1. Little Rock, Arkansas April 29, 2008
Integrating Behavioral Health Policy into a Comprehensive Approach to Early Childhood Development
Little Rock, Arkansas
April 29, 2008

2. Early Experiences Matter
Early Experiences Have Lasting Consequences
The “architecture” of a child’s brain provides the foundation for all future learning, behavior, and health.
Once the architecture is built, it cannot be changed, which makes it difficult, although not impossible, to change behavior.
Stable and stimulating environments in the early years help create a sturdy foundation for later school achievement, economic productivity, and responsible citizenship.
Graph created by the National Center for the Developing Child

3. Early Experiences Matter
At age 3, children with professional parents have a recorded vocabulary of 1,116 words, compared to 525 words for children with parents receiving welfare.
Welfare parents, themselves, have a recorded vocabulary of 974 words.
This vocabulary gap persists at age 10, and is strongly associated with reading comprehension scores in third grade. (Hart and Risley, 2003)
Also, At age 4, children below poverty are 18 months behind the developmental norm for their age; by age 10, the gap is still present. (Layzer, forthcoming)
Graph created by the National Center for the Developing Child

4. Early Experiences Matter
The significant lag in language arts and math skills that low-income children have before they enter kindergarten (as much as 1-2 years) are still present in third grade.
Sources: Hart and Risley, 2003
Cannon and Karoly, 2007

5. Early Experiences Matter
More than 20 years of data on small- and large-scale early intervention programs show that low-income children are more likely to:
stay in school,
go to college,
become successful, independent adults
And less likely to:
Need remediation
Be arrested
Commit violent crimes
For more information:

6. Impact of Risk on the Health and Development of Children
Multiple Risks Matter
Impact of Risk on the Health and Development of Children
A growing body of research documents the connection between adverse childhood experiences and poor health and development outcomes. The studies examine a variety of risks, document their association with poor outcomes, AND show that exposure to multiple risks has a compounding effect of increasing the odds of poor outcomes.
Stevens, Gregory D. "Gradients in the health status and developmental risks of young child ren: the combined influences of multiple social risk factors. " Maternal and Child Health Journal 10.2 (March 2006): 187(13).
Produces odds ratios for poor health or developmental risk associated with any combination of four specific risks: race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health.
This graph shows the associations between risk factor profiles and having poor health status (actually, poor= good/fair/poor, not excellent or very good) and Having developmental delay (as measured by Parents Evaluation of Developmental Status –PEDS).
Having a higher risk profile was associated - in a dose-response manner – to greater odd of poorer health status or developmental delay (third set of bar graphs, far right). For example, a child with one risk factor has 1.7 higher odds of experiencing poor health or developmental delays than a child with no risk factors. The odds ratio for two risk factors is 3.28, for three risk factors 4.69, and for four risk factors Higher risk factors are also associated with poorer access to health care.
Other Research:
Richards, M., and M.E.J. Wadsworth. "Long term effects of early adversity on cognitive function.” Archives of Disease in Childhood (October 2004):
Vincent J. Felitti, Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards, Mary P. Koss and James S. Marks “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study” American Journal of Preventive Medicine, 14(4)/,
Risks = race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health.
For two or more risk factors, all significant differences between risk profile and zero . Source: Stevens (2006)

7. Impact of Maternal Risk Conditions on Infant and Toddler Behavior
Multiple Risks Matter
Impact of Maternal Risk Conditions on Infant and Toddler Behavior
SOURCE: Whitaker, Robert C.; Orzol, Sean M.; Kahn, Robert S Maternal Mental Health, Substance Use, and Domestic Violence in the Year after Delivery and Subsequent Behavior Problems in Children at Age 3 Years. Archives of General Psychiatry 63(5):
CONTEXT: Mental health disorders, substance use, and domestic violence often occur together. However, studies examining the impact of these conditions in mothers on the well-being of their children have focused only on isolated conditions. OBJECTIVE: To examine the cumulative effect of maternal mental health disorders, substance use, and domestic violence on the risk of behavior problems in young children. DESIGN: A birth cohort ( ) followed up to age 3 years. SETTING: Eighteen large US cities.
PARTICIPANTS: At 3 years, 2756 (65%) were followed up from the population-based birth cohort of Thirty-six percent had annual incomes below the poverty threshold. MAIN
OUTCOME MEASURES: One year after delivery, mothers were asked questions about conditions in 3 categories: (1) mental health (major depressive episode and generalized anxiety disorder), (2) substance use (smoking, binge drinking, and illicit drug use), and (3) domestic violence (emotional and physical). At 3 years, mothers completed questions from the Child Behavior Checklist.
RESULTS: Fifty percent of mothers had a condition in at least 1 of the 3 categories. The prevalence of child behavior problems increased with the number of categories (0, 1, 2, or 3) in which the mother reported a condition: respectively, 7%, 12%, 17%, and 19% for aggression (P<.001); 9%, 14%, 16%, and 27% for anxious/depressed (P<.001); and 7%, 12%, 15%, and 19% for inattention/hyperactivity (P<.001). This graded risk persisted after adjustment for sociodemographic and prenatal factors and for paternal mental health and substance use.
CONCLUSIONS: The risk of child behavior problems increased with the number of areas--mental health, substance use, or domestic violence--in which the mother reported difficulties. Preventing behavior problems in young children requires family-oriented strategies that address the needs of both parents and their children
Maternal risk conditions = mental health, substance abuse, and domestic violence
All significant differences at p< Source: Whitaker et al. 2006

8. Multiple Risks Matter
Children with multiple risks are especially vulnerable. NCCP’s Improving the Odds database calculates young children’s exposure to these multiple risks for every state.

9. For More Information Improving the Odds for Young Children
Helene Stebbins,
Information about NCCP projects and resources are available at: