the claims: NSPCC briefing on home education

logicalincrementalism

The NSPCC briefing Home education: learning from case reviews claims to consist of ‘learning about child protection pulled from the published versions’ of seven Serious Case Reviews (SCRs) published between 2008-2013. In this and subsequent posts, I want to focus on the patterns of events that emerge from the case reviews, but I’ll also refer to examples of what happened to specific families or specific children. I’ve numbered the cases to anonymise the children as much as possible, but have linked to the published versions of the SCRs. I’ve listed brief details of each case below for reference.

Family 1 2007 serious maltreatment of adopted children
Child 2 2008 non-accidental poisoning with prescription drug
Child 3 2009 unexplained death
Child 4 2010 death due to severe malnutrition
Child 5 2011 suicide
Child 6 2012 death due to natural causes
Family 7 2013 neglect, and sexual abuse of adopted child

In…

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protecting disabled children: systems maltreatment and neglect

Ofsted’s assumptions in their report Protecting disabled children: thematic inspection that “risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe” appear to be based on some rather unreliable data. That doesn’t mean Ofsted wasted its time doing an inspection. But what concerned me about the report – in addition to the statistical analysis that triggered it – wasn’t so much what was said, as what wasn’t said about the risks to disabled children and support for them.

If we had robust data I’d be surprised if they didn’t show disabled children to be at an increased risk of maltreatment or neglect. That’s because of the risk factors involved. Many disabilities have a genetic component, meaning that other family members are more likely to have health or disability issues. Add to that the challenge of looking after a disabled child, the impact on siblings, the likelihood of a reduced income with increased expenditure and you have a situation where all those directly involved are likely to be vulnerable. But some protection from those risks can be offered by the community. Appropriate support from relatives, friends, neighbours and the local authority can make a big difference to families’ quality of life and thus reduce the risk of maltreatment or neglect.

Ofsted’s inspection focused on safeguarding and looked after children services in relation to disabled children. Nothing wrong with that focus, per se. But Ofsted also refers to more general support services that could have an impact on the safety and wellbeing of disabled children. In this post I want to examine some of the wider issues relating to child protection and support services for disabled children.

What does child protection mean?

‘Child protection’ is a term commonly used to refer to the protection of children from maltreatment and neglect by people they know well, like family members. There’s no doubt that children are most at risk from people they know well. That’s not because people who know children well are inherently more evil than people who don’t; it’s partly because not everyone who brings up a child is good at doing so, but also because children spend a great deal more time with people they know well, as distinct from with people they don’t. When that situation is reversed, historical evidence from children’s institutions suggests that the main source of risk to children changes accordingly.

‘Child protection’ can also refer to protection from people who work with children (hence Criminal Record Bureau checks), from strangers (hence ‘stranger danger’ warnings), and sometimes from other children (hence anti-bullying policies in schools). But ‘child protection’ is rarely used in the context of what the Australian government calls ‘systems abuse’, defined as:

preventable harm [that] is done to children in the context of policies or programs which are designed to provide care or protection. The child’s welfare, development or security are undermined by the actions of individuals or by the lack of suitable policies, practices or procedures within systems or institutions.

I’d broaden this definition by omitting the words ‘which are designed to provide care or protection’, since children can experience collateral damage from policies of any sort.

An example of what I mean was featured in a recent documentary shown on BBC 4 (unfortunately not currently viewable) entitled ‘Growing children: autism’. The last part of the programme shows footage of two young brothers, Jake and Zaine, both on the autistic spectrum. Their behaviour results in their mother spending much of her time protecting her shins. Zaine explains very clearly and persuasively why he doesn’t want to attend school (the people, the noise) but it’s no use, he has to go to school. (I’m not blaming his mother, incidentally, because her options might have been limited.) If a child had behaved like that at the end of the school day, rather than at the beginning, and said those things about going home, my guess is that social services would have been contacted. But despite much rhetoric about listening to the voice of the child (and s.17. 4(A) of the Children Act 1989 requiring the wishes and feelings of children in need to be ascertained in respect of service provision), the impact of some policies and programmes on children is simply ignored regardless of the distress and harm it causes, as many parents of children with disabilities and those children themselves can testify.

This is what Bronfenbrenner’s ecological systems theory highlighted; that children are most strongly influenced by people they come into direct contact with (for obvious reasons), but that the actions of people they never meet, such as decision-makers in organizations and national and international governments, can have a significant influence too – for good or ill. This brings me to the point about support services.

Support services

The Ofsted inspection involved 12 local authorities – that’s fewer than 10% of the total in England. Of the 12, seven had been judged ‘good’ and five ‘satisfactory’ in previous inspections of safeguarding and looked after children services (p.9). Ofsted wanted to look in detail at the ‘child’s journey through the system’, so it made sense to investigate authorities that were following procedures fairly closely, in order to identify shortcomings resulting from the design of the system rather than because of failures in implementation. Inspectors also met with “18 parents, 10 of whom had disabled children with child in need plans and eight of whom had children subject to child protection plans” (p.9). I couldn’t discover how many families were represented, but at best it was obviously a very small sample, an average of 1.5 per local authority inspected.

Ofsted’s focus is on safeguarding and looked after children services but several references are made to universal services. The introduction (p.7) begins:

When the national Aiming High for Disabled Children programme was being developed in 2007 by the previous government it was estimated that there were 570,000 disabled children in England. This programme put in place a range of support for disabled children and their families.”

Aiming high for disabled children

Let’s take a closer look at the Aiming High programme, as described in Aiming high for disabled children: better support for families, published jointly by HM Treasury and the Department of Education and Skills in May 2007 and signed off by Ed Balls, then Economic Secretary to HM Treasury and Andrew Adonis, then Parliamentary Under-Secretary of State for Schools. The Aiming High programme was the outcome of the Disabled Children Review, one strand of a Review of Children and Young People, in turn part of a Comprehensive Spending Review (CSR), undertaken by the previous Labour government. The CSR set government departmental spending plans and priorities for 2008-2011. (Aiming High p.10)

So what is the ‘range of support for disabled children and their families’ that the Aiming High programme put in place? The Aiming High report identifies three core areas, which I’ve summarized for brevity. You can read them in full on pp. 6-8 of the document.

Empowering disabled children, young people and their families

• a “core offer“ to make it clear what entitlements and services disabled children, young people and their families can expect

• piloting individual budgets

• spreading good practice on engagement such as parents’ forums

Promoting more responsive services and timely support

• a national disabled children indicator

• evaluation and benchmarking good practice on early intervention

• Local Authorities and PCTs will improve their data collection

• continuing the Early Support Programme

• a Transition Support Programme

Boosting provision of vital public services

• provision of short breaks for disabled children

• a childcare accessibility project

• a radical reform of community equipment and wheelchair provision and

• research the skills and behaviours required by the workforce and to identify gaps.

Funding was allocated to some of these areas and funding for short breaks and parent forums, for example, has been maintained by the coalition government. But how much of this actually constitutes ‘support’? And how much support is on offer? Feedback from parent groups and voluntary sector organisations suggests that parents who can access short breaks, specialist childcare and individual budgets value these services, but that provision varies and access is often limited. And although the Aiming High document repeatedly refers to improvements in educational provision, the Education and Skills Select Committee report on Special Educational Needs, published less than a year earlier, had described the SEN system as ‘not fit for purpose’. Little mention is made in the Aiming High document of medical provision except in the context of improving workforce skills and behaviours. More recent reports on the state of healthcare (Kennedy), social care (Munro) and education (Lamb) suggest that there is still considerable scope for improvement in terms of universal services for children with disabilities. This is somewhat at odds with the overall impression I got from the Ofsted report that despite some weaknesses in the system around prevention of maltreatment and neglect by parents and carers (paras. 104-8), most local authorities had good information about disabled children, a high level of commitment to supporting them, and offered a wide range of early support services (para. 15).

Clearly the quality of healthcare, social care and education services has a disproportionate effect on the development of children with disabilities and the functioning of their families. But the home is not the only source of child maltreatment and neglect. It could be argued that disabled children in England have always been subject to systems maltreatment and neglect because they have never had access to consistently high quality support that’s timely, appropriate and effective. Ofsted’s focus was on safeguarding and looked after children services. But a narrow view of what constitutes child protection, overlooking concerns about universal services raised in recent high-profile reports, and basing statistical analyses on assumptions and unreliable data doesn’t help to paint an accurate picture of the real level of risk to disabled children.

A fundamental principle of democracy is that everyone matters. A key indicator of the health of a democratic society is how it treats its most vulnerable members, and disabled children constitute one of the most vulnerable groups in our society. Disability can strike anyone at any time, which is why it’s so important to have timely, appropriate and effective interventions available. Such interventions can optimise the quality of life of disabled people and their families as well as increasing the likelihood that the disabled person and their carers will be able to work and reducing the cost of support and the interventions that are too little too late – outcomes dear to the heart of the current government.

Despite its obvious concerns about the wellbeing of disabled children, I felt the Ofsted report perpetuated their marginalisation by failing to consider the wider failings of systems that are supposed to offer support.

what is it about child protection plans and statistics?

Ofsted warns of abuse risks to disabled children” says the BBC headline about the report entitled Protecting disabled children; thematic inspection published last week. And indeed the report opens by reminding us that research “indicates that disabled children are more at risk of being abused than non-disabled children”. It goes on:

However, they are less likely than other children in need to become the subject of child protection plans. This suggests either that risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe.

The thematic inspection was undertaken to find out more. I’ll come back to the findings later, but in this post I want to take a closer look at the data about risk that appear to have prompted Ofsted’s interest. The research cited in support of Ofsted’s opening claim consists of one paper (Sullivan and Knutson, 2000) describing a large-scale study of children in Omaha, Nebraska during 1994-95. Disabled children were found to be 3.4 times more likely to have experienced maltreatment than non-disabled children.

By contrast, Ofsted points out;

The children in need census as at 31 March 2011 showed that there were 382,400 children in need in England of whom 54,100 (14.2%) were recorded as having a disability. At that time 42,700 (11%) children were subject to a child protection plan of whom 1,600 (3.8%) were recorded as having a disability. Children with a recorded disability were therefore less likely to be the subject of a child protection plan than other children in need.” (p.8)

If I’ve understood this correctly, it’s saying that if disabled children are at a higher risk of maltreatment than non-disabled children, you’d expect to see a higher rate of child protection plans (CPPs) amongst disabled children. But the frequency of CPPs amongst disabled children is lower (3.8% as compared to 11%), prompting concerns about children falling through the net.

There was something that didn’t look quite right about Ofsted’s analysis and I think I’ve figured out what it is. (I should point out that statistical analysis isn’t my forte, so please let me know if I’ve got it wrong.) I think there are three problems with Ofsted’s data;

– the level of risk to disabled children is based on an assumption
– the figures for children in need and disabled children are unreliable
– the level of risk and level of CPPs are derived from qualitatively different populations.

Assumptions about disabled children and the risk of maltreatment

First, let’s look at the figures for the risk of maltreatment. Little relevant research has been undertaken. Sullivan and Knutson’s study did indeed find that disabled children were 3.4 times more likely than non-disabled children to experience maltreatment. But they also cite an earlier finding that the risk was 1.7 times higher (p.1258). It’s clear from previous research that determining the prevalence of maltreatment is dependent on factors such as the quality of available data, quality of support services, definitions of disability and maltreatment, and whether disability has led to maltreatment or maltreatment has led to disability. This means that the prevalence of maltreatment is likely to vary widely between communities. The figure Ofsted took as its baseline for England was one that emerged from data gathered almost 20 years ago and 5,000 miles away in a community with a very different healthcare system. We don’t actually know the risk of maltreatment for disabled children in England.

Who qualifies as a child in need or a disabled child?

Let’s assume for the moment that disabled children are at a higher risk of maltreatment than non-disabled children. Whatever the level of increased risk, we’re still left with the question of the lower proportion of disabled children with a CPP.

Sullivan and Knutson’s sample consisted of 50,278 children enrolled in the Public (OPS) and Archdiocese schools of Omaha, Nebraska during the 1994–95 school year. It included children in other educational programmes and therefore covered an age range between 0-21. So the sample represented almost all children in a specific geographical area. But the sample Ofsted refers to consists, not of all children in a geographical area (in this case England), but of children in need in that location.

Section 17 (10) of the 1989 Children Act defines children in need as follows:

“For the purposes of this Part a child shall be taken to be in need if—
(a) he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services by a local authority under this Part;
(b) his health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services; or
(c) he is disabled”

and s. 17 (11) defines ‘disabled’ as;

For the purposes of this Part, a child is disabled if he is blind, deaf or dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed; and in this Part—
* “development” means physical, intellectual, emotional, social or behavioural development; and
* “health” means physical or mental health.”

The first problem that arises is one of classification. The Children Act appears to class all disabled children as ‘children in need’, whether or not they are considered to be otherwise at risk. But local authorities don’t necessarily do that. DirectGov site says ‘local councils must identify the extent of need in their area and make decisions about levels of service they provide’, and it’s clear from local authority websites that their criteria for ‘children in need’ and criteria for ‘disabled children’ vary somewhat. One local authority officer told me that her LA classifies all disabled children as children in need whereas Cheshire East, for example, carries out an assessment to determine whether a disabled child qualifies as a child in need.

Then there’s the issue of the reliability of local authority records. The Citizen’s Advice Bureau tells us that ‘the local authority must keep a register of children with disabilities in its area but does not have to keep a register of all children in need’. Local authorities might be required to keep a register of children with disabilities, but that doesn’t mean that all children with disabilities will be registered. A recurring complaint from my own local authority is that although they have a register, it’s perpetually out of date and incomplete. In short, if LAs are unclear about how many disabled children and how many children in need are living in their area, the census data cited by Ofsted might not be entirely reliable. I did try to find out what data were collected by the census, but failed. If you can figure it out, let me know.

Qualitatively different populations

A key problem with Ofsted’s data is that if some LAs are treating all disabled children as children in need, but are treating non-disabled children as children in need only if their health or development is at risk, this would result in non-disabled-children-in-need being at a higher risk of maltreatment than non-disabled children-in-the-general-population. Ofsted is comparing data drawn from two qualitatively different populations – the general population vs children in need.

Child protection plans

What difference does that make to Ofsted’s concern about CPPs? It means that you’d expect non-disabled-children-in-need to have a disproportionately high level of CPPs compared to non-disabled-children-overall. That would widen the gap between CPPs for non-disabled children and CPPs for disabled children, making the proportion of CPPs for disabled children look disproportionately low. Some calculations might clarify the point:

Sullivan and Knutson set out their data (for all children) in a 2 x 2 matrix as shown below:

If Ofsted’s data (for children in need) are set out in the same way, they look like this:

In Table 2, the proportion of non-disabled children with CPPs is 4 times the proportion of disabled children with CPPs, exactly the opposite of Sullivan and Knutson’s trend, and that’s what Ofsted is concerned about.

But Sullivan and Knutson’s finding was based on data from all children in a location, not just children in need. If we put Ofsted’s figures into the context of all children in a location (in this case, England), a different picture emerges. (The total figures for all children and for all disabled children are estimates – the figure for disabled children is the Aiming High estimate).

If my calculations are correct, the proportion of non-disabled children with CPPs in the whole population of non-disabled children is only 0.39%, whereas the proportion of disabled children with CPPs in the whole population of disabled children is slightly lower at 0.28%, considerably less than the 4-fold ratio if children in need only are taken into consideration. When the population differences are corrected for (as far as is possible with the data provided), the discrepancy between CPP rates for disabled and non-disabled children almost disappears.

*********

There’s something about child protection plans that seems to have an adverse effect on statistical analysis. UK readers who were home-educating their children during the Badman review in 2009 will probably recall the disagreement between Graham Badman and Graham Stuart (later to become Chair of the Education Select Committee) about the proportion of home-educated children subject to CPPs. The central issue was that the total number of home-educated children in the UK was unknown; estimates had varied between 20,000 and 150,000. You can read the full account here, but I thought it was worth reproducing some of the exchange in full:

Graham Badman: I reflected a great deal on our exchange of views, I promise you. I did go back and look at the figures and I came up with exactly the same conclusion. In fact, if you want me to qualify it, when surveying the number of child protection plans in the authorities that we covered in the last survey, we came up with a figure of 0.4 per cent., which is double that within the normal population. In fact, that figure could be fractionally higher, because we discounted any child protection plan that was there as a consequence of disability. I know you argued that because I did not know about the other half, that therefore negated it and made it even again. My argument in return, as you will recall, was that because we did not know about the other half, that did not mean to say that they were all safe either. It could be exactly the same figure or more.

Q 86Mr. Stuart: May I interrupt you there? The question was not about the letter to the Select Committee in which you suggested that I had said that any child who was not known about was automatically safe. I said no such thing, so you have your facts wrong there—again. What we were establishing was the rate of child protection plans in the home-educating community. We went through it slowly, and you want to rehearse it, so I will rehearse it.

If you have a child protection plan, automatically you are known to the local authority, so children previously not known to the local authority who become subject to a child protection plan are then known to the local authority. It does not by any means guarantee that children who are not known to the local authority and do not have a child protection plan are necessarily safe. But what you do know is that every child with a child protection plan is known to the local authority, and you claimed, completely erroneously—and although you have been corrected, here you are months later still getting it wrong, which is pretty frightening—that the percentage of children who are home educated who have a child protection plan is double the national average, when your own report suggests that the numbers are at least double the 20,000, which is the number registered with the local authority, and the Secretary of State said on Second Reading that the Government estimated the number was 70,000. They do not know for sure, but they think it is 70,000.

If you take the number of home-educated children with a child protection plan and you see that as a percentage of 70,000, it comes out at a great deal less than the average for the population, and that I believe is the definitive statement of what we know. It does not tell us everything we need to know, which is why I would not overstate my reliance on it. Could you please comment on whether you believe that we can truly say, as you have repeatedly said, that there is double the rate of the most serious level of child protection plan among children who are home educated?

Graham Badman: I fear we are in danger of going round in the same circle. I am afraid I fundamentally disagree with you. You think I am wrong; I think you are wrong.

Mr. Stuart: It is maths.

Graham Badman: Well, fine; we might want to debate that later—perhaps you went to a better school than me. The fact remains that I do not agree with your assumptions. On the basis of the data collected from the local authorities and from two surveys that have been validated by DCSF statisticians, I believe that we are quite safe in saying that on the basis of the child protection plan analysis that they carried out, there are twice as many young people on a child protection plan known to local authorities within that population as are within the general population. That is a fact. I am sorry that you do not agree with me, but we could go on for ever disagreeing.

I also have concerns about other aspects of the report, which I’ll discuss in the next post.

Reference

Sullivan, P.M & Knutson, J.F (2000). Maltreatment and disabilities: A population based epidemiological study. Child Abuse & Neglect, 24, 1257–1273,

policy makers on the brain

Findings from neurobiology research are presented as ‘medical evidence’ by politicians Graham Allen and Iain Duncan Smith to support their proposals for early intervention programmes for children from deprived backgrounds. Before looking in detail at what they have to say about brain development, it might be helpful if I summarise my understanding of the process. It squares with the account cited by Munro here [1]; so I’m assuming I’m on the right track.

Brain development

Brain development is an outcome of the interaction between four factors [2];

• genetic
• epigenetic (the impact of the environment on gene expression)
• environmental (from nutrition to the behaviour of others)
• behavioural (the impact of the child’s own behaviour)

The relative impact of the different factors varies between individuals and at different stages of development.

The number, formation and location of brain cells (neurons) is almost entirely genetically determined, although it can be affected by environmental factors. A baby has a full complement of neurons at birth, although some neurogenesis occurs in some areas of the brain in adults.

Interconnections between neurons are formed by synapses.

diagram of synapse

The evidence suggests that the role of synapses in learning is essentially a three-stage process.

Novel patterns of sensory input result in new synapses being formed (synaptogenesis). The number of synapses in the brain increases dramatically in the first three years after birth, running into trillions – far more than are found in adult brains.

If the same patterns of sensory input are repeated, some neuronal connections are reinforced and others weakened by synapses dying off (synaptic pruning), resulting in the formation of efficient information-processing pathways.

A third stage, myelination, takes place when neuronal pathways that are used repeatedly develop a fatty myelin sheath that greatly increases the speed of transmission of electrical impulses along the neurons. This makes some processes very fast and they are experienced as ‘automatic’.

Learning also appears to be kick-started by genetically-controlled factors such as the underlying structure of the brain and reflex responses. Reflexes are automatic, unconscious motor responses to stimuli [3], ranging from tongue protrusion to the step-reflex that forms the basis for later walking [4].

When DNA divides during the formation of gametes (eggs and sperm), and then recombines at conception, it is susceptible to the deletion, duplication and transposition of genetic material. Because of these genetic variations, and the impact of epigenetic factors during development, each human being is genetically unique. This means that due to genes alone, one would expect to find a wide range in abilities, behaviours and personalities across a large population. This variation would increase through interaction with environmental factors.

The second chapters of the papers by Allen and Duncan Smith are about brain development and particularly about how maltreatment and neglect can affect it. Although I can see what these chapters are getting at, my impression is that they include a number of misunderstandings, over-simplifications, assumptions and statements that are simply incorrect. This is a long post – I’ve detailed several examples.

Early Intervention: Good Parents, Great Kids, Better Citizens

Graham Allen MP

Rt Hon Iain Duncan Smith MP

1. “Human infants arrive ready to be programmed by adults. From our first moments of life we are tuned into the facial expressions of those around us, as can be seen from the infant reflex to mimic.” (p.56)

Although there’s no doubt that children are influenced by adults, I think many parents and teachers would question whether they can be ‘programmed’; if that were the case, children with good parents would consistently display exemplary behaviour.

It’s not clear what is meant by a ‘reflex to mimic’. A reflex is an automatic response to a stimulus. Mimicry (in humans) involves copying an action made by someone else. Newborns do appear to mimic some facial movements such as mouth opening and tongue protrusion, although it’s not clear whether this is a reflex response (e.g. tongue protrusion occurring in response to objects moving toward the baby’s face [5]) or active mimicry. In addition, there is the question of which adult behaviours children mimic, since they clearly don’t mimic all of them, which suggests that mimicry isn’t a reflex. Newborns are indeed tuned in to facial expressions, but whether that’s because the infant visual system is good at pattern-matching and adult faces are a frequently encountered visual pattern, or whether infants have an inbuilt preference for faces is still unclear.

2. “The problem is that this wonderful advantage turns into a disadvantage when it is met by the longterm lack of positive expression on the nearest face, that of the primary caregiver. When this most basic need for a positive response is not met, and when a tiny child does not feel secure, attached and loved, the effect can be lifelong. Neuroscience can now explain why early conditions are so crucial: effectively, our brains are largely formed by what we experience in early life.” pp.(56-57)

This statement assumes that from the ‘first moments of life’ a baby recognizes a positive facial expression, is capable of feeling security, attachment and love, and that the absence of these feelings can have a lifelong effect. There’s no doubt that what a newborn experiences affects brain development, but no evidence is cited for a basic ‘need’ in newborns for any particular facial expression or affect state.

Neuroscience does not claim that ‘our brains are largely formed by what we experience in early life’. Quite the contrary; what it claims is that our brains are formed by the interaction between genetic expression and experience. In the first moments of life genetic factors are disproportionately predominant because the child has had very little experience.

3. “As synapses are also strengthened and reinforced by experience, early life defines which of them live and which die. Synapses become ‘hard-wired’, or protected, by repeated use, enabling very rapid learning via early life experience. Conversely, just as a memory will fade if it is hardly ever accessed, unused synapses wither away in what is called ‘pruning’. In computer terms what takes place is the software (programming by the caregiver) becomes the hardware (the child’s fully-grown brain). The whole process has the effect of making early learned behaviour resistant to change.” (p.57)

If this model were correct, adults would be unable to learn anything. They wouldn’t be able to correct early misconceptions because the relevant synapses would be ‘protected’, nor would they be able to develop new skills because the relevant synapses would have ‘withered away’ through early lack of use. The term ‘hard-wired’ is usually used to refer to biologically determined connections in the brain (those that don’t rely on information from the environment), not to neural pathways developed via experience. Training in the armed forces and emergency services demonstrates that well-established patterns of what’s normally considered instinctive behaviour (panic, aggression etc.) can be over-ridden, provided enough rehearsal of new behaviours takes place. And the Cambridge delinquency study shows that violent and aggressive behaviour in young males falls off rapidly as they get older indicating that behaviour patterns are not set in stone.

In addition, the passage allocates all experience to ‘programming by the caregiver’ as if children receive no other environmental input. This might be the case for a child kept in a sound-proofed, darkened room, but for most children, however deprived, the caregiver’s ‘programming’ forms only a part of the input from the environment.

4. “To summarise: scientific discoveries suggest it is nurture rather than nature that plays the lead role in creating the human personality.” (p.57)

What scientific discoveries actually suggest is that nature and nurture play an approximately equal role in influencing human behaviour and that their relative contributions vary throughout the lifespan. Much of the environmental variation is due to chance events in later life rather than early experience [6].

5. “The more positive stimuli a baby is given, the more brain cells and synapses it will be able to develop”. (p.57)

The number of brain cells is almost completely genetically determined; neurons are not formed in response to positive stimuli and the baby has a full complement at birth. What the research suggests is that connections between brain cells (synapses) are formed in response to novel sensory information (‘positive’ or otherwise) and are then pruned when those stimuli are repeated, to create robust pathways for processing information that is handled repeatedly. And that synaptic pruning is what is critical for making information processing efficient. People whose synapses are not pruned at the typical rate often have significant learning difficulties [7].

6. “Trauma also confuses the neurotransmitter signals that play key roles in directing the paths of growing neurons and therefore hinders brain development.” (p.60)

Some neurotransmitters are involved in neuronal migration but no evidence is presented as to how trauma confuses their signals or what deficits occur as a result. The primary role of neurotransmitters is to activate or inhibit neighbouring neurons across synapses.

7. “ To the best of current knowledge, the sensitive window for emotional sensitivity and empathy lies within the first 18 months of life, and these ‘skills’ are shaped by the prime caregiver”. (p.60)

This assertion appears to be based on work by Schore [8] although there is no attribution in this section. There’s a debate over sensitive or critical periods; they certainly exist for basic visual and auditory processing skills, but windows for other more complex skills are less clear-cut. If there is a sensitive window for emotional development within the first 18 months of life, how is the success of emotional literacy programmes explained and how could early interventions up to the age of 3 years be effective?

8. “Because the infant’s cortical and hippocampal emotional circuits require significant time and experience to mature, the child must regulate its inner world primarily through attachment relationships with primary caregivers. It accomplishes this through aligning its state of mind with that of the caregiver, by establishing a conduit of empathic attunement, functioning as an emotional umbilical chord.

Babies who are healthily attached to their carer can regulate their emotions as they mature because the cortex, which exercises rational thought and control, has developed properly. However, when early conditions result in underdevelopment of the cortex, the child lacks an ‘emotional guardian’.”(pp.61-62)

I think what this passage is trying to say is that prior to the maturation of frontal cortex which plays a significant role in controlling behaviour, infants regulate their behaviour in response to what primary caregivers do. What the passage does say is open to question. It’s unclear what is meant by ‘emotional circuits’; there’s no mention of the significant role of the amygdala in emotional processing; no evidence is cited to support the idea that a child needs to ‘regulate its inner world’ as if through some form of emotional homeostasis, nor to support the idea that a child can do so only via an attachment relationship with a primary caregiver. What exactly is meant by a child ‘aligning its state of mind’ or ‘a conduit of empathetic attunement’ isn’t clear.

9. “Following a 10-year immersion in thousands of scientific papers on neurobiology, psychology and infant development, Alan Schore concluded:

The child’s first relationship, the one with the mother, acts as a template that permanently moulds the individual’s capacity to enter into all later emotional relationships’

We glimpse this in the way small children look to a parent’s facial expressions and other non-verbal signals to determine how to respond (and feel) in a strange or ambiguous situation.” (p.62)

Dr Schore has done some impressive work on brain development and emotion, but this statement doesn’t reflect the wide range of factors known to impact on emotional relationships. In fact, all the neurobiological findings cited in Early Intervention: Good Parents, Great Kids, Better Citizens appear to have been filtered through a psychodynamic model of child development, notably attachment theory. The paper also relies heavily on a small number of sources; Bruce Perry, for example, gets 17 mentions (and 11 in Early Intervention: The Next Steps). It’s difficult to avoid the impression that the paper started out with a thesis and then selected evidence to support it.

Now for;

Early Intervention: The Next Steps

10. The cover image

Cover image from “Early intervention: The next steps”

The caption for this image says the right hand scan is from a series of three children, but the original source (a paper by Bruce Perry) [9] says it’s from one child in a group of 40 identified as having suffered global neglect (defined as ‘relative sensory deprivation in more than one domain…e.g. minimal exposure to language, touch and social interactions’). MRI or CT scans were available for 17 of those children, of which 11 were deemed abnormal. It isn’t clear what variation there was within the group, or whether possible genetic causes or environmental causes other than sensory deprivation were investigated. Perry’s team found ‘dramatic differences’ from the average in head circumference. There was ‘some recovery of function and relative brain-size’ after a year in foster care. There were no marked differences between neglected and control groups in the much more common ‘chaotic neglect’ (physical, emotional, social or cognitive).

I don’t doubt that children with minimal exposure to language, touch and social interactions have brains that differ from the norm, nor that they improve in foster care. However, Perry’s analysis raises a number of questions. Healthy, non-neglected children don’t have identical brains (the healthy brain was on the 50th percentile), so why not compare the neglected brain with one at the lower end of the normal range? What type of neglect had the child suffered? Were genetic disorders taken into account? Or diet? Or disease? Does the rate of increase of head circumference change with age? Does it vary between individuals? Although striking, all this particular image actually tells us is that one child who suffered global neglect also had abnormal brain development.

11. “Our responses to situations are not pre-set at birth. The nature/nurture debate has moved on, as was demonstrated in ‘Early Intervention: Good Parents, Great Kids, Better Citizens’.” (p.13)

The nature/nurture debate has indeed moved on, but not quite in the way Good Parents, Great Kids, Better Citizens thinks. See point 3 above.

12. “ Children are born with an instinct to engage socially and emotionally, especially with their mothers. They communicate with the voice, face and hands. They express a curiosity about both the world and their need for comfort and security.” (p. 14)

See points 1 & 2 above.

13. “Recent research also shows insecure attachment is linked to a higher risk for a number of health conditions, including strokes, heart attacks and high blood pressure, and suffering pain, for example from headaches and arthritis. Secure attachment was not linked to any health problems that have been studied.” (p.15)

The validity of attachment theory appears to have been accepted without question. Like many constructs used in psychiatry, ‘attachment’ is loosely defined and difficult to operationalise. Not all children develop patterns of attachment that fit neatly into Ainsworth’s categories, nor are patterns of attachment solely determined by parental behaviour [10].

I’m also concerned about the conflation of correlation with causation. A correlation between insecure attachment and heart disease, smoking etc. does not mean that they are necessarily linked, or even if they are, it doesn’t follow that insecure attachment is the cause of heart disease, smoking or reckless driving. It could equally well be the case that inherited characteristics that predispose people to heart disease, addictions or risk-taking, via low dopamine levels for example [11], could also contribute to inadequate parenting.

14. “Although poor parenting practices can cause damage to children of all ages, the worst and deepest damage is done to children when their brains are being formed during their earliest months and years. The most serious damage takes place before birth and during the first 18 months of life when formation of the part of the brain governing emotional development has been identified to be taking place.” (p.15)

The second sentence appears on p.71 of the Munro Review of Child Protection: Final Report, and is attributed to a Royal Society publication Brain Waves Module 2: Neuroscience implications for education and lifelong learning (Munro reference 95) which contains no such statement. Munro’s reference 94 is to Early Intervention: The Next Steps, so the attribution is obviously a typo, but nonetheless the assertion that poor parenting causes ‘brain damage’ is presented here as a matter of fact without any supporting evidence.

15. “Different parts of the brain (governing, for example, sight, hearing, etc) develop in different sensitive windows of time. The estimated prime window for emotional development is up to 18 months, by which time the foundation of this has been shaped by the way in which the prime carer interacts with the child.” (p.16)

See point 7 above. Presumably this claim is based on the same source, but no sources are cited here.

16. “Infants of severely depressed mothers show reduced left lobe activity (associated with being happy, joyful and interested) and increased right lobe activity (associated with negative feelings)19” (p.16)

The Dawson et al. paper (reference 19) is behind a paywall so I couldn’t clarify what is meant by left and right ‘lobes’ and their supposed functions. Presumably this refers to work that suggests the left and right frontal lobes respectively have specialized functions, but this isn’t made clear. Nor is it clear whether the levels of activity in the ‘lobes’ is due to the mothers’ depression or whether mothers and babies share biologically inherited activity patterns.

17. “One result is significantly fewer synapses (or connections). Specialists viewing CAT scans of the key emotional areas in the brains of abused or neglected children have likened the experience to looking at a black hole. In extreme cases the brains of abused children are significantly smaller than the norm, and the limbic system (which governs the emotions) may be 20–30 per cent smaller and contain fewer synapses.” (p.16)

According to Sue Gerhardt in Why Love Matters: How Affection Shapes A Baby’s Brain (her presentation to the Quality of Childhood Group in the European Parliament in December 2009) the ‘black hole’ quote comes from Harry Chugani [12], and refers to the development of medial prefrontal cortex (MPC) in the brains of Romanian orphans. Here, Gerhardt is talking about the development of the ‘social brain’ (MPC):

The less attention a baby receives, the less this part of the brain connects up. In the worst cases, like some of the most damaged Romanian orphans, this area of the brain was virtually a black hole according to one researcher, Harry Chugani.” (Gerhardt, p.89)

and illustrates the point using Perry’s image – the one that’s on the cover of the Allen report (Gerhardt, p.88). Although MPC is involved in emotional regulation, it is also involved in risk assessment and decision-making using information from many parts of the brain. It’s not clear whether MPC in the orphans was permanently or temporarily abnormal, or what had caused the abnormality. Genetic, nutritional or infective factors don’t appear to have been controlled for. And a small brain isn’t a bad thing per se; autistic children tend to have larger brains than average, for example. Chugani et al were investigating glucose metabolism in the brain, but Gerhardt doesn’t mention this, so it would be all too easy for people unfamiliar with the technical problems associated with interpreting brain scans to go away with the impression that neglect causes children to develop holes in their brains.

18. “Schore has spoken of ‘the child’s first relationship, the one with the mother, acts as a template … [that] permanently moulds the individual’s capacity to enter into all later emotional relationships’25. ”

To attune to a child means responding to their emotional needs, resulting in the child’s sense of being understood, cared for and valued. Empathy begins with the sense of oneness with the other created in this process of attunement. The quality of empathy – the ability to feel for and with another – is not only key to building sound emotional stability, it is also a key inhibitor of the development of a propensity to violence. Conversely, empathy fails to develop when prime carers fail to attune to infants in the first 18 months of life. Absence of such parental attunement, combined with harsh discipline, is a recipe for violent, antisocial offspring. Empathy is influenced very early in life by observed parental reactions to another’s suffering. Even in their first year, children already show signs of whether their reaction to the suffering of another is empathy, indifference or downright hostility.” (p.17)

The quotation from Schore also appears on page 62 of Early Intervention: Good Parents, Great Kids, Better Citizens and is widely cited on the internet, but I couldn’t locate the source; I couldn’t find it in note 25, Schore’s account of the right hemisphere’s role in emotion regulation. There is no question that a child’s early relationships are significant; but no evidence is provided that the relationship with the mother forms a template for all other relationships.

Conclusion

Both Allen and Allen & Duncan Smith papers are about Early Intervention Programmes – the brain development chapters are simply there to add weight to their arguments in favour of the programmes. I haven’t discussed the interventions themselves because I was primarily concerned about the material on brain development. There’s little question that many of the interventions will do some children some good; whether they will address the social problems they are meant to address is another matter. One of the difficulties with social problems is that they are often caused by complex interactions between many factors – so interventions aimed at one or two factors are likely to have only a small effect overall. For example, an evaluation of the Carolina Abecedarian project [13] shows that mean mental test scores for children improved by less than 10 percentage points and that early gains reduced markedly over time – there was little difference at age 21. Age at the birth of a first child was 19 in the treatment group compared to 17.5 yrs in controls. Differences in academic achievement were larger and were maintained – possibly due to the early language support in the programme leading to improved reading. In short, the programme had a beneficial effect, but whether it made significant inroads into ‘social problems’ is debatable.

What concerned me most about Early Intervention: Good Parents, Great Kids, Better Citizens and Early Intervention: The Next Steps is that neither is based on a systematic evaluation of neurobiological data, with the data themselves providing information about what could be done to reduce social problems. Instead, both papers start from a Freudian framework for child development, without questioning its fundamental assumptions; Allan Schore [8] is explicit about the direct descent of this framework from Freud via Bowlby’s attachment theory, and I’ve already drawn attention to the shortcomings of attachment theory.

Instead of drawing on our wide range of knowledge about child development as a whole, both papers focus on just one facet of it; emotional development. Furthermore, they focus on one facet of emotional development – attachment; and on one facet of attachment – the child’s relationship with the primary caregiver. The primary caregiver is often implicitly assumed to be the parent, and more specifically the child’s mother – even though fathers, grandparents and siblings are often primary carers and many children have more than one primary carer. This narrow model of child development is supported with often over-simplified and misunderstood neurobiological findings, selected, it appears, because they support the assumptions that the model makes. Findings that do not support these assumptions are simply omitted.

It could be argued, with good reason, that an in-depth analysis of the neurobiological evidence would be beyond the scope of policy papers like these. However, the omission of aspects of child development other than attachment to the primary caregiver is a serious one. It implies that interventions are being proposed on the basis of a belief that they will be effective, rather than on the basis of an evaluation of research evidence across all areas of child development. This introduces a significant risk of interventions failing to eliminate social problems and being abandoned despite some beneficial outcomes for the children involved. A better approach might have been to enlist the help of a developmental neurobiologist for the evaluation of neurobiological evidence, to identify all the reasons why young people fail to reach their potential and to look at interventions which address each reason, including taking a critical look at the efficacy of current healthcare, education and social support systems.

References

1. National Research Council (2000), From Neurons to Neighborhoods: The Science of Early Childhood Development (Chapter 8), Washington D.C. (available online at http://www.nap.edu/openbook.php?isbn=0309069882)
2. Mareschal, D., Johnson, M., Sirois, S., Spratling, M., Thomas, M. & Westermann, G. (2007). Neuroconstructivism: How the Brain Constructs Cognition, vol. 1. Oxford: Oxford University Press.
3. See e.g. http://en.wikipedia.org/wiki/List_of_reflexes_%28alphabetical%29
4. Thelen, E. & Fisher, D. M. (1982). Newborn stepping: An explanation for a “disappearing” reflex. Developmental Psychology, 18, (5), 760-775.
5. Chen, X., Striano, T. & Rakoczy, H. (2004). Auditory–oral matching behavior in newborns, Developmental Science, 7, (1) 42–47.
6. Pinker, Steven (2002). The blank slate: The modern denial of human nature, Penguin.
7. Cohen, I.L. (2007). A neural network model of autism: implications for theory and treatment. In D. Mareschal, S. Sirois, G. Westermann & M. Johnson (2007). Neuroconstructivism: Perspectives and Prospects, vol. 2. Oxford: Oxford University Press.
8. Schore, A. (2000). Attachment and the regulation of the right brain, Attachment & Human Development, 2 (1), 23–47.
9. Perry, B. (2002). Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture, Brain and Mind 3, 79–100.
10. 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.
11. Iversen, L. (2008). Speed, Ecstasy, Ritalin: The Science of Amphetamines, Oxford University Press.
12. Chugani, H.T., Behen, M.E., Muzik,O., Juhasz, C., Nagy, F. & Chugani, D.C. (2001). Local Brain Functional Activity Following Early Deprivation: A Study of Postinstitutionalized Romanian Orphans, NeuroImage 14, 1290–1301.
13. Early Learning, Later Success: The Abecedarian Study (1999). Highlights of the Age 21 Follow-up Study, Chapel Hill: University of North Carolina, FPG Child Development Center. Available at http://fpg.unc.edu/sites/fpg.unc.edu/files/resources/reports-and-policy-briefs/EarlyLearningLaterSuccess_1999.pdf

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.