Introduction

Many years ago I heard a teenager screaming to her mother “You are a worm that enters the brain of your own child to drive her crazy!” In those days, blaming mothers for the mental health of their offspring was still a rather private business. Nowadays, the subject has entered the public debate, “in particular in relation to the UK” where “the nation’s future and how mothers bring up their children become hooked together”, as Gilles, Edwards and Horsley write in the in their new book Challenging the politics of early intervention (150).

In a previous post I illustrated some of the salient points in the history of such debate. In this post I want to look closely at the critical approach to early intervention (EI) adopted by the authors of the quote above. I start from the cover of their book. The image of a conveyor belt transporting doll heads is, first, distressing. Second, it is suggestive of a mechanical process that uses children as means to an end, rather than seeking to achieve their wellbeing. This image offers just a small taste of the kind and degree of criticism against EI that abounds in this book.

A critique of the critics

I focus upon two arguments made by the authors of this book, responding to each:

Morally judgemental

The authors claim that EI programs make targeted parents feel morally judged by looking at them as likely to raise problematic children, and for holding them responsible for the disadvantage they cause their offspring (8, 35). The authors concede that not all EI practitioners are necessarily persuaded by this notion of sub-standard and deficient parenting, nor that all EI professionals base their actions upon it (133). However, they argue that the notion is “implicit” in programmes, manuals and policy documents.

I criticize this claim by making the following three points.

1. First, by saying that this notion is implicit, the authors are only guessing rather than showing that the notion of deficiency is a core component of EI. They may be wrong.
2. Second, even assuming that EI programmes envisage certain mothers as lacking some skills or abilities, that is not problematic as long as it is specified that good mothering involves both innate and learned behaviours. Mothers are judged according to how well they learn the parenting skills that are taught to them as part of the EI programme, however, the model of ‘good parenting’ being taught is by no means objective, nor does it tell the whole story about what it means to be a good mum. Consequently, judgment does not imply moral blame but only a shared understanding of the work to be done as part of the programme.
3. Third, and most important, EI practitioners generally do not judge parents as deficient. They are adamant about that because they know that judging is detrimental to the learning process of new parenting skills. EI might be “strictly defined” and “carefully scripted” (7) in programmes, manuals and policy documents, but in reality people are much more flexible about how a parent should behave. That is what I personally observed during one year of in-depth ethnographic research in Preparing For Life, an EI initiative that pairs mothers and mentors in Dublin, Ireland. According to my experience, the assumption that EI practitioners do exactly as these documents “implicitly” say is incorrect.

For these three reasons, I reject the claim that EI is morally judgmental.

Scientifically determinist

The authors argue that EI rests on two assumptions based on misleading or even false scientific claims.

1. The first assumption is that bad parenting is scientifically proven to cause brain damage. Such damage is seen to be largely irreversible and will thus preclude certain desirable health outcomes in the future. This assumption, the authors say, rests on extrapolations, fabrications, and overblown conclusions drawn from the existing neuroscientific evidence.
2. The second assumption is that EI works, in all cases, for all children and families. The authors cite numerous published studies indicating that EI is far from being universally effective. And they criticise EI practitioners for insisting so much that EI works. The evidence, they remind us, is actually shaky and inconclusive.

I respond to this two-fold criticism by means of the following two-faced points.

1. The authors are right when they criticize policy reports and other outlets that extrapolate on neuroscientific findings. But that is not news. There has been a wave of publications making the same point, which they quote extensively. They also note how, among their interviewees, a few expressed concern that messages about brain damage and development must not be overemphasised (119). That is coherent with my experience: EI practitioners tend to emphasise neuroplasticity, rather than damage, in order not to scare parents off. That is quite far from a determinist attitude. So, again, equating what documents say and what EI practitioners do is incorrect.

2. The authors are right when they say that EI is not generally proven to work. However, again, that is not news. Their merit, hence, lies mainly in selecting some of the existing evidence to demonstrate their point. They did not, however, mention the studies that show the opposite, namely that EI sometimes does work (see Further readings, below). Hence, their argument is demonstrated, but their account is neither innovative nor balanced.

Conclusion

It might be true that EI manuals and policy documents imply a moral judgement of parents as universally not good enough and thus deserving to be conscripted into parenting courses. It is definitely true that the deterministic tendencies of most EI reports result in unnecessarily worrying conclusions concerning early brain damage, and unrealistic expectations about the effectiveness of EI. Nevertheless, the people in the EI industry do not necessarily treat those documents with evangelistic single-mindedness, nor are parents who sign up for EI services unable to question or reject a moral judgement (assuming that such a judgement is actually formulated for them and/or perceived by them). “Challenging the challenge” was only possible because, for one year, I looked at EI from the perspective of the people in the EI industry. Taking this ethnographic perspective, I have seen the empirical ethics of EI as substantially free from both moral judgement and infant determinism.

Further readings

Anderson, Laurie M., Carolynne Shinn, Mindy T. Fullilove, Susan C. Scrimshaw, Jonathan E. Fielding, Jacques Normand, and Vilma G. Carande-Kulis. 2003. ‘The Effectiveness of Early Childhood Development Programs: A Systematic Review’. American Journal of Preventive Medicine 24, no. 3: 32–46. https://doi.org/10.1016/S0749-3797(02)00655-4.

Aronen, Eeva T. and Sirpa A. Kurkela. 1996. ‘Long-Term Effects of an Early Home-Based Intervention’. Journal of the American Academy of Child & Adolescent Psychiatry 35, no. 12: 1665–72. https://doi.org/10.1097/00004583-199612000-00019.

Bruder, Mary Beth. 1993. ‘The Provision of Early Intervention and Early Childhood Special Education within Community Early Childhood Programs: Characteristics of Effective Service Delivery’. Topics in Early Childhood Special Education 13, no. 1: 19–37. https://doi.org/10.1177/027112149301300105.

Feldman, Maurice A., Bruce Sparks, and Laurie Case. 1993. ‘Effectiveness of Home-Based Early Intervention on the Language Development of Children of Mothers with Mental Retardation’. Research in Developmental Disabilities 14, no. 5: 387–408. https://10.1016/0891-4222(93)90010-H.

Kendrick, Denise, Ruth Elkan, Michael Hewitt, Michael Dewey, Mitch Blair, Jane Robinson, Debbie Williams, Kathy Brummell. 2000. ‘Does Home Visiting Improve Parenting and the Quality of the Home Environment? A Systematic Review and Meta Analysis’. Archives of Disease in Childhood 82, no. 6: 443–51. https://doi.org/10.1136/adc.82.6.443.

Olds, D. L., Henderson, C. R., Chamberlin, R., & Tatelbaum, R. 1986. ‘Preventing Child Abuse and Neglect: A Randomized Trial of Nurse Home Visitation’. Pediatrics 78, no. 1: 65–78.

About the Author

Rodolfo Maggio is a postdoctoral researcher at the Department of Psychiatry, University of Oxford. He works on the Mothers: Early Intervention Ethics (MO: EIE) study under the BeGOOD flagship project.

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This blog post is based on the opinions of the author and does not necessarily represent the views of the University of Oxford or the Oxford Department of Psychiatry.