The Science of Healthy Development:
Closing the Gap Between What We
Know and What We Do
JACK P. SHONKOFF, M.D.
JULIUS B
B. RICHMOND FAMRI PROFESSOR OF CHILD HEALTH AND DEVELOPMENT
DIRECTOR, CENTER ON THE DEVELOPING CHILD
HARVARD UNIVERSITY
Paul A. Harper Lecture, Johns Hopkins University | Baltimore, MD
April 2, 2008
The Importance of Viewing the Needs
of Children in a Broad Context
The healthy development of all children
benefits all of society by providing a
solid foundation for economic
productivity responsible citizenship
productivity,
citizenship, and
strong communities.
1
Science Tells Us that Early Life
Experiences Are Built Into
Our Bodies
Barriers to Social Mobility Emerge
at a Very Young Age
Cumula
ative Vocabulary (Words)
200
1200
College Educated
Parents
600
Working Class
Parents
Welfare
Parents
200
16 mos.
24 mos.
36 mos.
Child’s Age (Months)
Source: Hart & Risley (1995)
2
Risk Factors for Adult Depression are
Embedded in Adverse Childhood Experiences
5
Odds Ratio
O
4
3
2
1
0
1
2
3
4
ACEs
5+
Source: Chapman et al, 2004
Risk Factors for Adult Heart Disease are
Embedded in Adverse Childhood Experiences
Odds Ratio
3.5
3
2.5
2
1.5
1
0.5
0
1
2
3
4
ACEs
5,6
7,8
Source: Dong et al, 2004
3
Resilience is Related to the Interaction
Between Genetics and Experience
Depression
Risk
SS
.70
S = short allele
L = long allele
.50
SL
.30
LL
No Abuse
Moderate Abuse
Severe Abuse
Early Childhood Experience
Source: Caspi (2003)
Building an Integrated Science of
Child Health,
H lth Learning,
L
i
and
dB
Behavior
h i
Blending the tools of the biological,
behavioral, and social sciences to study the
interactive influences of genetics and
experience on the developing brain – and
closing the gap between what we know and
what we do to enhance the healthy
development of children.
4
Core Concepts of Development
Brains and skills are built over time, neural
circuits are wired in a bottombottom-up sequence,
and the capacity for change decreases with
age.
The interaction of genes and experience
shapes the architecture of the developing
brain, and the active agent is the “serve and
return” nature of children’s relationships with
the important adults in their lives.
Human Brain Development
Synapse Formation Dependent on Early Experiences
Language
Sensory Pathways
(Vision, Hearing)
Higher Cognitive Function
FIRST YEAR
-8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Birth
(Months)
(Years)
Source: C. Nelson (2000)
5
Early Childhood Adversity Can Influence
a Range
R
off Lif
Lifelong
l
Outcomes
O t
Research on the biology of stress helps
explain some of the underlying reasons for
differences in learning, behavior, and
physical and mental health.
Positive Stress
A necessary aspect of healthy development that occurs
in the context of stable, supportive relationships.
Brief increases in heart rate and mild changes in stress
hormone levels.
Tolerable Stress
Stress responses that could disrupt brain architecture,
but are buffered by supportive relationships.
Allows the brain an opportunity to recover from
potentially damaging effects.
6
Toxic Stress
Strong, prolonged activation of the body’s stress
response systems in the absence of the buffering
protection of adult support.
Can damage developing brain architecture and
create a short fuse for the body
body’s
s stress response
systems, leading to lifelong problems in learning,
behavior, and both physical and mental health.
Institutionalization and Neglect of Young
Children Disrupts Their Body Chemistry
35%
Percent of
Children
with
Abnormal
Stress
Hormone
Levels
30%
25%
20%
15%
10%
5%
Middle Class US Toddlers
in Birth Families
Neglected/Maltreated Toddlers
Arriving from Orphanages Overseas
Source: Gunnar & Fisher (2006)
7
Investigating the Biology of Disparities in
Health and Education Outcomes
Persistent elevations of cortisol, the development of
the hippocampus, and the “achievement gap.”
Increased levels of cytokines and the pathogenesis
off depression.
d
i
Chronic activation of the inflammatory response and
the development of cardiovascular disease and
diabetes.
Implications
I
li
i
for
f
Policy and Practice
8
There Are No Magic Bullets
Positive relationships and quality learning
experiences can be promoted both at home and
through a range of evidence
evidence--based parent
education, family support, early care and
education, and intervention services.
A balanced approach to emotional, social,
cognitive and language development will best
cognitive,
prepare children for success in school and later in
the workplace.
Highly specialized interventions are needed for
children experiencing tolerable or toxic stress.
Maximizing Return on Investment
The basic principles of neuroscience and human
capital formation indicate that later remediation
will produce less favorable outcomes than
preventive intervention.
Responsible investments focus on effective
programs that
h are staffed
ff d appropriately,
l
implemented well, improved continuously, and
generate benefits that exceed or justify their
costs.
9
Cost/Benefit for Two Early Childhood Programs
(Dollars returned for each dollar invested)
$18
$16.14
$16
Total Return per $1 Invested
$14
$12
Returns to Society
$11.35
$10
$2
Returns to Individuals
$4 10
$4.10
$6
$4
4x
$1.55
$2.28
$3.24
Perry Preschool
(through age 40)
Crime-cost savings
$0.16
1.5 x
$1.57
Special education,
welfare, income taxes
Increased earnings
Abecedarian Project
(through age 21)
Using the Science of Child Development
As a New Lens for Public Health Policy
Greater focus on causal links between toxic stress in
the early years and susceptibility to physical and
mental health impairments in later adulthood.
Increased investment in a skilled early childhood
workforce and evidence
evidence--based interventions to reduce
significant adversity in early childhood.
Leveraging an expanded science base to harness the
power, resources, and sustainability of bipartisanship
and publicpublic-private collaboration.
10
www.developingchild.harvard.edu
11