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Protecting children from adversity key to healthy development

August 16, 2011 — For years, state and national policy regarding early childhood has focused primarily on educational enrichment.

That’s all well and good, but it’s not enough, says Jack P. Shonkoff, Julius B. Richmond FAMRI Professor of Child Health and Development at Harvard School of Public Health (HSPH) and at the Harvard Graduate School of Education, and Professor of Pediatrics at Harvard Medical School. Shonkoff believes that it’s just as crucial to develop programs that will protect young children from adversity—such as neglect or violence—as it is to support their education. He cited a growing body of research that shows such adversity is associated with significant negative impacts on health as well as learning that can last into adulthood.

“We need new approaches to prevent disruption of developing biological systems in young children,” Shonkoff told listeners at an Aug. 9, 2011 Hot Topics lecture at HSPH. “The current early childhood policy arena, which is all about school readiness, has to not just reduce barriers to learning, but also build the foundations of physical and mental health.”

In his talk, titled “Leveraging Science to Shape the Future of Early Childhood Policy,” Shonkoff described the history of federal and state investment in early childhood and summarized a number of studies that have documented significant societal benefits.

Since the 1960s, Shonkoff said, early childhood policy has centered around developmental enrichment services and access to medical care. Such policy has been based on a handful of randomized trials that have produced evidence of long-term financial return to society, such as decreased special education costs, reduced welfare dependence, greater earning power (and, therefore, greater tax-paying power), and reduced incarceration.

In spite of an infusion of both federal and state dollars over the years, however, “There has been little impact on reducing poverty, economic inequality, or social class disparities in educational achievements and health,” Shonkoff said.

To remedy the situation, Shonkoff believes that researchers and policymakers must develop fresh ideas to support young children, focused not just on education but also on healthy development and disease prevention. Specifically, Shonkoff said it’s important to gear efforts toward ensuring that young children have supportive, stable relationships with adults, including family, friends, neighbors, and workers in early care and education programs. He also said policymakers should focus on children’s nutrition as well as the physical and chemical environments in which they live.

Recent advances in science, molecular biology, and genetics are helping researchers dig deeper into how early childhood trauma can undermine healthy development, Shonkoff said.

For example, he noted a recent U.S. study that suggested that the more risk factors a young child faces, such as abuse or neglect, the greater the probability that the child will fail a developmental test by age 3. “These results tell us that this pileup of adversity is obviously undermining healthy brain development,” Shonkoff said.

He also cited a recent longitudinal study from New Zealand that linked maltreatment in childhood to a biomarker of greater risk of cardiovascular disease at age 32. While the study doesn’t “prove” anything—it shows an association, not cause—it does add to a growing body of evidence suggesting that “biological memories” of early adversity can lead to higher risk for disease later in life, Shonkoff said.

Researchers are increasingly studying how stress responses in young children can affect the brain and other organs, he said. In response to adversity, the body produces elevated cortisol levels, which help to manage stress, but which can disrupt brain circuitry or even kill brain cells in high amounts. Likewise, stress can cause over-production of inflammatory cytokines, which are associated with accelerated atherosclerosis, and elevated glucose, which is associated with both insulin resistance and metabolic syndrome.

“The stress system is an acute response mechanism essential to survival,” Shonkoff said. “But it wasn’t meant to be activated all the time, and when it’s chronically activated, it can damage developing organs.”

Shonkoff believes it’s crucial for researchers to learn more about how to reduce or mitigate the effects of stress on young children. And it’s equally important to translate those findings into more effective interventions.

“The concept of enrichment and support is not wrong,” he said. “It’s necessary, but it’s insufficient. It needs to be balanced by greater attention to protection from biological harm for that part of the population that is dealing with significant adversity.”

–Karen Feldscher

Photo: Aubrey LaMedica

Learn more

Center on the Developing Child

“Healthy Children: The Best Investment” (Harvard Public Health Review)

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