NZCPD Forum

Dr Karen Hartshorn is Director of Translational Research at the new National Centre for Lifecourse Research, of which the Dunedin Study is a founding partner. She arrived at the Centre, based at the University of Otago, after studying at Harvard and Cambridge universities and working in science communication. This article is based on a speech given by Dunedin Study Director Richie Poulton in 2007.

For more information visit: http://www.lifecourse.ac.nz

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NZCPR Guest Forum
Dr Karen Hartshorn
4 May 2008
Investing in Children

Thirty years ago, Phil Silva (the founding director of the Dunedin Study) wrote that New Zealanders invested more time and care in maintaining their cars than they did their children.

Since then, a number of programmes geared towards monitoring childhood health have been developed – warrants of fitness for kids, if you will. These include Plunket visits, the Well Child programme, and, most recently, the “B4 School” checkups announced by the government. At the same time, news and current affairs has highlighted children’s issues – their increasing levels of poor behaviour and increasing violence towards them, for example.

So, are more programmes focussing on early childhood development the way forward? When is the right time to focus on behavioural and health issues?

This is where I digress a little and introduce the Dunedin Multidisciplinary Health and Development Study (henceforth shortened to Dunedin Study), and her sister study, the Christchurch Health and Development Study. Both are longitudinal studies, meaning that they have each followed the same group of babies born in the 1970’s right through to present day. In the case of the Dunedin Study, this equals 1,000 or so people, who have been assessed every few years since they were three years old; they’re turning 35 now.

The study has examined and described in great detail their life pathways: pathways to violence, sadness, obesity, heart disease, STD’s, and failures in work, family life and relationships.

Not all the research is negative, by any means, but I focus on the negative pathways because those are the ones that governments are interested in, that media pay attention to, and that advocacy groups focus on. Public money is usually invested in programmes that will ideally decrease negative outcomes, and lead to happy, healthy people.

What, then, are the most effective and cost effective ways of turning those negative outcomes into positive ones? We believe that the answer is simple and straightforward: what happens in childhood is critical and has far-reaching implications for how peoples’ lives turn out, the choices they have, and their capability to take advantage of positive opportunities.

This means early intervention, and even before that, prevention. Preventing children from starting down the negative pathways means better outcomes in adulthood, and that in turn means less demand on health, justice and social services. What we’re really talking about is the fence-at-the-top-of-the-cliff rather than the ambulance-at-the-bottom approach.

How can we say this so conclusively? And how do we know prevention would be effective? Because all the evidence, gathered over 35 years, shows that this is the case. The Dunedin Study has published research time and again showing that adult problems – physical, mental, and behavioural – can quite often be traced back to childhood and early adolescence.

ANTISOCIAL BEHAVIOUR – CAUSES AND CONSEQUENCES

I’ll give one extended example here, that of antisocial behaviour. For approximately 10% of males, the pathway to antisocial behaviour begins very early in life and continues right through to adulthood. They are called “life-course persistent” in terms of antisocial behaviour. These are the kids who bullied in the sandpit and drove primary teachers to distraction, then as they grew up graduated to stealing and violence.

Many people on the life-course persistent pathway to antisocial behaviour have societal, family or neurocognitive difficulties from the start. They are more likely to experience single parenting, a young mother, or a mother who had poor mental health. They may have experienced harsh discipline as kids, moved frequently between caregivers, or been exposed to family conflict. Some neurological factors are inherent – the kids may score lower on childhood reading tests, or show early tendencies to attention problems or hyperactivity.

That life-course persistent antisocial behaviour is linked to bad relationships, criminal behaviour and poor mental health in adulthood. Recently, we have also found that the same group is at a much higher risk for a range of adult physical health problems as well. These problems can include heart disease, chronic bronchitis, high rates of injuries, and high rates of health services use.

Life-course persistent antisocial behaviour also accounts for a much higher proportion in terms of burdens to the health, social and justice systems – they commit half of the crimes, and their poor physical health as adults eats up a higher percentage of public health monies.

Another group, making up about 20% of the population, have unremarkable childhoods, but then begin to engage in antisocial behaviour as adolescents. They are called the “adolescent-onset” group. Many of them stop the antisocial-behaviour by adulthood, though some do continue on. The driving force behind the antisocial behaviour for this group appears to be their peers; it’s before they assume adult responsibilities but while they are trying to be independent from their families. Influence from peers, therefore, becomes the most significant factor pushing them towards antisocial behaviour.

INTERVENTIONS

The implications for intervention from these findings are clear. For the lifecourse-persistent group, for example, you need to intervene with both the child and their family as early as possible. For the adolescent-onset group, the worst thing you could do would be group intervention, as much of the influence comes from peers (as an aside, think of the role of prisons as a large group intervention, which may explain why antisocial behaviour may actually expand rather than diminish).

There is also a lot to be said for having a clinical psychologist in every primary school in the country. Of course, that is also an expensive solution.

What about an intervention that is widely accessible, cheap, easy to use and effective? An example of this already exists – it’s an online programme created in Australia to fit with the health and personal development curriculum of most schools. Modules deal with issues such as bullying, stress, alcohol, sex ed, cannabis and depression. Since using the internet is something that most 21^st Century children are already familiar with, this seems an obvious way to go.

This particular solution, called CLIMATE.tv, is of course not the only solution. It’s aimed at intermediate/early secondary level kids, and there is a great argument for intervening earlier than that in many cases. Other researchers have proposed that the critical time, in terms of behavioural returns on monetary investment, is before the age of 5.

There is plenty we don’t know about 21^st Century kids in New Zealand – remember that the Dunedin and Christchurch data tracked kids growing up in the 1970’s and 1980’s. Luckily, two new longitudinal studies, one focussing on Pacific Islands families since 2000 and one beginning in Auckland and the Waikato next year, will soon begin to provide the data on 21^st Century children.

However, we can say now that attention to children, early in their lives, may be the single best way of giving social, health and economic benefits to New Zealand , now and well into the future.