Invisible disability: Building Great Britons

A report was published on Wednesday by the All Party Parliamentary Group (APPG) for Conception to Age 2 – the First 1001 days. It’s called Building Great Britons.
The thrust of the report is similar to Early Intervention: Good Parents, Great Kids, Better Citizens (2008) and Early Intervention: The Next Steps (2011) from MPs Graham Allen and Iain Duncan Smith. Building Great Britons sets out a policy framework aimed at preventing the social problems believed to originate in adverse experiences between conception and a child’s second birthday.

Breaking the cycle

The conceptual model underpinning the report is a familiar one. Neglect, maltreatment and insecure relationships in early childhood are assumed to be a primary cause of mental health problems and antisocial and criminal behaviour. Parents who had such experiences during childhood tend to adopt the same child-rearing strategies as their parents, setting up a damaging (and costly) self-perpetuating intergenerational cycle.

Like the Early Intervention reports, Building Great Britons argues that preventing child neglect, maltreatment and insecure attachment will save money and result in a flourishing society due to the emergence of well-rounded citizens who are “physically and mentally healthy, well educated, empathic, prosocial, hardworking and contributing to the costs of society” (p.3). As Tim Loughton, Co-Chair of the APPG says “the economic value of breaking these cycles will be enormous” (p.4).

“This” it’s claimed, “is not ‘rocket science.’ Technically it is ‘neuro-science’” (p.3).
The basis for that claim seems to reside in repeated references to brain development, although there’s no detail about how brain development is involved. The association between early adverse experiences and long-term unwanted outcomes is well established, but there are some problems with the model.

what causes what?
The first is that just because two things are correlated, it’s not safe to assume that one causes the other. They might both be caused by something else, or be totally unrelated. So parents might neglect, maltreat or form poor attachments with their children because their parents did, or because the family has a genetic predisposition towards severe post-natal depression, or because they are grappling with challenging life circumstances.

multiple causes
The second problem is that even if we could predict with certainty that all neglected, maltreated, chaotically attached children will develop mental health problems or anti-social behaviour in later life, the causal chain doesn’t always hold in the opposite direction because mental health problems and anti-social behaviour have other causes such as poor physical health, adverse life events or peer pressure.

looking back vs looking forward
A third problem is that retrospective surveys linking adverse childhood experience with later health and social problems, such as the ACE study referred to in Building Great Britons (p.14), tend to rely on self-reports – not always the most reliable sources of information, especially about early life. Prospective assessments that track children through their life course such as the Dunedin and Cambridge studies tend to be more reliable. They have also found correlations between adverse childhood experiences and problems in later life but that the emerging patterns are quite complex.

When reading through the research findings, I was struck by how often researchers expressed surprise at the frequency of adverse childhood experiences. The ACE study was prompted by the unexpectedly high incidence of sexual abuse in childhood reported by people dropping out of a weight loss programme. The Dunedin study began as a small-scale follow-up assessment of perinatal risk. Its scope was broadened after researchers found a higher incidence than they expected of accidental injury and impairments to sensory function, development and behaviour in 4/5 year olds. The implication wasn’t that the children had been neglected or maltreated (although some might have been), but that developmental impairments in the general population were more frequent than had been previously thought.

children with disabilities: noticeable by their absence

This brings me to a glaring omission in Building Great Britons. One group of children is especially susceptible to social, emotional and behavioural problems and is at increased risk of poor physical and mental health in later life. They are children with disabilities. But the only mention of disability that I could find in Building Great Britons was of children with Foetal Alcohol Syndrome, caused by a mother’s excessive alcohol intake during pregnancy.

Childhood disabilities can be caused by neglect or maltreatment but they can also be caused by factors such as;

• inherited genetic conditions
• spontaneous genetic variations at or before conception
• mother’s illness during pregnancy
• environmental damage during gestation (e.g. exposure to toxins)
• childhood infections
• accidental injury.

Whether you think disability is caused by a ‘functional impairment’ or by the way society responds to that functional impairment, for administrative and legal purposes a clear-cut distinction is usually made between someone who’s deemed disabled and someone who isn’t. But from a biological perspective the boundary is rather blurred. As the Dunedin study found, a significant proportion of children has some sort of developmental impairment; currently in the USA it’s 15%. In the UK, only 6% of children are classified as disabled, but that figure rises with age. Around 16% of the working-age population has a disability.

Not all disabilities are obvious, and some are difficult to detect. The average age at which autism is diagnosed, for example, is 5.5 years, and diagnosis is often much later than that. Autistic children have unusual attachment patterns and autism is so frequently confused with attachment disorder that Heather Moran, a consultant clinical psychologist, devised the Coventry Grid to help professionals distinguish between them.

There’s little doubt that neglect, maltreatment or poor attachment in childhood can, and does, lead to social, emotional and behavioural problems and to impaired physical and mental health. But what Building Great Britons does is to frame the causes of those problems solely in terms of neglect, maltreatment or poor attachment, and more specifically in terms of the ‘troubled families’ who are deemed to be the source of these societal ills (pp.3-4).

When I was delving into the thinking behind the Early Intervention reports, I asked a few researchers who’d been actively involved how some obviously erroneous claims about brain function had crept in. None had had a say in the final content of the reports, but one told me that it was sometimes necessary to present data in a way that was most likely to persuade government to come up with funding. I take his point; but I couldn’t see how that justified presenting the data in a way that was misleading.

What the data on social, emotional, behavioural, physical and mental health problems tell us is that children by definition are vulnerable, and parenting by definition is challenging. They also tell us that we are all, at all times, at risk from unforseen life events that could trigger social, emotional, behavioural, physical or mental health problems that result in us needing help from the community. That’s why in the developed world we have education, health and social care services.

It’s true that a minority of families cause a disproportionate number of problems, for themselves and others. There are good reasons why early intervention is appropriate for them. But because all children are vulnerable and all parenting is challenging, there are good reasons why early intervention should be available to all families. We shouldn’t have to justify it in terms of ‘good citizenship’ or the financial costs for ‘society’ – which at one time we were told didn’t exist.

Nor should reports produced by Members of Parliament about vulnerable children and challenged parents look right past one of the most vulnerable groups of children and one of the most challenged groups of parents. In the total of 351 pages that make up the two Early Intervention reports and Building Great Britons, childhood disability is mentioned, in passing, only five times – and three of those references are to Foetal Alcohol Syndrome.

When I contacted @first1001days, the Twitter account for http://www.1001criticaldays.co.uk/ to point out the omission, I got a prompt response inviting me to write some supplementary material. Within an hour, another parent and I had responded with a paragraph summarising the main issues, and notified @first1001days. I wasn’t surprised not to get an immediate reply, as the report was being launched that morning. But we’re still waiting…

Disabled people are still invisible, it seems.

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the myth of the first three years

Reading John Bruer’s book The Myth of the First Three Years was like watching the past few months of my life flash before my eyes. That’s because, gratifyingly, Bruer comes to similar conclusions about the basis of child development theories currently influencing public policy. My one reservation about his book is its title and the repeated references to the ‘myth’ in the text. Technically Bruer is right to use this word for the cluster of popular ideas about the first three years because myths often have some basis in fact, but I think it’s a bit misleading because the word ‘myth’ is also widely used to mean something that has no basis in fact. The myth of the first three years conforms closely to the OECD definition of a ‘neuromyth’ – a “misconception generated by a misunderstanding, a misreading or a misquoting of facts scientifically established (by brain research) to make a case for the use of brain research in education and other contexts”. Other people have other reservations about Bruer’s work. One Amazon.com reviewer complained that the book jacket reveals he’s ‘not even a doctor!’ She obviously missed the significance of Bruer’s presidency of the James McConnell Foundation that awards grants for biomedical and educational research.

Bruer’s book deals with three aspects of what I’ll call the first three years model. He describes how the model migrated from research findings to public policy and the changes it underwent en route. He then explains what the research findings actually were, and what they mean for parents. Although the book was published over a decade ago, the first three years model has, as is traditional, taken a decade to cross the Atlantic, so is now very relevant to the coalition government’s social policy in the UK.

How the first three years model evolved

Bruer cites the developmental psychologist Jerome Kagan’s view that infant determinism – the idea that early experiences have a lasting effect on development – dates from a folk belief in 18th century Europe popularised by writers such as Rousseau. I think that the origins are more likely to be as old as parenthood. Like many of my contemporaries I was brought up on Biblical wisdom and was familiar with sayings such as; “Train up a child in the way he should go: and when he is old, he will not depart from it” (Proverbs 22:6). “He that spareth his rod hateth his son: but he that loveth him chasteneth him betimes” (Proverbs 13:24). The book of Proverbs dates from around 900 BC – the origins of the proverbs are likely to be much older.

Infant determinism was a theme explored by Freud and further developed by figures such as John Bowlby, Mary Ainsworth, Harry Harlow, Rene Spitz and Benjamin Bloom. During this period, as Bruer points out, the study of the brain and the study of behaviour, despite being seen as complementary in the late 19th century, have followed largely independent paths. It’s only since the implications of brain research for human behaviour have become clearer that the two paths have begun to cross more frequently. From the 1970s onwards, fields such as education and child development began to co-opt findings from neuroscience into their own theoretical models. Bruer traces the way neuroscience has been interwoven with child development theories from, for example, the Clinical Infant Development Project that began in the 1970s and developed into Zero to Three: The National Centre for Infants, Toddlers and Families. And from the 1979 book Education and the Brain, through to the I Am Your Child campaign that began in the mid-1990s, and on into public policy.

Research findings

Bruer identifies three key areas of neuroscience research that underpin the first three years model; neural connections, critical periods and the effects of enriched or complex environments. To illustrate how misconceptions about research have arisen, I’ll summarise the findings he discusses and what they might tell us about child development.

Neural connections Neurons are the cells in the brain that transmit information. They are formed – around 100 billion of them – by the second trimester of gestation, and soon after birth will have migrated to their final destinations in the brain. Neurons are nerve cells and in order to transmit information between each other, they need to be connected. The connections aren’t direct however, they are via synapses – points where the axon terminal of one neuron is close enough to the dendrite of another for chemical or electrical signals to pass from one to the other (see figure). In humans, synapse formation begins a couple of months before birth and peaks at 2-3 years after birth, when the number of synapses is many times greater than it is in adults.

synapse

At the same time, two other processes are going on – apoptosis and synaptic pruning. Apoptosis is cell death, and many neurons, like other cells in the body, do die off during normal development. During synaptic pruning the neurons don’t die, but the number of connections the neuron has with other neurons decreases. Between early childhood and puberty, the number of synapses in the brain gradually declines but remains above adult levels. Between puberty and adulthood, synaptic pruning increases rapidly.

Critical periods In early research into the functioning of the visual cortex of the cat, Torsten Hubel and David Wiesel found that if kittens were deprived of visual input from one eye during the first few weeks of life, they remained blind in that eye. It’s long been known that children with congenital cataracts usually develop normal vision if the cataract is removed within the first year after birth. If cataract removal is delayed, vision may never be normal. We know that children can learn to speak a second language like a native if they acquire that language before their teens – if not, the language can still be learned, but with a noticeable accent. So there are critical periods in child development when certain sensory input is necessary for typical development to take place.

Enriched or complex environments
Charles Darwin had noted that animals reared in the wild tended to have larger brains than their domesticated offspring. Harlow’s famous experiments demonstrated that baby monkeys reared in isolation showed severe behavioural abnormalities. And experiments in the 1970s conducted by Greenough and colleagues showed that rats reared in complex environments had a greater density of synapses than those raised in solitary conditions. It was clear that the environment has a significant impact on brain development.

Applying the research findings to child development

The model of the first three years has arisen partly because research findings have been misunderstood. Several factors need to be borne in mind before applying the findings to children.

1. Many of the research findings relate to animals, notably rats and monkeys that are often used in research because they are small, easy to handle and have relatively short life-cycles. Rats and monkeys are also social, problem-solving mammals, which means they have a lot in common with humans. Although their brains are very likely to function in similar ways to human brains, there might be species-specific differences. One of the differences is that they develop at different rates; rats are sexually mature by about six weeks of age, and macaques at around five years, so extrapolating findings to humans relies on estimates for the ages at which children reach similar developmental stages.

2. Many of the research findings are estimations. It’s impossible to count the number of synapses or neurons in a brain, so proxy measures are used such as the density of synapses in a small portion of the cortex. But different techniques have been used to arrive at those measures; one group of scientists calculated density of synapses in whole human cortical tissue and found that density peaked at three years of age; others used a different method to calculate the synaptic density in monkeys and estimated that density would peak at seven months in humans. These differences were resolved, but demonstrate that research findings need to be interpreted carefully.

3. Many research findings apply to specific locations in the brain. Huttenlocher, for example, has reported the density of synapses in the human brain peaking at around three months after birth in the auditory cortex, at 8-12 months in the visual cortex but not until 3.5 years in the frontal area. Similarly, synaptic pruning in auditory and visual areas reduces synapse densities to adult levels by 11-12 years of age, but not in frontal areas until several years later.

4. It’s not always clear whether developmental changes in the brain are determined by biological factors, by environmental factors, or by both. Clearly biology would have more influence than environment on the migration of brain cells before birth, but work on synapse formation suggests it is triggered by novel learning experiences. Novel experiences tend to diminish as children get older, and familiar experiences are by definition experienced repeatedly, suggesting a cause for synaptic pruning. However, the increased rate of synaptic pruning after puberty implies that some biological control might be involved.

Common misunderstandings

It’s easy to see how the first three years model came into being. There are differences between the brains of toddlers, older children and adults. It’s tempting to assume that the rapid synapse formation and rapid learning that take place during the first three years of life offer a now-or-never window of developmental opportunity. Synaptic pruning, viewed from a ‘use it or lose it’ perspective, makes it look as if this opportunity soon runs out, despite clear evidence that older children, adolescents and adults can learn a great many things that toddlers can’t. This misconception underpins the current vogue for early interventions. The idea of critical periods has resulted in a tendency for governments (at least in the US and UK) to front-load the education system because of an assumption that the earlier learning takes place the better. What the evidence indicates is that critical periods tend to involve low-level processing of sensory information and that broader ‘sensitive periods’ (e.g. for language acquistion) are not clear-cut. With regard to enriched or complex environments, the enriched environment enjoyed by Greenough’s lab rats was probably a lot less stimulating than the environment experienced by wild rats. Lab rats, however well cared for, tend not to lead a very exciting existence. In other words, children would need to be pretty deprived to experience the kind of environment that resulted in a reduced synapse density.

Chinese whispers

The transformation of a tentative conclusion based on findings from rats or monkeys into public policy that lacks a sound evidence-base appears to have begun in one of two ways;

• Journalists have accurately summarised research findings but their reports have been misinterpreted by some readers
• Journalists have misunderstood research findings and have inadvertently misled readers.

Casual readers of newspapers or magazines can be forgiven for getting hold of the wrong end of the stick; they often don’t have the time or inclination to check the original data. Policy-makers, in my view, have no such excuse. Governments have enormous resources at their disposal, and academics, however busy, are usually only too keen to explain their findings to willing listeners. There is no good reason why public policy shouldn’t be based on sound evidence.

The first three years model fits easily into our pre-existing mental models. Infant determinism has been seen as the key to solving problems such as poor educational and health outcomes, addiction, anti-social behaviour and criminal activity that preoccupy policy makers – it’s simpler to blame parents for bringing up their children badly than to trace back the complex causes of ‘problem’ behaviours and address them all. The model has also played to the anxieties of parents who understandably want to do the best for their children. The acceptance of the first three years model by parents and policy-makers has resulted in a proliferation of early interventions. So what effect have they had?

The outcomes of early interventions

Evidence from the evaluation of early interventions cited by Bruer, and from studies tracking changes in people’s lives over time suggests that;

• the best predictor of a child’s school performance is mother’s IQ or educational attainment
• good quality childcare improves school performance for children from ‘deprived’ environments (but not from less deprived ones)
• early interventions that focus on verbal skills improve children’s school performance up to about the age of eight – enough to reduce the number of children who repeat the first few school years
• early interventions that focus on verbal skills result in a marginal improvement in school performance, in the length of time spent in education, and in slightly later parenthood
• people tend to settle down as they get older
• chance events play a big part in lifetime achievement.

The pattern that emerges from these evaluations – and this speculative because I don’t have access to raw data – appears to centre on two factors; children’s language skills when they start school, and the way schools educate children. I think these factors have two implications for early interventions.

Firstly, children who are behind their peers with verbal skills when they start school are clearly at a disadvantage, but only because schools use language as the primary medium for education. Language is one of the things that distinguishes homo sapiens from other species. Spoken and written language allow us to communicate vast amounts of information to each other, so it’s obviously desirable that as many children as possible develop good skills in spoken and written language. But being skilled in spoken and written language is not synonymous with learning; children can also learn through practical experience, watching plays or listening to stories. Language skills, although an important component of the school curriculum, shouldn’t be made an obstacle to learning.

Secondly, although some early interventions have had positive outcomes, the effects have tended to be small. Politicians in favour of these programmes would doubtless argue that any positive outcomes are worth it, but given the importance of verbal skills, it might be more cost effective to improve access to speech and language therapy, especially since so many developmental disorders involve speech and language deficits.

What should parents do?

When I was expecting my first child, a friend gave me a book that advocated a ‘best odds’ approach to pregnancy – the author pointed out that nothing can guarantee that a baby will be completely healthy, but there are things that mothers can do that increase the odds in their baby’s favour. It’s a sensible and realistic approach. Bruer’s conclusion is that most parents are doing fine with their children and that we already know what children need and what’s bad for them. He advises parents to interact with their babies, fix known problems – especially visual, auditory and language ones – as soon as possible, and as neuroscientist Steve Petersen put it “Don’t raise your children in a closet, starve them or hit them in the head with a frying pan”.

References
Bruer, John T., (1999). The myth of the first three years, New York: The Free Press.

Green, E.J., Greenough, W.T. & Schlumpf, B.E. (1983). Effects of complex or isolated environments on cortical dendrites of middle-aged rats, Brain Research, 264,, 233–240.

Huttenlocher, P.R, de Courtena, C., Garey, L.J. & Van der Loosa, H. (1982). Synaptogenesis in human visual cortex — evidence for synapse elimination during normal development, Neuroscience Letters, 33, 247–252.

Organisation for Economic Co-operation and Development (2007) Understanding the brain: the birth of a learning science: The Birth of a New Learning Science: v. 2, OECD.

Image of synapses from Wikipedia.

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.