Early moral development and Preventive interventions
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Transcript of Early moral development and Preventive interventions
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Early moral development Early moral development and and
Preventive interventionsPreventive interventions
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CLASSIC STUDY OF CLASSIC STUDY OF SKEELSSKEELS
A 30 YEAR FOLLOW UP
Skeels, H., Monographs of SRCD, 1966
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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 5XSKEELS/rne/4-97
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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
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Long-term Effects Of Early Long-term Effects Of Early Intervention for children living in Intervention for children living in
circumstances of povertycircumstances of poverty
On Conduct !On Conduct !
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Preventive intervention (P/I) studiesYoung children in poverty
Began Ages served
Follow up age
Perry Preschool * 1962 PS 27
Chicago CPC 1985 PS 18
Carolina Abecedarian * 1972 6-12W to 5 21
Syracuse Late 70’s Pre-n to 5 13-16
NFP Elmira HV * 1978 Pre-n to 2 17
* = RCT
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P/I follow up studies Young children in poverty
N program N control Design
Perry Preschool 58 65 RCT *
Chicago CPC 837 444 Neighborhood C
Carolina Abecedarian
47 43 RCT
Syracuse 65 54 Demographic C
NFP Elmira HV
97 148 RCT
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Perry Preschool ProgramPerry Preschool ProgramAbecedarian ProjectAbecedarian Project
• Less school dropout - P, A• Less teenage parenting- P, A
• Less juvenile delinquency- P• Less crime- P
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Chicago PCP longitudinal studyChicago PCP longitudinal study
• Fewer juvenile arrests• Fewer violent arrests
• Less grade retention• Less use of special education
• (Less child maltreatment)
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Syracuse family development Syracuse family development research programresearch program
• Fewer reported probation cases
• Fewer court offenses
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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
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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
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Perry Preschool Programage 40 follow-up
• Fewer arrests overall
• Fewer arrests for:– Violent crimes– Property crimes– Drug crimes
From Schweinhart , L.J. et al. . 2005
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From Schweinhart L.J.,et al. 2005
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Heckman theoretical curve for investment at different points in the life cycle
From Heckman, J., 2006
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Preventive intervention in circumstances of povertyPreventive intervention in circumstances of poverty
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“... child caregiver relationships ...are critical for providing infants and toddlers support, engagement, continuity and emotional nourishment necessary for healthy development... Within the context of caregiving relationships, the infant builds a sense of what is expected, what feels right in the world, as well as skills and incentives for social turn-taking, reciprocity, and cooperation.” ...The infant's activities are nourished and channeled in appropriate ways so as to encourage a sense of initiative and self- directedness. During the toddler period,...through repeated interactions with emotionally available caregivers, [the child] also begins to learn basic skills of self-control, emotional regulation and negotiation.”
(U.S. DHHS, 1994, p 7.)
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“...Empathy for others and prosocial tendencies for caring and helping also develop during toddlerhood as well as the emotions of pride and shame; experiencing and learning about these capacities require responsive caregiving relationships in the midst of life's inevitable stresses and challenges. ...A sense of pleasure, interest and exploration, early imaginative capacities, and the sharing of positive emotions also begin in infancy-- all of which require repeated and consistent caregiver relationship experiences and form a basis for social competence that carries through toddlerhood and the preschool period...”
(U.S. DHHS, 1994, p. 7)
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EHS RCT• EHS begins 1995• 17 sites selected for research
–University partnerships–Diverse
• RA begins 1996
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Programs• CD and Parenting Services• Enrollment before age12 mos.• Ave length enrollment 22 mos.• Different approaches
– Home– Center– Mixed
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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)
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National Results of National Results of ImpactImpact
N= 17 sites; 3001 familiesN= 17 sites; 3001 families
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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
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Impacts on Children’s Development and Learning at 2 and 3 Years of Age
8
-10-14
-10-8
711
15
20
-11-14
161312
-25
-20
-15
-10
-5
0
5
10
15
20
25
24 Months 36 Months
* p < .10 ** p < .05 *** p < .01
Aggressive Behavior
***
Effect Size(percent) Bayley
MDIVocabularyCDI-PPVT Engagement Negativity
SustainedAttention
Percent MDI< 85
***
**
***** **
**
***
****
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Beneficial Impacts on Parenting and the Home Environment
• Warmth and supportiveness• Detachment• Quality of assistance• Support for language and literacy• Reading daily• Negative discipline
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Impacts on Parents When Children Were 2 and 3 Years Old
-10 -9 -9
1
11111013.5
-14
9
17
101114.6
-25
-20
-15
-10
-5
0
5
10
15
20
25
24 Months 36 Months
HOMESupportive-
ness Read DailyDetachment Spanked
Effect Size(percent)
******
**
***
Education Employed
**
**
*
*** ** ****
* p < .10 ** p < .05 *** p < .01
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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.
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To Understand What Works To Understand What Works Under What Circumstances,Under What Circumstances,
And For WhomAnd For Whom
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Other Subgroup Analyses
• Teen parents• Depressed mothers• Demographic risk• Local site analyses
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Importance of longitudinal follow-up
• 5 years- pre K• Post first grade (4 sites)• Post fifth grade• Beyond ?
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Frontiers of researchFrontiers of research
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Thinking about genetic Thinking about genetic variationvariation
• 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 expressionGene expression– g/e correlations; - g/e interactions g/e correlations; - g/e interactions – Susceptibility genes Susceptibility genes
• Dimensional influencesDimensional influences• Background genetic influencesBackground genetic influences
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DisorderDisorder
GS1/ES1
GP1/EP1
GSn/ESn
GS2/ES2
GP2/EP2
GPn/EPn
Background genetic influencesBackground genetic influences
G1/G2
G1/G2
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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
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Caspi et al., Science, 297:851-854 (2002)
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Caspi, et al., Science, 301: 386-389 (2003)
NUMBER OF LIFE EVENTS
MA
JOR
DEP
RES
SIO
N E
PISO
DES
(%)
Short allele 5-HTT genotype n=581
Long allele 5-HTT genotype n=264
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Susceptibility genes, prevention and clinical practice
• Understanding the individual• Development • Dynamics• Specificities of intervention• Importance of longitudinal study
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27-Year follow-up of children in 27-Year follow-up of children in Elmira (N=340) will examineElmira (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
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Why are we interested in these Why are we interested in these particular polymorphisms?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
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Comparison Group
-0.5
0
0.5
1
1.5
2
0 10 20 30 40 50Number of Cigarettes Smoked per Day during Pregnancy - Registration
Arre
sts
Number of Arrests among 15-Year Olds and Number of Arrests among 15-Year Olds and their Prenatal Tobacco Exposure at their Prenatal Tobacco Exposure at
Registration – Elmira Comparison GroupRegistration – Elmira Comparison Group
Courtesy- David Olds
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Nurse-Visited Group
-0.5
0
0.5
1
1.5
2
0 10 20 30 40 50Number of Cigarettes Smoked per Day during Pregnancy - Registration
Arre
sts
Number of Arrests among 15-Year Olds and Number of Arrests among 15-Year Olds and their Prenatal Tobacco Exposure at their Prenatal Tobacco Exposure at
Registration – Elmira Nurse-Visited GroupsRegistration – Elmira Nurse-Visited Groups
Courtesy- David Olds
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Dopamine Transporter (Dopamine Transporter (DATDAT))R. Kahn et al., R. Kahn et al., J PedsJ Peds. 143: 104 (2003). 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
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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?
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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
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I look forward to our discussions
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