Empathy on the table: How pre-K access impacts the world for years to come

The Senate soon will vote on whether the education of American children is at all important. And that has a huge impact on everyone for generations to come — but for reasons many may not expect.  

In the Build Back Better program passed by the House of Representatives recently, the House rules committee recently amended the universal pre-K inclusion that President Biden mentioned in his State of the Union address.  

Arguing then that “12 years is no longer enough today to compete in the 21st century,” the plan would provide two years of “universal, high quality” preschool for 3- and 4-year-olds, reaching approximately 5 million children in need who are not presently enrolled in such programs.  

According to a 2005 study that’s considered a classic, early childhood education carries numerous benefits: Children who participate in preschool are 28 percent more likely to finish high school and twice as likely to finish college. 

A recent analysis of 26 studies assessing the effects of universal preschool programs confirmed these findings and also showed benefits in total earnings over the lifespan, with a 31 percent decreased probability of being on public welfare as adults, especially among those of lower socioeconomic status. 

The more salient argument is that early childhood educational programs build empathy. Broadly defined, empathy is the ability to understand and share the feelings of another person. 

To a psychiatrist like me who has been practicing for 12 years, it’s infinitely more than that.  

In cognitive developmental theory, there’s a classic experiment that demonstrates when a person learns to take on the mindset of another person — to essentially live their experience differently from their own. The experiment is simple. 

Two fictional children — call them Sally and John — are playing with two baskets in a room while a third child, Ann, watches closely. Sally’s basket contains a ball. Sally then leaves the room. In her absence, John removes the ball from Sally’s basket and places it in his basket. Sally then re-enters the room. The question here for Ann is: “Where will Sally look for the ball?”  

Many presume she will look in her own basket — because that’s where she left it — unaware of the switch that John made.

Psychologists and psychiatrists call this developmental milestone “theory of mind” or “mentalizing.” That is the ability to recognize that others may have not just a difference of opinion from someone else, but a truly unique experience of events. Mentalizing is an essential component of empathic development, but it doesn’t develop all at once. Instead, it occurs over time, slowly, gradually, eventually.  

By adulthood, this ability has even broader utility. Mentalizing becomes the foundation for compassion, caring for a child or ailing parent, as well as conflict resolution. One study demonstrated that individuals with greater empathy offered more comprehensive and less defensive apologies toward friends and romantic partners for unresolved conflicts.

Conversely, lack of empathic connection hinders interpersonal development, fosters maladaptive coping patterns towards stress, increases rates of aggression and incarceration and is central to the development of certain mental illnesses. 

But when does a child learn empathy? It turns out it’s earlier than someone might think.  

In my household, we have three children, six years of age or younger, so accidents are bound to happen. Often, what can’t be fixed with a Band-Aid almost certainly can be fixed with an ice pack.

Recently when my 6-year-old son took a toy from our 4-year-old daughter, my wife and I heard her burst into tears. Our younger son, Gavin, 2, took notice and read the distress on her face, so he raced to the freezer exclaiming, “I’ll get the ice pack, Ella!”  

It was endearing; he saw the hurt, but it was a different kind of hurt — emotional hurt — which can sting more than a bruised knee or paper cut on a finger.

Research shows that infants recognize distress in other babies and preferentially associate with prosocial peers rather than anti-social ones. And with the right supportive relationship and nurturing environment, many children gravitate towards empathy.

Directly witnessing the emotional reactions of peers at an early age and direct exposure to teachers who constructively frame these reactions has substantial import on a child’s ability to self-regulate their behavior and mood later in life.  

With these obvious benefits, it is unconscionable that access to early childhood education remains an option only for those who can afford it. Income gaps and racial and other inequities too often make preschool out of reach for those children with the most dire need, such as those with early adverse childhood experiences or other forms of ongoing stress, particularly children of color.  

The aftermath is tragic with negative effects on health, educational attainment and criminality, all of which further perpetuate an already entrenched powerhouse of structural racism.

A mentor shared with me in training, “You do your patients a great service by remaining in the position of being curious.” My mother taught me the same thing even earlier — “Cada cabeza es en mundo,” meaning, “Every head is its own world.”  

Empathy-building early in life cultivates this curiosity about others and is overdue in our nation’s school system. Universal preschool is a viable platform for America’s children to grow and develop themselves in this task. Everyone in society — not just the children enrolled — will be better for it.  

Charles Hebert, MD, is director of the Psychiatric Consultation Service and associate professor of psychiatry and behavioral sciences at Rush University Medical Center, and a Public Voices Fellow of The OpEd Project.