Starting from infancy, routine assessment of language and communication skills and provision of interventions are essential preventive undertakings. This is important because interventions during infancy or the preschool years can have a significant impact on child outcomes.29 Once identified, creating a comprehensive profile of communication, language, cognitive and psychosocial and emotional abilities is crucial to planning such preventive interventions. There has been a move away from one-to-one clinic-based therapy to a focus on functional language in naturalistic environments.30 Interministerial and multidisciplinary integration is required because of the implications that undiagnosed language impairments have for health, mental health, child care, education and the youth justice system. Information on the nature of language impairments, and their impact on academic and psychosocial and emotional functioning, should be available to parents and be part of the curriculum for professionals working with children. This includes pediatricians, family practitioners, speech/language pathologists, educators, early childhood educators and mental-health practitioners.
The question still remains as to whether there is something specific about language as a focus for study. On the one hand, language may be just one of a range of developmental functions caused by a common underlying factor.26 On the other hand, language may have a central role to play in the development of psychosocial and emotional disorders in that internalized language and verbally mediated rules play an important role in both self-control and achievement across domains.27
The authors propose a mechanism for the disorder whereby brain damage prevents patients from developing knowledge of the emotional aspects required for navigating and understanding social situations.
Key research questions include: (1) What is the pattern of development of communication and language in the first five years of life? (2) What is the prevalence of language and communicative impairment in the general population between birth and age five? (3) With which psychosocial and emotional disorders are language impairments associated? (4) Are there other developmental functions associated with language impairment other than psychosocial and emotional disorders? (5) What is the outcome for children with communication and language impairments? (6) What causal factors contribute to an association of language impairment with psychosocial and emotional development? (7) Is there something specific about language as a focus for study? (8) What are the best ways of treating language impairments?
. Female and child voices with the same emotional states. (experimental diphone inventory). "When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow." 1.12
Applying the principles of positive emotional plasticity to rewiring the stress response is a novel intervention that merits further evaluation. Stress-processing circuitry is formed early in life or during periods of trauma, and stored in implicit memory systems. Excessive and, especially, inappropriate activation of the stress circuitry strengthens maladaptive circuits and can lead to persistent maladaptive (allostatic) brain states. We hypothesize that with the recognition that dominant neurocircuitry can lead to persistent brain states, a new approach can be utilized for health care treatment of stress-related symptoms and diseases. Potentially, providing an indi-vidual with the skills to reconsolidate those stress citcuits, and thus decrease or reverse allostatic load, may improve health and well-being. Therefore, we propose a new paradigm for health care – focusing on rewiring the stress response in favor of adaptive neuroplasticity
Concept 2: Wiring triggers brain states
To promote the survival of the species, the brain has evolved into an organized hierarchy, which includes the simple, quick, regulatory functioning of the reptilian brain, the emotional arousal and fear-generating limbic brain and the slower, complex and analytical neocortical brain (36-37). In response to the activation of self-regulatory circuitry, the brain establishes a state in which a specific brain area becomes dominant (38). The actual number of brain states is not known. However, based on observed phenomena in EBT (consistent with the work of Perry investigating the effects of trauma (39)) there are at least five distinct brain states (see Figure 1).
We hypothesize that the self-regulatory circuitry that responds to stress and reflects potentiation involves three phases: 1) quick sub-cortical processing phase (responses of the HPA and SMA axes), which is non-specific, evolutionarily based and primarily emotive (based in fear) (34); 2) cortical/cognitive processing of emotions into conscious feelings based on expectations and past experiences – the second phase concludes with the identification of needs; 3) generation of thoughts and actions to marshal a corrective response to meet those perceived needs. The process, if adaptive, returns the person to a state of well-being.
The self-regulatory processing is learned from parental interaction with his/her infant. In combination with genetic and environmental factors, the attachment between parent and child is encoded in the circuits of the infant’s brain. This attachment is the result of the capacity of the parent to appraise the emotional state of the offspring and take necessary actions to change the child’s physiology from stress to well-being, optimizing the chances for survival. Those early connections, especially before the age of three, or later in life during periods of trauma, form the basis for the circuitry of resiliency and health (25-28).
Concept 4: We can change our wiring
Recent studies of neuroplasticity demonstrate presence/persistence of a high degree of plasticity in adult brain circuitry (44, 45) regulating motor behavior and cognition as well as emotions (46). EBT is based on positive emotional plasticity; repeated use of tools that mirror the evolutionarily-based secure attachment between parent and child, (which is critical to the survival of the species) (47–49). Adults can create their own secure attachment to return themselves to a state of well-being. Changing the allostatic state occurs in two steps: 1) activation (and identification) of the maladaptive circuit and 2) alteration of the circuit through intervention during the reconsolidation window (46, 50).