New Emergent Understanding of the Early Years

NCECDTL

EM ERGENT N EW UN DERSTAN DIN G O F DEVELO PM ENT IN THE EARLY YEARS DEVELOPMENTAL RESEARCH ADVANCES TO INFOR M THE NATIONAL CENTER ON EARLY CHILDHOOD DEVELOPMENT, TEACHING, AND LEARNING

P R EPA R ED BY: RO S S A . T H O M P S O N, PH D D EPA RTM EN T O F P SYC H O LO GY U N I V ERS I T Y O F C A L I F O R N I A , DAV I S R AT H O M PS O N @ U C DAV I S. ED U

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

1

NCECDTL

CONTENTS WHAT NEW THINGS EVERY EARLY CARE AND EDUCATION PROFESSIONAL SHOULD KNOW ABOUT YOUNG CHILDREN 4

EARLY THINKING IS FAR MORE CONCEPTUAL AND ANALYTIC—AND FAR LESS EGOCENTRIC— THAN COMMONLY BELIEVED.

4

SELF-REGULATION IS A SLOWLY DEVELOPING COMPETENCE IN THE EARLY YEARS. ITS DEVELOPMENT CAN BE SUPPORTED BY ADULTS IN DIRECT AND INDIRECT WAYS.

7

CHRONIC STRESS IMPAIRS EMOTIONAL WELL-BEING, THINKING, LEARNING. ADULT SUPPORT IS IMPORTANT IN BUFFERING STRESSFUL INFLUENCES ON CHILDREN.

9

SOME YOUNG CHILDREN ARE MORE SENSITIVE TO ENVIRONMENTAL INFLUENCES THAN ARE OTHERS

11

YOUNG CHILDREN’S EMOTIONAL LIVES ARE RICH BUT VULNERABLE. SOMETIMES THIS LEADS TO EARLY MENTAL HEALTH CHALLENGES THAT CAN HAVE ENDURING IMPACT.

13

THE SOCIAL AND EMOTIONAL FOUNDATIONS FOR EARLY LEARNING (SEFEL): OPPORTUNITIES FOR EXPANSION AND UPDATING

15

INCORPORATE TRAUMA-INFORMED TEACHING PERSPECTIVES INTO SEFEL

16

17

RECOGNIZE THAT CHILDREN’S CONCERNING BEHAVIOR MAY NOT ALWAYS BE DISRUPTIVE BEHAVIOR

EXPAND ATTENTION TO INFANT EARLY CHILDHOOD MENTAL HEALTH CONSULTATION

18

STRENGTHEN ATTENTION TO THE SPECIFIC, SOMETIMES UNIQUE, CHARACTERISTICS OF WORKING WITH INFANTS AND TODDLERS

20

23

INCORPORATE INSIGHTS FROM DEVELOPMENTAL NEUROSCIENCE

REFERENCES

24

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

2

NCECDTL During the past 10–15 years, research on early child development has expanded significantly in depth and scope. There are several reasons for this. First, as understanding of the influences on the behavior and development of preschool children expands, interest has somewhat naturally turned to exploring the origins of these competencies at younger ages—in particular, during the first three years. Second, a growing awareness of the numbers of young children living in adversity, including family poverty, has caused researchers to try to understand the effects of adversity at young ages because of how they may set enduring trajectories of physical and mental health that follow. Finally, research in developmental neuroscience has exploded in recent years, with a growing empirical research literature on children and expanding conceptualizations of how brain development emerges in the early years. Together, these have created a fertile climate for new understanding of early childhood development.

The problem this creates for all of us, however, is keeping up with these new research discoveries, their implications for practice, and the directions in which they are taking our understanding of young children. This is both a challenge and opportunity for the two programs for which this review is written.

The National Center on Early Childhood Development, Teaching, and Learning (DTL center) has an exceptional opportunity to conceptualize and advance early childhood learning within an inclusive birth-tofive framework that takes into account the recent insights of developmental neuroscience, the significance of early relationships, and the interaction of cognitive and social and emotional (and self-regulatory) development. The Social and Emotional Foundations for Early Learning (SEFEL) program has been, since its inception more than ten years ago, the go-to guide for early childhood practitioners in promoting positive social behavior and addressing challenging behavior for children from infancy through preschool.

The current opportunity is to update and expand the SEFEL approach, especially considering research knowledge that has emerged since it was created.

This research review contributes to both programs by summarizing recent advances in understanding development in the early years.

The review is organized in the following manner, developed in consultation with the DTL center leadership at ZERO TO THREE. The first section discusses a number of conclusions derived from current research on early childhood development, together with their relevance to the mission of the DTL center. Although this list is certainly not exhaustive, it summarizes some of the central ideas that are driving new thinking about children in the first five years of life. Some of these conclusions are also relevant to the SEFEL program. The second section highlights specific ideas for updating and expanding this program in the context of its success in promoting positive behavior in young children.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

3

NCECDTL WHAT NEW THINGS EVERY EARLY CARE AND EDUCATION PROFESSIONAL SHOULD KNOW ABOUT YOUNG CHILDREN Although (too) many people still believe that caring for and educating young children is a naturally intuitive process, news about developmental brain science during the past 20 years has convinced most that there is more going on in the early years. This conclusion is familiar to those who work with young children, whose understanding of early development was guided by the work of Piaget, Bowlby, Dewey, Vygotsky, and others long before brain development became a hot topic. From these, and other scholars, comes an understanding of the young child as an active learner who constructs understanding based on experience and reasoning, with early learning derived from actions and senses and adults facilitating cognitive growth as they observe, respond, and build on the child’s natural curiosity and interests. This understanding of early childhood has stood the test of time and nothing in what follows fundamentally supplants it.

Further research has elaborated, deepened, and sometimes modified this understanding in ways that are relevant to the work of the DTL center. Here’s some new research that enriches our understanding of child development.

EARLY THINKING IS FAR MORE CONCEPTUAL AND ANALYTIC—AND FAR LESS EGOCENTRIC—THAN COMMONLY BELIEVED. Although this conclusion reflects a consensus among developmental scientists that has existed for several decades, it’s news to many early childhood teachers who have been guided by Piaget’s portrayal of children as concrete, egocentric thinkers. Considerable research shows that infants are neither only concrete nor only egocentric in their thinking. This has significant implications for how they learn and the role of adults in their cognitive growth.

A recent review of this research is in the 2015 report of the Institute of Medicine (now National Academy of Medicine) and National Research Council, Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation. This report underscores that developmental researchers credit infants and young children with a remarkable theory-like way of understanding the world, by which they mean that infants and young children derive conclusions based on their observations, and progressively revise these conclusions based on their expectations (hypotheses) and experiences. This is one reason why infants seem to learn from events that are unexpected (Stahl & Feigenson 2015). On this basis, for example, infants and young children develop intuitive theories about physical objects (gravity; movement in space; physical force), living things (distinctions between the animate and inanimate world; uniquely biological processes such inheritance, disease, and nutrition), and people’s mental states (“theory of mind” described below). Language learning also reflects early conceptual sophistication. During the first year, infants engage in a process called “statistical learning” to prepare to learn words. They non-consciously calculate the probability that speech phonemes go together to form words—learning, for example, that an adult saying “Hello baby!” is saying two words rather than three (“He loba by!”) because of the infrequency that “lobay” is heard in English (Saffran 2003). Statistical learning helps infants denote the beginnings and ends of words and thus provides a foundation for the explosion in vocabulary during the second year.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

4

NCECDTL Infants also have an approximate number system by which they can distinguish quantities and that provides the basis for mathematical skills that develop in later years (Starr, Libertus, & Brannon 2013). Infants and young children are at various stages in the development of these competencies, of course, but together these findings indicate that the early developing mind is much more conceptual and analytical than formerly believed.

People are the most important elements in a baby’s world, so it’s unsurprising that early conceptual skills also appear with respect to social understanding (Thompson 2008). Infants are beginning to develop an intuitive “theory of mind” by which they gradually attribute mental states to people. They use this theory of mind to help explain and predict people’s actions (see review by Wellman 2014). By the end of the first year, for example, infants view people as acting according to their intentions and goals, and by 18 months they imitate another person—based not on the actions they observe—but on the goal underlying the action (such as dropping beads directly into a cup immediately after watching an adult trying, but failing, to do so) (Meltzoff 1995). Understanding intentions is an important contribution to word learning in the second year because toddlers consider the speaker’s intentions when interpreting the words adults say (when an adult says, for example, “I need the scissors” while reaching for scissors to cut out a picture) (Baldwin & Moses 2001). Infants are also adept at interpreting an adult’s emotional facial expressions, and they use this information to determine whether unfamiliar people or objects are dangerous or not by “reading” in a phenomenon called “social referencing” (Kim & Kwak 2011). They also become especially attuned when they perceive adults responding to them with communicative intent (such as then the adult makes eye contact, uses the child’s name, and uses infant-directed speech), creating what one researcher calls a “pedagogical orientation” in the baby (Csibra 2010). As they grow, children gradually understand that people’s actions are also motivated by their desires, expectations, and beliefs. After age four, they understand that people can be motivated by mistaken beliefs and ideas (which can lead to the child’s efforts to fool another). Because the intentions, goals, feelings, desires, expectations, beliefs, and other mental states that young children attribute to other people are often much different from the child’s own mental states, researchers have concluded that infants appear to have an intuitive expectation that others’ mental states will be different from their own. This motivates them to try to figure out what other people are intending, feeling, and so forth. In other words, current understanding is that the young child is not fundamentally egocentric.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

5

NCECDTL There are several implications of this portrayal of early thinking for early childhood practitioners.

First, it is important to recognize that beneath the apparently distractible, emotional, and poorly selfregulated behavior of a young child is an active mind that is establishing the foundations of conceptual skills that will only become apparent later. Language learning is an obvious example—the foundations of the vocabulary explosion of the second year are being laid in the influences of spoken language heard during the first year. This is why adults talk to babies who cannot talk back or even understand what adults are saying. Mathematical understanding is another example, especially with evidence that how adults talk using numbers to their toddlers is a foundation to their child’s number knowledge at age four (Levine, Suriyakham, Rowe, Huttenlocher, & Gunderson 2010). This may help to explain why cultural differences exist in children’s mathematical knowledge that may be related to how parents talk to their children using number terms earlier in life (Ni, Chiu, & Cheng 2010). Second, infants and young children are sponges for understanding of what other people think, feel, intend, and desire, and how this influences their actions.

Adults can facilitate this emergent understanding when they talk about those mental states in themselves and others (this is sometimes called “sportscasting”). They might explain why another child is frustrated or put into words the adult’s surprise at what the child just did. Third, an awareness of these emergent conceptual skills can guide the practitioner’s activity with a young child in other ways, whether this involves putting into words what a classroom pet can do, why someone looks sad, exploring together what happens when objects collide, playing counting games (while stacking blocks), engaging in imitative play or creating categorization (sorting) games. If it is safe to assume that young children are more conceptually aware than their behavior may reveal, then interaction with a young child can support these conceptual achievements and take the child to the leading edge of new advances (what Vygotsky called the “zone of proximal development”).

Finally, early childhood practitioners should be aware that what gives meaning and significance to these activities is the social context in which they occur: the young child’s interactions with an engaged, responsive adult. This is illustrated by the authors of Transforming the Workforce in an account of an adult interacting with a one-year-old over a shape-sorting toy: As they together are choosing shapes of different colors and the child is placing them in the appropriate (or inappropriate) cutout in the bin, the adult can accompany this task with language that describes what they are doing and why, and narrates the child’s experiences of puzzlement, experimentation, and accomplishment. The adult may also be using number words to count the blocks as they are deposited. The baby’s attention is focused on the constellation of adult behavior—infant-directed language, eye contact, and responsiveness—that signals the adult’s teaching, and this “pedagogical orientation” helps focus the young child’s attention and involvement. The back-and-forth interaction of child and adult activity provides stimulus for the baby’s developing awareness of the adult’s thinking (e.g., she looks at each block before commenting on it or acting intentionally on it) and use of language (e.g., colors are identified for each block, and generic language is used to describe blocks in general). In this interaction, moreover, the baby is developing both expectations for what this adult is like—safe, positive, responsive—and skills for social interaction (such as turn taking). (Institute of Medicine and National Research Council 2015, 103) This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

6

NCECDTL These activities flow together naturally in the interaction of a baby and a sensitive adult, and the activity loses meaning for the child outside of its social context. It is the activity embedded in mutual social responsiveness that is important. Similarly, the language that young children hear is important to vocabulary growth only in the context of the social interaction in which it occurs. A recent study showed that measures of the quality of parent-toddler interaction during conversation were more strongly related to the child’s language skills a year later than were the number of words that mothers used (Hirsh-Pasek et al. 2015).

Current public campaigns to encourage parents to “talk, read, and sing” to their young children to build vocabulary skills should not miss the importance of who is doing the talking, and how they are doing so.

Both cognitive stimulation and the relational context are each important, and they support each other.

This is especially true because young children’s abilities to apply their rapidly expanding conceptual capacities to everyday contexts depends on the support provided by an interested, sensitive adult. A toddler who is starting to understand the characteristics that distinguish animate from inanimate objects benefits from observations of the classroom rabbit with an adult who helps the child think about what that rabbit can do that a plush rabbit toy cannot. When that toddler is later in conflict with another child over a favored toy, the child’s ability to understand the peer’s feelings and desires is limited until a teacher puts them into words as a way of fostering mutual understanding. In short, young minds are remarkably conceptual, analytic, and nonegocentric. Thoughtful adults help children enlist these capabilities into daily experience.

SELF-REGULATION IS A SLOWLY DEVELOPING COMPETENCE IN THE EARLY YEARS. ITS DEVELOPMENT CAN BE SUPPORTED BY ADULTS IN DIRECT AND INDIRECT WAYS. In a 2009 survey of a nationally-representative sample of parents of children between birth and age three, ZERO TO THREE reported that 43% of parents believed that children can control their emotions when frustrated before the age of three, and the majority of parents thought they could share and take turns with other children (Newton & Thompson 2010). These parents also reported that their greatest parenting challenges were coping with temper tantrums, managing children’s emotions, and reducing aggressive conduct. It is not hard to see that these findings are connected by parents’ disappointment that their young children do not show greater self-regulation. Moreover, if parents believe that children can manage their feelings and impulses before the age of three, then a child who is unable to control his anger or frustration may be perceived as being defiant or stubborn rather than as having developmentally appropriate difficulties with self-control. It is possible, perhaps even likely, that those who care for young children have similar expectations for their self-regulation.

Unfortunately, developmental research does not support these expectations for early self-control (see review by the Center on the Developing Child at Harvard University 2011). Although some of the rudiments of self-regulation begin to develop during the first year, the brain regions most directly associated with self-control are among the slowest to mature, with their maturational timetable extending through adolescence and the early adult years (Thompson 2009). On most assessments of self-regulation relevant to behavioral control, three-year-olds perform poorly. However, by the age of five young children have advanced significantly in self-control, although there remains a wide range of individual differences in their This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

7

NCECDTL capability. Self-regulatory skills continue to develop and become refined throughout the school years (Best & Miller 2011). This means that those who work with young children must have appropriate expectations with respect to self-regulation, as well as understanding how characteristics of the environment and everyday experiences can enhance or undermine these capabilities.

There are at least three developing capacities that contribute to children’s self-regulation, and each shows slow but steady progress during the birth to five period. First, inhibition is the ability to resist a strong inclination to do one thing and instead do what is necessary or appropriate. The growth of inhibition is one reason children become less impulsive as they mature and instead able to raise their hands before speaking, take turns, and use words to express anger rather than fighting. Second, cognitive flexibility is the ability to switch perspective, attention, or mental focus. Cognitive flexibility enables children to become more flexible in their desires and goals. They become capable instead of changing goals, devising alternative problemsolving solutions, and seeing another’s perspective as well as their own. Third, working memory consists of the ability to hold information in mind while mentally working on it. Growth in working memory enables children to become more focused and less distracted. They are able to follow multistep instructions, remember a story narrative, and connect different things that are said in a conversation. These three components of self-regulation are called “executive functions” and they guide strategic and goal-directed activity. As these examples illustrate, however, the behaviors that are viewed as egocentric in young children often reflect limits in self-regulation. Poor cognitive flexibility causes young children to insist on playing with a toy that another child has, for example, and limited inhibition can result in a child who talks loudly despite repeated reminders to use their inside voice.

Developmentally appropriate expectations for self-regulation in young children require recognizing the significant individual variability in self-control among children of the same age and the reasons for these differences. Some of these individual differences arise from temperament. One temperamental characteristic, effortful control, is described as the ability to voluntarily manage attention and to inhibit (or activate) behaviors that are suitable to the situation (Eisenberg 2012). Some children who are strong in effortful control act in ways consistent with greater self-regulation. They might follow instructions, wait to take turns, and manage emotions. These children have a temperamental assist to their self-regulatory efforts. By contrast, children with other temperamental characteristics, such as high impulsivity or strong emotionality, may have greater difficulty exercising self-regulation for these reasons.

Another influence on the development of self-regulation concerns children’s exposure to chronic stress, such as the stress that derives from abuse, domestic or neighborhood violence, a neglectful home environment, enduring poverty, or parental withdrawal owing to depression or other mental health problems (Blair & Raver 2012). The impact of stress hormones on these regions impair the development of brain regions associated with self-regulation and, behaviorally, these children tend to be more impulsive, less focused and more distractible, more emotionally dysregulated, and achieve less in classroom learning (see next section for more detail). It is important to note that these children can be seen as problems by their teachers because of their impulsive, disruptive conduct—especially when teachers are unaware of the sources This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

8

NCECDTL of stress in children’s lives that may be contributing to these self-regulatory difficulties. This can contribute to the high rates of expulsion of children with behavioral problems from preschool and prekindergarten programs (Gilliam 2005).

Fortunately, a number of programs have been developed to strengthen self-regulatory capabilities, especially for children in difficult circumstances. Some programs (such as Tools of the Mind) focus on developing the three executive functions earlier described through structured classroom activities. Others emphasize training teachers in effective classroom management techniques that promote social and emotional and self-regulatory skills (Center on the Developing Child at Harvard University 2011). These approaches show promising evidence, and in some cases contribute to improvement in children’s cognitive skills as well as social and emotional competence. They are consistent with other kinds of classroom practices that can be used with young children to strengthen capacities for self-control, such as helping children learn strategies for inhibiting impulses (a seat cushion for remaining in place during circle time), giving children experience with simple rule-based games, helping children take the perspective of another child (sometimes through the teacher’s guidance), encouraging children to use their own words to think through alternative solutions to problems, and so forth. In addition to ensuring that expectations for children’s conduct are developmentally appropriate, teachers can also strengthen self-regulatory capacities by ensuring that the daily schedule is within children’s capabilities for self-management (with periods of directed activity alternating with periods of self-determined play), the environment is conducive to selfcontrol (is not overstimulating, and has spaces for quiet activity as well as louder group play), and transitions are handled suitably (helping children to anticipate transitions before they occur and with time provided for children to move from one activity to the new one). These supports are, of course, developmentally graded.

When infants and toddlers are concerned, their very limited abilities for self-management mean that selfregulation is a process of co-regulation, in which teacher support and the nature of the environment and schedule assume much larger roles.

Because self-regulation has a slow maturational course, children ages birth to five depend on adults’ support to manage their behavior and impulses. Throughout this period, moreover, the organization of the environment and teacher support can help young children’s slowly-developing capacities for self-regulation grow and flourish.

CHRONIC STRESS IMPAIRS EMOTIONAL WELL-BEING, THINKING, LEARNING. ADULT SUPPORT IS IMPORTANT IN BUFFERING STRESSFUL INFLUENCES ON CHILDREN. Growing understanding of early brain development has led naturally to efforts to understand the factors that can put healthy brain development at risk. Chronic stress has emerged as one of the most important risk factors for children and adults. Developmental researchers have focused particular attention on early stressful experiences (including those beginning prenatally) because of their potential to shape developing brain structure and function with potentially life-long implications. At the same time, they have examined how social support, particularly from adults, can buffer the effects of stress and contribute to young children’s well-being.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

9

NCECDTL Research has focused especially on how chronic stress “gets under the skin” to affect the developing brain and behavior (see Thompson 2014 and Institute of Medicine and National Research Council 2015, for reviews). In ordinary circumstances, when the brain detects a threat, a network of biological responses becomes activated with consequences that include the production of cortisol (a stress-related hormone) that mobilizes energy, the suppression of immune functioning, enhanced cardiac response, and other components of the stress response. These responses mobilize the body’s resources for responding to threat, increasing vigilance and self-defense, and promoting other forms of coping. When stress is chronic and severe, however, the biological systems that underlie the body’s regulation of stress responding can become altered. This is particularly true early in life as these biological systems are maturing. The manner in which these systems are altered by chronic stress is complex and depends, in part, on the nature of the stress that children experience. The behaviors that result can include heightened vigilance to threat, poorer coping and self-regulation when difficulty occurs, heightened emotional reactivity, and poorer social functioning.

In other circumstances, however, there may be a reduction in stress reactivity, as if the system has become overloaded. For some children, their behavioral response to chronic stress is withdrawal and inhibition.

What kinds of experiences create chronic stress of the severity that can result in these biological and behavioral changes? Research with young children identifies living in persistent poverty, growing up in the care of a depressed parent, witnessing persistent domestic violence, being abused or neglected, living in foster care, and similar experiences (Thompson 2014). It is important to note that some of these circumstances fall within the scope of what is commonly called “toxic stress,” but other circumstances (such as living with a depressed parent) are not typically thought of in this way. This suggests that young children experience a broader range of adverse conditions as “toxic” because of their dependence on others to nurture and protect them. Stated differently, an important feature of the experiences that constitute toxic stress for young children is the absence or unavailability of an adult who can provide protection and support.

This is certainly true of the emotional unavailability of a depressed parent, but it is also likely to be true of chronic neglect, and of growing up in a family in serious economic difficulty with an overwhelmed parent or parents. Currently just under 50% of children under age six (47%) live in low income families (Jiang, Ekono, & Skinner 2016).

Chronic stress has other consequences for children besides impairing coping and emotion regulation (Lupien, McEwen, Gunnar, & Heim 2009; Ulrich-Lai & Harmon 2009). The heightened vigilance associated with early adversity undermines young children’s ability to focus their attention, concentrate, and enlist their cognitive and learning skills in sustained work on a task. This can undermine their learning and classroom achievement. Their heightened emotional reactivity and poor emotion self-regulation also impair their social competence with peers. Moreover, because stress responses involve the suppression of immune functioning, young children experiencing chronic stress are more prone to both short-term and chronic illnesses (such as asthma). Self-regulation is also impaired because of the influence of stress hormones on areas of the brain regulating self-control. There is emerging evidence that brain areas related to memory and language are also influenced by stress hormones (McEwen 2012). Chronic stress thus influences multiple This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

10

NCECDTL biological and behavioral systems and, because stress creates a cumulative biological “wear and tear” on these systems, prolonged stress is reliably associated with long-term physical and mental health problems (McEwen 2012).

The effects of chronic stress are apparent in very young children, and current studies identify many of them in infants during the first year. One reason for the focus on early adversity is that the brain and biological systems affected by chronic stress are developmentally plastic—that is, they are capable of change in response to experience. This is one reason to focus on identifying and addressing sources of stress in young children before their effects on the developing brain and behavior become consolidated. Also, there is growing evidence for the beneficial effects of social support as a means of buffering or reducing the stress that young children experience. If young children depend significantly on the care and protection of adults, and adversity is particularly toxic for them when support is not available, then one means of reducing stress is to provide young children with social support from sensitive adults. This view is consistent with a large research literature on the stress-reducing and health-enhancing benefits of social support for children and adults (Thompson & Goodvin 2016) and with studies on the neurobiological effects of the social buffering of stress in humans and animals (Hostinar, Sullivan, & Gunnar 2014). Together, these studies indicate that social support not only counters many of the negative effects of chronic stress but also stimulates constructive processes that contribute independently to greater self-regulation and emotional well-being.

When young children are the focus, enhancing social support can consist of strengthening the nurturance and sensitivity of the child’s caregivers (at home or out of home) or introducing new caregivers into the child’s experience who can be supportive. One example of this comes from a study of families living in rural poverty. Toddlers’ chronic exposure to domestic violence in these families was associated with elevated stress responding. But this effect was buffered when mothers responded sensitively to their children (Hibel, Granger, Blair, & Cox 2011). Other studies have documented comparable benefits from the care and support of adults from outside the family. As a consequence, although it may not be possible for an out of home care provider to change the family or neighborhood conditions that are stressful to a young child, the caregiver can ensure that the child’s experience in-care is a safe haven in which the child can feel safe and secure. This can involve creating a classroom experience that is predictable, child-centered, and emotionally supportive. In a later section, these characteristics are considered further in the context of “trauma informed teaching.”

SOME YOUNG CHILDREN ARE MORE SENSITIVE TO ENVIRONMENTAL INFLUENCES THAN ARE OTHERS The effects of chronic adversity described above are likely to affect all young children who are exposed to it. But research and practitioner experience shows that children also respond very differently to such experiences. Some children react with immediate and long-term negative effects, while others seem to be much more resilient and relatively little influenced by difficulty. These differences in responding to adverse circumstances have traditionally been interpreted as reflecting inherited or acquired vulnerability to stress.

Stated simply, some children are more vulnerable than others.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

11

NCECDTL Although this conclusion is true in some cases, developmental scientists have made an important discovery that changes our thinking about many of these children. Growing evidence suggests that some of these children are not just more vulnerable to the effects of adversity, but they also more susceptible to the benefits of positive influences. They are undermined by difficulty but, conversely, thrive when provided support. Stated simply, some children are more sensitive to the environment for better and for worse (Belsky & Pluess 2009, Ellis & Boyce 2008). (Metaphors can be helpful—children who are more sensitive to environmental influences are sometimes compared to orchids, who wilt or bloom quickly depending on environmental conditions, whereas children who are less sensitive to the environment are like dandelions, who seem to grow regardless of the conditions in which they are planted.) Researchers have found this difference to be true with respect to a broad variety of environmental influences, including the warmth and sensitivity of parental care, the quality of child care, the effects of marital conflict vs. harmony, and even the effects of broader family stresses. In these and other cases, the children who show the most negative responses to adverse conditions are also the same who show the greatest benefits to positive, supportive circumstances. As another illustration, a program that was designed to improve the sensitivity of the parents of one- to three-year-old children with behavioral problems had the greatest benefits for children with a gene that contributes to behavioral difficulties compared to children without this gene (BakermansKranenburg, Van Ijzendoorn, Pijlman, Mesman, & Juffer 2008).

Where do differences in children’s sensitivity to the environment come from? Research suggests that sometimes they arise from temperamental qualities (particularly those associated with high reactivity or negative emotionality), physiological qualities (especially reactivity), genetic factors (as illustrated above), or some combination of these. These are differences, in other words, that arise early in life and appear to be constitutional in nature, although more research remains to fully answer this question and the role of experience in susceptibility.

What is the practical significance of these individual differences in children’s sensitivity to environmental influences? This question is also a source of continuing debate. Some have suggested, for example, that interventions for children might be adapted to whether children are more sensitive to the intervention effects or not, although others disagree.

Another question is how many early experiences—and what kinds—could shape whether children become environmentally sensitive or not. Regardless of these considerations, one conclusion seems important.

The children who seem most vulnerable to difficulty may also be the children who benefit the most from support. Rather than characterizing them as “vulnerable kids,” it may be better to think of them as sensitive kids who can flourish with nurturant support from an adult.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

12

NCECDTL YOUNG CHILDREN’S EMOTIONAL LIVES ARE RICH BUT VULNERABLE. SOMETIMES THIS LEADS TO EARLY MENTAL HEALTH CHALLENGES THAT CAN HAVE ENDURING IMPACT. The 2009 national parent poll by ZERO TO THREE described earlier found that parents of children from birth to age three tended to overestimate the self-regulatory capabilities of children of this age. The same national survey also found, however, that parents underestimate the emotional sensitivity of their young children (Newton & Thompson 2010). The majority of parents reported that children under six months do not experience sadness and fear, and the majority also felt that children under six months do not sense when their parents are angry or sad. Nearly 55% of parents believed that children do not feel good or bad about themselves until after the age of two, with some thinking that this occurs much later. As with parent beliefs about early self-regulation, research findings do not support parents’ beliefs about early emotional development. During the first year, infants have a rich emotional life, they are very much affected by the emotions of those who care for them, and others’ feelings and moods influence their own emotional responses and development (Field 1992). This is significant in light of the high proportion of nine-montholds (41%) in one study who were in the care of mothers with depressive symptomatology, especially in circumstances involving other stresses on the family, such as poverty (Vericker, Macomber, & Golden 2010).

With increasing age, young children’s emotional sensitivity remains acute, and extends to other caregivers.

In one recent study, researchers measured the depressive symptomatology of more than 750 home- and center-based care providers, and found that teacher depression was linked to higher levels of behavior problems in the three-year-olds in their care. This association was attributable to the poorer quality of the classroom environment provided by teachers (Jeon, Buettner, & Snyder 2014).

Findings such as these underscore the depth and vulnerability of early emotional development. Because of how much they depend on the nurturance of the adults who care for them, young children’s psychological well-being depends on the emotional well-being of these adults. In circumstances in which these adults are chronically depressed or anxious (which may be associated with broader problems such as marital or financial stress), or when there is regular marital conflict or domestic violence, or in more extreme circumstances when children are traumatized by physical abuse, their emotional development may be so significantly affected that questions of early mental health necessarily arise. Although these conclusions seem reasonable in light of what we know about early psychological development and the effects of stress, the idea that infants, toddlers, and young children can experience mental health problems is a new idea to many early childhood practitioners and to the public in general.

Indeed, the idea that infant and early childhood mental health problems require attention is also a new idea to psychologists. Their attention to these problems has grown with increasing evidence that even very young children show clear evidence of traumatization and posttraumatic stress, anxious and depressive symptomatology, behavioral and conduct problems, and other serious psychological problems (Egger & Angold 2006; Lieberman, Chu, Van Horn, & Harris 2011; Luby 2006; Zeanah 2009). The origins of these problems are complex, and often involve an interaction between environmental stresses and supports with This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

13

NCECDTL genetic factors that magnify or reduce young children’s susceptibility to these influences. Fortunately, there has been significant progress in creating developmentally-sensitive procedures for describing and identifying these problems even in very young children, most notably with the recent publication of DC:0-5, Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (ZERO TO THREE 2016).

An extended discussion of the nature of infant and early childhood mental health disorders and their treatment is beyond the scope of this review, but several conclusions seem relevant to the work of early childhood practitioners.

Like older children and adults, infants and young children become depressed, experience anxiety that disrupts typical functioning, and show posttraumatic stress and other psychological problems. Many of the behaviors associated with these problems in young children are similar to those observed at older ages. But other problems are more unique to younger children, including disorders associated with sleep, eating, and crying, language delay, sensory processing problems, as well as certain relationship disorders that are less commonly seen at older ages. These problems can be overlooked as symptoms of psychological difficulty by adults who provide care for young children without some sensitivity to the behavioral characteristics associated with problems like these that are more unique to young children.

The behavioral problems that typically command the attention of an early childhood practitioner are when a young child shows uncontrolled anger or aggression, impulsivity or overactivity, or is behaviorally disruptive in other ways. But there are also important symptoms of psychological distress that are manifested in less disruptive behavior, such as the withdrawal or inhibition that can be observed when children are suffering from anxiety or depression. For many young children, managing fear and sadness is more challenging then regulating their anger or frustration. These problems can also be easily overlooked because the behaviors with which they are associated are far less disruptive and do not seem to require an immediate response.

More than at later ages, psychological well-being is directly tied to the quality of young children’s relationships with those who matter to them. This is reflected not only in the ways that a caregiver’s emotional functioning can support or imperil a young child’s well-being, but also in disorders that are based in specific close relationships in the child’s world (ZERO TO THREE 2016). This is illustrated

by Axis II of DC:0-5, which focuses on the relational context of the young child’s experience, and includes not only an assessment of the quality of the child’s relationship with the primary caregiver but an assessment of the overall family caregiving environment (relationships with other family caregivers) and its influence on the child’s functioning. In light of a long history of clinical science in which psychological problems are perceived to be within an individual, it requires a reframing of orientation toward young children to appreciate that early mental health problems are often based in a relationship rather than solely within the child. Early childhood practitioners can benefit from this orientation by thinking of the child’s functioning within this relational context.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

14

NCECDTL The importance of familiarity with early childhood mental health concerns is not that an early childhood practitioner should expect to be able to diagnose and treat psychological problems that arise. In the next section, issues related to infant early childhood mental health consultation are considered. Rather, the value of becoming familiar with these concerns is to sensitize the practitioner to the richness and vulnerability of young children’s emotional experience, the possible origins of problems that arise, and the questions to ask in determining whether a particular child’s behavior warrants special concern.

THE SOCIAL AND EMOTIONAL FOUNDATIONS FOR EARLY LEARNING (SEFEL): OPPORTUNITIES FOR EXPANSION AND UPDATING Since its inception in the early 2000s, SEFEL has provided early childhood practitioners with outstanding guidance on evidence-based practices for promoting positive behavior, building constructive child-teacher relationships, and addressing challenging behavior in children from infancy through preschool. Its emphasis on strengthening young children’s social and emotional development as a means of preventing the growth of challenging behavior, implementing strategies to address problem behavior through the development of behavior support plans, and using individualized interventions and teacher teamwork has served the field well. Over the years, a range of online and published materials, many of them developed by partner organizations, has helped practitioners implement and adapt the Pyramid Model to their own classrooms. A recent clusterrandomized controlled trial showed that teachers who had received a professional development curriculum based on the Pyramid Model showed greater fidelity in implementing Pyramid Model practices compared to control teachers (who received no additional training) and, more importantly, the children they taught were rated as showing better social skills and fewer challenging behaviors on follow-up assessments (Hemmeter, Snyder, Fox, & Algina, 2016).

In considering how SEFEL could be updated and expanded in light of current research in early childhood development, the preceding research review offers some suggestions. Significantly expanded understanding of the biological and behavioral effects of early stress that has emerged during the past ten years helps to address questions of the origins of challenging behavior problems in the classroom, and also has potential implications for intervention. This is important because, unfortunately, the difficulties posed by challenging behavior that led to the development of SEFEL are still voiced by early childhood practitioners as well as parents. This is owing, in part, to the larger numbers of children served by early education programs and the greater levels of stress that many young children appear to be experiencing. In addition, expanded understanding of the development of self-regulation is the most prominent of several This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

15

NCECDTL ways in which developmental neuroscience offers new ideas about the growth of social and emotional skills. Moreover, the expansion of professional attention to infant and early childhood mental health has implications for the kinds of information and strategies that early childhood practitioners should receive as part of their learning about addressing challenging behavior. The expanding field of infant and early childhood mental health consultation during the past decade also provides opportunities to establish the boundaries of required expertise of early childhood teachers and the resources that are available when challenging behavior exceeds the teacher’s expertise.

With these considerations in mind, I offer below some suggestions for the expansion and updating of SEFEL. They are based on research that has emerged during the past ten years and consultation with developmental and clinical researchers and practitioners who are experienced in SEFEL. INCORPORATE TRAUMA-INFORMED TEACHING PERSPECTIVES INTO SEFEL During the last ten years, new ways of equipping teachers for addressing children’s challenging behavior have emerged. They are collectively described as “trauma-informed care” or “trauma-informed teaching.” Based on the developmental neuroscience discussed earlier about the effects of stress on children’s behavioral and biological functioning, trauma-informed perspectives underscore how prior experiences of trauma, victimization, exposure to violence, abuse or neglect, and other kinds of chronic stress contribute to disruptive, hyperreactive, withdrawn, or other dysfunctional behaviors.

Although it remains important to understand the classroom triggers that can provoke children’s disruptive behavior, these behaviors are also viewed within the broader context of how the child’s developmental history has prepared the child to respond in this way.

Stated differently, it is not just the current environment but also the effects of past experiences and how they have shaped behavior and biology that are included in a trauma-informed perspective (see National Child Traumatic Stress Network at http://www.nctsn.org).

Consequently, in trauma-informed teaching practitioners are provided training in identifying signs of stress and trauma in their students, coached in how to talk about traumatic experiences with children once they have developed trusting relationships with them, helped to understand the kinds of experiences that can provoke a heightened emotional response in stressed children (such as unexpected transitions, encountering persistent failure, or the child feeling vulnerable or frustrated), and guided in learning behavioral strategies that avoid escalating conflict and instead seek non-adversarial and non-exclusionary solutions to problems that arise. Informal (and sometimes formal) efforts are devoted to identifying children at particular risk, such as those whose family situations are known to be difficult, or children who are system-involved This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

16

NCECDTL (child protection, foster care, juvenile justice systems). Teachers learn interventions that address both the disruptive behavior and its antecedents, such as by strategies that help to create classroom environments of safety and predictability, coaching children in stress management techniques, building strong teacherchild relationships, and creating a constructive classroom environment. They enlist family members to the extent that they are not sources of trauma themselves and can contribute constructively to helping the child.

In certain circumstances, teachers obtain consultation with mental health experts. These strategies are consistent with those of SEFEL but also informed by the research on trauma and stress neurobiology.

Trauma-informed teaching also focuses on the stresses that teachers themselves experience both from challenging behavior in the classroom and from other influences in their lives. Recognizing that many teachers come from comparably stressful settings as those of their children, this approach encourages teachers to recognize the situations that cause them to overreact in the classroom, learn effective strategies of emotion management and self-care, and work together with supportive collegial teams. One practice that has become common in such circumstances is “reflective supervision,” in which teachers have the opportunity to take a broader perspective on their interactions with children in the context of a supervisor who prompts the teacher to reflect on thoughts, feelings, and goals in these interactions (Shahmoon-Shanok 2009). Regular supervision of this kind allows teachers to analyze their behavior outside of the context in which it was elicited and to return to the classroom with greater perspective and insight.

Trauma-informed teaching has become part of teacher preparation for those working with children from infancy through adolescence, and especially with children from at-risk environments. Many school districts, Head Start programs, and early care and education programs enlist trauma-informed perspectives and provide ongoing training to teachers in these approaches. Furthermore, there have been state-based SEFEL revisions that explicitly incorporate trauma-informed perspectives as well as early childhood mental health consultation into the Pyramid Model, such as Maryland’s SEFEL model (see https://theinstitute.umaryland.edu/sefel/index.cfm).

RECOGNIZE THAT CHILDREN’S CONCERNING BEHAVIOR MAY NOT ALWAYS BE DISRUPTIVE BEHAVIOR One primary reason SEFEL was developed was to provide teachers and parents with tools to manage disruptive behavior in young children. This is important because of how much a child’s aggressive, oppositional conduct can completely change the interpersonal climate of a classroom for children and adults—undermining learning and social interaction—and how much such behavior consumes the attention and energy of an adult until it is under control.

When considering the full range of behavior problems that young children exhibit, however, it is apparent that other behaviors also warrant concern (ZERO TO THREE 2016). Young children who are traumatized can become withdrawn and inhibited rather than angry and defiant. Some may show periods of dissociation (or “spaciness”) in which they are mentally disconnected from the moment. Young children’s anxiety may appear in eating or sleep disruptions—stomach pains or headaches that do not attract attention This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

17

NCECDTL and may be overlooked if the child does not draw attention to them. Depressive symptomatology for young children can include sluggish or agitated behavior as well as social withdrawal. In these and other situations, young children are experiencing psychological distress in ways that do not necessarily elicit the attention of parents or teachers as much as disruptive behaviors do. Unless adults are sensitized to their importance and meaning, these symptoms may fly under the radar and the child remains un-helped.

It is important that teachers understand that young children can experience mental health problems that are manifested in behaviors that are easy to overlook. This understanding can cause them to recognize that some children who do not often get in trouble may nevertheless require special attention and support. It can mobilize them, on occasion, to probe more deeply into a young child’s social withdrawal, refusal to eat, or sad mood. At times, it can cause them to ask questions of the child or the family that might not otherwise be asked. In short, if teacher guidance is focused on challenging behavior that is disruptive and requires an immediate response, teachers may not be prepared to consider whether children who do not get in trouble are showing signs of psychological distress in other ways.

This understanding is important because the way teachers respond to this challenging behavior is different from the ways they respond to challenging behavior that is disruptive or oppositional. Where young children’s generalized anxiety is concerned, for example, it may be less important to search for triggers in the child’s classroom experience than to search for the past and current experiences that may be contributing to anxious affect. When a child has become socially withdrawn, an adaptive approach may not teach social skills at first, but rather explore the reasons for withdrawn behavior toward peers. There may be little value, from the perspective of understanding the meaning of these behaviors, to consider how dissociation, inhibition, or eating and sleeping problems may reward the child, as approaches to disruptive conduct often emphasize. It may thus be important for teachers to become familiarized with new ways to address different kinds of challenging behavior in the classroom, some of which require immediate attention, but others a more searching discernment of their meaning and significance.

EXPAND ATTENTION TO INFANT EARLY CHILDHOOD MENTAL HEALTH CONSULTATION Important changes in the culture of early care and education during the last decade have derived from a growing awareness of larger numbers of young children showing signs of significant stress in their classroom behavior (see Raver & Knitzer 2002). It is likely that one reason for the rapidly increased interest in SEFEL since its inception is because of the tools it provides early educators for managing these behaviors.

Even so, teachers trained in SEFEL are encouraged to recognize when even individualized intensive This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

18

NCECDTL interventions require the assistance of an outside consultant to help the teacher understand behavior problems and how to address them. In light of the frequency with which more serious behavior problems of this kind arise, the growth in infant early childhood mental health (I/ECMH) training programs and personnel, and the need for consultation opportunities by early educators working with children at all ages, expanded attention to I/ECMH consultation in SEFEL seems warranted.

The value of I/ECMH consultation is reflected in Gilliam’s (1995) report that the rate of expulsion of young children from state-funded prekindergarten programs is significantly higher than the rate of expulsion of older children from kindergarten through twelfth-grade classrooms. The same analysis indicated, moreover, that teacher access to classroom-based mental health consultation significantly reduced the rate of child expulsion. A recent random-controlled evaluation of the effectiveness of early childhood mental health consultation with preschool teachers serving three- to four-year-olds found that teachers who received consultation services for approximately two months reported significantly lower ratings of hyperactivity, externalizing behaviors, problem behaviors, and total problems in the children of greatest concern to them compared to comparable ratings of children by teachers who had not received consultation services (Gilliam, Maupin & Reyes 2016). The design of I/ECMH programs varies and because this is the first random-controlled evaluation of its kind, the generalizability of these findings is uncertain. But in light of a growing number of published non-random-controlled assessments of the effectiveness of I/ ECMH consultation services (Hepburn, Perry, Shivers, & Gilliam 2013; Perry, Allen, Brennan, & Bradley 2010), there is reason for some confidence in their efficacy in supporting teachers’ classroom interventions to address behavioral problems. In short, I/ECMH has the potential to provide teachers with significant help in managing challenging child behavior.

There are at least two ways that an I/ECMH consultant can advance the general goal of building the capacity of an early childhood program to prevent, identify, and address mental health problems and challenging behavior in young children (Johnston & Brinamen 2006). Child- and family-centered consultation focuses attention on a particular child whose behavior concerns teachers, and may involve the consultant observing the child in interaction with peers and teachers before working with program staff to develop an intervention plan. Program-centered consultation, on the other hand, is intended to increase the capacity of the program to support healthy development in young children, and focuses attention on mentoring and coaching teachers and other staff. Not surprisingly, these two approaches to I/ECMH consultation often overlap.

One reason to increase attention to I/ECMH consultation in SEFEL is to help teachers (and their supervisors) tackle some of the challenges involved in enlisting consultants to their work. Although the landscape of I/ECMH services, the training of consultants, and the support of these programs through state funding have improved significantly during the past decade (see Caputo 2016 for an excellent report on the current status of this field), it remains true that the current availability of well-trained professionals who have expertise with young children and their families falls short of what is needed. It is typical that the search for a skilled I/ECMH consultant initiated by an early childhood teacher or program fails to find This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

19

NCECDTL one, and this is especially true in rural, impoverished, and otherwise underserved areas. In particular, unless states or communities have proactively worked to establish reliable funding streams to recruit and retain individuals with the needed expertise, they are unlikely to be available when needed.

Although these reflect broader problems in establishing a system of early childhood mental health care that is comparable to systems that exist for older children, adolescents, and adults, it means that early childhood teachers and administrators need to be creative in identifying the resources that are available to them. These may be found, for example, not only from an expert in private practice but also through a local school district (particularly in association with Early Intervention [Part C] services), foster care or child welfare systems, the statewide QRIS system, or other state programs, such as the Early Childhood Consultation Partnership in Connecticut or Project PLAY in Arkansas, that are typically administered by state mental health, education, early childhood departments (Caputo 2016). Referrals through local Head Start or Early Head Start centers may also be possible. The funding streams to support consultation services vary according to the program that supports a consultant’s services, which in turn can determine the duration and intensity of consultation. In short, the bridge between the need for I/ECMH consultation and the resources to provide it needs to be strengthened, and until it is, SEFEL will serve teachers and administrators by discussing in greater depth the avenues for obtaining the services that early childhood educators find necessary to their efforts to serve young children. Those who work with young children, along with parents, are also potentially influential advocates for the expansion of community- and schoolbased services to address early mental health needs in their communities.

The benefits of integrating expanded attention to I/ECMH in SEFEL is reflected in the work of several states that have integrated their early childhood mental health programs with the Pyramid Model, including Arizona, Arkansas, Maryland, Massachusetts, North Carolina, and Pennsylvania (Caputo 2016). Perry and Kaufmann (2009) have also thoughtfully discussed the issues involved in this integration.

STRENGTHEN ATTENTION TO THE SPECIFIC, SOMETIMES UNIQUE, CHARACTERISTICS OF WORKING WITH INFANTS AND TODDLERS Many of the ideas of SEFEL apply to children throughout the infancy through preschool developmental continuum. However, this is also a period of more rapid growth than any subsequent period (Thompson 2001), and inevitably this requires adaptation of SEFEL to the characteristics and needs of young children of different ages. In the past, practitioners have adapted the practices they used with preschoolers to suit the needs of infants and toddlers. With increased recognition of some of the unique features of thought, emotion, and relationships in the first three years, it is important to address the developmental needs of infants and toddlers on their own terms (Chazan-Cohen, Zaslow, Raikes, Elicker, Paulsell, Dean, & Kreiner-Althen 2017). This is certainly true with respect to practices that support early learning and cognitive growth in the first three years (Chasan-Cohen et al. 2017), and it is true also with respect to promoting a positive classroom environment, building strong social and emotional skills, and managing challenging behavior. A potentially important goal for the next edition of SEFEL is strengthening attention to the specific, and sometimes unique, characteristics of working with infants and toddlers.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

20

NCECDTL INFANT AND TODDLER CONSIDERATIONS

Infants and toddlers often receive care in family child care homes and family/friend/neighbor settings where they are in the care of one or two adults in a small group setting of multiage children. This contrasts with the more typical setting for older preschoolers, which consists of a center with classrooms of children of comparable age staffed by a few adults. The challenges of creating a positive classroom environment to promote social and emotional skills and address challenging behavior are much different in a home-based multiage context in several ways: a. Peer influences are very different and the social skills required to negotiate interaction with children of different ages are more complex, especially for younger children b. Promoting positive social and emotional skills requires working simultaneously with children of different ages who vary significantly in their social understanding, behavioral competence, and capacities for conflict management c. The self-regulatory capacities of children within a multiage setting are also significantly different, which means that a teacher must create regulatory supports for the youngest children while promoting self-regulation in the older ones d. Teachers in home-based settings are more capable of establishing influential relationships because they are more likely to care for children for several years, in contrast with the tendency of preschoolers in centers to “graduate” to new classes with new teachers in the fall e. Managing challenging behavior in an older child in settings where younger children, including toddlers, are present warrants more preemptory intervention by a teacher who must also be concerned with the safety of the youngest children There are certainly many other points of contrast between the challenges and opportunities faced by teachers in these different settings. Because SEFEL is primarily designed for teachers in care and education centers, adapting it to home-based, multiage programs is important for widening its relevance and impact.

Relationships are important to positive social and emotional development at any age, but they are especially important for infants and toddlers (Thompson 2006). The security that derives from infantcaregiver relationships colors the young child’s experience, especially in the environment in which that relationship is encountered, and shapes the child’s self-confidence, enthusiasm for new discoveries, emotional responsiveness, and self-regulation. More than for older children, each learning opportunity is defined by who participates in it as well as what it consists of. This is not meant to minimize the importance of relationships that preschoolers experience out of the home, which are also important to their learning and social functioning in the classroom. Rather, it emphasizes that at earlier ages, before a sense of self has more fully developed and social understanding has further unfolded, the central figures in a young child’s environment of relationships are profoundly important.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

21

NCECDTL This realization adds weight to the importance of the quality and security of child-adult relationships in infant and toddler care, especially in light of research reviewed earlier underscoring the sensitivity of very young children to the emotions and moods of those who care for them, and the nonegocentric manner in which they are attuned to the intentions and feelings of the significant adults in their experience. The importance of early relationships is one reason that the leading assessments of the learning environment developed for children of this age—the Quality of Caregiver-Child Interactions for Infants and Toddlers (Q-CCIIT) (Adkins-Burnett, Monahan, Tarullo, Xue, Cavadel, Malone, & Akers 2015), and the Infant and Toddler CLASS—focus more on the quality of teacher-child interaction than comparable measures designed for older children. This is also one reason that many care settings for infants and toddlers emphasize the development of a primary caregiving relationship for each child—that is, an adult who is reliably available to the child as a source of security and support. This emphasis on primary caregiving relationships for very young children underscores the child’s reliance on the adult with whom they have developed a relationship of security and trust, and sometimes motivates efforts to enable that adult to maintain this relationship as long as possible within that care setting.

Developing self-regulation is important to the growth of positive social and emotional competencies. But as indicated earlier, selfregulation develops very slowly in early childhood. One important difference between infants/toddlers and older children, therefore, is that behavioral regulation must be co-regulation for the youngest children whose limited capacities for self-control are complemented by teachers who structure the environment and the child’s experience in ways that facilitate wellbeing. As they grow, preschool-age children become more capable of independent self-regulation. The teacher’s greater responsibility for managing the emotions, attention, behavior, and thinking of the youngest children requires proactive as well as reactive strategies. In addition to responding to distress and frustration when it occurs, for example, those who care for infants and toddlers must consider how the environment is structured (is it overstimulating?), the design of the daily schedule (are activities sequenced to remain within a young child’s capacities?), how to make transitions manageable (including those transitions for regular caregiving activities, such as diaper changing), and the organization of peer interactions. Sometimes behavioral problems arise because infants and toddlers are overwhelmed by experiences that are beyond their ability to manage because of a poorly designed daily routine or an overstimulating physical environment.

Above all, adults’ co-regulation of infants’ and toddlers’ experiences in care means that they buffer the child’s experience by how they sensitively attend to the child’s responses, enlist their language and emotions to engage the child or, on other occasions, help the child transition to something that is more This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

22

NCECDTL interesting or less stimulating. This is a very different role in developing regulatory capabilities than what is necessary for a preschool educator, yet because it is developmentally appropriate to an infant’s or toddler’s capabilities it helps to establish a foundation for the subsequent growth of self-regulation in the years that follow.

As noted earlier, some of the challenging behavior that elicits the concern of teachers of preschool-age children are also apparent in younger children. Moreover, different developmental stages make certain problems more prominent at younger ages, and teachers of infants and toddlers should be aware of these.

Language delays, sensory processing challenges, significant disruptions in eating or sleep, and disordered crying are among the behaviors that may be of diagnostic significance even for children in the first three years of life (ZERO TO THREE 2016). In addition, because some problems—such as those involving inhibited or withdrawn behavior—are not especially disruptive, teachers of very young children need special sensitivity to their meaning and potential importance when working with infants and toddlers.

A language-rich environment is important at any stage of development, but language is used differently with children of different ages because of differences in children’s language development. In infancy, language in every context helps to bathe the baby’s brain in the language stimulation that helps to reorganize relevant brain regions to the phonemic structure of the language the child is beginning to learn. In the second year, language helps the child acquire nominal references to common objects, places, and people in the vocabulary explosion that begins during this year, while also familiarizing the child with the grammatical structure of the language the child is acquiring. With increasing age, language is used in more complex ways, such as to reference invisible realities (such as events of the mind), human characteristics (such as intentions and motives), and even aspirations (as in early moral discourse). Understanding not only the importance of language but also its relevance to children at different developmental stages, and its relevance to promoting positive social and emotional development, is one way that teaching infants and toddlers is different from teaching older children.

Relationships are important not only in the classroom but also as bridges between teacher and parents, as SEFEL emphasizes. The parent-teacher relationship is especially significant in the care of infants and toddlers. One reason is the importance, to very young children, of consistency in experiences at home and during out-of-home care in caregiving routines and rituals, eating and sleeping practices, and relational support. This can only be accomplished with good communication between teachers and parents. Another reason is how often the parents of very young children—particularly if they are firsttime parents—rely on the guidance of those who care for their children outside of the home. Because the experience of caring for a very young child can be perplexing, questions about behavioral regulation (how can I help my child calm down when she is crying?), expectations (how can I know whether to be concerned about something my child is doing, or not doing, compared to other children?), language (why should I talk to him when he can’t understand what I’m saying?), and other issues (what is the best discipline approach with my child?) are questions that are especially likely to arise in the context of caring for an infant or toddler.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

23

NCECDTL INCORPORATE INSIGHTS FROM DEVELOPMENTAL NEUROSCIENCE Finally, consistent with the theme of the preceding section, SEFEL might benefit from a broader developmental orientation to social and emotional development. In their efforts to build positive social skills in children and address challenging behavior, teachers can benefit when they can see children of an age in the context of their developmental capabilities and potential.

In recent years, research in developmental neuroscience has expanded knowledge of early development and the communication of that knowledge to practitioners. There is something about understanding children’s capabilities in terms of underlying brain functions that compels attention and elicits serious consideration from scientists and nonscientists alike. In the foregoing review there are several illustrations of conclusions from developmental neuroscience that are relevant to early education classrooms, including the slow maturation of brain regions underlying developing self-regulation, and the neurobiological effects of chronic stress on emotion regulation and early learning. These illustrations do not exhaust the range of applications of developmental neuroscience to understanding early development. The early maturation of the amygdala and other limbic structures early in life helps to explain early capacities for fear (and trauma), range (and anger), and sadness. Further development of the brain is required before these emotional reactions can be modulated through the influence of prefrontal structures that govern self-regulation. The growth of the hippocampus provides insights into the early development of memory and working memory in the early years, and the influence of emotions on memory. In these and other ways, teachers who work with young children can understand that young children’s behavior is complexly based on developing neurobiological capacities that require their own time to fully mature.

There is also considerable research in developmental science that can contribute to unfolding a developmental picture of young children in ways that are relevant to the growth of social and emotional competence. For example, research on early conscience development indicates that older preschoolers begin to develop a sense of themselves as moral people who seek to do the right thing and feel badly after misbehavior, and this “moral self ” is an important contributor to children’s moral development (Kochanska, Koenig, Barry, Kim, & Eun 2010). The development of this capacity to see oneself as motivated to do the right thing is potentially an important resource that can become enlisted to promote cooperative conduct and classroom citizenship.

There are other ways that developmental science can contribute to an understanding of social and emotional growth that can inform teachers’ efforts to support positive social and emotional conduct in the classroom (see, for example, Thompson 2014b). Incorporating these into the training materials for SEFEL can help teachers perceive the children in their classrooms in terms of the developmental sequences in which they are moving, envisioning both the capabilities they have already acquired and those they are on the verge of achieving, especially with the assistance of their experience in the classroom.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

24

NCECDTL REFERENCES Adkins-Burnett, S., Monahan, S., Tarullo, L., Xue, Y., Cavadel, E., Malone, L., & Akers, L. 2015.

“Measuring the Quality of Caregiver-Child Interactions for Infants and Toddlers (Q-CCIIT).” OPRE report 2015-13. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, Washington, DC. Retrieved May 29, 2017. https://www.acf.hhs.gov/opre/resource/ measuring-the-quality-of-caregiver-child-interactions-for-infants-and-toddlers-q-cciit Bakermans-Kranenburg, M. J., van Ijzendoorn, M. H., Pijlman, F. T. A., Mesman, J., & Juffer, F. 2008.

“Experimental Evidence for Differential Susceptibility: Dopamine D4 Receptor Polymorphism (DRD4 VNTR) Moderates Intervention Effects on Toddlers’ Externalizing Behavior in a Randomized Controlled Trial.” Developmental Psychology 44: 293-300.

Baldwin, D. A., & Moses, L. J. 2001. “Links Between Social Understanding and Early Word Learning: Challenges to Current Accounts.” Social Development 10: 309-329.

Belsky, J., & Pluess, M. 2009. “Beyond diathesis stress: Differential Susceptibility to Environmental Influences.” Psychological Bulletin 135: 885-908.

Best, J. R., & Miller, P. H. 2011. “A Developmental Perspective on Executive Function.” Child Development 81: 1641-1660.

Blair, C., & Raver, C. C. 2012. “Child Development in the Context of Adversity: Experiential Canalization of Brain and Behavior.” American Psychologist 67: 309-318.

Caputo, M. 2016. “Early Childhood Mental Health Consultation: Policies and Practices to Foster the Social-Emotional Development of Young Children.” Washington, DC: Zero to Three. Retrieved May 27, 2017. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-andpractices-to-foster-the-social-emotional-development-of-young-children Center on the Developing Child at Harvard University. 2011. “Building the Brain’s ‘Air Traffic Control’ System: How Early Experiences Shape the Development of Executive Function.” Working Paper no. 11.

Retrieved May 22, 2017. http://developingchild.harvard.edu/resources/building-the-brains-air-traffic-controlsystem-how-early-experiences-shape-the-development-of-executive-function/ Chazan-Cohen, R., Zaslow, M., Raikes, H., Elicker, J., Paulsell, D., Dean, A., & Kreiner-Althen, K. 2016.

“Working toward a definition of infant/toddler curricula: Intentionally furthering the development of individual children within responsive relationships.” Washington DC: Office of Planning, Research and Evaluation, Administration for Children and Families, Retrieved May 29, 2017. https://www.acf.hhs. gov/opre/resource/working-toward-definition-infant-toddler-curricula-intentionally-furthering-developmentindividual-children-relationships Csibra, G. 2010. “Recognizing Communicative Intentions in Infancy.” Mind & Language 25: 141-168.

Egger, H. L., & Angold, A. 2006. “Common Emotional and Behavioral Disorders in Preschool Children: Presentation, Nosology, and Epidemiology.” Journal of Child Psychology and Psychiatry and Allied Disciplines 47: 313-337.

Eisenberg, N. 2012. “Temperamental Effortful Control (Self-Regulation).” Encyclopedia on Early Childhood Development. Retrieved May 23, 2017. http://www.child-encyclopedia.com/sites/default/files/ textes-experts/en/892/temperamental-effortful-control-self-regulation.pdf This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

25

NCECDTL Ellis, B. J., & Boyce, W. T. 2008. “Biological Sensitivity to Context.” Current Directions in Psychological Science 17: 183-187.

Field, T. 1992. “Infants of Depressed Mothers.” Development and Psychopathology 4: 49-66.

Gilliam, W. S. 2005. “Prekindergarteners Left Behind: Expulsion Rates in State Prekindergarten Systems.”

Foundation for Child Development Policy Brief Series No. 3. Retrieved May 23, 2017. https://www.fcd-us. org/prekindergartners-left-behind-expulsion-rates-in-state-prekindergarten-programs/ Gilliam, W. S., Maupin, A. N., & Reyes, C. R. 2016. “Early Childhood Mental Health Consultation: Results of a Statewide Random-Controlled Evaluation.” Journal of the American Academy of Child and Adolescent Psychiatry 55: 754-761.

Hemmeter, M. L., Snyder, P. A., Fox, L., & Algina, J. 2016. “Evaluating the Implementation of the Pyramid Model for Promoting Social-emotional Competence in Early Childhood Classrooms.” Topics in Early Childhood Special Education 36: 133-146.

Hepburn, K. S., Perry, D. F., Shivers, E. M., & Gilliam, W. S. 2013. “Early Childhood Mental Health Consultation as an Evidence-Based Practice: Where Does it Stand?” Zero to Three Journal 33: 10-19.

Hibel, L. C., Granger, D. A., Blair, C., & Cox, M. J. 2011. “Maternal Sensitivity Buffers the Adrenocortical Implications of Intimate Partner Violence Exposure During Early Childhood.”

Development and Psychopathology 23: 689-701.

Hirsh-Pasek, K., Adamson, L. B., Bakeman, R., Owen, M. T., Golinkoff, R. M., Pace, A., Yust, P. K. S., & Suma, K. 2015. “The Contribution of Early Communication Quality to Low-Income Children’s Language Success.” Psychological Science 26: 1071-1083.

Hostinar, C. E., Sullivan, R. M., & Gunnar, M. R. 2014. “Psychobiological Mechanisms Underlying the Social Buffering of the Hypothalamic-Pituitary-Adrenocortical Axis: A Review of Animal Models and Human Studies Across Development.” Psychological Bulletin 140: 256-282.

Institute of Medicine and National Research Council. 2015. Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation. Washington, DC: National Academies Press.

Jeon, L., Buettner, C. K., & Snyder, A. R. 2014. “Pathways From Teacher Depression and Child-Care Quality to Child Behavioral Problems.” Journal of Consulting and Clinical Psychology 82: 225-235.

Jiang, Y., Ekono, M., & Skinner, C. 2016. Basic Facts About Low-Income Children: Children Under 6 Years, 2014. National Center for Children in Poverty, Mailman School of Public Health, Columbia University.

Retrieved May 24, 2017. http://www.nccp.org/publications/pub_1149.html Johnston, K., & Brinamen, C. 2006. Mental Health Consultation in Child Care. Washington, DC: Zero to Three Press.

Kim, G., & Kwak, K. 2011. “Uncertainty Matters: Impact of Stimulus Ambiguity on Infant Social Referencing.” Infant and Child Development 20: 449-462.

Kochanska, G., Koenig, J. L., Barry, R. A., Kim, S., & Eun, J. Y. 2010. “Children’s Conscience During Toddler and Preschool Years, Moral Self, and a Competent, Adaptive Developmental Trajectory.”

Developmental Psychology 46: 1320-1332.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

26

NCECDTL Levine, S. C., Suriyakham, L. W., Rowe, M. L., Huttenlocher, J., & Gunderson, E. A. 2010. “What Counts in the Development of Young Children’s Number Knowledge?” Developmental Psychology 46: 1309-1319.

Lieberman, A. F., Chu, A., Van Horn, P., & Harris, W. W. 2011. “Trauma in Early Childhood: Empirical Evidence and Clinical Implications.” Development and Psychopathology 23: 397-410.

Luby, J. L. 2006. Handbook of Preschool Mental Health. New York: Guilford.

Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. 2009. “Effects of Stress Throughout the Lifespan on the Brain, Behaviour and Cognition.” Nature Reviews Neuroscience 10: 434-445.

McEwen, B. S. 2012. “Brain on Stress: How the Social Environment Gets Under the Skin.” Proceedings of the National Academy of Sciences 109 (Suppl. 2): 17180-17185.

Meltzoff, A. N. 1995. “Understanding the Intentions of Others: Re-Enactment of Intended Acts by 18-Month-Old Children.” Developmental Psychology 31: 838-850.

Newton, E. K., & Thompson, R. A. 2010. “Parents’ Views of Early Social and Emotional Development: More and Less than Meets the Eye.” Zero to Three Journal 31: 10-15.

Ni, U. J., Chiu, M. M., & Cheng, Z. J. 2010. “Chinese Children Learning Mathematics: From Home to School.” In Oxford handbook of Chinese Psychology edited by M. H. Bond, 143-154. New York: Oxford University Press.

Perry, D. F., Allen, M. D., Brennan, E. M., & Bradley, J. R. 2010. “The Evidence Base for Mental Health Consultation in Early Childhood Settings: A Research Synthesis Addressing Children’s Behavioral Outcomes.” Early Education and Development 21: 795-824.

Perry, D. F., & Kaufmann, R. 2009. “Integrating Early Childhood Mental Health Consultation with the Pyramid Model.” Issue brief from the Technical Assistance Center on Social Emotional Intervention and the National Center on Effective Mental Health Consultation. Retrieved May 27, 2017. http:// challengingbehavior.fmhi.usf.edu/do/resources/documents/brief_integrating.pdf Raver, C. C., & Knitzer, J. 2002. “Ready to Enter: What Research Tells Policymakers About Strategies to Promote Social and Emotional School Readiness Among Three- and Four-Year-Old Children.” National Center for Children in Poverty Policy Paper no. 3. Mailman School of Public Health, Columbia University.

Retrieved May 27, 2017. https://academiccommons.columbia.edu/catalog/ac:127551 Saffran, J. R. 2003. “Statistical Language Learning: Mechanisms and Constraints.” Current Directions in Psychological Science 12: 110-114.

Shahmoon-Shanok, R. 2009. “What is Reflective Supervision?” In A Practical Guide to Reflective Supervision, edited by S. S. Heller & L. Gilkerson, 7-23. Washington, DC: Zero to Three Press.

Stahl, A. E., & Feigenson, L. 2015. “Observing the Unexpected Enhances Infants’ Learning and Exploration.” Science 348: 91-94.

Starr, A., Libertus, M. E., & Brannon, E. M. 2013. “Number Sense in Infancy Predicts Mathematical Abilities in Childhood.” PNAS 110: 18116-18120.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

27

NCECDTL Thompson, R. A. 2001. “Development in the First Years of Life.” The Future of Children 11: 20-33.

Thompson, R. A. 2006. “Nurturing Developing Brains, Minds, and Hearts.” In Concepts of Care: 20 Essays on Infant/Toddler Development and Learning, edited by R. Lally & P. Mangione, 47-52. Sausalito, CA: WestEd. Thompson, R. A. 2008. “The Psychologist in the Baby.” Zero to Three Journal 28: 5-12.

Thompson, R. A. 2009. “Doing What Doesn’t Come Naturally: The Development of Self-Regulation.”

Zero to Three Journal 30: 33-39.

Thompson, R. A. 2014. “Stress and Child Development.” The Future of Children 24: 41-59.

Thompson, R. A. 2014b. “Conscience Development in Early Childhood.” In Handbook of moral development (2nd Ed), edited by M. Killen & J. Smetana, 73-92. New York: Taylor & Francis.

Thompson, R. A. & Goodvin, R. 2016. “Social Support and Developmental Psychopathology.”

Developmental Psychopathology: Risk, resilience, and intervention, 86-135. New York: Wiley.

Ulrich-Lai, Y. M., & Harman, J. P. 2009. “Neural Regulation of Endocrine and Autonomic Stress Responses.” Nature Reviews Neuroscience 10: 397-409.

Vericker, T., Macomber, J., & Golden, O. 2010. “Infants of Depressed Mothers Living in Poverty: Opportunities to Identify and Serve.” The Urban Institute Brief #1. Retrieved May 25, 2017. http://www. urban.org/sites/default/files/publication/29086/412199-Infants-of-Depressed-Mothers-Living-in-PovertyOpportunities-to-Identify-and-Serve.PDF Wellman, H. M. 2014. Making Minds: How Theory of Mind Develops. New York: Oxford.

Zeanah, C, ed. 2009. Handbook of Infant Mental Health. New York: Guilford.

ZERO TO THREE. 2016. DC:0-5, Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. Washington, DC: author.

This document was developed with funds from Grant #90HC0012 for the U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start, and the Office of Child Care by the National Center for Early Childhood Development, Teaching, and Learning. This resource may be duplicated for noncommercial uses without permission.

28