Kunmi Sobowale, MD

“What if a game of peek-a-boo could change the world?” Seven-year-old Molly Wright, one of the youngest-ever TED speakers, posed this profound question in her July 2021 viral video.

 Why peek-a-boo? Because, as Molly so clearly articulated in her UNICEF and Minderoo Foundation-supported talk, this simple game captures the essence of what we know about young children’s healthy brain development: All of the everyday, back-and-forth interactions between caring responsive adults and babies serve to stimulate their senses, build social interaction skills, foster language development, and teach object permanence. These are all foundational brain-based skills.

Games like peek-a-boo are thus invaluable when it comes to brain building and supporting strategies that will help prepare today’s children to navigate a rapidly changing, increasingly complex, and globally connected world. With respect to the developing brain, early childhood is a time of particularly rapid change, with up to 90% of brain growth taking place by age 5. In other words, when it comes to strategic brain- and skill-building, these early years are critical for lifelong learning and well-being.

Building brains in the very earliest stage of life may ultimately be the best way to brace our societies for and empower our children to face a panoply of future challenges. Complex issues already impacting our societies today only stand to become more difficult as our children grow older.

Presently, rates of stress, depression, and anxiety are spiking due to the vicissitudes of COVID-19 (which still seems to have no end in sight for the globe).

 Further, COVID-19 seems to have exacerbated advanced cognitive skill deserts—areas characterized by low scores in standardized tests and poor educational infrastructure.

 This is concerning given that jobs are becoming increasingly knowledge-intense as automation subsumes lower-skilled roles. 

Current and future challenges related to climate change

 present issues to where we live, work, play, and eat. Taking action to tackle these issues is harder due to misinformation propagation, a global phenomenon spreading virally and accelerating radical and radicalizing conspiracy theories.

 Political and social divisions are increasingly stark and volatile. All in all, we have a collision of issues which, at their core, seem to be worsened by the overwhelming, overloading, or dysfunction of our brains and minds.

Of course, in the immediate term, one of the best strategies for ensuring the conditions needed for healthy early childhood brain development is rapid, global, vaccine-based herd immunity from COVID-19. This would allow economies, families, and communities to return to a normal life where, among other things, the mental health and safety of both young children and their caregivers is protected. But it is imperative that we are prepared to address what many predict will be the long-term detrimental 

 on our children, adolescents, and their families as well.

We are buoyed by the US President’s planned human infrastructure agenda, which both recognizes the importance of and provides supports for the boosting of brain-based skill development in early childhood.

 These proposed investments include childhood poverty reduction, universal pre-kindergarten, a child tax credit for low- and middle-income families, and a national paid leave program. If funded and executed well, these large-scale programs will facilitate early childhood brain development. We hope other 

 around the world take note of these ambitious plans.

Aligned with the planned human infrastructure agenda, poverty reduction is of the utmost value to early child brain development. 

 (ACEs) are associated with alterations in psychological, cognitive, and neurobiological development. From a brain-based skills perspective, executive function skills (encompassing skills such as cognitive flexibility and critical thinking), are clearly recognized to be of lifelong importance. Given that their most rapid rate of development occurs between the ages of 3 and 5, it is particularly concerning, but no surprise, that poverty has been found to increase the risk for executive functioning difficulties.

 Thus, efforts to better brain health go hand in hand with strategic investments in early childhood and measures to reduce childhood poverty, as well as other ACEs.

In considering the interplay between mental health, adversity, and early brain development further, research on the neural mechanisms underlying emotional processing in individuals of differing socioeconomic status (SES) point towards differences in brain structure and function as a link between mental health and SES.

 Innovative studies like the NIH- and philanthropically-funded Baby’s First Year Study aim to understand the impact of monthly, unconditional cash transfers to low-income 

 in the first 3 years of the child’s life.

 Currently underway, the Baby’s First Year Study is examining how poverty reduction affects early childhood development and the family processes known to support children’s healthy development.

Highlighting the cross-sector nature of this work, others suggest the need for social work to critically engage with the first 3 years, shifting focus from the individual and family to a more systems-level community and public health focus. Based on the old but sturdy Bronfenbrenner concept of socioecological influences on child development, we believe it is important to build skills at all levels: individual, family, community, service provision, policy, and systems. Targeting multiple levels of influence fosters mutually reinforcing positives effects on child development.

In addition to poverty reduction, interactional behaviors like serve-and-return (well demonstrated in a game of peek-a-boo), conversational turn-taking (see Harvard University’s 

), and child-directed speech are particularly important in early life. These early relational health behaviors build core life skills such as executive function/self-regulation, self-efficacy, trust, and resilience that serve to help buffer against adversity and better equip children (and their brains) to take advantage of future learning opportunities.

 It is worth noting that parenting behaviors like serve and return do not happen in a vacuum. Studies show that social and structural factors affect parental behaviors. We know that ongoing stress makes it difficult for parents to strengthen and use the executive function skills so central to providing nurturing, responsive, safe, and stimulating environments in which children and adolescents can thrive.

 In contrast, we also know that the presence of a caring responsive adult stands to serve as a protective buffer against the neurotoxic (and other harmful) effects of poverty.

Given the significant importance of the caregiver to early relational health, adequately addressing postpartum depression is also critically important. Simply put, better prevention, identification, and treatment of postpartum depression is key to boosting baby’s brain health and development. Not doing so proves to be both economically and individually quite costly. A recent study found that the state of Texas alone is losing $2.2 billion by not treating mothers’ mental health from pregnancy through their child’s first 5 years.

 Postpartum depression has also been found to have both maternal and infant consequences, including negatively affecting physical health, sleep, motor, cognitive, language, emotional, social, and behavioral development in the infant.

The impact of healthy brain development during the early years applies not only to physical and mental health, but early learning as well. Early childhood sets individuals up for lifelong learning. With converging accelerations in technology, globalization, and climate, lifelong learning is no longer desirable, lifelong learning is essential.

 The Organisation for Economic Co-Operation and Development (OECD) recently released the 

OECD Skills Outlook 2021: Learning for Life.

 This report noted that lifelong learning starts in childhood and youth, continuing throughout adulthood and old age. It encompasses formal learning in settings such as schools and training centers, informal and nonformal learning derived from colleagues and workplace trainers, and unintentional learning stemming from spontaneous social interactions.

In recognizing the impact of the early years to what ultimately becomes lifelong learning, the Minderoo Foundation’s Thrive by Five program engages with government, research institutes, and other stakeholders to advocate for effective policy and investment in early learning systems.

 This representative program has initial activities in Australia, with global ambitions. And while little formal research has been done to understand the effects of different parenting styles such as free range, helicopter, authoritative, or permissive parenting on brain development, in the brain-building context of early relational health and serve-and-return interactions, what is increasingly clear is that interactions shape brain development, and parents stand to serve as chief architects. With this in mind, The Minderoo Foundation’s Thrive by Five program also recently launched a new parenting app which leverages ground-breaking research into the early years to assist parents in developing their child’s life skills while going about their daily routines.

Though there is also an intrinsic link between education and early childhood brain development, more research is needed to better understand, build, and optimize education innovations that may bolster development. For example, German forest schools, known as 

, began in 1960 and encourage children to play, explore, and learn in a forest environment where adults assist rather than lead.

 The forest school model has spread to many locations around the world. Though research has elucidated the benefits of this model of education,

 little has been studied on the neurological affects.

Similarly, the Montessori method, developed in the 1900s by prominent psychiatrist and pediatrician Maria Montessori, MD, promotes independence through self-directed activities in a specially prepared environment and discourages conventional measures of achievement like tests and grades.

 Extensive connections between the Montessori method and early childhood brain development have been described and theorized, and research points towards many benefits of this model of education.

 However, more research is needed to understand the neuroscientific grounds of the Montessori method and how education can better facilitate brain development.

Better understanding is also needed for high-tech approaches to brain development in childhood. For example, leading baby-brain researcher Patricia Kuhl, PhD, demonstrates, through her research, how neuroscience can better inform our understanding of brain development, how children learn, and the way children are taught. One of her studies made use of magnetoencephaography (MEG) scans to monitor sensory and motor-sensory brain activation in infants from English-speaking families who were exposed to Mandarin.

 only when they were exposed to the novel language in live interaction, but not from television or audio-listening. This study suggests that neuroscience can guide us—both as to how and when technology should (or should not) be leveraged in education, and with respect to important aspects of foundational language development and bilingualism.

The value of investing in early childhood is unequivocal. Led by Nobel laureate and economist James Heckman, PhD, “The Lifecycle Benefits of an Influential Childhood Program” determined that high quality birth-to-5 programs for disadvantaged children can deliver as much as a 13% per year return on investment.

 Significant gains were realized for both children and mothers through better outcomes in education, health, IQ, crime reduction, social behaviors, future earnings, and employment.

 These early childhood programs work, in part, because they provide children with the skills they need to learn and socialize in primary school.

Developing transformative neuroscience insights which can generate new ways to understand, screen, diagnose, and treat brain disorders is also key. In this regard, we applaud new projects such as Advanced Research Projects Agency for Health (ARPA-H), which is a large-scale effort to accelerate medical innovation in areas such as autism.

Another of ARPA-H’s first 3 focus areas is Alzheimers disease—further exploration is needed into the value of starting dementia prevention strategies in childhood, which emerging evidence points to as promising.

Now more than ever, as nations across the globe are looking to build back better in a world facing globally complex challenges—from 

 to climate change and beyond—it is important that we do so strategically. According to International Monetary Fund Managing Director Kristalina Georgieva, PhD, the best investment in times of rapid change are investments in human capital.

 We agree. Based on all that the neuroscience now tells us about the importance of early brain and child development, we believe that achieving the goal of building back better must therefore include investments in child human capital. Actually, make that our children’s brain capital.

is a director at the PRODEO Institute, an Atlantic Fellow in Brain Health Equity at the Global Brain Health Institute (GBHI) at the University of California, San Francisco (UCSF) and a Thiel Fellow at Stanford University.

is a senior advisor to the Organisation for Economic Co-Operation and Development (OECD) Secretary General, head of the New Approaches to Economic Challenges Unit (NAEC), and co-lead of the OECD-PRODEO Institute Neuroscience-inspired Policy Initiative (NIPI).

is an economist, researcher at the IESE Business School, and president of the Venezuelan Alliance.

Paul Ramsay Foundation Fellow and Adjunct Professor, Queensland University of Technology (QUT) and convenor, Thriving Qld Kids Partnership.

is an advisor to ARACY (Australian Research Alliance for Children and Youth) and convener of the Brains Builders Alliance.

adjunct professor in engineering at Stanford University.

is professor and head of psychology at Baylor College of Medicine.

is a child and adolescent psychiatry fellow at UCLA.

is a pediatrician and professor with the Penn State Edna Bennett Pierce Prevention Research Center.

is Alfred Deakin Professor of Psychiatry at Deakin University and director of IMPACT at Deakin University (Institute for Mental and Physical Health and Clinical Translation).

s cofounder of the PRODEO Institute, co-lead of the OECD NIPI, and holds adjuncts roles with IMPACT at Deakin University, BrainLat, GBHI at UCSF and Baylor College of Medicine.

1. Wright M. TED and Minderoo Foundation: How every child can thrive by five. TED Talks. July 2021. Accessed September 24, 2021. 

https://www.ted.com/talks/molly_wright_how_every_child_can_thrive_by_five?language=en

2. Taquet M, Geddes JR, Husain M, et al. 

6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records.

3. Hoxby C. Advanced cognitive skill deserts in the US: Their likely causes and implications. 

. March 24, 2021. Accessed September 24, 2021. 

https://www.brookings.edu/bpea-articles/advanced-cognitive-skill-deserts-in-the-us-their-likely-causes-and-implications/

4. Letzing J. Are we at a turning point for tackling online extremism? World Economic Forum. April 12, 2021. Accessed September 24, 2021. 

https://www.weforum.org/agenda/2021/04/are-we-at-a-turning-point-for-tackling-online-extremism/

5. Behrmann S, Garrison J. Senate Democrats reach $3.5 trillion deal for Biden's 'human infrastructure' agenda, Medicare expansion. 

. July 13, 2021. Accessed September 24, 2021. 

https://www.usatoday.com/story/news/politics/2021/07/13/senate-democrats-reach-3-5-trillion-deal-reconciliation-package/7960565002/

Associations of early-life threat and deprivation with executive functioning in childhood and adolescence: a systematic review and meta-analysis.

The affective neuroscience of socioeconomic status: implications for mental health.

Baby’s first years: design of a randomized controlled trial of poverty reduction in the United States.

9. Willis D. Early Relational Health: Community Level Strategies for Supporting the Psychosocial Health of Infants, Toddlers, and Caregivers. June 2019. Accessed September 24, 2021. 

https://cssp.org/resource/early-relational-health-community-level-strategies/

10. Ellwood-Lowe ME, Foushee R,. Srinivasan M. What causes the word gap? Financial concerns may systematically suppress child-directed speech. 

. January 17, 2020. Accessed September 24, 2021. 

11. Center on the Developing Child at Harvard University. Building adult capabilities to improve child outcomes: a theory of change. May 14, 2013. Accessed September 24, 2021. 

https://www.youtube.com/watch?v=urU-a_FsS5Y

12. Villalpando N. Texas losing $2.2 billion by not treating mothers' mental health, report says. 

. March 21, 2021. Accessed September 24, 2021. 

https://www.statesman.com/story/news/healthcare/2021/03/21/untreated-mental-health-care-moms-costs-texas-2-2-billion/4740751001/

13. Slomian J, Honvo G, Emonts P, et al. 

Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes.

Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations.

15. Organisation for Economic Co-operation and Development (OECD) Skills Outlook 2021: Learning for Life. June 15, 2021. Accessed September 24, 2021. 

https://www.oecd.org/education/oecd-skills-outlook-e11c1c2d-en.htm

16. Weatherill J. Every child deserves to thrive by five. Bedrock. 2021;26(1):6-7.

17. Minderoo Foundation. Thrive by five: new app to help children reach their full potential. October 27, 2019. Accessed September 24, 2021. 

https://www.minderoo.org/thrive-by-five/news/new-app-to-help-children-reach-their-full-potential/

 Dimensionen eines pädagogischen Ansatzes. Neuwied, Kriftel, Berlin. 2001.

19. Nixon C. Remembering why forest schools are important: nurturing environmental consciousness in the early years. McGill University (Canada). March 2015.

Montessori education: a review of the evidence base. 

22. Kuhl P. The baby brain. BrainMind Summit. April 10, 2020. Accessed September 24, 2021. 

https://www.youtube.com/watch?v=ErPPXfsY6a8

23. García JL, Heckman JL, Leaf DE, Prados MJ. The life-cycle benefits of an influential early childhood program. IZA Institute of Labor Economics. December 2016. Accessed September 24, 2021. 

24. Westervelt E. How investing in preschool beats the stock market, hands down. NPR. December 12, 2016. Accessed September 24, 2021. 

https://www.npr.org/sections/ed/2016/12/12/504867570/how-investing-in-preschool-beats-the-stock-market-hands-down%20/

25. Vradenburg G, Sigal E. Created correctly, the Advanced Research Projects Agency for Health will accelerate medical innovation. Stat News. May 27, 2021. Accessed September 24, 2021. 

https://www.statnews.com/2021/05/27/create-advanced-research-projects-agency-for-health-correctly/

Association between adverse childhood experiences and dementia in older Japanese adults.

27. Georgieva K. Transcript of International Monetary Fund Managing Director Kristalina Georgieva's Opening Press Conference, 2021 Spring Meetings. April 7, 2021. Accessed September 24, 2021. 

https://www.imf.org/en/News/Articles/2021/04/07/tr040721-transcript-of-imf-md-kristalina-georgievas-opening-press-conference-2021-spring-meetings

A brain capital grand strategy: toward economic reimagination.

Articles

In order to face the rapidly changing, increasingly complex, and globally connected world, we need to focus on the importance of early brain and child development.

Let’s Build Brains Better! Brain Science-Inspired Policies for the Future 

There is a massive effort in the US to curb the spread of 

. But the US has been behind other countries in part because of lack of testing capacity. As testing capacity accelerates, the number of confirmed cases has grown. Singapore and South Korea have flattened the curve more quickly through efficiently identifying cases and exposures and promoting quarantine. This public health strategy, contact tracing, is old but their method is novel. They use phones.

Countries are using Bluetooth or mobility data (eg, Global Positioning System [GPS], cell tower) collected by the phone for contact tracing. One method of contact tracing involves scanning and recording Bluetooth signals from other nearby phones, usually within a 30 feet diameter. The real time data offer a novel means to track proximity and potential interaction with others. Another method for contact tracing involves use of mobility data (often GPS) collected by the phone that allows a digital trail of timestamped locations visited to be easily recreated.

Public health officials can leverage either approach, Bluetooth or mobility, to determine who an infected person may have been in close contact with—and then notify those exposed of possible risk. Countries have taken different approaches in what information they share with individuals identified as being at risk.

, where the age, gender, and location history of those infected are disclosed to those who may have been exposed. On the other end of the spectrum is Singapore, where people are only informed that they may have been exposed. Both South Korea and 

 have been successful in flattening the cure and their use of phone-based contact tracing offers clear potential to better understand how COVID-19 spreads and can be stopped. With increasing interest in using contact tracing in other countries, it is important to understand the potential risks and benefits of use in the US.


During these unprecedented times it is necessary to consider the benefits of disclosure to exposed third parties against the risks of not respecting individual privacy—everyone’s right to control their health information. People are reluctant to share their health information for various reasons, such us harm to one’s reputation, employment problems, and access to insurance.

In the US, health care professionals do not break confidentiality to disclose a patient’s disease status even for communicable diseases like COVID-19 that present a risk to others. One exception is HIV where many state laws encourage or mandate disclosure to public health identities and/or sexual partners. This HIV status disclosure is justified because public health benefits are thought to outweigh the risks to the individual, though this is not without controversy. For COVID-19, one’s personal data (such as age, gender, location, and health status) is shared with others in a public fashion. Yet a discussion about COVID-19 status disclosure does not appear to be happening in many countries where phone-based contract tracing is deployed. In other words, personal data is being shared without the input of people whose information is being shared—in this case those infected.

The current pandemic-related disclosed data can be very sensitive, especially if linked to GPS mobility data collected by phones. Intimate details like where a person sleeps, shops, and even eats can be easily inferred. Later secondary uses of this data can have numerous unintended consequences around employment, social standing, and health insurance coverage. People have already been assaulted because of suspected or confirmed COVID-19—now imagine their home address being shared too. While efforts to deidentify data can be undertaken, history seems to always show that in the near future reidentification is possible. It is assumed that the data are encrypted and secure. But is it? We do not know, key details are lacking.


The legal implications cannot be ignored either; will there be criminal consequences for spreading coronavirus? It may sound fantastical, but in the US there are criminal laws against certain high-risk behaviors that could spread HIV. In Singapore, refusal to share COVID-19 related data requested by the Ministry of Health can lead to prosecution. These consequences have likely led to people avoiding testing or care.

Ethically based solutions offer a path forward. One pathway is to simply ask for 

 to collect data. This could be done in multiple ways including an opt-in system (Singapore) or even opt-out in some circumstances. Although Iranian officials used an opt-in system, the consent was displayed in a non-native language or not at all for many users. Regardless of the system, to respect privacy, it is important that the data collected, shared, and where data are stored is clearly explained to users. Alternatively, it could be an opt-out consent, which may be more coercive because people are less likely to change from the default. If an infected person’s consent is required before his or her data are shared, an opt-in system could be more palatable. Another solution is to aggregate data at the community level to examine trends rather than an individual’s data. This does not necessarily preclude obtaining consent. Although less advantageous for contact tracing, storing contact data on the phone of an infected person rather than a centralized database lets that individual decide whether he or she want to share the data with public health officials.


COVID-19 has spurred many changes leading to wider adoption of various technologies to support public health efforts. But even data collected for the greater good such as phone-based contact tracing can have unintended negative or punitive consequences. There is always a risk when sensitive information is collected. Ultimately, US public health officials must weigh these risks against potential benefits in an informed fashion.

is a Child and Adolescent Psychiatry Fellow, University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA.

is Director, Digital Psychiatry Division, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. He is Digital Psychiatry Section Editor for 

COVID-19 has spurred many changes leading to wider adoption of various technologies to support public health efforts. But even data collected for the greater good can have unintended negative or punitive consequences.

Kunmi Sobowale, MD

Articles

Let’s Build Brains Better! Brain Science-Inspired Policies for the Future

A Novel Approach to Contact Tracing