Health

Can treating poverty change a child's brain?

A groundbreaking study is testing whether an injection of cash for poorer families can reshape a child's early life and educational outcomes

Kimberly Noble, a neuroscientist and pediatrician at Columbia University, clicked a remote on a TED Talks stage in New York last January and a screen beside her displayed what looked like a craggy, grey leftover snowbank. The image was an average of the brains of 1,099 children and adolescents she and her collaborators studied for a 2015 paper that received enormous attention.

They used MRI imaging and paid particular attention to the cerebral cortex, the wrinkly outer layer of the brain “that does most of the cognitive heavy lifting,” Noble explained. A larger surface area has been linked to higher intelligence.

The researchers found one characteristic associated with cortical surface area: “That factor was family income,” she said. And that link was especially pronounced in the areas of the brain that govern language skills such as vocabulary and reading, and self-regulation skills like avoiding distraction.

“Those are the very skills that children living in poverty are most likely to struggle with,” Noble noted. “In fact, a child living with poverty is likely to perform worse on tests of language and impulse control before they even turn two.”

It has long been established that low-income kids lag in school, but until recently, there was no research explaining why. It was as though everyone knew poor kids emerged from the forest of childhood at a different point than their more affluent peers, but no one had thought to trace back their path through the woods. Noble’s graduate research with University of Pennsylvania cognitive neuroscientist Martha Farah helped to change that, identifying the specific cognitive skills with which poor children struggle.

Noble is now director of the Neurocognition, Early Experience and Development (NEED) Lab at Columbia’s Teachers College. The MRI-based research she outlined in that TED Talk went beyond cognitive skills to studying how the physical structure of children’s brains was linked to growing up in deprivation.

“But it doesn’t have to be that way,” Noble said. “As a neuroscientist, one of the things I find most exciting about the human brain is that our experiences change our brains. This concept, known as neuroplasticity, means that these differences in brain structure don’t doom a child to a life of low achievement.”

On the screen beside her, four words appeared, like a vast life board game: “Poverty > Experience > Brain > Learning.” Poverty creates certain life experiences that are associated with a reshaping of children’s brains, and that influences their learning ability.

“Where along this pathway can we provide help?” Noble asked.

We could intervene at the last point with school-based programs once learning difficulties become obvious, she suggested. Or maybe in the previous step, by tackling one of the many life experiences—nutrition, health care, stress or discrimination among them—tied to family income.

READ MORE: A universal basic income in Canada is more realistic than you think

But trying to alter those things can be difficult and expensive, the list of issues is overwhelming, and it may be too late anyway, she said.

“So I want to share an idea with you,” Noble told her audience, her tone lilting and conspiratorial. “What if we tried to help young children in poverty by simply giving their families more money?”

Beside her on the screen, a box pinged to life around the first word in that sequence: “Poverty.”

This idea immediately suggests a public health analogy: If worsened life outcomes for poor kids are symptoms, and the experiences linked to poverty could be conceived of as the disease, then might it be most effective to take preventative action instead of seeking a cure after the fact?

Could an injection of cash for poor families provide some inoculation against the cascading effects of poverty?

Noble and an elite team of economists, social policy experts and neuroscientists are now a year and a half into an ambitious and potentially groundbreaking—but exquisitely simple—study examining exactly that. It is, in essence, the first clinical trial to test whether treating poverty itself might reshape the first three years of a child’s life, and what an intervention in that critical period of rapid growth could mean for their cognitive, emotional and brain development.

The study, called Baby’s First Years, is sprawling in scope and implications, but its design is “kind of blindingly obvious,” says Greg Duncan, a distinguished professor of education and economics at the University of California, Irvine. Along with Noble, he is one of six principal investigators running the study.

The team recruited 1,000 low-income mothers on maternity wards in New York City, New Orleans, Minneapolis-Saint Paul and Omaha when their babies were born. Each was given a debit card onto which funds would be loaded monthly for the first three years and four months of their child’s life, with no restrictions on how they could spend the money. Sixty per cent of the mothers—the control group, essentially receiving a placebo—get a “nominal amount” of $20, while the other 40 per cent—the “treatment condition”—will receive $333 monthly.

For the families in this study, who are below the U.S. federal poverty line—$20,420 for a family of three when the study began in 2018—that $4,000 a year represents a 20- to 25-per cent boost in their annual income.

The study finished recruiting its 1,000 moms in June, and now they and their children will be followed for the next several years. Around the children’s first and second birthdays, a researcher will visit them at home to quiz the mothers about the child’s development and the mom’s health, their family income and life at home, record video of them playing with their children, collect a hair sample from the mothers (to measure stress levels based on the hormone cortisol) and assess the child’s brain function using a portable EEG machine.

When the children turn three, the families will visit a local university lab to answer more questions, and researchers will test the children’s development in the realms of language, memory, executive function (skills such as working memory, self-control and paying attention to a task) and socio-emotional skills, along with measuring their brain function.

Noble and Duncan are joined by four other principal investigators: Katherine Magnuson, a professor of social work at the University of Wisconsin, Madison; Nathan Fox, a distinguished university professor in human development and quantitative methodology at the University of Maryland, College Park; Lisa Gennetian, a visiting associate professor of public policy at Duke University; and Hirokazu Yoshikawa, a developmental psychologist and professor of globalization and education at New York University.

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Reams of previous studies have established a daunting array of negative outcomes for kids who grow up poor. They are more likely to have low birth weight; to be stunted in height in childhood and in poor health, including spending more days in hospital. By the time they start kindergarten, their cognitive scores are significantly lower than their wealthier peers and they are more likely to experience emotional or behaviour problems—but less likely to get treatment. They are more likely to repeat a grade and to be suspended or expelled; they are less likely to finish high school or get a post-secondary degree. And they are much more likely to be involved in cases of abuse or neglect.

But the vast trove of research that has established this diminished universe of possibilities is all correlational—the studies show that poor kids are the ones who end up with these disadvantages, but they cannot prove it’s poverty that causes them. So observers can ask—quite reasonably—whether being poor is the true cause, or rather another factor that often occurs alongside it, like single-parent family structure.

“While many people would look at the literature as it stands and say, ‘Well, obviously, poverty is causing all of those problems,’ many other people would say, ‘No, it’s not poverty, it’s whether you’re willing to pull yourself up from your bootstraps,'” says Noble. “So it’s that classic problem of correlation not being causation. And there’s not really a scientifically vigorous way to counter that without doing the gold-standard scientific design, which is a randomized control trial.”

That is what BFY is undertaking with the help of $17 million in funding from government and private sources. Because the families in the study have been randomly assigned to the control or treatment groups, if differences emerge in how the two groups fare, then the one difference between them that is manipulated in the study—their levels of poverty—can finally be established as the cause.

If the hypothesis of the study is borne out and these monthly payments make any difference to the lives of these kids, Yoshikawa can envision two ways that might happen.

The first revolves around the chronic, pervasive strain of being poor and how that affects children. “Part of the stresses of poverty is the uncertainty of your ability, as a household, to deal with unpredictable things that come up: illnesses, health expenses, a leak in the apartment, the loss of a job,” he says. “You are more focused on survival and making ends meet, and that both increases your stress and (decreases) your ability to pay attention to all these other aspects of early child development.”

That strain can affect relationships, the warmth people show their kids or partner, their tendency to lash out—even in families with plenty of resources, that shortened fuse is relatable for anyone who’s juggled home life with a heavy deadline at work—and can lead to depression and anxiety that can affect people’s parenting.

The other obvious way he can imagine cash transfers disrupting the constellation of disadvantages poor kids experience is through the simple ability of their families to purchase materials and experiences that offer better learning opportunities, from books for the household to quality childcare.

“This is something that is a big, basic idea that really deserves a good, rigorous test,” says Yoshikawa.

The researchers deliberately structured the study around monthly payments because families that are stretched thin tend to use yearly windfalls such as tax refunds to pay off debts. Things like daycare or an apartment in a better neighbourhood must be paid for on a regular basis, so the investigators hoped the flexible and predictable nature of the payments might enable moms to make a broader range of choices.

The Canada Child Benefit—which is pegged to income and which Statistics Canada credited, in part, with 278,000 fewer children living in poverty in 2017, the first full year of the benefit—is one obvious parallel the researchers cite as an example.

“We really don’t know what is going to emerge from the results. It could be that expenditures really aren’t that different and don’t favour child enrichment activities. It could be stress levels aren’t any different, parenting isn’t any different, children aren’t any different between the two groups,” Duncan says. “One attractive option is to think that low-income moms, well, they certainly care as much as high-income moms about the well-being of their kids, and this is kind of a bet that that kind of flexibility with the money is going to enable them to do the kinds of things that fit into their vision for the future of the family.”

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The team recently completed an application for more funding to continue the study until the children are six. Early in his career, Duncan worked on the Panel Study of Income Dynamics, a project examining how people drift in and out of poverty that was supposed to run for five years at the University of Michigan, ending in 1972; it’s now a 55-year ongoing project, so he’s learned that you just never know.

“I will not live to see the end of the study, I predict,” he says of Baby’s First Years.

This study could end up having the most profound implications of the lot, but it’s part of a recent wave of experiments testing the effects of giving people in need no-strings-attached cash.

Jurisdictions including Ontario, Finland, Sweden and the cities of Stockton, Calif. and Barcelona, Spain have dabbled in cash transfers for needy residents. 2020 U.S. Presidential candidate Andrew Yang’s signature policy is a $1,000-a-month payment to every adult American intended to cushion the employment-eroding effects of automation. And the idea has increasingly grabbed attention as a novel way to provide aid in developing countries, with large-scale trial runs in places such as Rwanda and Kenya.

A recent study conducted in collaboration with GiveDirectly, one of the biggest organizations trying this approach, found that in an impoverished area of rural Kenya, every dollar of cash aid boosted local economic activity by $2.60, with an almost negligible effect on inflation.

Of course, domestically or abroad, this concept has an inherently political dimension embedded in people’s ideas about the causes of and appropriate remedies for poverty. With Baby’s First Years, the researchers’ response to navigating that fraught territory is, in part, to rigorously investigate the exact questions and critiques that are likely to surface, says Yoshikawa. And one question the researchers get from observers or critics “all the time” is about whether parents might use the money for vices or expenses unrelated to their children, says Noble.

The researchers conducted a pilot study of 30 mothers in New York City a few years ago to test the feasibility of the debit card idea, and of 1,100 transactions the mothers made, just three occurred at liquor stores. “Beyond that little pilot study, there’s a fair amount of social science literature to suggest that when low-income families get economic windfalls, they spent the money in much the same way as higher-income families,” Noble says.

People are often more comfortable giving services to people in need rather than cash because of stereotypes that poor people are more likely to spend money in wasteful ways, Noble observes, but the evidence simply doesn’t bear that out.

And this is where our collective notions of money, luck and life circumstances get very quickly existential. “When you think about the haves versus the have-nots, the haves think that they earned it and that the have-nots earned not having anything,” Noble says. “While there is probably some basis to truth in there, I think people really discount the extent to which fortune or misfortune is not always due to our own actions.”

It’s easy to perceive self-protective justification baked into this thinking: If I have more than others, they must have made poor choices to land in their situation, which means that I don’t have to feel guilty about having more, and I am surely protected from ever ending up where they are.

There is something deeply compelling about the possibility that this study could transform the debate around childhood poverty from a heartstring-tugging social justice conversation to one of simple dollar-for-dollar policy efficiency, and also upend our notions about earned and accidental luck in life, all at once.

Or, as Noble said from that TED stage: “If a child’s brain can be changed, then anything is possible.”

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