• Consider fathers’ health behaviors as well as mothers’,
• Assess and treat fathers’ mental health as well as mothers’,
• Treat family stress and attend to the couple relationship, and
• Provide access for fathers to family leave.

Much research focuses on how mothers-to-be influence babies’ health and development before and during pregnancy – touching on mothers’ environments, emotions, and behaviors. Mothers-to-be are often advised to alter their lifestyles accordingly.

Less attention is paid to fathers, but there is sufficient evidence to make a case for practice and policy to change in this regard.

This research review sets out seven ways fathers influence children’s development during pregnancy, providing a useful tool for planners of prenatal services and policies.

1. Epigenetic and genetic changes: Prior health behaviors

• Obesity is associated with epigenetic changes that predict restricted growth in childhood.
• Alcohol affects the sperm epigenome and is a risk factor for alcohol use and alcohol sensitivity in offspring.
• Fathers’ diabetes and fast-food consumption predict earlier births.

2. Epigenetic and genetic changes: Exposure to environmental toxins

• Exposure to workplace welding fumes is linked with higher prevalence of congenital abnormalities (Egyptian study).
• Fathers exposed to pesticides (e.g., nematocide, dibromochloropropane, ethylene dibromide) are more likely to have suboptimal sperm quality.

3. Epigenetic and genetic changes: Early life stress

• Children of fathers who survived the Holocaust and fathers with post-traumatic stress disorder show epigenetic differences, namely increased DNA methylation in a promoter region of the glucocorticoid receptor. These are linked with increased prevalence of psychiatric illness and reduced cortisol levels in the children.
• Studies of mothers have shown links between their exposure to disasters (e.g., natural disasters, terrorist attacks, COVID-19) and outcomes for their children. No such research exists for fathers but it would likely reveal similar links.

4. Neurobiological and hormonal changes

• First-time fathers with a higher prenatal testosterone level report less effective and positive parenting six months after the birth.
• First-time fathers with a higher prenatal oxytocin level endorse a more nurturing parenting philosophy after the child’s birth.

“This research review sets out seven ways fathers influence children’s development during pregnancy, providing a useful tool for planners of antenatal services and policies.”

5. Influences on expectant mothers’ health behaviors

• Alcohol use by an expectant father is linked to higher alcohol use by pregnant mothers (Ukrainian study).
• Expectant mothers engage more in prenatal health actions such as stopping smoking when their male partners do more caregiving (e.g., listening to baby’s heartbeat, purchasing items for baby, attending prenatal classes).

6. Influences on expectant mothers’ mental health

• A higher quality of couple relationship is associated with expectant mothers’ lower distress, which in turn is associated with more positive temperament of the baby (U.S. study).
• More relationship conflict correlates with greater incidences of medically complex births. Much research links prenatal stress in mothers to premature birth and low birth weight.
• Depression in expectant fathers correlates with depression in expectant mothers. Joint mental health symptoms in two parents prenatally predict the same symptoms in the parents 12 months after the birth, which in turn correlate with children’s executive function problems at 7-8 years (Finnish study).

7. Influences on mothers’ hormones

• A couple’s hormonal levels tend to synchronize and follow similar patterns. Lower testosterone levels in both expectant parents predict greater investment by the father in the parenting relationship after the birth.
• When cortisol levels are lower in both expectant parents, there is likely to be less conflict between them before birth and less depression on the part of the father after the birth.
• Hormonal changes in mothers can affect fetal development and children’s long-term social and emotional development.

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The key predictor of antisocial behavior and violent crime (as opposed to nonviolent crime) is poor emotion regulation in early childhood.

A very small group of boys grow up to become involved in persistent antisocial behavior and violent offending. Research has confirmed that there are reliable predictors of antisocial behavior in boys as early as the age of two or three.

A key predictor of violent crime (as opposed to nonviolent crime) is poor emotion regulation in early childhood. Where this is linked to persistent conduct problems through childhood, particularly when combined with hyperactivity/attention problems, there is a correlation with male violence and antisocial behavior in adolescence and early adulthood.

The problem mainly relates to boys. Research has suggested that the male brain is more vulnerable to adverse influences in early childhood. See Male violence: Early childhood development predictors.

The research suggests that violence prevention programs should prioritise the development of self-regulation skills in boys living in urban poverty, through working directly with them and through parenting programs. Some programs have already been successful in this regard. The High-Scope Perry Preschool Study reduced early violent antisocial behavior by targeting self-regulation skills in early childhood. Other programs, such as the Promoting Alternative Thinking Strategies (PATHS) curriculum and Family Check-Up, have improved children’s emotion regulation and reduced conduct problems. Positive parenting is often associated with the improvement in child conduct in these programs.

Stephanie Sitnick and colleagues have carried out research into early childhood precursors of male violence and antisocial behavior in young adulthood. They studied data from the Pitt Mother & Child Project, a study that followed low-income high-risk youth from the age of one until they were 20 years old; 310 families participated at the start, and 256 were still going at the end. The researchers measured child oppositional behavior, child emotion regulation and quality of the home environment. They also measured conduct problems throughout the period (physical aggression, oppositional behavior, temper tantrums) and hyperactivity/impulsivity/low attention. At 20 years, they measured violence and antisocial behavior both through court records and by interviewing the young adults. Their key finding was the link between poor early emotion regulation and adult antisocial behavior and violence.

A considerable amount of other research has linked early childhood development problems with later male violence and antisocial behavior, particularly impulsive, reactive crimes. Correlates include:

• impairments in early executive function
• poorer recognition of facial emotions linked to antisocial behavior
• poor early attachment and rejecting parenting
• oppositional behavior in early childhood
• poor self-control, particularly for those living in poverty.

Other factors linked to violence and antisocial behavior, reviewed by Adrian Raine, include the following.

Genetics: Studies of aggression in identical versus nonidentical twins show 65% heritability for aggression. Heritability for domestic violence is over 50%. Heritability relates more to impulsive/reactive violence. The genetics are complex and the only single gene found to occur more in violent offenders is MAOA (Monoamine Oxidase-A).

Brain impairments: Neurological impairments can be seen in several parts of violent offenders’ brains relating to emotion regulation, moral decision-making and impulse control. In particular, reduced structure and reduced glucose metabolism is often observed in the prefrontal cortex. The striatum is also more likely to be enlarged. The striatum is associated with the reward system and may suggest an oversensitivity to rewards in violent offenders.

Physical influences: The research suggests a variety of physical predictors of antisocial behavior and violence.

• Poor prenatal nutrition is associated with increased risk of antisocial personality disorder in adulthood. Child malnutrition is linked to aggression in childhood. One fatty acid critical for brain development, omega-3, is not produced by the body but is present in some foods, such as fish—and countries with diets high in fish have lower murder rates.
• Maternal cigarette smoking during pregnancy is linked to persistent offending. These links are stronger when other sources of stress exist, such as single-parent family status or an unwanted pregnancy.
• Alcohol consumption during pregnancy has been shown in many studies to be a risk factor for adult antisocial behavior and violence. Paternal alcohol consumption is also linked, possibly through epigenetic inheritance.
• Some birth complications, such as hypoxia, are linked to adult impulsive violent
• Lead exposure has been linked to adult antisocial behavior and violence. Lead is neurotoxic and affects boys more than girls, another indication of boys’ increased vulnerability to adverse influences in early childhood.
• Some traumatic brain injuries are linked to later violent behaviors.

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The best way to prevent chronic physical aggression in boys is intensive and long-term interventions initiated early in life targeting disadvantaged mothers.

Following research into aggression in children dating back to the 1980s, two leading researchers from Canada, Richard E Tremblay and Sylvana M Côté, have presented a wide range of factors that predict aggression and antisocial behavior in children, boys in particular. These include both genetic and social influences. Male aggression exceeds female aggression by a large margin and has done so for a long time. The ratio of female to male homicides in France 200 years ago was almost exactly the same as in the USA in 2014: 11.7:100 and 11.6:100 respectively.

The intergenerational nature of male aggression leads the authors to recommend that the best way to prevent chronic physical aggression and other antisocial behavior problems is intensive and long-term intervention initiated early in life and targeting disadvantaged mothers. This breaks the intergenerational transmission of violent behaviors.

Genetic influence on aggression

Large studies of twins have revealed the extent of genetic influence on physical aggression. Genetic factors explain 50% to 63% of the variance in frequency of physical aggression in children at 20 months. The link between genetics and physical aggression is stronger than the link between genetics and language development. However, this influence substantially diminishes as time goes on, while new influences come into play.

Parents’ life experience

When mothers report antisocial behavior during their own adolescence, their children are considerably more likely to display chronic physical aggression between the ages of 17 and 42 months. Chronic physical aggression in children is more frequent if the mother is young, poor, separated from the father, has not completed high school, has smoked during pregnancy, or suffers from depression.

This intergenerational phenomenon is exacerbated by assortative mating: mothers with poor childhood experiences are more likely to partner and have children with fathers who have had similar experiences.

A key mechanism of the intergenerational transmission of disadvantage is epigenetic change. The DNA methylation profiles of boys displaying chronic physical aggression are different from those of other boys (in 448 places on the genome in one study). Children whose mothers show more mental illness, more criminal behavior or more substance abuse have higher methylation of the oxytocin receptor gene at birth and later show higher callous-unemotional traits at 13 years of age. Similarly, boys displaying higher aggression have lower serotonin synthesis in the brain. This is linked to higher methylation of genes in the serotonin pathway.

Aggression begins early

In the 1990s, Tremblay found that physical aggression often starts in the second part of the first year after birth, substantially increasing in frequency up to the third year, then declining slowly. Aggression emerges between six and 42 months of age, after which a child would normally learn to control it. There is a substantial difference between boys and girls: 5% of boys between 17 and 29 months use physical aggression frequently, whereas only 1% of girls do.

Aggression in kindergarten and elementary school predicts aggression in adolescence

Other research by Tremblay in the 1990s in Canada showed that greater physical aggression among kindergarten boys predicts chronic physical aggression in adolescence. Another study in Canada, New Zealand and the USA found that boys showing high chronic physical aggression in elementary school were more likely to show the same in adolescence. This link was not seen for girls.

The authors note that the danger posed by aggression in childhood increases as children grow larger from 6 to 12 years of age.

In a randomized controlled trial in the early 1980s, Tremblay and colleagues found that a programme to address aggression and hyperactivity in kindergarten boys from low socioeconomic areas had positive outcomes for the children later in life: less aggression at the ages of 7 to 9, less physical aggressions and thefts at the ages of 11 to 17, increased rate of high-school completion and fewer criminal offenses in early adulthood. The programme consisted of both home-based parent training and school-based help for social and cognitive skills.

The evidence thus points to the importance of early intervention, starting at home before kindergarten.

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To take a modern approach to cognitive development theory it is important to emphasise relationships, and view social interaction as the crucible in which children’s cognitive development takes place. In other words, the mind forms through being part of and contributing to social interaction, a process charged by emotion. Growing up within families provides for a long period of intense social interaction.

(Other cognitive development theories include “nativist” approaches that regard the mind as having innate abilities, growing rather like a tree does from a seed, and “empiricist” approaches that focus only on the factors that act on the mind to form it, rather than also on how the mind influences those factors.)

A relational approach can be illustrated with Donald Winnicott’s memorable quotation from 1964: “there is no such thing as a baby”. What he meant was that a baby is embedded in a complex web of interactions with others, to the extent that the boundary between the baby and parent is no longer distinct.

This theory of cognitive development sees the baby and parent shaping each other’s neurological development. Babies don’t just engage with their surroundings; they influence and shape the environment in which they learn skills. Even basic gestures such as smiling emerge through a process of development.

The relational theory of cognitive development encompasses the wider societal level: the person and culture are co-created like parent and child. A person becomes a member of society by engaging in routines, traditions, rituals, and the use of objects and symbols, including language. The person both grows as part of the culture and forms the culture with others.

Nowadays, the dominant theory of cognitive development is termed “process-relational”.

Where does the biology stop and the social start? The nature/nurture argument does not apply in this worldview. For example, social experience has now been shown to influence the way genes are expressed, through epigenetic changes.

DNA is the source material and is fixed, but how it is expressed can be changed by experience. This has generated a whole new branch of research, social genomics: the study of how social experience shapes gene expression.

The father of cognitive development theory: Jean Piaget

Jean Piaget (1896-1980) has had a monumental impact on cognitive development theory. Piaget proposed a developmental theory based on the view of development known as “constructivism.” That is, we come to know the world through acting on it. He wrote that, “In order to know objects, the subject must act upon them and, therefore, transform them.”

Piaget argued that babies and children learn about the world through their action on the world. In this process they develop patterns of interaction involving emotions, sensations, motor movements, and perception, known as “schemes”.

Once a scheme begins to develop through particular interactions, it will be extended in slightly different situations. That is, the child assimilates new experiences to what she has previously learned, but since the experience will be different, the scheme will be modified or accommodated. Repeated many times, this process results in cognitive development.

(Photo: Shutterstock.)

Piaget said children learn through interaction with the world, developing patterns called “schemes”.

Piaget was interested in the stage-by-stage sequence of development that all children go through, each stage providing the foundation for the next. Through extraordinarily detailed observations of children, including his own three, he proposed four stages:

• Sensorimotor stage (during the first two years): a stage in which babies develop action schemes like sucking, pushing, hitting and grasping.
• Pre-operational stage (between two and seven years): the child develops the ability to think, but has limited ability to apply logic to a situation to deduce something by thought alone.
• Concrete operational stage (between seven and 11 years): the child starts working things out through logical thought, rather than just action.
• Formal operational stage (12-15 years): the child engages in systematic experimentation, forming hypotheses, testing them out and trying alternatives.

Sociogenesis theory of cognitive development: Lev Vygotsky

Another 20th-century giant of child development theory, Lev Vygotsky, is commonly regarded as the originator of the idea that the mind forms through social processes.

In fact, the idea predates him considerably, but he articulated it and developed it into a major influence on the modern science of child development, a remarkable feat since he only spent 11 years working on it, moving from work on art and literature when he was 27 and tragically dying when he was only 38.

According to Vygotsky, all higher mental functions occur twice, first between people in social interaction, then within the person’s mind. In this way, he said, social interactions form the mind, they don’t just influence a process already in motion like watering a seed to grow into a plant.

A key tenet of cognitive development theory is Vygotsky’s “zone of proximal development”. This follows from his idea that thinking is first social before becoming mastered by an individual.

In the process of developing a new way of thinking there is a gap between what children can achieve alone and what they can achieve with the assistance of others. Two children may appear to be at the same level of development, but with help, one may be capable of more than the other. They differ in their ability to master a new way of thinking.

The key to cognitive development, according to Vygotsky, is the help that the more experienced adult gives the child to grow within this zone.

(Photo: Shutterstock.)

Vygotsky’s “zone of proximal development” highlights how children learn best with guidance, bridging the gap between what they can do alone and with help.

Vygotsky introduced the idea of “elementary” and “higher” mental functions. Elementary functions are products of evolution and biologically explained. They include involuntary attention and the ability to make simple connections between events.

In contrast, higher mental functions emerge through social interactions and culture. These include language, systems of counting, memorising techniques, art, literature, maps, and so on.

Vygotsky paid much attention to how language develops and considered how children talk to themselves. According to his theory of cognitive development, children learn to talk through relationships and conversations and then use speech as a tool for their own thinking, by talking to themselves.

This applies equally to hearing children, and sign language used by children who cannot hear. Research has indeed shown that children who interact more with others talk to themselves more when they are alone, and that children who are not allowed to talk to themselves perform less well in cognitive tests.

Later, speech goes “underground” to become inner speech or verbal thought, though it sometimes comes back out during adulthood. For example, when we are working out particularly difficult problems. Vygotsky theorised that children (and adults) use speech when operating in their zone of proximal development, just beyond their level of competence.

How parents can support cognitive development: scaffolding

Cognitive development theory uses a metaphor from the construction industry: scaffolding, a temporary structure around the growing building to assist its construction.

In cognitive development theory, scaffolding gives children a structure to master a skill, after which it becomes redundant. In this context, scaffolding is about supporting children within their zone of proximal development: setting goals, regulating their actions and inhibiting unhelpful responses, organising their actions and selecting strategies. It can be as simple as a series of hints and prompts that are appropriate for the child’s developmental level.

Recently, many researchers have studied scaffolding and its impact on cognitive development when variously applied. Cognitive development advances when scaffolding is applied well and constantly adjusted to the child’s progress.

Piaget versus Vygotsky

Psychologists have long sought to discuss the theory of cognitive development by comparing the work of Piaget and Vygotsky, both of whom emphasised the role of social interaction, though in different ways.

In reality, both of them emphasised social interaction to such a degree that even leading experts often can’t read statements from one or the other and be certain of whether it was written by Piaget or Vygotsky.

One way to see a difference is through a thought experiment: What would happen to child development if there were no adults?

For Vygotsky, there would be no development, because children cannot move forward out of their zone of proximal development without more expert help.

For Piaget, there could be development, albeit not a type to be recommended. Two children interacting with each other could learn more than one child alone.

Executive function: a core concept in cognitive development theory

Put very simply, executive function is a set of mental skills that helps a person gain control over their actions and thoughts. Scientists have identified four components:

1. Working memory – the ability to hold information and recall it when carrying out a task.
2. Inhibitory control – suppressing initial impulses in favour of more rational action.
3. Attentional flexibility – changing from one way of solving a problem to another.
4. Planning – using all the skills above, creating a strategy to get a task done.

(Photo: Shutterstock.)

Executive function emerges through social interactions, particularly parental scaffolding that helps children operate in their zone of proximal development.

These skills develop in a sequence. Working memory typically develops in early childhood and improves during preschool and beyond. Inhibitory control and attentional flexibility develop in preschool. Planning skills develop during childhood and adolescence.

Like other cognitive development skills, executive function emerges through social interactions, particularly parental scaffolding that helps children operate effectively in their zone of proximal development. If children are specifically taught executive function skills at an appropriate level relative to their development, their skills improve.

Poverty is a key inhibitor of developing executive function skills. But its negative impacts can be mitigated if the parent-child attachment is secure and if the child has more social interaction, for example, at a daycare facility. Sadly, poverty reduces parental resources and is frequently associated with poorer relationships and more chaos.

Cognitive development theory: the importance of social interaction in language development

Unsurprisingly, language ability is critical to the cognitive development that takes place within relationships. The importance of social interaction in language development is one of the most consistent findings across cognitive development research.

Language develops in a critical early period of a child’s life. Research on feral children and on deaf children raised without sign language shows that they cannot learn normal syntax and morphology.

The first language abilities emerge shortly after birth. Babies will respond more to familiar voices, the language of their families, and books that were read aloud while they were in the womb. One-year-olds can distinguish among speech sounds that adults who have learned particular languages can no longer distinguish.

Babies understand words before speaking them. When they learn to speak in their second year, there is an explosion of understanding and speaking words.

So great is the richness and complexity of what children learn so quickly that some have proposed particular innate skills, beyond just the ability to use language that humans have, but other animals don’t.

Noam Chomsky has proposed an innate propensity to grasp syntax and proposed a “universal grammar” for human beings. As children develop, he argues, pre-existing on/off switches are triggered, leading the child from the universal grammar to the actual languages they learn.

Proponents of a social cognitive development theory find many problems with this version of nativism. The developmental view, based on Piaget and Vygotsky, is that children learn language through interaction with their parents and others and through learning social routines on which communication is based.

Parents typically modify language for babies and toddlers – a high intonation often called child-directed speech. This is often called motherese, though fathers do it too. Parents speak more slowly and more simply (though perhaps not in all cultures). Interestingly, in some contexts, fathers tend to use more complex speech, stretching children more within their zone of proximal development. This might be why a father talking with his child correlates better with later language skills than a mother talking with her child.

Researchers have also found that simply hearing words in their environment makes no difference to their language ability. Instead, children learn words in interactions with parents and carers. Time and again, the importance of social interaction in language development is reinforced, lying at the heart of cognitive development.

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Early child development is underpinned by brain development, by genetic and epigenetic inheritance and by physical development. Two key features of early childhood development that researchers study are ‘self-regulation’ and ‘executive function’.

Parental care shapes early childhood development. Neglect, the absence of adequate parental care, is a severe threat to early childhood development. Over-exposure to stress – ‘toxic stress’ – undermines development while strong relationships with parents provide protection and build resilience.

The mechanics of early childhood development

The brain

The human brain develops continually through childhood development, from before the birth and into adulthood. Like the construction of a building, the foundations are laid early. The brain builds from the bottom up in clearly defined development stages. That’s why early support for development is so important. A stronger foundation not only means the child is further ahead at a given moment in time, it also means learning and development can proceed more rapidly in the future.

Early childhood development sees the brain developing extremely rapidly. Billions of new connections are created every hour among neurons in different parts of the brain. After this rapid proliferation, brain development shifts towards efficiency. Some neural connections are made stronger and faster and others are pruned and lost. Meanwhile, the brain builds ever more sophisticated connections during later childhood and adolescence, associated with more enhanced skills. Pruning continues.

Brain development fundamentally shapes early child development stages. More basic capacities, such as vision, hearing and touch, develop earlier on. Later comes the development of more complex capacities, such as communication, understanding facial expressions, reasoning, and decision-making. Higher-level skills, such as the ability to sustain attention, set goals, follow rules, solve problems and control impulses, start developing in early childhood and continue through adolescence.

Children’s experiences of the world – how they see, hear and feel, and how they relate with parents and other carers – shape every aspect of the brain’s development. This reinforces some circuits and allowing others to be lost.

Genetics and epigenetics

The genes that children receive from their mothers and fathers give them certain predispositions and susceptibilities that influence early child development. Some children are naturally less fearful than others, for example, and those who are less fearful are less at risk of long-term anxiety and depression.

Photo: will kay. Creative Commons.

But some researchers have found that children who are more vulnerable to adverse environments may also be more sensitive to positive experiences and profit from them more. (See our article, Tackling child behaviour problems effectively requires better understanding of differences between an ‘orchid’ child and a ‘dandelion’ child.) This provides great hope for supporting more vulnerable children.

Experiences of the world, including relationships within the family and community, can influence the expression of genes rather than the genes themselves. Positive and negative experiences result in the production of proteins that regulate gene activity, creating temporary or permanent changes in the “epigenome”. These epigenetic changes to how genes are expressed can be inherited by the next generation. For example, the children of men and women who survived the Holocaust have inherited epigenetic changes associated with response to extreme stress. (See our article, Epigenetics offers hope for disadvantaged children.)

Physical development in early childhood

Early childhood development is defined not only by brain development and genetics/epigenetics. Cardiovascular, immune, neuroendocrine and metabolic systems all have a role to play in shaping a child’s capacities for the future.

Everything is intertwined. Supporting early child development is about ensuring that all the strands are strong.

Components of early child development

Although researchers still debate how to define different components of early childhood development, a number of concepts have become mainstream in the field.

The three domains of development most widely discussed are cognitive (thinking), social and emotional. Research has demonstrated that these are closely intertwined. Their development is associated with neural activity across the entire brain.

The connections can also be seen in children’s behaviour. For example, children develop the ability to think through relationships with carers. A child with high social skills will typically develop cognitive skills more quickly.

Self-regulation

Based in a part of the brain called the amygdala is an automatic and impulsive response to risk and danger, commonly known as the “fight or flight response”. Self-regulation is the ability to bring in a more conscious response to a situation, working out how to respond in that moment. It may be that more planned responses counteract the initial fight or flight instinct. The ability to regulate emotion is a vital skill acquired in early childhood in part through relationship with carers.

Executive function

Executive function is a cluster of skills that emerge in early child development that create the foundations for learning and interacting well with others. Researchers have divided executive function into several distinct abilities:

• Working memory – holding and using information for short periods of time.
• Mental flexibility (or cognitive flexibility) – adapting quickly in response to external stimuli.
• Self-control (or inhibitory control) – resisting impulsive behaviour.
• Sustaining focus and attention throughout a task.
• Solving problems.
• Following rules.
• Setting goals.
• Delaying immediate gratification for more reward later.

Photo: kris krüg. Creative Commons.

Developing executive function is a key part of the early childhood development stages. By the age of three, basic executive functions are in place – remembering and following simple rules. The skills develop substantially between the ages of three and five, but they continue to develop right through adolescence.

These more advanced stages of early child development involve increased speed and efficiency of neural circuits acting across different parts of the brain.

Parental care shapes early child development

Responsive caregiving from parents, the wider family and all those involved in a child’s life, along with experience of the world, shape children’s development. Researchers have coined the term “serve and return” to describe the reciprocal actions with parents and carers.

Multiple relationships enhance social and emotional development, building the child’s ability to sustain strong relationships in future. A child with multiple stable and caring relationships has a strong advantage. Conversely, a child without even one stable and responsive relationship is at a severe disadvantage.

Researchers have used the term “scaffolding” to describe the environment that caregivers can create for children to practice skills. Scaffolding includes establishing routines, modelling social behaviour, enabling creative play, facilitating social connection and encouraging physical exercise.

Threats to healthy early child development: neglect and toxic stress

Neglect

The world’s most widespread risk to children is a lack of responsive care, known as neglect: 78% of all child maltreatment cases in the world relate to neglect, which can have a more detrimental impact on early child development than physical abuse.

Photo: Brandon Warren. Creative Commons. 

Like physical abuse, neglect severely disrupts the brain’s development in early childhood by depriving children of adequate relationships, thereby altering the development of biological stress-response systems. Neglect is related to a multitude of poor outcomes in children’s later life – mental health, physical health, social relations and educational achievement.

Toxic stress

Stress, as a part of learning how to cope with adversity, is a normal and essential part of early child development. A threat triggers physiological changes associated with the hormone cortisol that support a quick response to mitigate the danger. A child exposed to simple stresses, and protected by strong relationships with adults, learns to cope, and to regulate the stress response system. Strong relationships can also mitigate the potentially damaging effects of high levels of stress caused by events like the death of a loved one, serious injury, or a local disaster.

Excessive and prolonged stress, termed toxic stress, is not a normal part of early child development. Examples of toxic stress include physical and emotional abuse, chronic neglect, poor care as a result of drugs or mental illness, persistent poverty and prolonged exposure to violence.

Exposure to chaos and constant threat impairs the development of self-regulation, trapping children in an instinctive fight and flight response. Toxic stress that undermines early childhood development stages is associated with many poor outcomes in later life.

Building resilience through relationships

Relationships with caregivers are the key to protecting children from the adverse effects of stress. Early in life, such care can prevent or even reverse the damaging effects of toxic stress.

Resilience emerges when a child exposed to stress also has access to reliable and nurturing relationships. A child’s heightened physiological response to stress can be restored by relating to a caring adult. Exposure to stress in the presence of a caring adult can help the child learn to feel some control in the situation and to develop self-regulation.

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Traits that seem to make a child vulnerable may also be the ones that offer them the greatest chance to bloom, given the right conditions.

What works for which children—and why—remains an unresolved question.

At first sight, the impacts of parent training and other interventions seem modest at best, when viewed across the general population. But we are beginning to understand that such across-the-board observations may obscure comparatively large effects for some children who turn out to be much more sensitive than others to both skilled interventions and to their absence.

Rather crudely, people sometimes draw an analogy between orchids and dandelions. Orchids are beautiful, but they need a lot of fertile soil and a good gardener even to survive. Given excellent circumstances, they can turn out looking fabulous. But if the soil is poor and the gardener inexpert, they wither away quickly.

On the other hand, consider dandelions. They can adapt to pretty much any environment. They don’t need a brilliant gardener, great soil or fine weather. They manage to survive and look OK in just about any environment. Indeed, improving the soil or hiring a great gardener may make little difference to how they turn out.

This analogy, although crude, illustrates the difference that research is finding between “orchids” —children whose well-being is more susceptible to environmental conditions—and “dandelions” —those whose outcomes are more constant, regardless of circumstances that might either seriously set back or transform the development of the orchids.

“To label people as intrinsically ‘at risk’ is dangerous because the characteristics that seem to make them vulnerable may be the very characteristics that offer them optimal development, provided they can find supportive environments.”

Part of the explanation may lie in the role that genes play in child development.

Children with certain, less efficient dopamine-related genes do worse in negative environments than children without this genotype. However, at least as interesting is the finding that the group with this “genetic risk” also profits most from positive environments.

A good example of this phenomenon is children who have a specific variant of the dopamine receptor gene. This gene is said to predict attention deficit disorder so it has a bad reputation in the psychological literature.

But, in a randomised controlled trial, we found that if you bring carriers of this risky genotype into a supportive environment, where they have to focus their attention closely in a series of games, they outperform those who don’t carry this genotype.

They seem more able to learn, provided the environment is structured in a way that is motivating and that helps these children, who were at risk of attention problems, to focus better. Such children might need an environment that’s different from a classroom, which can be too noisy and chaotic for them.

Classrooms require them to divide their attention in too many different ways. However, placed in the right environment—focused on a game—they learn better than do their peers.

These findings offer great hope in the search for interventions that can benefit children facing difficulties. They suggest that the children who may appear to be most at risk might be the very ones most likely to benefit from interventions. This observation holds the promise that we might achieve a better fit between interventions and groups of children, which might then result in a more cost-effective use of resources.

Genotyping children may not be practical or ethically desirable. However, it might not be necessary. We know that certain genotypes can be associated with specific personality traits, such as a “reactive” temperament or elevated biological stress reactivity.

Spotting these indicators can tell us that a child might particularly benefit from a certain intervention, or lose out if it isn’t available. All of this can make it easier to screen children to optimize the fit between child and treatment.

For example, we did a series of studies with children aged 3 and 4, where we used video feedback of interactions to show parents which of their interventions were of really high quality. This helped them hone their skills in responding and playing with the children.

We found that this guidance was particularly good at reducing aggressive behaviour by children with more reactive, difficult temperaments. These more irritable children, with their more vulnerable temperaments, benefited most in terms of less aggressive behaviour when they experienced quick, sensitive, positive parental interactions during periods of distress. The impact was much less pronounced for children with less reactive temperaments.

These observations are not an argument for withholding interventions from less susceptible children.

First, for reasons of equity, there cannot be a difference in eligibility for intervention between children with the same needs; second, apparently less susceptible children may simply be less responsive to the interventions that have been tried or tested so far. They may need different types of intervention.

Ideally, differential susceptibility should lead not to inequity but to differential, sensitive interventions and thus more effective treatment.

Our findings should also make us more careful about labelling children as ‘at risk’ because of their constitution, genetic makeup, or temperamental features.

We have shown that, in many cases, the problem is not with them but with the environment in which they find themselves. To label people intrinsically as ‘at risk’ is dangerous because the characteristics that seem to make them vulnerable may be the very ones that offer them optimal development, provided they can find supportive environments.

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