Thursday, November 17, 2016
Can Brain Science Help With Practical Decisions about Child Welfare, Custody, and Treatment Issues?
In the last week or two, I’ve come across several situations where neuroscience is referenced as helping provide understanding of interventions for children’s mental illness or educational problems. This use of scientific information is often called “translational” science, and it is receiving much well-deserved attention as we try to move from laboratory successes to practical benefits.
But, can neuroscience as it exists today tell us anything more about how to help at-risk children than we can learn from behavioral studies? That was the question I thought of when I read the following:
1. A Norwegian psychologist working with child placement decisions expressed his concern that evidence of maltreatment is equated with brain damage and used to argue that children should be placed in foster homes.
2. An editorial in the Brown University Child and Adolescent Behavior Letter was entitled “Distracted driving prevention needs leadership from the neuroscience community” (CABL, Nov. 2016, p.8). The author very correctly pointed out the failure of “scare tactics” to work with teenagers with respect to drug use or criminal behavior, and expressed doubt that such an approach would be helpful in preventing teenage distracted driving. But instead of suggesting other well-established techniques that are known to change behavior effectively, the author said, “what is sorely missing is the voice of the neuroscience community… each scientific nugget… may open a door in the prevention effort”.
3. In Child Development Perspectives (2016, Vol. 10 , 251-256), Philip Fisher and his co-authors have an article with the title “Promoting healthy child development via a two-generation translational neuroscience framework: The Filming Interactions to Nurture Development video coaching program”. This very helpful-sounding program for parents and young children uses videotaped interactions between the two to teach parents to pay attention to a child’s communications, to monitor and reflect on their own behavior, and to wait for children to respond rather than moving on impatiently. All good goals, and very much in line with recent efforts to help foster good parent-child relationships—but where did the translational neuroscience actually come into this program? Did neuroscience help the authors decide how to shape their program, or did they create a program that did the things we think are good for behavioral reasons, and then seek a neuroscience context to strengthen their argument?
4. If anyone wants more examples, just think about things like teaching to one side or the other of the brain, patterning, the “cross-crawl”, and dozens of other claims that a method has specific effects on the brain.
Let’s look at some of the assumptions that these examples share (and remember the old saying, ASSUME makes an ASS of U and ME).
One is that behavior and mental abilities are directly related to brain structures and functions. Of course, this is true at the coarsest level. Damage the visual areas of the cortex and you don’t see. Damage the frontal lobes and you don’t plan or anticipate well. But in fact brains have a lot of redundancy and can do many things in more than one way—even the person with damage to the visual cortex may be able to walk around an object in his path, although he is not aware of seeing it. People’s brains are not all just alike, with most people having the left hemisphere dominant and a smaller number having the right hemisphere—yet right- and left-handed people can do most cognitive tasks equally well, as can men and women, whose brains have some differences.
A second assumption is that we actually have quite a clear idea of how parts of normal. human brains work. In fact, neuroimaging gives us only a glimpse into what is happening in the specific parts of the brain we choose to look at, at a particular time. Most of what we know about connections between different parts of the brain still involves what has been studied by autopsy in individuals whose brains have been damaged during life. And, of course, we have the problem that some of the evidence put forward as explaining human brain functioning actually comes from information chosen from a variety of animals and not confirmed by human studies (see http://childmyths.blogspot.com/2014/04/disorderly-thinking-about-developmental.html).
A third assumption, and a very tenuous one, is that we know what experiences are problems from brain development, and that we can treat those problems with appropriate interventions, reverse the effects, correct the brain’s characteristics, and end up with desirable behaviors (Cf. the first assumption, above). This assumption seems to avoid the possibility that we could identify experiences that put a child at risk, intervene successfully, and have a desirable behavioral outcome—without having any measurable effect on the brain at all!
I am not in the least trying to claim that human brain functioning is not an important and most interesting topic of study. Of course it is. But to assume that we know all about the brain, understand how brain events cause or are caused by experiences, and have interventions (other than surgery and drugs) that “fix” brains—no, none of those are true.
So why do people bring neuroscience into discussions where no relevant information exists? The forthcoming book by David Wastell and Sue White, Blinded by science, will focus on this and similar issues and should be well worth reading. From my own perspective, I would say that today neuroscience is not only a discipline, but a rhetorical device. Whatever people would like to argue for in child welfare and related fields, they feel their arguments are stronger if neuroscience is invoked. And on the whole we let them get away with this; we don’t challenge their statements and ask what the one thing has to do with the other. To do so would for many of us open the door to a humiliating loss of face, as others whisper, “she doesn’t know how important neuroscience is!” If this happens in the context of professional work, it could mean loss of a job.
But perhaps we need to learn to tolerate this discomfort and question whether or not the neuroscientific emperor is wearing clothes. This may especially be the case when practical decisions are being made about children, as in my Norwegian correspondent’s concern about child placement. In the situation he mentioned, the argument appears to be: “This child was maltreated and neglected. Therefore, his brain is damaged. If a parent struck a child in the head with a brick and damaged his brain, we would terminate the parent’s rights. Brain damage is brain damage, so the brain damage resulting from neglect or verbal abuse is the same as that resulting from the brick, and the response should be the same.” Can anyone step forward and say, “Wait one minute. What evidence do you have that this child’s brain is damaged in any meaningful sense? And what can you say about the outcomes for the child if this parent is helped to improve his or her parenting skills, as compared to what will happen if the child enters the foster care system?” To make the best choice for the child, we may have to abandon the easy and fashionable neuroscience rhetoric, with its scary conflation of head trauma and the problematic (but very different) effects of neglect and poor parenting.
I admit, though, that few can step forward in this way, because the practical consequences of getting “out of step” may be quite severe.