J AC K P.

S H O N KO F F

Mobilizing Science
to Revitalize
Early Childhood Policy
Effective early childhood programs clearly make a difference, but we can do better,
and there is a compelling need for innovation.

resident Barack Obama has called for greater

investment in the healthy development of
the nations youngest children. But policymakers are facing difficult decisions about
the allocation of limited funds among a
range of competing alternatives, including
home visiting services beginning in pregnancy, child care from infancy to school entry, and various
early education options, among others. Advocates argue
that 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 destination that simply requires increased funding. Remarkable
progress in neuroscience, molecular biology, and genomics
has provided rock-solid knowledge that underscores the
role of positive early experiences in strengthening brain
architecture, along with compelling evidence that toxic stress
can disrupt brain circuits, undermine achievement, and

compromise physical and mental health. Evaluation science also is providing the means to differentiate effective early
childhood programs that should be scaled up from underperforming efforts that need to be either strengthened or discontinued. It is time for policymakers to strengthen efforts
to equalize opportunities for all young children by leveraging the science of child development and its underlying
neurobiology to create the framework for a new era of innovation in early childhood policy and practice.
Seeking new strategies
Exciting new discoveries at the intersection of the biological, behavioral, and social sciences can now explain how healthy
development happens, how it is derailed, and what society
can do to keep it on track. It is well established, for example, that the interaction of genetics and early experience
builds a foundation for all subsequent learning, behavior, and
health. That is to say, genes provide the blueprint for building brain architecture, but early experiences determine how

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the circuitry actually gets wired, and together they influence

whether that foundation is strong or weak. Families and
communities clearly play the central role (and bear most of
the costs) in providing the supportive relationships and
positive experiences that all children need, yet public policies that promote healthier environments for children can
also have significant positive effects.
In todays political world, policy discussions about improving the environments in which children live typically begin
and end with questions about the quality of the nations air,
water, and food supplies. For example, there have been
heated battles over the regulation of coal-burning power plants,
which emit mercury that contaminates rivers and streams
and can lead to elevated levels of methyl mercury in the food
supply. This presents a serious problem for embryos, fetuses,
and young children, whose brains are vulnerable to damage from mercury at levels that appear to be relatively harmless to adults. Beyond the compelling need to protect children from neurotoxic chemicals, however, science also has
a lot to say about how a young childs environment of relationships, including his or her family, nonfamily caregivers,
and community, can also be strengthened to produce better outcomes, not only for children themselves but for all
of society.
Ensuring the provision of a healthy and supportive environment for all young children requires responsible management of the nations 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 effective strategies to support families and expand opportunities
for children, especially for those who are unable to excel because
of significant adversity that is built into the environments
in which they are being raised. The science of early childhood and early brain development offers a useful framework
for productive public discussion and policy deliberation on
this critical issue. The most constructive way to begin is to
focus the nations collective attention on core concepts that
are well grounded in the cumulative findings of decades of
rigorous research. These concepts are:
Brain architecture is constructed through a process
that begins before birth and continues into adulthood. As
this architecture emerges, it establishes either a sturdy or a
fragile foundation for all the capabilities and behavior that
follow.
Skill begets skill as brains are built in a hierarchical fashion, from the bottom up, and increasingly complex circuits
and skills build on simpler circuits and skills over time.
The interaction of genes and experience shapes the

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circuitry of the developing brain. Young children offer frequent invitations to engage with adults, who are either
responsive or unresponsive to their needs. This serve and
return processwhat developmental researchers call contingent reciprocityis fundamental to the wiring of the
brain, especially in the early years.
Cognitive, emotional, and social capacities are inextricably intertwined, and learning, behavior, and physical
and mental health are highly interrelated over the life
course. It is impossible to address one domain without
affecting the others.
Although manageable levels of stress are normative
and growth-promoting, toxic stress in the early yearsfor
example, from severe poverty; serious parental mental health
impairment, such as maternal depression; child maltreatment;
and family violencecan damage developing brain architecture and lead to problems in learning and behavior as well
as to increased susceptibility to physical and mental illness.
As with other environmental hazards, treating the consequences
of toxic stress is less effective than addressing the conditions
that cause it.
Brain plasticity and the ability to change behavior
decrease over time. Consequently, getting it right early is less
costly to society and to individuals than trying to fix it later.
These core concepts constitute a rich return on decades
of public investment in scientific research. This evolving
knowledge base has informed the development, implementation, and evaluation of a multitude of intervention models aimed at improving early childhood development during the past 40 years. The theory of change that currently
drives most early interventions for children living in adverse
circumstances, which typically involve poverty, emphasizes
the provision of enriched learning opportunities for the
children and a combination of parenting education and
support services for their families, focused mostly on mothers. This model has been implemented successfully in a
number of flagship demonstration projects, such as the
Perry Preschool and Abecedarian projects, each of which has
confirmed that effective intervention can produce positive
effects on a range of outcomes. Documented benefits include
higher rates of high-school graduation and increased adult
incomes, as well as lower rates of special education referral, welfare dependence, and incarceration.
Persistent challenges, however, lie in the magnitude of the
effects that have been achieved, which typically falls within
the mild to moderate range, as well as in the marked variability in measured outcomes, which is associated largely with
inconsistent quality in program implementation. In order
to address these challenges effectively, early childhood pol-

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icy must be driven by two fundamental directives. The first

will help to close the gap between what we know and what
we can do right now to promote better developmental outcomes. The second calls for new ideas. Both are essential.
These directives are:
Decades of program evaluation indicate that the quality of early childhood investments will determine their rate
of return. Programs that incorporate evidence-based effectiveness factors that distinguish good services from bad
will produce positive outcomes. Programs with inadequately
trained personnel, excessive child/adult ratios, and limited
or developmentally inappropriate learning opportunities
are unlikely to have significant effects, particularly for the
most disadvantaged children. The strongest data on positive effects come from a few model programs that are based
on a clear theory of change that matches the nature of the
intervention to explicit child and family needs. The dilemma
facing policymakers is the debate about the relative effectiveness of current programs that vary markedly in the skills
of their staff and the quality of their implementation. Overcoming that variability is the most immediate challenge.
Continuing to invest in programs that lack sufficient quality 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 example, 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% from
45%) and lowered rates of arrest for violent crime (to 32%
from 48%) that represent impressive results with large benefit/cost ratios. But it is impossible to look at this intervention model, which results in only two of three participants
completing high school and one-third committing violent
crimes, and conclude that the remaining challenge is simply a matter of expanded funding for replication. The data
clearly demonstrate that improved interventions are needed.
Meeting this need will require the nation to build on current best practices and draw on strong science to develop
innovative interventions that get a bigger bang for the buck.
Promising new directions
With this challenge in mind, two areas of scientific inquiry
are particularly ripe for development. First, achieving a
deeper understanding of the biology of adversity and the evidence base regarding effective interventions would help in
fostering innovative policies and programs for children and
families whose life opportunities are undermined by toxic
stress. Toxic stress differs markedly from other types of

stress, called positive or tolerable, in terms of the distinctive physiological disruptions it triggers in the face of adversity that is not buffered by protective relationships.
Positive stress is characterized by moderate, short-lived
increases in heart rate, blood pressure, and levels of stress
hormones, such as cortisol and inflammatory cytokines, in
response to everyday challenges such as dealing with frustration, meeting new people, and getting an immunization.
The essential characteristic of positive stress in young children is that it is an important aspect of healthy development
that is experienced in the context of stable, supportive relationships that facilitate positive adaptation.
Tolerable stress is a physiological state that could potentially disrupt brain architecture through, for example, cortisol-induced disruption of neural circuits or neuronal death
in the hippocampus. Causes of such stress include the death
or serious illness of a parent, family discord, homelessness,
a natural disaster, or an act of terrorism. The defining characteristic of tolerable stress is that protective relationships
help to facilitate adaptive coping that brings the bodys
stress-response systems back to baseline, thereby protecting the brain from potentially damaging effects, such as
those associated with post-traumatic stress disorder.
Toxic stress comprises recurrent or prolonged activation
(or both) of the bodys stress-response systems in the absence
of the buffering protection of stable adult support. Major risk
factors in early childhood include deep poverty, recurrent
maltreatment, chronic neglect, severe maternal depression, parental
substance abuse, and family violence. The defining characteristic of toxic stress is that it disrupts brain architecture and affects
multiple organ systems. It also leads to relatively lower thresholds for physiological responsiveness to threat that persist
throughout life, thereby increasing the risk for stress-related
chronic disease and cognitive impairment.
This simple taxonomy, proposed by the National Scientific Council on the Developing Child, differentiates normative life challenges that are growth-promoting from significant adversities that threaten long-term health and
development and therefore call for preventive intervention
before physiological disruptions occur. Within this taxonomy, programs that serve children whose well-being is compromised by the generic stresses of poverty have demonstrated
greater effectiveness than have programs for children whose
development is threatened further by additional risk factors,
such as child maltreatment, maternal depression, parental
substance abuse, family violence, or other complex problems
that few contemporary early care and education programs
have the specialized expertise needed to address effectively.
This 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 problems overwhelm the visitors limited skills. Of perhaps
greater concern, children and parents from highly disorganized families struggling with mental illness and substance
abuse are less likely to participate in any formal early childhood program and are more likely to drop out if they are
enrolled. Thus, significant numbers of the most disadvantaged young children who are at greatest risk for school
failure, economic dependence, criminal behavior, and a lifetime of poor health are neither reached nor significantly helped
by current programs.
One promising route that innovation in early childhood
policy might pursue is illustrated by the efforts of scientists
in the Division of Violence Prevention at the federal Centers for Disease Control and Prevention, who are reconsidering child abuse and neglect as a public health issue
rather than as a social services concern. This shift in perspective incorporates new research about the extent to
which early maltreatment gets built into the body and leads
not only to impairments in learning but also to higher rates
of diabetes, heart disease, hypertension, substance abuse, depression, stroke, cancer, and many other adult diseases that
drive escalating health care costs. The high prevalence of child
abuse and neglect alone, estimated to affect 7.5% of children
aged 2 to 5, is arguably one of the most compelling threats
to healthy child development and certainly the most challenging frontier in early childhood policy.
Since their establishment more than a century ago, child
welfare services have addressed the needs of abused and
neglected children by focusing on physical safety, reduction
of repeated injury, and child custody. But advances in neuroscience now indicate that evaluations of maltreated children that rely exclusively on physical examination and x-rays
are woefully insufficient. They must be augmented by comprehensive developmental assessments of the children and
sophisticated evaluations of the parent-child relationship
by skilled examiners. Moreover, when foster care arrangements 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 gap
between what is known and what is done for children who
have been maltreated may well be the greatest shortcoming
in the nations health and human services system. Because
incremental improvements in child welfare systems have
been difficult to achieve, dramatic breakthroughs will require
creative thinking, scientific justification, and strong leadership committed to bold change.
The second promising area for scientific inquirycreatively

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applying new knowledge from the growing science of early

learning, beginning in infancy and extending to school
entrywould enhance the effects of early care and education programs for all children, and programs for disadvantaged youngsters would be especially strengthened. To
achieve this goal, it will be necessary to think beyond the
emphasis on language stimulation and early literacy that
informs current practiceefforts that certainly should be
continuedand to develop innovative teaching strategies that
target other domains of development that are essential for
success in school, at work, and in the community. This will
mean focusing on the early emergence of competencies in
areas known as executive functioning, such as working
memory, attention, and self-regulation, that contribute to the
ability to plan, use information creatively, and work productively with others.
Additional efforts also will be needed to integrate programs that target the emotional and social needs of young
children into the broader early care and education environment. Indeed, failure to acknowledge the interrelatedness of cognitive, language, emotional, and social capabilities, in skill development and in their underlying brain
architecture, undermines the full promise of what evidencebased investments in early learning might achieve. The conventional approach to this challenge focuses on treating
behavioral problems and emotional difficulties as they
become apparent. Yet advances in evidence-based preventive interventions offer much promise in the early childhood
years, particularly when combined with the skills and commitment required to address the mental health needs of
parents as well. Promising areas for creative intervention include
adopting preventive approaches that do not require the
assignment of clinical diagnoses to young children and providing health professionals who typically work outside of the
mental health field with the skills they need to address, or
at least identify, the mental health needs of their patients.
Key policy opportunities
Within the evolving context of current early childhood policy, the creative mobilization of scientific knowledge offers
an opportunity to close the gap and create the future in
three important areas.
First, the nation would benefit from a more enlightened
view of public expenditures for high-quality early care and
education programs in the first five years of life as an investment in building a strong foundation for later academic
achievement, economic productivity, and responsible citizenship, and not as a burdensome subsidy for places to
watch over children of working parents at the lowest pos-

E A R LY C H I L D H O O D P O L I C Y

sible cost. The evidence is clear that positive early learning

experiences are beneficial for children at all income levels,
and strategic investments in youngsters from disadvantaged
families yield the largest financial returns to society. The coordination of effective developmental programs with primary
health care and interventions that enhance economic security can further increase the odds of more favorable outcomes
for children living in poverty. A regular source of health care,
for example, increases the likelihood that a young childs developmental progress can be monitored, concerns can be identified early, and effective interventions can be provided
when needed. Linking innovative services that bolster parent employment, income, and assets presents another promising strategy for strengthening family resources, both
human and material, that are associated with more favorable child outcomes.
Second, specialized interventions as early as possible, at
or before birth, should be focused on improving life outcomes
for children whose learning capacity and health are compromised by significant adversity above and beyond the burdens
of poverty alone. As described above, the physiological effects
of excessive or chronic activation of the stress-response system can disrupt the developing architecture of the immature
brain. This can be particularly problematic during sensitive
periods in the formation of neural circuits affecting memory in the hippocampus and executive functioning in the prefrontal cortex. In a parallel fashion, the wear and tear of
cumulative stress over time can result in damage to the cardiovascular and immune systems that may help explain the
association between adverse childhood experiences and
greater prevalence of chronic disease in adulthood.
Third, significant social and economic benefits to society could be realized from greater availability of effective prevention and treatment services for young children with
emotional or behavioral problems, along with increased
assistance for parents and nonrelated caregivers whose own
difficulties with depression adversely affect a young childs
environment of relationships. This area of unmet need has
been underscored in recent years by media reports and
empirical evidence of young children being removed from
child care centers and preschool programs that are illequipped to deal with behavior problems that undermine
learning. Several studies by the National Academies offer a
wealth of knowledge to address this challenge. The Institute
of Medicines 1994 report Reducing Risks for Mental Disorders emphasizes the difference between preventing and
treating mental health problems and highlights the promise of prevention. A 2009 report from the National Research
Council and Institute of Medicine, Preventing Mental, Emo-

T
he dilemma facing policymakers
is the debate about the relative
effectiveness of current programs that
vary markedly in the skills of their
staff and the quality of their
implementation. Overcoming that
variability is the most immediate
challenge. Continuing to invest in
programs that lack sufficient quality
is unwise and unproductive.

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tional, and Behavioral Disorders Among Young People, summarizes the extensive progress that has been made in the development and evaluation of a broad array of evidence-based
preventive services during the past decade and notes that
the data on benefit/cost analyses have been most positive
for interventions in the early childhood years.
Taken together, these priority areas reinforce the importance of early childhood policies that focus on both children
and parents, but they also highlight the extent to which
current interventions are often too limited. For example, families who must deal with the daily stresses of poverty and
maternal depression need more help than is typically provided by a parent education program that teaches them the
importance of reading to their children. Youngsters who
are struggling with anxiety and fear associated with exposure to violence need more than good learning experiences
during the hours they spend in a preschool program. Families burdened by significant adversity need help to achieve
greater economic security, coupled with access to structured programs, beyond current informal efforts, that focus
on the mental health needs of adults and children. Such
two-generational models of intervention must be implemented by personnel with sufficient expertise to deal with
the problems they are asked to address.
Finally, continuing debate in the world of early childhood policymaking raises important questions about the definition of early. Neuroscience tells us that infants and toddlers 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 would
suggest that later remediation for children who are burdened early on by the physiological effects of toxic stress will
be less effective than preventive intervention at an earlier
age. Other observers point toward the positive effects of
preschool education beginning at age four and argue that
missed learning opportunities during the infant and toddler
period can be remediated by enrichment in the later preschool 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 beginning
interventions as early as possible for the most vulnerable young
children.
Reasons for optimism
Although serious challenges remain, public understanding
of the importance of the early years has grown considerably
during the past decade. This increasing awareness is grounded
in a greater appreciation of the extent to which early expe-

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rience influences brain architecture and constructs a foundation for all the learning and health that follow.
Science has been quite effective in answering the question
of why public funds should be invested in the healthy development of young children. In contrast, however, science has
been less conclusive in its answers to the how questions,
which are now primed to be addressed at a much more
focused and rigorous level. The challenge is straightforward
and clear: to move beyond the simple call for investing in the
earliest years and to seek greater guidance in targeting
resource allocation to increase the magnitude of return. A
2000 report from the Institute of Medicine and the National
Research Council, From Neurons to Neighborhoods: The Science of Early Childhood Development, articulated this challenge: Finally, there is a compelling need for more constructive dialogue between those who support massive public
investments in early childhood services and those who question their cost and ask whether they really make a difference.
Both perspectives have merit. Advocates of earlier and more
intervention have an obligation to measure their impacts
and costs. Skeptics, in turn, must acknowledge the massive
scientific evidence that early childhood development is influenced by the environments in which children live.
Pretending that the early years have little impact on later
life outcomes is no longer a credible position. Contending
that full funding of existing early childhood programs will
completely eliminate later school failure and criminal behavior is similarly indefensible. The concept of early intervention as a strategy for improving life outcomes for young
children is well grounded in the biological and social sciences, but the translation of that concept into highly effective programs that generate strong returns on investment needs
more work. For those who insist that the United States can
do better, current practice provides a good place to start.
If the nation is ready to support a true learning environment that makes it safe for policymakers, practitioners,
researchers, and families to ask tough questions, experiment with new ideas, learn from failure, and solve problems
together, 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 Outcomes in Learning, Behavior, and Health for Vulnerable
Children (Cambridge, MA: Harvard University, 2007)
(http://www.developingchild.net/pubs/persp/pdf/Policy_
Framework.pdf).
Committee on Prevention of Mental Disorders, Division

E A R LY C H I L D H O O D P O L I C Y

of Biobehavioral Sciences and Mental Disorders, Institute of Medicine, Reducing Risks for Mental Disorders:
Frontiers for Preventive Intervention, eds. P. Mrazek and
R. 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 Childhood Interventions: Proven Results, Future Promise (Santa
Monica, CA: RAND Corporation, 2005).
E. Knudsen, J. Heckman, J. Cameron, and J. Shonkoff,
Economic, Neurobiological and Behavioral Perspectives
on Building Americas Future Workforce, Proceedings
of the National Academy of Sciences 103 (2006):
1015510162.
J. Middlebrooks and N. Audage, The Effects of Childhood Stress
on Health Across the Lifespan (Atlanta, GA: Centers for
Disease Control and Prevention, National Center for Injury
Prevention and Control, 2008).
Committee on Integrating the Science of Early Childhood Development; Board on Children, Youth, and Families; Commission on Behavioral and Social Sciences and Education; 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 Substance
Abuse Among Children, Youth and Young Adults:

Research Advances and Promising Interventions; Board

on Children, Youth, and Families; Division of Behavioral and Social Sciences and Education; National
Research Council and Institute of Medicine, Preventing
Mental, Emotional, and Behavioral Disorders Among
Young People: Progress and Possibilities, eds. M. OConnell, T. Boat, and K. Warner (Washington, DC: National
Academy Press, 2000).
National Scientific Council on the Developing Child, Excessive Stress Disrupts the Architecture of the Developing
Brain (Working Paper No. 3, 2005) (http://www.
developingchild.net/pubs/wp-abstracts/wp3.html).
National Scientific Council on the Developing Child, The
Science of Early Childhood Development: Closing the
Gap 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, Neuroscience,
Molecular Biology, and the Childhood Roots of Health
Disparities: Building a New Framework for Health Promotion and Disease Prevention, Journal of the American Medical Association 301, no. 21 (2009): 22522259.

Jack P. Shonkoff (jack_shonkoff@harvard.edu) is the Julius B.

Richmond FAMRI Professor of Child Health and Development
and founding director of the Center on the Developing Child
at Harvard University.

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