2. Early moral development and Preventive interventions

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

4. E GROUP C GROUP (N=13) (N=12) AT TIME OF TRANSFER: X AGE 19 Months 17 Months X I.Q. 64 87 (“unsuitable for adoption”) 2 YEARS LATER: X I.Q. 93 60.5 5 YEARS LATER: 11 Adopted None Adopted X I.Q. 96 66 30 YEARS LATER: 11 Adopted None Adopted All Self Supporting 5 in Institutions; (1 Died @ Age 15) Education 12th Grade 3rd Grade Marriage 11 Married 2 Married Children T of 28 T of 5; X I.Q. 104 4 “Normal”; None Retarded 1 Retarded Estimated Cost 5X SKEELS/rne/4-97

5. 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

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

7. Preventive intervention (P/I) studies Young children in poverty BeganAges served Follow up age Perry Preschool *1962PS27 Chicago CPC1985PS18 Carolina Abecedarian *19726-12W to 521 SyracuseLate 70’sPre-n to 513-16 NFP Elmira HV *1978Pre-n to 217 * = RCT

8. P/I follow up studies Young children in poverty N program N control Design Perry Preschool5865RCT * Chicago CPC837444Neighborhood C Carolina Abecedarian 4743RCT Syracuse6554Demographic C NFP Elmira HV 97148RCT

9. Perry Preschool Program Abecedarian Project Less school dropout - P, A Less teenage parenting- P, A Less juvenile delinquency- P Less crime- P

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

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

12. Nurse Home Visitation- Elmira For C b low SES unwed mothers –Less running away –Less arrests –Less convictions –Less use cigarettes and alcohol –Fewer behavioral problems (reported) For mothers –Less welfare dependence –Less child maltreatment –Less criminality –Less use of adverse substances

13. P/I follow up studies Young children in poverty Est. dollar return Perry Preschool (27) 1  $8 * Chicago CPC (18) 1  $7 * Carolina Abecedarian (21) 1  $4 * Syracuse (13-16)--- NFP Elmira HV (17) 1  $2.9 ** * From Duncan and Magnuson, 2006 ** From Aos et al., 2004

14. Perry Preschool Program age 40 follow-up Fewer arrests overall Fewer arrests for: –Violent crimes –Property crimes –Drug crimes From Schweinhart, L.J. et al.. 2005

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

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

17. Preventive intervention in circumstances of poverty

21. EHS RCT EHS begins 1995 17 sites selected for research –University partnerships –Diverse RA begins 1996

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

23. Data points Observations; HV’s and Child Care –14 months –24 months –36 months Program evaluations –I+ year after study begins –3+ years after study –(5 years) Parent service interviews –Baseline –6 months after –14 months after –Exit; (25 plus after) –(5 years- pre K)

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

25. 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

26. Impacts on Children’s Development and Learning at 2 and 3 Years of Age 8 -10 -14 -10 -8 7 11 15 20 -11 -14 16 13 12 -25 -20 -15 -10 -5 0 5 10 15 20 25 24 Months36 Months *p <.10 **p <.05 ***p <.01 Aggressive Behavior ** * Effect Size (percent) Bayley MDI Vocabulary CDI-PPVT EngagementNegativity Sustained Attention Percent MDI < 85 *** ** *** ** *** **

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

28. Impacts on Parents When Children Were 2 and 3 Years Old HOME Supportive- ness Read DailyDetachmentSpanked Effect Size (percent) *** ** *** EducationEmployed * * ** * * *p <.10 **p <.05 ***p <.01

29. 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.

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

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

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

34. Frontiers of research

36. Thinking about genetic variation Smaller number of genes than expectedSmaller number of genes than expected Genes work in a multiplicity of waysGenes work in a multiplicity of ways Genes work with environmental influencesGenes work with environmental influences –Gene expression –g/e correlations; - g/e interactions –Susceptibility genes Dimensional influencesDimensional influences Background genetic influencesBackground genetic influences

37. Disorder G S1 /E S1   G P1 /E P1 G Sn /E Sn  G S2 /E S2   G P2 /E P2  G Pn /E Pn Background genetic influences G 1 /G 2   G 1 /G 2

38. 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

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

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

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

42. 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

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

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

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

46. 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

47. 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?

48. 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

50. I look forward to our discussions