health, education, nutrition, and casework services. This is the first point I would like to make, the multidisciplinary approach. These disciplines operate as equals and each of them is vital. Let no one tell us, for example, that health is more important than education, or that nutrition should have priority over health services. Let no one ask us to pick and choose between giving a child proper food and giving him a proper education. Let no one claim that any of these disciplines can succeed alone in doing the job.

I believe, Mr. Chairman and Senator Mondale, that this concept of the interdependence of the various disciplines has begun to achieve general acceptance. Even the American Medical Association has stated that medicine alone cannot solve the problems of the poor.

Yet many barriers have grown up over the decades between physicians, educators, caseworkers, nutritionists, and other disciplines. Many professionals have yet to appreciate the necessity of breaking down these barriers, of recognizing that physicians must be concerned about a child's education, and teachers must be concerned about his state of nutrition.

In this effort to encourage professionals to work together for the good of their patients, students, and clients, Project Headstart has made a special contribution that is not generally recognized, but that I would like to single out for special attention, and as the first of the four points.

Senator NELSON. Do you in your statement at any time comment on the developmental stages of the child?

I notice in Senator Mondale's opening statement some statistics which I have seen in a number of places, and I would like a comment on this, that is, the estimate that about 50 percent of an individual's intellectual development takes place between conception and age 4, another 30 percent between 4 and 8, and only about 20 percent between ages 8 and 17.

Do you comment on these stages of development at all in your statement?

Dr. MENDELSOHN. No, I do not, Senator, but I have seen those figures and others that agree with them, and I think that, in general, they appear to have the backing of most research studies.

I would further like to add an important point, that at any time of life the development of the child and, indeed, the development of the adult is changeable; it does not represent a fixed quantity.

The reason for saying this is because there is a tendency on the part of some to claim that if the child misses something in a certain formative period, say, in the first or second year of life, his chances for achieving normality are reduced.

I would like to indicate that the kind of statistics contained in Senator Mondale's statement and other supportive work demonstrates that such is not the case, and changes can be made at any point in a growing child's life in spite of what may have happened to him in the past.

Senator NELSON. I don't know whether this involves your field or not, and if it doesn't, we can reserve the question for someone else.

First, we have had testimony, I think in particular by Dr. Geiger on a previous occasion, commenting on the effect of nutrition on the development of the child in the first 18 months, and some rather

dramatic statistics that you have probably seen on the damaging effect on an inadequate diet, particulartly protein, but in any event, an inadequate diet in that first 18 months, and the conclusion that permanent damage can result from that.

Now, we aren't, in these statistics that Senator Mondale used, and I gather, as well, from the expert sources that I have seen from time to time, referring to that kind of damage to the child. Is that right? Dr. MENDELSOHN. That is my understanding. Senator MONDALE. Would you yield?

I serve on the Nutrition Committee, and we had testimony early in our hearings that pointed to irreversible damage that results from malnutrition.

As we have gone along, we find that we are not quite able to make that statement quite that clearly.

We know it is damaging. But we are not saying absolutely that it is irreversible. We are saying that it appears to be but that we don't know for certain. Is that correct?

Dr. MENDELSOHN. Yes; and I was about to make the same point in a little different fashion.

There is controversy whether malnutrition in the interuterine phase of development is permanent. Some studies have indicated that permanent damage to nerve cells of the brain does occur. I might refer to the studies of Dr. Winnik at New York Hospital, and there are others that support this.

However, it is difficult, as you know, to make an analogy between studies in laboratory animals and studies in humans.

I might say that if there is permanent and irreversible damage in some of these children that the human organism has ways of compensating for the damage that has been done, provided, and I underscore this, provided that the proper inputs and proper kinds of services are given at a later time in order to permit the individual to overcome the damage.

The reason I think this point is so important is that many people say the children have suffered irreversible damage, and therefore there isn't any point in doing anything for them. I wish to state my opposition to that kind of position, to that kind of erroneous position, and to encourage the provision of services to all children, regardless of what we might theoretically think might have happened to them as a result of their deprivation.

Senator NELSON. As I understand it, Senator Mondale, in his statistics presented here, has quoted experts in the field.

What I don't understand is the use of the words "intellectual development" in that context. In other words, 50 percent of an individual's intellectual development takes place between conception and age 4, and so forth.

I am not used to using "intellectual development" in that context. You obviously aren't talking about how much the child has learned, or maybe you are, but they learn very rapidly in the first 4 years, obviously. They learn to talk, and learn to walk, and many other things. But what does "intellectual development" mean in that context? Dr. MENDELSOHN. I would answer that, Senator, by saying that I would agree that that is a difficult point, and I think that that question might be better answered by some of the people who are going to

follow my testimony, since the measurement of intellectual achievement and intellectual deficiencies has not been one of my particular areas of focus.

Senator NELSON. All right. I don't expect you to comment on that. Senator MONDALE. Could I ask one question relative to the question that Senator Nelson asked:

While you state that it is true that later remedial programs might restore some of the initiatives lost in early years caused by deprivation, is it not still the case that it is harder and more difficult to do it in later years than it is in the early years?

In other words, if you want to be cost effective about giving human beings a chance, undoubtedly services delivered early in life will bring you a quicker return than trying to undo the deprivation later in life. Dr. MENDELSOHN. Senator Mondale, not only is it harder and more expensive, but in general overcoming the difficulties doesn't match what the individual would have achieved in the first place. I would be in agreement with your reservations on that point.

Senator MONDALE. Suppose a child has reading difficulties, and in early childhood you teach a child to read. That means that he or she will be learning from then on, because she can read. She has that tool.

If you solve her reading problem when she is 12, it means she has lost 6 or 8 years when we could have been reading and developing. While it is true that you might restore it, it would be such a cost, and the realities of budgetary pressures are such, that when you talk about $4,000 or $5,000 a year for special remedial education or health, it is difficult to get it.

Dr. MENDELSOHN. The cost of rehabilitation, both economically and to the individual, must always be higher than the cost of initial normal development. I would certainly agree.

Senator MONDALE. We had a witness here, Dr. Van Dusen, from the Public Health Service, who did a cost accounting of a child with kwashiorkor. She found out it cost $800 a pound to restore a child to health once they are suffering from kwashiorkor.

I wonder whether all deprivation doesn't have a cost, also. The cost of trying to catch up after deprivation is enormous.

Dr. MENDELSOHN. Just to give you another example, the cost of rehabilitation of a child who has suffered damage from lead poisoning, even if rehabilitation could be optimal, and it almost never is in the case of lead poisoning, has been estimated by some to be over $100,000, and you may have read in the newspapers, as I have, of some of the judgments that have been given that range in excess of $150,000, to the children and families of those children who suffer from lead poisoning.

So if we want to economize in terms of financing and in terms of human energy and in terms of the services that are available, it is better to do things right in the first place than to have to go back and do them again later on.

Senator NELSON. Go ahead, Doctor.

Dr. MENDELSOHN. The second of our four points relates to the family-centered nature of the program.

Project Headstart has been a family-centered program. S. 2060 recommends continuation of this basic approach. We recognize the importance of helping the parents to help the children. We appreciate the vital contribution that mothers and fathers can make as aides in the classroom and in other activities. We also know that a child cannot properly learn and develop unless he is able to respect his father and his mother, and I would like to underscore that particular sentence.

A child respects a father who has a job, who provides love and support for his family, and who has some reasonable control over his own life situation.

Project Headstart has made a good beginning in providing such opportunities for parents, and S. 2060 plans to continue this effort, not only in providing services for children, but to "provide for direct participation of the parents of such children in the development, conduct, and overall direction of the program at the local level."

In other words, we do not claim that the child is more important than his father and his mother. We instead emphasize that every member of the family most be enabled to live with dignity; otherwise all the services provided to the child per se, regardless of how much we spend, may be nullified.

I raise this issue because some voices are suggesting that the family of the child in poverty is inadequate and hopeless, and are recommending that it might be better to separate the children from his parents. I would remind the committee that the boarding schools for Indian children on reservations are an example of this kind of "parentectomy."

I am sure you all know about the situation over the years in the boarding schools on Indian reservations, and many reports indicate that the suicide rate of children in Indian boarding schools is among the highest in this country among that age group.

This committee may also have had their attention called to a recent book by a prominent Chicago psychologist suggesting that children in slums be reared separately from their parents.

I would like to underscore the great contribution Headstart has made in encouraging a "family centered" approach. It has taught even the professionals the value of this method. After all, most of our American institutions tend to be antifamily in orientation. Hospitals usually discourage parents from staying with their children; they even discourage parents from visiting with children, and I could go on and on as to how hospitals and other medical institutions tend to be individual centered and tend to discourage family togetherness. Schools have traditionally tried to keep parents at arms' length, and I give you the PTA as an example of that; welfare agencies until recently cut off payments if a father was found in the house; day care legislation is sometimes designed to force mothers to leave their home and children and go to work. Even American business discourages family integrity by practices such as frequent transfers of its executives and failure to provide day care centers for mothers who wish to work. While this antifamily bias works against all our population, it is especially cruel to families living in poverty. If you have any doubt, ask your local hospitals if there is any difference in the duration of visiting hours for private patients and for charity patients.

Project Headstart is almost unique in American life-along with the church-in recognizing that, while the individual is important, the family is the primary unit. The children in Project Headstart have made remarkable gains in part because of the range of services provided. But much of the credit belongs to the policy of including parents in the activities of the centers and in the decisionmaking processes themselves.

Let the committee beware of any who would counsel the weakening or elimination of services and provision of opportunities to parents and other family members.

The third point is CAP agency priority. This may initially seem of minor importance, but in my opinion, the preference to applications by community action agencies is one of the major contributions of S. 2060. CAA's have shown remarkable flexibility. They are not bound by the dead hand of tradition, as is too often the case with the public school systems.

Secretary Finch himself, testifying before Congressman Perkins' committee, has referred to the "encrusted elementary systems," and has stated that the stimulation received by the Headstart children "has been dampened and depressed by the conventional system."

So I think that the point about the situation in the public schools has achieved quite a degree of concensus in the last several months. The CAA's are considered by many observers to be more successful in involving parents, and in working with professionals. Many medical consultants reported that health programs operating under CAA auspices tended to be more successful, from the standpoint of both doctors and parents, than those programs operating within the public school system.

This is not at all surprising, and has many implications for the Headstart graduate who must enter the public schools. Therefore, although it is not immediately pertinent to the bill under consideration today, I am attaching to this statement a proposal for continuation of Headstart in the first grade; that is, leaving the child in Headstart and introducing first grade curriculum materials.

Senator MONDALE. Would this be in lieu of first grade in an elementary school?

Dr. MENDELSOHN. Yes: and perhaps I could spend a few moments amplifying on that, even though it doesn't relate to the bill itself. The hypothesis begins with the recognition that the achievements gained by children in Project Headstart are lost shortly after entry into the public school system: there seems to be general agreement that the public schools do exert this kind of depressing influence on children in poverty populations, and there is also general agreement that impressive gains have been made by the children during the Headstart experience.

So, what I am suggesting is that we maintain all the Headstart children who are eligible for first grade in Headstart centers in which they are already located.

That would be about 100,000 children this year who have already had the full year Headstart program.

Senator MONDALE. When they complete the additional year, would they then go into the second grade?