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From Neurons to Neighborhoods:
Reflections on Four Themes

In From Neurons to Neighborhoods: The Science of Early Childhood Development (NRC and IOM, 2000), the Committee on Integrating the Science of Early Childhood Development organized its main conclusions and recommendations around four overarching themes:

1. All children are born wired for feelings and ready to learn.

2. Early environments matter and nurturing relationships are essential.

3. Society is changing and the needs of young children are not being addressed.

4. Interactions among early childhood science, policy, and practice are problematic and demand dramatic rethinking.

More than 10 years later, these themes still deserve attention. The workshop held to commemorate the anniversary of the report’s release in 2011 consisted of two parts. On the first afternoon, 40 invited participants divided into four working groups to discuss the four broad themes. Their goals were to reflect on the continued relevance of the themes, discuss progress in the 10 years since the theme was identified, and point to future research and policy actions that could further realize the intent of each theme. Summaries of the working groups’ main observations and conclusions, which are included below, were given by the rapporteurs at a plenary session following these discussions. Each summary is preceded by a relevant quotation from the 2000 report, From Neurons to Neighborhoods.

The second day of the workshop was a public session, which was also a video webcast to audiences throughout the United States as well as other



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1 From Neurons to Neighborhoods: Reflections on Four Themes In From Neurons to Neighborhoods: The Science of Early Childhood Development (NRC and IOM, 2000), the Committee on Integrating the Science of Early Childhood Development organized its main conclusions and recommendations around four overarching themes: 1. All children are born wired for feelings and ready to learn. 2. Early environments matter and nurturing relationships are essential. 3. Society is changing and the needs of young children are not being addressed. 4. Interactions among early childhood science, policy, and practice are problematic and demand dramatic rethinking. More than 10 years later, these themes still deserve attention. The workshop held to commemorate the anniversary of the report’s release in 2011 consisted of two parts. On the first afternoon, 40 invited participants divided into four working groups to discuss the four broad themes. Their goals were to reflect on the continued relevance of the themes, discuss progress in the 10 years since the theme was identified, and point to future research and policy actions that could further realize the intent of each theme. Summaries of the working groups’ main observations and conclu- sions, which are included below, were given by the rapporteurs at a plenary session following these discussions. Each summary is preceded by a relevant quotation from the 2000 report, From Neurons to Neighborhoods. The second day of the workshop was a public session, which was also a video webcast to audiences throughout the United States as well as other 1

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2 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE countries. The program consisted of six invited presentations, which are summarized in Chapters 2 and 3 of this report. The archive of the video webcast (which includes the slides presented by each speaker) can be found at: http://www.iom.edu/Activities/Children/Neuronstoneighborhoods/2010- OCT-28.aspx. The anniversary workshop and this publication were sponsored by the Healthy Kids Communication Campaign, supported by private gifts to the Institute of Medicine. Many of the workshop participants included individuals who had been involved with the original study From Neurons to Neighborhoods. Additional participants included representatives from government agencies, foundations, professional organizations, advocacy groups, and other researchers. The workshop thus offered an opportu- nity to share reflections from the original study with insights drawn from knowledge and experience that have emerged in the decade since its publi- cation. Although the workshop was a celebratory activity, it is intended to stimulate future initiatives to synthesize and integrate the broad array of findings emerging from the many disciplines associated with the science of child development. The workshop was organized and hosted by the Institute of Medicine (IOM) and the National Research Council (NRC) through the Committee on From Neurons to Neighborhoods: Anniversary Workshop within the IOM-NRC Board on Children, Youth, and Families. The board brings the multidisciplinary knowledge and analytic tools of the behavioral, health, and social sciences to bear on the development of policies, programs, and services for children, youth, and families. It informs deliberations about some of the critical issues facing communities, states, and the nation, in- cluding child health and health services, family support, child care, and early child development; biological and behavioral changes among children and youth; preschool education, school engagement, and youth develop- ment; child abuse, family violence, and child welfare; and the prevention of underage drinking and other risky and dangerous behaviors. It is important to be specific about the nature of this report, which documents the information presented in the workshop presentations and discussions. Its purpose is to lay out the key ideas that emerged from the workshop, and this summary should be viewed as an initial step in building on new insights that have emerged since the publication of the original report. The report is confined to the material presented by the workshop speakers and participants. Neither the workshop nor this sum- mary is intended as a comprehensive review of what is known about the topic, although it is a general reflection of the field. The presentations and discussions were limited by the time available for the workshop. A more comprehensive review and synthesis of relevant research knowledge will have to await future development.

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3 REFLECTIONS ON FOUR THEMES This report was prepared by a rapporteur and does not represent find- ings or recommendations that can be attributed to the planning committee. Indeed, the report summarizes views expressed by workshop participants, and the committee is responsible only for its overall quality and accuracy as a record of what transpired at the workshop. Also, the workshop was not designed to generate consensus conclusions or recommendations but focused instead on the identification of ideas, themes, and considerations that contribute to the understanding of the topic. Theme 1: All children are born wired for feelings and ready to learn. From the time of conception to the first day of kindergarten, development proceeds at a pace exceeding that of any subsequent stage of life. Efforts to understand this process have revealed the myriad and remarkable accom- plishments of the early childhood period, as well as the serious problems that confront some young children and their families long before school entry. A fundamental paradox exists and is unavoidable: development in the early years is both highly robust and highly vulnerable. Although there have been long-standing debates about how much the early years really matter in the larger scheme of lifelong development, our conclusion is un- equivocal: What happens during the first months and years of life matters a lot, not because this period of development provides an indelible blueprint for adult well-being, but because it sets either a sturdy or fragile stage for what follows. (NRC and IOM, 2000, p. 4) The observation that babies come into the world with emotions and the ability to learn raises the question of whether early childhood development actually starts at birth. In addition, an emphasis on the period immediately after birth can be detrimental if it is assumed that this period is a strict de- terminant of later development. Although the first few years of life can be critical for initiating trajectories, they do not determine them. Development is a continuum from the prenatal to the postnatal periods, with a particular influence from maternal nutrition, stress, and health. In that sense, starting with “birth” can be both too late and too early. The word “wired” also can be problematic if incorrectly interpreted. That term can connote too much permanence, as if the brain were hard wired. But there is a diversity of wiring in the brain. Furthermore, this wiring constantly changes in response to biological and environmental in- fluences. Again, trajectories provide a better way of thinking about develop- ment. The farther out in time, the greater the divergence among individuals. These differences can be reduced, although there are limits to plasticity. The differences between individuals are not all positive or all negative. A difference can lead to advantages in one context and disadvantages in another. Differences sometimes are interpreted in terms of “atypicality”—

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4 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE defining some people as normal and others as not normal. But there are more useful ways of thinking about differences. For example, differences can be systematic, leading to phenotypic clusters that are not well under- stood. Differences also can be interpreted in terms of responsivity: How much do people change in response to context? The wiring of the brain has become an important consideration in research based on neuroimaging. The capability to visualize the structure and function of the brain is exciting but also raises issues. Neuroimaging lacks a developmental dimension, partly because the tools and protocols are not available to do imaging with young children. Also, the public and some quarters of the scientific community have gained the mistaken impres- sion that neuroimaging can reveal a direct link between brain activation and sophisticated behaviors, even though such a link is extremely complex. Another pressing issue is the integration of social-emotional develop- ment and cognitive development. Although the processes are integrated, they generally are not studied in an integrated way, nor are researchers trained to study them in an integrated way. Yet when the integration fails in individuals, serious problems can arise. An example is moral development. How can science study the development of values in young children? How are those values related to executive functions? And what are the roles of family and schools in forming values? Finally, the wiring of the brain is related to the roles of biological and environmental factors in the developing child. The understanding of the genome has undergone a revolution in recent years, but there is no corre- sponding theoretical, methodological, or taxonomic understanding of criti- cal environmental influences or concepts. Responsivity or sensitivity may offer a handle on some of these concepts, but an environmental framework for understanding development has yet to be created. All of these issues have implications for the training of researchers, practitioners, policy makers, and the public. All these groups need to have some understanding of systems science, which encompasses the content of several disciplines. Yet researchers need to be an expert in some area while also being able to communicate with people in different disciplines. Theme 2: Early environments matter and nurturing relationships are essential. The scientific evidence on the significant developmental impacts of early experiences, caregiving relationships, and environmental threats is incon- trovertible. Virtually every aspect of early human development, from the brain’s evolving circuitry to the child’s capacity for empathy, is affected by the environments and experiences that are encountered in a cumulative fashion, beginning early in the prenatal period and extending through-

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5 REFLECTIONS ON FOUR THEMES out the early childhood years. The science of early development is also clear about the specific importance of parenting and of regular caregiving relationships more generally. The question today is not whether early experience matters, but rather how early experiences shape individual de- velopment and contribute to children’s continued movement along positive pathways. (NRC and IOM, 2000, p. 6) From Neurons to Neighborhoods placed great emphasis on social- emotional development, but public policies still slight this area. Part of the problem is the lack of valid assessments of development. Today the empha- sis is on what is already being done and what can be measured. Researchers also know much more about the development of cognitive domains than they do about social-emotional development. Educational assessments are a prominent issue in measuring the out- comes of learning. Today, policy makers have expectations of learning programs that are not grounded in research. Assessment strategies need to encourage teachers to teach with understanding. Yet current research is not compelling enough to move toward greatly improved assessments of learning. The challenge of developing better assessments is even greater with English language learners. From Neurons to Neighborhoods was one of several reports that cata- lyzed conversations related to quality and access in education, which is also related to issues surrounding assessments. Having effective measurements and tools would help move early childhood education toward both greater quality and greater access. These measurements and tools also would con- tribute to the performance assessment of teachers, and they could provide a way to harness new knowledge and new technologies in early childhood education. A prominent feature of conversations regarding quality and access has been the need to integrate science into early childhood initiatives, including training and professional development. Research conducted on curricula has been necessary but not sufficient. The larger question is how to bring science to bear on matters of practice to improve quality in classrooms and homes. This task also requires effective messaging for parents, teachers, and policy makers, so that science is translated into actions that are concrete and doable. Have public policies and programs moved as far as they need to? The answer is clearly no. Large numbers of children are not served by early childhood education. Continued study of the benefits of early childhood development can continue to make the case for change. For example, policy makers should not think of early childhood education as a zero-sum game. Society will be better off by increasing quality and the number of children served.

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6 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE Even 10 years after the publication of From Neurons to Neighbor- hoods, important questions remain: How can science be used to bring par- ents, policy makers, and other players together in a coordinated way? What are reasonable outcomes for children 5 years, 10 years, or 30 years after a program ends? Has human capital been overemphasized compared with children’s well-being? From Neurons to Neighborhoods helped broaden the context of early childhood development, but this context still needs to be better integrated for scientific research to have maximum impact. Theme 3: Society is changing and the needs of young children are not being addressed. Profound social and economic transformations are posing serious chal- lenges to the efforts of parents and others to strike a healthy balance between spending time with their children, securing their economic needs, and protecting them from the many risks beyond the home that may have an adverse impact on their health and development. (NRC and IOM, 2000, p. 8) Are children better off today than they were 10 years ago? The general answer is that children are not as far along as people interested in early childhood development would like them to be. There have been pivotal changes, however. The idea that early childhood development is important has reached the consciousness of parents and policy makers. But the transla- tion of scientific information into policy and systems change has not gone as far it needs to go. In addition, large disparities among population groups continue to exist and are growing. It is more difficult to identify effective interventions for children ages 0 to 3 than for older age groups. One reason is that there is not the same infrastructure of programs and policies for young children. Again, the translation of science to action is not happening at the level that it needs to happen. In the search for effective interventions, a focus on relationships is es- pecially important. These relationships exist between parents and children as well as between care providers and children. They also exist at all ages. For example, the relationships between teenagers and their peers, including boyfriends and girlfriends, can be instrumental in determining the course of their lives. The centrality of relationships raises many questions. For example, should parenting education become universal, and if so how? It is critical for service providers to meet parents and families where they are in their lives. Existing systems sometimes fail to recognize the cir- cumstances surrounding families and children, especially in cases in which those circumstances have been changing rapidly. Furthermore, these systems

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7 REFLECTIONS ON FOUR THEMES face a much greater challenge than just changing the environment. In many cases, they need to change how communities function. Another issue in the search for effective interventions is the use of evidence. Studies of interventions need to concentrate on the features and approaches of what works, not necessarily on which program or model works. Which features or approaches across programs make for effective interventions? Similarly, randomized control trials have a role in evaluating programs, but more and different kinds of evaluations need to be used to determine the effective aspects of programs. Complementary evaluations that use mixed methods offer a better means of studying programs than the application of a single gold standard. When does an intervention work, for whom, and under what conditions? And how can evaluations be conducted closer to real time so that interventions can be continually monitored and improved? Today, science is not being used to the extent that it needs to be used to generate new ideas about how to structure and motivate interventions. Scientific findings need to push people’s thinking and their commitment to change. Theme 4: Interactions among early childhood science, policy, and practice are problematic and demand dramatic rethinking. Policies and programs aimed at improving the life chances of young chil- dren come in many varieties. Some are home based and others are deliv- ered in centers. Some focus on children alone or in groups, and others work primarily with parents. A variety of services have been designed to address the needs of young children whose future prospects are threat- ened by socioeconomic disadvantages, family disruptions, and diagnosed disabilities. They all share a belief that early childhood development is susceptible to environmental influences and that wise public investments in young children can increase the odds of favorable developmental out- comes. The scientific evidence resoundingly supports these premises. (NRC and IOM, 2000, p. 10) More than a decade after the release of From Neurons to Neighbor- hoods, many remaining needs in early childhood development can be eas- ily identified. A comprehensive reassessment of the nation’s child care and income support policies is needed. Education should recognize and incorpo- rate early learning. The health system needs greater emphasis on prevention and health promotion. The family’s role should be more deeply appreciated. A more extended vision is needed for policy, such as the use of Medicaid as a key financing mechanism. Many of these needs raise the question of whether proposed solutions should be systemic or more targeted. But this is a polarizing way to view

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8 FROM NEURONS TO NEIGHBORHOODS: AN UPDATE what needs to be done. Targeted interventions should be framed within larger systems that are robust, appropriately financed, and universal so that individual programs are not isolated. A discussion of “systems” is not very accessible to policy makers or the public. A better way of talking about systems is needed so that people can more easily understand what it means to support the child, adolescent, and adult over the lifespan. In the past, reform efforts have tended to focus on programs rather than systems. A better approach is to focus on quality and outcomes rather than programs. This approach is more realistic in terms of the life of a child and developmental issues. It also would apply to everyone, which would make it more palatable to policy makers. The state of Colorado has taken such an approach by convening all of the individuals and programs involved in the lives of children and condens- ing their different visions into a single one-page description. Similarly, the state of Pennsylvania has created benchmarks with appropriate outcomes. For example, teacher certification for K-12 education was restructured so that the same criteria apply to everyone. State policy and federal policy have quite different functions, and in early childhood development state policy is crucial. The state may be the best place for policy change to occur, and leadership in a state is also es- sential to policy change. At the federal level, several concerns exist. Open-ended block grants may be less effective than more directive grants that provide guidelines for what is needed. Funding for early childhood development tends to be scat- tered, inadequate, and incoherent. Given the burden of bureaucratic costs, would the consolidation of scattered efforts within the federal government provide more money for programs? Or would consolidation make it easier for a program to be pruned or eliminated? Federal initiatives also have resulted in successes, such as the domes- tic violence initiative during the Clinton administration. In that case, the Department of Justice and the Department of Health and Human Services worked closely together and made significant progress. New champions for early childhood development could include phil- anthropic organizations that are familiar with the science, business leaders, economists, and young entrepreneurs. They could help pave the way for a new overview of the science of early childhood development, which could be called From Neurons to Neighborhoods to Nations.