The Two Year Window

The New Republic had a fantastic cover article a couple weeks ago, "The Two Year Window."  (Sorry, you need a subscription. Mother Jones has a summary. Here's a backdoor version of the article.)

The author, Jon Cohn, describes research on early childhood development, including the fascinating and horrfying accounts of Romania orphanages. The upshort of the research is that the first two years of a baby's development is incredibly important. Ignore or abuse a child during those first two years and the damage is permanent. No amount of love and attention can entirely heal the child's brain. 

Romanians horror orphanages are extreme, but there are quite a number of substandard daycare centers in America. Imagine kids strapped into carseats watching cartoons all day.

If early childhood is so important, why aren't we spending more on babies than on prisons? Cohn says we spend $4,000 on early childhood education, while we spend $11,000 on older kids. We spend even more on senior citizens.

Maybe we need to adjust our priorities. 

32 thoughts on “The Two Year Window

  1. There is very little political will in support of intense parenting interventions. Parenting is seen as private business and no one wants to be the one to tell people how to do it best.
    While high quality child care is important, terrible early care is only a minor contributor to poor child outcomes. Family factors are by far the biggest determinant of outcomes and a lot of improvement could be made in this area through systemic changes like universal health care but those changes really need to be coupled with family level interventions.
    The Harlem Children’s Zone’s partial effectiveness in implementing parenting improvement programs targeting birth to three provides some idea of what these programs should look like: run by neighborhood residents, making the programs free and accessible (yes, you WILL need to provide child care if you want people to come to a parenting group), and ensuring that parents have access to the health care and job training services that make it a lot easier to be good parent.
    But this all takes lots of money and two year olds can’t vote, so…

  2. There’s actually some precedent for community-run programs to target these areas, even decades before the HCZ. In the 1970s, for example, welfare mothers in Las Vegas occupied an old hotel and set up health clinics, preschools, parenting classes and more AND got paid to staff them–there’s a wonderful book all about this particular aspect of the welfare rights movement, but I can’t think of the title right now (have it at home, will add later).

  3. This one hits close to home because our four-year-old came to us through the foster care system right before her third birthday after having been removed from her mother’s care right before her second and then spending the intervening year with an overwhelmed and underprepared family member and then an overwhelmed and thus inadequate foster home.
    She’s amazingly smart and has done so well in the last year, but she has speech delays characteristic of kids who were left alone without sufficient interaction and counterproductive self-soothing behaviors (hair-pulling, pica) that are probably a direct result of those first two years. The only times I’ve gotten weepy about what she missed out on is when I’ve seen friends talking about their younger kids’ active vocabularies and realizing they were bigger than hers.
    I haven’t thought a whole lot about what interventions might have helped, because I do admit it makes me sad. Families like hers have some reasons not to trust state social workers, and the worker who had been involved with her since birth was routinely having her suggestions ignored by the judge until the final removal suggestion was approved. She was already being seen by a WIC nurse every six months, but that’s not the same as having someone who’s able to influence parenting choices. And none of that is going to happen in a situation where her mother wouldn’t or couldn’t do more or do better. I do think that an intensive support program and definitely decent subsidies (I’d prefer at par with foster rates, which aren’t enormous but definitely help) for kinship caregivers might have let her remain with her relative after being removed from her mom’s care. I’m glad she’s with us and fully believe she’s the greatest kid ever, but things could have been better early on.

  4. My children were in an orphanage for 5.5 months and it took lots of therapies until about 3 to make up for that time. Orphanage care/institutionalized care is still not good around the world. You can’t put a price on those first few months/years, any international adoption Dr will tell you, you are loosing milestones lost by the minute in a not so great orphanage. And I would say that adoption Dr’s opinions/strategies would probably be very relevant to those children neglected and then fostered or adopted in the US.

  5. “If early childhood is so important, why aren’t we spending more on babies than on prisons?”
    Prisons are more expensive than daycare centers because under-3s weigh less than 40 pounds, are less than three feet tall, and won’t kill you if you turn your back on them.

  6. It’s a little unfair that day care centres are always mentioned in conjunction with this topic. The instances of abuse and neglect I see reported usually come from overwhelmed carers like the ones in Thorn’s comment.

  7. I’ve always had a problem with the “experiments” in severe childhood deprivation (Romanian orphanages, wire mother monkeys, sensory deprivation in mice) being used to drive policy. Severe abuse is horrible and life altering, but these studies can’t be extrapolated to suggest that substandard care will have significant long term effects.
    We need to stop the abuse — but a lack of enrichment does not have the kind of consequences that abuse does.

  8. “I’ve always had a problem with the “experiments” in severe childhood deprivation (Romanian orphanages, wire mother monkeys, sensory deprivation in mice) being used to drive policy.”
    Definitely. I remember reading about one of those studies where they raised some rats with lots of toys and some without any, and I remember thinking that the total deprivation situation was artificial and would not occur naturally. Lots of toys is what the natural world (or your attic or kitchen) looks like to a baby rat.
    With regard to bad daycares, I would expect that overstimulation could be just as much of a problem as understimulation. A lot of us just find it tiring to be around other people all the time.

  9. There’s something very circular about the argument. A government program (the Romanian orphanages) warehoused large numbers of infants. The damage caused by the lack of all human contact justifies more governmental supervision of parenting in this country?
    How do you determine who needs these services? Anyone who has an accent? Any young female? Should any unmarried mother be subject to mandatory supervision by bureaucrats? Mind you, the infants weren’t harmed by a lack of Baby Einstein–they were harmed by a lack of basic human nurture. Governments have no business trying to improve the basic mother-child bond.

  10. What if Bill Gates, or any other wealthy foundation/individual, decided parenting intervention was his main philanthropic priority? It doesn’t have to be the government.
    “Governments have no business trying to improve the basic mother-child bond.”
    This belief that parenting is sancrosant is the what I was talking about in my initial comment. Sometimes there is no parental bond. Sometimes it’s because the parent is mentally ill and can’t afford medication, or she got pregnant at 15 and has no support system, or he grew up in a household where beratement and corporal punishment were the only ways to discipline and he has no alternate model.
    Is it threatening to the mother-child bond to provide assistance to address these hardships?

  11. “the parent is mentally ill and can’t afford medication…”
    Or (what is more likely) doesn’t want to take it.
    If there is literally “no parental bond,” what hope is there of creating one? While that genuinely happens (even among cows, as a matter of fact), I don’t think you’re really talking about those cases. When there is literally no parental bond, that’s when the foster care system takes over. I think that what you’re talking about is the more marginal cases where the parental bond is weak.
    One of my cousins-in-law used to be a social worker at a maternity home for young or troubled single mothers. She needed to do really basic (but important) stuff like persuade the moms not to give their infants coffee. I’ve visited another maternity home (Mom’s House) in Pittsburgh. I know there are not that many maternity homes today, but I think there’s a lot to be said for that residential model, especially for those first, dangerous sleepless months when even middle class mothers wonder what do I do with this thing, and is it too late to send it back?
    “What if Bill Gates, or any other wealthy foundation/individual, decided parenting intervention was his main philanthropic priority?”
    So far, Bill Gates has excelled at discovering what doesn’t work in education. Please don’t set him loose on the under-twos!
    “How do you determine who needs these services?”
    Anybody getting food stamps or other government support for their children would be an obvious place to start (and perhaps end).

  12. I’d like to note here that in most cases, we’re not starting from zero. There’s a lot of natural affection already. As a rule, lower-middle class parents love and take pride in their kids, as you can tell from their tiny children’s adorable little outfits and hair done just so, even for a trip to Walmart. (Interestingly, I think upper middle class parents usually put a lot less effort into the physical appearance of their toddlers than lower middle class parents do.)
    It is fortunately rare to hear a (white) mother scream “I’m gonna cut you!” to a more or less well-behaved toddler in the grocery store as I did a few months ago. But not knowing the mother, it’s hard to say whether she was just having a bad day (and would be better for an ongoing relationship with a social worker) or if she was like that all the time, in which case, I wouldn’t bet on being able to improve her parenting.

  13. Sometimes there is no parental bond. Sometimes it’s because the parent is mentally ill and can’t afford medication, or she got pregnant at 15 and has no support system, or he grew up in a household where beratement and corporal punishment were the only ways to discipline and he has no alternate model.
    Is it threatening to the mother-child bond to provide assistance to address these hardships?

    I once read in Spiegel an account of a (iirc) Catholic home for the mentally disabled, in which a client had become pregnant while at the home. The center was helping the mother raise the resulting child. This effort required the full attention of multiple adults.
    Every once in a while, especially when some terrible abuse case appears in the media, people will fantasize about licensing childbearing. It’s an attractive thought, as long as you don’t think you’ll ever be found not fit to reproduce.
    Sometimes a mother is not fit to care for her child. How do we decide this? If a mother can’t take care of her child, what level of assistance could protect the child? The history of forced sterilization in this country is shameful. There is not a good record of authorities being able to judge women’s capacity for parenting.
    Writing for the majority in the Supreme Court’s affirmative decision of this landmark case, Oliver Wendell Holmes Jr. described Charlottesville native Carrie Buck as the “probable potential parent of socially inadequate offspring, likewise afflicted” stating that “her welfare and that of society will be promoted by her sterilization.”
    Current scholarship shows that Carrie Buck’s sterilization relied on a false diagnosis premised on the now discredited science of eugenics. It is likely that Carrie’s mother, Emma Buck, was committed to a state institution because she was considered sexually promiscuous, that the same diagnosis was made about Carrie when she became an unwed mother at the age of 17 due to being raped, and that her daughter Vivian was diagnosed as “not quite normal” at the age of six months largely in support of the legal effort to sterilize Carrie.

    Of course the article Laura linked to isn’t advocating sterilization. It does, however, advocate encouraging parents to adhere to upper-middle class norms of child nurture. What if the parents one most wants to “help” don’t agree that the services provided are necessary? What if they don’t place the same emphasis upon developing brain circuitry?
    The local child protective agencies in each city and state could print out lists of truly neglectful parents, who shouldn’t be allowed to bear more children. I don’t have the impression that a few home nursing visits will improve matters in those families. Should their children be taken away at birth, and given to other families to raise?
    Note that Britain already practices forced adoptions, which the “the first two years are the most important” argument could be used to support: .
    When their children are seized, on suspicions which too often turn out to be unfounded, this is almost invariably with full support from the police. When one mother was recently breast-feeding her newborn baby at 3 o’clock in the morning, no fewer than nine police officers and social workers entered the hospital room to wrest the baby from her.

  14. Sometimes a cow will reject a calf. This happens not infrequently with twins–the mother will accept one twin and not allow the other to nurse. I believe rejection also sometimes comes up in the case of first time mothers who are just confused by the whole calf thing. (What is this thing? And why is it following me?)
    In the case of cattle, it’s relatively simple to induce more maternal behavior. You take the cow and calf (or calves) and pen them up in a small pen until the cow softens up toward the rejected calf and permits nursing. Then they can return to the herd. This isn’t a 100% effective method. If it doesn’t work, you have to resort to bottle feeding, and even so, the rejected calf is quite likely to die.

  15. I agree with bj. What does a Romanian orphanage tell us about a normal poor kid who has “normal” loving interactions and stimulation on nights and weekends, and then spends 40-60 hours per week with minimal (but some) interaction and lots of TV at a daycare center?
    As I understand it, the Romanian orphans were left alone to stare at white walls all day. Giving them a TV and a dozen episodes of “Barney” might have been a huge improvement.
    As with most things, “more” is “better,” but “more” is also “more expensive.” So the question has to be, how much “more” constitutes “enough.” And just because the first two years are the most important, doesn’t mean that they have to be the most expensive.

  16. There’s a case in our newspaper right now, of a mom & dad who think their babies are too fat and don’t feed them. The eldest 2 children are in foster care and the mom put laxatives in the bottle when she was given the opportunity to feed her child. There are 3 children under 4 (the last born in Sept 2011) and the mom is now pregnant again.
    It’s tough not to do something other than clean up the messes (as best you can, which often isn’t very well). But, unfortunately, not much can be done that still respects the liberty of the individual.
    There was a deeply disturbing report on the removal of native american children (no, not 50 or 100 or even 25 years ago, but now) in South Dakota:
    Unfortunately some starved infants are the price we pay for avoiding whole sale transfer of children away from their parents.

  17. Although it’s true that both in Canada and the US, the national government has a long history of interfering in native family life, NPR really botched the South Dakota story.
    John Hinderaker did quite a few installments explaining why, and here is an important one:
    The key issue that NPR botched is that because of the high degree of legal autonomy that Indian reservations have within the United States (they are nations and they have treaties with the US government), the State of South Dakota has no authority over reservation children.
    “But the idea that the [South Dakota] Department of Social Services sends social workers onto reservations to snatch children is ludicrous. It has no such power; in fact, it has no jurisdiction at all inside any reservation. Every time the state agency takes custody of a child, it is under the supervision of a court. And if the child is on a reservation, South Dakota’s courts have no jurisdiction either–the order must come from the tribal court. So, in the case of the Yellow Robes, if the Department took custody of the children, it was because tribal law enforcement or the Crow Creek tribal court directed it to do so. If the Howes have a grievance, it is not against Child Protection Services, it is against their own tribal court. And you can be sure that the tribal court did not issue its order without a hearing.”

  18. To throw a spanner into the works…when I worked at a childrens’ mental health centre doing family therapy, we had the whole range of economic classes of families. Here in Canada, there is free access to counselling services for families with kids 0-18 although you might have to wait a few months on a wait list (unless of course someone is suicidal in the family – then they are seen immediately).
    You would be surprised to see how many families of the middle and upper classes have kids with fetal alcohol effects. Not FAS – fetal alcohol effects. Not as severe but it plays out in lots of ADD, ADHD, impulse control issues, etc. It’s not only the working classes who may have a drink or two while pregnant. It just doesn’t get as much attention as the upper classes can afford all sorts of learning challenge assistance, etc.
    That all being said, there must be room for some assistance/support between “Romanian orphanage-type neglect” and “doing a reasonably decent job” no matter what the social class. The former with all its attendant horror stories are not the norm of those kids/families needing help.
    I can only imagine that a lot of it gets back to the determinants of social and physical and mental health. If the kids are well fed, if the parents have adequate maternity/paternity leave and child care and health care, then all sorts of ills are solved.
    The old pay now or pay later…

  19. The NPR story did mention the role of the tribal council. I believe that the tribal council can intervene, but they are not participants in the actions unless they choose to intervene. I’m not sure what your quotes are saying, but was are we suppsoed to find the idea that SD DSS would snatch children from reservations ludicrous because they supposedly don’t have the legal authority to do so (kind of like it’s impossible for someone to have stolen my wallet from my house because that’s illegal?)
    There was no question, though, from the stories, that something very nasty was going on, probably with the collusion of more than one governmental body as well as some well meaning folks. Sounded much like the suborning of the government that you see in developing countries (and some more remote areas in the US), including the potential for people using the lack of protection in the law for their own purposes (like reporting neighbors they’re annoyed at).
    To bring it back to this discussion, the issues illustrate the reasons why we can’t issue childbearing licenses or really give the state free reign to do what’s “in the best interests of the child.”

  20. “(kind of like it’s impossible for someone to have stolen my wallet from my house because that’s illegal?)”
    Nah, it’s more like if you’d told me that Sasquatch had helped himself to your Thanksgiving leftovers.
    Indian reservations (at least everywhere I’ve ever heard of) are extremely assertive about sovereignty. Now, I believe that some people might wind up getting run roughshod over by the tribal council (which can be run along very third world kleptocratic lines), but it wouldn’t be case of evil South Dakota authorities swooping in out of the blue on their own initiative.

  21. How about British authorities sweeping in on their own initiative?
    After World War II, Britain shipped 10,000 white children from British orphanages to Australian orphanages. The families who had placed the children in the orphanages were lied to. The stories of these children were the basis for the movie “Oranges and Sunshine.”
    From the end of the World War II to the early 1970s, the British government forcibly relocated British children who had been placed in a children’s home and sent them to Australia, Canada, New Zealand and the former Rhodesia, now Zimbabwe.
    The parents in England when they returned to the children’s home to retrieve their youngsters were told that they had been adopted by a good family in England. The children who were sent to Australia had been told that their mother or father had died and they were going to live the good life, filled with oranges and sunshine and a perfect family in Australia.
    Instead, the children were sent to orphanages usually run by Roman Catholic brothers in Western Australia or Queensland, where they were abused and forced to work in the worst possible conditions.

  22. Amy — you should read or listen to the report before comparing it to Sasquatch.
    But I expect the report to spawn lawsuits that will expose more of what happened in SD. I’m only mildly swayed by the cultural arguments, but the financial ones, including the fact that the main recipient of federal funds is a group home that was owned by the liutenant governor.
    Unparsing, I believe that is some kind of agreement by the tribal council that social services will be handled by the state, under guidelines, including the 1978 law — but the tribal council has to enforce these rights and rules. It’s the same sort of issue that has come up in some of the group home contracts in ny state — the with SD playing the role of contractor to the weak enforcement by the council.

  23. Actually — I was wrong — There appears to be no agreements with the tribes. The state just asserts the right to handle all child welfare cases within their borders. It’ll be interesting to see how this evolves.
    I was truly horrified by the stories when I listened to the reports. And, unlike British orphan abductions, the removals are happening now.

  24. “Sandra, I am not surprised to hear of upper class children showing the effects of fetal alcohol exposure.”
    I am. Thanks to all those bossyboots pregnancy guides, I’m used to thinking of a daily cup of decaf coffee as a major indiscretion. (Not that I wouldn’t drink a cup of decaf a day myself.)

  25. Amy P, there isn’t an absolute correlation between income and common sense, or functional families. The more educated families generally make better choices, but there are exceptions–more than you’d think.
    Wealth allows people to hide bad habits. If the housekeeper or nanny can do the housekeeping and drive the kids to school, many things can be hidden. If the families can obviously afford the best lawyers, legal problems can go away.
    As my daughter’s peers reach high school age, some are not thriving. Some seem to be acting out in an attempt to reach their parents. These teenagers have all the toys money could buy, but little parental attention. I could tell some very sad stories. I think there are families which are outwardly very successful, but one or both parents drink much more than they should–and it’s not a new habit.
    A number of the most “successful” people in our affluent town must travel frequently. In some families, both parents must travel. The children may be effectively raised by nannies or au pairs. If the first two years are essential for an infant, and bonding to a reliable adult caretaker makes an enormous difference, I know of some wealthy families which could not have matched your family in the category of responsible parenting.
    I think the au pair system can be wonderful, if it’s used as the equivalent of a visiting teen relative, who can babysit at times. If the au pair is supposed to provide the majority of the care for the children in their first years, well, she’s generally not yet a competent English speaker, and she’ll stay for one year–or less. Then the child must grieve the loss of the caretaker, when she goes home.

  26. I don’t deny that children who end up in foster care may have difficulties stemming from poor parenting, poverty, or abuse. On the other hand, the recent GAO report about the use of antipsychotics on foster children horrifies me. I think the most likely use of such medications on powerless children is for the convenience of adults–as it seems happens to people in nursing homes.
    Of all the psychiatric medications, antipsychotics are, by far, the most prescribed, especially for foster children. Foster children are given antipsychotics at a rate nine times higher than children not in foster care, according to a 2010 16-state analysis by Rutgers University of nearly 300,000 foster children.
    Dr. Jeffrey Thompson, chief medical officer for Medicaid in the state of Washington, said, “Nobody gets up in the morning to overdose kids. It just happens that it’s a momentum in the system. Kids get aggressively diagnosed and sometimes we look for the easy solution, which is a pill over psychotherapy or better parenting.”

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