Early childhood policies and practices over the past several decades have been guided by multiple theoretical models of human development that have been refined over time. Together, these models underscore the extent to which life outcomes are influenced by a dynamic interplay between the cumulative burden of risk factors and the buffering effects of protective factors that can be identified within the individual, family, community, and broader socioeconomic and cultural contexts. Each of these models also emphasizes the influence of reciprocal child-adult interactions in the developmental process, thereby underscoring the importance of stable and nurturing relationships as well as the recognition that young children play an active role in their own development.

The challenges of applying this multidimensional framework, however, lie in its complexity. The acknowledgment of numerous influences on developmental outcomes underscores both the futility of searching for simple solutions to complicated problems and the difficulty in choosing which variables to include and which to leave out when designing a specific policy, program, or research project. Building on these widely supported developmental models, programs for young children living in disadvantaged circumstances (most typically associated with low family income and limited parent education) are currently driven by a theory of change that emphasizes the provision of enriched learning opportunities for the children and a combination of parenting education and social support for their families (usually focused exclusively on mothers), both in community-based centers and in the home.

Over four decades of program development and evaluation, this basic model has been implemented successfully in a number of flagship demonstration projects, each of which has confirmed that effective intervention can produce desirable impacts on a range of long-term outcomes, including educational attainment, unplanned pregnancies, economic productivity, and criminal behavior, among others. This is best illustrated in 40-year follow-up data from the most frequently cited program, the Perry Preschool Project, which reported higher rates of high school graduation (66% in the intervention group versus 45% in the control group) and lower rates of arrest for violent crime (32% versus 48%). Notwithstanding these impressive effects, the fact that a third of the intervention group had at least one arrest and the impacts on high school completion rates were significant for girls only demonstrates the continuing need for enhanced interventions that produce greater impacts.

Although the basic principles of development have stood up well over time, recent scientific advances offer an exciting opportunity to formulate augmented theories of change that could guide the design of new intervention strategies that exceed the impacts of current best practices. These enhancements are particularly critical for disadvantaged, young children whose needs are not addressed adequately by existing policies and services. This is perhaps best illustrated by current approaches to child abuse or neglect, which focus primarily on physical safety and custody concerns, rather than addressing the pressing need for interventions that promote healing relationships.

The urgency of this challenge is further underscored by a growing evidence base in the biological sciences that illustrates the physiological disruptions caused by excessive adversity early in life and their long-term manifestations in disorders of learning, behavior, and both physical and mental health. This evidence supports the potential benefits of a “biodevelopmental framework” for understanding the common roots of these disparities, particularly in abusive or neglectful environments of relationships and health-threatening physical circumstances. This concept of common origins and converging pathways for impairments in health and development could help guide coordinated innovation across service sectors. It could also inform the use of selected biomarkers to assess relative vulnerability as well as measure physiological changes in response to interventions designed to reduce toxic stress.

Related Reading & Resources

• The Foundations of Lifelong Health Are Built in Early Childhood
• Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention
• How Early Experiences Get Into the Body: A Biodevelopmental Framework (Interactive Feature)
• Toxic Stress Response: The Facts

The Need for a New Vision for Young Children Living in Adverse Circumstances

Early childhood policy for children and families at risk for poor outcomes is attracting the interest of increasing numbers of public sector and private sector leaders across the political spectrum. Much of this growing support is being driven by converging evidence from neuroscience, behavioral research, program evaluation studies, and economic analyses, all of which indicate that providing a positive environment that promotes healthy development early in life produces better outcomes at less cost—physiologically as well as financially—than trying to fix problems later. As the demand for greater investment has grown, four challenges have become increasingly clear:

• Marked variability in the quality of implementation of successful programs as they are taken to scale.
• Continuing evidence that the most effective interventions for children living in families with low income and limited parent education produce positive outcomes but a parallel recognition that the magnitude of their impacts is insufficient to fully close the gaps they are designed to reduce.
• The persistence of a relatively smaller but important subgroup of young children at greatest risk, particularly those experiencing significant adversity in the absence of supportive adult relationships (e.g., from child maltreatment, severe maternal depression, or other sources of toxic stress), who do not appear to benefit sufficiently from existing services. 
• The need to view policies and programs targeting young children living in adverse circumstances as strategies for lifelong health promotion and disease prevention, not just as vehicles for enhancing readiness to succeed in school.  

These challenges underscore the extent to which future policy must be informed by a broader understanding of the importance of early childhood influences on health as well as on learning and behavior. Extensive scientific research indicates that the origins of many adult diseases can be found in the physical impacts of significant adversities in the early years of life, which establish biological “memories” that weaken physiological systems and produce long-term susceptibilities to illness. When early experiences prepare a developing child for conditions involving a high level of stress or instability, the body’s regulatory systems retain that initial programming and put the stress response systems on high-alert status. For many young children facing such circumstances, the benefits of short-term survival therefore come at a significant cost to longer-term physical and mental health.

All four challenges underscore the need for greater efforts to create the building blocks for a new era in early childhood policies and practices that is grounded in cutting-edge science, embraces creativity, and invites experimentation, above and beyond the current focus on enhanced staff development, increased quality improvement, appropriate measures of accountability, and expanded funding to serve more children and families. Stated simply, existing best practices must be viewed as a promising starting point, not a final destination.