brain development and social problems

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

Graham Allen MP

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

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

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

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

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

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

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

What’s the evidence?

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

what social workers are supposed to know about child development

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

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

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

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

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

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

Then, on disability and developmental milestones:

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

And from Marchant (see [3] below);

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

Comment

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

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

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

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

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

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

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

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

Comment

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

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


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

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

Comment

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

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

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

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

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

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

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

Comment

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

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

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

What these texts aren’t saying

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

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

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

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

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

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

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

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

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