Tuesday, March 24, 2015

Early Intervention in Schools: A Site for Empirical Neuroethics

By Ilina Singh, MSc

Ilina Singh is a Professor of Science, Ethics, and Society in the department of Social Science, Health, and Medicine at King’s College London, and is cross-appointed to the Institute of Psychiatry. Her work examines the psycho-social and ethical implications of advances in biomedicine and neuroscience for young people and families. She is also a member of the AJOB Neuroscience Editorial Board.
The developmental logic of early intervention is currently all the rage across child care-related sectors, including education, mental health, juvenile justice and social policy. It’s not a new logic by any means (witness longstanding programmes such as HeadStart), but it has new energy and justification with the emergence of epigenetic theories of development. Epigenetics has brought attention to ‘environment’ to the fore, particularly in pediatrics and in child psychiatry. While epigenetic theories are still that – theories – the last few years have seen a surge in research and policy focused on children’s early environments: womb, home, school, community. Students and researchers interested in neuroscience ethics, particularly in relation to children and adolescents, should find rich and fruitful ground for research here. In this blog I outline some thoughts about why neuroethicists might be interested in early intervention programmes in one key environment - schools.

From iStockPhoto

Schools have a long history of collaborations with psychiatry, psychology and pediatric medicine. A rich and frequently critical sociological literature details how these collaborations have informed and embedded a range of normative understandings of child development, particularly in the interrelated areas of behaviour, morality, intelligence and attachment. Scientific discoveries have had an important influence on shifting tropes in child education; from the ‘well adjusted’ child in a psycho-analytic framework, to a contemporary focus on child ‘wellbeing’ and ‘flourishing’ informed especially by positive psychology and emerging discoveries in developmental biology and neuroscience. In this context, early years schooling provides both the environmental conditions to kindle the capacities that promote flourishing, and a pre-clinical site in which to monitor and evaluate children and deploy early intervention strategies when a child appears to be at risk of failure to flourish.

From a critical perspective, these educational tropes and the aligned clinical, social, economic and political interests can appear as largely suspect forms of disciplinary “biopower” (to use a Foucaultian concept). The very notion of early intervention could suggest an institutional desire to impress prevailing norms upon the mind and body of the child even before the child has exhibited problems. The presence of formal early mental health identification and intervention procedures in schools can thus be represented as a first step in a ‘psychiatric career’; that is, a path to medicalization, diagnosis and psychiatric treatment. Post-genomic scientific discoveries that highlight the importance of early environments and early interventions with children can be seen to provide biological impetus for an ethically problematic agenda.

It could equally be argued, however, that the move away from pathological labeling of children to a more open and generic vision of ‘wellbeing’ engenders a more ethically sensitive ground on which to identify children at risk. From this perspective, schools can be seen to provide a more neutral site for early identification and intervention, in so far as support on the basis of flourishing is not dependent upon a medical label and therefore does not require or presuppose a pathway to medicalization, diagnosis and treatment. Moreover, school-based early intervention is likely to reduce the potential for a form of reductionism that views a child’s behavioural and developmental difficulties largely in light of individual factors, thereby eliding attention to the ecological conditions that mitigate and potentiate a child’s capacities for key cognitive and emotional skills; e.g. attention, self-regulation and decision-making. Finally, the presence of school-based early intervention may to some extent evade the stigma associated with mental illness labels and treatments, thereby increasing the chances that children in need will themselves engage support at an early stage. Scientific explanatory models are not necessary to support the intuition that children’s early experiences have lasting effects, but such models can engage political and social support for required resources.

From youthtoday.org

It’s probably quite easy to come up with critical arguments about these early intervention programmes (interventions to ‘build character’ in children particularly worry me!), but I predict that criticism alone will shed little light on the substantive social and ethical goods and harms involved. I think empirical neuroethics has an important role to play here, in so far as it can help achieve more nuanced understandings through a ‘bottom-up’ investigation of school-based early intervention. Researchers might study the ‘local ethics’ of a school-based programme, in order to better understand how participation in the programme configures social-biological identities, moralities and futures. The empirical work can then be used to inform a normative analysis (although how one moves between empirical data and normative analysis should be the subject of another blog!)

One of the lovely aspects of working on issues related to children is that the researcher is freed from the confines of ‘the usual ethical concerns’. Child development centrally involves issues of love, care and hope, as well as responsibility, value, freedom and citizenship. The scientific and policy focus on environment in developmental wellbeing opens neuroethics up to research opportunities in new sites, such as schools and other spaces that children frequent and inhabit. I’m hopeful that neuroethics will come to focus more on the lives and experiences of children and young people in the future, particularly as they are increasingly subjects of neuro- and psy-interventions. For those interested in the area, I’ll soon be starting a few projects on early intervention strategies in child and adolescent mental health and wellbeing, funded by the Wellcome Trust. Do get in touch, especially if you have projects and/or experience in talking with young people about moral and ethical concerns.

Want to cite this post?

Singh, I. (2015). Early Intervention in Schools: A Site for Empirical Neuroethics. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/03/early-intervention-in-schools-site-for.html

No comments: