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Expensive Problems: Researchers Say 'High Cost' Adults Can Be Predicted At Age 3

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(Daiga Ellaby/Unsplash)

A new study suggests that your earliest years may be even more critical than previously thought: Your brain health before you're 3, it finds, may well predict how much you cost society in mid-life, including your health care bills.

"About 20 percent of the population use the lion's share of public services," summed up senior researcher Terrie Moffitt, a professor at Duke University, at a press conference about the study. Among the New Zealand population followed, those services ranged from hospital stays and drug prescriptions, to criminal courts and prisons, to welfare benefits and insurance claims.

That same one-fifth — what we might call "the expensive-problem people" — even smoked more than half of cigarettes and accounted for two-fifths of pounds in the obesity category, the study finds.

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It's not news that some people cost society more than others. What is news is that the researchers could link those high expenses to the health of the subjects' brains all the way back when they were tested at age 3.

The researchers used a long-running study called the Dunedin birth cohort, based in the southern New Zealand city of Dunedin, that has followed a group of roughly a thousand people since they were born in the early '70s. It tested for measures of brain health in the subjects when they were 3: How well could they understand what adults were saying to them? How strong were their motor skills? How well could they control their own emotions and impulses?

The central finding: Those measures of brain health were highly accurate predictors of whether those 3-year-olds would end up in the cohort of publicly expensive people by the time they were nearing 40.

"Our paper seems to identify a very small group of children who turn out to be hugely costly to the public purse," Moffitt says. "And that would seem to lead naturally to the conclusion that what we need to do is find out who those children are now, and send someone out to do something about that. So that would be a targeted intervention."

Of course, we already know that children facing disadvantages and challenges need early intervention and extra help. But this new paper appears to add still more ammunition to the economic argument for paying for early interventions. It connects the dots between those early brain health scores and highly expensive mid-life costs — like the extra health care you likely need if you smoke and eat too much and take many medications.

The researchers say that while criminal behavior peaks earlier, they had to wait until the Dunedin cohort reached mid-life to count these health care costs. And fortunately, New Zealand has public databases that let them connect all those dots.

Alarm bells going off? Are you concerned that young children could be fingered or targeted as potentially expensive people, stigmatized by the label and unable to shake it?

Moffitt points out that when you understand that certain people were already massively disadvantaged at age 3, it "gives you a feeling of compassion for these people as opposed to a feeling of blame."

Still troubled? I turned to Dr. Jack Shonkoff, director of the Center for the Developing Child at Harvard University and long a thought leader on early interventions to protect kids' brains against the stresses of poverty and other childhood adversity.

Shonkoff says the key is to recognize risk factors in kids but to be aware that a risk factor does not equal a diagnosis.

"If you have a pile-up of risk factors in your life, it means that you have an increased probability for a problem, but it doesn't mean you have a problem," he says.

"We have to make a choice," he says. "We could either say, 'This is too subject to misuse, and therefore we're not going to use it at all,' or we could say, 'We're going to be thoughtful and careful in a scientifically accurate way, and not prematurely label children.' "

Shonkoff says he sees the issue as a pediatrician, and pediatrics is all about prevention.

"It's about identifying risk factors, and doing something before problems occur," he says. "Would we worry about stigmatizing children by measuring lead levels in their blood? If you have an elevated lead level, it doesn't mean you have a problem, but it means we've identified something early on to prevent the problems that occur later."

While potential stigma and stereotyping are concerns, Shonkoff says, it's also not acceptable to "put our heads in the sand," because children at high risk are not inevitably doomed; changing early experiences can change outcomes.

What works to change those outcomes? The common phrase is "high-quality" programs, which means they don't come cheap. But they can also bring hefty returns, as another new study finds here: "How Investing In Preschool Beats The Stock Market, Hands Down." The Center on the Developing Child sums up recent findings here.

Shonkoff says that the biggest economic return from high-quality early childhood support has seemed to be a lower prison rate — until now.

"The reality is that the health care costs overwhelm the incarceration costs," he says, "but we've never studied them, and that's the other important message to come out of this study."

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Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth blog.

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