The Role of Genetic Codes in Child Behavior with Dr. Danielle Dick

Folks, in this exciting episode of New Frontiers we touch upon topics very close to my heart – genetics, epigenetics, kids, and why the heck they are so hard to raise! Brilliant professor of psychology and research scientist Dr. Danielle Dick shares guilt-banishing parenting strategies and her incredibly liberating research findings on genetics, temperaments, and child development. As an award-winning expert with over 350 scientific publications, Dr. Dick does an excellent job dispelling some deeply-rooted parenting myths and provides evidence-based approaches to understanding children and supporting their development. I can’t wait to get my hands on her new book The Child Code which contains many awesome resources and practical tips, including questionnaires on children’s temperaments and their genetically-influenced dispositions. To all the parents and caregivers out there – this one’s for you! Please share and leave a review to let me know what you think! ~ DrKF

The Role of Genetic Codes in Child Behavior with Dr. Danielle Dick

Can research help us with the challenges of child rearing? And why are the parenting messages we get from the world not matching the research? In this episode of New Frontiers, we dive into the world of psychology, genetics and child development with Dr. Danielle Dick, professor of psychology and genetics, author of The Child Code – and one of the most cited scientists in the world. Drawing on her extensive research experience in the fields of child development, genetics, and human behavior, Dr. Dick discusses genetic dispositions and temperament, applying child development research in parenting, interpreting polygenic risk scores, and the influence of epigenetics on behavior.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi, everybody. Welcome to a New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine. And of course, today is no exception. We’re going to be talking about all things kids, genetics, why the heck they are so hard to raise, with a brilliant research scientist, Dr. Danielle Dick. And let me just give you a little bit of her background. You’re going to be so excited to hear from her. And we’ll just jump right in.

So Dr. Dick is a professor of psychology and genetics, and the author of The Child Code. She’s internationally recognized an award-winning expert on genetics and environmental influences on human behavior. She has led and contributed to more than 20 grants from the National Institutes of Health, with grant funding exceeding $30 million. She has 350, actually over 350, peer-reviewed publications in the areas of child development, addiction, mental health, genetics, and human behavior, and has won numerous national and international awards for her work. She has been named one of the most highly cited scientists in the world. I know. I know. It’s an impressive bio and you’re just dying to hear what she has to say. Dr. Dick, welcome to New Frontiers.

Dr. Danielle Dick: Thank you so much for having me, Kara.

Dr. Kara Fitzgerald: It’s just really been a delight to get to know you. We had to keep delaying, folks, over the recording of our podcast, so Danielle and I were connecting multiple times, and I just resonate with her thinking, with her approach to her research or experience, just a copious amount of science that she’s conducted. And I’m just delighted to bring her to our audience. Her book is called The Child Code, and she opens the book around just talking, and I’m resonating with this as a mom. So I’m interested in both hats and how challenging it is to raise a kiddo, especially in our approach to child rearing today. I love your John Wilmot quote. This is a guy from the 1600s, you can tell me who he is, I actually don’t know who he is.

“Before I got married, I had six theories about bringing up children. Now I have six children and no theories.” So we’re insane with ideas around how we need to raise our kids, how we need to kind of get them to behave, and how they don’t do that for us. I mean, I was so sleep deprived with my daughter. Actually, my neighbor said, “Kara, I’m going to hire a night nanny for you for a couple of days, so you can get some sleep.” It was so challenging for me out the gate. And our pediatrician said to me, “Kara, you got this. It’s actually easier than the Krebs cycle,” but I was like, “No way. Parenting is super, super challenging.” But then, you kind of get your sea legs and it gets a little bit better. But talk to me about just what’s going on with us today, and why is it so challenging?

Dr. Danielle Dick: Well, firstly, thank you so much for having me, Kara. And the other piece of my bio, of course, that’s relevant here is I’m also a mom. So I am in the trenches too. My son is now 15 and I have a stepdaughter who is five.

Dr. Kara Fitzgerald: You’re in there.

Dr. Danielle Dick: I have the whole spectrum right now of kindergarten to high school.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: And one of the things that actually led me to write this book is because I found myself raising the challenging child that I study when I had my son. And I found the research to be so helpful.

Dr. Kara Fitzgerald: Awesome.

Dr. Danielle Dick: But I also was blown away by how much the messages we get from the world surrounding parenting don’t match the research. And so you are absolutely right that we live in a culture that has just doubled down on parenting. And we see it everywhere. We read in the news about tiger moms and helicopter parents and snowplow parents, and there’s parenting books and blogs. And per that quote, one of the reasons I love it is because it is fascinating to me that we have been raising small human beings for literally hundreds of thousands of years. We have done amazing things over the course of history. You and I are in different parts of the country and are talking to each other right now, yet raising kids is still so challenging.

When we have kids that are struggling or were struggling, I was blown away by how much I saw my amazingly competent parent friends, very often mothers, doubting themselves and wondering, “What am I doing wrong? Or what should I be doing? Should I be reading more books? Should I be taking more advice? Why is my friend’s child sleeping great and mine isn’t? Or why is my child hitting and my best friend’s child isn’t?” Those kinds of things.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: And ultimately, what led me to write this book is that we put so much pressure on ourselves and we’ve created this idea that if you want a better child, you need to be a better parent. Nothing from the child development literature suggests that that is within our power. I call it the parenting myth, the idea that if we just try hard enough or we’re good enough parents, that we can parent our kids right into that Nobel Prize and that Ivy League school. Right?

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: Because what all of that information out there about parenting, many of which is very good advice about parenting, but what is most often omitted is the fundamental role of our kids’ genes in their behavior and their emotions. It influences everything from how well they sleep as babies to how well they eat. And if you have more than one child, you’ve probably experienced this, you’re doing the same thing and you’re like, “Why is this one turning out so differently?” It’s as if when our children are born, we think, “Okay, it’s all on us now. Now I’ve got it from here. Now my parenting is just going to shape them into the dreamy human being that I imagined.” But in fact, we know that in the same way we can look around and see differences between us all on the outside.

Our brains are all wired differently, so our kids’ brains are wired very differently and that influences their dispositions toward everything from how impulsive they are to how fearful they are, to how aggressive they are, to how extroverted they are. So lots of these differences that we attribute to or wonder about, is it something I’m doing, it’s actually due to differences in their dispositions that come from the way that they were born, the genetic codes that they inherited.

Dr. Kara Fitzgerald: Mm-hmm (affirmative). So talk to me about your research then. It’s extraordinary to me how the genesis of this book came from being a mom, in the trenches with a challenging kid. I know. Honestly, we were flying home on a plane, literally last night, we were coming home, me and my four-year-old daughter. There were two rows. There was actually a three-year old next to me. Mom was deep into how to raise a difficult child. She was reading this book. Because we were divided up, so my daughter was over with our nanny, and then I was over here next to this little girl. And then behind us, there was just an adorable little boy. But anyway, the three, four-year old sat, took over our little section of the plane, and it was pretty hysterical, but mom was deeply tucked into this how-to-raise-a-difficult-kid book.

I mean, it was amazing to me to sit there and witness the differences in the temperaments, but they all played, they took the plane over. I’ve never encountered it. And it was actually pretty cool. Usually, kids, we try to hush them on planes, but these guys really took it over. Anyway, so here you are, you’re a mom you’re struggling with how to figure it out like this mom was, but you’re a research scientist so you’re reading the literature and seeing that this doesn’t jive. I mean, I want to know, why doesn’t it jive and what did you figure out? And how did you direct your research? And how do we need to be approaching our kids? So there was basically the entire podcast in my next question to you.

Dr. Danielle Dick: Absolutely.

Dr. Kara Fitzgerald: No pressure on that.

Dr. Danielle Dick: So, one of the things that I do is twin studies. The reason that we study twins is because it allows us to have a sense of how important genetic influences are and how important environmental influences are.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: Twins essentially come in two types, identical or what are often called MZ twins, single egg fertilized by single sperm, at some point during cell division, splits into two. So they’re genetically identical individuals largely. And then DZ or fraternal twins, two eggs fertilized by two sperm, except they share an intrauterine environment, same age. And so what you have essentially are age match siblings sharing the same home environment, same set of parents, but that differ in that one set of siblings shares more genes than the other set of siblings, or more of their genetic variation. And so twin studies were kind of the workhorse in figuring out to what extent are behaviors influenced by genes versus environment. If you think back several decades, we used to think that most all behavioral and substance and mental health outcomes, mothers were the ones who always got blamed. Right? They were all either moral deficits or the fault of parents. Schizophrenia was thought to be caused by cold mothers.

Dr. Kara Fitzgerald: Mm-hmm (affirmative), right.

Dr. Danielle Dick: Autism was thought to be caused by cold mothers. Alcohol use disorders were thought to be caused by people who just couldn’t pull themselves up by their bootstraps and stop drinking. So we really placed a lot of blame on the environment or the person. And what twin studies were really pivotal in showing, and there have now been literally hundreds of thousands of twins assessed on virtually every outcome that you could be interested in, and what a robust finding is, is that when it comes to behavior, both normal behavioral variation, so things like impulsivity, anxiety levels, fear, aggression, as well as clinical disorders so ADHD or conduct problems if we’re talking about kids, or an adult substance use disorders, anxiety disorders, depression, et cetera, that both normal behavioral variation and behavioral disorders, on average, are about 50% heritable. Meaning, about 50% of the differences between us in how much we drink, how depressed we get, how anxious we are is due to differences in our DNA sequence. The other half is differences in our environments.

Again, that’s true, not just of us as adults, but it’s true of our kids. And so when you see the child that’s bouncing around in his seat at church or at school, or the child who’s more aggressive or who’s more fearful, we tend to look at parents and go, “Parent, you need to [fill in whatever your favorite parenting advice is].” But what the research really profoundly unambiguously shows is that, a large part of why our kids differ so much is due to differences in their dispositions. So some kids are just, just like adults, more extroverted than others. Some kids are simply more impulsive than others. Some kids are naturally quicker to fear and frustration and distress. So a lot of these behavioral and emotional differences that we see between kids that we’re so quick to often judge other parents or to judge ourselves, if our children are what we might call acting out, it’s just that a lot of that is hardwired in differences in their natural tendencies. Now, that doesn’t mean we don’t have an important role to play as parents. We absolutely… And DNA is not destiny. They have dispositions.

Dr. Kara Fitzgerald: Right.

Dr. Danielle Dick: But so much of the parenting literature essentially ignores the genetics piece.

Dr. Kara Fitzgerald: Right.

Dr. Danielle Dick: And I think it’s because it feels like there’s nothing we can do about that. It feels like, “Well, how is that helpful to me as a parent to say that my child is more impulsive or more emotional because of the way that their brains are wired? Well, what do I do with that?” I think that’s a huge mistake to ignore the genetics piece for that reason because it can lead us to be more judgmental of ourselves, of others, but also because it makes parenting so much harder. And this is really the crux of my book, which is by understanding and paying attention to the way each of our kids is wired, by understanding where they fall on some of these big genetically influenced temperamental dimensions, what we can do is tailor our parenting to what will work best for each of our particular children. There is no one best way to parent or right way to parent because all of our kids are wired differently. And so good parenting is actually flexible parenting. It’s figuring out which strategies are most important and work best for kids with different dispositions.

Dr. Kara Fitzgerald: I want to ask you about, of course, our prerecord conversation, where we talked about polygenic risk. I want to get into the genes and some of you want to know it right now, but some of you are parents also. How did this change you? I mean, I can see, A. that this information allows parents to exhale. I mean, one of my thoughts as a parent was becoming a parent as an older adult, after I’ve already established I’ve been adulting for a while, and astonishing thing that I observed in myself was that I started to experience guilt at a level that I had no idea existed. I mean, it was absurd. My friend, Dr. Helen Messier, who’s also a scientist and physician, I’m talking to her about it and she would hear this guilt voice come up and she would just be like, “You need to stop doing that.”

Dr. Danielle Dick: Yes.

Dr. Kara Fitzgerald: And I thought, well, is it that we’re in this massive helicopter parent era, as you describe in your book, of it’s all on us, it’s completely on us, whether our kid wins the Nobel or not? Or is part of this genetically hardwired? Is this how you keep your kid alive? You just have this insane guilt so you’re sort of obsessively focused. But it was extraordinary for me to meet that mom brain later on, and be able to juxtapose it with a pre-mom brain. So I’m curious about that. And also, how did this influence you in your own, in your home life? And then we’ll talk about some of the science, folks.

Dr. Danielle Dick: Yes. So to your first point about mom guilt or parent guilt, it is real, and there has been a huge cultural shift in this. So we spend more time, working moms spend more time with their kids now than moms who stayed home with their children a generation ago, spent with their kids. We’re tending on average to have fewer kids, and so we tend to expel more energy and pressure and all of our hopes and dreams on these smaller number of children that we have, as opposed in past generations where it was more typical to have more children and to allow children more freedom and flexibility to explore and discover things on their own.

Actually, there’s a lot of evidence that this more intense parenting style that we have and the fact that we do monitor our children and spend much more time with them from a very young age through to the time they leave for college, in many ways, is detrimental for children because it turns out that figuring things out on your own is a really important life skill. Many of us will remember running around in the neighborhood or in the woods with our friends when we were kids. And when somebody fell out of a tree and broke their arm, you had to figure out what to do.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: Now, first of all, children are very infrequently running around, having free time when they’re not supervised by parents, and parents then tend to step in and arbitrate whatever is going on in a way that’s much more involved than in previous years. But also, children have cell phones too, so something happens, they immediately call someone, an adult comes and takes care of it. And so we see this at the college level now where kids show up at university and they don’t know how to manage their lives because someone has always arranged and been there for them. So in some sense, monitoring our children and paying attention to them is of course wonderful and good. We do it because we care about their safety and we do it because as adolescents, we know that unsupervised kids tend to do things like, use drugs more and drink more and have unprotected sex and things of that sort.

But the flip side of it, is that learning, failing, and figuring things out is actually a really important developmental skill that our kids aren’t getting as much. And the flip piece is that, by being so involved, we have started placing so much pressure and we feel guilt constantly if we’re not there and being engaged with them and helping nurture them. I always say, what we need to do is step back and remember… I talk about parenting in the way that we thought of it when we were pregnant or our partner was pregnant, which is that, we’re trying to do things to provide a good environment for that developing baby. So we’re trying to eat healthy and we’re trying to keep our stress levels down. But we’re not thinking, “Oh my gosh, if I don’t have a perfect diet, my baby isn’t going to grow arms.” Or if you just take enough prenatal yoga classes, I’m going to grow an extra arm for my baby.

Really, we know a lot of what is going on that is amazing and beautiful related to our child’s development is happening without us. It’s pre-wired. Their genes are doing a lot of that heavy lifting. Our job is really to provide a good environment to help them grow and develop. But there’s limits to that. I mean, we, as I was just talking about it, doesn’t have to be perfect. We really are just marveling at that growth. And it’s as if, once our kids pop out, I realize it’s a little more difficult than the popping out I just alluded to, but once our children are in the world, it’s like, we think, “Game on. Okay, now it’s all on my shoulders. I’ve got it from here.” But evolution dictates, kids have a lot of what they need to grow and develop encoded in their genes. So yes, mom guilt is real. And I think one of the messages from understanding how important our kids’ genes are is that we don’t have to worry as much as we do.

The second piece is that by paying attention to your child’s natural disposition, you can help them accentuate their strengths, know what their likely challenges are going to be, and teach them skills that don’t come to them naturally, which can ward off future problems when it comes to health or mental health or substance use problems. We can see what kind of characteristics put kids at risk at that. Some of them show up very early. And the other piece is, we can know what kind of parenting strategies will work best. And we can sort of reduce some of the friction that’s associated with raising kids. And I’ll give you an example of that.

So when my son was young, on Saturday mornings, I used to plan a fun outing for us. And I would get together with my friends and we would plan something for all of our kids. We’d be having cereal in the morning and I would say, “Guess what? Today, we’re going to go to the park, the festival, whatever it might be, with so and so, and so and so. Do you remember their kids so and so, and so and so, and so and so?” And next thing I know, he would go from pulling on his shoes to throwing the shoe across the room, or sweeping the cereal bowl off the table and going, “I’m not going.” And my natural inclination, I bet many of our natural inclinations as a parent, is to focus on that “misbehavior.” “That’s not okay to throw your shoe. You are going. We’ve made plans.” He would double down, “No, you can’t make me.” You don’t have to have a PhD to know this is going nowhere good.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: So when I stopped and thought about, okay, what’s going on here? My son, it turns out, is far more introverted than I am. I’m very high on extroversion. He’s low on extroversion. And so what sounded like a really fun day for the two of us to me was terrifying to him. And his little toddler brain didn’t have the ability to say, “Mom, that sounds very stressful to me to be in an environment that I’m not familiar with all these people I don’t know.” Instead, he’d sweep the cereal bowl off the table or throw the shoe because it was just this overwhelming emotion that even he didn’t understand or recognize. He’s a child who’s high on emotionality. He’s really quick to fear and frustration and distress.

And so once I realized this, then what I did is, okay, I plan small get togethers with a friend, a child that he knew. And then we could slowly work our way up to being at the big festival with all my friends and their friends. But what I was doing was the equivalent of throwing him into the deep end when he wasn’t ready for that. We naturally assume that other people’s brains work the way that ours do. It’s the only way we know of being in the world. And we tend to assume that with our kids too. Sounded like fun to me, why wouldn’t it sound like fun to him?

Dr. Kara Fitzgerald: Mm-hmm (affirmative).

Dr. Danielle Dick: But he wasn’t ready for that. And so I was able to work with him to build up those social skills so that we could then go to the outings with lots of folks. His preference is still to be with a smaller group of people. That’s who he is naturally. But he has the skills, if needed, to be at the big family get together or these other kinds of things. So that’s an example of how by understanding and being intentional about your child’s disposition, you can help teach them skills that might be lagging or might not come to them naturally and you can reduce some of the hidden friction points, that sometimes it’s like, “Ugh, why is my child doing this? It’s driving me crazy.” And it starts contributing to tension, and that’s true whether you have a toddler or a teenager. And very often, it’s these places where our dispositions are clashing.

Dr. Kara Fitzgerald: That’s awesome. God, I just love it. I love it. And so you’ve created in your book, and I want you to speak to that, just a ton of resources to help us figure out our kids.

Dr. Danielle Dick: Absolutely. Because I know that parents… It’s nice to have access to research, but it’s also really nice to know what to do with it.

Dr. Kara Fitzgerald: Exactly, yeah. And you’ve done that, I just want to say.

Dr. Danielle Dick: And so what I did was, I took questionnaires that researchers use to understand kids’ temperament and genetically influenced dispositions, and created short surveys for parents to fill out, that focus on three big genetically influenced temperamental dimensions that have shown up across multiple studies conducted all around the world. And those dimensions are extroversion, emotionality, and effortful control or what we sometimes call self-control, or on the flip side, impulsivity in kids. Strongly genetically influenced, you can take the survey and figure out where your child falls on those dimensions because then, what we know is that whether you have a child who’s high, medium, or low, they have different needs and there tend to be different tension points and different parenting strategies that work better or worse for kids with different dispositions. So as you started out saying, we’re all stretched thin, parents have so much on their plate, especially now with everything we’ve all been through over the last couple years, and so we can’t do it all. And the idea is, this helps cut down some of that trial and error to figure out your child and what will work best for your child.

Dr. Kara Fitzgerald: Awesome. Just really lovely resources in the book. And I can just see, what a neat aha moment, it’s nice for you get to do the science and then sort of bring it home and apply it. And I’m sure your experience, obviously, at home influenced what you were doing in the lab. So talk to me about genes. When you say it’s genetically influenced, talk to me about what you’re thinking there. I’m going to actually just let you explain it.

Dr. Danielle Dick: Absolutely. My work really spans the translational spectrum. So I do everything from leading big gene identification projects. A lot of which focuses on impulsivity, self-regulation, substance use, and other addictive outcomes.

Dr. Kara Fitzgerald: So you’re looking for genetic patterns, like these large…

Dr. Danielle Dick: Absolutely.

Dr. Kara Fitzgerald: Are they GWAS, studies, types of things?

Dr. Danielle Dick: They are. So we are scanning the genome and looking for areas where individuals who are affected, say with a substance use disorder, or who are higher if we’re looking at something like impulsivity in kids, are more likely to have a particular variant at that location than other individuals. Because what we know when it comes to substance use and mental health outcomes and behavioral outcomes and emotional outcomes in kids and adults, there is no gene for depression, alcohol use disorder, ADHD, huge temper tantrums at Target, any of those things. They’re all genetically influenced, but there’s no genes of large effect that impact that.

Dr. Kara Fitzgerald: Mm-hmm (affirmative).

Dr. Danielle Dick: So instead, what we know is that our dispositions are a result of probably thousands of genetic variants across the genome. And so what we do is, I run these big gene identification studies, as do many others, and we can create what are called polygenic risk scores. So we’re essentially summing up all the genetic variants that appear to be associated with the outcome, weighted by their effect size, each of them just has teeny effect sizes on their own. And so then what you get is a number that indexes an individual’s vulnerability or liability toward that outcome. They’re not great right now, which is why they’re not yet in the clinic.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: But they’re getting better and better every day. The hope of precision medicine, of course, is that what we’ll be able to do is give individuals information about how at risk they are for a variety of health outcomes and of course these complex multifactorial ones where there are thousands of genetic variants involved and the environment. These are the things that affect so many of us, whether it’s cardiovascular outcomes or psychiatric and substance use outcomes.

Dr. Kara Fitzgerald: Sure.

Dr. Danielle Dick: So the way we will eventually be able to give individuals risk is through these polygenic risk scores. They form a bell curve, as you would expect, and so people kind of fall across that distribution. And where they’re most useful right now is for individuals who are in the upper end of that distribution. Knowing they’re at elevated risk and then working on how could we develop more targeted interventions, hopefully early interventions, or even preventative measures, associated with reducing the risk of that particular outcome. One of the things that we need to be able to make that work, because we know it’s not just genes, it’s also the environment of course, all the kinds of things that you work on as well, I also run a lot of studies of kids. So we’re looking at what do kids, who are carrying genetic vulnerability, look like as they’re growing up, and what kinds of environments either reduce risk or exacerbate risk.

Dr. Kara Fitzgerald: Mm-hmm (affirmative).

Dr. Danielle Dick: And so if you take something like substance use disorders, an environment is necessary to express genetic risk, i.e., you could be genetically at risk for substance use disorders, but if you never drink alcohol, use a particular drug, you will never develop a substance use disorder. That’s one extreme. But we also know, coming back to parenting, that, for example, parents who monitor their kids more in adolescents, so who ask, “Who are you with? And where are you going?” and who reduce access to alcohol and other drugs in the home, that for kids who are genetically at risk, that actually reduces the likelihood that they will start experimenting with alcohol using in risky ways because you have changed the environment. You have essentially reduced access to a risky environment. And so by doing that, you’re actually changing the likelihood that that child will display problems. So those are the ways that kind of, by understanding genetic risk, either in the future, probably with a measured genetic risk score, or now even by looking at behavior and understanding their dispositions, we can actually change the environment to change risk outcomes in our kids.

Dr. Kara Fitzgerald: By doing your surveys, we’re getting some insight into how we need to approach them. So we don’t have a polygenic risk score available to us at this time, but by sort of meeting them where they’re at emotionally, behaviorally, and making room for allowing them to be, we are in fact addressing their polygenic risk. Would you say that’s true? So these are like surrogate tools.

Dr. Danielle Dick: Absolutely, yes.

Dr. Kara Fitzgerald: That’s really cool. Yeah.

Dr. Danielle Dick: Because we know that these behaviors would show up very early.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: Temperament starts to show up in a kind of stable way, usually around three- ish, from there on out. A lot of the things, the ups and downs when our kids are infants, is a product of sleep or other things.

Dr. Kara Fitzgerald: Right?

Dr. Danielle Dick: If you have a colicky baby, it does not mean you’ll have a colicky teenager necessarily.

Dr. Kara Fitzgerald: Right.

Dr. Danielle Dick: But when you start to see patterns that are emerging in your kids, that are consistent across time and across situations. So for example, all kids are fearful sometimes. And there’s good reason to be fearful sometimes. But if you have a child who’s fearful in situations that might not even warrant it, like the neighbor’s friendly little dog comes running over, they’ve never been bitten by a dog, there’s no reason for them to be afraid, and they’re cowering behind your legs. And they’re also afraid to go on play dates, afraid to go to school. The teacher talks about how they’re afraid to speak up in class. Then you can start to see, “Okay, so my child has a disposition toward being more anxious.” So you can start to figure these things out by looking at their behavior patterns, even though we don’t, right now, have an underlying index of their genetic risk. We see that genetic risk playing out through these, what we call, temperament or these dispositions in our kids.

Dr. Kara Fitzgerald: I love it. I just love it. It just feels really good to me as a mom. And it’s really nice. It’s nice to have the science behind it, that we’re using sort of a surrogate precursor of these polygenic risk scores. I’ve been paying attention. So Harvard was working on, I think, a polygenic risk score that was getting some PR around cardiovascular disease. And I’m, as you know, researching epigenetics. And part of that came from really kind of being disappointed with the promise of genetics, except that it seemed to me logical that the way that we could really dive in and use genetics, because it’s not a one gene, one disease reality, is exactly what you’re doing, these polygenic scores. I can’t wait for you to get in there and finish your research so that we’ve got access to these in the clinic. But it just makes a lot of good sense and I’m thrilled. I’m always thrilled to understand how we can start to use some of it.

And so, again, just going back to your surveys as a starting point. I want to ask you about something like 23andMe. I mean, in my world, in the world of functional medicine, and in the people who are interested in coming, they tend to have a 23andMe panel. We’re thinking about these single nucleotide polymorphisms, and oftentimes, we are really giving them a lot of power. I write in my book actually, the MTHFR gene, the methylation cycle, has brought individuals to seek out my care because they’re absolutely wildly anxious that they’re vulnerable to diseases A, B, C and D and E and F, and they need to address them. I mean, how useful are these? How useful are they in clinic practice? How useful are they for folks getting them? I know I’m going to hear from people, “What about COMT, Dr. Fitzgerald? You didn’t ask her.” I mean, how can we use these? Can we benefit from them? Should we get them? Should we even be considering them in clinic practice?

Dr. Danielle Dick: So right now, for most complex outcomes and so for psychiatric and substance use outcomes, the genetics is not ready for prime time. Many of the genes that you see in the news, COMT and others, DRD2 and DRD4 got a lot of press for a while on the news too, what we have found over time is that, these genes have small effects, like most of the other genes that influence risk. And so the best way to index an individual’s vulnerability or liability is through these polygenic risk scores, which sum up risk across literally thousands of genetic variants across our genome.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: In most psychiatric and substance use outcomes, there are not big genes of effect, one example, or one exception I suppose, in say, the alcohol use field is that there is a variant in the ALDH gene, which makes it very difficult for individuals to break down acetaldehyde, this sort of toxic byproduct that ethanol gets broken down into. And when you can’t break that down, then it creates nausea, facial flushing. And so if that happens every time you take a drink, it turns out it’s very difficult to drink enough to actually develop problems. And alcohol is very unpleasant and so people tend not to drink. That variant is found almost entirely in individuals of Asian descent. And that’s an example where it’s actually a protective variant of large effect.

Other than that, most all of the genes that are involved in say, substance use outcomes, or many of these common psychiatric outcomes, like depression, anxiety that we’re talking about, any gene on its own doesn’t really give you any information because you need to know the information across the genome. And even those are not incredibly powerful yet. We work with 23andMe, they’re a collaborator on our big gene identification projects.

Dr. Kara Fitzgerald: They have a ton of data. They have like-

Dr. Danielle Dick: Yes. And you also hit on a really important issue too, which is, when people are coming to you with genetic results in the clinic, we’re in a really challenging place right now because there’s been exponential growth in the public’s interest in genetics. And you can get your genetic information through these direct-to-consumer tests, and you can even upload them to public websites that will generate PRS, polygenic risk scores, for you. And they don’t tell you they’re not very good yet and whatnot. And it turns out that psychiatric and substance use disorders make up half of the top 12 most requested polygenic risk scores. So people are interested in getting this information. But doctors also are not trained as to what to do with it, and so many of us feel ill-prepared when people show up in our clinics too, and are saying, “Hey, what do I do about this genetic risk?”

I think all of this underscores the importance of really getting information out about how to understand and interpret now these polygenic risk scores, i.e, risk that is a risk across the population. Right? So it’s a number, it’s not a, “You have a positive or negative test result,” it’s, “You’re above average. You’re below average. You’re average.” What do you do with that information? And how do you make sure, like you said, people understand that isn’t destiny? It means that you’re at elevated risk, but one of the wonderful things is that, environmental interventions can be very effective for many of these outcomes. So we need to help people understand that actually, knowing this information is powerful because then you can enact behavior change, that many of the kinds of things that you study and that your field focuses on, in order to alter your risk of developing that outcome. There’s a lot of people who don’t understand that.

Dr. Kara Fitzgerald: So interestingly, I haven’t had anybody, nor have I, obtained a polygenic risk score. I have one eye open towards the evolution of the area because I do think it’s how we’re going to use genetic data in a way that’s actually very meaningful, but I didn’t realize that they were being put out for prime time. So the take home is, be extremely loose on interpreting your 23andMe data as it is and looking at single nucleotide polymorphisms as predictors. Sounds like you’re saying that’s a bad idea. And it’s also a bad idea to use the available polygenic risk score tools out there currently. Or actually, I shouldn’t say it’s a bad idea. You just want to be nuanced in how you interpret them perhaps. But again, as you said multiple times in our podcast, your genes are not your destiny. So even if you get something that’s an anxiety provoking score, this is an opportunity for a more sort of broad preventative kind of conversation or approach.

Dr. Danielle Dick: Yes. And I don’t mean to suggest that there are not single gene effects that are important, there are for many other disorders and outcomes.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: And many of the information that 23andMe is providing now is kind of fun traits and outcomes, like the gene influences-

Dr. Kara Fitzgerald: You likely have straight hair.

Dr. Danielle Dick: Yes. Or whether you can smell asparagus in pee, or those kind of things.

Dr. Kara Fitzgerald: Right, right.

Dr. Danielle Dick: But-

Dr. Kara Fitzgerald: Hey, look, they’re right.

Dr. Danielle Dick: Yes, exactly.

Dr. Kara Fitzgerald: I have straight hair.

Dr. Danielle Dick: But these polygenic risk scores are really not ready for prime time. Interestingly, the group that you mentioned at Harvard that’s working on cardiovascular risk and PRS for that, we’re actually collaborating with them on some tools for how do you provide this information, this polygenic risk information, to people in ways that they can understand so that they don’t come away with deterministic mindsets or thinking, “Oh, I can’t do anything about this.” And if we bring it back to our kids for a second, I think an example that helps one wrap their head around this is, if you imagine that you have a child who is more prone to anxiety. Well, of course, we know that that is genetically influenced, which means that there is an increase likelihood that one or both parents are a bit more prone to anxiety as well, which is another point we haven’t talked a ton about. But it’s not just our kids, of course, who have genetic dispositions, it’s us. And so sometimes, these mismatches between our kids and us can create some challenges.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: If you can imagine, if you have a child who’s more predisposed to anxiety and a parent who’s more predisposed to anxiety, if that parent is then responding to the child every time they get nervous with, “Yes, you’re right. Okay, well, we won’t go do that then,” and they’re constantly telling the child, “Oh, watch out or be careful,” or, “Oh, I’m concerned about this or that,” what you can do is create this feedback loop that is exacerbating the child’s anxiety.

Dr. Kara Fitzgerald: Yes.

Dr. Danielle Dick: They started with a disposition. Their environment is now enhancing that disposition, that can lead to increased anxiety. But you can imagine that the parent could also respond to that child, who is displaying increased anxiety, a more anxious temperament, by saying, “Okay, I understand that it makes you really nervous to go to new places. So you know what? We’re going to practice taking some deep breaths and we’re going to do that,” and then, “Oh, do you feel how your body’s calming down? Okay. Are we ready now? Let’s try going in now.” You can help teach them the skills to manage that, which is such a gift, because now what you’re doing is reducing the likelihood that that child who had a disposition, which could put them at elevated risk for anxiety. You are essentially providing environmental manipulations, teaching them skills that don’t come naturally to them, to reduce the likelihood that they’ll actually go on to display problems.

And so oftentimes, when I talk about parents, they’ll say, “Well, I worry about my child because there’s substance use, or there’s anxiety, or there’s depression in my family,” or, “I’ve suffered from this and now I feel guilt, or I’m not sure how I’m going to manage it in my child.” And I always say, “When you have learned and you have been through that, and you have essentially learned how to work with that disposition, you have taught yourself and been through whether it’s therapy or other things to essentially manage your anxiety, now what a wonderful guide you have the ability to be for your child to understand and empathize with them and also teach them skills.” And so that’s also how we can break some of these intergenerational challenges that folks have if something like substance use, depression, anxiety, other kinds of mental health challenges run in families because, yes, your kids might be at elevated risk, but that does not mean that they are destined to go on and develop problems. And when you can see risk patterns showing up early, you can intervene.

Dr. Kara Fitzgerald: Right. And also too, I think what I’m hearing you say is, the more that we’re engaging in our own self-awareness and self-care, clearly the better we’re going to be able to deliver this really lovely foundation that you’re describing, which is stepping away from the helicopter and just allowing them to be, but also giving them some really lovely skills that we need ourselves, remembering that breath.

Dr. Danielle Dick: Yes. Sometimes I think we inadvertently place pressure on our children, and we know this also from the trends of skyrocketing rates of anxiety and kids and whatnot, to be the way that we want or we imagined they would be. For example, I’ve talked about my son being low on introversion. So as a more extroverted parent, you can see how you could easily be like, “Why don’t you have more friends? Why aren’t you out more? When I was your age, I was out with all of my friends.” And what you can inadvertently do is send the message, even if you don’t mean to. You might be very well meaning that was what was good for you. But for your very differently wired child, it can send the message, “You’re not enough. You’re doing something wrong. Why aren’t you more like this other way I want you to be?”

Dr. Kara Fitzgerald: Yep.

Dr. Danielle Dick: Or if we have a child that’s prone toward high emotionality, they get frustrated or distressed. If we respond with, “You don’t need to get so upset. Why are you getting mad all the time?” Often, those feelings scare our kids as much or more than they upset us. And when we sort of reinforce that this is bad, this is a problem, then that again can really harm our kids’ ability to learn to manage it and learn to make peace with it, and can instead contribute to this cycle where now they think, “I’m not enough. My mom doesn’t like me the way I am,” these kind of things.

Dr. Kara Fitzgerald: Yeah.

Dr. Danielle Dick: Yes, by being intentional about understanding our kids, we also cannot put this, sometimes inadvertent, added pressure that we put on our kids in addition to putting on ourselves.

Dr. Kara Fitzgerald: Yeah. Yeah. I’m excited to do the surveys and just really kind of think about it. It’s neat. I’ve got this extraordinary human being who I’m charged with walking with as she grows up and to get to know her instead of any kind of lens I might be popping on her from my own nearsighted or farsighted, or my own cluster of expectations. Just to take that off and to just really see her, I mean, what more could we want as parents?

Dr. Danielle Dick: Yes. What a beautiful way to sum it up. I couldn’t agree more.

Dr. Kara Fitzgerald: So listen, it would be remiss of me not to talk about epigenetics, leaning into the environment, talking about our genes are not our destiny, because obviously I’ve spent a lot of time writing about epigenetics and it’s my area of science. So I love that you’re doing polygenic risk scores, and I just want us to stay in touch and I want to talk to you about them as you feel as they head more towards prime time. And any papers, actually, we can pop in the show notes. So anything that might be interesting to our listener, our listening audience, a lot of them are clinically trained, or scientifically trained, or at least really interested in it. We’ll put some in there.

But I’m thinking of my advisor on our study, Dr. Moshe Szyf, at McGill university, he’s a leading epigeneticist the world over and he was involved in Project Ice Storm. Do you remember? I don’t know if you came across it. It’s in Canada. So it happened, I feel like maybe it was in the 80s, maybe it was the 90s. Quebec was hit with a massive ice storm that just kind of shut their world down for a couple of weeks. And it was very stressful. So it was literally stressful physically, just the challenges for some individuals. And it was also really emotionally stressful. And women who were pregnant gave birth to kids who had higher rates of autism, actually autism and asthma. I’m sure you’ve noticed that there’s a stress component to allergies. This was an epigenetic change, and they’ve identified some of that. And clearly, it wasn’t genetic because it just happened with the direct offspring in these pregnant women, associated with the women’s response. There was no difference between physical stress and emotional stress, interestingly either. Both were equally impactful.

So it seems to me… And he’s also shown really interesting early life licking and grooming in maternal care of mice, and they’ve shown this in humans as well, sort of either creates greater stress resilience or less if, conversely, you haven’t had that kind of nurturing. And we see that in kids. And they’ve shown that there’s methylation patterns that change in the release of cortisol, correlated with what they identify. Anyway, I believe, and I want to get your thoughts on those, that polygenic plus some of these epigenetic investigations will… So these multiomic investigations at some point are really going to be where the rubber meets the road. Would you agree with that? What are your thoughts?

Dr. Danielle Dick: Yes, I agree. And I share your interest and enthusiasm about epigenetics in the sense that it addresses what has always been a huge puzzle, which is, we know genes are important and we know the environment is important. How does the environment get under the skin to influence our behaviors and lives? Epigenetics is clearly one mechanism by which we now understand the environment can literally change the expression of our DNA, not changing the sequence as you note, but it’s changing the expression of it. So I definitely agree that in the future, the ability to better characterize… Obviously, your DNA sequence is one part of what could put one at risk, but it’s not the only thing. We’ve been talking about many ways that the environment can moderate risk, and epigenetics is one of those mechanisms. We’re not as far along in the area of psychiatric and substance use disorders in terms of characterizing and really understanding those epigenetic changes.

Dr. Kara Fitzgerald: Yes.

Dr. Danielle Dick: There’s clearly compelling evidence from some of these natural experiments and the animal work that you were mentioning, that demonstrate it must be going on.

Dr. Kara Fitzgerald: Mm-hmm (affirmative).

Dr. Danielle Dick: But the problem with understanding and quantifying it in many of these psychiatric and substance use outcomes is that… So if we take alcohol use for example, we know that alcohol can change gene expression in many ways, but when you’re actually trying to quantify that in humans, then the problem is that people start using alcohol usually during adolescence, and the escalation to problems is also often happening with many other things going on in the individual’s life, increases in stress, as you talked about, potentially other traumas, probably changes in peer groups and lifestyle. And so there’s so many pieces going on that when we see epigenetic changes, it can be hard to know, gosh, well, was that a marker of the onset of, say, substance use across adolescence? Or was that a marker of all of the myriad of things that are going on and changing in our lives across adolescence? So we’re certainly trying to tease apart some of those things as our many other groups, but that’s going to be a complicated puzzle for those very reasons that I was talking about.

Dr. Kara Fitzgerald: Yeah. Yeah, I get it. I get it. I get it. Ugh, it’s an interesting puzzle there nonetheless and one that I’ll be paying attention to. And I know that you’re going to just be right at the fore of teasing it out. Even as it’s extraordinarily complex, the hope is, we will have more and more tools and we can intervene and think about things earlier and earlier.

Dr. Danielle Dick: Absolutely. One of the things that we’re trying to do with… You were talking about omics research because of course there’s genomics or genome, but of course, there’s then transcriptomics, which is looking at, it’s getting closer to what’s actually being transcribed which is now a degree closer to things like epigenetic changes, because are the genes being turned on or off? And then proteomics and looking at what proteins are actually being produced. So as our ability to do these large-scale omics studies and to integrate these huge informatics, databases, that we have across these different levels of analysis, ultimately, putting these things together should allow us to do a much better job. They all have limitations right now, especially when it comes to psychiatric and substance use outcomes, because of course what we’re most interested in is what’s going on in the brain and the blood, and other areas where we can look at transcription, and things are only kind of a loose proxy.

Dr. Kara Fitzgerald: That’s right.

Dr. Danielle Dick: It turns out people don’t really want their brains being sampled and taken while they’re alive. So we’re making progress, but there’s several of these technical limitations that we’re slowly working our way around, but that’s why we don’t have the scores that integrate genomics, transcriptomics, proteomics quite yet.

Dr. Kara Fitzgerald: Well, everybody, stay tuned. We’ll get there. And listen, I just want to say that it was absolutely lovely to talk to you. We’ve got actionable steps. So folks, get The Child Code. You can get the science and then you can get the surveys, and what next, what to do. I think it’s a useful book for us in clinical practice to kind of frame how we’re thinking about, well, geez, our patients, and if we’re doing peds, how we’re working with kids in our practice. But I think it’s a really useful framework for talking to parents. And then plenty of us are parents ourselves and we can use your book in our home. So Danielle, again, it’s just lovely to have you. I’m so glad we had a chance to talk. I look forward to continued conversations with you over the years.

Dr. Danielle Dick: Absolutely. Thank you so much for having me on and for all the important work that you’re doing in this space as well.

Dr. Kara Fitzgerald: Thank you.

As always, thank you for listening to New Frontiers in Functional Medicine, where our sponsors help bring the very best minds in functional medicine, and today is no exception. Not everyone can be a sponsor on my platform, and I so appreciate the good work, relentless research, and generous support from my friends at Biotics, TA Sciences, and Integrative Therapeutics. These are brands I know and trust in my own clinic and can confidently recommend to you. Visit them at BioticsResearch.com, TASciences.com, and IntregrativePro.com, and please, tell them you learned about them on New Frontiers.

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Danielle Dick, PhD is a Professor of Psychology and Genetics, author of THE CHILD CODE, and an internationally recognized, award-winning expert on genetic and environmental influences on human behavior. She has led and contributed to more than 20 grants from the National Institutes of Health, with grant funding totaling over 30 million dollars. Dr. Dick has more than 350 peer-reviewed publications in the areas of child development, addiction, mental health, genetics, and human behavior, and has won numerous national and international awards for her work. She has been named one of the most highly cited researchers in the world.

The Child Code

Danielle Dick, PhD

Development of a clinical polygenic risk score assay and reporting workflow (Harvard study)

Project Ice Storm

Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome

Younger You

DrKF Study

DrKF FxMed Resources

DrKF FxMed Clinic: Patient consults with DrKF physicians

Clinician Professional Development: DrKF FxMed Clinic Immersion