ecobiodevelopmental theory asserts that:

Individual variation in biological sensitivity to context (see the Appendix for a glossary of terms, concepts, and abbreviations) contributes to heterogeneity in both responses to adversity and responses to interventions. Translating these principles into pediatric practice will require FCPMHs to: Understand the toxic stress framework, which explains how many of our societys most intractable problems, such as disparities in health, education, and economic stability, are rooted in our shared biology but divergent experiences and opportunities (see Table 1). The Ecobiodevelopmental Model of Health. 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. intel director salary. 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. A multigenerational perspective is fundamental. Simply put, public policies, social constructs, and societal norms that divide, marginalize, alienate, and isolate are clear threats to the well-being of all children. Symbolic interactionism theory asserts that society is composed of symbols and can be understood and analyzed by addressing the subjective meanings that people attach to objects, events, and behaviors that they consider as symbols. Molecular biological processes play an essential role in human development. 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. See the Appendix for full descriptions of the abbreviations. Identify and address potential barriers to SSNRs. For children who are symptomatic or meet criteria for toxic stress-related diagnoses (eg, anxiety, oppositional defiant disorder, or posttraumatic stress), indicated, evidence-based therapies are needed. Explain how human development is rooted in biological processes that have evolved to promote adaptation and survival. Simply put, successfully implementing a public health approach that prevents childhood toxic stress and promotes SSNRs will require FCPMHs to put relational health at the center of everything they do.172, There is an emerging evidence base that social isolation is on the rise and detrimental to both individual173 and community health.174 Social scientists have documented the fragmentation of society at the community level175 as well as its negative impact on how communities view their collective stewardship of their most treasured resource: their children.176 Psychologists have decried a crisis of connection and point to a culture that values the self over relationships and individual successes over the general welfare, leading to declining levels of empathy and trust.177 Epidemiologists have demonstrated that an individuals degree of social isolation is a powerful predictor of mortality, much like traditional clinical risk factors (eg, obesity or hypertension) or ACE scores.178 Both epidemiologists and economists have pointed to increasing levels of inequity as correlating with poorer levels of overall health for both the impoverished and the wealthy.174 Finally, physiologists have long known that social deprivation in childhood alters the programming of the bodys stress response.179,180. See the Appendix for full descriptions of the abbreviations. A quasi-experimental study (GoWell) of a UK neighbourhood renewal programmes impact on health inequalities, Towards health equity: a framework for the application of proportionate universalism, University College of London Institute of Health Equity, Safe, stable, nurturing relationships break the intergenerational cycle of abuse: a prospective nationally representative cohort of children in the United Kingdom, Building the Brain's Air Traffic Control System: How Early Experiences Shape the Development of Executive Function: Working Paper No. The Healthy Outcomes From Positive Experiences framework promotes relational health through positive childhood experiences, such as being in nurturing, supportive relationships; living, developing, playing, and learning in safe, stable, protective, and equitable environments; having opportunities for constructive social engagement and connectedness; and learning social and emotional competencies.126,127. The HMG Model System Model, Healthy Steps: a case study of innovation in pediatric practice, HealthySteps: transforming the promise of pediatric care, COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE, Ensuring the health of children in disasters, DISASTER PREPAREDNESS ADVISORY COUNCIL AND COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, Providing psychosocial support to children and families in the aftermath of disasters and crises, Paid parental leave and family wellbeing in the sustainable development era, Time off to care for a sick child--why family-leave policies matter, Support for restorative justice in a sample of U.S. university students, A neighborhood-based approach to population health in the pediatric medical home, Mapping neighborhood health geomarkers to clinical care decisions to promote equity in child health, From medical home to health neighborhood: transforming the medical home into a community-based health neighborhood, Implementing a trauma-informed approach in pediatric health care networks, Cross-cultural interactions and shared decision-making, The relationship between physician humility, physician-patient communication, and patient health, The impact of racism on child and adolescent health, Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: challenges, solutions, and future directions for provider communication training, Implicit bias: what every pediatrician should know about the effect of bias on health and future directions, Tackling implicit and explicit bias through objective structured teaching exercises for faculty, A systematic review of the impact of physician implicit racial bias on clinical decision making, Comparison of physician implicit racial bias toward adults versus children, Translating developmental science to address childhood adversity, Social: Why Our Brains Are Wired to Connect, The Spirit Level: Why Greater Equality Makes Societies Stronger, Bowling Alone: the Collapse and Revival of American Community, The Crisis of Connection: Roots, Consequences, and Solutions, Social isolation: a predictor of mortality comparable to traditional clinical risk factors, Social deprivation and the HPA axis in early development, Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation, Subjective social status and inflammatory gene expression, The potential protective effect of friendship on the association between childhood adversity and psychological distress in adulthood: a retrospective, preliminary, three-wave population-based study, The Relationship between social cohesion and urban green space: an avenue for health promotion, Exposure to natural space, sense of community belonging, and adverse mental health outcomes across an urban region, Sigmund Freud Collection (Library of Congress). The buffering and skill-building roles of responsive relationships are biologically embedded, and they are essential promoters of healthy development.59 Existing AAP reports on managing perinatal depression,90 supporting grieving children,195 fostering male caregiver engagement,196 partnering with home visiting programs,142 encouraging developmentally appropriate play,74,197 discouraging screen time,125 and promoting shared-book reading67,68 include additional recommendations on ways primary care pediatricians might promote SSNRs. Below we briefly discuss each of the five components, review relevant empirical support, and identify enduring questions. Maternal distress mediated links between environmental chaos and children's mental health. Public health approaches are vertically integrated when they are founded on universal primary preventions (eg, promoting family resilience and connection and positive childhood experiences), with tiered, targeted interventions (eg, addressing SDoHs) and indicated treatments (eg, PCIT) being layered on this foundation, depending on the specific needs of the particular child, family, or community. Its components emerge in infancy and are dependent on genetic, medical, and environmental factors. 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. But those same biological changes could prove to be maladaptive, toxic, and health harming over time.10,11. Adapted with permission from Garner AS, Saul RA. What is ecobiodevelopmental theory? Conceptualizing and operationalizing environmental chaos For example, in an abusive context, biological changes, such as the methylation of the glucocorticoid receptor gene,35 an increase in the size or activity of the amygdala,68 and a hypersensitivity to potentially threatening cues9 could be considered adaptive, at least initially, because those changes might promote survival in a threatening environment. Ecological includes experiences in a child's home environment, such as reading, talking, teaching,. Trainees need to understand all of these many facets so they are prepared to be effective advocates for their patients and families. Ecobiodevelopmental Theory b. Overview of Domain-Specific Theories. Bronfenbrenner's theory explains that there are certain cultural and social factors in the immediate environment of a child affect child development and experience. Just another site. Biological Sensitivity to Context/Adaptive Calibration Model. 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 . Ecobiodevelopmental theory asserts that: Early experiences create the structure of the brain. For younger children, these therapies may include attachment and biobehavioral catch-up (ABC),9698 parent-child interaction therapy (PCIT),99102 and child-parent psychotherapy (CPP).103105 For older children, trauma-focused cognitive-behavioral therapy (TF-CBT) may be beneficial.106,107 The effectiveness of these evidence-based therapies may be reduced if targeted interventions are not used to address emerging areas of risk or if universal primary preventions are not applied as well.59,108 A layered public health approach mirrors the concept of proportionate universalism (see the Appendix for a glossary of terms, concepts, and abbreviations), in which the delivery of universal services is at a scale and intensity that is proportionate to the degree of need.109112 For example, if access to healthy foods is a universal objective, a proportionate response would recognize that some families may only need education about which foods are healthy, whereas some may need education about healthy foods and additional financial resources to purchase those healthy foods, and still others may require education about healthy foods, additional financial resources, and access and/or transportation to stores that sell healthy foods. 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. Neurology also plays a role in the biological perspective of psychology. But underlying this approach are 2 fundamental assumptions. In the end, the ability of the FCPMH to leverage change within the family context is entirely dependent on the capacity of the pediatric providers to form strong therapeutic relationships with the patients, caregivers, and families. Scientists now theorize that toxic stress causes epigenetic changes that allow trauma to be transmitted over the generations. The ecobiodevelopmental model suggests that, to improve the likelihood of positive developmental outcomes across the life span, efforts should be made to improve the salient features of the childs environment. 11, The Timing and Quality of Early Experiences Combine to Shape Brain Architecture. Similarly, many of the risk factors for toxic stress responses that are the targets of secondary interventions are also potential barriers to the development of SSNRs that need to be identified and addressed (eg, child ACE scores, parent ACE scores, SDoHs, or even a strong biological sensitivity to context). Part 1 - Overview of Developmental Domains, Periods, and Theories a. Domains of Development b. In the original ACE Study, 10 categories of adversity were examined: emotional, physical, and sexual abuse; 5 measures of household dysfunction, including the mother being treated violently (intimate partner violence), household substance abuse, household mental illness, parental separation or divorce, and incarcerated household member; and emotional or physical neglect. An FCPMH is not a building or place; it extends beyond the walls of a clinical practice. For example, expanding family leave policies154 could reduce family stress and promote positive childhood experiences. The commitment of the AAP to the well-being of all children requires that it not only address a wide spectrum of adversities but, also, that it speak against public policies, social constructs, and societal norms that perpetuate the ongoing, chronic precipitants of toxic stress responses such as poverty87,88 and racism166 and for public policies that promote relational health, inclusion, and equity.111,188191. This principle points to the potential benefits of addressing stressors from across the spectrum of adversity, including those that might have been considered well beyond the scope of traditional pediatric practice in the past. The mechanism offers an explanation for the historical trauma. The term toxic stress refers to a wide array of biological changes that occur at the molecular, cellular, and behavioral levels when there is prolonged or significant adversity in the absence of mitigating social-emotional buffers.2 Whether those adversity-induced changes are considered adaptive and health-promoting or maladaptive and toxic depends on the context.