IV

Knowledge into Action



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From Neurons to Neighborhoods: The Science of Early Childhood Development IV Knowledge into Action

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From Neurons to Neighborhoods: The Science of Early Childhood Development This page in the original is blank.

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From Neurons to Neighborhoods: The Science of Early Childhood Development 14 Conclusions and Recommendations Two profound changes over the past several decades have coincided to produce a dramatically altered landscape for early childhood policy, service delivery, and childrearing in the United States. First, an explosion of research in the neurobiological, behavioral, and social sciences has led to major advances in understanding the conditions that influence whether children get off to a promising or a worrisome start in life. These scientific gains have generated a much deeper appreciation of: (1) the importance of early life experiences, as well as the inseparable and highly interactive influences of genetics and environment on the development of the brain and the unfolding of human behavior; (2) the central role of early relationships as a source of either support and adaptation or risk and dysfunction; (3) the powerful capabilities, complex emotions, and essential social skills that develop during the earliest months and years of life; and (4) the capacity to increase the odds of favorable developmental outcomes through planned interventions. Second, the capacity to use this knowledge constructively has been constrained by a number of dramatic transformations in the social and economic circumstances under which families with young children are living in the United States. Among the most significant are: (1) marked changes in the nature, schedule, and amount of work engaged in by parents of young children and greater difficulty balancing workplace and family responsibilities for parents at all income levels; (2) continuing high levels of economic hardship among families with young children, despite overall increases in maternal education, increased rates of parent employment, and

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From Neurons to Neighborhoods: The Science of Early Childhood Development a strong economy; (3) increasing cultural diversity and the persistence of significant racial and ethnic disparities in health and developmental outcomes; (4) growing numbers of young children spending considerable time in child care settings of highly variable quality, starting in infancy; and (5) continuing high levels of serious family problems and adverse community conditions that are detrimental for children. While any given child may be affected by only one or two of these changes, their cumulative impact across the 24 million infants, toddlers, and preschoolers who are now growing up in the United States warrants our dedicated attention and most thoughtful responses. This convergence of advancing knowledge and changing circumstances calls for a fundamental reexamination of the nation's responses to the needs of young children and their families, many of which were formulated several decades ago and revised only incrementally since then. It demands that scientists, policy makers, business and community leaders, practitioners, and parents work together to identify and sustain policies that are effective, generate new strategies to replace those that are not achieving their objectives, and consider new approaches to address new goals as needed. It is the strong conviction of this committee that the nation has not capitalized sufficiently on the knowledge that has been gained from nearly half a century of considerable public investment in research on children from birth to age 5. In many respects, we have barely begun to use existing science and our growing research capabilities to help children and families negotiate the changing demands and possibilities of life in the 21st century. The fundamental issues addressed by this report concern the relation between early life experiences and early development. Although there have been long-standing debates about how much the early years really matter in the larger scheme of lifelong development, the committee is unequivocal in its conclusion: what happens during the first months and years of life matters a lot. It does not matter because all early damage is irreversible, because missed opportunities can never be made up later, or because the early years provide an indelible blueprint for adult outcomes: early damage may be reversible, some missed opportunities can be made up later, and adult outcomes do not proceed inexorably from early experiences. Rather, the early years of life matter because early damage—whether caused by prenatal injuries or personal rejection —can seriously compromise children's life prospects. Compensating for missed opportunities, such as the failure to detect early difficulties or the lack of exposure to environments rich in language, often requires extensive intervention, if not heroic efforts, later in life. Early pathways, though far from indelible, establish either a sturdy or fragile stage on which subsequent development is constructed. This chapter presents the committee's conclusions and recommendations. They are designed to stimulate fresh thinking and promote construc-

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From Neurons to Neighborhoods: The Science of Early Childhood Development tive public dialogue and action about the most important issues facing the nation's youngest children and their families. They address two complementary agendas. The first is rooted in contemporary concerns about promoting human capital development in a highly competitive and rapidly changing world. It asks: How can society use knowledge about early child development to maximize the nation's human capital and ensure the ongoing vitality of its democratic institutions? The second is focused on the present and asks: How can the nation use knowledge to nurture, protect, and ensure the health and well-being of all young children as an important objective in its own right, regardless of whether measurable returns can be documented in the future? The first agenda speaks to society's economic, political, and social interests. The second speaks to its ethical and moral values. The committee is clear in our responsibility to speak to both. POLICY AND PRACTICE State-of-the-art knowledge about early childhood development is multidimensional and cross-disciplinary. It extends from painstaking efforts to understand the evolving circuitry and biochemistry of the immature brain to large-scale investigations of how family characteristics, neighborhood influences, and cultural values affect the well-being of children as they grow up. It includes studies of infants, toddlers, and preschoolers with a broad range of typical and atypical behavioral patterns, as well as young children with diagnosed developmental disabilities. It is derived from a variety of quantitative and qualitative research methods that have been used to understand the process of development as it unfolds, as well as from evaluations of efforts to alter its course. Drawing on its extensive review of this highly diverse knowledge base, the committee identified four overarching themes that have guided scientific inquiry and have important implications for the design and implementation of the nation's early childhood policies: (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, and (4) interactions among early childhood science, policy, and practice are problematic and demand dramatic rethinking. These four themes provide a framework for our conclusions and recommendations to guide policy and practice. The chapter then addresses promising directions for research and evaluation and the challenges of informing the public about the early childhood years, with a particular focus on speaking to the aspirations and concerns of parents of young children.

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From Neurons to Neighborhoods: The Science of Early Childhood Development 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 accomplishment 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. The committee's review of research on the achievements and vulnerabilities that characterize the earliest years of life has led to the following conclusions: From birth to age 5, children rapidly develop foundational capabilities on which subsequent development builds. In addition to their remarkable linguistic and cognitive gains, they exhibit dramatic progress in their emotional, social, regulatory, and moral capacities. All of these critical dimensions of early development are intertwined, and each requires focused attention. The early childhood years have value not only as a preparation time for the later accomplishments in school and beyond that have galvanized public attention, but they also have value in their own right as a time of extraordinary growth and change. The developmental tasks of this period range from the mastery of essential building blocks for learning and the motivation to succeed in school, to the ability to get along with other children, to make friends, and become engaged in a social group, as well as the capacity to manage powerful emotions. Although the study of child development has traditionally sorted such accomplishments into discrete functional categories (e.g., cognitive, linguistic, social), in practice they are inseparable beginning in the earliest years of life. Acknowledging and acting on this fundamental principle is critical to the success of a wide array of initiatives in child health, mental health, early education, and early intervention. Striking disparities in what children know and can do are evident well before they enter kindergarten. These differences are strongly associated with social and economic circumstances, and they are predictive of subsequent academic performance. Redressing these disparities is critical, both for children whose life opportunities are at stake and for a society whose goals demand that children be prepared to begin school, achieve academic success, and ultimately sustain economic independence and engage constructively with others as adult citizens. School entry is a critical transition point at which individual differences in what young children know and can do begin to be predictive of longer-

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From Neurons to Neighborhoods: The Science of Early Childhood Development term patterns of learning and achievement. Marked inequalities in children's early learning opportunities are therefore a cause for serious concern. In this context, although there has been a proliferation of prekindergarten and early intervention initiatives designed to promote school readiness, access to these programs is highly uneven across the early childhood population in the United States. Early child development can be seriously compromised by social, regulatory, and emotional impairments. The causes of such impairments are multiple but often revolve around disturbances in close relationships. Indeed, young children are capable of deep and lasting sadness, grief, and disorganization in response to trauma, loss, and early personal rejection. Given the substantial short- and long-term risks that accompany early mental health impairments, the incapacity of many early childhood programs to address these concerns and the severe shortage of early childhood professionals with mental health expertise are urgent problems. The mental health of young children has been a relatively neglected topic within the domains of both scientific inquiry and early childhood intervention. Yet debilitating levels of anxiety and emergent conduct disorders can be seen in the early years and may have enduring effects on how children view themselves and how they are accepted by others over time. Despite little demonstration of efficacy, extensive pharmacotherapy is being used to treat preschoolers with behavior problems. This is of concern for many reasons, not the least of which is the difficulty in these early years of differentiating children with serious emotional disorders from those who are simply immature or are experiencing transient delays in emotional control. Regardless of the severity of their difficulties, however, children with social or emotional impairments warrant our deepest concern, not only for who they might become as adolescents and adults, but because of their fundamental unhappiness and its consequences for their experiences as young children. Recommendations To support the early learning and social-emotional development of young children, as well as to address the serious mental health needs that can arise during the early years of life, three complementary recommendations require urgent attention. Recommendation 1 — Resources on a par with those focused on literacy and numerical skills should be devoted to translating the knowledge base on young children's emotional, regulatory, and social development into effective strategies for fostering: (1) the development of curiosity, self-

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From Neurons to Neighborhoods: The Science of Early Childhood Development direction, and persistence in learning situations; (2) the ability to cooperate, demonstrate caring, and resolve conflict with peers; and (3) the capacity to experience the enhanced motivation associated with feeling competent and loved. Such strategies and their widespread diffusion into the early childhood field must encompass young children both with and without special needs. Successful action on this recommendation will require the long-term, collaborative investment of government, professional organizations, private philanthropy, and voluntary associations. Recommendation 2 — School readiness initiatives should be judged not only on the basis of their effectiveness in improving the performance of the children whom they reach, but also on the extent to which they make progress in reducing the significant disparities that are observed at school entry in the skills of young children with differing backgrounds. Recommendation 3 — Substantial new investments should be made to address the nation 's seriously inadequate capacity for addressing young children's mental health needs. Expanded opportunities for professional training, as recently called for by the Surgeon General, and incentives for individuals with pertinent expertise to work in settings with young children are essential first steps toward more effective screening, early detection, treatment, and ultimate prevention of serious childhood mental health problems. Early Environments Matter and Nurturing Relationships Are Essential The scientific evidence—ranging from behavioral genetics and neuroscience to policy analysis and intervention research—on the significant developmental impacts of early experiences, caregiving relationships, and environmental threats is incontrovertible. 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 throughout 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 development and contribute to children's continued movement along positive pathways. Within this context, the committee's synthesis of the pertinent scientific literature has led to the following conclusions: The long-standing debate about the importance of nature versus nurture, considered as independent influences, is overly simplistic and sci-

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From Neurons to Neighborhoods: The Science of Early Childhood Development entifically obsolete. Scientists have shifted their focus to take account of the fact that genetic and environmental influences work together in dynamic ways over the course of development. At any time, both are sources of human potential and growth as well as risk and dysfunction. Both genetically determined characteristics and those that are highly affected by experience are open to intervention. The most important questions now concern how environments influence the expression of genes and how genetic makeup, combined with children 's previous experiences, affects their ongoing interactions with their environments during the early years and beyond. The range of human possibilities is exceedingly broad. At the moment of birth, each baby is neither a preformed individual whose destiny is set, nor a blank slate whose individuality can be shaped entirely by external forces. Children clearly differ in their genetic endowment from the time of conception. Some actively seek out experiences and some are more inhibited. Some cry frequently and others are better able to soothe themselves. Some are more predictable and easy to read while others are less easily understood. Biology, however, is modified by life experience. Depending on the caregiving they receive and the environments they encounter, shy children can become sociable, fearful children can become secure explorers of their surroundings, and highly exuberant children can develop considerable self-control. Each child's individual capacities are both limited and broadened by his or her genetic makeup and life circumstances. Both operate together in influencing the probability of any given outcome. Parents and other regular caregivers in children's lives are “active ingredients” of environmental influence during the early childhood period. Children grow and thrive in the context of close and dependable relationships that provide love and nurturance, security, responsive interaction, and encouragement for exploration. Without at least one such relationship, development is disrupted and the consequences can be severe and long-lasting. If provided or restored, however, a sensitive caregiving relationship can foster remarkable recovery. Young children establish and can benefit greatly from a variety of close relationships. Yet those adults who are most consistently available and committed to the child's well-being play a special role in promoting competence and adaptation that cannot be replaced by individuals who are present less consistently or whose emotional commitment is not unconditional. Young children who do not have a relationship with at least one emotionally invested, predictably available caregiver —even in the presence of adequate physical care and cognitive stimulation —display an array of developmental deficits that may endure over time. Some children develop intense emotional ties to parents and other caregivers who are unresponsive, rejecting, highly erratic, or frankly abusive. These relationships can also be a

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From Neurons to Neighborhoods: The Science of Early Childhood Development source of serious childhood impairments, ranging from problems with focused attention and problem solving to difficulty in forming healthy relationships, failure to thrive, and a variety of serious psychiatric disorders. The remarkable recovery that many such children demonstrate, once they receive responsive and consistent caregiving, provides some of the strongest evidence of the power of these earliest relationships. Indeed, the earlier that children experience supportive and stable caregiving environments, the more likely it will be that they will exhibit healthy development later. Children's early development depends on the health and well-being of their parents. Yet the daily experiences of a significant number of young children are burdened by untreated mental health problems in their families, recurrent exposure to family violence, and the psychological fallout from living in a demoralized and violent neighborhood. Circumstances characterized by multiple, interrelated, and cumulative risk factors impose particularly heavy developmental burdens during early childhood and are the most likely to incur substantial costs to both the individual and society in the future. Extensive research has documented the adverse impacts on young children of parental mental illness (particularly maternal depression), substance abuse, and recurrent violence. The prevalence of such problems is high, the extent to which they are overlooked is problematic, and the relatively limited availability of specialized expertise to address them reflects an urgent unmet need. Although these conditions are more common among families living in poverty, they are found in all social classes. Moreover, significant dysfunctions frequently cluster together—i.e., maternal depression and substance abuse often go hand in hand; family and community violence may often affect the same child. These youngsters and their parents are among the most vulnerable members of society, and they require a level of professional expertise that is neither routinely considered in the staffing of conventional early childhood programs nor necessarily available in many high-risk neighborhoods. The short-term financial costs of the professional resources needed to confront these problems are high. The long-term financial and social costs of ignoring serious family disadvantage or frank pathology, however, are much higher and ultimately contribute to policy failures in other domains, such as education reform, welfare reform, economic and workforce development, and violence prevention and crime control. The time is long overdue for society to recognize the significance of out-of-home relationships for young children, to esteem those who care for them when their parents are not available, and to compensate them adequately as a means of supporting stability and quality in those relation-

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From Neurons to Neighborhoods: The Science of Early Childhood Development ships for all children, regardless of their family's income and irrespective of their developmental needs. The importance of primary caregiving relationships both within the family and in child care settings during the early childhood years has been documented extensively. For parents and child care providers alike, the experience of caring for a young child is deeply affected by the context in which it is conducted. As both the science of early childhood development and the prevalence of nonparental care have expanded dramatically over the past few decades, the failure to use available knowledge to influence the quality of the nation's child care is increasingly difficult to understand or to justify. Strategies that are used to recruit and retain talented elementary schoolteachers are no less important for children before they enter school. There is, in particular, an urgent need to upgrade the qualifications and compensation of child care providers. Early experiences clearly affect the development of the brain. Yet the recent focus on “zero to three” as a critical or particularly sensitive period is highly problematic, not because this isn't an important period for the developing brain, but simply because the disproportionate attention being given to the period from birth to 3 years begins too late and ends too soon. The mechanisms of neurodevelopment are designed specifically to recruit and incorporate a broad spectrum of experience into the developing architecture of the brain. Animal studies make this abundantly clear, and there is no reason to expect that humans, so wonderfully capable of learning and adaptation, are any less sensitive to the effects of experience on brain development. Yet despite a small number of examples, we know remarkably little about the role of experience and the existence (or lack thereof) of time-limited sensitive periods during which specific experiences are obligatory for normal human brain development.. The evidence to either support or refute claims about critical or sensitive periods in humans simply does not exist. It does appear, however, that development of the neural systems supporting cognitive, social, and emotional competencies remains open to experience at least through adolescence. In fact, the brain's ongoing plasticity enables it to continually resculpt and reshape itself in response to new environmental demands well into adulthood. It is important to emphasize that these findings do not in any way diminish the importance of the early years. They simply remind us of the continuing importance of the years that follow. Abundant evidence from the behavioral and the neurobiological sciences has documented a wide range of environmental threats to the developing central nervous system. These include poor nutrition, specific infec-

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From Neurons to Neighborhoods: The Science of Early Childhood Development tions of temperamental and genetic vulnerability, dysfunctional parenting, and stressful or disorganized early environments that are found in the preschool years. Many of these empirical associations are now sufficiently consistent to warrant a solid investment in programmatic longitudinal studies designed to: (1) elucidate pathways toward psychopathology and identify factors that leave some children at continuing risk while steering others toward adaptive outcomes, (2) distinguish early clinical patterns that are indicative of serious emergent disorders from those that reflect transient concerns, and (3) support efforts to translate the findings from such research into (initially) small-scale interventions in a range of settings. To this end, the development of interventions geared to preschool classrooms offers a particularly promising avenue for advancing the early detection and prevention of problems that become apparent when children first encounter peer groups, with their associated demands for compliance with group norms. Research that integrates investigations focused on how early biological insults, (e.g., iron deficiency anemia, lead ingestion) and adverse environmental conditions (e.g., chronic stress) interfere with healthy prenatal and postnatal development, with efforts to design both preventive and ameliorative interventions for women and children who are exposed to such threats, as well as for children with identified disabilities. A central objective of such integrative research is the exploration of interactions among biological vulnerability, environmental risk, and effective interventions. Previous investigations of this type have stimulated the development of a number of beneficial policies and programs, such as the Women, Infants, and Children (WIC) nutrition support program to prevent iron deficiency anemia and state initiatives to eliminate lead in gas and house paint to prevent lead intoxication. The important issues that such research could address include: (1) the timing and duration of effects, for both exposures and interventions; (2) the capacity for recovery and what it takes to produce improved outcomes; (3) factors that contribute to individual differences in outcomes; and (4) pathways from diverse deleterious experiences to common neurobehavioral outcomes. Studies that elucidate the causal pathways through which impoverished family resources contribute to adverse outcomes for individual children and persistent disparities across groups of children in learning skills and other developmental outcomes. The committee reached strong agreement that there is little scientific merit in additional research that simply reconfirms the association between poverty and poor developmental outcomes. Furthermore, new evidence from studies of welfare reform underscores the urgent need for a new

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From Neurons to Neighborhoods: The Science of Early Childhood Development generation of research aimed at understanding: (1) the modifiable mechanisms through which financial hardship and economic insecurity affect parenting behaviors, the emotional climate of the home, and parent mental health which, in turn, affect children's well-being; (2) the levels of earned income and features of work that are associated with improved outcomes for children and the processes that account for observed relations among income, work, and child development; and (3) differing patterns of association and causality between children 's circumstances and their well-being for children and families at varying initial levels of risk as defined by socioeconomic conditions, parent and child well-being, (health and developmental status), neighborhood conditions, and cultural factors. Experimental investigations of the developmental effects of variations in child care quality, extending from center-based early intervention programs, which have been the focus of previous program evaluations, through the broader range of child care and early education programs available, which have rarely been assessed with experimental designs. Although there is firm, experimental evidence that high-quality, comprehensive, center-based early intervention programs can shift the odds in favor of more positive short- and long-term developmental outcomes for young children, and thereby produce a handsome social return on their investments, we lack comparable causal evidence on the developmental consequences of more typical child care arrangements, only some of which are center-based. Given the unlikely possibility that sufficient investments will ever be made to ensure access for all low-income children to programs that approach the magnitude and scope of the High/Scope Perry Preschool or Abecedarian projects, for example, policy makers need credible information about the potential impacts of lesser investments in program quality. New research and secondary data analyses that integrate studies of parenting with evaluations of parenting interventions in order to advance understanding of what it takes to change parenting practices and what magnitude of change is required to produce positive (and enduring) changes in child developmental outcomes in a wide range of circumstances, both inside and outside the home. The inconsistent and uneven evaluation literature on parenting interventions is a serious deterrent to sound policy making at a time when many governors and state legislators are proposing greater investments in such early childhood initiatives. At this stage in the maturation of the field, there is little justification for additional correlational studies of home visiting or parent education programs. Alternatively, there is a compelling need for rigorous evaluations that examine causal links between parenting interventions and specific parent (or parenting) outcomes and that assess mediated

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From Neurons to Neighborhoods: The Science of Early Childhood Development pathways from treatment effects on the parent to developmental impacts on the child. At the same time, there are some very promising examples of parenting interventions that have been guided by basic research on parent influences and behavior change. These studies are contributing to growing understanding of the relative plasticity of parenting and the dimensions that matter most for children growing up in different circumstances. The challenge is to extend these models of theory-based, causal assessments of parenting programs to broader scale interventions. Research that draws on the significant theoretical work and practical guidelines that have been developed regarding culturally competent practice, in order to refine this construct empirically and assess the benefits that are gained from its incorporation into training models, policy development, service strategies, and program evaluations. The growing ethnic, racial, and linguistic diversity of the early childhood population in the United States confronts service providers (who are a relatively homogenous population) with the complex task of considering when to tailor their efforts to specific populations of children and families and when to treat all families similarly. Currently, however, there is little empirical research to inform this pressing issue. Studies that integrate qualitative and quantitative methods are especially well suited to address the fundamental questions in this area. Efforts to undertake the laborious, but vitally needed, task of improving the available tools for measuring important but generally neglected early developmental outcomes (i.e., before school entry) for use in both basic and evaluation research. Leading candidates for this work include measures of the multiple components of self-regulation, emotional development, the capacity to make friends and engage with others as a contributing member of a group, language use (as distinct from static measures of vocabulary), and executive functions, such as working memory. Notwithstanding the continuing emphasis on standardized cognitive evaluation and the persistent popularity of IQ scores in the policy arena, a lesson from the early intervention literature is that these assessments may not be very sensitive to the behaviorally meaningful effects of a program. The developmental sciences offer a richer array of assessment options. In the absence of dedicated attention to this agenda, multiple opportunities for detecting important intervention effects will continue to be missed. Several challenges are central to this work. First, there is an urgent need to adapt instruments that are already available for use in intervention studies. Second, a balance of attention needs to be given to matters related to internal and external validity. Third, it is essential that this work not only ensure that validation samples include children from diverse cultural

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From Neurons to Neighborhoods: The Science of Early Childhood Development backgrounds, but also that it explicitly consider how competencies are most appropriately assessed in different cultural groups and how each instrument functions as part of a constellation of outcome measures for children with different backgrounds. Fourth, the development of instruments that could contribute to the integration of research on typically and atypically developing children would be a significant advance for developmental science. Finally, the compelling need and considerable costs of such an undertaking underscore the importance of public-sector leadership. Improving Evaluations of Early Childhood Interventions In an effort to improve the nation's capacity to learn more from evaluations of early childhood interventions, the committee recommends that: Much greater attention be paid to the challenges of program implementation, using both qualitative and quantitative research methods, as an integral component of all early childhood evaluation research. To this end, it is essential that funding for evaluations of intervention services build in support for the time-consuming and ongoing assessment of the range of factors that are tied to effective implementation. Inattention to implementation issues can undermine the utility of program evaluations aimed at causal questions and seriously compromise the interpretation of study findings. These issues include concerns about (1) program take-up and differential engagement by different targeted populations, (2) goodness of fit between program objectives and strategies and the needs and values of the families who are being served, (3) how the broader community responds to the intervention, (4) the skill and stability of program staff, and (5) the nature of the transactions that occur between the staff delivering the intervention and the individuals receiving it. Implementation is also a moving target that can change, sometimes dramatically, over the course of an intervention, making it a more complex and challenging endeavor than is commonly acknowledged. Funding agencies adopt higher standards and demand rigorous and appropriate study designs that: (1) draw explicit links between the theory guiding the program and the assessment of program effects, (2) maximize opportunities for making causal connections between intervention and outcomes through the use of experimental designs whenever feasible and well-designed quasi-experimental studies when necessary, (3) add to the field' s understanding of the mechanisms involved in successful change efforts, and (4) assess the cost-effectiveness of alternative courses of action. The development of effective early intervention strategies hinges on the validity of the reasoning that underlies the program's goals and design, the

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From Neurons to Neighborhoods: The Science of Early Childhood Development adequacy and fidelity of its implementation, and the availability of reliable information about the extent to which the program meets its objectives given its costs. Too often, these elements are poorly conceptualized or seriously compromised as a result of tight budgets, inadequate expertise, a rush to evaluate, or other related pressures. Funding agencies can play an instrumental role in upgrading the quality of the early childhood evaluation enterprise by addressing these concerns in both the selection of their grant recipients and the monitoring of funded projects. A high priority should be placed on research programs that move from efficacy trials (which test an intervention under optimal conditions) to effectiveness studies (which test the intervention under more typical conditions, as when the program is conducted on a larger scale) to dissemination studies (which examine the degree to which the program is conducted with fidelity to the model, once it has been exported to new communities and administered as a service rather than as an experimental intervention) (see Olds et al., 1999). The National Institutes of Health, in conjunction with appropriate programmatic agencies and private foundations, convene regular forums to synthesize evaluation research evidence across programs and strategies that share similar developmental aims. There is an urgent need for more rigorous synthesis of streams of related intervention research across the multiple domains of early childhood services in order to investigate causal questions and assess the generalizability of findings. Consensus conferences convened by the National Institutes of Health provide a highly regarded mechanism for evaluating available scientific information and assessing its practical implications. These meetings afford a vehicle for moving beyond the piecemeal presentation of evidence from diverse bodies of literature and for ensuring the unbiased synthesis of findings that can inform broader discussions of effective strategies, in contrast to “up or down” appraisals of individual programs. Among the topics that such conferences could address are: (1) the relative costs and benefits of early interventions that are directed primarily at parents (and only indirectly at children) in comparison to those that provide services directly to children, or combine both approaches in a two-generation strategy; (2) the importance of timing, duration, and intensity of services, in addition to the qualifications, training, and supervision of staff, as significant determinants of their effectiveness; and (3) the issues discussed above regarding program implementation. The universe of programs that typically are assessed with regard to their impacts on early childhood development be expanded beyond the traditional child- and family-focused models to encompass broad-based economic and community interventions as well.

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From Neurons to Neighborhoods: The Science of Early Childhood Development Despite growing awareness of the vulnerabilities and opportunities that characterize the early childhood years, several promising social and economic interventions and their evaluations have failed to include early childhood outcomes within their assessment protocols. Evaluations of the Moving to Opportunity neighborhood experiment and a number of state-designed welfare-to-work experiments are examples of such lost opportunities. These and other interventions that have not been designed explicitly to enhance child well-being may nevertheless have significant impacts on children. The committee therefore urges those who fund and design evaluations of broad-based social interventions, ranging from economic development strategies to housing and transportation initiatives, to consider the value of including assessments of early (and later) childhood outcomes. THE CHALLENGE OF EDUCATING THE PUBLIC New scientific information relevant to the health and development of children is always of interest to the general public. Parents of very young children are particularly eager for authoritative guidance, and this insatiable thirst provides a highly receptive environment for both responsible education and irresponsible manipulation. Within this context, research-based knowledge can be both informative and useful, but the reality of childrearing is always more of an art than a science. Helping the public to understand the science of early childhood development is not an easy task. This challenge can be facilitated by differentiating among established knowledge, reasonable hypotheses, and unwarranted assertions. Established knowledge (e.g., the important influence of the infant-caregiver relationship on early cognitive and emotional development) is determined by strict rules of evidence and evolves continuously. Reasonable but untested hypotheses (e.g., repeated exposure to violence alters neural circuits in the developing brain that control an infant's reaction to threat) make up a large proportion of the knowledge base that guides responsible policy, service delivery, and parenting practices at any point in time, but they may be confirmed or disproved by subsequent investigation. Unwarranted assertions in the name of science (e.g., access to expensive educational toys will boost infant intelligence) distort or misrepresent knowledge, undermine its credibility, and are most insidious when put forth by individuals with professional credentials. In a curiously parallel fashion, successful parenting, effective service delivery, and informed policy making may all very well be defined as the ability to make reasonable judgments and avoid irresponsible practices in the face of incomplete knowledge. Ultimately, each must reconcile the neverending quest for more information with a comfortable level of tolerance for the unavoidable ambiguity and essential mystery of human devel-

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From Neurons to Neighborhoods: The Science of Early Childhood Development opment. In this context, an educated public would be better informed about early childhood development by a clear understanding of state-of-the-art concepts and expectations than by the rote memorization of age-specific milestones and highly prescriptive advice. To this end, the committee presents the following scientific conclusions: The development of the brain begins before birth, continues throughout life, and is influenced by both genetics (i.e., what one is born with) and experience (i.e., the kind of environment in which one lives). All behavior and development reflect brain function, but currently there are very few scientific data that link specific experiences at specific times with specific effects on the developing central nervous system. Moreover, more is known about the adverse impacts of deprivation than the beneficial effects of enrichment, and most of the knowledge about brain development comes from studies of adults and animals other than humans. The astonishing developmental achievements of the earliest years occur naturally when parents and other caregivers talk, read, and play with young children and respond sensitively to their cues. There are no special programs or materials that are guaranteed to accelerate early learning during infancy. Nurturing, stable, and consistent relationships are the key to healthy growth, development, and learning, and there are many ways to be a successful parent. The best enrichment comes from loving interactions with people who provide a rich variety of opportunities for exploration and discovery. The early years of life are an important time of active development, foundation building, and clear periods of reorganization. There is, however, no sharp break at age 3 (or 5), and there is no scientific reason to believe that the behavioral consequences of negative early experiences cannot be ameliorated by interventions initiated in later childhood, or that positive early experiences provide permanent protection against later adversity. There are many variations along the road to competence, and a wide range of individual differences among normally developing children can present quite formidable challenges to parents and other caregivers along the way. Notwithstanding the inevitable bumps in the road, the course of human development, like that of all living organisms, moves naturally in the direction of positive adaptation. The developing brain is dependent on the inputs of a variety of early sensory, perceptual, and motor experiences (e.g., sound, binocular vision, movement through space) that are easily met, unless a child is born with an auditory, visual, or motor deficit that interferes with the expected input.

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From Neurons to Neighborhoods: The Science of Early Childhood Development The early detection and remediation of such problems are essential components of primary health care. Efforts to protect early brain development are best embedded in an overall strategy of general health promotion and disease prevention. This includes attention to the importance of adequate nutrition (beginning during the prenatal period), the avoidance of harmful exposures (e.g., drugs, viruses, and environmental toxins), and protection from the stresses of chronic understimulation or significant maltreatment (i.e., abuse or neglect). There is considerable variability among childrearing environments that promote healthy development, much of which is embedded in different values and cultural practices that are passed on from one generation to the next and are continually transformed by each generation based on the times in which it lives. Well-described deviations that exist in all cultures (e.g., extreme and persistent poverty, serious parental psychopathology, family violence) can be extremely damaging to all children. Specific threats to development can originate from within the child or the environment, but significant vulnerability results less from a single source and more from the cumulative burden of multiple risk factors. Within this context, the boundaries among normative variations, transient maturational differences, and persistent disabilities are often blurred and difficult to define in the early childhood period. The combined impact of both biological and environmental risk presents the greatest threat. The early detection of problems and the prompt provision of an appropriate intervention can improve developmental outcomes (i.e., shift the odds) for both children living in high-risk environments and children with biologically based disabilities. However, not all interventions are effective, when they do work they are rarely panaceas, and (unlike immunizations followed by an occasional booster) they do not confer a lifetime of protection. In summary, the well-being and “well-becoming” of young children are dependent on two essential conditions. First is the need for stable and loving relationships with a limited number of adults who provide responsive and reciprocal interaction, protection from harm, encouragement for exploration and learning, and transmission of cultural values. Second is the need for a safe and predictable environment that provides a range of growth-promoting experiences to promote cognitive, linguistic, social, emotional, and moral development. The majority of children in the United States today enjoy the benefits of both. A significant number do not.

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From Neurons to Neighborhoods: The Science of Early Childhood Development CONCLUDING THOUGHTS As this report moved to completion, it became increasingly clear to the members of the committee that the science of early childhood development has been viewed through highly personalized and sharply politicized lenses. In many respects, this is an area in which personal experience allows everyone to claim some level of expertise. Moreover, as a public issue, questions about the care and protection of children confront many of the basic values that have defined this country from its founding—personal responsibility, individual self-reliance, and restrained government involvement in people's lives. In a highly pluralistic society that is experiencing dramatic economic and social change, however, the development of children must be viewed as a matter of intense concern for both their parents and for the nation as a whole. In this context, and based on the evidence gleaned from a rich and rapidly growing science base, we feel an urgent need to call for a new national dialogue focused on rethinking the meaning of both shared responsibility for children and strategic investment in their future. The time has come to stop blaming parents, communities, business, and government—and to shape a shared agenda to ensure both a rewarding childhood and a promising future for all children. Central to this agenda is the importance of matching needs and capabilities. Families, for example, are the best vehicle for providing loving and caring relationships and for creating safe and nurturing environments that promote healthy physical, cognitive, linguistic, social, emotional, and moral development. Communities are ideally situated to provide a wide range of supports for families through formal voluntary organizations and informal social networks. Businesses have the opportunity to support family well-being through creating positive work environments, offering flexible work schedules, and providing important financial benefits, such as family health insurance and child care. Local, state, and federal governments have substantial opportunities to influence the quality of family life and the availability of resources to support child needs through such diverse mechanisms as tax policies to alleviate economic hardship (e.g., earned income and child care tax credits), minimum wage laws to boost the incomes of low-wage workers, policies to support working parents and promote the health and development of their children (e.g., child care standards and subsidies), policies to support parent choice regarding employment (e.g., paid family leave), and funding for early intervention programs, among others. No single locus of responsibility can address all the needs of young children and their families. Effective policies clearly require aggregate responsibility. Finally, there is a compelling need for more constructive dialogue between those who support massive public investments in early childhood services and those who question their cost and ask whether they really

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From Neurons to Neighborhoods: The Science of Early Childhood Development make a difference. Both perspectives have merit. Advocates of earlier and more intervention have an obligation to measure their impacts and costs. Skeptics, in turn, must acknowledge the massive scientific evidence that early childhood development is influenced by the environments in which children live. Continued “winner takes all” conflict between advocates and skeptics serves only to fuel a siege mentality in the early childhood community that undermines critical self-evaluation in the service of short-sighted self-preservation. In the final analysis, a constructive approach to early childhood policy would mobilize the best available knowledge (and promote its continued growth) in order to move beyond simple questions about whether environments and early experiences make a difference. The ultimate challenge for the nation is to answer questions about how to enhance the quality of those environments and experiences in an effort to promote the health and development of young children. The charge to this committee was to blend the knowledge and insights of a broad range of disciplines to generate an integrated science of early childhood development. The charge to society is to blend the skepticism of a scientist, the passion of an advocate, the pragmatism of a policy maker, the creativity of a practitioner, and the devotion of a parent—and to use existing knowledge to ensure both a decent quality of life for all of our children and a promising future for the nation.

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