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The first 5 years: Starting early

Early Childhood Series No. 2. 2011

Acknowledgements

This publication was produced on behalf of the Department of Education and Training by the
Menzies School of Health Research.

Recommended citation

Silburn SR, Nutton G, Arney F, Moss B, 2011. The First 5 Years: Starting Early. Topical paper
commissioned for the public consultations on the Northern Territory Early Childhood Plan. Darwin:
Northern Territory Government.

ISBN: 978-0-9871030-2-4 (Paperback)

ISBN: 978-0-9871030-3-1 (Online).

This publication is also available on-line and may be downloaded from:

www.det.nt.gov.au/parents-community/early-childhood-services/ntecplan

THE FIRST 5 YEARS: STARTING EARLY i

Contents

ACKNOWLEDGEMENTS I

RECOMMENDED CITATION I

CONTENTS II

ACRONYMS III

EXECUTIVE SUMMARY IV

1. INTRODUCTION 1

1.1 Why the early years are so important 1

2. WHY INVEST IN EARLY CHILDHOOD DEVELOPMENT? 2

2.1 New scientific understandings of healthy development 2

2.2 Brain development before birth 2

2.3 Smoking, alcohol and drug use in pregnancy 3

2.4 Brain development during infancy and early childhood 4

2.5 Brains are built in a ‗bottom-up‘ sequential process 5

2.6 Attachment, early interaction and the brain 5

2.7 Sensitive periods of development 6

2.8 Stress and the child‘s developing brain 6

2.9 Life-course developmental research 8

3. PREVENTION SCIENCE AND EFFECTIVE INTERVENTIONS 10

3.1 Quality early childhood programs 10

3.2 Improving health and nutrition 10

3.3 Improving capability and confidence in parenting 11

3.4 Family supports to reduce sources of toxic stress 11

4. THE ECONOMICS OF HUMAN CAPABILITY FORMATION 12

5. IMPLICATIONS FOR CHILDHOOD POLICY AND SERVICES 14

BIBLIOGRAPHY 16

ii THE FIRST 5 YEARS: STARTING EARLY

Acronyms
NT Northern Territory
COAG Council of Australian Governments
NAPLAN National Assessment Program for Literacy and Numeracy
AEDI Australian Early Development Index
WHO World Health Organization
USA United States of America
UK United Kingdom

THE FIRST 5 YEARS: STARTING EARLY iii

Executive summary
Investing in the early years is now understood to be one of the most effective strategies available to
governments for reducing inter-generational disadvantage, building human capability and creating
a fairer society.

The evidence of the benefits of investing in early childhood development derive from four
converging areas of recent research.

New methods in brain science and epigenetics showing how children‘s

experiences in their family, community and early learning environments
influences early brain development and establishes the foundation for their
future health, learning and behaviour.
Longitudinal studies showing the extent to which adult health, wellbeing and
capability have their origins in family and community environments of early child
rearing.
Intervention studies demonstrating the effectiveness and long-term (adult)
benefits of evidence-based preventive strategies and programs for children in
their early years.
Economic studies of proven early childhood interventions documenting the high
return on investment of preventive strategies and programs delivered early in
the life-course.
The Council of Australian Governments‘ National Reform Agenda to close the life outcomes gap
between Indigenous and non-Indigenous Australians and the Investing in the Early Years—A
National Early Childhood Development Strategy are two important policy initiatives drawing on this
evidence. These policy initiatives, together with the level of new funding now available through a
range of national partnership agreements, provide an unprecedented opportunity for making the
transformational changes needed to improve early childhood development outcomes in the NT.

Recent breakthroughs in scientific understanding of how genes and the environment interact in
shaping overall human development have resulted in the study of the developmental origins of
adult health and disease as one of the fastest growing ‗cutting-edge‘ areas of medical research.
Other advances in neuroscience have also shown that the quality of early brain development is
much more important for children‘s longer-term developmental outcomes than previously realised.

Evidence from animal studies and new functional brain imaging methods with humans show that
the brain is a self-organising system in which the neural circuits of the brain are progressively
‗hard-wired‘ by their repeated activation through the child‘s experiences and behaviour. While
genes provide a ‗blueprint‘ for the sequence in which different anatomical structures of the brain will
emerge, the actual way in which they connect, and hence how they function, is also shaped by
experience. In other words, it is a matter of both nature and nurture.

Many of these environmental influences begin even before birth. A range of commonly occurring
antenatal health and lifestyle factors are now known to affect the unborn child‘s growth and early
brain development. These include poor maternal nutrition, smoking, alcohol use, exposure to
chronic or traumatic stress as well as maternal illnesses such as antenatal depression and
gestational diabetes. Each of these antenatal risks is associated with a higher likelihood of adverse
cognitive, behavioural and health outcomes in childhood, as well as longer-term susceptibility to a
range of adverse adult physical and mental health conditions.

The hierarchical sequence in which brain structures develop before and after birth—from the
development of relatively simple circuitry for sensory-motor and reflexive responses necessary for
basic survival to the elaborate circuitry underpinning more complex processes such as those
involved in self-regulation of attention and higher cognitive functioning—is significantly impacted by
the nature of the child‘s early experiences with her or his caregivers.

Each new stage of brain growth and skill development is underpinned by the quality of the neural
circuitry established in preceding stages. This is why it is important that parents, families and
communities are assisted to understand how responsive caring and stimulation helps children
establish a sturdy foundation for their long-term health, learning and wellbeing.
iv THE FIRST 5 YEARS: STARTING EARLY
Brain research has identified sensitive stages of child development when specialised brain regions
are especially receptive to particular developmental opportunities in their environment of child
rearing. These sensitive periods are important windows of opportunity where appropriate
developmental stimulation can boost children‘s development and readiness for school learning.

There is strong evidence for the long-term benefits of early learning programs which help children
to focus their attention, persist with tasks and be receptive to the kinds of instruction and activities
they are likely to encounter in the more structured learning environments of primary school.

Programs enabling good health care and adequate nutrition before and after birth are fundamental
to improvements in childhood developmental outcomes. Access to regular child primary health
care, use of evidence-based protocols such as the Healthy Under 5 Kids program is essential for
development. These programs can provide a base for evidence-based parenting support and
family counselling and can enable the early detection and treatment of developmental and health
problems that are often much more difficult to manage if they become entrenched.

Life-course development research has identified key developmental processes and environmental
circumstances that are strongly associated with adverse (or better) developmental outcomes. This
research has enabled more effective targeting of policies and services as well as the design of
better programs for families, schools and communities to improve child health and development.

There are a number of evidence-based early child development and parenting programs now
available which should be considered for application in the NT. The Nurse Home Visiting Program
is one such program having the strongest evidence of efficacy and effectiveness in producing
significant improvements in early child development and educational outcomes, as well as
increased longer-term employment and social and emotional benefits. A version of this program
adapted for use with Indigenous families is currently being trialed in the Alice Springs area.

These and other programs such as the WHO Care for Child Development family counseling
program typically seek to aid parents‘ understanding of their children‘s health care and
developmental needs, strengthen attachment and responsive interaction, and teach ways to
encourage desirable behaviour and non-coercive ways of managing misbehaviour.

Longitudinal studies of representative population samples consistently show the strong link
between socioeconomic disadvantage in early life and the overall population burden of adult
chronic disease, social and emotional problems, poor educational outcomes and unemployment.
The implication of this for the NT is that systematic efforts to improve children‘s developmental
outcomes will continue to be thwarted without more effective investment to ensure the universal
availability of basic human services in housing, environmental health, primary health care, family
support, child care and early education.

The research evidence summarised in this paper has four clear messages for community leaders
and decision makers seeking to improve the health, capability and wellbeing of NT children.
The most cost-effective means of reducing the proportion of children failing to
realise their developmental potential for educational success and improved life
opportunities is through community and government investment to strengthen
early childhood development.
The earlier in life that prevention and intervention can begin, the greater the
opportunity for shifting children‘s developmental pathways in a positive
direction. Later interventions, although important, are considerably less effective
if good early foundations are lacking.
Significant reductions in many of the chronic diseases responsible for the
reduced life expectancy of the Indigenous population could be achieved by
decreasing the number and severity of adverse experiences that threaten the
wellbeing and development of young children, as well as by strengthening the
protective relationships that help to mitigate the harmful effects of toxic stress.
Current health promotion and disease prevention policies which are now
predominantly focused on adults would be more effective if greater evidence-
based investments were made to strengthen the foundations of health in the
prenatal and early childhood period.

THE FIRST 5 YEARS: STARTING EARLY v

1. Introduction
1.1 Why the early years are so important
The value of investing to ensure all children get the best start in life is increasingly evident to
1
governments around the world. The need for such investment in Australia was recognised by the
Council of Australian Governments with its endorsement of Investing in the Early Years—A
2
National Early Childhood Development Strategy. This national initiative is supported by the
accumulating body of evidence showing that investing to support and strengthen all aspects of
early childhood development brings long-term benefits to children over the course of their lives and
to the whole community (refer Figure 1). Investing in early childhood development is now
recognised as one of the most effective strategies for breaking the intergenerational cycle of
34
disadvantage and creating a fairer society.

Understanding and responding to problems facing Australian children, including children and young
people growing up in the NT today, is vital to ensuring a better future for all Territorians. Sharing
and integrating the new knowledge about how children‘s health, safety and development can be
optimised in the early years is an essential step towards closing the gap between what is known
about early years development and the choices which can be made by governments, communities
56
and families to ensure that all children get the best possible start in life.

The Council of Australian Governments‘ 2006 National Reform Agenda includes an agreement for
a focus on early child development as a priority area of reform for Australia‘s future health (for the
prevention of chronic diseases in adulthood), capability and economic prosperity (improved
education, skills and productivity). This reform initiative recognises that, for Australia to be
st
competitive in the knowledge-intensive global economy of the 21 century, it is vital that
governments and the nation take account of the current evidence showing the many long-term
7
benefits of investment in early childhood.
7
Figure 1. Benefits of early child development for individuals and society

THE FIRST 5 YEARS: STARTING EARLY 1

2. Why invest in early childhood development?
―When we invest wisely in children and families, the next generation will pay that back
through a lifetime of productivity and responsible citizenship. When we fail to provide
children with what they need to build a strong foundation for healthy and productive
lives, we put our future prosperity and security at risk.‖ (US National Scientific Council
on the Developing Child, 2007) 8

A number of major national and international reports have recently been published
bringing together the research evidence that underpins arguments for investment in the
9 10
early years of life. In summary, this evidence indicates that investing resources to
support children in their early years brings long-term benefits to children and to the
whole community. In these reports four converging strands of evidence emerge:

 Recent advances in brain science and the behavioural and social sciences have brought
new understandings of how healthy child development happens, how it can be derailed
and what societies can do to keep it on track. This research has helped to explain how
children‘s early life experiences shape the basic architecture of the developing brain and
11
why this has important implications for health and human capability over the life-course.

 Ecologically-based, longitudinal studies conclusively demonstrate the long-term effects of

children‘s family, community and early learning environments for their health and
wellbeing later in life. These studies show that children‘s socioeconomic and physical
environments of childrearing and their relationships (e.g. with parents, families and other
caregivers) all matter a great deal for their healthy development and education
12
outcomes.
 New developments in prevention science have enabled the effective implementation and
scaling up of evidence-based programs to achieve population-level improvements in
13
children‘s developmental outcomes.
 Economic studies of the costs and benefits of the systematic implementation of proven
early childhood programs with families, schools and communities have quantified the
longer-term economic and social benefits of such early childhood programs. These have
demonstrated the need for a more effective balance between ‗up-stream‘ preventive and
early intervention services as opposed to the ‗down-stream‘ costs of treatment or
14 15
remediation later in the life-course.

2.1 New scientific understandings of healthy development

The availability of new methods of brain imaging such as functional magnetic resonance imaging
has enabled detailed mapping of the neural circuitry or ‗wiring‘ of the brain. Research discoveries in
the new science of epigenetics have also brought dramatic new insights into the molecular and
genetic processes through which the child‘s early experiences play a critical role in shaping the
16
nature and quality of the brain‘s developing architecture and function.

2.2 Brain development before birth

Around one-quarter of our overall brain development occurs before birth. The future brain and
6
nervous system first become apparent at around 3 to 4 weeks of development (Figure 2). At this
early stage, new brain cells (neurones) are forming at a rate of more than 250 000 per minute. This
rapid neuronal growth continues throughout the pregnancy so that by the time of birth the number
17
of neurones is well over a billion. From about the eighth week of development, neurones also
begin to become more specialised and start sending out multiple branches to form an intricate
17
pattern of connections with other neurones in different regions of the brain The development of
the child‘s brain during gestation is particularly sensitive to the mother‘s health, nutrition and
environmental circumstances.

2 THE FIRST 5 YEARS: STARTING EARLY

Figure 2. Stages of brain development before birth

Cerebrum

Midbrain Cerebrum
Midbrain Hindbrain Hindbrain Cerebrum
Midbrain
Forebrain Ear bud
Eye bud Cerebellum Cerebellum
Pons Pons
Medulla Medulla Cerebellum
1 week Forebrain
Spinal chord Pons
Spinal chord
7 weeks 11 weeks Medulla

Spinal chord
7 months

neurulation

Neuronal prolifertion 9 months (at birth)

Neuronal differentiation

Neuronal migration

Synapse formation

Programmed cell death

Synaptic pruning

Mylenation

4 8 12 16 20 24 28 32

Gestation (weeks) BIRTH Infancy

Source: Perspectives from Developmental Neuroscience, pp 113-150, In O'Connell, Boat and Warner, (Eds)
Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research
6
Advances and Promising Interventions, 2009.

2.3 Smoking, alcohol and drug use in pregnancy

Smoking and foetal development:
The use of alcohol and other drug use during pregnancy has long been known to be detrimental to
an unborn child‘s development. More recently, large-scale population studies have confirmed that
maternal smoking during pregnancy is a very important risk factor for infant survival, Sudden Infant
Death Syndrome, for infant and child respiratory health, as well as its impact on infant and longer-
term sleeping patterns, intellectual development and behaviour—particularly disruptive behaviour
18 19
disorders and attention difficulties.

Alcohol and foetal development:

There is conclusive evidence showing that maternal alcohol consumption has significant effects on
the foetal brain development and children‘s subsequent cognitive and behavioural outcomes. The
extent of the symptoms of Foetal Alcohol Syndrome and Foetal Alcohol Spectrum Disorders
depends on the timing and frequency of maternal drinking, the amount of alcohol consumed and
the stage of foetal development at the time of consumption. Though the severity of the damage
depends on all these factors, no safe threshold of alcohol use has been found, and the medical
recommendation is that no alcohol be consumed during pregnancy. Even small amounts can cause
20 21
brain damage that can affect the child for life.

Foetal Alcohol Syndrome and Foetal Alcohol Spectrum Disorders are now understood to be some
of the most frequent causes of intellectual impairment. Children, adolescents and adults with Foetal
Alcohol Syndrome and Foetal Alcohol Spectrum Disorders have poor judgement, poor social
perception, a lack of impulse control and the inability to predict the consequences of their
behaviour and thus have a greatly increased likelihood of finding themselves in trouble with the
law. USA and Canadian studies indicate that adults with Foetal Alcohol Spectrum Disorders are a
much larger proportion of the prison population than of the general population. The disability of
prisoners with Foetal Alcohol Spectrum Disorders also means that, they are generally less likely to
22 23
benefit either from rehabilitation or deterrent offered by incarceration.

THE FIRST 5 YEARS: STARTING EARLY 3

These are all compelling reasons for ensuring that maternal health and family support services take
a proactive approach in providing preventive counselling on the risks of alcohol in pregnancy and
that more strenuous efforts be made to improve community understanding of the national
24
guidelines on alcohol use during pregnancy.

Maternal stress:
High levels of stress experienced by the mother also affect the unborn child‘s brain development.
Where a mother is exposed to high levels of stress during pregnancy (caused by inadequate
housing, food insecurity, or family violence) her child is much more likely to experience later
emotional or cognitive problems, including attention deficit-hyperactivity disorders, as well as
anxiety and language delay. This effect has been shown to be separated from the effects of
25 26
maternal postnatal depression and anxiety.

Where pregnant women are exposed to very intense or multiple stresses this can result in over-
production of the stress hormone cortisol. The unborn child‘s exposure to high levels of this
hormone in the womb has been shown to not only slow the rate at which new neurones are
produced but also to selectively influence the way in which the brain‘s stress response system
26
develops, predisposing the child to higher levels of impulsivity and emotional overreaction.

Antenatal depression:
Between 7 and 20% of pregnant women experience antenatal depression which is as common as
the wider known condition, postnatal depression. It is also less well recognised due to the
symptoms of depression developing gradually and because symptoms such as fatigue are also
26
common during most pregnancies.

Perinatal depression has been shown to be associated with infants and children having increased
likelihood of problems in many aspects of cognitive and behavioural functioning and increased
susceptibility to the later development of depression and other disorders. These problems range
from affective and interpersonal functioning to brain and neuroendocrine (hormonal)
27
abnormalities.

2.4 Brain development during infancy and early childhood

A child‘s brain grows from around one-quarter the size of the adult brain at birth to two thirds the
size of the adult brain by age three. Over this period there is a phenomenal surge in the formation
of new neurones (brain cells) and their branching out to form connections with other neurones
(synapses). Around 700 new synapses are estimated to be formed every second during this period
17
of maximum growth and development of skills.

By age 3 years the human brain has more neurones and synapses than it will have at any other
stage in life. Then two other processes brain development become more active. First, the pathways
between brain cells which make up the brain circuits associated with specific brain functions tend to
be strengthened and retained as they are activated by the child‘s experience and behaviour. At the
same time the neuronal connections which are infrequently activated are selectively eliminated or
‗pruned‘ in a ‗use it or lose it‘ manner. So, from the age of 3 years the overall number of neurones
in the brain and their synaptic connections progressively declines (see Figure 3 below). This
interaction of the child‘s biology with their conditions and experiences of child rearing – particularly
before age 5 years - literally shapes the brain circuitry which forms the foundation for all
17
subsequent health, behaviour and learning.

4 THE FIRST 5 YEARS: STARTING EARLY

Figure 3. Brain development from infancy to adolescence

Source: Illustration from AEDI Results Guide (2010) 2819

2.5 Brains are built in a ‘bottom-up’ sequential process

Brain development begins with the simplest circuits vital for survival being built first, then moving on
to more complex circuits such as those that underpin adaptive (intelligent) functioning. Every new
skill the child develops is built upon the skills that came before. Sensory pathways, like those for
basic vision and hearing, are the first to develop, followed by early language skills and then more
complex cognitive functions such as reasoning.

While genes determine the order in which new brain cells develop, branch out and connect to
different areas of the brain, the child‘s experience of its environment also plays a key role in how
this process unfolds and whether specific brain circuits become strong or weak.

2.6 Attachment, early interaction and the brain

One of the most important early ingredients in this developmental process is the ‗two-way‘
reciprocal relationship of emotional engagement between children and their parents or other
caregivers. From early infancy children develop in an environment of relationships and naturally
reach out for interaction through babbling, facial expressions and gestures. Parents and other
adults typically respond with the same kind of vocalising and gesturing back at them. As these
relationships extend into other child care settings, children develop best when the caring adults
29 30
around them respond in warm, individualised and stimulating ways.

In contrast, when the environment is impoverished, neglectful, unpredictable or abusive, the brain‘s
architecture does not form as expected, which can have long-term effects such as impairments in
17
learning, behaviour and health . There is now a growing body of research showing that the
prompt, contingent and appropriate responsiveness by the child‘s mother or other primary
caregiver has important consequences for the child‘s sense of emotional security and long-term
benefits for the child‘s developing brain. These benefits range from better cognitive and
29 30
psychosocial development to protection from chronic disease and early mortality.

THE FIRST 5 YEARS: STARTING EARLY 5

2.7 Sensitive periods of development
Neuroscience and experimental psychology have described sensitive periods for the development
of different brain functions (e.g. binocular vision, emotional control, language and a various
cognitive abilities) and their brain circuits (see Figure 4). The neural connections in the areas of the
brain associated with these functions proliferate at different times. During these critical periods the
‗use it or lose it‘ process of synaptic pruning is especially important. Where the child‘s environment
provides the right kind of stimulation at the right time, the child‘s development is optimised and it is
much easier for the child to acquire certain skills. For example, by the first year, the parts of the
brain that recognise the difference between different vocal sounds are becoming specialised to the
language(s) the baby hears in its family of child-rearing. At the same time it is beginning to lose the
16
ability to recognise important sound distinctions that occur in other languages.

Figure 4. Sensitive periods for synapse formation

Source: Shonkoff J, Phillips D (Eds) 200017

Because the brain prunes away the circuits that are not used, those that are used become stronger
and increasingly difficult to alter over time. This reduction in plasticity, or ability of the brain to grow
and change in response to its environmental circumstances, means that the early childhood years
offer the ideal time to provide the experiences that shape healthy brain circuits. It also means that it
is easier and more effective to influence a baby‘s developing brain architecture than it is to rewire
parts of its circuitry later in childhood or adolescence. In other words, we can ‘pay now‘ by ensuring
positive conditions for healthy development, or ‘pay more later‘ in the form of costly educational
17
remediation, health care, mental health services and increased rates of incarceration.

―Early experiences determine whether a child‘s developing brain architecture provides

a strong or weak foundation for all future learning, behaviour and health.‖
Center on the Developing Child at Harvard University, 20078

2.8 Stress and the child’s developing brain

Recent international research shows that adults who have had traumatic stress in their lives as
32
children show earlier signs of ageing and premature death , more depression and higher risks for
33 34
attempted and completed suicide , more cardiovascular disease , as well as increased risks for
33 35 36
substance abuse , insulin resistance and type II diabetes. Further, there is robust evidence
that specific prolonged stresses, such as abuse as a child, raises the risks of depression, suicide,
36-38
substance abuse, and reduces the body‘s immune response and resistance to infections.

When children are exposed to intense or overly frequent stressors, stress hormones are produced
at high levels and these affect the developing brain significantly through the rate at which new
neurones are produced and how they connect up with each other. Children with continuing high
levels of stress hormones, such as adrenaline and cortisol, have an increased risk of developing
37
longer-term dysfunction of their self-regulatory ‗stress response‘ system.

6 THE FIRST 5 YEARS: STARTING EARLY

One such atypical stress response is where an individual develops an autonomic nervous system
‗overreaction‘ pattern. These children characteristically overrespond to frustration or external
provocation (e.g. increased heart rate, raised blood pressure or heightened aggressive reactions).
This pattern of overarousal can be evident from an early age and is now known to be a major risk
factor in later behavioural and mental health problems as well as adult cardiovascular disease.

Another common pattern of stress response dysregulation is where the body‘s arousal to stress
becomes unusually prolonged, e.g. the stress response has difficulty ‗switching off‘. These
individuals show a pattern of response to stress where blood cortisol levels take much longer to
return to their normal ‗resting‘ levels after the source of a stress has subsided. Individuals with this
stress response pattern with chronically elevated levels of cortisol are at significantly higher risk of
obesity and type II diabetes—in addition to the generally better known risk factors of diet and
36 37
exercise.

Shonkoff and Phillips (2000) have summarised the recent research on the effects of different levels
of stress on the body‘s stress regulatory systems and the way in which this can have immediate
and longer-term effects on how the child‘s nervous, endocrine and immune systems will develop
and function. Some of these effects are described schematically in Table 1 below.

Table 1. The impact of different levels of stress

Positive stress Tolerable stress Toxic stress

Characteristics Moderate, short-lived stress More traumatic or chronic Traumatic and chronic
responses, lead to brief unpredictable stresses can unpredictable stresses result in a
increases in heart rate or produce bio-physiological strong and prolonged activation of
mild changes in stress responses that may disrupt the body‘s stress management
hormone levels. the structure and longer-term systems in the absence of the
functioning of the brain buffering protection of adult
circuits that regulate emotion. support.
However where such stresses
are buffered by supportive
relationships this usually
facilitates adaptive coping.

Precipitants Precipitants include such Examples of precipitants of Examples of precipitants include

challenges as meeting new this level of stress could extreme poverty, physical or
people, dealing with include death or serious emotional abuse, chronic neglect,
frustration, getting an illness of a loved one, a severe maternal depression,
immunisation, or adult limit frightening injury, parent substance abuse or family violence.
setting. divorce, a natural disaster,
terrorism or homelessness.

Impact on This level of stress is an Generally occurs within a ‗Toxic‘ levels of stress disrupt the
health important and necessary time-limited period, which structure and functioning of the
outcomes aspect of healthy gives the brain an opportunity brain‘s stress management
development. It is much to recover from potentially systems. This is evident in
better managed by the damaging effects. prolonged ‗fight-flight‘ autonomic
individual when it occurs in overactivity and responding at
the context of stable and relatively lower thresholds.
supportive relationships.
This pattern of chronic stress
overresponsiveness significantly
increases the risk of stress-related
adult physical illness, mental health
and behavioural disorders.

Source: Shonkoff J, Phillips D, 200017

THE FIRST 5 YEARS: STARTING EARLY 7

2.9 Life-course developmental research
Life-course developmental research has its early origins in observational, experimental and clinical
studies of the psychological and physical development of infants and children, particularly over the
38
latter half of the twentieth century. More recently, life-course developmental research has
expanded to include studies of the entire life span and has had a greater focus on the ecological or
contextual influences on the social, economic and cultural aspects of people‘s lives. There is also
expanding scientific interest in epidemiological studies showing how early life environmental
exposures (such as infections, nutrition, or stress) are associated with increased adult susceptibility
39
to chronic diseases such as diabetes, cardiovascular disease, and mental health problems.
Since the completion of the mapping of the human genome in 2003, there has also been a rapid
growth of laboratory and population-based epigenetic studies investigating how genes and
39
environmentally-based experiences influence the way in which genes are expressed. The
epigenetic study of the environmental and early-life origins of adult health and disease is now one
40
of the most rapidly expanding areas of medical science.

In light of the growing understandings of the developmental origins of health and disease, Shonkoff
(2010) has proposed that future policy and services for children should be informed by what he
terms the ‗new biodevelopmental framework‘. This would involve policy and services being targeted
more effectively to take account of how genetic and environmental factors interact to influence the
41
long-term health and wellbeing of individuals. The key elements of this developmental model,
which help to explain the biological basis of disadvantage, are summarised in Figure 5 below.

Figure 5. How early experiences get into the body

41
Source: Shonkoff, 2010

There is now a growing number of longitudinal studies following up large samples of children from
very early in their lives (i.e. birth or prenatally) through to adulthood which provide information that
can further explain these bio-developmental processes and how they can be modified. These
42
studies include the Avon Longitudinal Study of Parents and Children , the Millennium Cohort
43 44 45
Study , the Dunedin Study , the Raine Study (WA Pregnancy Cohort Study) and the USA
National Children‘s Study, which in 2009 began enrolling pregnant women in a study of 100,000
46
children from birth to age 21 years.

The Longitudinal Study of Australian Children commenced in 2004 with two cohorts of 5,000 infants
47
aged 0-1 years and another 5,000 children aged 4-5 years . The Longitudinal Study of Indigenous
Children commenced in 2008 with a cohort of around 2,000 Australian families with Indigenous
children aged 6 to 18 months and 3½ - 4½ years. It is following these families annually to develop a
better understanding of the way in which Indigenous children’s early social, economic and cultural
48
environments contribute to their longer-term adjustment and wellbeing.

8 THE FIRST 5 YEARS: STARTING EARLY

A consistent finding from longitudinal studies around the world is the extent to which
socioeconomic gradients, particularly in the formative early years of life, matter a great deal in
accounting for the overall population burden of adult physical and mental health disorders,
3
psychosocial problems and educational outcomes.

In resource-rich countries such as the UK, Canada and Australia, social gradients (differential
outcomes based on an individual‘s social position) are evident by school entry in a range of human
development domains: physical, social and emotional, language and cognitive development. Such
early disparities tend to increase over time.

Data on some 14 000 children in the 1970 British Birth Cohort Study has highlighted the extent to
which early social gradients can influence children‘s functional ability later in childhood – and how
these can be modified. Waldfogel found that children who had low cognitive scores at age 22
months, but who grew up in families of high socioeconomic position, improved their relative scores
as they approached the age of 10 (Figure 6 below). Conversely children with high cognitive ability
at age 22 months, but who were raised in low socioeconomic families, had worse cognitive function
at age 10 than the children with low cognitive ability at age 22 months who were raised in high
49
socioeconomic families.

Figure 6. Social position at age 22 months and cognitive development

to age 10 years: 1970 British Birth Cohort Study

Age of school entry

Note: Q = Standardized cognitive score

Source: 1970 British Cohort Study

48
Source: Waldfogel, 2004

Similar findings from a range of other longitudinal studies suggest that to have an impact on longer-
term educational and health inequalities, it is necessary to address the social gradient in children‘s
opportunities for positive early developmental experiences. Later interventions, although important,
49
are considerably less effective where good early foundations are lacking.

THE FIRST 5 YEARS: STARTING EARLY 9

3. Prevention science and effective interventions
Life-course development research has been valuable in identifying environmental risk and
protective factors that can inform more effective targeting of policies and services, as well as the
design of programs for families, schools and communities to improve child health and
development. It has also provided a wealth of information about the benefits of early childhood
programs for children and society. While this evidence is mostly from the evaluation of targeted
programs, it also includes findings from longitudinal studies showing the benefits of universal and
51-53 54 55
selectively targeted preschool parenting programs in Australia , the USA and Europe and of
56 57
universal preschool in the UK and the USA.

3.1 Quality early childhood programs

Although early childhood programs vary, most offer combinations of quality maternal, child and
family health services, early childhood education and care, and parent support services. They aim
to strengthen the capacities of caregivers and communities to promote the health and development
of young children.

The more effective programs tend to be those that work directly with children and also with parents
to improve engagement with their children, and to foster skills and confidence in parenting.
Outcomes are generally better when services are well-coordinated within a community and where
58
there is good continuity of care for the child and their parent or caregiver.

The quality of the workforce, their training and support are vitally important for early childhood
services to achieve good outcomes for children. It has also been found to be useful to structure
programs around key transition points such as pregnancy and birth, from home to early childhood
education and care, and the transition to school. These are times when parents face new
challenges and situations, but also when they are more receptive to support and information
11
relevant to the developmental needs of their children.

3.2 Improving health and nutrition

Ensuring access to primary health care services (including mental health care when needed) is one
of the most effective policies for reducing perinatal and early childhood health impairments. Home
visiting programs, ensuring regular primary health care for pregnant mothers and children, are an
important way of monitoring maternal health, social support needs and the adequacy of infant and
59
childhood growth and other aspects of development. They are valuable in identifying and initiating
early intervention for maternal and child concerns that could lead to more serious problems later.

These programs also encourage the parent or caregiver to undertake activities in the home that
can enhance their children‘s development. Such activities include ways of engaging attention,
playing, storytelling and using picture books to stimulate the child‘s imagination and language
59
development.

Over and above the cost-benefit studies of maternal and child primary health care which
demonstrate significant returns, there is growing evidence of the benefits on Supplemental Food
Programs for Women, Infants and Children in the USA and several developing countries. For
example, low income mothers who participate in the Supplemental Food Program for Women,
Infants and Children in the USA are less likely to have pre-term or low birth weight babies—
situations which are associated with lower educational achievement, lower probability of
60
employment and lower earnings as an adult.
61
Similarly, the WHO Infant and Childhood Nutritional Counselling Program and home
micronutrient supplementation (e.g. iron, folate and vitamin C) programs have been shown to be
effective in reducing rates of growth retardation (stunting), wasting and childhood anaemia—all of
62 63
which can adversely affect the developing brain. Of particular relevance to the NT are
international studies showing that the benefits of nutritional counselling and supplementation in
communities with high proportions of undernourished and stunted children are significantly
enhanced when families are also counselled by Indigenous health workers on care, interaction and
63 64
activities that stimulate child development.

10 THE FIRST 5 YEARS: STARTING EARLY

3.3 Improving capability and confidence in parenting
Most families adapt successfully to the challenges of preparing for the birth of an infant, and then
caring for a new child. However, this transition can be a challenging time, particularly for parents
having their first child or where parents are themselves very young, or where parents are socially
isolated or are experiencing serious adversity or disadvantage. In such circumstances there is
strong evidence that home visiting services can provide the critical support needed and have
13
positive and substantial effects on a variety of childhood and adult outcomes.

However, not all home visiting programs have proven to be equally effective. The programs found
to be more effective are those provided by well-trained and adequately supervised professional
staff who implement a range of defined services guided by clear goals, and who are successful in
engaging families for the duration of the program. The home visiting program with the strongest
evidence is the Nurse Family Partnership Program, which provides home visits usually starting in
the second trimester before birth. This program involves weekly visits immediately following the
59
birth and a total of around fifty home visits by the time the child is aged two.

Of particular relevance to the NT are the findings from a recent large-scale randomised control trial
of the universal implementation of an evidence-based parenting program (Triple-P) in 18 US
54
counties with population sizes between 50,000 and 175,000. The introduction of the program
was found to have been associated with significant and large effect-size reductions for three
independently measured population indicators: substantiated child maltreatment, child out-of-home
placements, and child maltreatment injuries within these counties where the program was delivered
in comparison of counties not receiving the program.

3.4 Family supports to reduce sources of toxic stress

Those families in greatest need of support (e.g. parents with mental health, drug and alcohol
misuse, parents experiencing family violence, or parents at risk for child abuse) can benefit from
more focused services targeted to some of the sources of their stress. For example, parents at high
risk for child abuse have been found to benefit from individualised coaching to increase their
awareness and responsiveness to specific child behaviours, to learn to use praise and non-
coercive discipline strategies, and to learn to stimulate their child‘s development of language and
51 54
other skills.

There are also promising screening programs implemented in hospital and midwifery services to
identify mothers with postnatal depression to enable early intervention and additional supports in
the care of their children. While not all of these programs have shown benefits for parent-child
interaction, family functioning and children‘s development this remains an important area for
65
practice improvements and future research.

THE FIRST 5 YEARS: STARTING EARLY 11

4. The economics of human capability formation
The stage-by-stage way in which a child‘s early capabilities lay the foundation for later capabilities
in education and other domains of development has been informed by the research of two Nobel
66 67
economics prize winners Gary Becker and James Heckman . Their human capital modelling
based on USA population data has been a major influence on the reappraisal of early childhood
and education policy that has occurred in most developed countries over the past decade.
Heckman‘s findings indicate programs that deliver on the key principles of human growth and
development in the early years of childhood offer the best returns on dollars spent on program
67
development and implementation.

The National Assessment Program for Literacy and Numeracy (NAPLAN) provides Australia with a
convenient population measure of the human capabilities of literacy and numeracy during the
69
school Years 3, 5, 7 and 9. While NAPLAN assesses just a few aspects of all the knowledge and
competencies that children learn in school, these scores nevertheless provide an indication of how
these capabilities vary between States and Territories. In Figure 7 below it can be seen that the
reading achievement of almost all non-Indigenous students in the NT is at or above the national
minimum standard and has a similar distribution to their counterparts in other States and
Territories. In contrast, over two-thirds (69%) of NT Indigenous students score below the national
minimum standard, a far greater proportion than in any other State or Territory.

Figure 7. NAPLAN Year 3 Reading, by Indigenous Status, by State and Territory: Australia,
2009

69
Source: NAPLAN, 2009

Given that ‗skills beget skills, and early strengths beget later strengths‘ it is useful to consider the
NAPLAN Year 3 reading results in relation to the developmental status of children as they
commence their first year of school as measured by the Australian Early Development Index
70
(AEDI). The AEDI is a teacher-rated measure of over 100 behavioural items describing five
domains of early childhood development which was used to assess all Australian 5 year olds in
2009. Figure 8 below shows the percentage of Indigenous and non-Indigenous children in each
State and Territory who were assessed as ‗developmentally vulnerable‘ on the AEDI language and
th
cognitive skills domain (i.e. they had scores below the 10 percentile of the national population of 5
year olds on this domain scale).

12 THE FIRST 5 YEARS: STARTING EARLY

 (1)
Figure 8. Percentage of children ‘developmentally vulnerable’ on AEDI language and
cognitive skills by jurisdiction and Indigenous status: Australia, 2009

60

Non-Indigenous Indigenous

50
46.7

40
37.3
35.5
Percentage

30 28.6

22.9
20.7
20 17.6
15.2
14.2 14.4

10.4
10 7.4 7.4 7.9 7.9
5.4 6 5.5

0
NSW Vic Qld WA SA Tas ACT NT Australia

(1) ‗Developmentally vulnerable‘ This refers to children who scored below the 10 th percentile of the national AEDI
population on the AEDI Language and Cognitive Skills domain scale

Source: AEDI National Support Centre 71

These findings are of particular relevance to the NT for two reasons. First, they highlight the extent
of the disparity between Indigenous and non-Indigenous children on this domain of early child
development which is so critical to subsequent success in school learning. Second, the relative
position of States and Territories in terms of their proportions of Indigenous and non-Indigenous
children with AEDI scores in the vulnerable range on this scale is closely similar to the comparable
relative positions of NAPLAN Year 3 reading scores as reported by jurisdiction and Indigenous
status (refer Figure 7).

It would therefore seem that much of the present disparity observed in the poor overall educational
outcomes of Indigenous children is attributable to developmental factors operating in the early
childhood years before children commence school.

This suggests that current reform initiatives to ‗close the gap‘ in the educational outcomes of
Indigenous children should include a greater focus on what can be done to strengthen the capacity
of families, communities, child care and early learning settings to better support children‘s early
development and their readiness for school learning.

THE FIRST 5 YEARS: STARTING EARLY 13

5. Implications for childhood policy and services
The recent growth in knowledge about early childhood development together with the range of new
national partnership funding agreements between the Australian Government and the States and
Territories offers a unique opportunity to strengthen policy and services for NT children. This has
potential to not only improve children‘s developmental outcomes and support their successful
transition into school learning – it can also make a lifelong difference to their health, employment
and opportunities for participation in their communities and elsewhere.

Figure 9 below outlines four key areas of action and influence identified by the Harvard University
Centre on the Developing Child as a suggested framework for re-conceptualising childhood policies
and programs to be better aligned to achieve population-level improvements in health, capability
and wellbeing.

Figure 9. A framework for re-conceptualising early childhood policies and programs to

strengthen lifelong health, capability and wellbeing

Source: Center on the Developing Child at Harvard University, 201011

There is now a range of evidence-based early childhood development programs for families and
children which should be considered for implementation in the NT context. These include:
 home visiting programs that work with parents before birth, during infancy and early
childhood
 integrated childhood services supporting multifunctional centres that provide non-parental
care when parents are working or studying
 intensive child development programs delivered through primary health, child care or early
learning settings
 relevant training and higher education for a suitable early childhood workforce
 whole of government coordination of policies, funding, strategy, evaluation and
accreditation
 child development and family support centres that are accessible, affordable and available
to all families.

14 THE FIRST 5 YEARS: STARTING EARLY

The quality of early childhood programs and the fidelity with which they are delivered is a
consistent feature of evidence-based programs which are more effective. This in turn requires the
availability of a suitably qualified workforce that receives structured pre-and in-service training and
which has access to more specialised professional support where needed. Maintaining the quality
and effectiveness of such programs also requires accountability frameworks and information
systems for the on-going monitoring of the outcomes achieved, for whom, and at what cost.

The international and national evidence reviewed in this discussion paper clearly demonstrates the
critical importance of children‘s early environments of child rearing and learning for later outcomes
in health, learning and behaviour. Children‘s outcomes are better when parents and families are
able to provide nurturant and responsive care and give high priority to encouraging their children‘s
early development. The capability of families in supporting their children‘s development is also
better where parents and other caregivers have access to early childhood services that are well-
coordinated within a community, where there is good continuity of care for children, and where
more specialised family supports are available when needed.

These conclusions are also reflected in the following statement from the United Nations 2010
Status Report on the UN Convention on the Rights of the Child.

―All children are entitled to the full realization of rights, without discrimination, throughout their early
childhood, as guaranteed by the Convention on the Rights of the Child and other internationally
agreed instruments. They have the right to survive and to enjoy their early childhood and be fully
respected both in their own right and as members of families, communities and nations, with their
own concerns, interests and points of view. To exercise their rights, young children have particular
requirements, including access to quality health and nutrition services and safe and emotionally
fulfilling environments where they can play, learn and explore, under the responsive guidance of
72
parents and other primary caregivers.‖
72

THE FIRST 5 YEARS: STARTING EARLY 15

6. Bibliography
1. Young MS, Richardson LM. Early Childhood Development: Measurement to Action Washington
DC: World Bank, 2007.
2. Australian Government. Investing in the Early Years- A National Early Childhood Development
Strategy. Canberra: Council of Australian Governments, 2009.
3. World Health Organization. Closing the Gap in a Generation: Health equity through action on the
social determinants of health. Geneva: WHO Commission on the Social Determinants of
Health, 2008.
4. Hertzman C. Making early childhood a priority, lessons from Vancouver. BC Office: Canadian
Centre for Policy Alternatives, 2004.
5. Bammer G, Michaux A, Sanson A, editors. Bridging the “Know-Do" Gap: Knowledge brokering to
improve child wellbeing. Canberra: ANU Press, 2010.
6. O'Connell ME, Boat T, Warner KE, editors. Preventing Mental, Emotional, and Behavioral
Disorders Among Young People: Progress and Possibilities: Research Advances and
Promising Interventions. Washington: The National Academies Press, 2009.
7. COAG. National reform agenda - human capital Indicative outcomes and associated progress
measures across the lifespan (Attachment D - COAG communique, 14 July 2006) 2008.
8. Center on the Developing Child at Harvard University The Science of Early Childhood
Development: Closing the gap between what we know and what we do, 2007.
9. New Economic Foundation. Backing the Future: Why investing in children is good for us all.
London: New Economic Foundation, 2009.
10. Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, et al. Fair Society, Healthy
Lives: The Marmot Review. London: University College of London, Research Department
of Epidemiology and Public Health, 2010.
11. Center on the Developing Child at Harvard University. A Science-Based Framework for Early
Childhood Policy using Evidence to Improve Outcomes in Learning, Behavior, and Health
for Vulnerable Children. Cambridge MA: Center on the Developing Child at Harvard
University, 2010.
12. McCain MN, Mustard, F.J. & Shanker, S. Early Years Study 2: Putting Science into Action.
Toronto: Council for Early Child Development, 2007.
13. Karoly LA, Kilburn RM, Cannon JS. Early Childhood Interventions: Proven results, future
promise. New York: RAND Corporation, 2005.
14. Heckman JJ. Schools, Skills, and Synapses. No 3515. ed. Bonn: The Institute for the Study of
Labour (IZA), 2008.
15. Moore TG. Rethinking universal and targeted services. CCCH Working Paper 2. Parkville,
Victoria: Centre for Community Child Health, 2008.
16. Restak RM. The secret life of the brain. New York: National Academy Press, 2001.
17. Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early
Childhood Development: National Academy of Sciences, 2000.
18. Langley K, Holmans PA, van den Bree MBM, Thapar A. Effects of low birth weight, maternal
smoking in pregnancy and social class on the phenotypic manifestation of Attention Deficit
Hyperactivity Disorder and associated antisocial behaviour. BMC Public Health, 2010:525.
19. Breslau N, Paneth N, Lucia VC, Paneth-Pollak R. Maternal smoking during pregnancy and
offspring IQ. International Journal of Epidemiology 2005;34:1047–53.
20. Talge NM, Neal C, Glover V, The Early Stress Translational Research and Prevention Science
Network. Fetal and neonatal experience on child and adolescent mental health (2007)
Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?
Journal of Child Psychology and Psychiatry 2007;48(3):245-61.
21. O‘Leary C. Fetal alcohol syndrome: A literature review prepared for the national expert advisory
committee on alcohol. Canberra: Commonwealth of Australia, 2002.
22. Guerri C, Bazinet A, Riley EP. Foetal alcohol spectrum disorders and alterations in brain and
behaviour. Alcohol and Alcoholism 2009;44:108-40.
23. Stad B, Ungar WJ, Stevens B, Beyen J, Koren G. The burden of prenatal exposure to alcohol:
Measurement of cost. Journal of Fetal Alcohol Studies International 2006;4(5).
24. NHMRC. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra:
Commonwealth of Australia, 2009.
25. Van de Bergh BRH, Mulder EJH, Mennes M, Glover V. Antenatal maternal anxiety and stress
and the neurobehavioural development of the fetus and child: links and possible
mechanisms. Neuroscience and Biobehavioral Reviews 2005;29:237-58.
26. Goodman SH, Rouse MH. Perinatal depression and children:A developmental perspective
Atlanta:: Centre of Excellence for Early Childhood Development, 2010.
16 THE FIRST 5 YEARS: STARTING EARLY
27. Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on
brain, behavior and cognition. Nature Neuroscience, 2009;10:434-45.
28. AEDI National Support Centre (2010) Australian Early Development Index Results Guide
(Available on-line at: http://training.aedi.org.au/Home.aspx).
29. Eschel N, Daelmans B, de Mello MC, Martines J. Responsive parenting: interventions and
outcomes. Bulletin of the World Health Organisation 2006;84(12):991-8.
30. Richter L. The importance of caregiver-child interactions for the survival and healthy
development of young children: A review. Geneva:: World Health Organization, 2004.
31. Landry SH, Smith KE, Swank PR, Guttentag C. A responsive parenting intervention: The
optimal timing across early childhood for impacting maternal behaviors and child
outcomes. Developmental Psychology 2008;44(5):1335-53.
32. Gunnar MR, Quevedo K. The neurobiology of stress and development. Annual Review of
Psychology 2007;58:145-73.
33. Afifi TO, Enns MW, Cox BJ, Asmundson GJ, Stein MB, Sareen J. Population attributable
fractions of psychiatric disorders and suicide ideation and attempts associated with
adverse childhood experiences American Journal of Public Health 2008;98(5):946-52.
34. Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, et al. Insights into causal
pathways for ischemic heart disease: adverse childhood experiences study. Circulation
2004;110(13):1761-66.
35. Koss MP, Nicole P. Yuan, Dightman D, Prince RJ, Polacca M, Sanderson B, et al. Adverse
childhood exposures and alcohol dependence among seven native American tribes. Am J
Prev Med 2003;25(3):238-44.
36. Tamayo T, Christian H, Rathmann W. Impact of early psychosocial factors (childhood
socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic
disturbances and obesity: a systematic review. BMC Public Health 2010;10:525.
37. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. The enduring effects
of abuse and related adverse experiences in childhood. A convergence of evidence from
neurobiology and epidemiology. European Archives of Clinical Neuroscience
2006;256(3):174-86.
38. Bowlby J. Maternal care and mental health. WHO Mongograph. Geneva: World health
Organization, 1951.
39. Szyf M, McGowan P, Meaney MJ. The social environment and the epigenome. Environmental
and Molecular Mutagenesis 2008;49:46-60.
40. Sinclair KD, Lea RG, Rees WD, Young LE. The developmental origins of health and disease:
Current theories and epigenetic mechanisms. . :. . Soc Reprod Fertil Suppl 2007;64:425-
43.
41. Shonkoff JP. Building a new biodevelopmental framework to guide the future of early childhood
policy. Child Development 2010;81(1):357–67.
42. Golding J. Avon study of children and youth (ALSPAC). . University of Bristol, UK ALSPAC
University of Bristol, 2005.
43. Centre for Longitudinal Studies. Millennium cohort study. London: Institute of Education
University of London, 2010.
44. Silva PA, Stanton W. From Child to Adult: The Dunedin multidisciplinary health and
development study. New York: Oxford University Press, 2006.
45. Newnham SFJ, Landau L. The Raine study Perth WA: Telethon Institute for Child Health
Research, 2010.
46. Shriver UK. The National Children‘s Study. Atlanta: National Institutes of Health, 2007.
47. Australian Institute of Familly Studies. Growing up in Australia: The logitudinal study opf
Australian children. 2005-06 Annual Report. Melbourne: Australian Institute of Family
Studies, 2006.
48. Department of Families Housing Community Services and Indigenous Affairs. Footprints in
Time: The longitudinal study of Indigenous children—Key summary report from wave 1.
Canberra: FaHCSIA, 2009.
49. Waldfogel J. Social mobility, life chances, and the early years. London: London School of
Economics, 2004.
50. Early Child Development Knowledge Network of the Commission on Social Determinants of
Health. Early Child Development: A powerful equalizer. Geneva: World Health
Organisation, 2007.
51. Ochiltree G, Moore T. Best start for children: The evidence base underlying investment in the
early years. Melbourne: Department of Human Services Government of Victoria, 2001.
52. Zubrick SR, Northey K, Silburn SR, Williams AA, Blair E, Robertson D, et al. Prevention of child
behaviour problems via universal implementation of a group behavioural family
intervention. Prevention Science 2007;6(4):287-304.

THE FIRST 5 YEARS: STARTING EARLY 17

 53. Sanders M, Ralph A, Sofronoff K, Gardiner P, Thompson R, Dwyer S, et al. Every Family: A
population approach to reducing behavioural and emotional problems in children making
the transition to school. Journal of Primary Prevention 2008;29:197-222.
54. Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR. Population-based prevention of
child maltreatment: The U.S. Triple P System population trial. Prevention Science
2009;10:1-12.
55. Dretzke J, Davenport C, Frew E, Barlow J, Stewart-Brown S, Bayliss S, et al. The clinical
effectiveness of different parenting programmes for children with conduct problems: A
systematic review of randomised controlled trials. Child and Adolescent Psychiatry and
Mental Health 2009;3(7).
56. Sylva K, Melhuish E, Sammons P, Siraj-Blatchford I, Taggart B. Effective Preschool and
Primary Education 3–11 Projects Final Report from the Primary Phase: Preschool, school
and family influences on children‘s development during key stage 2 (age 7–11). London:
Institute of Education, 2008.
57. Payton J, Weissberg R, Durlak J, Dymnicki A, Taylor R, Schellinger K, et al. The Positive
Impact of Social and Emotional Learning for Kindergarten to Eighth-Grade Students:
Findings from scientific reviews. Chicago: Collaborative for Academic, Social, and
Emotional Learning (CASEL), 2008.
58. Centre for Community Child Health. Services for young children and families:an integrated
approach. Parkville, Victoria: Royal Childrens Hospital, 2006.
59. Olds DL, Robinson J, O‘Brien R, Luckey DW, Pettitt LM, Henderson CJR, et al. Home visiting
by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics
2002;110(3):486 - 96.
60. Bitler M, Currie J. Does WIC work? The effects of WIC on pregnancy and birth outcomes.
Journal of Policy Analysis and Management 2005;24:73-91.
61. World Health Organization. Planning guide for the implementation of the global strategy for
infant and young child feeding. Geneva: WHO Press., 2006.
62. World Bank. Repositioning nutrition as central to development: A strategy for large scale action.
New York: World Bank. . New York: World Bank, 2005.
63. Grantham-McGregor SM, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B, et al. Child
development in developing countries 1. Developmental potential in the first five years for
children in developing countries. Lancet 2007;369:60-70.
64. Grantham-McGregor SM, Powell C, Walker S, Chang S, Fletcher P. The long term follow-up of
severely malnourished children who participated in an intervention program. Child
Development 1994;65:428-39.
66. Chaudron LH, Szilagyi PG, Campbell AT, Mounts KO, McInerny TK. Legal and ethical
considerations: Risks and benefits of postpartum depression screening at well-baby visits.
Pediatrics 2007;119:123-28.
66. Becker GS. Human capital: A theoretical and empirical analysis, with special reference to
education. 2nd ed. New York:: NBER Books, 1975.
67. Heckman JJ. Skill formation and the economics of investing in disadvantaged children. Science
2006;312(5782):1900-2.
68. Heckman J, Malofeeva L, Pinto R, Savelyev P. Understanding the Mechanisms Through Which
an Influential Early Childhood Program Boosted Adult Outcomes. Chicago: The University
of Chicago 2010.
69. Australian Curriculum and Reporting Authority. Years 3, 5, 7 and 9 national results in reading,
writing, language conventions and numeracy. . http://www.naplan.edu.au/, 2010.
70. Centre for Community Child Health and Telethon Institute for Child Health Research 2009. A
Snapshot of Early Childhood Development in Australia – AEDI National Report 2009,
Australian Government, Canberra.
71. AEDI National Support Centre (2010). Percentage of children ‗developmentally vulnerable‘ on
AEDI language and cognitive skills by jurisdiction and Indigenous status: Australia, 2009
Custom table produced for the Menzies school of Health Research.
72. United Nations General Assembly (2010) Status Report of the Committee on the Rights of the
Child. New York: United Nations.

18 THE FIRST 5 YEARS: STARTING EARLY

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