The Two Year Window | The New Republic

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http://www.tnr.com/article/economy/magazine/97268/the-two-year-window? page=0,3&passthru=YzBlNDJmMmRkZTliNDgwZDY4MDhhYmIwMjYyYzhlMjg The Two Year Window The new science of babies and brains—and how it could revolutionize the fight against poverty. By Jonathan Cohn A decade ago, a neuroscientist named Charles Nelson traveled to Bucharest to visit Romania’s infamous orphanages. There, he saw a child whose brain had swelled to the size of a basketball because of an untreated infection and a malno
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  http://www.tnr.com/article/economy/magazine/97268/the-two-year-window?page=0,3&passthru=YzBlNDJmMmRkZTliNDgwZDY4MDhhYmIwMjYyYzhlMjg  The Two Year Window The new science of babies and brains—and how it couldrevolutionize the fight against poverty. By Jonathan CohnA decade ago, a neuroscientist namedCharles Nelsontraveled to Bucharest to visitRomania’s infamous orphanages. There, he saw a child whose brain had swelled to thesize of a basketball because of an untreated infection and a malnourished one-year-old no bigger than a newborn. But what has stayed with him ever since was the eerie quiet of theinfant wards. “It would be dead silent, all of [the babies] sitting on their backs and staring  at the ceiling,” says Nelson, who is now at Harvard. “Why cry when nobody is going to pay attention to you?” Nelson had traveled to Romania to take part in a cutting-edge experiment. It was tenyears after the fall of the Communist dictator Nicolae Ceauşescu, whose scheme for increasing the country’s population through bans on birth control and abortion had filledstate-run institutions with children their parents couldn’t support. Images from theorphanages had prompted an outpouring of international aid and a rush from parentsaround the world to adopt the children. But ten years later, the new government remainedconvinced that the institutions were a good idea—and was still warehousing at least60,000 kids, some of them born after the old regime’s fall, in facilities where manyreceived almost no meaningful human interaction. With backing from the MacArthur Foundation, and help from a sympathetic Romanian official, Nelson and colleagues fromHarvard, Tulane, and the University of Maryland prevailed upon the government to allowthem to remove some of the children from the orphanages and place them with foster families. Then, the researchers would observe how they fared over time in comparisonwith the children still in the orphanages. They would also track a third set of children,who were with their srcinal parents, as a control group.In the field of child development, this study—now known as the Bucharest EarlyIntervention Project—was nearly unprecedented. Most such research is performed onanimals, because it would be unethical to expose human subjects to neglect or abuse. Buthere the investigators were taking a group of children out of danger. The orphanages,moreover, provided a sufficiently large sample of kids, all from the same place and allraised in the same miserable conditions. The only variable would be the removal from theinstitutions, allowing researchers to isolate the effects of neglect on the brain.Prior to the project, investigators had observed that the orphans had a high frequency of serious developmental problems, from diminished IQs to extreme difficulty formingemotional attachments. Meanwhile, imaging and other tests revealed that some of theorphans had reduced activity in their brains. The Bucharest project confirmed that thesefindings were more than random observations. It also uncovered a striking pattern:Orphans who went to foster homes before their second birthdays often recovered some of their abilities. Those who went to foster homes after that point rarely did.This past May, a team led byStacy Drury of Tulane reported a similar finding—with an intriguing twist. The researchers found that telomeres, which are protective caps that siton the ends of chromosomes, were shorter in children who had spent more time in theRomanian orphanages. In theory, damage to the telomeres could change the timing of how some cells develop, including those in the brain—making the shorter telomeres aharbinger of future mental difficulties. It was the clearest signal yet that neglect of veryyoung children does not merely stunt their emotional development. It changes thearchitecture of their brains.Drury, Nelson, and their collaborators are still learning about the orphans. But one upshotof their work is already clear. Childhood adversity can damage the brain as surely as  inhaling toxic substances or absorbing a blow to the head can. And after the age of two,much of that damage can be difficult to repair, even for children who go on to receive thenurturing they were denied in their early years. This is a revelation with profoundimplication—and not just for the Romanian orphans.APPROXIMATELY SEVEN MILLION American infants, toddlers, and preschoolers getcare from somebody other than a relative, whether through organized day care centers or more informal arrangements, according to the Census Bureau. And much of that care isnot very good. One widely cited study of child care in four states, by researchers inColorado, found that only 8 percent of infant care centers were of “good” or “excellent”quality, while 40 percent were “poor.” The National Institute of Child Health and HumanDevelopmenthas found that three in four infant caregivers provide only minimalcognitive and language stimulation—and that more than half of young children in non-maternal care receive “only some” or “hardly any” positive caregiving.Of course, children in substandard day care are not the only children at risk in the UnitedStates. There are also hundreds of thousands of babies born each year to Americanteenagers, about 60 percent of them poor. The vast majority of teen mothers areunmarried when they give birth, and frequently lack either family support or the financialresources to find capable outside help. Then there are the children who begin their livesin traumatic circumstances for other reasons—because they have a parent with clinicaldepression, or they witness violence in the home. Nobody has a precise definition of adversity, let alone a number for the children who experience it. But experts like Nelsonthink at least a few hundred thousand children suffer from serious abuse or neglect everyyear. Presumably they are disproportionately, although far from exclusively, in low-income families.For a long time, social science has known of correlations between childhood turmoil andall sorts of adult maladies that carry massive social and financial costs—mental illness,addiction, tendencies toward violence. And for decades, we have attempted to addressthose problems with a variety of social interventions: Head Start, which aims to preparelow-income kids between the ages of three and five for school; investments in elementaryand high school children; programs for rehabilitation of juvenile delinquents. While somehave achieved important successes, many of the problems stemming from childhood poverty remain intractable.But a scientific revolution that has taken place in the last decade or so illuminates adifferent way to address the dysfunctions associated with childhood hardship. Thisscience suggests that many of these problems have roots earlier than is commonlyunderstood—especially during the first two years of life. Researchers, including those of the Bucharest project, have shown how adversity during this period affects the brain,down to the level of DNA—establishing for the first time a causal connection betweentrouble in very early childhood and later in life. And they have also shown a way to prevent some of these problems—if action is taken during those crucial first two years.  The first two years, however, happen to be the period of a child’s life in which we investthe least. According to research by the Urban Institute and the Brookings Institution,children get about half as many taxpayer resources, per person, as do the elderly. Andamong children, the youngest get the least. The annual federal investment in elementaryschool kids approaches $11,000 per child. For infants and toddlers up to age two, it is justover $4,000. When it comes to early childhood, public policy is lagging far behindscience—with disastrous consequences.THE ADULT BRAIN consists of about a hundred billion nerve cells, or neurons, thatcommunicate with each other and the rest of the body by transmitting electrical impulses.A baby’s genes contain a blueprint for what cells to build and when, and how those cellsare capable of operating, over the course of a lifetime. But experience and environmenthave profound effects on how the body reads and applies that blueprint.Hormones affect this process, especially stress hormones. Like all living creatures,human babies are hard-wired with a stress reaction. It’s a survival mechanism that,millions of years ago, allowed humans to protect themselves from hunger, cold, or asaber-toothed tiger about to pounce. Today, that stress response kicks in whenever a baby perceives a threat, which can be as simple as hunger or the feeling of a wet diaper. Deepinside the adrenal glands, which sit atop the kidneys, cells pump out adrenaline—ahormone that makes the lungs breathe and the heart beat faster, increasing the supply of oxygen to the muscles. In the outer shell of the glands, different cells produce cortisol,which helps the body devour stored sugars and prepare the immune system to ward off invaders.With these hormones sloshing around, blood pressure rises, muscles tighten, and energysurges. A baby wails, waiting for somebody to provide milk, dry clothing, or maybe justa warm embrace. When comfort comes quickly, the body produces fewer stresshormones, the baby calms down, and the brain goes back to business as usual. And if thishappens repeatedly, as it should, the nerve impulses crackling in the brain will carry thesignals for effective coping with stress over and over again—building pathways that the baby can use later in life to solve problems and overcome difficulty.But the baby who is ignored or neglected just keeps screaming and flailing. Eventually,he exhausts himself and may appear to withdraw. Yet the quiet child is not a contentchild. Constant activation of the stress system causes wear and tear on the brain, alteringthe formation of neural pathways, so that coping and thinking mechanisms don’t developin the same way. For example, a baby who endures prolonged abuse or neglect is likely toend up with an enlarged amygdala: a part of the brain that helps generate the fear response.Some of the earliest and most important research establishing this process dates to the1950s, when investigators observed that rats were better at solving problems if they gotmore nurturing at very young ages. Among the pioneering scientists in this field wereSeymour Levine of Stanford, Michael Meaney of McGill, andBruce McEwenof 
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