Expert opinions: Called into question

Just because someone has Doctor or Professor in front of their name, it doesn't necessarily mean they have all the answers. Jennie Lindon offers some healthy scepticism

A spate of recent court cases has raised serious consequences for families when expert opinion is accepted without challenge. Many examples that have hit the headlines featured paediatrician Professor Sir Roy Meadow, who frequently acted as an expert witness in cases about the possible non-accidental injury and death of children. The publicly reported cases have been heard in the criminal court, but Meadow's personal testimony has also been heavily used within the civil proceedings of family courts in England.

Meadow's work as a paediatrician led him to highlight Munchausen Syndrome by Proxy, a condition in which carers, often but not always a parent, deliberately harm children.

Meadow is not the only person who regarded this pattern of child abuse as a real possibility. A very small minority of disturbed adults may well boost their self-esteem through allegedly being the dedicated carer of a very sick child. However, in cases where there is uncertainty, serious problems can arise when the burden is on parents to prove they are not abusing their children.

There is now a significant campaign mounted by parents affected by Meadow's stance and his use of statistics about multiple unexplained infant deaths within a family. However, the events raise broader issues about expert knowledge and beliefs, ones that are particularly important for early years practitioners.

Open to challenge

Significant risks arise when high profile 'experts' become immune from effective challenge. People with titles such as doctor or professor can suffer from the same human weaknesses as anyone else, including being unwilling to see the wood because they have a favourite tree. Some level of respect and trust is inevitable, but nobody should be excused the responsibility of a full reply to questions such as, 'On what do you base your claims?' or, 'What makes your explanation more likely than the alternatives?'

Problems can arise when any professional becomes heavily associated with a single issue, syndrome or theory. There is a great temptation to rubbish any competing theories, and academic debate can surprise outsiders with the 'playground' level of some exchanges, despite the long words and complex sentences. There is also the related temptation to take the 'tip of the iceberg' approach, where people fear a problem may be greater than it appears. Only careful, non-partisan observation and research can establish whether icebergs are really involved or if it is rather a situation involving ice cubes.

It can be hard for practitioners - and parents for that matter - to realise how much disagreement can exist around a theory or syndrome, when they only hear about the most outspoken person in the debate.

When you recognise the diversity of views over Attention Deficit Hyperactivity Disorder, for instance, you could be forgiven for wishing for the security of not knowing very much. Yet early years practitioners have a responsibility to weigh up the issues in this area and express them coherently.

You need to ground your judgement in the context of the normal range of lively behaviour - not labelling young children whose behaviour is an understandable response to an over-structured day. You can support parents to know that some professionals are convinced there is a dietary link for ADHD and some are dismissive. Some professionals are in favour of medication; some vehemently oppose it. There are sound reasons to be wary about enthusiastic use of drugs, especially for younger children and where there are no other strands to the treatment programme.

Continually evolving

We need the perspective of social history to give research and theory an appropriate role. It is also responsible to avoid making the assumption, 'We know it all now!' If, with hindsight, we can identify the bias or mistakes of the past, who is to say the same pattern may not occur again? For instance:

n In the 1970s, it was accepted expert opinion that the pattern of child behaviour we now call autistic spectrum disorder was caused by emotionally cold and unresponsive mothers. The mother-blaming theory sat comfortably with contemporary views within psychiatry, and inevitably created a considerable amount of distress in families.

n During the 1970s and 80s, parents were firmly told that lying babies on their back put them at risk of choking. The advice was to put babies on their stomach or side. This direction was given on the basis of a small piece of research into the care of premature babies, with no further checks about the generalisation to full-term babies. By the 1990s, further research identified the stomach sleeping position as one risk factor in unexplained infant death. A reversal of the advice was soon followed by a significant drop in infant deaths.

The exact perspective may change, but some research continues to have messages for good practice. In recent years, there has been a renewed focus on the importance of children's early experiences and their feelings of attachment. John Bowlby's work on attachment, with his focus on maternal deprivation, was a product of the time - the 1950s and 60s - along with Bowlby's theoretical stance. The ideas spent many years at the back of the proverbial broom cupboard, yet some very positive results came from that work.

If you distance yourself from the cultural tunnel vision that claimed mothers were the only people of significance to young children, then it is possible to see that, for instance, the films made by James and Joyce Robertson in the 1960s led to radical changes in the experience of children and families in hospital. Recent research into the brain is one reason we have come back full circle to recognise that early experiences and close affectionate relationships really do matter.

Perhaps part of the problem for practitioners is to find out what is happening in research. For instance, undiluted Piaget and his stage theory still seems to lead some textbooks and childcare courses. There is often little or no mention of the child-centred research into cognitive development that started with Margaret Donaldson in Edinburgh in the 1970s.

Many of that team are now well established around the country, still in the business of finding out what children actually understand, rather than what the theory said they should be able to do.

Questions and answers

Social research is often not as objective as either the researchers or practitioners prefer to believe. The questions asked by research, as well as the interpretations made of any data, are affected by time and place, as well as funding sources.

For example, initial research into the effects of divorce on children was established to find negative consequences, on the grounds that children must be damaged by such a socially unacceptable event. As family breakdowns became more common, the interpretations sometimes veered far in the opposite direction - that children's interests were best served if unhappy adults split. As projects began belatedly to talk with children, it became clear their well being depended on their individual experience, but few were emotionally untouched.

In a similar way, early research into the effects of out-of-home daycare on children was set up to look for negative impact. The received wisdom was that if young children were not cared for by their mother, they would inevitably be harmed. The job of research was to quantify that damage. Then research and reviews through the 1980s and 90s explored what was important in out-of-home care to ensure children's well being.

With the high profile of childcare now on the political agenda, there is reason to worry that the pendulum has swung too far. Research suggesting children may be harmed by long hours of childcare is frequently met with derision. But there is every reason to question what will happen to children's family attachments, if they have very limited time with their parents in their own home.

More extensive out-of-home care is regularly promoted as the solution to the demands of the job market. Some early years organisations face ethical issues where research meets practice, policy and politics. In some quarters it is now common to repeat how research proves that time spent in an early years setting delivers measurable benefits for children's development.

Some statements are so enthusiastic they almost imply that young children will be harmed if their parents fail to take them to some kind of pre-school group setting. But the research in question, in particular the long-term US projects, is based on well-funded programmes, often with family support. Recent UK research, such as the REPEY project, highlights that, in practice, children's group experiences can be very varied.

We need to be aware of our own version of 'early years spin'. Something can be said many times, and with great energy, but that does not necessarily make the statement any more true than when it was spoken the first time around. Yet constant repetition takes a statement closer to the 'everybody knows ...' position, and away from the valid question, 'What exactly are the details of the research you keep quoting?'