavioural and emotional functioning, which, in turn, appear to increase the risk for unipolar depression and other disorders of affect regulation. Depression is a chronic and serious mental illness that appears to change brain architecture and function (McKinnon, Yucel, Nazarov, & MacQueen, 2009). It is linked to an increased risk of other mental and physical health problems. In addition, the whole family of an individual who experiences depression may experience depression, as well, as it is a chronic and cyclical disease. The specific neurobiological and psychological mechanisms, however, through which adverse early life experiences confer risk for mental health and addiction disorders are just beginning to be understood. Several areas of research offer promising potential for greater understanding of such mechanisms. For example, alterations in brain structure and function in the limbic and prefrontal cortical regions of the brain, certain changes in cognitive function which co-occur with or pre-date the onset of mood disorders, basic social cognition processes, and emotional temperament and personality factors may all affect vulnerability to mood disorders.
The third paper is called “Risk, Resilience and Gene-Environment Interplay in Primates” by Stephen Suomi. It reviews research investigating how genetic and environmental factors act – and indeed actually interact – to shape the behavioral and biological developmental trajectories of individuals. The paper is organized into three areas: description of the normal patterns of social organization and development in rhesus monkeys; behavioural and biological consequences of different early attachment relationships; and, gene by environment interplay. Rhesus monkeys share many of the same genetic factors and social characteristics with humans and thus offer a useful comparative perspective for understanding primary developmental issues. Genetic factors are not the only source of inter-individual variability in the behavioral and biological characteristics of monkeys, as social experiences also matter, especially early attachment experiences with the infant monkeys’ biological mothers (or in some cases, alternative caregivers or peers) during their initial months of life. These early attachment-related experiences become manifest not only in terms of observable behaviors and expressions of emotions but also in terms of neuro-endocrine output, neurotransmitter metabolism, brain structure and function, and even gene expression. Secure attachment relationships somehow confer resiliency to individuals who have certain genetic factors (particularly the 5-HTT and MAO-A genes) that may otherwise increase their risk for adverse developmental outcomes. Much of this “maternal buffering” appears to take place in the context of early face-to-face interactions between rhesus monkey infants and their mothers. The study of rhesus monkeys provides compelling evidence of how gene-environment interactions can yield a wide range of positive and negative outcomes later in life (Suomi, 2006).
Implications of the Research
These three review papers each highlight research that underscores a central theme of the importance of early experiences in contributing either to lifelong health and resiliency or to illness and psychiatric problems. The exciting collaboration of research scientists from psychiatry and neurobiology has yielded some interesting and important insights into how the brain develops over time and how it is affected both by genetic and biological factors as well as social factors.
For scholars and practitioners in the field of child and adolescent psychiatry who work with very young parents, there are several important implications. The first is the need for a strong emphasis on a context of positive social relationships for pregnant mothers and during early parenting years. This period is one of high-risk for maternal depression and stress for all other family members who must adjust to a new child. Providing supports, skills training, therapeutic interventions and mental health treatments for young parents is one area where child psychiatry can make a difference.
A second implication is that the period of adolescence is a fertile time when many mental health illnesses and addictions may first emerge and for family stress to peak as well. As the brain of the adolescent continues to mature until the age of the early- to mid-20’s, targeted psychiatric interventions for teens and young adults can effectively identify and address risks and early warning signs much sooner than is typical of first treatment interventions during the years of the late 20’s or early 30’s. Such early interventions are shown to decrease both the severity and treatment-resistance of future mental illnesses.
A third theme from the neuroscience research on early development relevant to the readers of this Journal is the recognition of the social context in general. The interplay of the child and care-giver and of the child in other relationships interacts with the neurobiological maturation processes and is a major component of how genes are expressed and thus of healthy neurocognitive development. And this is precisely the area where child and adolescent psychiatry has a lot to offer in terms of theory, research and clinical applications that address how to have positive social relationships, both within the family and with the larger social milieu that affects every one of us.
The application of these insights for clinical practice, intervention programs, and social policy is an important next step. Please note that the final paper in this special issue addresses this issue in depth. However, in the next part of the present paper, we present an example of an innovative approach to knowledge translation in the area of early brain and biological development that began last year through two recent applied action symposia. Part of this work identifies new knowledge translation tactics for how to communicate the “core stories” from the research to the public and to policy makers. It also examines how this area of neuroscience and child development can shape the development of best practices in addiction treatment and recovery.
PART 2: Review of Science in Action Symposia
In 2010, the Alberta Family Wellness Initiative partnered with Alberta Health Services and Alberta’s Safe Communities Secretariat to develop two inter-related and interdisciplinary knowledge-mobilization strategies to bring scientific findings and knowledge to issues of early childhood and addiction.1 As part of a three-year plan for Alberta, these strategies aim to create a platform to provide knowledge competencies and encourage engagement and integration among and between researchers, policy makers, and clinical practitioners in a variety of fields. The strategies were launched with two major five-day symposia held in Banff, Alberta, Canada. The first symposium was held in the spring of 2010 and focused on the topic of early brain and biological development. The second symposium was held in the fall of 2010 and addressed the neuroscience and developmental foundations of addiction and related best practices in treatment and recovery from addiction.
Over 100 participants from various organizations in the Province attended each symposium. The participants were different for each symposium and were carefully selected through a competitive application process. Furthermore, each participant was asked to continue his or her involvement over a three-year period. These people represented a diverse range of backgrounds, perspectives, and professions including: policy makers, program developers, health practitioners, clinicians, researchers, physician residents in training, students, members of the judiciary, advocates, and funders, in addition to numerous professional bodies and organizations. The learning environment for both symposia featured plenary presentations in the mornings by the expert faculty, followed by afternoon sessions with large cohort groups that focused on understanding and learning to communicate the science. Various applied learning tasks, including considerations in communicating the symposium content to colleagues, were accomplished in small groups and as individuals. On the last day of each symposium, the learning team small groups made presentations to senior level guests from academic, health care, and policy areas in Alberta on their plans to carry the work forward in the year ahead following the symposium.
The faculty presenters at the Early Brain and Biological Development (EBBD) Symposium included 11 professors from major university research programs in Canada and the United States. The Recovery from Addiction (RFA) Symposium featured a faculty of 17 professors and senior clinicians from research universities and treatment programs in Canada and the United States. The RFA Symposium also had four experienced clinicians who led large-group interactive workshops and discussions each afternoon. Three of the faculty members (Bryan Kolb, Glenda MacQueen and Stephen Suomi) are also co-authors of papers in this issue. Due to the overlap in content between their symposium presentations and their papers in this issue, the material from their talks in Banff is not included in the symposium summaries presented below.
Each symposium has a detailed summary report that is available at no cost (see Table 1). The first author of the present paper was the rapporteur for both of these reports. Much of the material presented in the following sections is adapted from these more detailed reports.
1Created in 1997, the Norlien Foundation is a proactive private foundation with offices in Calgary and Edmonton, Alberta. The Foundation is active in knowledge translation and transfer, applied research, evaluation, and networking. It has established partnerships with numerous national and international organizations working in the areas of childhood development, addiction, and mental health. In 2007, the Norlien Foundation created the Alberta Family Wellness Initiative. Based on a framework of epigenetics and developmental and behavioural neurosciences, this initiative creates opportunities to better understand and apply scientific knowledge to factors influencing child development and its relationship to addiction and other mental health outcomes. For further information see http://www.norlien.org