Why Infant Mental Health?Neil W. Boris, MDTulane Institute of Infant and Early Childhood Mental Health
Reason 1:      Fetal Programming      2)   Attachment      3)   Therapy
Fetal or Developmental Programming:“…biological systems adapt to input from the environment during especially sensitive pe...
Consider the nightmare of the                      “Hungerwinter” of 1944                •    Dutch under German occupatio...
Dutch Famine Study 1944-5Periconception    1st Trimester   3rd Trimester  Schizophrenia
Dutch Famine Study 1944-5Periconception    1st Trimester       3rd Trimester  Schizophrenia                  Increased Obe...
Dutch Famine Study 1944-5Periconception    1st Trimester        3rd Trimester                                          Bir...
Dutch Famine Study 1944-5Periconception              1st Trimester           3rd Trimester      Fertility         Gestatio...
Fetal Nutrient demand   Maternoplacental nutrient supply   • Nutrient availability   • Placental function and transfer   •...
Anne Murphy Paul @ TED                   What we learn before we’re bornhttp://www.ted.com/talks/annie_murphy_paul_what_we...
The Adverse Childhood Experiences (ACEs)                        Study            • The largest study of its kind ever done...
Abuse  Physical    10.6%  Sexual      28.3%  Emotional   20.7%
Abuse   Physical    10.6%   Sexual      28.3%   Emotional   20.7%Neglect   Physical     9.9%   Emotional   14.8%
Abuse   Physical                        10.6%   Sexual                          28.3%   Emotional                       20...
Adverse Childhood Experiences and         Adult Depression  Odds Ratio               Adverse Events                       ...
Adverse Childhood Events and   Adult Substance Abuse  Self-Report: Alcoholism   Self-Report: Illicit Drug Use             ...
Cumulative ACEs Increase the Risk of       Negative Outcomes 14                               Attempted                   ...
ACE Studies Summary of Findings• Adverse Childhood Experiences are very  common.• ACEs are strong predictors of later heal...
ACE Studies Summary of FindingsThis combination makes ACEs one of theleading, if not the leading, determinant of thehealth...
Felitti’s General Model-Trauma Effects                    Early                    Death                  Disease &       ...
James Heckman and the Question of        When to Intervene….• Nobel prize winning economist who teaches at  U-Chicago• Foc...
Early Intervention Pays
Thank you for your attention! Neil W. Boris, MD Tulane Institute of Infant and Early Childhood Mental Health
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Reason 1: Fetal Programming

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Reason 1: Fetal Programming

  1. 1. Why Infant Mental Health?Neil W. Boris, MDTulane Institute of Infant and Early Childhood Mental Health
  2. 2. Reason 1: Fetal Programming 2) Attachment 3) Therapy
  3. 3. Fetal or Developmental Programming:“…biological systems adapt to input from the environment during especially sensitive periods of development; furthermore, the malleability of biological systems to adjust to environmental input is developmentally constrained, so that systems that adapt to environments early in life do not readapt to subsequent changes in the environment…” p. 674, O’Connor, 2003
  4. 4. Consider the nightmare of the “Hungerwinter” of 1944 • Dutch under German occupation • Sudden starvation • 20,000 people die • What happens to pregnant women?http://www.pnas.org/content/107/39/16757.full.pdf+html
  5. 5. Dutch Famine Study 1944-5Periconception 1st Trimester 3rd Trimester Schizophrenia
  6. 6. Dutch Famine Study 1944-5Periconception 1st Trimester 3rd Trimester Schizophrenia Increased Obesity
  7. 7. Dutch Famine Study 1944-5Periconception 1st Trimester 3rd Trimester Birth weight incl. 2nd Generation Schizophrenia Increased Obesity
  8. 8. Dutch Famine Study 1944-5Periconception 1st Trimester 3rd Trimester Fertility Gestation length-preterm Maternal Weight Birth weightOrganic Brain Defects Stillbirths incl. 2nd Generation Schizophrenia Neonatal Mortality Mortality Months Antisocial Behavior Increased Obesity Decreased Obesity Nutr Rev 1994, 52: 84
  9. 9. Fetal Nutrient demand Maternoplacental nutrient supply • Nutrient availability • Placental function and transfer • Uteroplacental blood flowFetal adaptations (e.g., re-programming) If demand is > maternoplacental supply Then alterations how key organs function Disease and Disability—YEARS later!
  10. 10. Anne Murphy Paul @ TED What we learn before we’re bornhttp://www.ted.com/talks/annie_murphy_paul_what_we_learn_before_we_re_born.html
  11. 11. The Adverse Childhood Experiences (ACEs) Study • The largest study of its kind ever done: ~18,000 participants. • Examined the health and social effects of adverse childhood experiences over the lifespan. • Conducted by a group at Kaiser Permanente, a large HMOFor more on the Adverse Childhood Experiences Study, see:http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=DetailsSearch&term=adverse+childhood+experiences+study
  12. 12. Abuse Physical 10.6% Sexual 28.3% Emotional 20.7%
  13. 13. Abuse Physical 10.6% Sexual 28.3% Emotional 20.7%Neglect Physical 9.9% Emotional 14.8%
  14. 14. Abuse Physical 10.6% Sexual 28.3% Emotional 20.7%Neglect Physical 9.9% Emotional 14.8%Household Dysfunction Mother treated violently 12.7% Household substance abuse 26.9% Household mental illness 19.4% Parental separation/divorce 23.3% Incarcerated household member 4.4%
  15. 15. Adverse Childhood Experiences and Adult Depression Odds Ratio Adverse Events Chapman et al, 2004
  16. 16. Adverse Childhood Events and Adult Substance Abuse Self-Report: Alcoholism Self-Report: Illicit Drug Use Dube et al, 2002, 2005
  17. 17. Cumulative ACEs Increase the Risk of Negative Outcomes 14 Attempted suicide 12 Injected drug use Alcohol problem 10 Illicit drug use Depressed 8 Chronic bronchitis 50+ sex partners 6 STDs Poor Self-rated health 4 Current Smoker Cancer 2 Severe obesity 0 0 1 2 3 4+
  18. 18. ACE Studies Summary of Findings• Adverse Childhood Experiences are very common.• ACEs are strong predictors of later health risks.
  19. 19. ACE Studies Summary of FindingsThis combination makes ACEs one of theleading, if not the leading, determinant of thehealth and social well-being of our nation.
  20. 20. Felitti’s General Model-Trauma Effects Early Death Disease & Disability Adoption of Health Risk Behavior Social, Emotional, & Cognitive Impairment Adverse Childhood Experienced
  21. 21. James Heckman and the Question of When to Intervene….• Nobel prize winning economist who teaches at U-Chicago• Focus is on human capital and on policy that promotes this commodity• See: www.heckmanequation.org
  22. 22. Early Intervention Pays
  23. 23. Thank you for your attention! Neil W. Boris, MD Tulane Institute of Infant and Early Childhood Mental Health

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