What Determines a Success

Baby Steps

Racism isn't born, folks, it's taught. I have a two-year-old son.
You know what he hates? Naps! End of list.

- Dennis Leary

Do Our First 3 Years of Life Determine How We'll Turn Out?

by Malcolm Gladwell

In April of 1997, Hillary Clinton was the host of a daylong conference at the White House entitled "What New Research on the Brain Tells Us About Our Youngest Children." In her opening remarks, which were beamed live by satellite to nearly 100 hospitals, universities, and schools in 37 states, Mrs Clinton said, "Just 15 years ago, we thought that a baby's brain structure was virtually complete at birth." She went on:

Now we understand that it is a work in progress, and that everything we do with a child has some kind of potential physical influence on that rapidly forming brain. A child's earliest experiences - their relationships with parents and caregivers, the sights and sounds and smells and feelings they encounter, the challenges they meet - determine how their brains are wired. These experiences can determine whether children will grow up to be peaceful or violent citizens, focused or undisciplined workers, attentive or detached parents themselves.

At the afternoon session of the conference, the keynote speech was given by the director turned children's advocate, Rob Reiner. His goal, Reiner told the assembled, was to get the public to "look through the prism" of the first 3 years of life "in terms of problem solving at every level of society":

If we want to have a real significant impact, not only on children's success in school and later on in life, healthy relationships, but also an impact on reduction in crime, teen pregnancy, drug abuse, child abuse, welfare, homelessness, and a variety of other social ills, we are going to have to address the first 3 years of life. There is no getting around it. All roads lead to Rome.

The message of the conference was at once hopeful and a little alarming. On the one hand, it suggested that the right kind of parenting during those first 3 years could have a lasting effect on a child's life; on the other hand, it implied that if we missed this opportunity the resulting damage might well be permanent. Today, there is a 0-3 movement, made up of advocacy groups and policymakers like Hillary Clinton, which uses the promise and the threat of this new brain science to push for better pediatric care, early childhood education, and day care. Reiner has started something called the I Am Your Child Foundation, devoted to this cause, and has enlisted the support of, among others, Tom Hanks, Robin Williams, Billy Crystal, Charlton Heston, and Rosie O'Donnell.

Some lawmakers now wonder whether programs like Head Start ought to be drastically retooled, to focus on babies and toddlers rather than on preschoolers. The state of California recently approved a 50¢-per-pack tax on cigarettes to fund programs aimed at improving care for babies and toddlers up to the age of 5. The state governments of Georgia and Tennessee send classical-music CDs home from the hospital with every baby, and Florida requires that day-care centers play classical music every day - all in the belief that Mozart will help babies build their minds in this critical window of development.

"During the first part of the 20th century, science built a strong foundation for the physical health of our children," Mrs Clinton said in her speech that morning. "The last years of this century are yielding similar breakthroughs for the brain. We are coming closer to the day when we should be able to insure the well-being of children in every domain - physical, social, intellectual, and emotional."

Mrs Clinton took pains not to make the day's message sound too extreme. "I hope that this does not create the impression that, once a child's 3rd birthday rolls around, the important work is over," she said, adding that much of the brain's emotional wiring isn't completed until adolescence, and that children never stop needing the love and care of their parents.

Still, there was something odd about the proceedings. This was supposed to be a meeting devoted to new findings in brain science, but hardly any of the brain science that was discussed was new. In fact, only a modest amount of brain science was discussed at all. Many of the speakers were from the worlds of education and policy. Then, there was Mrs Clinton's claim that the experiences of our first few years could "determine" whether we grow up to be peaceful or violent, focused or undisciplined. We tend to think that the environmental influences upon the way we turn out are the sum of a lifetime of experiences - that someone is disciplined because he spent 4 years in the Marines, or because he got up every morning as a teen-ager to train with the swim team. But Hillary Clinton was proposing that we direct our attention instead to what happens to children in a very brief window early in life. The ex-First Lady, now a United States Senator, associated herself with a curious theory of human development. Where did this idea come from? And is it true?

John Bruer tackles both these questions in his new book, The Myth of The First Three Years (Free Press; $25). From its title, Bruer's work sounds like a rant. It isn't. Noting the cultural clout of the 0-3 idea, Bruer, who heads a medical-research foundation in St Louis, sets out to compare what people like Rob Reiner and Hillary Clinton are saying to what neuroscientists have actually concluded. The result is a superb book, clear and engaging, that serves as both popular science and intellectual history.

Mrs Clinton and her allies, Bruer writes, are correct in their premise: the brain at birth is a work in progress. Relatively few connections among its billions of cells have yet been established. In the first few years of life, the brain begins to wire itself up at a furious pace, forming hundreds of thousands, even millions, of new synapses every second. Infants produce so many new neural connections, so quickly, that the brain of a 2-yr-old is actually far more dense with neural connections than the brain of an adult. After 3, that burst of activity seems to slow down, and our brain begins the long task of rationalising its communications network, finding those connections which seem to be the most important and getting rid of the rest.

During this brief initial period of synaptical "exuberance," the brain is especially sensitive to its environment. David Hubel and Torsten Wiesel, in a famous experiment, sewed one of the eyes of a kitten shut for the first 3 months of its life, and when they opened it back up they found that the animal was permanently blind in that eye. There are critical periods early in life, then, when the brain will not develop properly unless it receives a certain amount of outside stimulation.

In another series of experiments, begun in the early 70s, William Greenough, a psychologist at the University of Illinois, showed that a rat reared in a large, toy-filled cage with other rats ended up with a substantially more developed visual cortex than a rat that spent its first month alone in a small, barren cage: the brain, to use the word favoured by neuroscientists, is plastic - that is, modifiable by experience.

In other words, Hillary Clinton's violent citizens and unfocussed workers might seem to be the human equivalents of kittens who've had an eye sewed shut, or rats who've been reared in a barren cage. If in the critical first 3 years of synapse formation we could give people the equivalent of a big cage full of toys, she was saying, we could make them healthier and smarter.

Put this way, these ideas sound quite reasonable, and it's easy to see why they have attracted such excitement. But Bruer's contribution is to show how, on several critical points, this account of child development exaggerates or misinterprets the available evidence. Consider, he says, the matter of synapse formation. The 0-3 activists are convinced that the number of synapses we form in our earliest years plays a big role in determining our mental capacity. But do we know that to be true? People with a form of mental retardation known as fragile-X syndrome, Bruer notes, have higher numbers of synapses in their brain than the rest of us. More important, the period in which humans gain real intellectual maturity is late adolescence, by which time the brain is aggressively pruning the number of connections. Is intelligence associated with how many synapses you have or with how efficiently you manage to sort out and make sense of those connections later in life?

Nor do we know how dependent the initial burst of synapse formation is on environmental stimulation. Bruer writes of an experiment where the right hand of a monkey was restrained in a leather mitten from birth to 4 months, effectively limiting all sensory stimulation. That's the same period when young monkeys form enormous numbers of connections in the somatosensory cortex, the area of the monkey brain responsible for size and texture discriminations, so you'd think that the restrained hand would be impaired. But it wasn't: within a short time, it was functioning normally, which suggests that there is a lot more flexibility and resilience in some aspects of brain development than we might have imagined.

Bruer also takes up the question of early childhood as a developmental window. It makes sense that if children don't hear language by the age of 11 or 12 they aren't going to speak, and that children who are seriously neglected throughout their upbringing will suffer permanent emotional injury. But why, Bruer asks, did advocates arrive at 3 years of age as a cutoff point? Different parts of the brain develop at different speeds. The rate of synapse formation in our visual cortex peaks at around 3 or 4 months. The synapses in our prefrontal cortex - the parts of our brain involved in the most sophisticated cognitive tasks - peak perhaps as late as 3 years, and aren't pruned back until middle-to-late adolescence. How can the same cutoff apply to both regions?

Greenough's rat experiments are used to support the critical-window idea, because he showed that he could affect brain development in those early years by altering the environment of his animals. The implications of the experiment aren't so straightforward, though. The experiments began when the rats were about 3 weeks old, which is already past rat "infancy," and continued until they were 55 days old, which put them past puberty. So the experiment showed the neurological consequences of deprivation not during some critical window of infancy but during the creature's entire period of maturation. In fact, when Greenough repeated his experiment with rats that were 450 days old - well past middle age - he found that those kept in complex environments once again had significantly denser neural connections than those kept in isolation.

Even the meaning of the kitten with its eye sewn shut turns out to be far from obvious. When that work was repeated on monkeys, researchers found that if they deprived both eyes of early stimulation - rearing a monkey in darkness for its first 6 months - the animal could see (although not perfectly), and the binocularity of its vision, the ability of its left and right eyes to coördinate images, was normal. The experiment doesn't show that more stimulation is better than less for binocular vision. It just suggests that whatever stimulation there is should be balanced, which is why closing one eye tilts the developmental process in favour of the open eye.

To say that the brain is plastic, then, is not to say that the brain is dependent on certain narrow windows of stimulation. Neuroscientists say instead that infant brains have "experience-expectant plasticity" - which means that they need only something that approximates a normal environment. Bruer writes:

The odds that our children will end up with appropriately fine-tuned brains are incredibly favourable, because the stimuli the brain expects during critical periods are the kinds of stimuli that occur everywhere and all the time within the normal developmental environment for our species. It is only when there are severe genetic or environmental aberrations from the normal that nature's expectations are frustrated and neural development goes awry.

In the case of monkeys, the only way to destroy their binocular vision is to sew one eye shut for 6 months - an entirely contrived act that would almost never happen in the wild. Greenough points out that the "complex" environment he created for his rats - a large cage full of toys and other animals - is actually the closest equivalent of the environment that a rat would encounter naturally. When he created a super-enriched environment for his rats, one with even more stimulation than they would normally encounter, the rats weren't any better off. The only way he could affect the neurological development of the animals was to put them in a barren cage by themselves - again, a situation that an animal would never encounter in the wild.

Bruer quotes Steve Petersen, a neuroscientist at Washington University, in St Louis, as saying that neurological development so badly wants to happen that his only advice to parents would be "Don't raise your children in a closet, starve them, or hit them in the head with a frying pan." Petersen was, of course, being flip. But the general conclusion of researchers seems to be that we human beings enjoy a fairly significant margin of error in our first few years of life.

Studies done of Romanian orphans who spent their first year under conditions of severe deprivation suggest that most (but not all) can recover if adopted into a nurturing home. In another study, psychologists examined children from an overcrowded orphanage who had been badly neglected as infants and subsequently adopted into loving homes. Within 2 years of their adoption, one psychologist involved in their rehabilitation had concluded:

We had not anticipated the older children who had suffered deprivations for periods of 2½ to 4 years to show swift response to treatment. That they did so amazed us. These inarticulate, underdeveloped youngsters who had formed no relationships in their lives, who were aimless and without a capacity to concentrate on anything, had resembled a pack of animals more than a group of human beings. As we worked with the children, it became apparent that their inadequacy was not the result of damage but, rather, was due to a dearth of normal experiences without which development of human qualities is impossible. After a year of treatment, many of these older children were showing a trusting dependency toward the staff of volunteers and self-reliance in play and routines.

Some years ago, the Berkeley psychology professor Alison Gopnik and one of her students, Betty Repacholi, conducted an experiment with a series of 14-month-old oddlers. Repacholi showed the babies two bowls of food, one filled with Goldfish crackers and one filled with raw broccoli. All the babies, naturally, preferred the crackers.

Repacholi then tasted the two foods, saying "Yuck" and making a disgusted face at one and saying "Yum" and making a delighted face at the other. Then she pushed both bowls toward the babies, stretched out her hand, and said, "Could you give me some?"

When she liked the crackers, the babies gave her crackers. No surprise there. But when Repacholi liked the broccoli and hated the crackers, the babies were presented with a difficult philosophical issue - that different people may have different, even conflicting, desires. The 14-month-olds couldn't grasp that. They thought that if they liked crackers everyone liked crackers, and so they gave Repacholi the crackers, despite her expressed preferences. Four months later, the babies had, by and large, figured this principle out, and when Repacholi made a face at the crackers they knew enough to give her the broccoli.

The Scientist in the Crib (Morrow; $24), a fascinating new book that Gopnik has written with Patricia Kuhl and Andrew Meltzoff, both at the University of Washington, argues that the discovery of this principle - that different people have different desires - is the source of the so-called terrible twos. "What makes the terrible twos so terrible is not that the babies do things you don't want them to do - one-year-olds are plenty good at that - but that they do things because you don't want them to," the authors write. And why is that? Not, as is commonly thought, because toddlers want to test parental authority, or because they're just contrary. Instead, the book argues, the terrible twos represent a rational and engaged exploration of what is to two-year-olds a brand-new idea - a generalisation of the insight that the fact that they hate broccoli and like crackers doesn't mean that everyone hates broccoli and likes crackers.

"Toddlers are systematically testing the dimensions on which their desires and the desires of others may be in conflict," the authors write. Infancy is an experimental research program, in which "the child is the budding psychologist; we parents are the laboratory rats."

These ideas about child development are, when you think about it, oddly complementary to the neurological arguments of John Bruer. The paradox of the 0-3 movement is that, for all its emphasis on how alive children's brains are during their early years, it views babies as profoundly passive - as hostage to the quality of the experiences provided for them by their parents and caregivers. The Scientist in the Crib shows us something quite different. Children are scientists, who develop theories and interpret evidence from the world around them in accordance with those theories. And when evidence starts to mount suggesting that the existing theory isn't correct - wait a minute, just because I like crackers doesn't mean Mommy likes crackers - they create a new theory to explain the world, just as a physicist would if confronted with new evidence on the relation of energy and matter. Gopnik, Meltzoff, and Kuhl play with this idea at some length. Science, they suggest, is actually a kind of institutionalised childhood, an attempt to harness abilities that evolved to be used by babies or young children.

Ultimately, the argument suggests that child development is a rational process directed and propelled by the child himself. How does the child learn about different desires? By systematically and repeatedly provoking a response from adults. In the broccoli experiment, the adult provided the 14-month-old with the information ("I hate Goldfish crackers") necessary to make the right decision. But the child ignored that information until he himself had developed a theory to interpret it.

When The Scientist in the Crib describes children as budding psychologists and adults as laboratory rats, it's more than a clever turn of phrase. Gopnik, Meltzoff, and Kuhl observe that our influence on infants "seems to work in concert with children's own learning abilities." Newborns will "imitate facial expressions" but not "complex actions they don't understand themselves." And the authors conclude, "Children won't take in what you tell them until it makes sense to them. Other people don't simply shape what children do; parents aren't the programmers. Instead, they seem designed to provide just the right sort of information."

It isn't until you read The Scientist in the Crib alongside more conventional child-development books that you begin to appreciate the full implications of its argument. Here, for example, is a passage from What's Going On in There? How the Brain and Mind Develop in the First Five Years of Life, by Lise Eliot, who teaches at the University of Chicago: "It's important to avoid the kind of muddled baby-talk that turns a sentence like "Is she the cutest little baby in the world?" into "Uz see da cooest wiwo baby inna wowud?" Caregivers should try to enunciate clearly when speaking to babies and young children, giving them the cleanest, simplest model of speech possible." Gopnik, Meltzoff, and Kuhl see things a little differently. First, they point out, by 6 or 7 months babies are already highly adept at decoding the sounds they hear around them, using the same skills we do when we talk to someone with a thick foreign accent or a bad cold. If you say "Uz see da cooest wiwo baby inna wowud?" they hear something like "Is she the cutest little baby in the world?" Perhaps more important, this sort of Motherese - with its elongated vowels and repetitions and overpronounced syllables - is just the thing for babies to develop their language skills. And Motherese, the authors point out, seems to be innate. It's found in every culture in the world, and anyone who speaks to a baby uses it, automatically, even without realising it. Babies want Motherese, so they manage to elicit it from the rest of us. That's a long way from the passive baby who thrives only because of the specialised, high-end parenting skills of the caregiver.

"One thing that science tells us is that nature has designed us to teach babies, as much as it has designed babies to learn," Gopnik, Meltzoff, and Kuhl write. "Almost all of the adult actions we've described" - actions that are critical for the cognitive development of babies - "are swift, spontaneous, automatic and unpremeditated."

Does it matter that Mrs Clinton and her allies have misread the evidence on child development? In one sense, it doesn't. The First Lady does not claim to be a neuroscientist. She is a politician, and she is interested in the brains of children only to further an entirely worthy agenda: improved day care, pediatric care, and early-childhood education. Sooner or later, however, bad justifications for social policy can start to make for bad social policy, and that is the real danger of the 0-3 movement.

In Lise Eliot's book, for instance, there's a short passage in which she writes of the extraordinary powers of imitation that infants possess. A 15-month-old who watches an experimenter lean over and touch his forehead to the top of a box will, when presented with that same box 4 months later, do exactly the same thing. "The fact that these memories last so long is truly remarkable - and a little bit frightening," Eliot writes, and she continues:

It goes a long way toward explaining why children, even decades later, are so prone to replicating their parents' behaviour. If toddlers can repeat, even several months later, actions they've seen only once or twice, just imagine how watching their parents' daily activities must affect them. Everything they see and hear over time - work, play, fighting, smoking, drinking, reading, hitting, laughing, words, phrases, and gestures - is stored in ways that shape their later actions, and the more they see of a particular behaviour, the likelier it is to reappear in their own conduct.

There is something to this. Why we act the way we do is obviously the result of all kinds of influences and experiences, including those cues we pick up unconsciously as babies. But this doesn't mean, as Eliot seems to think it does, that you can draw a straight line between a concrete adult behavior and what little Suzie, at 6 months, saw her mother do. As far as we can tell, for instance, infant imitation has nothing to do with smoking. As the behavioural geneticist David Rowe has demonstrated, the children of smokers are more likely than others to take up the habit because of genetics: they have inherited the same genes that made their parents like, and be easily addicted to, nicotine. Once you account for heredity, there is little evidence that parental smoking habits influence children; the adopted children of smokers, for instance, are no more likely to smoke than the children of non-smokers. To the extent that social imitation is a factor in smoking, the psychologist Judith Rich Harris has observed, it is imitation that occurs in adolescence between a teen-ager and his or her peers. So if you were to use Eliot's ideas to design an anti-smoking campaign you'd direct your efforts to stop parents from smoking around their children, and miss the social roots of smoking entirely.

This point - the distance between infant experience and grownup behaviour - is made even more powerfully in Jerome Kagan's marvellous new book, Three Seductive Ideas (Oxford; $27.50). Kagan, a professor of psychology at Harvard, offers a devastating critique of what he calls "infant determinism," arguing that many of the truly critical moments of socialisation - the moments that social policy properly concerns itself with - occur well after the age of 3. As Kagan puts it, a person's level of "anxiety, depression, apathy and anger" is linked to his or her "symbolic constructions of experience" - how the bare facts of any experience are combined with the context of that event, attitudes toward those involved, expectations and memories of past experience. "The Palestinian youths who throw stones at Israeli soldiers believe that the Israeli government has oppressed them unjustly," Kagan writes. He goes on:

The causes of their violent actions are not traceable to the parental treatment they received in their first few years. Similarly, no happy African-American 2-year-old knows about the pockets of racism in American society or the history of oppression blacks have suffered. The realisation that there is prejudice will not take form until that child is 5 or 6 years old.

Infant determinism doesn't just encourage the wrong kind of policy. Ultimately, it undermines the basis of social policy. Why bother spending money trying to help older children or adults if the patterns of a lifetime are already, irremediably, in place? Inevitably, some people will interpret the 0-3 dogma to mean that our obligations to the disadvantaged expire by the time they reach the age of three.

Kagan writes of a famous Hawaiian study of child development, in which almost 700 children, from a variety of ethnic and economic backgrounds, were followed from birth to adulthood. The best predictor of who would develop serious academic or behavioural problems in adolescence, he writes, was social class: more than 80% of the children who got in trouble came from the poorest segment of the sample. This is the harsh reality of child development, from which the 0-3 movement offers a convenient escape. Kagan writes, "It is considerably more expensive to improve the quality of housing, education and health of the approximately 1,000,000 children living in poverty in America today than to urge their mothers to kiss, talk to, and play with them more consistently."

In Kagan's view, "to suggest to poor parents that playing with and talking to their infant will protect the child from future academic failure and guarantee life success" is an act of dishonesty. But that does not go far enough. It is also an unwitting act of reproach: it implies to disadvantaged parents that if their children do not turn out the way children of privilege do it is their fault - that they are likely to blame for the flawed wiring of their children's brains.

In 1973, when Hillary Clinton - then, of course, known as Hillary Rodham - was a young woman just out of law school, she wrote an essay for the Harvard Educational Review entitled "Children Under the Law." The courts, she wrote, ought to reverse their long-standing presumption that children are legally incompetent. She urged, instead, that children's interests be considered independently from those of their parents. Children ought to be deemed capable of making their own decisions and voicing their own interests, unless evidence could be found to the contrary. To her, the presumption of incompetence gave the courts too much discretion in deciding what was in the child's best interests, and that discretion was most often abused in cases of children from poor minority families. "Children of these families," she wrote, "are perceived as bearers of the sins and disabilities of their fathers."

This is a liberal argument, because a central tenet of liberalism is that social mobility requires a release not merely from burdens imposed by poverty but also from those imposed by family - that absent or indifferent or incompetent parents should not be permitted to destroy a child's prospects. What else was the classic Horatio Alger story about? In Ragged Dick, the most famous of Alger's novels, Dick's father runs off before his son's birth, and his mother dies destitute while Dick is still a baby. He becomes a street urchin, before rising to the middle class through a combination of hard work, honesty, and luck. What made such tales so powerful was, in part, the hopeful notion that the circumstances of your birth need not be your destiny; and the modern liberal state has been an attempt to make good on that promise.

But Mrs Clinton is now promoting a movement with a different message - that who you are and what you are capable of could be the result of how successful your mother and father were in rearing you. In her book It Takes a Village, she criticises the harsh genetic determinism of The Bell Curve. But an ideology that holds that your future is largely decided at birth by your parents' genes is no more dispiriting than one that holds that your future might be decided at 3 by your parents' behaviour. The unintended consequence of the 0-3 movement is that, once again, it makes disadvantaged children the bearers of the sins and disabilities of their parents.

The truth is that the traditional aims of the liberal agenda find ample support in the arguments of John Bruer, of Jerome Kagan, of Judith Rich Harris, and of Gopnik, Meltzoff, and Kuhl. All of them offer considerable evidence that what the middle class perceives as inadequate parenting need not condemn a baby for life, and that institutions and interventions to help children as they approach maturity can make a big difference in how they turn out. It is, surely, a sad irony that, at the very moment when science has provided the intellectual reinforcement for modern liberalism, liberals themselves are giving up the fight.

Russian Shock at "Gagged" Babies

A gagged baby at Yekaterinburg hospital

Russian prosecutors are investigating allegations that hospital staff in Yekaterinburg gagged babies because they did not want to hear them crying. The patient at the hospital in the southern Urals who reported the case heard the children's muffled cries. She used her mobile phone to film a baby lying in a cot with his mouth taped, while others had dummies taped to their mouths. They are all orphans.

The case, covered widely by Russian media, has caused deep shock. Russians are used to scandals in the hospital, but this case has touched a raw nerve, says the BBC's Richard Galpin in Moscow.

The patient who reported the incident, Elena Kuritsyna, had been in the hospital with her own children. She said she heard the suppressed crying of young children in the next ward. "I heard that a baby was mumbling in a neighbouring room; when I looked in, I saw the baby with plaster over his mouth; he could not cry or do anything, was just mumbling," she told Reuters television. She approached the nurse in the ward and was initially told to mind her own business. Children were crying too loudly, and distracting nurses from their work, she was told. She eventually persuaded the nurse to remove the plaster, but she says that afterwards the nurse did it again.

The nurse has been suspended and on Wednesday the head doctor at the hospital was reprimanded. Prosecutors have opened a criminal investigation, and say they have discovered that sticking plaster was used more than once. "Children in the first year of life were systematically gagged with sticking plaster to make children behave quietly," the prosecutors' press service said. It is alleged the babies were silenced because there were too few staff to deal with them.

Source: news.bbc.co.uk 1 February 2007 photo credit NTV

Don't Give Up on Any Kid

Child abuse casts a shadow the length of a lifetime.

- Herbert Ward

On watch - "A third of the children I've seen are preschool. The sooner you catch this thing the less work it is to really set them back on a new path, says Dr Robin Fancourt.

Hope for Abused Children

A leading child abuse expert says there is hope for children - and parents - damaged by abuse.

Robin Fancourt has seen more abused children than she cares to remember. As a paediatrician qualified to make forensic examinations of the young victims of physical and sexual abuse, she has seen some harrowing things. But she never forgets she is there for the children first and the judicial system second.

"It's not really a forensic examination to me. I'm there to meet the children's needs. That's often for them to know they look normal down there and everything's going to work properly, refer them to counselling ...and keep an eye on them."

The forensic evidence is collected after those needs have been met, she says. Although she has been examining abuse victims for about 5 years, she says she will never become desensitised because the children are always in great need. "You have to adapt to their emotional problem at the time and work around it to gain a bit of trust from them that you're going to be doing the right thing and you're going to be supporting them."

Dr Fancourt's 22 years as a paediatrician and her expertise in child development have been captured in a newly published book, Brainy Babies. It sets out new scientific evidence about brain development before birth and in early childhood.

As well as offering practical advice for parents and caregivers about the functions of the child's brain and how to help it grow, the book warns of the consequences of neglect and abuse. "Neglect or abuse can impair or destroy the development of the brain, leading to disastrous results for children. Scars are actually burnt into the brain stem."

The speed at which the infant brain develops is astronomical, and she stresses the need for swift intervention. "The judge who decides that more physical evidence is needed to remove a 2-year-old child from her home and asks for a review in 6 months is making a dangerous decision," she says. "Several months can permanently impair brain development of the 2-year-old."

Dr Fancourt makes no apology for her criticism of the judicial system and says she will criticise any system ignorant of the needs of children. "A young child's brain has 2½ times more activity than an adult's. They are just taking things in enormously. We have no concept of that when we are grown up. If that child has been abused, you go on leaving it to be exposed to all these awful experiences for what would be the equivalent of years for an adult."

But the health profession, which should know better, she says, is just as guilty of not acting quickly enough in the interests of children. "It's very common for people in my profession to say, 'I'm not sure what's going on, let's wait until I see him again'."

Many children at the centre of recent high-profile abuse cases have been too young to tell anyone what was happening to them, but the signs were probably there. "There are behaviours and play and so on in which these children will demonstrate their distress. Obviously you've got to exclude other causes but at the moment they just tend to be brushed aside. Driven by fear and terror, a child's brain development is shaped by the persistent activation of the survival response. This reduces the child's capacity to process other experiences, and can affect memory, hinder the ability to learn, suppress the immune system and leave the child to see the entire world as dangerous. These children then either turn their pain inwards or pass it on to others in destructive ways, continuing the cycle of abuse.

"A third of the children I've seen are preschool. The sooner you catch this thing the less work it is to really set them back on a new path."

But there is hope for children damaged by abuse. Dr Fancourt cites good counselling as a prime healer. "Abused children need to go and see someone who is really good at it, who can be just quietly there and give them some sense of direction and help them unravel all the emotion and psychological problems that result."

Even parents who were abused as children and who have grown up to be abusers themselves can be taught good parenting skills, she says. "If you're not exposed to normal parenting as a child you don't have those skills, you don't have that emotional capacity. You find some of those parents will respond to how to do things and how not to do things. For some it might take visits to the house to show them how to do things."

For some parents though, there is no help. "If they haven't ever developed an attachment to their own parents or any empathy with other people, these things can be huge barriers."

Dr Fancourt does not see the problem as predominantly Maori. "People who are in the lower socio-economic class, which is a lot of Maori and Pacific Island people but also a hell of a lot of pakeha people that I see, they are the ones that tend to be stressed, unemployed and packed in a house. I think I probably would have hit my children if I lived like that."

However, it is not just the stereotypical abusive parents who risk harming their children's brain development. Busy parents who put their children in front of the TV as a substitute for human contact will hinder their development. "Children don't learn that way. You learn if you have an interest in something with an emotional content and when you are little [the television] doesn't have that."

Computers are also out. Small children simply don't have the skills, and computers are isolating.

But given the stresses and lack of spare time these day, parents are generally taking the right approach to the healthy mental development of their children. "This brain stuff just gives you that extra information. It says, 'Hey, those normal things are really, really important.' The sort of thing [the book] is endorsing is really what normal parents do with their children anyway."

Simple contact such as hugging, caressing, touching, praising and singing to children is absolutely necessary for children to develop a healthy brain structure. "You don't need to go and buy any special toys or do any special things. You just need to do normal things, conversations and asking them questions." - NZPA

Source: The Evening Post Friday 15 September 2000