Early moral development and Preventive interventions

1. Early moral development and Preventive interventions

2. CLASSIC STUDY OF SKEELS A 30 YEAR FOLLOW UP Skeels, H., Monographs of SRCD, 1966

3. E GROUPC 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.9360.5 5 YEARS LATER: 11 AdoptedNone 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 5X SKEELS/rne/4-97

4. 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

5. Long-term Effects Of Early Intervention for children living in circumstances of poverty On Conduct !

6. Preventive intervention (P/I) studiesYoung children in poverty * = RCT

7. P/I follow up studies Young children in poverty

8. Perry Preschool ProgramAbecedarian Project • Less school dropout - P, A • Less teenage parenting- P, A • Less juvenile delinquency- P • Less crime- P

9. Chicago PCP longitudinal study • Fewer juvenile arrests • Fewer violent arrests • Less grade retention • Less use of special education • (Less child maltreatment)

10. Syracuse family development research program • Fewer reported probation cases • Fewer court offenses

11. 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 Nurse Home Visitation- Elmira

12. P/I follow up studies Young children in poverty • * From Duncan and Magnuson, 2006 • ** From Aos et al., 2004

13. 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

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

15. Heckman theoretical curve for investment at different points in the life cycle From Heckman, J., 2006

16. Preventive intervention in circumstances of poverty

20. EHS RCT • EHS begins 1995 • 17 sites selected for research • University partnerships • Diverse • RA begins 1996

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

22. 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) Data points

23. National Results of Impact N= 17 sites; 3001 families

24. 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

25. Impacts on Children’s Development and Learning at 2 and 3 Years of Age Effect Size (percent) Bayley MDI Sustained Attention Aggressive Behavior Percent MDI < 85 Vocabulary CDI-PPVT Engagement Negativity 25 *** 20 20 *** 16 *** 15 ** 13 15 ** 12 ** 11 8 10 7 5 0 -5 -8 -10 ** -10 * ** -10 -11 -15 ** -14 ** -14 -20 -25 24 Months 36 Months * p < .10 ** p < .05 *** p < .01

26. Warmth and supportiveness Detachment Quality of assistance Support for language and literacy Reading daily Negative discipline Beneficial Impacts on Parenting and the Home Environment

27. Effect Size (percent) Supportive- ness Detachment HOME Read Daily Spanked Education Employed *** *** ** ** ** ** ** ** * * * * *** Impacts on Parents When Children Were 2 and 3 Years Old * p < .10 ** p < .05 *** p < .01

28. 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.

29. To Understand What Works Under What Circumstances,And For Whom

30. Other Subgroup Analyses • Teen parents • Depressed mothers • Demographic risk • Local site analyses

32. Importance of longitudinal follow-up • 5 years- pre K • Post first grade (4 sites) • Post fifth grade • Beyond ?

33. Frontiers of research

35. Thinking about genetic variation • Smaller number of genes than expected • Genes work in a multiplicity of ways • Genes work with environmental influences • Gene expression • g/e correlations; - g/e interactions • Susceptibility genes • Dimensional influences • Background genetic influences

36. GS1/ES1 GP1/EP1 GS2/ES2 GP2/EP2 Disorder GPn/EPn GSn/ESn G1/G2 G1/G2 Background genetic influences

37. 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

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

39. Short allele 5-HTT genotype n=581 Long allele 5-HTT genotype n=264 MAJOR DEPRESSION EPISODES (%) NUMBER OF LIFE EVENTS Caspi, et al., Science, 301: 386-389 (2003)

40. Susceptibility genes, prevention and clinical practice • Understanding the individual • Development • Dynamics • Specificities of intervention • Importance of longitudinal study

41. 27-Year follow-up of children in Elmira (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

42. Why are we interested in these particular polymorphisms? • DATinteracts with prenatal tobacco exposure to increase early impulsivity and oppositional behavior among 3-year olds • MAOAinteracts with child abuse and neglect to increase risk for APD and violence • 5-HTTinteracts with child maltreatment and life stress to increase risk for depression • Program has affected these earlier environmental risks Courtesy – David Olds

43. Number of Arrests among 15-Year Olds and their Prenatal Tobacco Exposure at Registration – Elmira Comparison Group Courtesy- David Olds

44. Number of Arrests among 15-Year Olds and their Prenatal Tobacco Exposure at Registration – Elmira Nurse-Visited Groups Courtesy- David Olds

45. Dopamine Transporter (DAT)R. Kahn et al., J Peds. 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

46. 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?

47. 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

49. I look forward to our discussions