Early moral development Early moral development and and

Preventive interventionsPreventive interventions

CLASSIC STUDY OF CLASSIC STUDY OF SKEELSSKEELS

A 30 YEAR FOLLOW UP

Skeels, H., Monographs of SRCD, 1966

E GROUP C GROUP (N=13) (N=12)

AT TIME OF TRANSFER:X AGE 19 Months 17 Months

X I.Q. 64 87 (“unsuitable for

adoption”)2 YEARS LATER:X I.Q. 93 60.5

5 YEARS LATER: 11 Adopted None Adopted

X I.Q. 96 66

30 YEARS LATER:

11 Adopted None Adopted All Self Supporting 5 in Institutions;

(1 Died @ Age 15)Education 12th Grade 3rd Grade

Marriage 11 Married 2 Married

Children T of 28 T of 5; X I.Q. 104 4 “Normal”;

None Retarded 1 Retarded

Estimated Cost 5XSKEELS/rne/4-97

Outline

• Introduction: long-term studies and surprises• Surprises from 5 US early intervention studies• Recap: Surprises about early moral development • Early Head Start• Understanding genetics and development• Conclusions:

– Specifying the how– Answering Freud’s dream and the value of longitudinal

study

Long-term Effects Of Early Long-term Effects Of Early Intervention for children living in Intervention for children living in

circumstances of povertycircumstances of poverty

On Conduct !On Conduct !

Preventive intervention (P/I) studiesYoung children in poverty

Began Ages served

Follow up age

Perry Preschool * 1962 PS 27

Chicago CPC 1985 PS 18

Carolina Abecedarian * 1972 6-12W to 5 21

Syracuse Late 70’s Pre-n to 5 13-16

NFP Elmira HV * 1978 Pre-n to 2 17

* = RCT

P/I follow up studies Young children in poverty

N program N control Design

Perry Preschool 58 65 RCT *

Chicago CPC 837 444 Neighborhood C

Carolina Abecedarian

47 43 RCT

Syracuse 65 54 Demographic C

NFP Elmira HV

97 148 RCT

Perry Preschool ProgramPerry Preschool ProgramAbecedarian ProjectAbecedarian Project

• Less school dropout - P, A• Less teenage parenting- P, A

• Less juvenile delinquency- P• Less crime- P

Chicago PCP longitudinal studyChicago PCP longitudinal study

• Fewer juvenile arrests• Fewer violent arrests

• Less grade retention• Less use of special education

• (Less child maltreatment)

Syracuse family development Syracuse family development research programresearch program

• Fewer reported probation cases

• Fewer court offenses

Nurse Home Visitation- Elmira

• For C b low SES unwed mothers– Less running away– Less arrests– Less convictions– Less use cigarettes and

alcohol– Fewer behavioral

problems (reported)

• For mothers – Less welfare

dependence– Less child

maltreatment– Less criminality– Less use of adverse

substances

P/I follow up studies Young children in poverty

Est. dollar return

Perry Preschool (27) 1 $8 *

Chicago CPC (18) 1 $7 *

Carolina Abecedarian (21) 1 $4 *

Syracuse (13-16) ---

NFP Elmira HV (17) 1 $2.9 **

• * From Duncan and Magnuson, 2006

•** From Aos et al., 2004

Perry Preschool Programage 40 follow-up

• Fewer arrests overall

• Fewer arrests for:– Violent crimes– Property crimes– Drug crimes

From Schweinhart , L.J. et al. . 2005

From Schweinhart L.J.,et al. 2005

Heckman theoretical curve for investment at different points in the life cycle

From Heckman, J., 2006

Preventive intervention in circumstances of povertyPreventive intervention in circumstances of poverty

“... child caregiver relationships ...are critical for providing infants and toddlers support, engagement, continuity and emotional nourishment necessary for healthy development... Within the context of caregiving relationships, the infant builds a sense of what is expected, what feels right in the world, as well as skills and incentives for social turn-taking, reciprocity, and cooperation.” ...The infant's activities are nourished and channeled in appropriate ways so as to encourage a sense of initiative and self- directedness. During the toddler period,...through repeated interactions with emotionally available caregivers, [the child] also begins to learn basic skills of self-control, emotional regulation and negotiation.”

(U.S. DHHS, 1994, p 7.)

“...Empathy for others and prosocial tendencies for caring and helping also develop during toddlerhood as well as the emotions of pride and shame; experiencing and learning about these capacities require responsive caregiving relationships in the midst of life's inevitable stresses and challenges. ...A sense of pleasure, interest and exploration, early imaginative capacities, and the sharing of positive emotions also begin in infancy-- all of which require repeated and consistent caregiver relationship experiences and form a basis for social competence that carries through toddlerhood and the preschool period...”

(U.S. DHHS, 1994, p. 7)

EHS RCT• EHS begins 1995• 17 sites selected for research

–University partnerships–Diverse

• RA begins 1996

Programs• CD and Parenting Services• Enrollment before age12 mos.• Ave length enrollment 22 mos.• Different approaches

– Home– Center– Mixed

Data points

• Observations; HV’s and Child Care– 14 months– 24 months– 36 months

• Program evaluations– I+ year after study begins– 3+ years after study

– (5 years)

• Parent service interviews– Baseline– 6 months after– 14 months after– Exit; (25 plus after)

– (5 years- pre K)

National Results of National Results of ImpactImpact

N= 17 sites; 3001 familiesN= 17 sites; 3001 families

Positive Impacts on Multiple Dimensions of Children’s Development

•

Cognitive:

• Higher mean Bayley MDI • Smaller percent with MDI < 85

• Language:• Larger receptive vocabularies• Smaller percent PPVT<85

• Social-emotional development:• Lower levels of aggressive behavior• Higher sustained attention with objects• Greater engagement of parent• Less negativity toward parent

Impacts on Children’s Development and Learning at 2 and 3 Years of Age

8

-10-14

-10-8

711

15

20

-11-14

161312

-25

-20

-15

-10

-5

0

5

10

15

20

25

24 Months 36 Months

* p < .10 ** p < .05 *** p < .01

Aggressive Behavior

***

Effect Size(percent) Bayley

MDIVocabularyCDI-PPVT Engagement Negativity

SustainedAttention

Percent MDI< 85

***

**

***** **

**

***

****

Beneficial Impacts on Parenting and the Home Environment

• Warmth and supportiveness• Detachment• Quality of assistance• Support for language and literacy• Reading daily• Negative discipline

Impacts on Parents When Children Were 2 and 3 Years Old

-10 -9 -9

1

11111013.5

-14

9

17

101114.6

-25

-20

-15

-10

-5

0

5

10

15

20

25

24 Months 36 Months

HOMESupportive-

ness Read DailyDetachment Spanked

Effect Size(percent)

******

**

***

Education Employed

**

**

*

*** ** ****

* p < .10 ** p < .05 *** p < .01

Conclusions

• All program approaches had impacts

– Patterns of impacts varied by approach

• Full implementation matters

– Implementing key services in accordance with the Head Start Program Performance Standards for quality and comprehensiveness is important to success.

To Understand What Works To Understand What Works Under What Circumstances,Under What Circumstances,

And For WhomAnd For Whom

Other Subgroup Analyses

• Teen parents• Depressed mothers• Demographic risk• Local site analyses

Importance of longitudinal follow-up

• 5 years- pre K• Post first grade (4 sites)• Post fifth grade• Beyond ?

Frontiers of researchFrontiers of research

Thinking about genetic Thinking about genetic variationvariation

• Smaller number of genes than expectedSmaller number of genes than expected• Genes work in a multiplicity of waysGenes work in a multiplicity of ways• Genes work with environmental influencesGenes work with environmental influences

– Gene expressionGene expression– g/e correlations; - g/e interactions g/e correlations; - g/e interactions – Susceptibility genes Susceptibility genes

• Dimensional influencesDimensional influences• Background genetic influencesBackground genetic influences

DisorderDisorder

GS1/ES1

GP1/EP1

GSn/ESn

GS2/ES2

GP2/EP2

GPn/EPn

Background genetic influencesBackground genetic influences

G1/G2

G1/G2

Dunedin study

• Representative birth cohort of children born in Dunedin, NZ

• N= 1037• Ages 3,5,7,9,11,15,18,21 and 26 years• Retention 96% at 26 years• Genotyped sample

Caspi et al., Science, 297:851-854 (2002)

Caspi, et al., Science, 301: 386-389 (2003)

NUMBER OF LIFE EVENTS

MA

JOR

DEP

RES

SIO

N E

PISO

DES

(%)

Short allele 5-HTT genotype n=581

Long allele 5-HTT genotype n=264

Susceptibility genes, prevention and clinical practice

• Understanding the individual• Development • Dynamics• Specificities of intervention• Importance of longitudinal study

27-Year follow-up of children in 27-Year follow-up of children in Elmira (N=340) will examineElmira (N=340) will examine

History of arrests and convictions (records and self-report)

Reports of criminal behavior and substance abuse

Major Depression & Anxiety Disorders

Antisocial Personality Disorder & CD

Reports of abuse and neglect in childhood

Child maltreatment in second generation

Polymorphism in DAT – reuptake of dopamine; site of action for psychostimulants (ADHD)

Polymorphism in MAOA – metabolizes neurotransmitters (e.g. NE, 5-HT, DA)

Polymorphism in 5-HTT – reuptake of serotonin Courtesy - David Olds

Why are we interested in these Why are we interested in these particular polymorphisms?particular polymorphisms?

DAT interacts with prenatal tobacco exposure to increase early impulsivity and oppositional behavior among 3-year olds

MAOA interacts with child abuse and neglect to increase risk for APD and violence

5-HTT interacts with child maltreatment and life stress to increase risk for depression

Program has affected these earlier environmental risks Courtesy – David Olds

Comparison Group

-0.5

0

0.5

1

1.5

2

0 10 20 30 40 50Number of Cigarettes Smoked per Day during Pregnancy - Registration

Arre

sts

Number of Arrests among 15-Year Olds and Number of Arrests among 15-Year Olds and their Prenatal Tobacco Exposure at their Prenatal Tobacco Exposure at

Registration – Elmira Comparison GroupRegistration – Elmira Comparison Group

Courtesy- David Olds

Nurse-Visited Group

-0.5

0

0.5

1

1.5

2

0 10 20 30 40 50Number of Cigarettes Smoked per Day during Pregnancy - Registration

Arre

sts

Number of Arrests among 15-Year Olds and Number of Arrests among 15-Year Olds and their Prenatal Tobacco Exposure at their Prenatal Tobacco Exposure at

Registration – Elmira Nurse-Visited GroupsRegistration – Elmira Nurse-Visited Groups

Courtesy- David Olds

Dopamine Transporter (Dopamine Transporter (DATDAT))R. Kahn et al., R. Kahn et al., J PedsJ Peds. 143: 104 (2003). 143: 104 (2003)

Stimulant medications affect ADHD by inhibiting dopamine transporter (DAT), protein responsible for reuptake of dopamine.

Children homozygous for 10-repeat (480-bp) allele (DAT +/+) are at > risk for ADHD in most, but not all studies.

Prenatal tobacco exposure upregulates nicotine receptors.

Activation of nicotine receptors enhances stimulated release of dopamine.

In this study, 5-yr-old children with DAT +/+ genotype and prenatal tobacco exposure had > hyperactive-impulsive scores and > oppositional scores compared to children with no tobacco exposure and DAT +/- or -/-.

Neither prenatal tobacco exposure alone nor DAT +/+ alone was associated with increased hyperactivity or oppositionality.

HYPOTHESIS: program effect on ADHD, CD, & arrests > for those in control group with DAT polymorphism and prenatal tobacco exposure

Courtesy- David Olds

Conclusion: Specifying the how questions

• How does early intervention work among the disadvantaged to promote the development of conduct and moral behavior?

• What interventions work for whom, under what circumstances and How?

• How can we take advantage of the forthcoming knowledge about specificity?– For individuals identified at risk?– For individuals identified with strengths?– For environments identified for specific risk and

protection?

Conclusion …

• Importance of longitudinal study• Freud’s dream---

– Today we are getting closer to understanding the links between neurobiology (brain functioning and genetic-E influences) and mental activity- links that Freud abandoned

• Our vision---– Using such knowledge to create better environments

for strengthening character and early moral development as well as prevention of disorder

I look forward to our discussions