Professor Kevin Nugent:

Tá an-áthas orm bheith os bhúr gcomhair anseo inniú; is mór an onóir é. Déanfaidh mé mo dhícheall bhúr gceisteanna a fhreagairt agus pé saineolaíocht atá agam a thabhairt daoibh. Go raibh míle maith agaibh.

I feel especially privileged to be here to discuss some of the research in which my colleagues and I have been engaged for the past 35 years or so at Boston Children’s Hospital and Harvard Medical School and that of colleagues both here and abroad. I am particularly grateful as a researcher to be talking to policy makers because there is often a wide gap between research and public policy. It is very gratifying for me to be able to share these ideas with the committee.

My focus is on the youngest members of society, those who literally do not have a voice - infants and toddlers. Committee members perhaps assume they have very little to say because they cannot say much, as I once assumed. We understood very little about their minds, hearts and brains. The foundations of sound mental health are built in the first three years or 1,000 days of life. These early years provide the essential foundations of stability for all other aspects of human development, the capacity to face adversity, to have friendships, to have success and happiness in school, the community and work. They are crucial for the long-term health of any society.

I wish to cover five key points: brain development in the first three years, or 1,000 days, of life; the influence of early experiences on brain development; the importance of prevention rather than treatment for children in adverse environments; the need for professional training in infant mental health and indications for public policy.

For much of the 20th century, many people, including many scientists, severely underestimated the mental and social capacities of infants. We assumed, for example, that newborns could not see, that infants could not think or that if they could, their thought processes were concrete, immediate and extremely limited. We also assumed that infants were fragile and had a narrow emotional range. We failed to be convinced that babies could grieve, be sad or even traumatised.

We – nurses, doctors, psychologists, therapists and teachers - tended or perhaps wanted to believe young children did not quite understand what was happening around them, or were so resilient that they would simply grow out of the problems they were facing. That infants and toddlers could have mental health problems was beyond our ken. The field of infant mental health had not yet emerged. However, all that has changed. In the past 30 years there has been a revolution in our understanding of the capacities and inner lives of babies and toddlers and, in particular, the workings of the infant brain. Brain development in the first three years of life is more extensive and vulnerable to environmental influences than in any other period in one's lifespan and has a longer term impact than was previously thought. We now know that the brain doubles in size in the first year of life. By age three, the brain is at 80% to 90% of its adult volume. Even more importantly, the synapses - the connections between neurons and brain cells - are formed at a faster rate during these years than at any other time in life. In the first years of life between 700 and 1,000 new neural connections are formed every second, as the brain builds synapses. If any member of the committee goes home tonight and meets someone under three years, he or she should look at that little girl or boy in the eye and realise this is happening. All of the synaptic connections in the child's brain are being stimulated and the adults around him or her are contributing to his or her well-being as he or she is building up his or her brain architecture.

The environment influences brain development; the process of building the brain is not genetically determined. Between birth and the age of three years, children's brains are malleable and more plastic than at any other time in their lifespan. Sensitive and responsive caregiving is a requirement for the healthy neurophysiological and psychological development of a child. It even mediates lifelong outcomes. We know that during the first three years children’s long-term capacities to think, understand, trust, empathise and feel concern for others are being fundamentally shaped. By age three years, the child's orientation towards life is very firmly established. This means that the relationship between parents, caregivers and all who make up the child's network are critical in shaping that little brain. The people mentioned set up the child's expectations for life. On the other hand, strong, prolonged adverse experiences such as extreme deprivation, abuse, neglect, exposure to violence or the absence of supportive adult relationships can lead to changes in the physical structure and functioning of the brain. Such changes include chemical responses, impaired cell growth, changes in the proteins and other molecules produced by the brain, the death of neurons and interference with the formation of healthy neural networks. The strength and quality of the child's relationships are critical.

The importance of prevention rather than treatment must be emphasised in this regard. By preventing problems from developing in the first place, not just treating them after they have occurred, we can undo the effects of these early adverse experiences. The earliest years of life present the greatest opportunity for preventing and mitigating harm from trauma and setting the course for optimal development. In the case of child maltreatment, for example, there is a shift towards a prevention promotion framework rather than just addressing it when it actually occurs. Our aim is to strengthen the capacity of parents and communities to care for children in ways that promote optimal health and well-being. The research paradigms have shifted our focus towards strengths-based approaches to prevention and towards valuing what parents bring to the table in the first place rather than labelling them or taking a pathological approach. Our approaches should allow parents to dig deep and we should be looking at the social and cultural capital within communities on which parents can draw in bringing the best out of their young children.

The need for professional training in infant mental health is also significant. Physicians, nurses, psychologists, teachers, providers of early care and education, physiotherapists and occupational therapists, speech pathologists, social workers – anyone who has responsibility for the care of infants and toddlers – should be required to seek professional training in infant mental health to better understand and appreciate the inner world of infants and their parents. Anybody who comes in touch with a baby and its family and who has responsibility for the care of infants and toddlers should be required to receive this training as it enables them to have a sympathetic understanding of what is happening in the child's life, as well as a non-judgmental approach towards parents. Nothing can really replace an informed and sympathetic understanding of the needs of infants and families or a non-judgmental and culturally respectful approach to parents and their families.

In Ireland we have the Irish Association of Infant Mental Health which provides training for professionals from a range of disciplines to prepare them to promote early social and emotional development in babies and toddlers and the establishment of healthy and secure attachment relationships. Having a new cadre of professionals trained in infant mental health will undoubtedly reduce the burden of mental health problems for future generations and allow for the full development of vulnerable children.

On the implications for public policy, early disadvantage such as the impact of poverty, ill health and other adversities such as homelessness can have a significant influence on children's future progress. More often than not, such disadvantages are beyond the control of individual families. That is why I am grateful to be before the committee. Policies that support families and communities are critical, as the strength and quality of the relationship between caregivers, families and their children are fundamental to the effective development of children’s brain functions and capacity. Besides, as James J. Heckman who was awarded the Nobel Prize in Economics in 2000, pointed out, early interventions with infants and toddlers result in much higher economic returns than later interventions. Although early intervention is never too late, at age three years, just before school, it is very late. Initiating programmes that meet the developmental needs of children from birth to age three years is as much about building a strong foundation for lifelong physical and mental health as it is about enhancing readiness to succeed in school. This approach puts families and children at the centre of a multifaceted model that includes building protective practice for families, reducing risk factors for children, strengthening local communities and connecting all this through systems change and policy.

I thank the committee for giving me the opportunity to address it. I feel very privileged.