‘Give me the child until he is 7 and I will give you the man’ — Psychologically informed reflections on the importance of early life experiences on later life…’

25.06.2021: When thinking back over the past week for this week’s PIE blog, as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity: Centrepoint, I have been again reminded of the key importance of our early life experiences on our later lives. At the start of the week, I ran a further online PIE day staff training session that specifically considers these issues in relation to the homeless young people (aged 16–25 years) that we support within the charity. Specifically, within this training we reflect on how many of these vulnerable young people have experienced adverse early life experiences that can often result in later challenges, which we need to address within our support work (e.g. mental health issues, challenging behaviours, emotional dysregulation, substance misuse, difficulties with relationships and access to education, training and employment opportunities).

In addition to this issue being discussed within staff training sessions, I have also had conversations this week with other senior colleagues at Centrepoint about this because of the link to the recently launched ‘Royal Foundation Centre for Early Childhood’ by HRH Duchess of Cambridge (c.f. https://royalfoundation.com/the-duchess-of-cambridge-launches-the-royal-foundation-centre-for-early-childhood/). We are extremely honoured at Centrepoint to have HRH Prince William (Duke of Cambridge) as our Royal Patron (c.f. https://centrepoint.org.uk/about-us/who-we-are/our-patron/), who following in the work of his late mother HRH Princess Diana (our previous Royal Patron) has been supporting Centrepoint for many years. Although it is his wife, not directly him, that is highlighting the importance of the ‘early years’ of a child’s life, the link to his patronage and work at Centrepoint is clear. Firstly, we are involved in direct delivery work in the early years sphere, through our services to homeless young parents and their small children in several London boroughs (e.g. Wandsworth, Greenwich, Camden) as well as in Sunderland (c.f. https://www.chroniclelive.co.uk/news/north-east-news/sunderland-homeless-hostel-worker-opens-18210086), in order to improve the longer term outcomes for both them and their children. Moreover, as noted above, we are often supporting young people who are dealing with the consequences of not having got ‘the right support at the right time’ in their early years, with the result being them becoming homeless. Therefore, as a psychologist, a parent, and a primary school governor, I am excited to see that there is now rightly an increased prominence being placed on the importance of the early years in public discourse, (and hopefully as a consequence increased research, funding and resources in this area!), through the Royal Foundation’s work.

The opening title of this blog: ‘Give me the child until he is 7 and I will give you the man’, is a well-known quote that attributed to both Aristotle and St. Ignatius Loyola, the founder of the Jesuit order. It even formed the basis of the now infamous TV documentary of over 50 years where a selection of British children were followed up and filmed every seven years, from the age of seven, throughout their lives (c.f. https://www.theguardian.com/film/2019/jun/01/seven-up-at-63-documentary-michael-apted-cameraman-george-jesse-turner-interview). As a psychologist, I would however argue that this is perhaps a rather pessimistic and/or deterministic view that our life chances are firmly set and not amenable to any change because of our experiences by the time we are seven years old. However, the principle that this critical period in our lives can affect all that comes later has actually been repeatedly shown in many research studies.

The most famous of these psychological research studies is the ‘Adverse Childhood Experiences’ or ACE’s study (Anda et al, 2010). This study investigated the association between childhood trauma or ACE’s, and later adult health outcomes, including biological, psychological, neurobiological, social, cognitive and spiritual. This research found a clear association between having more adverse childhood experiences and a greater impact on health and well-being over the lifespan. These negative outcomes included the perhaps more obvious ones such as mental health, substance use, risk of contact with the criminal justice system, self-destructive behaviours, homelessness, and vulnerability to abusive adult relationships. However, there were also perhaps less obvious negative outcomes including both short term (e.g. sexual and reproductive health issues) and longer term chronic physical health condition such as cancer and diabetes, as well as significant neurobiological impacts (e.g. heightened threat perception, brain development and overproduction of stress hormones), and even premature death. A good summary of the power of ACE’s to impact our later life can be found here: https://www.youtube.com/watch?v=XHgLYI9KZ-A

Anda et al (2010) also proposed the mechanisms or process by which an increased number of ACE’s risks having a significant impact on our later well-being — see diagram below:

Essentially, this notes that ACE’s disrupt our normal neurobiological, social, cognitive and emotional development, which increase our risk of engaging in health risk behaviours through exposure to, or as a means of coping with the trauma experienced, which then increase the risk of disease, disability and social problems, which finally increase the risk of an early death. Of course, this pathway is not inevitable and this is where both statutory and voluntary or charity organisations, such as Centrepoint, can work to intervene to mitigate against the risk that ACE’s continue to dominate our later life. However, as the Royal Foundation rightly notes in their recently released ‘Big Change Starts Small’ (2021) report (c.f. https://centreforearlychildhood.org/report/), ‘early childhood represents one of the best investments we can make for the long-term health, well-being and happiness of our society’ (p.5). Therefore, the earlier we intervene the better the outcomes. I know from my clinical experience that working to support positive change in clients gets harder as we get older, as patterns of thinking and behaviour become more entrenched and opportunities to make significant changes may decrease as we grow older.

The Royal Foundation Centre for Early Childhood also highlights, as does our Centrepoint PIE framework, the critical role that relationships, and in particular attachment to primary care-givers, has in our early life and psychological development. Specifically, their recent report highlights that ‘simple, consistent and responsive interactions between caregiver and child … contribute to secure attachment — a sense of safety and security, help with regulating emotions and a safe base from which to explore … build[ing a child’s] sense of agency and confidence to ultimately navigate their physical and social worlds independently’ (p.5). This is Bowlby’s (1969) Theory of Attachment, which describes how all humans have a lifelong innate biological system to drive connections towards others. This system is argued to have developed because of the evolutionary necessity for a helpless new-born infant to connect or ‘attach’ to their primary caregiver in order to get both their physical (e.g. food, shelter, protection) and emotional (e.g. warmth, love, regulation of distress) needs met. In the early years, the primary caregiver facilitates this secure attachment by (1) providing a safe base for exploration, (2) being available and flexible), (3) being sensitive and responsive to distress, and (4) intervening when needed. Bowlby (1977; 1988) also argues that these early experiences with primary caregivers effect how we feel about ourselves (e.g. worthy vs. worthless, loved vs. unlovable), our ability to build and expectations of relationships with others (e.g. trustworthy vs. untrusting, supportive vs. rejecting) as well as our view of the wider world (e.g. safe vs. hostile, worth engaging with vs. need to avoid or ‘drop out’ from).

At Centrepoint, we often see many homeless young people that because of their ACE’s, such as trauma or abuse, periods in social care, family breakdown etc., are ‘insecurely attached’ with all the associated presenting issues. Consequently, often the most important role of our amazing frontline ‘key-workers’ is relationship building with the homeless young people that they support. As Cockersell (2012) argues, as per a PIE, relationship building is the ‘bread and butter’ of homeless services work as everything else follows from this. These therapeutic relationships provide homeless young people with this ‘secure and safe base’, perhaps for the first time, and a different experience of relationships that can undo the previous damaging attachments they have experienced. This then enables them to modify their often-negative view of themselves and motivates them to engage in the wider world through education, training and employment to #changetheirstory. Merely offering a ‘roof over their head’ and addressing their immediate homelessness is just the start of undoing the damage of their ACE’s. PIE is therefore all about building a ‘mental and relational sense of home’ (Cockersell, 2012) and there is evidence that this approach has a positive impact on outcomes (e.g. Phipps et al, 2017).

I would also argue that a focus on the impact of ACE’s is critical in any homeless services because of the evidence that a significant number of people who become homeless have experienced significant trauma in their early lives (Johnson & Haigh, 2012). Put another way, there is evidence that more the ‘complex’ needs seen amongst those experiencing homelessness are often associated with early traumatic experiences or ACE’s (Maguire, 2006). Of course, the experience of homelessness itself is also often traumatic, which can further compound the negative consequences of ACE’s. Consequently, Keats et al (2012) in the PIE Good Practice Guide (c.f. https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf) highlight the need to be aware of previous trauma when working with homeless populations. They note that ‘there is growing evidence of the extent and range of psychological and mental health problems amongst homeless people and rough sleepers … over-represented [in this population] are histories of neglect, abuse and traumatic life events dating back to childhood and continuing through adult life’ (p.3). Homelessness can be therefore be viewed as one of the many damaging consequences of having experienced ACE’s as well as arguably, a failure of many multiple systems and services to undo the damaging impact of early trauma upon that individual up to that point.

Therefore, a renewed focus on the importance of positive early attachments and the key role of early years provision and support is extremely welcome from the perspective of Centrepoint. It also naturally aligns with our work, even though we are not often (apart from in our Young Parents services) working directly with the 0–5 age range, as our focus is on working with young people aged 16–25 years. Nevertheless, we are as a charity often dealing with the consequences of ACE’s and their ongoing impact as an individual reaches adolescence and early adulthood. Positively, as we have evidenced over the past 50 years, change at this point is possible. I have had the pleasure of seeing this first-hand when I am out delivering staff support, staff training and reflective practice sessions within our supported accommodation services, as I witness how secure therapeutic relationships between our staff and the young people they support can modify, compensate or undo previous damaging or traumatic experiences.

However, it continues to sadden me at times that our services are needed at all, as I have to ask myself why as a modern developed society we are still failing to get these critical early years right? Ultimately, even though this would do me out of my current employment(!), it would be preferable to remove the need for charities like Centrepoint to be needed in the future. Therefore, our newly launched strategy with the goal to #endyouthhomelessness by 2037 has an important focus on ‘Prevention’ of homelessness for the future generation being born today (c.f. https://editor.centrepoint.org.uk/media/4764/d201-strategy-03.pdf). Although we won’t (and couldn’t possibly) provide all the specific interventions to achieve this aim across the UK, our strategy highlights the role of partnership and collaborative working with other organisations as well as our role in increasing awareness of the importance of the early years stage in conjunction with others such as the Royal Foundation Centre for Early Childhood. As we are a psychologically informed organisation or PIE, we can highlight, through this collaboration with others, the psychological research evidence of the impact of ACE’s on our homeless young people and the consequences of not getting these critical early years ‘good enough’. Of course, we would argue in Centrepoint that we can and do bring about positive change for the homeless young people we support and that even when their history has been littered with ACE’s, their lives are not (and should not) be predestined by the age of seven. However, we are also realistic and know that intervention in early adulthood (rather than early years) is much more challenging because we are trying to reverse the damaging impact of ACE’s and trauma that would have been so much easier to reverse if support or interventions had been available earlier.