Five-year-old Naja Tunneyās home is filled with books. Sometimes she will pull them from a bookshelf to read during meals. At bedtime, Naja reads to her 2-year-old sister, Hannah.
āWe have books anywhere you sit in the living room,ā said their mother, Cheryl Tunney, who curls up with her girls on an oversized green chair to read stories.
Naja and Hannah are beneficiaries of Reach Out and Read, an early intervention literacy program that collaborates with medical care providers to provide free books when families come in for check-ups.
āI learn things that my brain will always know,ā Naja said during an appointment at Group Health Cooperativeās Capitol Clinic in Madison.
Najaās and Hannahās brains are in critical phases of development, and they are being stimulated by a home environment that prioritizes education.

But children who do not have this same experience early in life ā especially those growing up in poverty ā could experience delayed brain development that significantly harms their educational progress, according to recent research by psychology professor Seth Pollak and economist Barbara Wolfe at the University of Wisconsin-Madison.
Their study is part of a growing body of socioeconomic brain research documenting what Joan Luby, a child psychiatry professor at Washington University in St. Louis, calls āpovertyās most insidious damageā ā that poor children are up against their own biological development.
Along with graduate students Nicole Hair and Jamie Hanson, Pollak and Wolfe found that poverty can cause structural changes in areas of the brain associated with school readiness skills.
These parts of the brain are susceptible to circumstances often present in poor households, including stress, unstable housing, nutritional deficiencies, low academic stimulation and irregular access to health care.
To isolate the effects of poverty from other factors, the study included mostly children of educated mothers ā 85 percent reported at least some college-level education and 22 percent had some graduate-level education. Families with factors that could negatively affect brain development, such as a risky pregnancy or a history of psychiatric problems, were excluded.

The study examined brain development of 389 mostly white young people ages 4 to 22 with educated mothers. Household income ranged from less than $5,000 to between $100,000 and $150,000. The fathers had similar educational backgrounds.
The findings suggest that while schools have been the focus of reforms aimed at closing Wisconsinās long-standing racial and economic achievement gaps, efforts perhaps should start much earlier and be directed at raising income levels of poor children.
An estimated 28 percent of the stateās children live below 150 percent of the federal poverty level. Pollak found that income bracket ā which for a family of four is $36,450 a year or less ā was associated with diminished brain development and learning.
In a 2016 policy statement, the American Academy of Pediatrics calls the amount of child poverty in the United States āunacceptable and detrimental to the health and well-being of children.ā
Legislators on both sides of the aisle in Wisconsin are beginning to agree that more needs to be done to help children.
Pollakās study found that as much as 20 percent of the gap in test scores of low-income children is explained by developmental lags in the frontal and temporal lobes ā critical areas of the brain responsible for learning, including attention, emotion regulation, processing complex ideas, memory and comprehension. Children below 1.5 times the federal poverty level scored four to eight points lower on two standardized tests than children who were not poor.

These tests are the Wechsler Abbreviated Scale of Intelligence and the Woodcock-Johnson III Tests of Achievement. On both tests, a composite score between 90 and 110 is considered average.
Researchers also found that children from these poor households have less gray matter ā 3 to 4 percent below developmental norms for their sex and age. A larger gap of 7 to 10 percent was found in children living below the federal poverty level, $24,300 for a family of four.
āThis is suggesting that there is something about a childās early environment that is affecting the way their neural systems are working that undermine their ability to extract information and succeed in school,ā said Pollak, who is also the director of UW-Madisonās Child Emotion Lab.
Other research has shown a connection between early childhood trauma and ātoxic stressā on the ability of children to learn.
Gaps big in Wisconsin
Wisconsin has the largest disparity in the country between the performance of black and white students and the rate at which they graduate. The state also has the highest suspension rates for black high school students in the nation, the Wisconsin Center for Investigative Journalismās Children Left Behind series reported in December. Despite various local and state efforts, the pattern has not changed much over 20 years.

Wisconsin also has the second-largest poverty gap in the United States between blacks and whites, a disparity that has grown faster than the national average, according to a December report from the UW-Madison Applied Population Lab.
Pollakās study shows poverty can have biological effects long before children enter the classroom, strengthening the case that efforts to close the achievement gap should begin prior to a childās first day of school. Given the findings, it is ānot really a surprise,ā Pollak said, that children from low-income families are doing so poorly.
In 2013, in an earlier study, a team led by Wolfe and Pollak examined how family poverty can affect the rate of brain growth among young children.
They found that infants from lower-income families started life with a similar amount of gray matter to infants whose families were not poor. But by their toddler years, poor children had less total gray matter, they found.
Smaller volumes of brain tissue also were tied to greater behavioral problems in the preschool years, the 2013 study found. The effects of poverty on brain size were strongest among the most impoverished children.

āAs infants aged ā and presumably had increased exposure to the effects of their environments ā the differences in brain volume between poor children and those with greater resources widened,ā according to the study.
These studies provide a biomedical explanation for why poor children tend to do worse in school.
āIt is the delay of brain development that is accounting for the significant achievement test scores in children living in poverty,ā Pollak said. āNow we know that that achievement gap in poverty is at least partially explained by slower brain growth attributed to poverty.ā
The effects of poverty on the brain were concentrated among children from the poorest households, those below 150 percent of the federal poverty level. There was no difference between lower-middle-class children and those from affluent families.
āItās not like we need to get everybody up to affluence,ā Pollak said, āwe just need to have kids not living in scarcity.ā
Stress adds to school woes
While researchers now can point to poverty as a cause of developmental brain delays, they do not know what specifically about poverty is changing childrenās brains. Pollak theorized it could be the āpervading sense of stressā that can accompany poverty.
The prolonged activation of stress response systems, known as toxic stress, in a child without the buffer of a stable environment can disrupt brain development and cause other harmful consequences such as increased risk for disease into adulthood, he said.

āItās that whole atmosphere that is contributing to the way kids sleep, to the stress level, or the regulation level of the way they digest food and the way that they grow,ā Pollak said. āAnd that whole environment taken together, that it is poverty, and thatās what is actually affecting central nervous system development.ā
So-called adverse childhood experiences can rewire a childās brain in a way that makes it harder to learn, Dr. Bruce Perry told a group of Wisconsin juvenile court and child welfare officials meeting in Wisconsin Dells last fall.
Perry, professor of psychiatry and behavioral sciences at Northwestern University, emphasized that not all stress is bad.
āStress is what helps you develop. Stress makes you a better musician. Stress makes you a better athlete,ā Perry said. āStress makes you better. It is the pattern of stress that makes all the difference.ā
He explained that if the stress is āmoderateā and ācontrollable,ā children can develop successful mechanisms for responding to future, unexpected stresses. But other kinds of stress caused by factors such as violence or neglect in the home can create a state of alarm that makes children more reactive, often described as the fight, flight or freeze response.
When presented with new material in school, for example, such children may have a hard time activating the thinking part of the brain.
āIf you are a child who is dysregulated, and you are introduced to the very same challenge that the rest of the class is, you are so overwhelmed that you shut down your cortex completely and your cortex is unable to actually process information,ā Perry said.
āAnd in order to master the same content, you are required to have 10 times the repetition, which is not going to be provided in the typical classroom environment, and youāre going to fall further behind.ā
Parent, child brains linked
Not only are childrenās brains more malleable in early childhood, the brains of new parents are also subject to change, according to a June 2015 study from the Aspen Institute, an education and policy studies nonprofit organization based in Washington, D.C.
New mothers and fathers experienced structural changes during the first few months after their childrenās birth, according to the report, as their newbornsā brains are also developing ā emphasizing a need for a two-generation approach to early intervention.

āTrue two-generation interventions donāt say ⦠the parent is just a route to making the childās life better,ā said Dipesh Navsaria, a UW-Madison associate professor of pediatrics, who was not involved in the study. āThe parent and the child both have inherent value, and we should be investing in them both because ⦠thatās where we get an added effect.ā
Pollak explained that human brains develop structurally in an inside-out pattern. The frontal lobe behind the forehead controls behavior and attention ā skills children need in school ā and it develops later.
āBecause those parts of the brain are very late developing, they might be very vulnerable ⦠because theyāre growing a lot while children are encountering or not encountering things in the world,ā Pollak said.
Childrenās brains are in a constant state of growth, or plasticity, and they can tolerate a number of adverse experiences before long-term effects are seen, Pollak said. That resiliency means some effects can be reversed.
āItās just a question of whatās the cost of waiting longer and longer before we do something,ā Pollak said.
As Navsaria explained, it is more difficult to address a speech delay in an 8-year-old than a 3-year-old, and in a 3-year-old than an 18-month-old.
āThe upshot of this is that you have this fantastic opportunity in the first five years of life to wire things right, or if theyāre not wired right, to do remediation,ā Navsaria said. āIf we get it right early on, then we have a better likelihood of a good outcome.ā
Reading gateway to learning
Navsaria is also the medical director of the Wisconsin branch of the national Reach Out and Read program, which was examined as part of an October 2015 Aspen Institute report. There are about 160 Reach Out and Read programs and 50 clinics in training in Wisconsin.

The program distributes one book per well-child visit from ages six months to 5 years, for a total of 10 visits. The program costs about $20 per child, said Brian Gallagher, executive director of the national organization based in Boston. Clinics pay for the program through fundraisers, grants or by including it in their budget.
Francesca Vash, a nurse practitioner at Group Health Cooperativeās Capitol Clinic in Madison, said her patient population includes families who are transient or homeless with little access to books.
āNo matter the age of the child, I always talk about the importance of reading,ā Vash said.
By intervening through the health care system, Navsaria said, medical professionals can keep track of childrenās development and model reading techniques to parents in a consistent manner.
āI think it changes how people think about (achievement gaps) ā that it could be any one of us and it isnāt a moral failing, this isnāt some sort of irresponsibility, this is the effects of childrenās brains being under siege,ā Navsaria said.
āHuman capital being wastedā

Some experts say early interventions also are more cost-effective than remedial programs in adolescence and early adulthood.
University of Chicago economist James Heckman found it is cheaper to pay for high quality preschool than later interventions such as hiring teachers to create low student-to-teacher ratios, government-funded job training or rehabilitation programs for ex-convicts.
Heckmanās analysis of low-income African-American children who attended the High/Scope Perry Preschool Program in Ypsilanti, Michigan, during the 1960s found that every $1 invested returned about $7 to $12 back to society.
Investing in programs aimed at older individuals is still beneficial, he wrote, although the return is lower.
āInvesting in disadvantaged young children is a rare public policy initiative that promotes fairness and social justice and at the same time promotes productivity in the economy and in society at large,ā Heckman wrote.
Pollak said such research shows the āhuman cost to the human capital being wasted.ā
Bipartisan effort to combat poverty
Ed Hubbard, an assistant professor of educational psychology and the director of the Educational Neuroscience Lab at UW-Madison, said Pollakās research should serve as ammunition for policy changes for Republican and Democratic legislators alike.
āThese types of data put the ball squarely back in the politiciansā court,ā Hubbard said.
That appears to be happening in Wisconsin. State Sen. Julie Lassa, D-Stevens Point, and Rep. Joan Ballweg, R-Markesan, kicked off the bipartisan Legislative Childrenās Caucus in April.

Lassa said the goal is to advocate for evidence-based public policies that will benefit the stateās children.
To Lassa, Pollakās research provides proof that poverty harms children.
āTo me, there shouldnāt be any more arguing about the science,ā Lassa said.
āI think all together the work that (Pollak) is doing is helping us to bring awareness to the necessity to do more comprehensive help when it comes to children,ā Ballweg added.
The lawmakers said helping children could have long-term economic benefits.
Said Lassa: āThese children are our future workforce, theyāre our future leaders. ⦠We need to be making sure that they get the best start possible.ā
Cap Times reporter Abigail Becker wrote this story while working as an intern at the Wisconsin Center for Investigative Journalism. Wisconsin Public Radio reporter Bridgit Bowden and Center Managing Editor Dee J. Hall contributed to this report. The nonprofit Center (www.WisconsinWatch.org) collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the UW-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.


And every penny spent on this research went to families of affluent children led by highly educated and involved parents.