Several years ago, Joan Luby and her colleagues from the Department of Psychiatry at Washington University in St. Louis published an important paper in JAMA Pediatrics examining the influence of poverty on the physical development of the brain. More recently, Kimberly Noble and colleagues reported in Nature Neuroscience and Nicole Hair and colleagues reported in JAMA Pediatrics further research regarding the relationship of caregiver income and educational level on the brain development of children.

One or more of these three studies support four major conclusions:  

First, low family income is associated with delayed development and structural changes in specific brain regions. Some of these brain regions are involved in memory processing, language function, executive function (planning, decision making, and organizational skills), and emotional regulation. These relationships are most evident in the lowest income group.

Second, the educational level of caregivers influences brain development in children. This relationship remains even after accounting for income level.      

Third, at-risk children have deficits in school readiness skills. One of these studies estimates that 15 to 20 percent of the deficits in school readiness skills directly involve structural brain differences.

Fourth, the studies suggest that improving the parenting skills of caregivers early in children's lives can decrease the effects of poverty on structural brain development.

In addition to improving nurturing skills of caregivers, it is possible that modest improvements in income and educational achievement of caregivers might influence children's brain development and cognitive and emotional functioning. Specific research is needed to determine whether this is true. 

To paraphrase Dr. Luby’s comments in an editorial accompanying Dr. Hair's paper in JAMA Pediatrics: The scientific literature on the effects of poverty on child brain development and the efficacy of early interventions to support better outcomes provides “a rare roadmap to preserving and supporting our society's most important legacy, the developing brain.”

The results of these studies offer a basis for changes in public policy that may potentially correct some of the ills and disparities that now plague our society. Nonetheless, it is important to emphasize the need for well-designed and carefully controlled studies to determine the most optimal and cost-efficient paths forward.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.

References

Luby, J., Belden, A., Botteron, K., Marrus, N., Harms, M.P., et al. The effects of poverty on childhood brain development: the mediating effect of caregiving and stressful life events. (2013). JAMA Pediatr. 167(12):1135-1142.

Noble, K.G., Houston, S.M., Brito, N.H., Bartsch, H., Kan, E., et al. Family income, parental education, and brain structure in children and adolescents. (2015). Nat Neurosci. 18(5):773-778.

Hair, N.L., Hanson, J.L., Wolfe, B.L., & Pollak, S.D. Association of child poverty, brain development, and academic achievement. (2015). JAMA Pediatr. 169(9):822-829.

Luby, J.L. Poverty's most insidious damage: the developing brain. (2015). JAMA Pediatr. 169(9):810-811.

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