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Reported November 15, 2004

A Brighter Generation: Smarter Babies -- White Paper

By Marybeth Lambe, M.D., Ivanhoe Health Correspondent

THE GROWING BRAIN...

(Ivanhoe Newswire) -- From the moment we hold our children in our arms for the first time, we long for their happiness and health. Even the most helpless infant holds the emerging miracle of human intelligence. How does a newborn baby’s brain grow? How can we best help them to develop that intellect? The beauty and mystery of the human brain confounds us. From infant to child, the rate of brain growth almost defies understanding. An adult brain weighs only three pounds and constitutes a mere 2 percent of our bodyweight. Yet at least half of our entire genome (the full genetic blueprint of our chromosomes) is devoted to producing this organ. The adult human brain is believed to consist of at least 100 billion neurons (nerve cells) and probably five- to 10-times as many glial (support) cells. Laid end to end, to employ the overused science metaphor of bigness, that's enough nerve cells to circle the globe 20,000 times.

While still in the womb, the fetus produces a great excess of neurons -- twice as many as it will eventually keep. Though the infant brain contains virtually all the nerve cells it will ever have, the pattern of wiring between them has yet to stabilize. In utero, the brain begins to lay out primitive and preliminary circuits -- synapses -- for vision, language and other functions. Neuroscientists have discovered that, after birth, driven by a flood of sensory experiences, neural activity explodes. An infant lays down over a billion new synapses a second, trillions in the first few months of life alone. These connections disappear forever by about age 10 if they are not used.

PARENTS OR TEACHERS?

In the past, researchers believed brain development was simply genetic. This neural wiring was assumed to be the result of a preordained blueprint. The revolution in brain research proves conclusively heredity is only part of the intelligence equation. A child does not have a predetermined rate of intellectual growth. A child’s level of brain power is shaped -- for better or worse -- by his environment during the early years of his life. Rich experiences produce rich brains. Experiences and learning in the early years of childhood make a permanent difference in a human’s lifelong intelligence. Genetics and environment work together to create each unique individual. The implications for early childhood experiences, early childhood education, are critical. Much of our intelligence is shaped, we now know, by the learning which occurs before formal schooling even begins. These new neurologic discoveries have profound implications for our national policy as well. Increasing numbers of young children are at serious risk for not getting adequate stimulation to help their brains grow. Today more than 3 million children live in poverty and over 25 percent are born to unwed mothers, many of them adolescents themselves. Yet this new research also offers hope for these children. A multitude of studies have shown that early enrichment can go a long way to make up for these early setbacks and help children of all socioeconomic levels reach their full intellectual potential. Such research has also infused new energy into the old political debates over daycare and family leave. We now understand that the parent plays the most critical role as a child’s first and most important teacher.

CRITICAL PERIODS AND MILESTONES

Researchers describe important windows of opportunity for specific brain development. In 1962, Harvard scientists Torsten Wiesel and David Hubel demonstrated this with visual connections in kittens. Newborn kittens, whose vision had been blocked at birth, could not see two weeks later, when the eye was uncovered. Although anatomically perfect, the eyes that had been closed could not see. This Nobel Prize winning research was the most vivid evidence that there are critical stages of development in which the brain needs the right kind of outside stimulation to teach brain cells how to do their jobs. In this case, it was vision.

Bill Greenough, of the University of Illinois, demonstrated this is also true for intelligence. He exposed one group of young rats to a stimulating environment -- toys, colors, playmates, exercise devices, and challenges. A comparison group of rats was housed in routine laboratory cages with little stimulation. When Greenough looked at the brains of the animals in the two groups he found a startling difference in brainpower. The animals living in the stimulating environment had 25-percent more connections between their brain cells than the control rats, and they were much more adept at solving mazes and other problems. When they looked at the brains of these animals, Greenbough noted there were two basic categories of changes brought about by learning. The first kind of change involved an increase in the number of synapses -- nerve connections -- in the rats who had an enriched environment.
 
The second kind of change noted was that support elements of the brain were altered. For example, the rats had more blood vessels, the capillaries that bring blood to the brain, per nerve cell. More nourishment was being delivered to the rats raised in the stimulating environment. Studies of human subjects show us the most important windows of opportunity for children’s brain growth is from birth to age 3. This research underscores a phenomenon that educators have long observed that children who are exposed to a rich and varied education early in life develop a great capacity for learning throughout life.

Deprived of a stimulating environment, a child's brain suffers. Researchers at Baylor College of Medicine, for example, have found children who don't play much or are rarely touched develop brains 20 percent to 30 percent smaller than normal for their age. Without ample, appropriate stimulation, unused neurons in a child’s brain vanish and are lost forever. Vital connections are never formed. The brain loses its capacity and potential—forever. What are the implications then, for developing a child’s intelligence? If genetics are not the only determination for IQ, what are the experiences we can provide to help our children learn better and become smarter?

Doctors have been able to help infertile couples by injecting genetic material from another woman. Cytoplasm from a donor egg is injected into the infertile mother’s egg with successful pregnancies as a result. When injecting the donor cytoplasm, donor mitochondrial DNA also enters the recipient egg. Genome mapping and manipulation is advancing throughout the world. It is not too far-fetched to imagine, one day, that genetic manipulation of intelligence may be also possible. Already, at Princeton University, geneticist Dr. Joe Tsien has built a smarter mouse. Dr. Tsien's genetically altered mice learned faster than normal rodents, due to an extra copy of a gene encoding. He did this by stimulating a protein that boosts communication among neurons in their brains. This gene called NR2B, produces mice with greatly heightened intelligence and memory.

Human brains are believed to have a similar genetic mechanism. What about the infant still in the womb? Researchers Bernie Devlin, Michael Daniels, and Kathryn Roeder, at Carnegie Mellon, report an unborn infant's maternal environment may have a substantial impact on its intelligence quotient. In the British scientific journal Nature, Devlin and his colleagues showed that maternal or prenatal environments for unborn children can have a major impact on the IQ of those children. "Our statistical analysis implies that a relatively sizable portion of IQ variability can be attributed to the aggregate effect of prenatal environment and provides a rationale for reconsidering studies that have little evidence of a link." Bernie Devlin notes, “If this is the case, improved cognitive functioning might be an unexpected benefit of public health initiatives aimed at improving maternal nutrition and reducing prenatal exposure to toxins.” Scientists agree use of prenatal use of alcohol, cigarettes and hard drugs cause a decrease in IQ and a good diet during pregnancy seems to benefit an unborn child’s future intelligence. Some factors on the womb environment need not be immediate. Rather they might accumulate throughout life prior to pregnancy, as well as during pregnancy. Toxic exposure to lead is a simple example: A recent study suggests that lead absorbed by mothers before pregnancy is absorbed by the baby in utero.   

DOES MUSIC INSPIRE INTELLIGENCE?

Less clear are studies involving external stimuli to increase the fetus’s future intelligence. In a research project at the University of Rochester's Eastman School of Music, professor Donald Shetler played recorded music to unborn children through high fidelity stereo earphones placed on the abdomen of their mothers. He visited with the children regularly after birth and discovered that, within eight months, some of these children could imitate melodies of two or three notes. Even more remarkable was the ability of some 80 percent who, at 2 years of age, could pick out simple tunes with one finger on the piano. Most young children bang randomly on keyboards. Prenatal exposure to music may have a positive effect on intelligence but the research to support this is just not there. Some animal studies show that prenatal and early exposure to music, particularly complex music, resulted in improved maze-learning in rats. In this study, researchers exposed groups of rats in utero up to 60 days postpartum to different tunes: complex music, in the form of a Mozart sonata; minimalist music, as represented by a Philip Glass composition; white noise; or complete silence. After the exposure period, multiple trials through a maze demonstrated that rats exposed to the Mozart piece were able to finish the maze with greater speed and fewer errors than rats in the other groups. However, other studies have failed to demonstrate this improvement.

LANGUAGE ACQUISITION

If prenatal attempts to improve our children’s brain development are less clear, what do we know about enhancing children’s intelligence after birth? Here, research is much more compelling and riveting.

This new research also emphasizes there are windows of opportunity in developing a baby’s brain. Various parts of the brain are "wired" at different times after birth, making it possible to pick the optimal times for learning different skills. An example of this phenomenon is seen in language acquisition. Pat Kuhl, a neuroscientist at the University of Washington, reminds us that a newborn infant is prewired to hear all the phonemes of any language. Kuhl sought to determine at exactly what age children’s brains are being connected to learn language. She exposed infants to a "Ra" sound, and trained them to turn their heads when it changed to "La." American and Japanese children recognized the difference between "Ra" and "La" at the age of 6 months. When Kuhl repeated the experiment six months later, the Japanese children no longer could do so. She theorizes that between the ages of 6 and 12 months these infants had been exposed to Japanese. Japanese is a language that doesn’t distinguish between "Ra" and "La," so their brains had simply discarded the neural connections that had earlier helped them tell the two apart. As Pat Kuhl explains: “We used to think language began at the 1-year stage when kids started producing their first words and they started to understand words. Now what we’re learning is well before the stage at which babies understand or produce any words at all, their hearing systems are beginning to be sculpted by language input.” Her studies show the infant’s amazing talent to discriminate between all sounds is short-lived. In a year's time, a baby can no longer discriminate between all the sounds of all the worlds' languages, though she could when she was 6 months old.   By the time an infant has reached 12 months of age, this talent is lost; a baby can only discriminate and hear - the sounds of the languages to which she has been previously exposed. The critical period is between the ages of 6 and 12 months. In other words, exposure to a particular language alters our brains and shapes our minds, so that we perceive sounds differently.

The auditory cortex, which processes sound, explodes with new connections after birth and maintains this high level of activity until about age l2. Many advocates suggest this should change the way we teach foreign languages. Why do we teach French, Spanish, or Japanese in high school? Shouldn’t we be teaching foreign languages to our young children during this critical auditory window of opportunity? Most researchers would answer in the affirmative.

LANGUAGE DEVELOPMENT

We have learned other things about baby’s language development. Babies have a hidden talent for communicating. Though their language mastery comes in the second year, many parents have taught their hearing infants to sign. Some believe this may stimulate a child’s intellectual development. A long-term study of Baby Signs funded by the National Institutes of Health and conducted at the University of California, found using Baby Signs actually makes it easier for babies to learn to talk. When they compared children who had been encouraged to use Baby Signs with children from the same areas who had not, they noted the Baby Signers consistently scored higher on standardized tests of both receptive language development (how much they understand) and expressive language development (how much they can say). Baby Signers enjoy a “jump start” in the development of the neural substrate of language.

Author Linda Acredolo, Ph.D., professor of psychology at the University of California, Davis, notes:  “When babies use Baby Signs to call attention to things, adults quite naturally respond with lots of appropriate words (e.g., “Oh! You see a kitty! That’s right! That is a kitty! That kitty looks just like our kitty, doesn’t it!”). And we know that the more language a baby hears, the faster language acquisition proceeds.” She adds: “Recently we revisited as many of the families from our long term, NIH-sponsored study as we could find. As was true in our earlier comparisons, these included families who had experienced Baby Signs and families who had not. The children at this point had all just finished second grade. We assessed each of them with a standard IQ test called the WISC-III and were astonished to discover a statistically significant, 12-point IQ advantage for the children who had experienced Baby Signing during infancy! In more familiar terms, the non-Baby Signers were performing just about how you'd expect 8-year-olds to score. In contrast, the Baby Sign alumni were performing on the average more like 9-year-olds! Apparently the jump start from Baby Signs kept these children moving in a very positive cognitive direction.”

NATURE VS. NURTURE

Very recent experiments on rats by Canadian researchers suggest a mother’s nurturing stimulates neural connections in her baby's brain and improves learning. Those offspring subsequently scored higher in intelligence and memory tests. Researchers examined cells extracted from the rats’ hippocampus, a brain region critical to memory and learning. In rodents, cells in the hippocampus rapidly connect in the first days of life. These scientists found extra connections between nerve cells in samples from the nurtured offspring. They also discovered more receptors for growth hormones and the NMDA neurotransmitter, which is central to learning. The cells of the neglected offspring did not show similar augmentation. 

“There is evidence for a direct relationship between maternal care and hippocampal development, and spatial learning in adulthood,” voiced researcher Michael Meaney, a neuroendocrinologist at McGill University who led the study. He says, “This is experience-dependent development: Use it and it grows. Don’t, and it disappears.” Researchers said the results, which appear in a recent issue of Nature Neuroscience, are broadly applicable to humans, too. “It’s never nature vs. nurture. The influences are inseparable,” added Meaney. “Activity of the genes is always influenced by the environment. And the most important feature of the environment for an infant is mother.”

Harry Chugani studied a group of neglected children, the neglected orphans of Romania. His work echoes that done on animals. Lack of early nurturing leads to a diminishment of brain development and intelligence. Evaluations on children at Tehran and Beirut orphanages, where deprivation was severe, also showed sensory deprivation early in life can have permanent and catastrophic effects on mental development. University of Washington psychologist Geraldine Dawson agrees research supports that a baby’s experiences -- whether he’s happy, whether he hears lots of music or speech, gets hugs and eye contact -- actually change the physiological development of his brain -- the quality and quantity of the electrical wiring between cells. Babies who have more sensory experiences are able to develop more brainpower. Dr. Frederick Goodwin, the director of the National Institute of Mental Health participated in some similar research. His conclusion? "You can't make a 70 IQ person into a 120 IQ person, but you can change their IQ measure in substantial amounts. Touching, holding, rocking, talking, listening and reading, or just playing with a child dramatically influences the youngster's brain development.”

sensory experiences are able to develop more brainpower. Dr. Frederick Goodwin, the director of the National Institute of Mental Health participated in some similar research. His conclusion? "You can't make a 70 IQ person into a 120 IQ person, but you can change their IQ measure in substantial amounts. Touching, holding, rocking, talking, listening and reading, or just playing with a child dramatically influences the youngster's brain development.” Another study details the effect of a stressful environment on infants and toddlers.

Young children exposed to a steady diet of stress lay down abnormal connectors in their brains because of high levels of stress hormones such as cortisol and adrenaline. These abnormal connectors set up aberrant networks of connections, causing the child to learn violent responses to benign stimuli. These networks create a brain that is designed for "fight or flight," which may lead an individual to violence and other inappropriate responses. Even if the child later moves into a safe and caring atmosphere, this early hyper-vigilance is hardwired into the brain. All of this tells us that an infant’s experiences actually develop his brain. Sensory experiences (hearing, seeing, touching, feeling and tasting) actually teach brain cells their jobs. A lack of such sensory experiences results in brain cells failing to make connections and eventually dying off. If a child lies in a playpen all day, he is experiencing a limited number of sensations. He will not have many new experiences through which he can establish new brain connections. Unfortunately, these connections must be made in infancy. A person cannot go back and "redo" these experiences. The first four years of life are when the brain is "built."

A nurturing adult is critical to helping a child develop his full intellectual ability. Many studies report breastfed infants have higher test scores throughout their school years. Rather than breast milk itself though, many scientists believe it is the act of cuddling and interaction which improves an infant’s brain power. When parents respond to their infant, whether it’s reading aloud, singing, or simply holding them, a child’s chance for higher intelligence improves dramatically.

HOW MUCH IS TOO MUCH?

Many worry that some parents might overdo infant mental stimulation in the misguided belief that they can turn their newborns into "super brains" by exposing them to flash cards and other types of activity.

The reputed pediatrician, T. Berry Brazelton, points out that infants exposed to too much stimulation respond either by crying, by extending their periods of sleep, or by developing colic or withdrawing from any new approaches. In providing increased stimulation, one always has to keep in mind the need for adequate time at each phase of information processing -- input, assimilation and output. The integration of the input is essential before we can anticipate a meaningful output. As adults, we frequently say, "Let me think things over." It is essential to give the infant the same opportunity.

Even as we learn the importance of early childhood learning through a rich environment, this does not mean later learning is not possible. Dr. Peter Huttenlocher, a University of Chicago professor of pediatrics, addresses such thoughts. "There has been a great deal of emphasis lately on the importance of early learning," Dr. Huttenlocher says. "That is important, but we need to realize what children are able to learn and not cram them with information they are not ready to handle. Though the prefrontal cortex, which is involved in processing higher thoughts and motivation, undergoes an initial huge growth spurt after birth, but it does not appear to be fully developed until early adolescence,” says Dr. Huttenlocher. “This may be the best time to teach such things as calculus.”

These findings, reported in the Journal of Comparative Neurology, reaffirm earlier discoveries of the importance of the first three years in brain development, but they go much further. They show that wiring of the brain -- the explosive burst of synaptic connections between brain cells after birth -- appears to extend well into adolescence, when reasoning and other higher functions mature. "We have always suspected that there may be a difference in the ways children learn at different ages, but until we did this study we didn't know for sure that those differences reflected the development of synapses," says Dr. Huttenlocher. Alyson McCain and Stewart Gordon agree with such reports. “Infancy is not the only time such growth occurs. New research shows that adolescents also go through a similar cycle of rapid neural growth followed by pruning.”

Brain development is nonstop. Although early childhood is very important, parents of children who are older than age 3 still have much parenting to do and should not feel as though they've missed the only chance to help their child's brain growth. Opportunities will abound in the years ahead to impact positively on the well-being of their child. It is never too late to help a child learn and develop.

WHAT’S A PARENT TO DO?

The following elements of a child's health are important in early brain development:

  • Proper prenatal care and avoiding alcohol, cigarettes, and toxic substances during pregnancy give an infant his best chance for optimal brain development.
  • Nutrition: Breast-feeding or proper formula feeding provides the best nutrition and encourages positive mother-child interaction. A proper balanced diet plays a vital role in the growth and development throughout childhood.
  • The relationship between parent and child, how well they interact, is crucial to the development of a baby’s brain. The earlier a parent engages a child’s brain, the more it will develop. Infants are capable of interacting immediately and can benefit dramatically from early interaction. It is not possible to spoil a newborn baby. Responding to an infant’s cry of distress helps them build trust in the world around them. Touch and holding help connect an infant to her environment as well as stimulate brain growth. When a baby is touched, he becomes calmer. A baby who is calm can take in the sights, sounds, textures and smells around him. These are the experiences that build connections in his brain.
  • Children need protection from environmental hazards such as lead paint, open electrical sockets and hazardous household products. Safeguards for protecting small children include electrical outlet covers, cupboard and drawer locks, infant and child car seats, and smoke and carbon monoxide detectors in the home.
  • Quality daycare is paramount for our nation’s children to develop their full potential. Parents need to take an active role in selecting their child’s preschool. Parents should look for healthy, non-harried and responsive daycare workers in a safe, supportive environment, provided by qualified caregivers who are trained in early childhood development.
  • Speak, sing and listen to your young child. Infants whose mother spoke frequently to them developed more complex language and at an earlier age. Early understanding of language is correlated with a child’s later intelligence. Children learn language from being with people who talk to them and listen to them, not from watching television. Talk a lot. Say aloud what you are doing. Use as many different words as you can to say the same thing. For example, “The dog is big -- huge -- large -- gigantic.” Recognize that saying “don’t touch” or “stop that” does not teach your child very much. Instead, try to be positive and use lots of words: “Let me give you something safe to play with. We can play with this red ball. I’ll roll it to you, and you roll it to me.” Consider baby sign language in addition to the spoken word.
  • Through play, kids learn much of what they need to know to function every day: gross motor skills, fine motor skills, and cognitive skills. Play is the child’s work and parents interactions in such play enhance a child’s rich experiences. Play is often referred to as the ‘social dance.’ Your baby does something and you respond. He does it again, and you repeat the sound or action. This little dance goes on and on until your baby gets tired and turns away or shuts his eyes. That’s his way of letting you know he is not interested anymore. It’s time to stop for a while. Before long, your baby will start the game himself and invite you to play again.
  • The simple act of reading to children can have a huge impact on their development, including how well they do in school. It is never too early to start. The more parents read to their children, the more they learn, and the more physiological connections their brains will make. When you read to your child, his brain cells are turned on and begin to make connections. As he looks at the picture on the page and hears the words you are reading, his brain is hard at work.
  • The brain connections which control movement are formed during the first four years of life. Learning basic motor skills -- rolling over, sitting, crawling, walking, running, reaching, and climbing -- is much easier during this time than at any other time in a child’s life. Some ways a child moves actually improve her learning. As your baby works tirelessly to roll over, to sit up, to crawl, or to reach for objects, both sides of the brain are put to work. This is notable because both sides of the brain are used in many learning skills.

CONCLUSION

A child has an innate drive to explore, to seek new experiences, and to learn. Using every one of his senses, he pushes to satisfy his limitless curiosity. This impulse is just as strong as the drive of hunger and thirst, and must be satisfied if a child is to develop to their full emotional and intellectual capacity. This exciting new understanding reshapes the way we care for and interact with our children. Intelligence is not a fixed and preordained level but is shaped by the care and interaction we provide for infants and young children. This is not a call to pushing our young ones through flash cards or rote memorization but a reinforcement of the significance of play, of loving, supportive caretakers, and a rich, stimulating environment. As child education professional, Joan Beck notes:  “The evidence is overwhelming that the quantity and quality of learning experiences your child has -- even before he is out of diapers-- can greatly influence how well his brain works all the rest of his life.”

The political repercussions of this area of brain research remain to be seen. Better funding of such programs as Head Start, improved access to quality daycare, and support for stressed or poorly motivated parents is just beginning. We can no longer ignore the risks an adverse environment present to the growing brain of a young child. We have a national investment in promoting our nation’s youngest citizens’ right to developing their full potential. A good start in life does more than just promote learning. It ensures the best chance for full emotional development as well. We know now what it takes to help an infant reach their full abilities. Preventing a child’s risk of damaged cognitive, emotional, or physical well-being seems the most important task of all.

SOURCES

BOOKS:

1. A Celebration of Neurons : An Educator's Guide to the Human Brain by Robert Sylwester; Assn for Supervision & Curriculm Development; July 1995
2. Awakening Your Child's Natural Genius : Enhancing Curiosity, Creativity, and Learning Ability by Thomas Armstrong and J P Tarcher; May 1991
3. Baby Signs by Linda Acredolo, Ph.D. and Susan Goodwyn, Ph.D.; NTC/Contemporary Publishing ; April 1996
4. Building Your Baby’s Brain A Parent’s Guide to the First Five Years by Diane Trister Dodge,and Cate Heroman;  Teaching Strategies, Inc; 1999
5. Enriching Heredity by Marian Diamond;  Macmillan; 1988.
6. From Neurons to Neighborhoods : The Science of Early Childhood Development by Jack P. Shonkoff (Editor), Deborah Phillips (Editor), Family Board on Children, National Research Council, Committee on Integrating the Science of Early Childhood Development; National Academy Press; November 2000
7. How To Raise A Bright Child: The Case for Early Learning by Joan Beck; Pocket Books; 1999
8. Human Behavior and the Developing Brain by Geraldine Dawson; Guilford Press; 1999
9. The Developing Mind: Toward a Neurobiology of Interpersonal Experience by Daniel J. Siegel; Guilford Press; 1999
10. Inside the Brain : Revolutionary Discoveries of How the Mind Works by Ronald Kotulak. Andrews McMeel Publishing; August 1997
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12. Is Suzuki Education Working in America by Ray Landers (Editor) Summy-Birchard Incorporated;  February 1996
13. Magic Trees of the Mind: How to Nurture Your Child's Intelligence, Creativity, and Healthy Emotions from Birth Through Adolescence by Marian Diamond and Janet L. Hopson; Penguin USA; 1999
14. Making Connections: Teaching and the Human Brain by Renate Nummela Caine, and Geoffrey Caine; Addison-Wesley Pub Co;  June 1994
15. MindShifts: A Brain-Based Process for Restructuring Schools and Renewing Education by Geoffrey Caine,  Renate Nummela Caine, and Sam Crowell;  Zephyr Press; 1994
16. Nurtured by Love by Shinichi Suzuki, Waltraud Suzuki (Translator); Warner Brothers Publications; June 1986
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19. Smart Start: The Parents' Guide To Preschool Education by Marian Edelman Borden; Facts On File, Inc., October 1997
20. The Magical Classroom: Creating Effective, Brain-Friendly Environments for Learning  by Noah Gordon;  Zephyr Press, 1995.
21. The Myth of the Early Years: A new understanding of early brain development and lifelong learning by Dr. John T. Bruer; Free Press; 1999
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23. The Youngest Minds: Parenting and Genes in the Development of Intellect and Emotion by Ann B. Barnet, Richard J. Barnet; Touchstone Books; July 1999
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25. Young Children's Talent Education and Its Method by Shinichi Suzuki, Kyoko Selden (Translator); Summy-Birchard Incorporated; July 1999
26. Your Child's Growing Mind : A Guide to Learning and Brain Development from Birth to Adolescence by Jane M. Healy; Main Street Books; August 1994

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CONFERENCES:

1. Learning How To Use The Brain presented by Ronald Kotulak at "Brain Development in Young Children: New Frontiers for Research, Policy, and Practice." Conference, Chicago, on June 13, 1996
2. ”What New Research on the Brain Tells Us About Our Youngest Children. Understanding Our Selves: The Science of Cognition.” White House Conference on April 17, 1997
3. Carnegie Task Force on “Meeting the Needs of Young Children.  Starting points: Meeting the needs of our youngest children.” Carnegie Task Force, New York, 1994
4. Advancing Children's Health 2000: Pediatric Academic Societies (PAS) and the American Academy of Pediatrics (AAP) Year 2000 Joint Meeting

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