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compromise physical and mental health. Evaluation sci-ence also is providing the means to differentiate effective earlychildhood programs that should be scaled up from under-performing efforts that need to be either strengthened or dis-continued. It is time for policymakers to strengthen effortsto equalize opportunities for all young children by leverag-ing the science of child development and its underlyingneurobiology to create the framework for a new era of innovation in early childhood policy and practice.

Seeking new strategiesExciting new discoveries at the intersection of the biologi-cal, behavioral, and social sciences can now explain how healthydevelopment happens, how it is derailed, and what societycan do to keep it on track. It is well established, for exam-ple, that the interaction of genetics and early experiencebuilds a foundation for all subsequent learning, behavior, andhealth. That is to say, genes provide the blueprint for build-ing brain architecture, but early experiences determine how

J AC K P. S H O N KO F F

Mobilizing Scienceto Revitalize

Early Childhood PolicyEffective early childhood programs clearly make a difference, but we can do better,

and there is a compelling need for innovation

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President Barack Obama has called for greaterinvestment in the healthy development of the nation’s youngest children. But policy-makers are facing difficult decisions aboutthe allocation of limited funds among arange of competing alternatives, includinghome visiting services beginning in preg-

nancy, child care from infancy to school entry, and variousearly education options, among others. Advocates arguethat more money is needed, yet there is no consensus about

which programs should be priorities for increased support.Current early childhood programs should be viewed as

a promising starting point for innovation, not a final des-tination that simply requires increased funding. Remarkableprogress in neuroscience, molecular biology, and genomicshas provided rock-solid knowledge that underscores therole of positive early experiences in strengthening brainarchitecture, along with compelling evidence that “toxic” stresscan disrupt brain circuits, undermine achievement, and

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the circuitry actually gets wired, and together they influencewhether that foundation is strong or weak. Families andcommunities clearly play the central role (and bear most of the costs) in providing the supportive relationships andpositive experiences that all children need, yet public poli-cies that promote healthier environments for children canalso have significant positive effects.

In today’s political world, policy discussions about improv-ing the environments in which children live typically beginand end with questions about the quality of the nation’s air,water, and food supplies. For example, there have beenheated battles over the regulation of coal-burning power plants,which emit mercury that contaminates rivers and streamsand can lead to elevated levels of methyl mercury in the foodsupply. This presents a serious problem for embryos, fetuses,and young children, whose brains are vulnerable to dam-

age from mercury at levels that appear to be relatively harm-less to adults. Beyond the compelling need to protect chil-dren from neurotoxic chemicals, however, science also hasa lot to say about how a young child’s environment of rela-tionships, including his or her family, nonfamily caregivers,and community, can also be strengthened to produce bet-ter outcomes, not only for children themselves but for allof society.

Ensuring the provision of a healthy and supportive envi-ronment for all young children requires responsible man-agement of the nation’s physical and human resources. Thus,it is essential that we act on existing knowledge and close

the gap between what is known and what is done. Equally important, however, is the need to seek new and more effec-tive strategies to support families and expand opportunitiesfor children, especially for those who are unable to excel becauseof significant adversity that is built into the environmentsin which they are being raised. The science of early child-hood and early brain development offers a useful framework for productive public discussion and policy deliberation onthis critical issue. The most constructive way to begin is tofocus the nation’s collective attention on core concepts thatare well grounded in the cumulative findings of decades of rigorous research. These concepts are:

• Brain architecture is constructed through a processthat begins before birth and continues into adulthood. Asthis architecture emerges, it establishes either a sturdy or afragile foundation for all the capabilities and behavior thatfollow.

• Skill begets skill as brains are built in a hierarchical fash-ion, from the bottom up, and increasingly complex circuitsand skills build on simpler circuits and skills over time.

• The interaction of genes and experience shapes the

circuitry of the developing brain. Young children offer fre-quent invitations to engage with adults, who are eitherresponsive or unresponsive to their needs. This “serve andreturn” process—what developmental researchers call con-tingent reciprocity—is fundamental to the wiring of thebrain, especially in the early years.

• Cognitive, emotional, and social capacities are inex-tricably intertwined, and learning, behavior, and physicaland mental health are highly interrelated over the lifecourse. It is impossible to address one domain withoutaffecting the others.

• Although manageable levels of stress are normativeand growth-promoting, toxic stress in the early years—forexample, from severe poverty; serious parental mental healthimpairment, such as maternal depression; child maltreatment;and family violence—can damage developing brain archi-

tecture and lead to problems in learning and behavior as wellas to increased susceptibility to physical and mental illness.As with other environmental hazards, treating the consequencesof toxic stress is less effective than addressing the conditionsthat cause it.

• Brain plasticity and the ability to change behaviordecrease over time. Consequently, getting it right early is lesscostly to society and to individuals than trying to fix it later.

These core concepts constitute a rich return on decadesof public investment in scientific research. This evolvingknowledge base has informed the development, implemen-tation, and evaluation of a multitude of intervention mod-

els aimed at improving early childhood development dur-ing the past 40 years. The theory of change that currently drives most early interventions for children living in adversecircumstances, which typically involve poverty, emphasizesthe provision of enriched learning opportunities for thechildren and a combination of parenting education andsupport services for their families, focused mostly on moth-ers. This model has been implemented successfully in anumber of flagship demonstration projects, such as thePerry Preschool and Abecedarian projects, each of which hasconfirmed that effective intervention can produce positiveeffects on a range of outcomes. Documented benefits include

higher rates of high-school graduation and increased adultincomes, as well as lower rates of special education refer-ral, welfare dependence, and incarceration.

Persistent challenges, however, lie in the magnitude of theeffects that have been achieved, which typically falls withinthe mild to moderate range, as well as in the marked vari-ability in measured outcomes, which is associated largely withinconsistent quality in program implementation. In orderto address these challenges effectively, early childhood pol-

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EARLY CHILDHOOD POLICY

icy must be driven by two fundamental directives. The firstwill help to close the gap between what we know and whatwe can do right now to promote better developmental out-comes. The second calls for new ideas. Both are essential.These directives are:

Decades of program evaluation indicate that the qual-ity of early childhood investments will determine their rateof return. Programs that incorporate evidence-based effec-tiveness factors that distinguish good services from badwill produce positive outcomes. Programs with inadequately trained personnel, excessive child/adult ratios, and limitedor developmentally inappropriate learning opportunitiesare unlikely to have significant effects, particularly for themost disadvantaged children. The strongest data on posi-tive effects come from a few model programs that are basedon a clear theory of change that matches the nature of the

intervention to explicit child and family needs. The dilemmafacing policymakers is the debate about the relative effec-tiveness of current programs that vary markedly in the skillsof their staff and the quality of their implementation. Over-coming that variability is the most immediate challenge.Continuing to invest in programs that lack sufficient qual-ity is unwise and unproductive.

The most effective early childhood programs clearly make a difference, but there is considerable room for improvement and a compelling need for innovation. For exam-ple, 40 years of follow-up data from the most frequently cited preschool program, the Perry Preschool Project, reveal

increased rates of high-school graduation (to 66% from45%) and lowered rates of arrest for violent crime (to 32%from 48%) that represent impressive results with large ben-efit/cost ratios. But it is impossible to look at this interven-tion model, which results in only two of three participantscompleting high school and one-third committing violentcrimes, and conclude that the remaining challenge is sim-ply a matter of expanded funding for replication. The dataclearly demonstrate that improved interventions are needed.Meeting this need will require the nation to build on cur-rent best practices and draw on strong science to developinnovative interventions that get a bigger bang for the buck.

Promising new directionsWith this challenge in mind, two areas of scientific inquiry are particularly ripe for development. First, achieving adeeper understanding of the biology of adversity and the evi-dence base regarding effective interventions would help infostering innovative policies and programs for children andfamilies whose life opportunities are undermined by toxicstress. Toxic stress differs markedly from other types of

stress, called positive or tolerable, in terms of the distinc-tive physiological disruptions it triggers in the face of adver-sity that is not buffered by protective relationships.

Positive stress is characterized by moderate, short-livedincreases in heart rate, blood pressure, and levels of stresshormones, such as cortisol and inflammatory cytokines, inresponse to everyday challenges such as dealing with frus-tration, meeting new people, and getting an immunizationThe essential characteristic of positive stress in young chil-dren is that it is an important aspect of healthy developmentthat is experienced in the context of stable, supportive relationships that facilitate positive adaptation.

Tolerable stress is a physiological state that could poten-tially disrupt brain architecture through, for example, cor-tisol-induced disruption of neural circuits or neuronal deathin the hippocampus. Causes of such stress include the death

or serious illness of a parent, family discord, homelessnessa natural disaster, or an act of terrorism. The defining char-acteristic of tolerable stress is that protective relationshipshelp to facilitate adaptive coping that brings the body’sstress-response systems back to baseline, thereby protect-ing the brain from potentially damaging effects, such asthose associated with post-traumatic stress disorder.

Toxic stress comprises recurrent or prolonged activation(or both) of the body’s stress-response systems in the absenceof the buffering protection of stable adult support. Major riskfactors in early childhood include deep poverty, recurrentmaltreatment, chronic neglect, severe maternal depression, parenta

substance abuse, and family violence. The defining character-istic of toxic stress is that it disrupts brain architecture and affectsmultiple organ systems. It also leads to relatively lower thresholds for physiological responsiveness to threat that persistthroughout life, thereby increasing the risk for stress-relatedchronic disease and cognitive impairment.

This simple taxonomy, proposed by the National Scien-tific Council on the Developing Child, differentiates nor-mative life challenges that are growth-promoting from sig-nificant adversities that threaten long-term health anddevelopment and therefore call for preventive interventionbefore physiological disruptions occur. Within this taxon

omy, programs that serve children whose well-being is com-promised by the generic stresses of poverty have demonstratedgreater effectiveness than have programs for children whosedevelopment is threatened further by additional risk factorssuch as child maltreatment, maternal depression, parentasubstance abuse, family violence, or other complex problemsthat few contemporary early care and education programshave the specialized expertise needed to address effectivelyThis gap can be seen when highly dedicated yet modestly

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trained paraprofessionals are sent to visit the homes of deeply troubled families with young children whose prob-lems overwhelm the visitors’ limited skills. Of perhapsgreater concern, children and parents from highly disorgan-ized families struggling with mental illness and substanceabuse are less likely to participate in any formal early child-hood program and are more likely to drop out if they areenrolled. Thus, significant numbers of the most disadvan-taged young children who are at greatest risk for schoolfailure, economic dependence, criminal behavior, and a life-time of poor health are neither reached nor significantly helpedby current programs.

One promising route that innovation in early childhoodpolicy might pursue is illustrated by the efforts of scientistsin the Division of Violence Prevention at the federal Cen-ters for Disease Control and Prevention, who are recon-

sidering child abuse and neglect as a public health issuerather than as a social services concern. This shift in per-spective incorporates new research about the extent towhich early maltreatment gets built into the body and leadsnot only to impairments in learning but also to higher ratesof diabetes, heart disease, hypertension, substance abuse, depres-sion, stroke, cancer, and many other adult diseases thatdrive escalating health care costs. The high prevalence of childabuse and neglect alone, estimated to affect 7.5% of childrenaged 2 to 5, is arguably one of the most compelling threatsto healthy child development and certainly the most chal-lenging frontier in early childhood policy.

Since their establishment more than a century ago, childwelfare services have addressed the needs of abused andneglected children by focusing on physical safety, reductionof repeated injury, and child custody. But advances in neu-roscience now indicate that evaluations of maltreated chil-dren that rely exclusively on physical examination and x-raysare woefully insufficient. They must be augmented by com-prehensive developmental assessments of the children andsophisticated evaluations of the parent-child relationshipby skilled examiners. Moreover, when foster care arrange-ments are deemed necessary, the need for additional intervention for the child and specialized support for the foster

parent is often not recognized. Consequently, the current gapbetween what is known and what is done for children whohave been maltreated may well be the greatest shortcomingin the nation’s health and human services system. Becauseincremental improvements in child welfare systems havebeen difficult to achieve, dramatic breakthroughs will requirecreative thinking, scientific justification, and strong leader-ship committed to bold change.

The second promising area for scientific inquiry—creatively

applying new knowledge from the growing science of early learning, beginning in infancy and extending to schoolentry—would enhance the effects of early care and educa-tion programs for all children, and programs for disadvan-taged youngsters would be especially strengthened. Toachieve this goal, it will be necessary to think beyond theemphasis on language stimulation and early literacy thatinforms current practice—efforts that certainly should becontinued—and to develop innovative teaching strategies thattarget other domains of development that are essential forsuccess in school, at work, and in the community. This willmean focusing on the early emergence of competencies inareas known as executive functioning, such as workingmemory, attention, and self-regulation, that contribute to theability to plan, use information creatively, and work produc-tively with others.

Additional efforts also will be needed to integrate pro-grams that target the emotional and social needs of youngchildren into the broader early care and education envi-ronment. Indeed, failure to acknowledge the interrelated-ness of cognitive, language, emotional, and social capabil-ities, in skill development and in their underlying brainarchitecture, undermines the full promise of what evidence-based investments in early learning might achieve. The con- ventional approach to this challenge focuses on treatingbehavioral problems and emotional difficulties as they become apparent. Yet advances in evidence-based preven-tive interventions offer much promise in the early childhood

years, particularly when combined with the skills and com-mitment required to address the mental health needs of parents as well. Promising areas for creative intervention includeadopting preventive approaches that do not require theassignment of clinical diagnoses to young children and providing health professionals who typically work outside of themental health field with the skills they need to address, orat least identify, the mental health needs of their patients.

Key policy opportunitiesWithin the evolving context of current early childhood pol-icy, the creative mobilization of scientific knowledge offers

an opportunity to close the gap and create the future inthree important areas.

First, the nation would benefit from a more enlightened view of public expenditures for high-quality early care andeducation programs in the first five years of life as an invest-ment in building a strong foundation for later academicachievement, economic productivity, and responsible citi-zenship, and not as a burdensome subsidy for places towatch over children of working parents at the lowest pos-


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sible cost. The evidence is clear that positive early learningexperiences are beneficial for children at all income levels,and strategic investments in youngsters from disadvantagedfamilies yield the largest financial returns to society. The coor-dination of effective developmental programs with primary health care and interventions that enhance economic secu-rity can further increase the odds of more favorable outcomesfor children living in poverty. A regular source of health care,for example, increases the likelihood that a young child’s devel-opmental progress can be monitored, concerns can be iden-tified early, and effective interventions can be providedwhen needed. Linking innovative services that bolster par-ent employment, income, and assets presents another prom-ising strategy for strengthening family resources, bothhuman and material, that are associated with more favor-able child outcomes.

Second, specialized interventions as early as possible, ator before birth, should be focused on improving life outcomesfor children whose learning capacity and health are compro-mised by significant adversity above and beyond the burdensof poverty alone. As described above, the physiological effectsof excessive or chronic activation of the stress-response sys-tem can disrupt the developing architecture of the immaturebrain. This can be particularly problematic during sensitiveperiods in the formation of neural circuits affecting mem-ory in the hippocampus and executive functioning in the pre-frontal cortex. In a parallel fashion, the wear and tear of cumulative stress over time can result in damage to the car-

diovascular and immune systems that may help explain theassociation between adverse childhood experiences andgreater prevalence of chronic disease in adulthood.

Third, significant social and economic benefits to soci-ety could be realized from greater availability of effective prevention and treatment services for young children withemotional or behavioral problems, along with increasedassistance for parents and nonrelated caregivers whose owndifficulties with depression adversely affect a young child’senvironment of relationships. This area of unmet need hasbeen underscored in recent years by media reports andempirical evidence of young children being removed from

child care centers and preschool programs that are ill-equipped to deal with behavior problems that underminelearning. Several studies by the National Academies offer awealth of knowledge to address this challenge. The Instituteof Medicine’s 1994 report Reducing Risks for Mental Dis-orders emphasizes the difference between preventing andtreating mental health problems and highlights the prom-ise of prevention. A 2009 report from the National ResearchCouncil and Institute of Medicine, Preventing Mental, Emo-

FALL 2009 83

The dilemma facing policymakersis the debate about the relativeeffectiveness of current programs that

vary markedly in the skills of their

staff and the quality of theirimplementation. Overcoming that variability is the most immediatechallenge. Continuing to invest inprograms that lack sufficient qualityis unwise and unproductive.

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tional, and Behavioral Disorders Among Young People, sum-marizes the extensive progress that has been made in the devel-opment and evaluation of a broad array of evidence-basedpreventive services during the past decade and notes thatthe data on benefit/cost analyses have been most positivefor interventions in the early childhood years.

Taken together, these priority areas reinforce the impor-tance of early childhood policies that focus on both childrenand parents, but they also highlight the extent to whichcurrent interventions are often too limited. For example, fam-ilies who must deal with the daily stresses of poverty andmaternal depression need more help than is typically provided by a parent education program that teaches them theimportance of reading to their children. Youngsters whoare struggling with anxiety and fear associated with expo-sure to violence need more than good learning experiences

during the hours they spend in a preschool program. Fam-ilies burdened by significant adversity need help to achievegreater economic security, coupled with access to struc-tured programs, beyond current informal efforts, that focuson the mental health needs of adults and children. Suchtwo-generational models of intervention must be imple-mented by personnel with sufficient expertise to deal withthe problems they are asked to address.

Finally, continuing debate in the world of early child-hood policymaking raises important questions about the def-inition of “early.” Neuroscience tells us that infants and tod-dlers who experience toxic stress are at considerable risk for

disrupted neural circuitry during early sensitive periods of brain development that cannot be rewired later. This wouldsuggest that later remediation for children who are bur-dened early on by the physiological effects of toxic stress willbe less effective than preventive intervention at an earlierage. Other observers point toward the positive effects of preschool education beginning at age four and argue thatmissed learning opportunities during the infant and toddlerperiod can be remediated by enrichment in the later pre-school years, thereby saving earlier program expenses.Whether broad-based investments are made earlier or later,the long-term societal costs associated with significant early

adversity underscore the potential benefits of beginninginterventions as early as possible for the most vulnerable youngchildren.

Reasons for optimismAlthough serious challenges remain, public understandingof the importance of the early years has grown considerably during the past decade. This increasing awareness is groundedin a greater appreciation of the extent to which early expe-

rience influences brain architecture and constructs a foun-dation for all the learning and health that follow.

Science has been quite effective in answering the questionof why public funds should be invested in the healthy devel-opment of young children. In contrast, however, science hasbeen less conclusive in its answers to the how questions,which are now primed to be addressed at a much morefocused and rigorous level. The challenge is straightforwardand clear: to move beyond the simple call for investing in theearliest years and to seek greater guidance in targetingresource allocation to increase the magnitude of return. A2000 report from the Institute of Medicine and the NationalResearch Council, From Neurons to Neighborhoods: The Sci-ence of Early Childhood Development , articulated this chal-lenge: “Finally, there is a compelling need for more con-structive dialogue between those who support massive public

investments in early childhood services and those who ques-tion their cost and ask whether they really make a difference.Both perspectives have merit. Advocates of earlier and moreintervention have an obligation to measure their impactsand costs. Skeptics, in turn, must acknowledge the massivescientific evidence that early childhood development is influ-enced by the environments in which children live.”

Pretending that the early years have little impact on laterlife outcomes is no longer a credible position. Contendingthat full funding of existing early childhood programs willcompletely eliminate later school failure and criminal behav-ior is similarly indefensible. The concept of early interven-

tion as a strategy for improving life outcomes for youngchildren is well grounded in the biological and social sci-ences, but the translation of that concept into highly effec-tive programs that generate strong returns on investment needsmore work. For those who insist that the United States cando better, current practice provides a good place to start.

If the nation is ready to support a true learning environ-ment that makes it safe for policymakers, practitioners,researchers, and families to ask tough questions, experi-ment with new ideas, learn from failure, and solve problemstogether, then the benefits of a more prosperous, cohesive,and just society surely lie ahead.

Recommended reading Center on the Developing Child, A Science-Based Framework

for Early Childhood Policy: Using Evidence to Improve Out-comes in Learning, Behavior, and Health for VulnerableChildren (Cambridge, MA: Harvard University, 2007)(http://www.developingchild.net/pubs/persp/pdf/Policy_Framework.pdf).

Committee on Prevention of Mental Disorders, Division


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of Biobehavioral Sciences and Mental Disorders, Insti-tute of Medicine, Reducing Risks for Mental Disorders:Frontiers for Preventive Intervention, eds. P. Mrazek andR. Haggerty (Washington, DC: National Academy Press,1994).

J. Isaacs, Impacts of Early Childhood Programs (Washington,DC: First Focus and the Brookings Institution, 2008).

L. A. Karoly, M. R. Kilburn, and J. S. Cannon, Early Child-hood Interventions: Proven Results, Future Promise (SantaMonica, CA: RAND Corporation, 2005).

E. Knudsen, J. Heckman, J. Cameron, and J. Shonkoff,“Economic, Neurobiological and Behavioral Perspectiveson Building America’s Future Workforce,” Proceedingsof the National Academy of Sciences 103 (2006):10155–10162.

J. Middlebrooks and N. Audage, The Effects of Childhood Stress

on Health Across the Lifespan (Atlanta, GA: Centers forDisease Control and Prevention, National Center for Injury Prevention and Control, 2008).

Committee on Integrating the Science of Early Childhood Devel-opment; Board on Children, Youth, and Families; Com-mission on Behavioral and Social Sciences and Educa-tion; National Research Council and Institute of Medicine,From Neurons to Neighborhoods: The Science of Early Childhood Development , eds. J. Shonkoff and D. Phillips(Washington, DC: National Academy Press, 2000).

Committee on Prevention of Mental Disorders and SubstanceAbuse Among Children, Youth and Young Adults:

Research Advances and Promising Interventions; Boardon Children, Youth, and Families; Division of Behav-ioral and Social Sciences and Education; NationaResearch Council and Institute of Medicine, Preventing

Mental, Emotional, and Behavioral Disorders AmongYoung People: Progress and Possibilities, eds. M. O’Con-nell, T. Boat, and K. Warner (Washington, DC: NationaAcademy Press, 2000).

National Scientific Council on the Developing Child, Excessive Stress Disrupts the Architecture of the DevelopingBrain (Working Paper No. 3, 2005) (http://www developingchild.net/pubs/wp-abstracts/wp3.html).

National Scientific Council on the Developing Child, TheScience of Early Childhood Development: Closing theGap Between What We Know and What We Do (2007)(http://www.developingchild.net/pubs/persp/pdf/Science_

Early_Childhood_Development.pdf).J. Shonkoff, W. T. Boyce, and B. McEwen, “NeuroscienceMolecular Biology, and the Childhood Roots of HealthDisparities: Building a New Framework for Health Pro-motion and Disease Prevention,” Journal of the American Medical Association 301, no. 21 (2009): 2252–2259

Jack P. Shonkoff ([email protected]) is the Julius BRichmond FAMRI Professor of Child Health and Developmentand founding director of the Center on the Developing Childat Harvard University.

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