Dr. Allan Schore On Early Relationship & LifeLong Health

Repost from Let's Grow Kids on April 28, 2015: https://www.letsgrowkids.org/expert-articles/dr.-allan-schore-on-early-relationships-and-lifelong-

Dr. Allan Schore is on the clinical faculty of the Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, and at the UCLA Center for Culture, Brain, and Development. He is author of four important volumes: Affect Regulation and the Origin of the Self, Affect Dysregulation and Disorders of the Self, Affect Regulation and the Repair of the Self, and The Science of the Art of Psychotherapy, as well as numerous articles and chapters. His contributions appear in multiple disciplines, including developmental neuroscience, psychiatry, psychoanalysis, developmental psychology, attachment theory, trauma studies, behavioral biology, clinical psychology, and clinical social work. The American Psychoanalytic Association has described Dr. Schore as "a monumental figure in psychoanalytic and neuropsychoanalytic studies." Find out more about his work at www.allanschore.com. Dr. Schore spoke with Dr. Miriam Voran on behalf of Let's Grow Kids in preparation for his May 2015 visit to Vermont.

You’ll be giving a public lecture on Early Relationships and Lifelong Health. Can you explain the connection?

It’s long been held that the first relationship—usually this is between the mother and her infant—has an enduring impact on all later stages of human development. The means by which this occurs has been described by Bowlby’s attachment theory. Attachment theory, at its core, is about how the mother helps the infant regulate emotion. And these emotion-based mother-infant attachment communications are essential because they directly affect the development of the brain.

More specifically, the focus is on the development of the right brain, which develops earlier than the left brain. The right brain is involved in the regulation of emotion and arousal states, and in the nonverbal processing of social and emotional information. The right brain is also involved in empathy and creativity, as I’ll explain later. Now, the infant’s brain development literally depends on this social interaction, on right-brain to right-brain communication with its mother. Through these emotionally intimate interactions, the actual organization of the infant’s right brain moves from simple to more complex. And here’s where the link to physical health comes in. The emerging right brain is more connected to the body than the later developing left brain. So there are strong brain-mind-body connections, including into the immune system, and in this way, to physical health.

As you know, since 1994, I’ve written about the significance of the attachment relationship as the source of these right brain functions that are organized in the first year of life and then operate over the lifespan. Remember that in the first year of life, the infant and toddler have powerful emotional needs—to feel safe and secure, to expand their emotional range and learn to handle feelings, to feel understood--all at the time of a right brain growth spurt. Meeting these emotional needs fosters secure attachment. Secure attachment leads to a background state of emotional wellbeing, and emotional wellbeing is critical to physical wellbeing.

So, given that early relationships are so important for lifelong health, what are the “take-away” messages for health care providers?

First, let me say that during the last three decades, developmental neuroscience has clearly shown that the dynamic relationships between genes and social experience have direct effects on brain development and behavior. Where first we had a theory, now we have solid evidence for the enduring impact of the environment on the genome. That’s called epigenetics. Another way to say this is that the brain needs more than genes to grow. It needs social experience.

This new understanding of epigenetics is driving research and clinical practice, and it’s of great importance for health care providers. Remember that the brain doubles in size during the 1st year. This means that the first year is a critical period when disruptions of developmental processes can have life-long effects. It’s a period of vulnerability for the developing infant. And it’s a period when therapeutic interventions will have the strongest effects. Another way to say this is that there is maximal plasticity in the brain during this period.

Now, there has been a misconception by developmental psychology that all infants are resilient. This is not the case. The more precise term is malleable. This misconception has been challenged. It’s now clear that just about every significant psychiatric disorder reflects a disruption of developmental processes. Therefore, it is critical to observe the earliest stages of these disorders, so that we can identify the first signs of their disrupted developmental processes. This could revolutionize their treatment. In my own work, I have been very interested in the early assessment of attachment—which means looking at how the mother helps her infant regulate emotional arousal. So an essential message for health care providers is to promote the early assessment of attachment and all psychiatric and developmental disorders, including autistic spectrum disorders.

And you’ll be talking more about the assessment of attachment in primary care when you give Pediatric Grand Rounds at Geisel School of Medicine in Hanover, NH, right?

Absolutely.

What are the take-away messages for policy makers?

A recent UNICEF report says that the US is 26th out of 29 countries on child wellbeing. This report holds that the importance of the early years is now well-established and that gene and environment interactions scaffold all later development. And because the early years are so critical, the report concludes that a child’s wellbeing is most in need of society’s concern and protection.

What concerns me most is the scandalous behavior of the US—unlike all other countries in the industrialized world, we have no paternal or maternal leave policy. Because of this, many infants go into day care at 6 weeks and the sad fact is that the training of many child care workers is less than optimal. This country should come up to par with the other industrialized nations and have a parental leave policy.

Speaking of child care providers, you’ll be giving a workshop for them and educators about how children learn self-regulation. Can you explain what self-regulation is, and what is most beneficial for its development?

The essential experience for the development of self-regulation is the baby’s communication of emotion to the mother and the mother’s regulation of this emotion. The mother regulates both positive and negative states for her baby--positive states in play, including intense states of joy and excitement, and negative states, like anxiety and depression, through her calming and soothing. These interactive regulations of infant emotion lie at the core of attachment. You see, the mother is not just regulating the infant’s behavior; she’s first regulating the infant’s emotion and arousal states—the infant’s internal state of being. These regulations shape the right brain that is dominant for affect and state regulation. The baby is learning through these interactions with the mother to self-regulate. So, these interactions between mother and baby lay the groundwork for self-regulation.

Now, there are two principles that govern a well-developed self-regulation system. First, it is stable. But second, it is resilient, capable of change, as the context requires. Now, I don’t mean that the baby can bounce back from anything. But the baby can develop an emotional flexibility or resilience to tolerable stress. The baby isn’t always in a state of positive affect, but can move in and out of positive emotion, according to the situation.

You asked about self-regulation, but it’s really important to remember that there are two forms of regulation—for the young child and throughout the lifespan. The first is interactive regulation, when we go to other human beings to regulate our internal states--to share our feelings and to get comfort. Now, I know that this doesn’t sound like part of self-regulation, but it actually is--because we can choose to go to somebody else to help us. The second form is auto-regulation, when we’re apart and we use our own resources to self-soothe. The young child, for example, might listen to music or play with a calming toy. What’s important is that the child can shift back and forth between interactive regulation and auto-regulation. It’s not that one is better than the other. The child needs the flexibility to shift back and forth as the situation demands.

Let’s come back to what caregivers can do to develop the child’s self-regulation.

It really is tuning in to the child’s emotion and inner state—being open and receptive to the child’s emotional communications, and then helping them—through your own empathic responses—to regulate their emotional world.

You’ve said that the field of education is about 10 years behind the latest neuroscience. What should early childhood educators understand about promoting school readiness for each child?

I read a study last week that just rocked me. It was done by an economist from the London School of Economics and said that the most important predictor of adult life satisfaction is the child’s emotional health, followed by the child’s conduct. The least powerful predictor is the child’s intellectual development. Now, the implications of this for education are obvious. Rather than focus just on language and verbal skills, on rote and explicit memory, educators should also emphasize social intelligence and interpersonal competence. For preschoolers, reading the emotional cues of other kids and forming a bond with the teacher are more important than the pre-academic skills of learning letters and colors and shapes. Remember, the right brain is dominant for regulating emotion and internal states and handling social interactions. Educating the right brain should be as important or more important than educating the left brain. Right now, there’s too much emphasis on executive function, which is a later-developing left-brain function. Preschools should make sure to keep the focus on the social and emotional experiences that promote healthy right brain development, especially if kids are entering child care so early.

Your newest work is on creativity. How can parents and educators nurture creativity in young children, and what impact does that have on their future?

Creativity is now becoming a rich area of study for psychology and neuroscience. In the past, studies of creativity have focused on artists, on artistic genius, or on the relationship between creativity and madness. Now we’re looking at creativity as an aspect of personality that’s important for all human beings. Creativity is the capacity to have a spontaneous, original response to the environment, and we’re becoming more aware of how important it is for individuals to be able to respond in this way. More and more, we realize that to succeed in our rapidly-changing society, we need to move the focus from convergent thinking—finding a single solution to a problem—to divergent thinking--generating more ideas and many possible solutions.

Now, to your question about how parents and schools can encourage creativity. You know, what leads to creativity is the opposite of what leads to linear left-brain activity. Emotions underpin creativity. When the infant and mother use their emotions to explore, each responding spontaneously to the other, creativity is nurtured. So, the roots of creativity are in the first two years of life. Young children need protected, unrushed time to explore, and time to hang out with their parents, with no agenda but to be together, and to let spontaneous novel things emerge.

You must have thoughts on how parents can nurture their own creativity.

Definitely, and that’s a big topic. Let’s save that for the Q and A when I’m here.

What breakthrough moments about development did you experience while observing your children in their earliest years?

I’ll answer this both as a scientist and in a personal way about my own development. First, as a scientist, it’s clear that there’s enormous plasticity in the adult brain. A man’s brain changes within intimate relationships and mine definitely has. Studies have shown that during the first year after birth of children, there are brain changes in adults. For example, after becoming fathers, men carry babies on the left side, which optimizes right-brain to right-brain communication, and their eyes dilate more when looking at pictures of an infant. Other studies show mothers’ brains changes in the first months after birth.

On the more personal side, my wife and I had our first child six years into our marriage. For the first five to six years of my marriage, even before children, I was becoming more and more comfortable with my emotions and with emotional intimacy. Now, remember that this was during the 70s and the feminist movement. So, I was learning to shift from controlling my emotions to tolerating emotions, and expanding my comfort with the whole range of positive and negative emotions. Then, when my first daughter was born, this changed my emotional world even more so. I became even less emotionally controlled and softer. I have very strong memories of just gazing at my daughter when she was in the crib, because we were engaged in this intimacy with each other.

Now, once I became a parent I also became much more aware of my own emotional experiences as a child, and of my relations with my mother and my father. And of course, these parent-child relationships keep changing over the lifespan. My father continued to influence me until he recently died in his 90s. My kids are now in their 40s and our relationship continues to evolve.

So, you’re saying that the brain contin

Definitely. That’s what’s hopeful about the neuroscience. Intimacy is a powerful context for shaping the right brain. It starts in infancy, but it really does continue throughout the lifespan.

We hear lots about “toxic stress.” Can you explain what that really looks like in a young child’s life? Do you have other language to describe this?

First, I want to differentiate between physical environmental stress and relational stress. Crime and war and environmental toxins all have negative effects on brain development, especially on the brain’s arousal systems and energy systems. These effects are especially marked during what we call the critical 1000 days—from the third trimester of pregnancy to the end of the second year.

Then there are the social—or relational--stressors. In 2001, I coined the term relational trauma. Now, it’s important to distinguish between big T trauma and little t trauma. Big T trauma is abuse and neglect in infancy and of course it has enduring negative effects on the brain. Little T trauma may not be as obvious, but it also compromises brain development. This is when the mother and infant may often be mis-attuned in their interactions and not in sync. The British use the term “benign neglect” to describe this. The mother may not be emotionally responsive. She may be responding to the infant more with her left brain, but not her right brain. In these situations, the child will shut down and disengage. These situations can be subtle and harder to identify. You know, if a child is crying for 6 hours a day, it’s clear that there is dysregulation. But a withdrawn child may just be considered an “easy baby.” This gets back to why it’s so important to build expertise in the assessment of early relationships.

Our culture is flooded with information-technology. What does neuroscience tell us about its effects on infants? And on the infant-parent relationship?

The American Academy of Pediatrics has put restrictions on the use of screens in the first years and a number of experts in pediatrics and psychology have written about the dangers of this. Remember how important interactive regulation with the mother is for brain development. Technology can interfere with this. If a child is watching a screen, that child is using the signals from technology to auto-regulate. And an over-reliance on auto-regulation interferes with the development of empathy. Now also, infants are very good at noticing where the adult’s attention is going. If the adult attention is going away from them and towards a technological device, the infant will eventually protest. Or, the infant might just withdraw, which really jeopardizes getting the social interaction needed for right brain development.

You know that parents and caregivers want to feel good about what they’re doing with children to help them develop well in all areas. How do you talk with them when neuroscience says that a different approach would be more helpful?

What all parents want to do is to shape the character of their child so that the child will become a good human being and treat others and themselves with value and respect. In the end, parents have more influence during the first 2 years than at any other point. So the idea that you can shape the child through words and ideas misses the most powerful window of influence. The way you are with your infant shapes the way he or she will be with other human beings. Remember that during the first year of life, the brain is doubling in size. This tells you how much of the brain is devoted to these foundational emotional right-brain processes.

To reassure parents, I remind them that stress is a part of life. Infants need to learn to tolerate both positive emotions—like intense joy and excitement—and negative emotions. In typical parent-infant interactions, the dyad is mis-attuned one-third of the time. So, the repair of this mis-attunement is key, not perfect parenting. Also, these inevitable mis-attunements are valuable stress tolerance practice time for the infant. Infants use manageable stress to grow and develop. We can all use stress to propel us forward to more complexity and out of complacency.

Now, in the second year, the mother’s role changes. She becomes a socializing agent. The child is now walking and getting into things. So, we can’t forget the importance of limits. Remember that in the first year, the infant experiences the mother as up-regulating its emotions—building up excitement and joy. We call this the development of positive narcissism, which is the foundation for healthy self-esteem. But then, in the second year, the mother needs to down-regulate this narcissism. Robert White, a Harvard psychologist, said it well. He explained that at around 14 months, the child is terribly important and his needs are terribly important, but he is no more important than any other person, especially his parents. Remember, this is the time when the toddler is saying “no,” and pushing against his parents, so there has to be a down-regulation of his energy in order for the child to learn true autonomy.

I also encourage parents to access mental health services, not just for serious problems, but as important resources to help with these developmental transitions.

You mean, like having mental health services integrated into primary care? There are a number of practices in Vermont and neighboring New Hampshire that are experimenting with this.

Exactly. That’s one of the opportunities of health care reform.

This has been a great start to our conversation. The Let’s Grow Kids campaign is really looking forward to you bringing your ideas to Vermont.

Yes, there’s much more to talk about. I’m looking forward to the workshops and lectures, and to hearing what folks are working on here. I look forward to a fruitful dialogue. Plus some beautiful New England springtime.