Behaviour (Affect), Literacy, and Early Child Development

By J. Fraser Mustard

Canadian Institute for Advanced Research,

The Founders’ Network

5^th International Encounter of Early Childhood

Monterrey, Mexico

May 25, 2005

It has been recognized for a long time that the circumstances of early child development influence development and health and well-being in the later stages of life.� Although this was recognized back in the time of Erasmus, [1] most societies in periods of major socioeconomic change have had difficulty coming to grips with the implications of this knowledge.� Societies have from time to time tried to establish social structures that support good early child development but these have been difficult to sustain because of the underlying population, technological, social changes in societies and the lack of outcome measures.� In today’s world the continuing growth in the human populations and the exponential growth in knowledge and technologies, migration of individuals has made the conditions for early child development increasingly important. [2] � It is difficult for communities to become prosperous, pluralistic and democratic if they cannot establish highly competent populations whose behaviour (low level of violence) supports strong social capital and economic growth. [3] � On the basis of the evidence now available, societies that under-invest in the development of young children are likely to have unstable and violent communities and weak economies and less than competent populations.^{3 [4]} � To address the competence of the population, reduce poverty and violence in developing countries, we will have to design institutional structures that support high quality early child development.�

There are no simple strategies for doing this, but the emerging revolution in understanding brain development and its effect on learning, health, and behaviour throughout the life cycle has given us some clues as to what can be done and how the outcomes can be measured.� Ability to read and understand what is written is an index of brain development in the early years and the impact of education programs.� Today it has been pretty well established that competence in language and literacy in the school system is largely determined by the quality of early child development. [5] [6] � We also know that children with poor language and literacy capabilities as teenagers are at high risk for violent behaviour. [7] [8] � The biological basis of these relationships has become better understood.�

Literacy

Examining the literacy performance for Latin American countries based on population assessments by UNESCO [9] shows that with the exception of a few countries, particularly Cuba, all the Latin American countries perform less well in this assessment than the more affluent developed countries.� The studies carried out by the OECD [10] show that Chile, despite its reasonable affluence, performs less well in the literacy assessments of the adult population than Cuba.� The OECD assessment technique uses a scale of minus one to five.� Level minus one is truly illiterate.� Those at level one can read but have great difficulty understanding what they have read (in my country they can read a prescription but do not understand it).� The group in level two is slightly better.� The outstanding groups are levels four and five.� Level five can easily understand material and can cross-link it with other material effortlessly.� In Canada, 42% of our adult population is at levels one and two and only 24% at levels four and five.� Latin American countries with the exception of Cuba, the proportion at levels one and two is over 60% and the proportion at levels four and five is less than 5%.� UNESCO, in a similar kind of study, [11] found that with the exception of Cuba, all the Latin American countries studied performed like Chile in the OECD assessment.� This achievement in Cuba is poorly understood and appreciated but may provide a strong lesson of what nations have to do to improve language and literacy and behaviour for their population.� A clue about why Cuba’s performance is so high is that the government has made major investments to support young mothers and the development of their children.� The comparison of school performance carried out by UNESCO¹¹ provides some evidence as to what the Cubans have done.� This study showed that in the language tests¹¹ of children in grades three and four in several Latin American countries, Cuba’s performance in this test was dramatically better.� In this assessment Cuba was ranked as 96% literate as was Argentina.� However, in terms of the grade three test scores, Cuba was much better than Argentina, 343 versus 263.� We now know that language and literacy competence at grade three is powerfully influenced by the quality of early child development and is a predictor of subsequent literacy.� The weight of the evidence shows that verbal skills are set early in child development and that the level of performance at age three predicts language and literacy performance in the school system. [12] [13] � The other interesting point that comes out of this UNESCO study is that while the GDP per capita in Argentina (US$) was 8,498, Cuba’s GDP per capita was 3,100.� The other observation from this study that is relevant to this presentation, is that the fights in the schools were substantially less in Cuba. [14] � In contrast with Mexico, Cuba had only one quarter as many fights per student in grade four than in Mexico.�

These observations are in keeping with our increasing understanding that the quality of early child development is important for literacy and reduced violent behaviour.�

Neuroscience, Behaviour and Literacy

The brain is the master organ that controls the function of the human body (metabolism, cardiovascular system, immune system, behaviour, cognition and other functions). [15] [16] � It is now clear that experience in the early period of life (in utero and up to age six to eight) has a major effect on the differentiation of nerve cells (neurons) and the wiring and sculpting of the billions of neurons in the brain that determine how the different parts of the brain function. [17] [18] � Understanding how experience (sensory stimuli received by the brain) determines brain development is important in understanding the steps that can be taken to enhance early child development and the quality of the citizens of a country.� The brain is most sensitive to stimuli affecting its development in the early years. [19] �

The brain is composed of billions of neurons that have the same genetic coding but as the brain develops through experience the neurons acquire different functions.� It is essentially stimuli (experience) that these neurons are exposed to in the early years of development that sets their different functions. [20] � The second biological point that is relevant to this is how experience affects the formation of the connections (synapses) among neurons to establish the pathway that connect to the different parts of the brain. [21] [22]

The development of the part of the brain responsible for vision established one biological mechanism whereby experience affects the brain.� Occasionally children are born with lens cataracts (prevent light stimulating the retina) that render them blind. [23] Surgeons felt that it was not wise to operate to remove such cataracts until the child was older because of the risk of surgery on small children.� It was found that such children never managed to perceive depth or shape properly after removal of the cataracts later in life.� It was simply too late for the visual system to learn how to see.� David Hubel and Torstein Wiesel established in animal experiments that if signals did not pass from the retina to the brain during a critical period in early life, it was not possible for the neuron in the vision cortex to develop normally.� Extensive experiments since then have shown that there appears to be a dormant program for the wiring and development of the brain for vision that can be triggered once but only once. [24] � This has led to the concept of critical periods for the development of at least some of the sensing systems of the brain.� One of the important points is that the neurons that interpret the signals from the retina in the visual cortex have to communicate with the rest of the brain, whose neuronal functions require inputs from vision for their functions, for example, in behaviour, language and literacy.�

There is evidence that hearing also has a similar critical period.� For example, children born with failure of the cochlear system in the ear are deaf. [25] � This defect can be corrected by surgical implantation of cochlear devices.� If they are too late in doing this corrective surgery, normal hearing is not restored.� The other sensing pathway which may have a critical period but which operates by a different biological pathway is touch.� Touch [26] [27] [28] has a very significant effect on what is often referred to as the stress, or hypothalamus-pituitary-adrenal gland (HPA) pathway.� This pathway is also connected to the other pathways since it influences, for example, behaviour, cognition, and the immune system response to external stimuli.�

In other work, it has become clear that for other parts of the brain there are sensitive periods [29] that are not as sharply defined as the critical periods.� There are parts of the brain that appear to be capable of continuing renewal in normal circumstances. [30] � The one region that has been extensively studied is that part of the brain associated with memory, the hippocampus.� It appears to be capable of the synthesis of new neurons under appropriate stimulation.� This also appears to be true for parts of the hypothalamus and the amygdala.

One of the other biological processes which is important in brain development is the development of the connections (synapses) between the axons and the dendrites which are the structures that allow neurons to communicate with each other.²² [31] � The development of these neural pathways is obviously critical in terms of how the brain functions.� Hebb ²¹ postulated 50 years ago that the stability of these connections were determined by the frequency of use.� The original experiments of Pavlov [32] of conditioning dogs to salivate on the signal of a bell, depended upon repeatedly giving the dogs meat and ringing the bell at the same time.� The animals then began to associate the ringing of the bell indicating meat was to be available and they would salivate.� To achieve this conditioning the animals had to have repeated exposure to the bell ringing when the meat was given and this repeated frequently in order for the brain to develop pathways for the brain to respond with salivation to the bell alone.� The nature of this process is now fairly well understood but its application to the development of the pathways in the brain is only now beginning to emerge.� The biological process is that the signaling neuron’s axon interacts with the dendrite of the target cell.� This stimulus causes, through its electrical pathways, the nerve membranes to open up the calcium pores leading to an influx of calcium into the neuron, which activates CREB in the nucleus that activates the gene to produce what is called a synapse strengthening protein.²² �This diffuses to the site where the axon and dendrite are interacting, strengthening the connection.� To get a strong connection, this has to be done repeatedly or the strength of the connection will weaken or be lost.�

The role of brain experience and gene activation has now offered an explanation for one of the major behavioural problems we face in the mental health field - depression.� It has been recognized in monkeys that if they are separated from their mothers when they are young, they can develop abnormal behaviour patterns which can lead to antisocial behaviour and the risk of alcohol addiction. [33] � In these studies it was found that the vulnerable animals had the short gene coding for the serotonin transporter protein. [34] ��� The animals with the long gene structure were very resistant to adverse circumstances in early monkey development.� Studies with the 1970 Dunedin birth cohort [35] have shown that children with a history of a poor environment for development in the early years including abuse were at risk for manifestation of depression in adult life.� It was found that the subjects most at risk were those with the two short serotonin transporter genes.� The ones with the long serotonin transporter gene structure were resistant to the adverse effects of early child development.� Normally gene abnormalities are thought to be caused by genes producing a defective protein.� However, since the DNA of both the short and long genes is normal, some other mechanism has to be involved.� Recent studies in rats have provided evidence about the genetic pathway that is involved. [36] � Rat pups neglected by their mothers are at high risk of showing abnormal behaviour and development.� Studies of these animals show that adverse circumstances when they are pups leads to methylation of the DNA in the gene which codes for the serotonin transporter protein.� Methylation of a gene inhibits this function. [37] � Thus, the animals with the long gene will have more DNA and therefore be less likely to have all of the gene function shut down through methylation.� This is an important pathway affecting gene function and is referred to as epigenetics.� We do not at present know how experience triggers the methylation process.

An important point that comes from this work is that it shows a non-genetic mechanism for transmitting these patterns of behaviour to the next generations.� The female with the short gene structure who has suffered from poor early child development will have the behaviour problems as a consequence of the short gene structure.� She will then be at risk to bring up her offspring poorly regardless of whether it has the short gene structure or the heterozygous structure (short and long gene).� The offspring will likely suffer from the same defects as the mother.�

The HPA (hypothalamus-pituitary-adrenal) pathway influences the frontal brain and how we respond to stress.� This pathway involves the amygdala, the hypothalamus, the pituitary gland, the adrenal gland and the hippocampus.^{16 20} � [38] � It also involves the autonomic nervous system.� How this pathway works influences the cortisol levels in the blood which influences all the tissues in the body.� Thus, excess sterol can affect muscle function being a cause of back pain with physical exercise, affect metabolic pathways and vulnerability to type II diabetes [39] [40] and also affects the immune system and the function of the brain.� Recent evidence shows that the control of obesity is also influenced by this pathway. [41] � Leptins, which are produced by fat tissue, can feed back to the hypothalamus which can then, through its pathways, reduce the desire for more food.� If the leptin levels are too low, stimulus to eat will become dominant leading to a gain in weight.� As well as being influenced by leptin levels, this will also be influenced by the function of the HPA axis in relation to its response to leptins.

This pathway also has major effects on cognition and memory through the action of cortisol on receptors for cortisol in the human brain.� In a normally functioning HPA pathway, increased sterol levels in the blood interact with receptors in the hypothalamus and hippocampus to shut down the stimulus (cortical releasing factor) from the hypothalamus to the pituitary and adrenal gland.� In this dynamic, stimuli to the amygdala can override the system and lead to continuous stimulus for sterol production from the adrenal gland.� This system can be thought of as similar to a thermostat in that its operation maintains an appropriate balance for normal homeostasis in the individual.� Although we do not know the precise pathways that are involved, touch in the early period of life seems to influence or set how the sterol pathway is regulated.� In rats, it has been shown that if the pups are neglected by the mother at birth, they have a poorly regulated sterol pathway, which has major effects on brain development including cognition and behaviour in adult life. [42] [43] � In detailed studies of the parts of the rat brain HPA system, there is now evidence that neglect after birth (lack of touch) leads to increased methylation of gene structures. ³⁶ � In this work, they have been able to show that the offsprings of mothers who show low licking of their pups will have a poorly regulated HPA pathway.� However, if these pups from a poor nurtured mother are placed with a mother who has the high licking characteristics, the pups develop normally.� Conversely, pups of high licking mothers raised by mothers that are low licking will tend to have the same defect as pups of low licking mothers raised by these mothers.�

Another pathway that is influenced by the HPA pathway is the immune system.¹⁵ ��Low sterol levels apparently affect the immune system in a manner that makes it vulnerable to causing autoimmune disorders.� The neuroendocrine system plays a major role in how the body responds to infections.� The immune system, which is a primary defense system for the body, also influences the brain.� The feedback to the brain through cytokines can affect brain function.�

Literacy

The biological pathways that are involved in the development of language and literacy are only partially understood.� It is clear that what is picked up through the vision pathway or the hearing pathway has to be linked to Broca’s area and Wernicke’s area as well as being linked to speech and writing.¹⁵ �Today we know that the sounds that an infant is exposed to when very young influence how this part of the brain develops and its relationship to language. [44] � For example, infants exposed to two languages in the first seven to eight months of life will have little difficulty in setting the base for mastering the two languages and they will not have an accent. [45] � Individuals who develop understanding of two languages early in life have a larger left hemisphere of the brain than individuals from monolingual backgrounds.� Proficiency in the second language is directly related to the size of this part of the brain.� The increased gray matter density in the left inferior parietal region was found to be related to the age of acquisition of the second language.� Since acquisition of a secondary language is best achieved in very early life, this indicates that there is a sensitive period for optimum language acquisition.� It is interesting that the other findings from these studies are that individuals acquire a second language very early in life find it easier to learn third and fourth languages later in life.� It would appear that the neurological systems that evaluate sound develop a sensitivity to sounds of different languages in early life that make it easier to develop the neurological pathways necessary for a second language.� These findings are in keeping with other studies showing structural changes in the brain in association with learning and functions other than language. [46] �

Experts in the field of human speech and birdsong have long commented on the parallels between the two in terms of communication and its development. [47] � Both humans and songbirds learn their complex vocalizations early in life showing a strong dependence on hearing the adults.� Both humans and birds have a critical period for vocal learning with a much greater ability to learn in early life.� Both humans and songbirds have evolved a complex hierarchy of specialized forebrain areas in which motor and auditory centers interact closely.� Dyslexics show a slow communication between Broca’s and Wernicke’s areas. [48] They also show impairments in naming pictures of subjects in addition to the difficulties with reading. [49] � In recent studies, reduced activation in the left occipital temporal area was found for both word reading and picture naming.� This could mean a common neurological deficit in word reading and picture naming which could be related to the development of the neural circuits.�

The studies of literacy and behaviour have illustrated the relationship between the development of different pathways in the brain in early childhood.� A number of studies have shown a relationship between the development of intelligence in the early years and delinquency and criminality in teenagers and young adults.� Stattin and Klackenberg-Larsson⁷ examined, in a longitudinal study of 212 subjects in Sweden, the relationship between language development and literacy and criminality.� In this study they found significant correlations between language development at 6, 18, and 24 months and criminality in later life.� The explanation for this relationship was not defined in the study although they did observe the relationship between parents in the early years and the development of language and literacy.� A possible explanation is that since the verbal skills that develop in the first three years are related to the degree of language exposure,¹² that in reading to a child as a toddler or infant, the child will usually be held.� As discussed earlier in this article, touch in the early years has a significant effect on the development of the HPA pathway.� Poor development of the HPA pathway at this early stage of development could lead to dysfunction of the HPA system, hippocampus, and frontal brain leading to behavioural problems, some of which would place individuals in the justice system.� In this respect, it is interesting that Cantwell et al [50] [51] reported a high prevalence of Attention Deficit Disorders along with hyperactivity and oppositional disorders in a sample of young children with speech and language problems.� There is also a range of articles showing a relationship between IQ and Attention Deficit Disorders.� Since IQ is hugely influenced by the period of early child development and probably relates to language and literacy, all of these relationships indicate that the quality of caregiver interaction with the young infant and toddler is probably very important and probably relates to a lack of adequate of touch or contact.�

Programs to Enhance ECD

The weight of the evidence shows that the quality of the experience an infant, toddler, and young child is exposed to during the preschool phase of development affects learning capacity in the school system as well as behaviour.� There are three sources of information that are relevant to discussion of the effectiveness of early child development programs.� The data come from birth cohort longitudinal studies, observational studies, and randomized controlled trials.�

The longitudinal birth cohort studies clearly show that children in center-based preschool programs do better than children who are not in these programs. [52] [53] � The recent reports from the study of the 1970 British birth cohort clearly show that preschool programs significantly affect learning in the school system.� In these studies they show quite conclusively that preschool programs and parenting practices were important predictors of the mobility of children from all social classes out of the disadvantage in the school system.� Jefferis, Power, and Hertzman [54] found in their analysis of the 1958 British birth cohort a clear relationship between birthweight and social class and cognitive development measured at ages 7, 11, and 16 years.� The largest effect was in the preschool period, not in the school period.� This evidence is compatible with the effect of early child development on cognitive development.� The trajectories set in the preschool period is difficult to change when the children enter the school system.� In further analysis of this population, Feinstein [55] found that the development score at 22 months of age predicted educational qualifications at age 26.� An interesting observation was that children who scored poorly on the early test but had wealthy parents tended to catch up, whereas children who had worse off parents were extremely unlikely to catch up.� The overall conclusion from this study was that children who show low performance at the time of school entry are unlikely to have the process reversed when they are in the school system.�

The Infant Health and Development Program (IHDP) study of children from birth to age 3 to examine how early experiences relate to cognitive and language development has shown that the quality of the child’s care during this period had a significant effect on outcome by age 3. [56] � Children in exclusive maternal care did not differ significantly from children in childcare.� Jeanne Brooks-Gunn concluded from their work with the IHDP that high quality center-based care showed excellent results on early child development. [57] They concluded that the provision of universal high quality center-based childcare is beneficial to everyone including children solely cared for by their mothers.� They concluded that these positive benefits continued into the late elementary and high school years.� In their studies of low birth-weight premature infants, they found sustained effects of early center-based programs on the WISC verbal scores at age 8. [58] �� The center-based programs were started at year 1 and carried on to year 3.� Since the children were all premature, they had appropriate healthcare after birth.� The striking thing in this study was the parents with these children who used the center for more than 400 days over the 2 year period had children who had much better verbal scores at age 8 than the children who spent less time in the early years centers.� The children who attended these centers scored much better than the children who were not involved in the center programs.� This is good evidence of a dose effect on brain development in the early years for premature infants.�

Grantham-McGregor in her studies of the effect of nutrition and stimulation on the development of stunted children showed that while both food supplementation and stimulation improved development in contrast to the control group for which nothing was done, the two together led to the stunted children matching the control group by 24 months of age. [59] A follow up study of these children 11 years later showed that the psychosocial stimulation had a significant long term effect on growth restricted children.� At this age there was no significant benefit from supplementation to growth or cognition. [60] � However the growth restricted children had significantly poorer performance than non growth restricted children supporting the conclusion that growth restriction has long term consequences.� The mean IQ of the children who received stimulation was about one-half of standard deviation of the controlled children.� An increase of this magnitude is of importance for educational achievement and later occupation and learning.� A recent study by Berkman et al [61] found from their study in Peru that malnutrition in early childhood associated with diarrhea disease was associated with poor cognitive function at age 9.� In a number of countries, an association between height in the first few years and a range of deficits in school performance in later childhood or adolescence has been shown.�

The Perry Preschool program [62] (Ypsilanti study) found that a program for 3-4 year olds on weekday mornings along with a 1-1/2 hour home visit to each mother and child on weekday afternoons during the school year had a significant effect on child development. [63] � Fifty-eight of these children were randomized to the preschool program and 65 received no preschool program.� The children in the program significantly outperformed the no program group.� (Sixty-five percent in the program graduated from high school in comparison to 45% not in the program.)� A higher proportion of the children in the program went on to university.� The children in the program performed much better on the literacy tests.

Another key finding from the Ypsilanti study was the substantial reduction in crime by the individuals in the intervention group.� The reduction in antisocial behaviour was substantial leading to far fewer violent crimes, property crimes, or drug crimes.� The estimated cost benefit of this program was that the $12,000 per student in this program produced a return for the individual of $20,000 per year and for the public overall $88,000 per year. [64] � Although this program had an initial effect on IQ, it was not sustained.� This is perhaps not unexpected since the weight of the evidence today is that IQ is heavily influenced by the conditions during infancy. [65] �

The Abecedarian project [66] [67] provides interesting information about the value of early intervention on cognitive development over 20 years.� In this program a group of African American children whose families with mothers had IQ’s less than 80 were randomized into four groups:� a control group; a group exposed to a preschool program; a group given a special education program during the first three years of primary school; and a group given the preschool program plus the school program.�� The children were randomized into these four groups at the age of 6 months.� This study was primarily focused on language and literacy development.� A striking observation from this study was the finding that the children randomized to the special school program on entry showed better reading scores than the control group but the effect was largely lost by age 21.� The group given the preschool program showed a dramatically better reading score on school entry but this effect was gradually lost.� The group given the preschool program plus the special program were the best overall and the effect tended to be sustained.� This evidence is compatible with there being brain sensitive periods of development which influence later periods of development.� In this case, the preschool program clearly enhances the effect of the school program.

Measures of Brain Development

The one biological measure that appears to reflect conditions of early child development is the HPA (hypothalamus-pituitary-adrenal) or stress pathway.� From extensive animal studies involving mice, rats and monkeys and recent studies in humans, the weight of the evidence is that this pathway affects learning, behaviour and health throughout the life cycle. ^{15 16 26 33} ��The function of this pathway is strongly influenced by the conditions of early development.� The output of sterols rises early in the morning and gradually declines to low levels by evening unless there are circumstances that tend to keep it elevated.�

Recently, measures of circulating sterols levels have been carried out by assessment of salivary sterol levels. [68] [69] � This is an accurate measure of circulating plasma sterol levels.� The principle findings from this work are that the regulatory control of the sterol pathway is being set in the early years of development.� McEwen refers to the effects of these mediators of the stress pathways as allostasis.¹⁶ �A very important aspect of this pathway is that after these mediators are secreted, they must be turned off.� Sometimes the shut-off mechanism fails and the chemical mediators of stress controls remain in the on position.� This can lead to damaging effects over longer periods if there are many adverse life events or the hormonal secretion is disregulated.� The other side of this equation is that when the cortisol response is inadequate, other body systems such as the immune system (inflammatory incytokines), which are normally contained by elevated levels of cortisol, behave excessively leading to autoimmune disturbances. ^{15 16} �

Animals are not able to manage the stress pathway in the early years without effective maternal care.^{26 33 6} ��Touch is an important stimulus affecting the regulatory control of this pathway.� In humans, children who do not receive responsive care or are inappropriately managed will end up with abnormal responses affecting their behaviour and cognition.� One of the critical questions is, does placing children in childcare centers affect their sterol pathways?� There is evidence that children in general childcare tend to have higher sterol levels at the end of the day than children cared for at home.� However, there is substantial evidence that quality childcare does not lead to negative outcomes.^{68 69 [70]} � The cortisol research shows a difference in outcomes between high and low quality childcare.� Children in high quality childcare show sterol patterns that decline normally during the day.�

Measures of language development and literacy are also indicators of brain development in the early years.^{12 13 67} � This is because, as discussed earlier, verbal skills and language capability are primarily set in the early years of life before school entry.� Critical and sensitive periods of brain development that relate to verbal skills and language are strongly influenced by experience in the early years.� The other aspect of this measurement is that individuals with poor verbal skills and low levels of literacy tend to be at higher risk for health problems in adult life and behaviour including mental health problems as well as antisocial behaviour.⁷ [71] � As outlined earlier, the explanation for this may well be that since reading to a child in the early years is important for picking up verbal skills, it also drives the touch pathway which has a major effect on the development of the stress pathway.�

Quality of Early Child Development in Countries

One of the difficult tasks is to be able to determine population-based assessments of early child development.� In Canada, when we did the Early Years Study,⁶ there were no reliable population-based assessments of child development that could be easily related to the neurobiology of brain development.� Neither the community services nor the education system had any reliable indicators.� The only robust indicators were the measures around child birth (prematurity and birthweight).� Fortunately our country had established the National Longitudinal Survey of Children and Youth (NLSCY) which every two years does a population-based assessment of children at different ages.� The vulnerability index [72] developed from this study was based on measures of learning and behaviour at different ages.� The learning measure at ages 4-5 was receptive vocabulary skills, and for behaviour, parent interviews were used.� The behaviour component included hyperactivity, anxiety, emotional problems, inattention, conduct disorders, physical aggression, and indirect aggression.� It was found that about 33% of children in the lower socioeconomic category were vulnerable at the time of school entry and that about 12% of the children in a high socioeconomic class were vulnerable.� Because this relationship is a gradient, the largest number of children in difficulty are in the middle class of our population.� The conclusion from this work is that any program to enhance early child development should be available to all families in the country and easily accessible. �

Outcome Measures

To be able to effectively measure at a community level, the quality of early child development, there needs to be outcome measures that will inform a community how well their children are developing.� There are a number of measurement tools that have been developed to measure early child development.� Often they are called readiness to learn or some similar term which has led to them being used as a diagnostic tool.� In our country, we have developed what is called the Early Development Instrument (EDI) [73] which is not used as a screening tool, does not diagnose children, does not recommend which children should be placed in special education, does not recommend specific teaching approaches, and is not used to design “curriculum”. [74] � The EDI assessment is carried out at the time of school entry and is not used at the individual level but at the group level to assess how well children are doing in the community.� The objective is to let communities know where they can improve the conditions for early child development to improve outcomes.� At present we are attempting to put in place community-based strategies for implementing high quality early child development and parenting centers associated with the primary schools to improve outcomes. [75]

We are also considering introducing a measure at 18 months that can be largely carried out through our system for healthcare involving family physicians at our public health programs.� The importance of this measure carried out at this time will be to identity communities where there are substantial in child development at this stage and allow programs to be put in place at this stage of development.� The weight of the neuroscience evidence is that the earlier you take steps to improve outcomes, the better the results.�

Economic and Political Considerations

The difficult challenge for societies is how to implement programs in societies that enhance early child development.� The weight of the evidence is that center-based programs that involve parents are obviously a very powerful strategy to improve early child development and the quality of populations 20-25 years later.� It has proven difficult to get societies to recognize the importance of investments in the preschool area to improve the quality of populations (behaviour and education levels) to be able to take part in today’s world.� There is exponential growth in knowledge and advanced technologies all of which require a society with minimum violence and a high quality competent population.� Heckman, a University of Chicago Nobel Laureate in Economics [76] has done a detailed analysis in the US of the return on investment at different stages of development on the competence and qualities of populations.� He has concluded from the study of programs in the US that the return for every dollar invested preschool is much greater than the investment in school based programs.� The return on investments in education is about three to one in contrast to at least eight to one for early child development programs.� The return on investments in older populations is limited.� Although this evidence is stark, the difficulty in implementing early child development programs in societies is not easy.� Part of the reason for this is that governments in democratic societies find it difficult to make investments and create programs that will not produce significant benefits to society for 20-25 years.� Ministers of finance like investments that can show a product, like a new bridge or dam, within two to three years.� Thus, in looking at investment in early child development, we must have outcome measures that measure development that can relate to future capability.� The EDI is one such measurement since if there is a community with poor performance, programs can be initiated that can change that outcome measure within five years.� The other outcome measure that can be related to improvements in early child development is school retention and the proportion of children being forced to repeat the early grades.�

The cost of good high quality early child development programs will per infant, toddler, and young child be approximately the same as the cost per child in the primary school system.� The challenge to all societies is that we want to have reasonably prosperous societies in the developing and developed world with few people living in poverty and greatly reduced levels of violence leading to stable societies with high measures of social capital.� Thus, the issue of early child development in terms of public policy is as important as any other activities we can engage in our diverse societies.

[76] Heckman, JJ. and Carneiro, P. Human capital policy. National Bureau of Economic Research, Working Paper 9495, 2003.