DEVELOPMENT AS STATE INTEREST

The modern concern for child development has its roots in the public reaction to the rapid industrialization that characterized the United States in the 19th century. Waves of immigration and the mass relocation of families from rural areas into large urban centers overwhelmed existing housing, sanitation, and virtually all municipal services, which resulted in tragically high rates of illness and death among children. Public apprehension for the well-being of children was broadly framed by these general living conditions, but of special concern was the widespread employment of children in a variety of industrial and street occupations, many of them extremely hazardous in nature. Although the peril urban life posed to children took many forms, the exploitation of children working in factories, mills, and on the street was seen as a particularly egregious threat and ultimately served as a distilled image for the development of requisite political will to ultimately address what in fact was a variety of societal threats to children’s well-being at the turn of the 20th century.

Critics of child labor could draw on only a fledgling knowledge base to support their positions. Heavily influenced by Darwin’s theories of evolution, G. Stanley Hall advocated childhood as a series of progressive stages, each requiring freedom from deleterious societal pressures and an emphasis on play and guided exploration.⁷ John Dewey, although conceptualizing on a different basis, also emphasized the need to create environments that would optimize children’s psychological and social development.⁸ However, far more important in shaping public perceptions of vulnerable children was less science than, quite literally, fiction. Following a romantic thread woven earlier by Jean Jacques Rousseau and William Wordsworth, 19th century authors such as Charles Dickens in England, Victor Hugo in France, and Mark Twain in the United States cast, in deeply emotional terms, the transcendent innocence of children mistreated by a harsh and unfeeling adult world.⁹ This body of literature, coupled with the work of reformist photographers, particularly Jacob Riis, Lewis W. Hine, and Wallace Kirkland at Hull House, created powerful public images of children as “innocent victims” and moved the affective center of the prevailing political will to a new position, one far more sympathetic to children and, of significance, to public action on their behalf.

There remained, however, a need to provide social strategies that could transform this political will into effective programs and policies. Ultimately, this was supplied by the emergence at the end of the 19th century of a strong women’s movement in shaping local programs to assist poor children and their families through education, social assistance, and health interventions. Under the leadership of remarkable women such as Jane Addams and her associates at Hull House in Chicago,¹⁰ community-based social work, which Skocpol¹¹ termed maternalistic social reform strategies, provided an alternative to “paternalistic” reform efforts, such as improved wages, worker’s compensation, and safety legislation, which at the time met heavy resistance at both the state and federal levels.

The influence of Addams and her Hull House associates quickly extended beyond local social work. Their studies and advocacy led to a successful campaign to pass the Illinois Juvenile Court Act in 1899. Realizing that judges knew little about the developmental capacities and backgrounds of the children appearing in their court, these advocates helped to establish the Illinois Juvenile Psychopathic Institute in 1909, which pioneered clinical studies of children and their families. They recruited Dr. William Healy to direct the research, and in the process, the discipline of child psychiatry was established, perhaps the only instance in which a medical specialty grew out of community action.

The convergence of these political, scientific, and programmatic forces led to the first White House conference on children, convened by President Theodore Roosevelt in 1909, and ultimately the establishment of the Children’s Bureau in 1912. The Bureau was directed to “investigate and report… upon all matters pertaining to the welfare of children and child life among all classes of our people and shall especially investigate the questions of infant mortality, the birth rate, orphanages, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, legislation affecting children.”¹² Under its first director, Julia Lathrop (an alumna of Hull House), the Bureau embarked on a series of research and support activities to help state and local groups address the general health and well-being of children and mothers.^13,14 However, from the beginning, the Bureau emphasized assisting children “who were abnormal or subnormal or suffering from physical or mental ills” both because of the urgent needs these children demonstrated and in the contention that such assistance “…also serves to aid in laying the foundations for the best service to all children of the Commonwealth” (Bradbury,¹⁵ pp 17, 15, 39). The pediatrician Ethel Dunham was recruited to develop studies for the better prevention and management of prematurity, which paved the way for the development of neonatology as a medical specialty.

Although the Children’s Bureau’s influence was manifold, perhaps its most enduring function was to represent and ultimately to embody a recognition of the federal government’s responsibility to promote the health and welfare of the nation’s children. Until establishment of the Bureau, federal efforts on behalf of children were relatively isolated and idiosyncratic, based mostly on a long-standing reliance on familial provision and local charity. With each new report and local initiative, the Children’s Bureau emphasized and eventually solidified the proposition that there was indeed a state interest in the well-being of children, and that that interest was best served by action at the federal level.

The nature of this initial federal action was to establish a grants-in-aid program to assist agencies at the state level to expand services for young children and their mothers. Passed in 1920, the Sheppard-Towner Act created the means by which the expertise developed at the Children’s Bureau could be transmitted throughout the country. This extended the Bureau’s actions far beyond what its meager budget could ever have allowed in isolation. Among the many improvements that occurred at this time were the establishment or growth of state child hygiene agencies, which incorporated for the first time the latest views on child health and development into its programs; the proliferation of maternal and child health centers, which provided direct health and development services to local communities; and a remarkable increase in the scale and expertise of visiting nurse services throughout the country. Unfortunately, the success of the Sheppard-Towner Act became its undoing, as opposition from conservative politicians and the organized medical establishment blocked its renewal in 1929. Although this was a major setback, the Act, and through it the Children’s Bureau, had already begun the transformation of the well-being of children into a public good, and therefore even the termination of the Act could not reinstate federal indifference to the needs of children. Indeed, the Sheppard-Towner Act’s goals foretold the coming of a new era of public provision, and its structure ultimately provided the basic architecture for federal initiatives for child development to this day.

DEVELOPMENT AS CASUALTY

The period between 1930 and 1950 was defined by two predominant events: the Great Depression and World War II. Although these events were associated with a variety of complex political changes, among the most far-reaching was the popular embrace of the government’s role in advancing social welfare in general and the well-being of children in particular.

The social strategies developed during the years of the Sheppard-Towner Act continued to provide a blueprint for translating this public support into actual programs and services. The recommendations of the 1930 White House Conference on Child Health and Protection gave considerable support for a comprehensive approach to the public provision of maternal and child health services, particularly, for what was then termed “crippled children.” The Conference specifically recommended that “Grants-in-aid constitute the most effective basis for national and state cooperation in promoting child welfare and in securing the establishment of that national minimum of care and protection which is the hope of every citizen.”⁸ This argument was embraced fully with the passage of the Social Security Act of 1935, as it included as Title V (“Promoting Informed Parental Choice and Innovative Programs”) of the Act federal grants to the states for maternal and child health services, including services specifically for “crippled children.”

This period also witnessed a rapid growth in the knowledge base regarding child development. With financial support from private philanthropy, particularly the Laura Spelman Rockefeller Fund and the Commonwealth Fund, a number of child guidance centers and research institutes were created, including the Child Research Council in Denver; The Fels Research Institute at Yellow Springs, Ohio; the Yale Child Study Center in New Haven; and the Berkeley Institute of Child Welfare Research. These programs produced more scientific observations of normal child development, as well as explorations of the determinants of mental retardation and behavioral problems in children. Work done at developing programs in child psychiatry, such as the Judge Baker Foundation in Boston, added to these insights.

Perhaps the most influential early scientific observer and analyst of child development was Arnold Gesell (1880–1961), a psychologist and pediatrician. Working in the early part of the 20th century, Gesell conducted a variety of studies on children with normal development and those with specific physiological challenges, such as children with Down syndrome and those experiencing harmful perinatal events. Although his techniques of observation and analysis were to shape the methods of a broad range of developmental scientists for years to come, Gesell’s theoretical bearings were set by a clear embrace of biological determination and were largely descriptive. Not only did he view the effect of experience as relatively trivial but he also looked with skepticism on the potential of interventions to alter developmental pathways.^16,17

This emphasis on biological determinants included both inherited etiologies of developmental disabilities and nonhereditary biological mechanisms, particularly adverse fetal and perinatal events. This focus attracted a growing body of empirical observations linking early adverse events to later neurodevelopmental outcomes. Much later, this “continuum of reproductive casualty” was a framework that served not only as a conceptual tool for scientific analysis but also as a means for representing the determinants of adverse developmental disorders to the broader public.^18–20 Other events tended to strengthen the public acceptance of biologically determined disabilities, including the impression of casualty transmitted by the large-scale return of disabled soldiers after World War II and later, the tragedy of birth defects caused by the ingestion of thalidomide during pregnancy in the late 1950s.

A strong alternative perspective was being advanced at approximately the same time by those who endorsed the primacy of environmental influences. Generally framed as behaviorism, this perspective was boldly articulated by one of its prominent, early spokesmen, John B. Watson (1878–1958):

This alternative to biological determinism became even more fashionable as behaviorism became more technically grounded by the experiments of B. F. Skinner (1904–1990). Psychoanalytical thought was attracting much attention at this time as well. Although Freud’s concepts were grounded in biology, social interaction was seen as forming the basis for the emergence of emotions and behavior. Erik Erikson (1902–1994) built on this psychoanalytical base to emphasize periods of transition or crisis, heavily shaped by social contexts and culture.²²

Alongside this core tension between biological and environmental determination, the history of child development policies has also been heavily informed by a second arena of research: the extent to which and the mechanisms by which child development is influenced by early life experiences.²³ The research community’s response to these questions was first based in examining the effect of profound early deprivation on later developmental outcomes, primarily among institutionalized infants. These studies suggested that profound isolation and the lack of a nurturing environment could interfere with normal development and result in a variety of adverse conditions, including growth retardation and social maladjustment.²⁴ Spitz,²⁴ Bowlby,²⁵ and others in the 1950s provided observations of early social deprivation in a variety of settings, which ultimately led to a theoretical framework underscoring the importance of early attachment processes between parent and child in shaping developmental outcomes later in life.^26,27

The tension between the biological and environmental models of developmental influence grew as more scientific evidence was generated in support of each of these two perspectives. The child development laboratories and guidance centers continued to increase the knowledge base regarding brain development and adverse biological insults and, at the same time, confirmed the sensitivity of the child to caregiving practices and social pressures. A new formulation was needed, one that could make sense of the disparate findings, powerful enough to engage the complexity of child development, and yet disciplined enough to offer a basis for popular understanding and ultimately for constructive action.

DEVELOPMENT AS JUSTICE

In the 1960s, the directions of political will and the knowledge base began to converge in ways that dramatically altered the nature and scale of child development programs in the United States. Politically, the civil rights movement was elevating public awareness of the profound racial inequalities that had so long characterized American society.²⁸ The publication of Michael Harrington’s The Other America in 1963 extended this awareness to broader economic stratification affecting all racial and ethnic groups.²⁹ These powerful challenges to the status quo were interpreted in a variety of ways and led to a variety of disparate political arguments and movements. What resonated most profoundly in the mainstream of American politics was the notion that existing policies did not facilitate, much less guarantee, equal opportunity for the requirements of a fulfilled life. Indeed, the rhetoric of opportunity permeated the public justification of major ameliorative legislation such as the Civil Rights Act of 1964 and an array of initiatives that were included in President Johnson’s “war on poverty.” Indeed, the legislation enabling the war on poverty was the Economic Opportunity Act of 1964 (our italics).

This political embrace of opportunity as the central theme of policy reform in the early 1960s also began to find support in the scientific community’s reframing of early child development. The antagonism between biological and environmental explanations for adverse developmental outcomes began to lessen as more integrative models became more widely accepted. Empirical and theoretical support grew for the important role of both biological determinants and early life experiences in shaping later developmental outcomes. In addition, a series of studies suggested that many of these outcomes were difficult to predict with certainty and that many were potentially amenable to later remedial interventions.^30,31

Jean Piaget (1896–1980), whose work became well known in the United States in the 1950s and 1960s, challenged the sharp distinctions between biologically determined and behaviorist visions of child development by stressing the dynamic character of cognitive capacities in children. According to his theories, children were not blank slates waiting to be written on but active participants, builders of understanding, constantly creating and testing their own theories of the world.³²

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