Session 161 2005-6: Presidential Address - What's so special about the first year of life?

Presidential address given to The Society on Thursday 13th October 2005 by Dr Philip Wilson.

What's so special about the first year of life?
How do the experiences of babies shape their destiny?

The meeting was chaired by Dr David Vernon, President for the 160th session. The minutes of the previous meeting were approved. Dr Vernon informed members of the death of Dr Gerry Creane but also of the recovery from prolonged serious illness of Dr Stephan Slater who remains a strong supporter of the Society. Dr Jonathan Oates was introducing an innovation of recording the meeting to be available via the Society’s new web site—www.gsms.org.uk.

Dr Vernon then introduced our President for the session, Dr Philip Wilson, a man like himself with Manx connections, whose work is split between a local surgery and the University department of General Practice.

Phil gave a fascinating insight into evidence for first year influences in later social development. Brain development continues after birth – to a much greater extent in humans than other species – and this development is influenced by external factors. Thus physiological evidence indicates the influence of visual input on visual cortical connections during the first year of life. This plasticity of the brain seems to last longer in some other brain areas such as the pre-frontal cortex with potential influence on behaviour patterns. Different patterns of response in babies to strange situations are seen in what might be regarded as different levels of security of parental care. Is it possible that such early influences determine behaviour patterns followed in later life?

Dr Wilson’s talk concentrated on disruptive behaviour in young adults – a range of identified conduct disorders. An unattractive series of studies in monkeys demonstrates continued behaviour effects of a period of social deprivation in early months. Observations in Romanian orphans who suffered effectively similar isolation support these conclusions with identification of a reactive attachment disorder where individuals can be abnormally inhibited or disinhibited in forming relationships. Harsh and inconsistent parenting has similarly been related to future conduct disorders. Intriguingly the strength of these levels becomes much clearer when a potential genetic effect is taken into account – a New Zealand study shows evidence of genetic linkage and protection from raised levels of MAO. Increasingly there is evidence in study of various behaviour disorders of substantial genetic factors modified by early life experiences. These disorders cost society – a group of London 10 year olds with conduct disorders cost 10 times their peers in care and support by age 28.

Can we intervene? We were treated to a video demonstration of one area where parenting can be insensitive or unresponsive – post-natal depression. Intervention with a 'mellow parenting' package dramatically altered the obvious shared communication between mother and child. A New York randomized study of regular health visitor type intervention up to the age of 2 years substantially reduced various behaviour problems at age 15. Such clearcut evidence will be difficult to obtain. However, there is now sufficient evidence of the long term improvement of these first year experiences to justify an emphasis on good support for parenting when potential problems are apparent.

After considerable discussion of Dr Wilson’s paper, Dr Douglas Mack gave a vote of thanks, reminding the audience of the challenging breath of fresh thinking felt by many when Phil first arrived on the scene as a local GP. Dr Vernon reminded members of the forthcoming dinner and closed the meeting.
35 members had been in attendance.

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tags: primary care child development deprivation psychology epidemiology