Advice for Parents on Enhancing Early Childhood Development

From The Quarterly, May 2016

James F. Leckman, M.D., Ph.D., is the Neison Harris Professor of Child Psychiatry, Psychiatry, Pediatrics and Psychology at Yale. He is well known for his research into Tourette Syndrome, Obsessive-Compulsive Disorder (OCD) and other related childhood onset neuropsychiatric disorders. For more than 20 years he served as the Director of Research for the Yale Child Study Center. Under his leadership, the Center emerged as one of the leading sites for child psychiatric research in the United States.

Most recently, in partnership with colleagues at UNICEF and the Mother-Child Education Foundation (AÇEV) based in Turkey, Dr. Leckman with several partners at Yale have begun to explore the question of whether enhancing child development can create a more peaceful world.

What led you to study the question of how to enhance early childhood development?

Early childhood development is such a crucially important issue. In the mid-1990s, after a lecture I gave, one of my colleagues at Yale suggested that we look at the subject of parenting. I was really curious to learn about the level of preoccupation (recurrent intrusive thoughts that resemble obsessions) that mothers and fathers (especially first-time mothers and fathers) experience as the birth of their child draws near. Then I looked at how that level of preoccupation changes in the weeks and months that follow the birth, and what changes in the structure and function of the mother’s and father’s brain as they become new parents. My research showed how early parenting behaviors and preoccupations resembled the symptoms of obsessive-compulsive disorder (OCD). People don’t really expect how transformative being a new parent will be.

I was also interested in how parents formed attachment to their children. In research I did with Ruth Feldman, Ph.D. (at Yale University) we found that the mother’s level of the hormone oxytocin—which is released in social bonding situations— is correlated with the father’s oxytocin levels. We also found that higher levels of oxytocin in the mother are associated with more responsive interactions with her new infant, while in fathers, higher levels of oxytocin are associated with stimulatory play, like throwing your child up in the air and catching them.

In October 2013 we held the Ernst Strungmann Forum, which brought together colleagues from around the world, who were experts either in attachment behavior in animals or implementation of parenting programs and early child development, to talk about the idea that if we raise our children better, are we going to create a more peaceful world?

Can you briefly state the case for why behavioral, mental health, and other health-related interventions are important to stress?

There are some wonderful analyses by the Nobel laureate James Heckman which show that if you intervene early in the developmental life of an individual you are much more likely to see higher cost-benefits—one of the biggest being savings on the costs associated with incarceration and with criminal behaviors.

If you intervene early, the person has a greater likelihood of finishing high school, of going to college, and is less likely to be involved in criminal behavior.

Do parents who have mental health issues end up passing those or other issues to their kids either through genes or by social interaction? What advice can you offer these parents?

There is a greater risk either because of the symptoms or genetics. This is especially true for conditions like depression. Depressed mothers, for instance, have more difficulty taking care of their young children. This is an example of how symptoms of an existing condition can affect the outcome in a child. As for genetics, a lot of mental health conditions have a strong genetic component, but the genetic background to illness is highly complex, and determining an individual’s risk is not straightforward by any means. In brief, the genetic portion of risk in various disorders is determined in part by different combinations of risk genes—versions of genes or sections of the genome that have mutations or other irregularities which may or may not affect an individual, and which may be active in one family or individual versus another.

The important thing I would say to a parent with mental health issues is to help yourself deal with those issues. Reach out to a mental health professional—find someone who is really invested in addressing the problem.

Adverse events early in life are detrimental to a child’s development and associated with a broad range of negative outcomes, including major emotional and behavioral problems. Why do some children cope better than others and is it possible to foster resilience?

Adverse childhood experiences such as exposure to trauma or violence, even during the prenatal period when the brain is first developing, mold how the brain is organized, and have major impact on how our genes are expressed. Brain imaging studies show that traumatized children or children raised in poverty have different interconnections in their brain regions. If you’ve been exposed to violence, you’re at an increased risk of being re-victimized.

To some extent it’s a mystery why some people are more resilient than others. We are still struggling to have a deeper understanding of why people change. We really don’t know all of the ingredients there are in terms of why some individuals go down one path versus another path. But I’m convinced that an important ingredient in fostering resilience is an understanding adult who in some ways sees in you something special, in some way idealizes you and sees you as someone who is able to make a positive contribution.

To what extent are we prisoners of our own family history?

I’m convinced that how you were raised and what the nature of your early experiences were, including in utero, shape your moral reasoning, compassion, equity and other character traits and set the stage for later life.

However, your early experiences don’t mean that you don’t have a choice. They are a significant but not a final determinant of who we become.

On balance, though: are you saying our development is more about nurture than nature?

There is a fascinating study looking at parenting behaviors in Norwegian rats. There were some mothers who licked and groomed their pups a great deal, and others who hardly licked and groomed at all. Turns out that if your mother had groomed you a lot, you were a high licker and groomer yourself when you became a new parent and vice versa.

Then the researchers took pups born to a high-licking mom and had them raised by a low-licking mom, and vice-versa. The offspring’s parenting behavior was determined by how they were nurtured rather than what kind of mother they were born to. So the outcome had less to do with an individual’s genetics and more to do with environmental exposure.

When we look at our genome, the actual protein coding regions, virtually identical to those of primates and rodents, account for a relatively small proportion of the entire genome. Our regulatory regions are what distinguish us from other species. They determine how or when certain genes are turned on or off. The big question is how flexible are these regions.

Many of the interventions you have advocated teach responsive parenting. Do moms and dads need to be taught how to parent?

We usually think that this is something that comes about naturally and that we don’t need any special knowledge to be responsive parents. But attachment and responsiveness sometimes don’t come easily. This can be especially problematic if you were raised in a family where unresponsiveness was the nature of the interaction you had with your parents, or if you received harsh treatment or punishment. The really sad thing is that a lot of trauma happens in the home.

Many of our interventions have focused on mothers, but the more we can engage fathers, the more likely there will be a positive long-term benefit.

What can parents do to have a better relationship with their children?

I would encourage people to have second thoughts about the way they were parented. If there are problems in their relationship with their children, then they should question whether it makes sense for them to learn more about positive parenting strategies. There are many programs out there to enhance parenting skills.

It’s really the interaction between parent and child that matters the most when it comes to behavioral problems in children. Eli Leibowitz, Ph.D. at the Yale Child Study Center, for instance, has developed an intervention to help parents of children with obsessive compulsive disorder avoid what we call “family accommodation.” Family accommodation refers to ways in which family members inadvertently take part in the performance of rituals, avoidance of anxiety-provoking situations, or modification of daily routines in response to their child’s requests. The idea is, when a child approaches you and asks for reassurance, you should not respond to them with, “You are okay. I am okay. Don’t worry.” If you respond to those obsessive questions in the way the child is hoping and you do that as often as the child asks, you are providing reinforcement for them to continue to ask. Significant improvement of OCD symptoms with treatment is associated with reductions in family accommodation. To achieve this Dr. Leibowitz suggests that parents wait for a time when your child is not acting fearful and you are not feeling frustrated by his avoidance. Sit down in a relaxed way and say, “We know how difficult it is for you to do [fill in]. We understand it makes you feel really anxious or afraid. We want you to know that this is perfectly natural and everyone feels afraid sometimes. But it is our job as your parents to help you get better at things that are hard for you. We are all going to be working on this for a while and it will probably take time, but we love you too much not to help you. Soon we’ll talk about this again and we will have some ideas for things to do that will help with this. We are really very proud of you!”

Some of the interventions you have advocated are home-visitation based, but many are in group settings. What kind of advantages does the group offer?

One of the wonderful things about these programs—for example, those of the Mother-Child Education Foundation in Turkey—is that it’s done in groups of moms and dads. The trainers in these group settings are obviously important, but so are the participants. If you respond to your child in a different way and the child changes, that can be enormously reinforcing to parents. When other parents in the group hear about these changes it’s much easier for them to go out and try those changes themselves. Sometimes parents are also recruited as co-trainers.

The participants form a support system. When I first met with the board of the Mother-Child Education Foundation (AÇEV) they wanted me to explain from a neuroscience perspective why it was that fathers who came from different social, cultural and religious backgrounds become friends with one another and decided to continue interacting with one another even after the curriculum ended. I reviewed with the AÇEV Board the direct interface between our affiliative and our stress response pathways in our bodies and brains and the power of group processes to break down social barriers and stereotypes of the “other.”

Some good examples of early intervention programs include Circle of Security, a program designed to enhance attachment security that has various locations in the U.S., and in the world. Another program, Mom Power in Michigan, is a parenting group for mothers receiving Medicaid whose children are under age 6. Other programs for parents of children across the age range include Triple P the Power of Positive Parenting (originally developed in Australia) and Parenting Management Training (initially developed in Oregon).