It's the parents' lament: 'Where did we go wrong?' Often the answer is that the adults simply didn't know how to bring up their children. Reva Klein looks at a scheme in the US that offers crucial help to parents struggling to give infants the start they need.
Inside the timber-frame house, which stands on a desolate plot where nothing grows, there's a strong sense that all is not well. Apart from a few photographs of her children that Marsha has stuck on the wall, and a dusty, incomplete set of the World Book Encyclopaedia on display underneath the vast television, the living room in St Louis, Missouri, is eerily soulless. There is nothing to suggest the presence of the house's other occupants: Marsha's four children, one of her cousins and her cousin's toddler.
But the clearest signal of things not being right comes when Marsha's youngest daughter, Aisha, aged four-and-a-half, enters the room. The mother speaks to her in staccato monosyllables, avoiding eye contact; you get the feeling that they're not used to talking to each other.
A 10-minute car ride away, another African-American mother, Verna, is at home with her three children. Unlike Marsha's, her house is spacious and well furnished, situated in a leafy street with new Chevys and Oldsmobiles in the driveways. But Verna, a one-time university student married to an engineer, is as awkward with her three young children as unemployed, uneducated, single mother Marsha appears to be with her daughter. Verna's two boys, aged five and four, both have learning difficulties and the younger has emotional and behavioural problems. He also has a bruise over his eye which he says was inflicted by his softly spoken, articulate mother.
These two women are not alone. All across the US - and beyond - there are parents of all races, cultures and socio-economic backgrounds who don't know how to give their children what they need.
But thanks to a national scheme piloted in St Louis in the early 1980s, they and many thousands of families around the country are getting help. The Parents as Teachers (PAT) programme is built on the premise that parents are children's first and most influential teachers; and that fulfilling that role has nothing to do with education or income and everything to do with confidence, guidance and support.
"Parent educators" from the local school district visit all parents of children under the age of three who have agreed to take part in the programme. They demonstrate how reading to children, doing number games and playing with shapes and different textures can help children's intellectual and physical development, and improve their relationship with their parents. They also discuss rewards and sanctions: the importance of both giving children the freedom to explore and imposing boundaries.
The St Louis pilot showed that the early introduction of playing, reading and talking improved children's problem-solving and social development skills by the time they started school at the age of six. Moreover, the early intervention by parent educators enabled early detection of cognitive and behavioural problems, so that remedial work could start at pre-school level.
The pilot also showed the universality of parents' needs. As a white professor at the University of Missouri says: "I have an education, but when we had our first child I didn't know anything about child development or about what you do with children."
So successful was the three-year pilot that in 1985 the governor of Missouri ordered the programme to be implemented across the state. Since then, PAT has opened nearly 2,000 centres across the US and in six other countries.
The experts love it. PAT has been lauded by Yale child psychologist Edward Zigler, founder of the Head Start scheme for disadvantaged children, as "a vanguard programme. It's where the world ought to be going." Another American authority on early childhood, Burton White, has said it will "revolutionise the way we educate our children".
In Normandy, a St Louis suburb whose schools have a 98.9 per cent African-American intake and where Marsha, Verna and their families live, PAT is very much a partnership between parents and parent educators.
Trust is the key. That the overwhelming majority of parent educators are black themselves helps to break down suspicion. But, says Evail Boyd, supervisor of PAT and a parent educator herself, "In the beginning, there were rumours that we were looking for signs of child abuse and were going to take the children away. We sorted that out quickly."
The Normandy team works with more than 500 families, whose parents are "recruited" into PAT at maternity wards and their older children's primary schools. Parent educators make an average of five bi-monthly visits to each family, but they can go up to 25 if necessary. "I've never yet found a family that needed that many," says Evail Boyd.
Evail has been visiting Verna for a couple of years to work with her and her two boys. Today, the focus is on her daughter, Rachel, who is two-and-a-half. Evail gets stuck in on the floor, pouring and scooping cornmeal with Rachel, intermittently explaining to Verna the developmental stages that the activity relates to as well as why cornmeal is better than sand ("you can talk about the colour and it's easier to get out of their hair"). At the same time she encourages the boys to draw with felt-tip pens and paper that she's brought with her.
For Verna, PAT has been a godsend. She says: "Michael, who's five, was always quiet and I didn't think anything was wrong till Evail first saw him when he was three. She identified him as having developmental problems and arranged an assessment. So now he's attending pre-school special education. My regret is that I didn't start working with him earlier.
"And then when, as a three-year-old Jonathan was attending the children's centre (part of Normandy's pre-school programme), they let me know that there were problems with him, too, in delayed development. If it wasn't for Evail working with him, he wouldn't be as advanced as he is now. I've seen such changes in him, and I anticipate even bigger changes when he starts kindergarten."
Verna has changed, too. Because she lacks confidence in her parenting abilities, she finds Evail's calm, non-judgmental guidance invaluable. "Watching what she does with the kids has given me ideas about what to do with them when we're on our own," she says. "Since we've been in the programme, I can see changes in them, in how they benefit and how I've benefited, too."
The visit to Marsha is a different story. As part of the pre-school programme at Normandy's child centre for low-income families with children aged four and five, teachers or parent educators make home visits when necessary. This time the visitors are Monique Kyles and Diane Worth. Marsha's daughter, Aisha, has speech and cognitive problems.
"At pre-school we'll ask her a question," says Monique, "and she'll give us a little smirk and we'll say, 'Don't you talk at home?' " Marsha laughs - "Too much!" - and explains that all her other children receive speech therapy. Monique gives her a form to sign which will enable Aisha too to get therapy at pre-school.
Over the next half an hour Monique and Diane work with mother and daughter, showing them how to play alphabet bingo, how to make a number game with clothes pegs and cut-out numbers, how to ask questions about a story that's being told. Marsha is polite but quiet and looks relieved as we walk out the door. We all wonder when Aisha will play the next bingo game or listen to a story.
In addition to standard pre-school services, Normandy runs a summer school for children about to enter kindergarten, and a post-kindergarten summer school for children with deficient areas. The costs of all these services, as well as PAT, are met by the Missouri state government.
Rose Coleman, Normandy's director of elementary education, wants to see more systematic evaluation of PAT. "We want to take the children in PAT, put them in full-time kindergarten and look at them in comparison with the non-PAT children," she says. "My hunch is that if we can maintain that group intact, we'd be seeing measurable improvements over a period of years."
But that is the future. For now she is just pleased that, in an area where more than 30 per cent of households are headed by a single parent, PAT is making a difference. "All parents to begin with, no matter what their socio-economic standing, are ill equipped. PAT gets them to think about the issues around being parents."
PATS ON THE BACK
Four independent evaluations of PAT between 1985 and 1991 have shown that: * Children in the programme "performed significantly higher than national norms in intellectual and language abilities and social development" by the time they started school.
* Over half the children with developmental delays overcame them by age three.
* The progress that PAT children demonstrated at the age of three continued through to the end of first grade, putting them "significantly ahead of their peers in reading and mathematics".
* Parents' knowledge of child development and parenting practices had increased through being in the programme.
* PAT parents were particularly involved in their children's schools.