brain development and social problems

Reading the final report of the Munro Review of child protection, my attention was caught by what turned out to be a minor typographical error. The last sentence of paragraph 5.8 appears to refer to reference 95, the Royal Society paper Brain Waves Module 2: Neuroscience: implications for education and lifelong learning, but in fact cites reference 94. Reference 94 is an independent report commissioned by the current UK coalition government, published in January 2011, written by Graham Allen, Labour MP for Nottingham North and entitled Early Intervention: The Next Steps.

Graham Allen MP

Early intervention is summed up as follows by the ‘Early Intervention Review Team’;

Early Intervention is an approach which offers our country a real opportunity to make lasting improvements in the lives of our children, to forestall many persistent social problems and end their transmission from one generation to the next, and to make long-term savings in public spending….” (p.vi)

In 2008, Graham Allen had written another paper on early intervention, this one co-authored with Iain Duncan Smith and entitled Early Intervention: Good Parents, Great Kids, Better Citizens published jointly by the Centre for Social Justice (CSJ) and the Smith Institute. Iain Duncan Smith is a former leader of the Conservative Party and currently Secretary of State for Work and Pensions. In 2004, he founded the Centre for Social Justice, a centre-right think tank, just after his period of party leadership ended. The Smith Institute is a left-leaning think tank set up in 1996 in memory of the former Labour Party leader, John Smith. Ed Balls, later to become the Labour government’s Secretary of State for Children, Schools and Families, worked for the Institute between 2004 and 2005.

Rt Hon Iain Duncan Smith, Secretary of State for Work and Pensions

In previous posts I’ve complained (at some length) that the model of child development being used by children’s services pays little attention to recent biological research. It would be unfair to suggest that biology is entirely absent however. There are many references to physical development in this literature, Aldgate et al’s book contains a chapter on genetic and biological influences and the Munro report cites the National Research Council’s From Neurons to Neighbourhoods: The Science of Early Childhood Development – chapter 8 contains a comprehensive summary of brain development. The second chapter of each of the two documents written by Graham Allen is also dedicated to brain development. It’s these two chapters I want to concentrate on in this post.

I’m not entirely clear why it was deemed necessary to refer to brain development in papers about early interventions intended to forestall social problems. After all, few people would want to see evidence from brain scans before they could be persuaded that sanitation, a balanced diet or education have good outcomes for individuals and for the population as a whole. And given the technical problems with brain scanning and the interpretation of the resulting images, there are other more reliable ways of measuring the effectiveness of interventions. Allen and Duncan Smith’s Early Intervention: Good Parents, Great Kids, Better Citizens justifies the inclusion of material on brain development as follows;

We make no apology for presenting, as laymen, a considerable body of medical evidence in this chapter. When economic resources are under intense pressure, and facing strong claims from well-established programmes and special interests, we believe that this medical evidence points overwhelmingly in favour of a shift to Early Intervention.” (Good Parents p.45)

What’s the evidence?

The first few pages of chapter 2 of Good Parents focus on results from three large-group, longitudinal studies purported to show that early adverse childhood experiences result in later health risks such as smoking, alcoholism, illicit drug use, obesity and high level promiscuity (Good Parents p.54). At first glance, the conclusions presented are persuasive, but when you look a little more carefully, the picture isn’t quite so clear-cut.

I’ve mentioned several other documents that in some cases refer to each other. To clarify how they are linked, I’ve mapped out the connections here:


Two of the studies, Farrington and West’s Cambridge Study in Delinquent Development, a Prospective Study of South London Males From Ages 8–32 and the Dunedin Multidisciplinary Health and Development Study are prospective – that is, they started with children and have periodically sampled their health, development and behaviour over many years.

According to Allen and Duncan Smith the Cambridge study showed that adult offending could be predicted in childhood (Good Parents p. 51). That’s not quite what the study records. The 2006 report, which tracked the participants up to the age of 48, found that there were predictive factors in childhood for adult offending. In other words, some factors were predictive of behaviour for a particular group, not for particular individuals. The highest correlation between childhood factors and persistent offending was for children having a convicted parent or sibling. What this means is that children with previous offenders in their families are more likely to offend, not that offending can reliably be predicted in individual children. A significant number of children from families with an offender didn’t commit crimes, whereas some children from non-offending families did.

The Dunedin study looked at the health and development of 1037 babies born in Dunedin, New Zealand, between 1972-73. Data from the Dunedin study has been used in over 1000 publications but I couldn’t find which one Allen and Duncan Smith were referring to. They claim that nurses’ assessments of which of a group of 3 year-olds were at risk, predicted criminal convictions, violent behaviour and domestic abuse at age 21. They conclude;

the fact is that children who are likely to have poor outcomes, including adult criminality, can be identified at age three when they are still riding their tricycles.” (Good Parents p.52)

Not exactly. As Allen and Duncan Smith themselves point out, not all of the at-risk children offended, and some of the not-at-risk children did – 18% exhibiting violent behaviour and almost 10 % abusing their partners (Good Parents p.51).

The third study, the Adverse Childhood Experiences (ACE) Study, by contrast, is retrospective; it relies on self-reports about childhood maltreatment, family dysfunction and health status, and therefore on that notoriously unreliable data source, human memory. You can read the questions that were posed to participants in Preventing child maltreatment: a guide to taking action and generating evidence. It’s published jointly by the World Health Organization and ISPCAN, The International Society for the Prevention of Childhood Abuse and Neglect. My curiousity about Preventing child maltreatment: a guide to taking action and generating evidence was initially piqued by the title. I have no problem with taking action against child maltreatment, but do have concerns about ‘generating evidence’. Evidence is usually ‘gathered’ or ‘found’ – implying that it’s already out there, researchers just have to go and look for it. ‘Generating evidence’ suggests that, like Bettelheim, your case might not actually have strong evidence behind it so you need to create some.

I was also concerned by a reference in the Foreword to the idea that

the traditional “privacy barrier” between the domestic and public spheres has inhibited the evolution of policies and legal instruments to prevent violence within the family and provide services for those affected by it.” (p.vi)

I’d predict that the prohibition of violence is as likely to be effective as the prohibition of alcohol consumption, but that violence might be lessened if its causes were to be addressed. Furthermore, the ‘traditional “privacy barrier”’ isn’t about “privacy” – a relatively recent development in human history – but about protecting the individual from the abuse of power by the state. I’m sure the author, who’s had extensive experience with the UN, is aware of that. But I digress.

I also had concerns about Box 1.1 (p.8). It’s entitled Child maltreatment and damage to the developing brain and is adapted from a pamphlet published in 2001 by the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse called In Focus: Understanding the Effects of Maltreatment on Early Brain Development. The pamphlet lists 31 references, 11 by Bruce Perry and one by Allen Schore. In 13 pages, Schore’s work is cited 17 times and Perry’s 40 times. These names crop up again in the papers by Allen and Duncan Smith.

My concerns about Box 1.1 and the In Focus pamphlet weren’t so much about what they said, as about their emphasis. Firstly, maltreatment and neglect of children is, by definition, harmful – that’s why they are called maltreatment and neglect. We already know that certain practices cause harm to children, at the time they happen, immediately afterwards, and, in some cases, throughout life. We don’t need evidence from brain scans to tell us that. But maltreatment and neglect are being presented as if pre-existing evidence of harm isn’t sufficient to persuade legislators that more stringent legislative measures are required to prevent maltreatment and neglect, so neurobiological findings are being recruited for this purpose. Secondly, although there is certainly evidence to suggest that maltreatment and neglect have a negative impact on brain development, they are only two of the factors that do so. In other words, you could predict with some confidence that maltreatment and neglect would result in ‘abnormal’ brain development, but you can’t assume that because someone’s brain has developed abnormally, that they were maltreated or neglected as a child. Thirdly, there’s an implicit assumption in the way the evidence is presented that maltreatment and neglect are the primary cause of ‘social problems’, when social scientists have been aware, for decades, that those causes are many, varied and have complex interactions.

In short, the evidence doesn’t appear to support the idea that the predominant cause of social problems is child maltreatment or neglect. Allen and Duncan Smith call for a study along the lines of the Dunedin study to be carried out in the UK “in order to provide definitive evidence on the benefits of Early Intervention” (Good Parents p.52). I can’t see why another study is necessary – the Cambridge study makes clear that the causes of antisocial behaviour are complex and that patterns of behaviour change significantly over the lifespan.

Update 13/12/16:  Thanks to @PaulWhiteleyPhD on Twitter for drawing attention to this article in Nature analysing the Dunedin study findings.

In the next post, I want to look at what Graham Allen and Iain Duncan Smith have to say about brain development.

Photographs of Graham Allen and Iain Duncan Smith from Early Intervention Early Intervention: Good Parents, Great Kids, Better Citizens.

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the assessment framework for children in need

In September last year I attended a presentation by a local authority on the way they plan to assess the needs of children with disabilities. They intended to use this framework;

I couldn’t see how the framework would help other than to remind LA staff of different areas of need, since many of the needs of children with disabilities and their families involve ‘health’ – only one of seven types of developmental need, and not mentioned at all in relation to parenting capacity or environmental factors. The framework doesn’t unpack any of the factors into their component parts, even though the health issues of children with disabilities and their families are many and varied. In addition, some needs have arisen only because of service inadequacies; e.g. problems getting a diagnosis, a wheelchair, sufficient nappies, a suitable education or respite care. It seemed a bit pointless to be developing a comprehensive assessment framework when known needs couldn’t be met anyway.

I’ve since discovered that the local authority in question didn’t devise this assessment framework. It was proposed by the Department of Health (DH), Department for Education and Employment and the Home Office in a document published by the DH in 2000 called Framework for the Assessment of Children in Need and their Families. The document is largely about the circumstances in which the framework should be used and who should use it. A companion document was also produced by the DH in 2000. It’s called Assessing Children in Need and their Families: Practice Guidance. I hoped it would explain how the Assessment Framework works in practice, which it does to some extent. The Practice Guidance contains four chapters. The first introduces the Framework, chapters 2 and 3 are dedicated to assessing the needs of ‘black’ and ‘disabled’ children respectively and the fourth is about resources.

Chapter 1 sets out a now-familiar model of child development in terms of milestones and ‘optimal’ outcomes (1.4), but doesn’t explain how the concept of ‘optimal’ is arrived at. It sees children’s development at different ages as predominantly physical (infancy to preschool), social and academic (middle childhood) and social and emotional (adolescence) (1.4), despite physical, cognitive, social and emotional changes being important features of each period of development. Experience in infancy is framed in terms of attachment (1.5), attachment theory is presented as ‘relatively new’ (1.8) despite being developed in the post-war period, and there are claims for a ‘wealth of research’ into it (1.11) despite Barth et al finding only four evaluations of the theory in the social science literature since 1996. Child development is grounded in psychodynamic theory (1.12) and learning theory prior to 1980 (1.13). References to ecology of the child tend to refer to social ecology only (1.50).

In my previous comments on this model of child development, I’ve pointed out that recent research in molecular and developmental biology doesn’t support a normative pathway for development; children have many similarities, certainly, but each child is developmentally unique. Physical, cognitive, social and emotional factors interact throughout development, implying that no aspect can be isolated from the others and that a model of child development grounded only in attachment theory is incomplete. The biological knowledge underlying psychodynamic theory has been superseded by a much more accurate understanding of the interactions between genes and the environment, and recent work in the neurosciences has made sense of earlier rather disjointed learning theories. But recent biological research isn’t reflected in the model of child development set out here.

In this post I want to make four observations about the model of child development set out in the Practice Guide and the Assessment Framework that’s based on it;

• a normative model of child development poses problems that those working with children then have to resolve

• a normative model of child development runs counter to the social model of disability

• the Assessment Framework is descriptive rather than explanatory

• the model of child development presented and the Assessment Framework are policy-based rather than evidence-based.

OK, now to explain those points.

a normative model of child development sets up problems that those working with children then have to resolve

In 2000, the Department of Health would probably have justified the inclusion of chapters dedicated to ‘black’ children and ‘disabled’ children on the grounds that their needs have been consistently marginalized for a long time. Although that is undoubtedly true, I would argue that a normative model of child development by definition creates demographic groups that don’t conform to the developmental pathway of a hypothetical average child. A normative pathway is challenged by any child who in any respect falls outside the normal range. Children and young people from ethnic minorities, whose first language isn’t English, who don’t fall into neat categories in terms of gender or sexual orientation, have minority religious or philosophical beliefs or unusual lifestyles, are chronically sick, have long-term functional impairments, minor problems with motor control, speech or attention or who have specific learning difficulties are all unlikely to meet their developmental milestones. This poses a problem for anyone assessing a child’s needs according to a normative developmental pathway because they have to figure out which exceptions are acceptable and which aren’t.

For example, Figure 2 in the Practice Guidance is a table of developmental ‘tasks’ relevant to different age groups (1.4). I understand the meaning of the word ‘tasks’ in the behavioural sciences, but it strikes me that here the word ‘duties’ could be easily substituted. The developmental tasks include school attendance and appropriate conduct, learning to read and do arithmetic, following the rules of society and involvement in extra-curricular activities. In addition to being about school, rather than about development per se, all of these ‘tasks’ could pose significant problems for a disabled child. Can allowances be made for children with disabilities? Apparently not. Paragraph 3.4 informs us that:

Disabled children and young people need to complete the same tasks of emotional development as all children: early attachments are just as important for disabled babies and children, and the development of relationships, self-confidence and sexuality are just as important for young disabled people.”

The big problem with a normative model of development is that services based on it are designed to meet the needs of a hypothetical average child, not the needs of all children. As a consequence, frontline practitioners such as GPs, teachers and social workers have been trained to address the needs of children following an average developmental pathway, but not the needs of all children. Another consequence is that all exceptions to the average pathway have to be treated as special cases, so we have ‘black’, ‘disabled’ and ‘poor’ children and those with ‘special educational needs’, for each of whom special provision has to be made. Special provision comes with a price tag, and a price tag attached to a specific demographic group is politically vulnerable. The group itself becomes vulnerable if children within it or their families are seen as being unwilling to achieve the milestones they are supposed to aspire to. By contrast, a model of child development that recognizes the inherent natural variation between children in different aspects of development would be more likely to result in services designed to meet the needs of all children, with professionals receiving appropriate training, and wouldn’t generate a plethora of special cases.

a normative model of child development runs counter to the social model of disability

The social model of disability locates disabilities in their societal context. In other words, someone might have what’s described as a ‘functional impairment’, but what actually prevents them leading what most people would consider a normal life isn’t the functional impairment itself, but barriers to leading a normal life that society imposes or fails to remove. Say for example, Mrs A is unable to work because she’s severely short-sighted, but because she can’t get a job she can’t afford the spectacles that would give her 20/20 vision. Mrs A’s problem would be resolved by giving her access to affordable spectacles. That particular scenario isn’t currently a problem the UK, mainly because so many people have impaired vision, but it illustrates the point. Viewing phenomena in their societal context is a powerful analytical tool, because it enables us to see relevant factors that are sometimes invisible when we take the societal framework for granted.

As human beings we tend to prefer people who are similar to ourselves – in appearance, beliefs, values and lifestyles. (Note that this is a tendency, not a hard-and-fast rule.) As a consequence we assign others to ingroups – people we feel comfortable with and/or approve of, and outgroups – people we don’t feel comfortable with or disapprove of. Often our perceptions of outgroups are over-simplified (stereotyped) because we don’t know much about them. The social model of disability addresses the tendency of the non-disabled majority to make the implicit assumption that everybody is non-disabled like them, and to ignore (accidentally or deliberately) the needs of the whole community. In other words, the able-bodied majority, as a whole, holds a normative model of human functioning that implies that everyone can or should function like the able-bodied majority.

A normative model of child development is in serious danger of creating precisely the kind of situation that the social model of disability has been developed to address; that a majority group assumes that everybody is like them or should be like them (or as is often the case, a group with resources decides how groups without resources should behave). Just as this assumption creates disabilities that wouldn’t exist in a society that actively addressed the needs of all its members, so a normative model of child development creates problems for children who can’t or don’t want to conform to the developmental pathway of the hypothetical average child.

The Practice Guidance takes a social model of disability perspective (3.10). But what seems to have happened to the social model of disability in relation to public policy is that a subtle change in understanding of the model has occurred. Instead of it being seen as explaining one of the causal factors for disabilities, there has been a shift to disability being seen only in social terms. Paragraph 3.10 says;

This guidance is informed by an understanding of the ‘social model’ of disability, which uses the term disability not to refer to impairment (functional limitations) but rather to describe the effects of prejudice and discrimination: the social factors which create barriers, deny opportunities, and thereby dis-able people…” (3.10)

There is no mention of the systemic factors that arise not so much from prejudice and discrimination but rather from poor planning, inadequate funding or patchy data. Viewing disabilities primarily in social terms risks marginalizing the causes of functional impairments. Paragraph 3.10 goes on to say;

Children’s impairments can of course create genuine difficulties in their lives. However, many of the problems faced by disabled children are not caused by their conditions or impairments, but by societal values, service structures, or adult behaviour…

That’s certainly true, but tends to belittle the effect that ‘impairments’ can have. Most people would think it unacceptable if someone couldn’t obtain spectacles that corrected a visual impairment, or crutches if they had broken a leg, but it’s currently very difficult to obtain comprehensive assessments, never mind treatments, for impairments that cause significant sensory, attentional, communication or mobility problems for children. Framing disabilities only in terms of social factors and failing to give GPs, teachers and social workers adequate training with regard to functional impairments, has, I suggest, resulted in some of the service structure failings paragraph 3.10 refers to.

the Assessment Framework is descriptive rather than explanatory

The DH describes the Framework as ‘systematic’ (Framework p.viii). I think what it really means is ‘comprehensive and consistent’, because the Framework isn’t actually systematic, but instead provides a checklist (albeit one divided into different domains and arranged in the form of a triangle) that helps identify the kinds of needs children have. The defining feature of a system is that it has interacting component parts, so for the Assessment Framework to be systematic it would need to show how its components interacted. As the Framework is presented, it’s just a list.

One thing it doesn’t do is help identify the ultimate, rather than immediate causes of children’s needs. Obviously, if a child has serious immediate needs those will take priority, but identifying ultimate causes is essential if needs are to be met effectively over the long term. Nor does the framework indicate how needs and/or their causes interact – essential if appropriate services are to be provided in a timely and cost-effective manner. I agree with the DH (Framework p.ix) that those assessing children and families shouldn’t be expected to follow a manual and should instead should use their professional judgement, but some indication in the Framework of the ultimate causes of children’s needs and the way factors interact would have been helpful, especially given the inadequacies in training highlighted recently.

The failure to present the Framework in systems terms means there’s a risk of several causal factors for children’s needs being overlooked;

• low-level causes such as health issues that aren’t immediately obvious
• high-level causes such as unwanted and unintended outcomes of social policy or legislation
• systemic causes such as different services having conflicting goals or competing for funding

However accurately those working with children identify the types of need they have, unless the causes of the needs are accurately identified as well, it will be impossible to prevent the needs arising.

the model of child development and the Assessment Framework are policy-based rather than evidence-based

The Practice Guidance places a strong emphasis on evidence-based practice and contrasts this with the use of evidence in judicial processes, quoting from a 1991 DH publication Patterns and Outcomes in Child Placement;

Social workers tend to think of evidence in terms of court hearings and reports, but evidence in the sense of ‘facts which lead to conclusions’ must be at the heart of every decision..” (1.62)

Evidence is used in many domains to inform decision-making. The aim, whether the decision relates to guilt or innocence, right or wrong, or the validity of a scientific theory, is to evaluate all available relevant evidence, so the decision best reflects the situation in the real world – what actually happened or happens. In the judicial system a judge or jury does the evaluating, in a formal debate it’s the audience, in government it’s parliament and in science it’s scientists. In the judicial system, debating and politics, each party involved cites evidence that supports their case and downplays evidence that doesn’t. Scrutiny by the opposing party is supposed to expose any flaws in reasoning. But people working in those domains aren’t usually the ones doing the evaluating so there’s a risk of them losing sight of the importance of taking into account all the evidence and instead to focus on evidence that supports a particular case.

Scientists, however, do evaluate evidence. A scientist would tackle an issue like children’s needs by first examining all the data. Any framework for assessing children’s needs would then be based on the data – addressing the most frequently occurring or serious needs, their causes and what interventions were most effective. Contradictory and inconclusive evidence would be included so that those using the assessment framework would be aware of its strengths and weaknesses and could apply their professional judgement accordingly. But in the case of the Assessment Framework, the evidence doesn’t appear to have been approached in that way. The Framework document opens with this statement;

Securing the wellbeing of children by protecting them from all forms of harm and ensuring their developmental needs are responded to appropriately and the duty of Local authority social services departments working with health authorities to safeguard and promote the welfare of children in their area who are in need and to promote the upbringing of such children, wherever possible by their families, through providing an appropriate range of services…

and sets the Framework in the context of national and international policy (p.viii). In other words, the starting point isn’t data on children in need, but government policy in relation to them. Supporting evidence for the policy is then cited in the form of a model of child development that’s based on partial and out-of-date information. Recent findings from molecular and developmental biology aren’t mentioned, nor is the policy framework itself critiqued (see for example Garrett, 2003). This isn’t surprising since it’s a government publication, but it’s not evidence-based in the scientific sense.

What summed up these documents, for me, was this from the Practice Guidance;

Recent empirical research, for example, has suggested connections between biological and other areas of development. The development of the infant brain mirrors developmental experience in general. It is argued by Perry (1993) that the brains of developing infants react to the quality and nature of sensory information…” (1.6)

The fact that biological factors are presented as a novel area of research and that only Perry’s work (of which more in a future post) is cited in relation to sensory information and brain development suggests that the authors of this chapter are less than familiar with the vast biological literature on this subject.

This brings us back to the comparison I made in another post, between Leo Kanner and Bruno Bettelheim regarding their level of expertise and the way they handled evidence in relation to children with autism. Kanner was up to speed with developmental biology, and used contemporary theory to develop hypotheses, which he then tested against data. As the data changed, so did his conclusions. Bettelheim knew about psychoanalysis and philosophy but didn’t have a biological background. He decided from the outset what was causing the children’s unusual behaviour and cited supporting evidence only. The outcomes of their work were very different; Kanner’s highlighted the developmental problems of a large group of children, Bettelheim’s resulted in needless guilt and misery for many parents and quite possibly wasted a substantial research grant from the Ford Foundation. In the case of the Assessment Framework, it’s difficult to avoid the conclusion that the Department of Health, bizarrely, doesn’t appear to know anything about research in developmental biology or genetics since the 1950s, nor much about how systems work or what expertise is necessary in order to identify children’s needs.

Some years ago, I complained to a government department that I couldn’t trace documents cited as evidence in a Green Paper because the references to them weren’t detailed enough. The minister concerned responded, rather tartly I felt, that the Green Paper wasn’t an academic paper. The implication was that academics might have to subject their evidence to public scrutiny, but government wasn’t obliged to do so. Personally, I don’t doubt that the intention of the previous UK government in relation to children’s needs was benign. Unfortunately, in order to be effective policy has to reflect the real world, not just part of it, and has to take into account the actual causes of those needs whether they are located in individuals or in flawed social policy, legislation or service delivery. A scientific approach to evidence stands a better chance of doing that than offering only evidence that supports what’s ultimately a nice idea. Science, like democracy, might not be perfect, but, also like democracy, it’s the best system we’ve found to do the job.

References

Barth, R.P, Crea, T.M., John, K, Thoburn, J. & Quinton, D (2005). Beyond attachment theory and therapy: Towards sensitive and evidence-based interventions with foster and adoptive families in distress, Child and Family Social Work, 10, 257–268.

Department of Health (2000). Assessing Children in Need and their Families: Practice Guidance. London, TSO.

Department of Health, Department for Education and Employment and the Home Office (2000). Framework for the Assessment of Children in Need and their Families. London, TSO.

Garrett, P.M. (2003). Swimming with dolphins: The assessment framework, new Labour and new tools for social work with children and families, British Journal of Social Work, 33, 441-463.

what social workers *really* need to know about child development

In the final report of her review of child protection, one of Eileen Munro’s recommendations is the development of social workers’ expertise, including an understanding of child development and attachment – in relation to which she cites four texts. In my previous post I suggested that the model of child development presented in these texts is normative, over-emphasizes emotional and social development and has an incomplete frame of reference, for two reasons;

It’s policy-based rather than evidence-based – an evidence-based model would give weight to all factors of child development.

It’s based on biological knowledge that pre-dates WWII. Old knowledge isn’t necessarily wrong, but research has moved on since then. The model of child development proposed by the texts doesn’t seem to recognize this. Continue reading

what social workers are supposed to know about child development

Earlier this year, I read through the final report of the Munro review of child protection. The report is part of a lengthy investigation of the child protection system in the UK prompted by the deaths of several children known by social services to be at risk. The report’s scope is broad – it looks at all aspects of child protection and makes some wide-ranging recommendations including the need to develop social worker expertise. Eileen Munro cites four texts to support one of her recommendations in respect of expertise – that social workers know about child development and attachment (6.41; ref. 152). What surprised me about these documents was that they weren’t so much about child development and attachment, but about child development as attachment. Or at least, their predominant focus was on emotional and social development rather than development per se.

Here are some quotes from the four texts to illustrate the point. I’ve commented briefly on each and will discuss the collective implications of the texts later. (My access was restricted to material that’s online; I don’t want to misrepresent the texts, so bear this in mind when reading.)

[1] Aldgate, J. (2006), ‘Children, Development and Ecology’, in The Developing World of the Child, Aldgate, J., Jones, D., Rose, W. & Jeffrey, C. (eds.), pp.17–34. London, Jessica Kingsley Publishers.

In her opening chapter Aldgate includes several citations from a textbook published in 1990 by Mussen et al, which I assume to be Child Development and Personality by Mussen, Conger, Kagan and Huston. They include the following quotations:

Child development is both a basic and an applied science. It is the study of how and why children develop perception, thought processes, emotional reactions, and patterns of social behaviour. It also provides knowledge that is important for advising parents, forming educational programmes, creating and defending Government programmes for children, making legal policies affecting children, and devising treatments for problem behaviour.” (pp.17-18)

“‘Children may go through different stages at different ages, but they all go through them in the same order.’” This is a fundamental principle and one that can be applied to all children no matter whether they have the special circumstance of illness or disability or have been affected by abuse or neglect.” (p.20)

Then, on disability and developmental milestones:

The authors [in Aldgate’s book] have strong views about the imperative to avoid stigmatising or ‘pathologising’ children and believe such an approach is unethical. We also believe that to do nothing where a child may be impaired on the grounds that this will place the child apart from others is unethical. Accordingly, this book takes the stance that, in order to apply our vast fund of knowledge in a non-stigmatising way, we need to know, what are, for want of a better phrase, the normative expectations. Using milestones, for example, to identify expected stages of development, is a useful tool in identifying impairments as early as possible, so that each child who has a developmental problem may be given the best possible opportunity to address that problem and reach his or her optimal potential as an individual.” (p.22)

And from Marchant (see [3] below);

professionals should assess whether the child is developing in line with what would be expected of a child with similar impairments at a similar level of development (not necessarily age).”(p.22).

Comment

1. The model of child development described in Aldgate’s book is comprehensive but noticeable by their scarcity were references to children’s physical development. There is a chapter on genetics and biological influences (from a neuropsychiatrist) and physical development is mentioned in the four chapters that deal with different stages, but overall, child development appears to be construed in terms of perception, thought, emotion and social behaviour, with genes, physical health and the physical environment playing a minor role. I could find no geneticists, developmental biologists or specialists in developmental disorders on the advisory panel. This was puzzling, since children are embodied beings; perception, thought, emotion and social behaviour are dependent on physical development.

2. The developmental trajectory is presented as normative; it has pre-determined stages so even a child with a disability is expected to develop in line with other children with similar impairments – despite the complexity of the outcomes of biological and environmental differences of individuals.

3. Several unresolved tensions emerge in relation to policies regarding children with disabilities:

• Normal/average trajectory vs abnormal/individual trajectory
• Stigmatising and pathologising vs identification of impairment/difference
• Social inclusion vs providing an enabling environment for child.

For individual practitioners and parents, these tensions pose serious problems because anyone attempting to identify the cause of a child’s developmental differences and to meet the child’s needs risks accusations of pathologising, stigmatising or socially excluding the child.

[2]Davies C. & Ward H. (2011), Safeguarding Children Across Services: Messages from research on identifying and responding to child maltreatment Executive Summary. London, Department for Education, Research Report DFE-RBX-10-09.

Davies and Ward’s report isn’t about child development – or attachment for that matter, though both are mentioned – it’s a review of the findings from The Safeguarding Children Research Initiative “an important element in the government response to the Inquiry following the death of Victoria Climbié; the research has encompassed a specific focus on neglect and emotional abuse, significant elements in the maltreatment of Victoria Climbié.” (p.12)

While there is considerable consensus both nationally and in other Western societies concerning what constitutes physical and sexual abuse, there is much less common agreement concerning the definitions and the thresholds for emotional abuse and neglect. Both the systematic reviews of literature that explored the evidence in this area concluded that neglect and emotional abuse are associated with the most damaging long-term consequences, yet they are also the most difficult to identify.” (p.18)

Comment

The authors are explicit about why they highlight neglect and emotional abuse and acknowledge the complexity of the factors involved in atypical development. But their focus on emotion (264 mentions in 226 pages) could give the impression that emotional abuse has more significant outcomes than, for example, physical neglect or poor support of parents and children by public sector services – although these are mentioned too.

[3] Marchant, R. (2009), ‘Making assessment work for children with complex needs’, in The Child’s World, J. Horwath (ed.), London, Jessica Kingsley Publishers.


I couldn’t access Ruth Marchant’s chapter in this book, but I did find a pdf [no longer accessible] with the same author, title and chapter number, which I assume to be the same one. It considers;

• what is meant by complex needs
• human rights issues and the social model of disability
• issues in the assessment of children with complex needs
• involving children in the assessment process
• pointers to anti-oppressive practice with disabled children. (p.161)

Comment

Marchant offers some sensible, practical advice about how to approach assessment, but little about assessing the complex needs themselves. The emphasis appears to be on the form rather than the content of assessment. Horwath’s book is based on the assessment framework proposed by the Department of Health (DH) in their Framework for the Assessment of Children in Need and their Families, published in 2000. I’ll discuss this framework in more detail in a later post.

[4] Brandon M., Sidebotham P., Ellis C., Bailey S. & Belderson, P. (2011). Child and family practitioners’ understanding of child development: lessons learnt from a small sample of serious case reviews. London, Department for Education, Research Report.

The report opens with a clear statement about the authors’ theoretical position:

Attachment is the principal theoretical foundation for the analysis of the child’s development in the context of their environment … (Howe 2006)”. (p.3)

In their conclusion, they address social workers’ expertise directly:

Social workers should have a good working knowledge of the key developmental processes for the child from infancy through to adolescence and maturity (Aldgate et al 2006). They do not need to be experts in child development, and indeed will work closely with colleagues in other agencies to consider the child’s developmental progress. Nevertheless they should be able to recognise patterns of overall development, to promote optimal child development and to detect when such development may be going off track. However in a recent study, Ward and colleagues found that many social workers did not feel that child development had been a major part of their professional training and also that some professionals showed “little understanding of infant attachments; the impact of maltreatment on long term well being; of how delayed decisions can undermine life chances.” (p.20)

Reference is made to gathering expertise from other disciplines: community nursing services, GPs, secondary health care providers, adult mental health care and education staff (p.20). The authors also draw attention to the current absence of child development from training for social workers, teachers and GPs. (p.21)

Comment

1. Brandon et al acknowledge the complexity of child development in listing the areas of expertise that social workers might need to draw on. But the claim that “attachment is the principal theoretical foundation for the analysis of the child’s development in the context of their environment” simply isn’t accurate. Attachment is only one strand of one facet of child development.

2. Their model of child development also appears to be normative. ‘Optimal’ child development should be promoted and social workers should be able to detect when development may be going ‘off track’ (p.20). There are several references to children not ‘meeting milestones’.

3. Despite the issue of an inadequate understanding of child development amongst those working with children in health, education and social care being raised (p. 21), I couldn’t find an acknowledgement of the possible adverse effects of this. I still fail to understand why child development should not feature prominently in the training of people who work with children.

What these texts aren’t saying

At first, I found it difficult to put my finger on exactly what it was about these texts that made me uneasy. After all, they recognize that child development involves the complex interaction of many factors, they’re comprehensive in scope, and children’s welfare is at the heart of their agenda. On reflection, I had three main reservations about the model of child development presented:

• It’s normative. It assumes that there is a normal sequence of developmental milestones and that each child should meet them – even if the trajectory might be a bit different for children with disabilities.

• It emphasizes some aspects of child development, such as emotional and social development, but others are almost completely overlooked – genetic, physiological and socio-political factors, for example. As a consequence, the causes of the problems experienced by children are marginalized.

• It’s coherent and complete within its own frame of reference – that is, in relation to promoting and safeguarding the welfare of children in need (DH, 2000). If the model is viewed from the perspective of child development as a whole, some flaws start to appear.

I suspect that these three issues have arisen for two reasons;

The model is policy-based rather than evidence-based, despite claims to the contrary. If it was evidence-based it would be framed in terms of child development as a whole. This would include an evaluation of the physical factors involved in individual development, the root causes of children’s needs and the socio-political context that determines which children are in need and what their needs might be.

The model is based on biological knowledge that pre-dates WWII. (I’ll expand on this point in the next post). Old knowledge isn’t necessarily wrong, but research has moved on since then. The model of child development proposed by the texts doesn’t seem to recognize this.

I can understand why practitioners working in child protection focus on the emotional and social aspects of a child’s development and why attachment theory has intuitive appeal. But attachment theory and social and emotional development aren’t synonymous with child development per se.

My understanding of the term child development is that it refers to every change that a human being undergoes between conception and adulthood; genetic, anatomical, physiological, emotional, cognitive and social. It would be unreasonable to expect everyone working with children and families to be experts on every aspect of development, but since all aspects are interrelated, it doesn’t seem unreasonable to expect them to have an accurate overview of all aspects. This is analogous to the level of knowledge one would expect in relation to common infections. To become an expert on bacteria and viruses would take many years of study, but a basic overview of the differences between these organisms, what illnesses they cause, what symptoms to look for and how to treat infections can be grasped in a matter of minutes. Similarly, it wouldn’t take long to understand the basic principles of physical development and how they impact on children’s development as a whole. I think there’s a reason for the physical aspects of child development being marginalized. In the next post, I’ll explain what it is and expand on my misgivings about the model of child development set out in the four texts.

what’s wrong with attachment theory?

I’ve encountered enough examples of inadequate, chaotic, manipulative and abusive parenting to understand why people working with troubled children might view parents as prime suspects. However, there are many possible causes for children’s unusual behaviour and a focus only on parental behaviour means that other causal factors are likely to be overlooked.

In the next few posts, I want to explore three concepts – Attachment Theory, Fabricated or Induced Illness (FII) and the ‘cycle’ theories of deprivation and abuse – that attribute the cause of children’s abnormal behaviour primarily to parental behaviour. Although these concepts aren’t directly related to autism, parents of children with developmental issues and learning difficulties have reported these ideas being proposed as causes for their children’s behaviour despite evidence to the contrary.

Attachment theory

Attachment theory was an idea developed by John Bowlby, born in 1907, one of the six children of Sir Anthony Bowlby, surgeon to the King’s household, and his wife Maria. Like many children in well-to-do families of the period, Bowlby was brought up by a nanny and sent to boarding school at the age of seven. He later became a psychologist, psychiatrist and psychoanalyst who worked with maladjusted and delinquent children, studied the effects of maternal deprivation and after WWII became a mental health consultant to the World Health Organization. Bowlby’s work led him to the conclusion that ‘to thrive emotionally, children need a close and continuous caregiving relationship’ (Bretherton, 1992). He drew on new research in cybernetics, brain function and on Lorenz’s work on imprinting to develop his theory, and realized that a complete revision of Freudian ideas about child development was required. This he attempted to do in three books published under the title Attachment and Loss: Attachment (1969), Separation (1973) and Loss, Sadness and Depression (1980).

In 1950, a University of Toronto graduate called Mary Ainsworth had joined Bowlby’s research team. Three years later, having moved with her husband to Uganda, she carried out the first of several studies on infant-mother attachment. She then developed an assessment procedure for determining the nature of an infant’s attachment – the Strange Situation – and concluded that infants showed one of four distinct patterns of attachment to their mothers; secure, anxious-resistant insecure, anxious-avoidant insecure and disorganized/disoriented. The patterns of attachment developed with primary caregivers were seen as foundational for social interactions and mental health throughout later life – an insecure or disorganized attachment could lead to later problems.

It’s easy to see how attachment theory could be used to lay the blame for a child’s behavioural issues at the feet of parents, particularly mothers. Bowlby, however, doesn’t appear to have had any intention of blaming parents; his theory is firmly grounded in the idea of behaviour involving an interaction between genes and environment. But that doesn’t seem to be the way attachment theory is presented in texts that inform public policy. Before moving on to these texts I want to examine the ideas behind attachment theory in more detail because, like the concept of autism, it’s a theory constrained by the state of knowledge at the time of its inception.

Background to attachment theory

In the opening chapters of his first volume of the Attachment and Loss series – Attachment – Bowlby explains, systematically and in detail, the theoretical framework for his model. Bowlby brought together concepts from a number of different fields. Here’s a summary of his reasoning:

• Observations have shown that separation from the mother-figure can be extremely traumatic for children. There is evidence that this separation can result in problems with behaviour, personality and mental health in later life – e.g. stealing, depression and schizophrenia.

• Attachment theory is grounded in psychoanalytic theory because ‘despite limitations, psychoanalysis remains the most serviceable and most used of any present-day theory of psychopathology’ (p.xv).

• Data can be obtained by observing behaviour, as well as from introspective reports from participants.

• Freud drew attention to the importance of feedback in homeostatic biological systems; in behaviour, motivation is regulated by homeostasis in the same way.

• Instinctive behaviours can be complex and are the outcome of an interaction between ‘genetic endowment’ and environment – partly innate and partly acquired.

• Behavioural systems are goal-directed (ie they evolve in order to fulfil a specific purpose) – analogous to engineering control systems.

As I understand it, at inception, the Freudian psychodynamic model of behaviour was a novel idea; it was developed from first principles derived from contemporary understanding of biological mechanisms. Bowlby’s model wasn’t novel; it was an extension of the psychodynamic model based on new knowledge about those mechanisms. This means that Freud and Bowlby based their theories on the same assumptions:

1. Species-specific patterns of behaviour are biologically ‘provided’ – although they can be affected by the environment.

2. Biologically provided behaviour patterns are normative. That means that in the ‘right’ environment they will unfold naturally, but could be disturbed if something goes ‘wrong’ with either the genetic endowment or the environment.

3. Biologically provided behaviour patterns are goal-directed – they have evolved to fulfil a specific purpose.

4. Behaviour is driven by the need to maintain emotional (feelings) homeostasis.

5. Relationships between parents and children are central to child development.

Attachment theory is clearly a theory of its time, since research in all these areas has since moved on. That doesn’t necessarily invalidate attachment theory, but does suggest there are some problems with it.

What’s wrong with attachment theory?

1. Freud saw social and sexual development as central to human behaviour because of their importance in sexual reproduction – the means by which inherited characteristics (including behavioural drives) are passed on to offspring. This is why a child’s relationship with his or her parents was seen as so important; it could disturb the natural unfolding of social and sexual drives. Subsequent research, by contrast, shows that social and sexual behaviour is influenced by complex array of factors that change over time. Despite revising Freud’s framework, Bowlby still viewed social and emotional factors as central to the development of human personality rather than being two factors amongst many.

2. Much of Bowlby’s research was carried out prior to the structure of DNA being discovered and the consequent development of molecular biology. Subsequent research suggests that rather than behaviour patterns being biologically provided, they emerge from interactions between genetic expression and environment. Similarities between individuals in both genetic material and environment result in species-specific behaviours but differences mean that species-specific behaviour patterns vary between individuals. Oppenheim et al. (2009) noted, for example, secure attachment patterns in autistic children that were different to the one that Ainsworth described.

3. Biological behaviour patterns can only be goal-directed if the genome and the environment remain stable – but they don’t. Genetic make-up is unique to an individual and the environment changes constantly; behaviour patterns emerge from a dynamic interaction between the two. Although there’s no doubt that children do exhibit patterns of behaviour towards their primary caregivers, and it’s likely that those patterns can be seen across different individuals, the patterns are descriptive, rather than normative. Even if the patterns provide a useful way of identifying problems in infant-parent relationships, they show how children interact, not how they should interact.

4. Some biological systems – those that regulate body temperature or the levels of oxygen and water in the body, for example – are maintained via homeostasis because the biochemical reactions necessary for survival can occur only within certain narrow limits. Emotions and behaviour aren’t so constrained and tend to be cyclical rather than stable.

5. There’s no doubt that a child’s relationship with his or her primary caregiver is important. But in focussing on a single relationship, attachment theory by definition marginalises the role of genetic, biological and other environmental factors – including other relationships – in a child’s social and emotional development.

This brings us back to the concept of reification that cropped up in a previous post about Kanner’s model of autism – although I didn’t call it that at the time. Reification literally means ‘making a thing’ – the implication being that a ‘thing’ is made that doesn’t necessarily exist in the real world. There’s no question that ‘attachment’ can be used as a descriptive label for certain kinds of behaviour, just as ‘autism’ can. It doesn’t follow that attachment must be a clear-cut psychological function, nor that autism must be a distinct medical disorder.

When I studied psychology as an undergraduate in the 1970s, attachment theory was already being viewed with some skepticism for the above reasons. I haven’t kept in touch with child development research so I was surprised to find that attachment theory is still alive, well and influencing social policy in the 21st century. That’s the subject of the next post.

References

Bowlby, J (1969). Attachment and Loss vol 1: Attachment. Revised 2nd edition, 1997, Pimlico.
Bretherton, I (1992). The origins of attachment theory:John Bowlby and Mary Ainsworth, Developmental Psychology, 28, 759-775.
Oppenheim, D., Koren-Karie, N., Dolev, S. and Yirmiya, N. (2009) Maternal insightfulness and resolution of the diagnosis are associated with secure attachment in preschoolers with autism spectrum disorders. Child Development, 80: 519–527

Acknowledgements

I want to thank everyone who sent me links relevant to this and related posts. You know who you are!

why parents get the blame

Popular opinion about the right way to bring up children has, throughout history, varied between authoritarianism at one extreme and liberalism at the other. Child-rearing practices have typically been determined by expediency, experience or belief. Freud’s ideas about child-rearing caused a sea-change in thinking about the relationship between parents and children, because his ideas were based on an explicit theory involving the biological characteristics of human beings, rather than being derived from beliefs or pragmatic responses to circumstance.

Sigmund Freud

If I’ve understood Freudian psychodynamic theory correctly, it’s grounded in the Darwinian principles of inherited characteristics and natural selection. Freud proposed that the psychological forces that drive behaviour are passed on from generation to generation in the same way as physical characteristics are inherited. Over time, natural selection ensures that the physical characteristics and behavioural drives that maximise a species’ chances of survival are preserved. During a child’s development, all that’s required for these biologically provided physical and behavioural characteristics to ‘unfold’ naturally is a suitable environment. Physical development can be ‘disturbed’ by factors such as a poor diet or living conditions or by practices such as circumcision or foot-binding; behavioural development can be disturbed by parents or other adults being too controlling or imposing unnecessary social or religious taboos. In short, the model is one of each child having a species-specific genetic blueprint for development that, given appropriate conditions, will unfold naturally to produce a healthy adult human being. Two factors could disturb that unfolding process;

-a fault in the mechanism of inheritance (a chromosomal abnormality)
or
-external interference with the child’s natural course of development.

Two key points about the psychodynamic model

Firstly, the psychodynamic model assumes that potentially there is such a thing as a ‘normal’ human being – someone whose biologically provided development has been allowed to unfold naturally – even if in real life, the course of development is often disturbed, resulting in everybody having flaws of some kind.

The second point is that this theory puts parents squarely in the firing-line – developmental problems arise either because parents have passed on their faulty genes (even if they have no control over that) or because they are the most likely suspects when it comes to the child’s course of development being disrupted.

Psychodynamic theory had a huge impact on thinking about child development in the early part of the 20th century – it made people think about child development for a start. It also had beneficial outcomes for many children in terms of their health, education and psychological development. But there was a downside. Regardless of the personal views of psychodynamic theorists, psychodynamic theory is closely associated with eugenics. Although genocide, enforced sterilisation and limiting opportunities for certain sectors of the community have happened throughout history and would probably have happened in the early 20th century even if psychodynamics hadn’t been thought of, psychodynamic theory undoubtedly lent weight to these policies.

Logo from the Second International Eugenics Conference, 1921

Both Freud and Kanner were aware that knowledge about the biological process of inheritance was sketchy, and both expected subsequent research to shed light on their theories. Although some of Freud’s ideas have received support, there’s little evidence for the idea that social and sexual behaviour derives solely from unconscious drives. Although unconscious processes must affect social and sexual behaviour, the brain areas most involved during our interactions with others are higher-level rather than lower-level areas.

Despite 50 years of research into genetics and brain function bringing psychodynamic theory into question, the two explanations offered by psychodynamics for abnormal human behaviour have become deeply embedded in popular thinking in the developed world; either there’s a genetic/medical explanation or the parents must be responsible. Since WWII politicians and social scientists, not surprisingly, have been wary of genetic explanations for atypical or socially unacceptable behaviour, so causes are frequently framed only in environmental terms, often in terms of childhood experiences. In the absence of a medical diagnosis, the parent is often assumed to be responsible. But research suggests that the relationship between genes, environment and behaviour is much more complex than psychodynamic theory suggested.

Genes

The psychodynamic model saw genetic material as providing a blueprint – an engineering diagram – for development, based on Gregor Mendel’s ideas of independent segregation and assortment of genes. But later research has shown that DNA doesn’t work quite like that. DNA is a complex molecule, so when gametes (eggs or sperm) are formed, and when DNA from two parents combines during fertilisation, there’s plenty of scope for genetic variation. Indeed it’s the genetic variation in individuals that maximises a species’ chances of surviving environmental change. Because of the structure of the DNA molecule, some genetic variations are robust enough to be transmitted between generations and are inherited. Others might arise spontaneously. Some variations are common, others rare. As far as genetics is concerned, it’s meaningful to talk about ‘normal’ and ‘abnormal’ in descriptive terms (most people are like this but not like that) but not in normative terms (people should be like this but not like that).

Environment

Human beings are biochemical organisms so many environmental factors impact on our development. Some (epigenetic) factors can affect the expression of genes. Other factors, such as diet, toxins, allergens or infections can disrupt physiology and development. Other people’s behaviour affects children but parents aren’t the only people involved; other children, teachers, neighbours and wider community and societal issues can have a significant impact on a child’s development.

In short, what the last 50 years of research has shown is that inherited characteristics and parental behaviour are only two of many factors that interact in complex ways to influence a child’s development. But you wouldn’t know to that to look at current ideas regarding child health, education and social care. In fact, social policy relating to children often reflects the psychodynamic model rather than modern understandings about genetics and child development. I suggest this is largely because of the way we think.

The way we think; heuristics and biases

Human beings are capable of using logical, rational thought but as Herb Simon pointed out, we tend to do so only as a last resort. That’s because the ways of thinking that we’ve evolved as a default tend to be in the form of heuristics (rules of thumb) and biases (inbuilt tendencies) – rough and ready ways of responding to our environment. That’s because rough and ready ways of thinking that are due to the way our brains are wired up and that improve our chances of survival are more likely to get passed on to our offspring. These thinking strategies might maximise our chances of survival, but unfortunately they don’t lend themselves to figuring out solutions to complex problems or planning long-term strategies that will make everybody’s lives better.

For example, human beings have excellent pattern-matching skills. These enable us to recognise a tiger, a rattlesnake or our children, in an instant. They also result in pareidolia – seeing a pattern as significant when it isn’t. We’re good at spotting correlations; helpful when trying to figure out what causes what, but meaning we have a tendency to conflate correlation with causality. We like phenomena to have explanations; that improves our understanding of the world around us, but also results in us inventing concepts like ghosts or evil spirits. We’re also prone to looking for agents -assuming that if something happens someone must have made it happen – not that it could have happened by chance. Heuristics and biases have been investigated in some depth, notably by Daniel Kahnemann, Paul Slovic and Amos Tversky. You can find an extensive list of human biases here, though it’s likely that many of them are actually different facets of a few underlying cognitive phenomena.

Bettelheim’s philosophers

People have long been aware that we don’t get information directly from the world around us, but via the filter of our perceptions. Errors and biases in our perceptions result in theories like the sun moving round the earth or the earth being flat. It’s only when our observations don’t match up with how we think things work that we start using logical rational thought to figure out why. The problem of how to work round unreliable perceptions was what Bettelheim’s favourite philosophers were attempting to tackle. The reason they didn’t opt for the scientific method, which has developed as a way of counteracting unhelpful perceptive errors, was I suspect, because science also gets things wrong. A fundamental point to bear in mind is that science doesn’t deal in certainties, but in degrees of uncertainty. We have enough certainty about some phenomena to land probes on Mars, replace human organs and communicate instantly with someone on the other side of the world. We’re much less certain about the causes of other phenomena – human behaviour, for one. But science has a large toolbox of methods for systematically eliminating less likely explanations for phenomena and investigating explanations that are more likely, so even though our knowledge will always be subject to our perceptions and will always be limited, it is possible to have knowledge that’s reliable enough to be useful.

In my previous post, I highlighted two differences between Kanner and Bettelheim; their use of evidence and their level of relevant expertise. I suggest that these two factors are among the reasons why parents are often (wrongly) blamed for their children’s behaviour.

The use of evidence

Science evaluates evidence by comparing hypotheses about how things happen with observations of what happens. If a theory makes predictions and they turn out to be wrong, we modify the theory – evidence that conflicts with theory can be very informative. Other disciplines handle evidence differently. In disputes, for example, opposing parties marshal evidence that supports their argument, and in courts of law or formal debates an independent party evaluates the evidence from both sides and makes a decision about which is most likely to accurately map onto the real world. The difference between the use of evidence in science and in adversarial situations is that what’s most important to science is what’s actually happening in the real world, not who wins an argument about what’s happening. Obviously scientists do have arguments – and whoever wins influences which theories get investigated and which don’t, but that’s not what science is about.

Many people developing social policy in relation to children are from disciplines that don’t handle evidence in the way science does, so legislation is often derived from policy-based evidence rather than evidence-based policy.

Levels of relevant expertise

Some years ago, I carried out a short research project on men’s and women’s perceptions of the clothing that women wore to work. I employed a technique called card sorts which had previously been used to find out how experts categorised their knowledge. What I found was that men tended to see women’s workwear in either/or terms (e.g. either the woman is married or she isn’t) significantly more frequently than women did. Some people thought this demonstrated that men think in black-and-white terms whereas women think in shades of grey, but other work with card sorts shows that experts in a particular knowledge domain tend to use more complex categorisation than novices. This suggests that women are likely to be experts on the non-verbal signals conveyed by other women’s clothing, but men aren’t. There are implications for theories about how women dress, but that’s another story. Most of my male research participants were professionals, so for the purposes of this post, what my study demonstrated is that you can be an expert in one domain, but a novice in another.

I don’t dispute that GPs, teachers and social workers have expertise; whether they have expertise that enables them figure out who or what is to blame for a child’s abnormal behaviour is another matter. It would be unrealistic to expect everybody to know about everything, but it doesn’t seem unreasonable to expect professionals working with children to have a basic grasp of relevant factors from other domains. For example, I’ve had to explain to a local authority attendance officer why doctors don’t prescribe antibiotics for viral infections. I’ve disagreed with a GP about the ‘gold-standard’ nature of randomised controlled trials and NICE guidelines. And I didn’t even try to explain one of my son’s teachers why spelling isn’t simply reading in reverse, that is, why he might be a good reader but be incapable of spelling words of more than three letters. I’m not alone; recent reports from the UK have drawn attention to the lack of training in child development received by GPs, teachers and social workers.

In the next post, I want to examine three areas where use of evidence and levels of expertise have had a significant impact on social policy development and on the experience of children showing atypical behaviours; attachment theory, fabricated and induced illness and cyclical models of socio-economic deprivation.

Further reading

Kennedy, I (2010). Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs. HMSO.

Munro, E (2011). The Munro Review of Child Protection. Final Report: A Child-Centred System. HMSO.

Rugg, G. & McGeorge, P. (2005). The sorting techniques: a tutorial paper on card sorts, picture sorts and item sorts. Expert Systems,22, 94-107.

Teather, S. (2011). Support and Aspiration: A new approach to special educational needs and disability – a consultation. HMSO.

Photograph of Freud by Max Halberstadt, 1921. Image from the Google-hosted LIFE Photo Archive where it is available under the filename e45a47b1b422cca3.