The new science of babies and brains—and how it could
revolutionize the fight against poverty.
As an adoptive parent, I cannot stress how critical the first two years are for a baby in need of nurture and care. Our girls came to our lives when they were turning four. It has been a long but rewarding road to travel. We love our two adopted daughters very much and wish we could have been there for them in the beginning. This article by Johnathan Cohn really speaks to this.
A decade ago, a neuroscientist named Charles Nelson traveled to Bucharest to
visit Romania’s infamous orphanages. There, he saw a child whose brain had
swelled to the size of a basketball because of an untreated infection and a
malnourished one-year-old no bigger than a newborn. But what has stayed with
him ever since was the eerie quiet of the infant wards. “It would be dead
silent, all of [the babies] sitting on their backs and staring at the ceiling,”
says Nelson, who is now at Harvard. “Why cry when nobody is going to pay
attention to you?”
Nelson had traveled to Romania to take part in a cutting-edge experiment. It
was ten years after the fall of the Communist dictator Nicolae Ceauşescu, whose
scheme for increasing the country’s population through bans on birth control
and abortion had filled state-run institutions with children their parents
couldn’t support. Images from the orphanages had prompted an outpouring of
international aid and a rush from parents around the world to adopt the
children. But ten years later, the new government remained convinced that the
institutions were a good idea—and was still warehousing at least 60,000 kids,
some of them born after the old regime’s fall, in facilities where many
received almost no meaningful human interaction.
With backing from the
MacArthur Foundation, and help from a sympathetic Romanian official, Nelson and
colleagues from Harvard, Tulane, and the University of Maryland prevailed upon
the government to allow them to remove some of the children from the orphanages
and place them with foster families. Then, the researchers would observe how
they fared over time in comparison with the children still in the orphanages.
They would also track a third set of children, who were with their original
parents, as a control group.
In the field of child development, this study—now known as the Bucharest
Early Intervention Project—was nearly unprecedented. Most such research is
performed on animals, because it would be unethical to expose human subjects to
neglect or abuse. But here the investigators were taking a group of children
out of danger. The orphanages, moreover, provided a sufficiently large sample
of kids, all from the same place and all raised in the same miserable
conditions. The only variable would be the removal from the institutions,
allowing researchers to isolate the effects of neglect on the brain.
Prior to the project, investigators had observed that the orphans had a high
frequency of serious developmental problems, from diminished IQs to extreme
difficulty forming emotional attachments.
Meanwhile, imaging and other tests
revealed that some of the orphans had reduced activity in their brains. The
Bucharest project confirmed that these findings were more than random
observations. It also uncovered a striking pattern: Orphans who went to foster
homes before their second birthdays often recovered some of their abilities.
Those who went to foster homes after that point rarely did.
This past May, a team led by Stacy Drury of Tulane reported a similar
finding—with an intriguing twist. The researchers found that telomeres, which
are protective caps that sit on the ends of chromosomes, were shorter in
children who had spent more time in the Romanian orphanages. In theory, damage
to the telomeres could change the timing of how some cells develop, including
those in the brain—making the shorter telomeres a harbinger of future mental
difficulties. It was the clearest signal yet that neglect of very young
children does not merely stunt their emotional development. It changes the
architecture of their brains.
Drury, Nelson, and their collaborators are still learning about the orphans.
But one upshot of their work is already clear. Childhood adversity can damage
the brain as surely as inhaling toxic substances or absorbing a blow to the
head can. And after the age of two, much of that damage can be difficult to
repair, even for children who go on to receive the nurturing they were denied
in their early years. This is a revelation with profound implication—and not
just for the Romanian orphans.
APPROXIMATELY SEVEN MILLION American infants, toddlers, and preschoolers get care
from somebody other than a relative, whether through organized day care centers
or more informal arrangements, according to the Census Bureau. And much of that
care is not very good. One widely cited study of child care in four states, by
researchers in Colorado, found that only 8 percent of infant care centers were
of “good” or “excellent” quality, while 40 percent were “poor.” The
National Institute of Child Health and Human
Development has found that three in four infant caregivers provide only
minimal cognitive and language stimulation—and that more than half of young
children in non-maternal care receive “only some” or “hardly any” positive
caregiving.
Of course, children in substandard day care are not the only children at
risk in the United States. There are also hundreds of thousands of babies born
each year to American teenagers, about 60 percent of them poor. The vast
majority of teen mothers are unmarried when they give birth, and frequently
lack either family support or the financial resources to find capable outside
help. Then there are the children who begin their lives in traumatic
circumstances for other reasons—because they have a parent with clinical
depression, or they witness violence in the home. Nobody has a precise
definition of adversity, let alone a number for the children who experience it.
But experts like Nelson think at least a few hundred thousand children suffer
from serious abuse or neglect every year. Presumably they are disproportionately,
although far from exclusively, in low-income families.
For a long time, social science has known of correlations between childhood
turmoil and all sorts of adult maladies that carry massive social and financial
costs—mental illness, addiction, tendencies toward violence. And for decades,
we have attempted to address those problems with a variety of social
interventions: Head Start, which aims to prepare low-income kids between the
ages of three and five for school; investments in elementary and high school
children; programs for rehabilitation of juvenile delinquents. While some have
achieved important successes, many of the problems stemming from childhood
poverty remain intractable.
These problems incur large costs. Think about the lost wages from serious
mental health problems, which total $200 billion a year, according to a 2008
study from the
American Journal of Psychiatry. Or think about the
expense of incarcerating criminals: about $60 billion a year, according to a
2006 study from the Commission on Safety and Abuse in America’s Prisons.
Childhood adversity obviously doesn’t account for all of these sums. But if the
studies are correct, then adversity explains a significant portion—certainly in
the tens of billions of dollars.
And the implications go beyond mental illness or crime. Children who fail to
develop coping mechanisms struggle from the earliest days in school, because
even the slightest provocations or setbacks destroy their focus and attention.
They can’t sit still and read. They have trouble standing in line. They lash
out at classmates or teachers. And these struggles, naturally, lead to other
problems that perpetuate the cycle of poverty. All of this is to say that the
science of early childhood may play a significant role in the dominant
political question of our time: rising inequality.
THE FIRST TIME I heard of this field of research was during a conversation with
a woman named Diana Rauner. In the early ’90s, about a decade after graduating
from Yale, Rauner had left a lucrative career in private equity to study
developmental psychology at the University of Chicago. For her dissertation,
she visited day care centers in the city, hoping to learn about how infants and
toddlers pick up language skills. But she learned a lot more about the sorry
state of child care. Rauner described facilities where infants were strapped in
car seats, “watching
The Lion King all day,” while the older kids were
“circling the room almost like sharks” and throwing things at the infants,
because they had nothing else to do. But the infants frequently didn’t cry. “A
lot would just stare, which is almost worse,” Rauner says.
Today, Rauner runs a nonprofit organization called the
Ounce of Prevention Fund,
a $40 million-per-year initiative that applies the latest scientific findings
about early childhood—in particular, those first few years—to help some of
Chicago’s most disadvantaged families. The fund trains workers at day care
centers on how to nurture babies in ways that will stimulate positive brain
activity. It also operates its own child care center and school, called
Educare, that became the model for a national network of such facilities
designed to improve day care for infants and young children, including those
too young for Head Start. But perhaps the program’s most intriguing initiative
is its work with agencies that provide at-home visits to young women,
particularly teenagers, who are either pregnant or are new mothers. Some of
these agencies employ doulas, who are specially-trained to provide advice and
support to mothers, from the prenatal period all the way up through early
childhood.
A few weeks ago, I went on a visit with Maria Caref, a doula who works for
Christopher House, an organization that partners with Ounce of Prevention.
Maria was visiting Rosaria, a 17-year-old high school student with a
four-month-old baby boy. (As a condition of my attendance, I agreed not to
identify the real name of Rosaria or her baby.)
Rosaria lives on the second floor of a house in a lower-income,
predominantly Latino neighborhood on the west side. When we walked in, her son
was lying face-up on a Winnie-the-Pooh fleece blanket on the floor, playing
with a ball. Rosaria was on the floor next to him. Children’s music was playing
loudly in the background. Like most of the young mothers Caref visits, Rosaria
came to Christopher House via a referral (in this case, from a health clinic)
while she was pregnant. The official agenda for the visit was to assess whether
she was still working toward her own goals as a student and as a parent. But,
as always, it was also a chance to check up on the baby and how Rosaria was
caring for him.
Rosaria told Caref she was pleased that her boy was aware of her voice and
would turn his head to follow her. “He laughs all the time; he’s smiling,” she
said. When Caref pulled out a rattle, it got his attention right away. “
Curioso,”
Rosaria said, “like Curious George.” At that point, Rosaria pointed out a
plaything she’d made the baby, by sewing buttons onto socks that she’d turned
into mittens. Caref smiled but, after tugging on the buttons with her fingers,
warned that they were actually a hazard: “Wow, mom is so creative,” Caref
cooed, while holding the baby. “But you have to be careful,” she said,
carefully switching gears. “He can pull this hard and he can swallow this. It
would be very dangerous.” Later the two talked about whether Rosaria had
followed up with immunizations (she had) and whether she was still reading to
the boy regularly (she was, although not as regularly as before because she was
busy with her own homework). “For some mothers, it’s really hard to keep up,”
Caref told Rosaria as we left. “You’ve been doing really well.”
A major goal of these visits is to establish long-term relationships, so
that the young women come to see the visitors as both a source of support and
an advocate for their interests. Visitors like Caref are trained to deal with a
wide range of issues, from basic psychology to health. During the visit, Caref
talked to Rosaria about breastfeeding, which has significant health benefits
for both mother and child. They also spoke about birth control. Studies have
shown that teen mothers who have more than one child, particularly in rapid
succession, are by far the most likely to fall into crisis.
The model for these efforts is a visiting nurse program that David Olds, a
University of Colorado pediatrician, tested in Elmira, New York, during the
’70s and ’80s, and which grew into the national Nurse-Family Partnership. In
2011, the program, which the federal government helps finance, will serve more
than 20,000 families; they receive home nurse visits from when they become
pregnant until their children are two years old. Olds’s program is one of the
more unambiguous success stories in the modern history of social policy. Two
long-term studies published in the
Journal of the American Medical
Association found that adolescents whose mothers had been in the program
were less likely to run away, get arrested, or consume alcohol or tobacco.
Reports of child abuse were lower by about 50 percent.
When the RAND Corporation evaluated the initiative, it determined that the program
would save between $1.26 and $5.70 for every $1 spent, with the higher savings
from the higher-risk families, thanks to reduced spending on hospitals,
incarceration, and cash assistance. And according toTimothy Bartik, an
economist and author of
Investing in Kids, every dollar that goes into
the Nurse-Family Partnership will raise incomes for the entire population by
$1.85, once you factor the economic benefits of a more productive workforce—and
a tax base that won’t be so strained picking up the tab for remediation and
crime. High-functioning day care centers that cover birth through age five,
Bartik says, produce a larger payoff per dollar: $2.25.
The science of early adversity, then, offers a blueprint for tackling the
effects of poverty and neglect, one that is more precise and observable than
any tools policymakers have ever had at their disposal. “The concept of
disrupting brain circuitry is much more compelling than the concept that poverty
is bad for your health,” says Jack Shonkoff, a Harvard pediatrician and chair
of the
National
Scientific Council on the Developing Child. “It gives us a basis for
developing new ideas, for going into policy areas, given what we know, and
saying here are some new strategies worth trying.”
AFTER MY VISIT with Caref, it was possible to imagine what a comprehensive
policy response to the problems of impoverished early childhood might look
like. Young families would have the option of home visits, from doulas or
social workers. Child care would be higher quality across the board. It would
also be affordable, even for families at or below the poverty line. Such
services wouldn’t be available exclusively to the poor, since middle-class
families could also benefit from many of these programs. That would make them
more popular, too.
From a policy standpoint, probably the biggest question about home visiting
is how well it would work on a much larger scale. Not all home programs are
going to be as thorough as the effort I saw in Chicago, which means they may
not produce the same benefits. This is a familiar problem: Studies of Head
Start, for example, suggest that it does not have the long-lasting effects on
test scores that exemplary programs like the famous Perry Preschool in
Ypsilanti, Michigan, do. Instead, Head Start’s impact on test scores tends to
fade (although many researchers argue plausibly that dismal assessments of
reading or math skills overlook other advantages that Head Start students
gain).
But the bigger questions right now are political. Nobody is talking about
launching a new government initiative, no matter how much money it might save
in the long run. On the contrary, the focus today is on slashing government
spending.
The Affordable Care Act has $1.5 billion over five years for
expanding visiting nurse programs for brand new mothers. That’s a massive
expansion over the previous investment which, according to administration
officials, was only in the millions. But even as that money works its way
through the pipeline, the net investment in early childhood care is probably
declining, given how much of it flows through cash-strapped state governments
that are frantically cutting their budgets. In Illinois, to give just one
example, about 5,000 at-risk children will lose state-financed schooling, care,
or developmental services this year because of a 5 percent budget cut,
according to Adam Summers, from Illinois Action for Children. And that’s in
addition to 14,000 kids who lost access to state-funded pre-kindergarten in the
last two years. At the federal level, House Republicans have proposed
eliminating the new home visit funds altogether.
Hard times require hard choices, of course. But these cuts can be
counterproductive. One of the most convincing advocates for this argument is
James Heckman, a Nobel Prize winning economist from the University of Chicago.
Earlier in his career, Heckman undertook a project to study the effects of high
school equivalency (GED) programs. To his chagrin, he discovered that the
graduates didn’t seem to be much better off, despite the considerable public
investment in the programs. So Heckman began a quest to discover what kinds of
government spending
would work. His research led him to the conclusion
that earlier is better, until eventually he came to focus on the first years of
a child’s life.
Heckman argues that a dollar spent on the earliest years of life generates
more payoff than a dollar spent on later childhood—let alone a dollar spent on
adulthood. Neither he nor any of the scientific researchers believes the United
States should stop funding later interventions as long as the programs actually
have some impact. Among other things, plenty of infants with nurturing
caregivers still develop problems later on, for other reasons. But Heckman
agrees with researchers who argue that the older the child, the more expensive
and difficult those interventions will be.
Heckman has tried to make this case to anybody who will listen, including
members of the congressional super committee on deficit reduction, whose cuts
to social services—either directly or through reduced aid to the states—could
decimate existing services while leaving little room for new initiatives. “We
can gain money by investing early to close disparities and prevent achievement
gaps, or we can continue to drive up deficit spending by paying to remediate
disparities when they are harder and more expensive to close,” Heckman wrote in
a formal letter to the committee in September. “The argument is very clear from
an economic standpoint.”
Jonathan Cohn is a senior editor at The New Republic.
This
article appeared in the December 1, 2011, issue of the magazine.
