Why the dean of early childhood experts wants to get beyond the brain

Harvard’s Jack Shonkoff, a luminary in the field of early childhood, has spent years showing that events in the earliest years of life have profound implications for how budding brains develop, and in turn, shape a child’s later potential at school and work.

Now, Shonkoff says it’s time to connect the brain to the rest of the body.

“The message now is to say that there is a revolution going on in molecular biology and genomics and in the biology of adversity and resilience,” he told journalists at the 2020 National Fellowship this week. “If we start recognizing it’s not just about the brain, that the impact of experiences and the impact of stress activation also affects the immune system, metabolic systems, and therefore the impacts are not just on school readiness and educational achievement, but they are also on physical and mental health outcomes.”

That means Shonkoff, director of the Center on the Developing Child at Harvard, is rowing against the public perception that early childhood is all about education and the policies that promote it. While he’s still among the first to say that early life events shape brain development and related traits such as the ability to direct attention, the stakes are ultimately far bigger in his view.

“What the science is screaming at us right now is that not only is this also about the foundations of lifelong health, but it actually may even be more about lifelong health than it is about school readiness,” he said.

The medical science that Shonkoff alludes to here is emerging and complex, involving the intricate interplay of everything from the body’s cardiovascular system and nervous system to metabolic pathways and the immune system’s defenses. All of these essential bodily systems can become redlined by chronic levels of stress and adversity — an extraordinarily broad term in the literature — in the first years of life. But one of the central ideas to emerge from Shonkoff’s quick tour of the science is the concept that the body develops and adapts to the world it expects to meet.

For instance, he points to the story of the Dutch famine during World War II, when the country was blockaded by the Germans and the average birthweight of babies dropped. When researchers later tracked those children, they found much higher rates of chronic diseases such as obesity, hypertension and cardiovascular disease than among otherwise similar peers.

A starving mother is a particularly harrowing form of adversity, but exposure to pollutants or a mentally ill parent or an abusive relative can also hijack the body’s stress response system, and over time that kind of elevated stress can have toxic effects on young bodies, priming them for lifelong health problems.

“The message is the body, the brain, other organ systems develop mechanisms early on the world that they expect to live in,” Shonkoff said. “And the reason for that is short-term survival.”

The body’s short-term defenses can become long-term liabilities when they don’t recede, and a growing body of science is coalescing around the notion that chronic inflammation is a kind of “black box” for all kinds of stress-related diseases, from diabetes to arthritis to some types of cancer. Since families of color tend to face far greater levels of adversity — from systemic racism to greater exposure to industrial pollutants and neighborhood violence — the argument for policies that better support children and families in the first years of life is also an argument for addressing some of the persistent health disparities laid bare by the pandemic. And it’s an argument that is consistent with the dawning realization among policy makers and philanthropists in recent years that the forces that ultimately shape health don’t reside at the doctor’s office or hospital, but in the very different physical and social waters through which we swim, from conception through adulthood.

In Shonkoff’s view, every program that touches the lives of young families has a role. “If early childhood is a time of building strong foundations for lifelong physical and mental health, where is the locus of responsibility for addressing it? The answer is, it’s everything that touches the environment in which families are raising young children — child care, education, social services. All of them have the capacity to affect health as well as learning.”

One of the most important ways they can do that is by throttling down the levels of stress and adversity facing families. That’s not exactly a classic public health intervention. But in Shonkoff’s view, it would have a vastly greater impact than the usual focus on lifestyle changes in your 30s and 40s.

“So, dealing with housing instability, dealing with food insecurity, dealing with levels of violence in the community, dealing with untreated mental health problems in the family,” he said. “These can all reduce source of stress that will translate into greater biological homeostasis.”

His other broad emphasis in on helping parents become better versions of themselves: stable, nurturing caregivers who spend plenty of time talking, reading and interacting with their kids. Shonkoff calls these “responsive relationships,” and points to the oft-cited concept of “serve and return” as a fundamental buffer of stress and driver of early brain development.

It also requires helping parents build up their own “executive function” or life skills, teaching them through coaching and practice strategies for regulating emotions, focusing attention and getting things done. Kids in turn learn these essential life skills by seeing them modeled by their parents.

“These seem pretty basic,” Shonkoff conceded. “These are not new discoveries on our part. The devil is in the details. How do you reduce sources of stress? How do you build responsive relationships? How do you strengthen core skills? That will vary. This is where the need for people with the training and expertise to provide this — and for policies to be thinking explicitly about how they’re impacting these principles.”