Tag Archives: Ellie Lee

On the social environment

I was brought to thinking about child development and the influence of early parental nurturing after watching a lively exchange on BBC’s Newsnight between the clinical psychologist, Oliver James, and Dr Ellie Lee, a lecturer in social policy at the University of Kent.*

From what I could see, the intense antagonism (aside from James’ unwavering dogmatism) was partly the result of a difference between a purely clinical look at child development, by which controlled scientific studies are held up to encourage the need for early intervention, and the sociological implementation of these ideas, which can introduce many variables to successful intervention.

For instance, showing that supportive parenting behaviours can lead to improved mental and language abilities in infants is one thing (as James would point out), but how you successfully communicate that to parents and change behaviour, is another (as Lee might counter). To lay down a hard-and-fast prescription for parents to follow, without layering burden upon burden, is not always straightforward. A more nuanced approach is required, as appreciated in the Early Intervention report featured in the Newsnight item.

Oliver James, in particular, seems very disposed to attach blame to a parent for any perceived character flaw in their child, and guilt-tripping parents in this way seems an overly blunt approach. And this is the point that Dr Lee may have wished to explain more explicitly.

It seems to me, albeit speculatively, that the parent’s well-being is an important consideration when encouraging them to follow particular regimens. The current consensus of the scientific community may be that a child should be doing X, Y and Z, but it may also be the case that to achieve this, one or both of the parents would end up dangerously sleep deprived, mentally exhausted and with a strain on their relationship. This would be differentially affected by a person’s physiology, underlying immunity, predisposition to mental illness, and so on. It would also depend fairly heavily on a person’s life – their age, whether they’re a single parent, in proximity to close family, in a high pressured job, etc. All of these considerations temper any absolute assertion of an intervention based on clinical data.

The field of psychosocial research, which seeks to understand the interplay between one’s psychology and their social environment, is an important factor to consider when establishing any health initiative. It would be great to see whether there is any direct evidence related to this in the context of early intervention programmes for parents. A recent special issue in the journal Science, lays out some of the issues facing educational intervention initiatives, including the obstacles faced when moving from scientific research to public policy. The need for a holistic approach is summarised in the introduction:

Early childhood education remains peppered with both opportunities and debate. Continued progress will require new research that bridges traditional disciplines of neuroscience, psychology, sociology, economics, public policy, health, and education.

So whilst the clinical research may show that a particular intervention leads to the absolute best outcomes, it may be that a parent ends up finding a middle ground that still provides a beneficial environment for their child, but also a satisfactory outcome for themselves (a sort of cost-benefit assessment, if you like). It would be no good hectoring parents into following a specific course of action, with no amount of flexibility, if it leads to a significant worsening of their own physical or mental health, especially if the knock-on effect is a deterioration in family relationships. It seems highly unlikely that this would allow people to be good parents nor provide a decent environment for the child (a brief look at the scientific literature suggests this assumption isn’t entirely unreasonable, e.g. this, this and this).

I should emphasise that I do not wish to appear as though I am justifying or accepting of ‘bad behaviour’ of parents. There are clearly things we should all strive to do, things that are a struggle, and this will involve a series of adaptations, compromises and sacrifices.

Why, say, do one in five British adults smoke when we know categorically that is causes lung cancer, heart disease and increased risk of stroke? Worse, why do so many adults still smoke in the presence of children or during pregnancy, when passive smoking can cause the same health problems in children (and more) and parental smoking increases the chances that a child will smoke as an adult? A look at how mothers from disadvantaged backgrounds respond to tobacco control initiatives gives some clues – in short, increasing stigmatisation can be counter-productive.

I would like to think, though, that most, if not all, parents are happy to put their very best efforts in and would never be wilfully neglectful. But the point which seems to emerge is that the results of clinical research should be considered against a backdrop of social and population variances. In the case of early intervention, labelling a child as ‘at risk’ or categorically predicting their development, could be helpful in targeting the right guidance and support to the right people, but should not lead to undue and counter-productive stigmatisation.

So, appreciating that each baby, each parent, each family’s circumstance is different, is very valuable. It is critical, as always, to be guided by the scientific evidence available and make this the basis of any initiative to improve child development, but it may not be possible to then arrive at a ‘one-size-fits-all’ formula, a point similar to that made by Dr Luisa Dillner regarding sleep routine.

In short, it’s complicated. Plus ça change…

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* Better quality video embedded (05/10/2011) – thanks to Denys Andrianjafy.

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