RESILIENCE - HOW TO HELP OUR CHILDREN RIS ABOVE LIFE'S ADVERSITIES
Dr Natalie Ong
Registrar, Department of Paediatrics
The Children's Medical Institute, National University Hospital
All of us at one
time or another have come across people who have been dealt a bad
deal in life eg. poor health, lack of educational opportunities,
family discord, severe psychological trauma, extreme poverty,
famine, war and the like. Yet, strange as truth be told, some of
these ‘unlucky’ ones, despite all the odds have turned out
successful in life, in more ways than one. It has long been
postulated and proven that there are ‘resilient’ qualities or
factors which are the driving forces that mould the identity,
influences the life and shape the destiny of the human person.
The story of
tragedy to triumph
Hellen Keller was
born at the end of the 19th century and the story of her life has
been universally recognized as one of the greatest triumphs above
adversity of all time.
At 19 months of life
she was struck down by an illness which left her blind and deaf. At
the age of seven, her parents hired a fresh graduate teacher from
the Perkins school for the blind in an attempt to educate and
discipline her. Her difficulties in communication had resulted in
severe behavioural problems. Through Anne Sullivan’s guidance,
Hellen not only improved in her behaviour but made her breakthrough
discovery of language.
Within 4 months, she
had learnt a vast vocabulary and was learning to write.
9 years old - learnt speech
24 years old - graduated from Radcliffe college during which she
wrote her highly acclaimed “The Story of my Life”
39 years old – starred in Hollywood movie
41 years old – spokesperson for the American Association for the
Blind, travelling and speaking to raise funds for the organisation
50 years old – overseas travel for speeches
52 years – honorary degree of Doctor of Laws (University of Glasgow)
She interacted and
corresponded with dignitaries, and visited disabled soldiers during
World War 2. Her work with the AFB continued for many years. She had
written and published 13 novels some of which were bestsellers. She
passed away peacefully at the age of 88.
What makes a
child resilient?
Since the 1940s
researchers have extensively studied populations of children from
diverse backgrounds in order to find out what were the determinants
of a better outcome. A longitudinal study from Harvard led by one of
the pioneers in risk and resilience research, Norman Garmenzy looked
at ‘high risk’ children from a central metropolitan city found that
children who were deemed to be well adjusted had better temperaments
as babies, had mothers who thought they were more cuddly and
lovable. This raised the issue about whether the child’s innate
temperament resulted in them being treated with more affection or
the fact that their mothers were more attentive to them which made
them more secure emotionally.
The answer we now
know is that it involves both internal and external factors closely
intertwined. Numerous sociological studies done through the decades
all resound with the fact that there are ‘risk’ and ‘resilience’
factors interplaying in a child’s life that set the child on a
trajectory of good vs. bad developmental outcome.
List of Risk and
Resilience Factors
Biological
Makeup/ Genetics
High IQ, good
temperament / personality vs. Low IQ/Syndromes/ Congenital
illnesses
Family factors
Good parenting
Healthy bonds with caregiver
Extended family support
Cultural/ religious values vs. Single parent
Parent education/ employment
Marital problems
Mental illness
Alcohol/ drug use
Environmental
factors
Poverty
Housing
Access to health/ social services
Childcare/Preschool/ School experiences
Peer influence
Physical Factors
Nutrition, Health
and Disease etc.
Does the
magnitude of risk and resilience factors influence outcome?
Dunst and Trivette
(1994) looked at the relationship of risk/protective factors on
intellectual development of babies from birth to 18 months.
Mother’s education
Parent occupation
Marital status
Maternal psychosocial health
Maternal locus of control
Mother child interaction
Life events
Personal social network
Mean 18 month dev
index
-6 0 +6
no. of factors
Figure1.
There is a
correlation between presence of resilience factors with better
developmental outcomes and a negative correlation between risk
factors and developmental outcomes.
Halforn and Mclearn
2002 followed a group of children from birth to preschool age and
assessed them school readiness. Again they found certain risk and
‘opportunity’ factors that affect the ability of the child to attain
skills required for school readiness.
What was also
important to note was that the best outcomes for school readiness
were not of those who did not have any risk factors but for those
who had the most number of protective factors. These risk/
protective factors were pervasive in that the factors experienced at
a phase of life influenced the presence of other risk/ protective
factors later in life.
Sameroff, Gutman and
Peck (2003) looked at the effects of multiple risk factors on
adolescents development and functioning. A sample of 500 adolescents
were taken and questionnaires looking at
-
Family Processes
-
Patient
Characteristics
-
Family Structure
-
Management of
Community
-
Peers
-
Community
Adolescent
functioning were assessed by their parents and teachers looking at
-
Psychological
adjustment
-
Self competence
-
Behaviour
-
Activity
involvement
-
Academic
Performance
They found an
inverse correlation between healthy adolescent functioning with
increasing risk factors.
Norman Garmezy and
his colleagues have identified three major areas that tend to serve
as protective factors. These factors have been found to contribute
to success for children and youth, even when experiencing some
extreme hardships.
Reciprocal
Influences on Development
Not only do these
factors directly affect the child but in actual fact, from a
macroscopic perspective, there is a continuum of interplay of
factors ranging from genetics/ neurology to national/global effects
creating an ‘onion peel’ effect on the influences of these factos on
a child’s development. For example, having a civil war in the
country that a child lives in would have some indirect (eg. poor
access to health care) or direct impact (eg. parental death) on his/
her development trajectory.
GENE & NEURAL
ACTIVITY
vs
INDIVIDUAL BEHAVIOUR & FUNCTIONING
vs
FAMILY FACTORS
vs
COMMUNITY FACTORS
vs
NATIONAL FACTORS
vs
GLOBAL FACTORS
Are there some
factors more important or have greater impact on the child’s life
than others?
Studies show that
for infants, the biopsychosocial health of the mother is crucial in
determining developmental outcomes. There is mounting evidence that
poor bonding or constant changing of primary care givers can result
in the poor development of trust relationships and poor coping
skills and esteem.
In a recent study
done by the University of Minesota on homeless children in
Minneapolis, they found that homeless children had poorer outcomes
than children with homes with similar risk factors. When they
compared with parenting quality as a variable, those homeless
children with high quality parenting displayed better school
performance even when other factors eg. IQ, were taken into
consideration. Those with poor quality parenting showed more
behavioural problems and learning difficulties.
A recent study
reported by the National Institute of Health in the US stated that
in the group of 1000 children in childcare, the length of stay in
childcare produced more behavioural problems than when compared to
other factors like maternal depression and infant temperament. More
so the centre based child care had more behavioural problems than
the other forms of care arrangements. The strongest predictor of how
well a child behaves was maternal parenting (how sensitive was the
child’s mother to the child’s needs, moods, interests and
capabilities). Similary children of parents of higher income and
education were less likely to engage in problem behaviours. Majority
of problem behaviours were still considered in the ‘normal range’.
This raises the issue of whether these problem behaviours if not
addressed could lead to an increases risk of oppositional behaviours
and future antisocial behaviour but more long term studies are
required.
From Neurons to
Neighbourhood
JP Shonkoff.
Old and New challenges for Developmental and Behavioural Pediatrics
NRC/IOM 1997 -
Committee Integrating the Science of Early Childhood Development was
set up to:
Some core
concepts:
Children are active
participants in their own development
Development unfolds along individual pathways
Development is shaped by the ongoing interplay between sources of
vulnerability/ resilience
Timing of experiences matter but influenced by factors from
antenatal through to adulthood
Course of development can be altered by effective interventions that
change the balance between risk and protection thereby shifting the
odds in favour of more adaptive outcomes.
Some broad
themes:
Early environments
matter and nuturing relationships are essential
Society is changing and the needs of the young are not addressed
Interactions between early childhood science, policy and practice
are problematic – demand major rethinking
Some Conclusions:
Essential features
of the environment that influence the child’s development are their
relationships with the most important people in their lives.
How children feel
are as important as how they think with regards to school readiness.
Early childhood
programs that deliver carefully designed services can have sig.
positive impacts on children with developmental difficulties –
costly and difficult to implement.
Recommendations
- Education
reform of early
childhood educators – focus on social/ emotional competence not just cognitive
-
Supporting
families
– promote healthy relationships
-
Employment
climate
– economically feasible
- Early
identification/preventive strategies,
improve mental health services for the young traumatized - reduce criminal
violence
-
Invest in
healthy development
= economic productivity for the future
How can we learn
from these lessons?
In Singapore, not
unlike westernised countries, most young mothers contribute to the
workforce. Not only do parents both work but they spend long hours
at work often leaving their children to the care of a babysitter,
grandparent, maid or childcare setting.
An aging society,
families are under tremendous stress, with more old people than
young to support the economy and declining birth rates. The
productive income earners are stretched between caring for their
young, caring for their aging parents and holding down jobs to
financially support the family. Unfortunately, this leaves little
time for parents to spend time with their children and furthermore
not desiring to have more children due to the abovementioned
constraints. Government incentives to help increase birth rates so
far have been not very successful.
What support
services are available?
Under the umbrella
of the Ministry of Community Development and Sports, a variety of
family support services have been set up with the intent of
providing support for families and improving quality of life:
Family Services
Centre
Casework and counselling
Information and referral
Family life education programme
Outreach programmes
Healthy Start Program for high risk families
Various support
groups
Children’s literacy program
Family violence program
School social work
Each Community
Development Council - financial assistance
TOUCH Community
Centre:
Advisory for
caregivers of elderly, children with special needs and terminally
ill
Learning Centres
Childcares – Integrated (Special needs)
Home help services
Other: PCS, AWWA,
Good Shepherd sisters, Pertapis Shelter – for women and children
Worklife Strategy
Program –
(MCDS, MOM, SNEF, NTUC) provide consultancy services to employers
who wish to make their organisation more family friendly,
publications for guides for employers, how to set up telecommuting
and flexiwork, part-time and home working arrangements, etc.
Despite these well
planned and run services, the fact still remains is that most young
Singaporean families still struggle on their own with burgeoning
costs of living, increasing demands at work and lack of quality time
with their children to provide due parenting they so deserve.
What can parents
do?
-
Promoting
resilience by providing protective factors – effective parenting
-
Programs,
Publications, Counselling
-
Respond to
situations
-
Constructive
approaches
-
How they help
their child to respond to difficulties
-
Bullying in
school, grief, access to help
-
Collaboration
among family members, schools and community agencies
-
ensure positive
experiences and effectively dealing with negative ones
What can we do as
health providers and advocates for children?
1) Preschool
teacher training and education
2001 Pre-School
Qualification Accreditation Committee (PQAC) was set up to oversee
standards and quality of pre-school teacher training for both
kindergarten and child care sectors in Singapore (MOE/ MCDS). What
still needs to be seen is how these training standards translate to
practice.
- Survey of preschool teachers
knowledge in handling children with behavioural and developmental differences.
-
Better
streamlining the selection process of childcare and preschool
educators
-
‘Tag on’ model
experienced teachers
2) Opportunities
for parents to parent
-
Positive
parenting
-
Support groups
for mothers
-
System of
choosing childcare close to parents workplace
3) Promote family
friendly policies
-
Paternity leave
-
Flexible work
arrangement to be practised in more organisations and companies
-
Influence
‘grassroots’ MP to work towards family friendly policies in
society
References
- Tragedy to Triumph - Helen
Keller. In Search of the Heroes website. Grace Products Corporation.
- Masten A.S.,
Wright K.M., Garmezy N., Resilience and Development:
Contributions from the study of children who overcome adversity.
Developmental and Psychopathology;2:425-44.
- Dunst, C.
J., Trivette, C. M., & Deal, A. G. (Eds.) (1994). Supporting and
strengthening families. Cambridge, MA: Brookline Books.
- Shonkoff,
JP. From Neurons to neighbourhood: Old and new challenges for
Developmental and Behavioural Pediatrics. Dev Behav Peds 2003.
- Garmezy, N. Children in
poverty: Resilience despite risk. Psychiatry 1993;56:127-36.
- Sameroff.A,
Gutman,L.,Peck S.C Adaptation among youth facing multiple risks:
prospective research findings. Resilience and Vulnerability.
Adaptation in the Context of Childhood Adversities 2003.
- Flexible
Work Arrangements. Case Study Series 2001.
- Work – Life
effectiveness. A cutting edge strategy. MCDS Brochure.
- National Institute
of Health News Release: July 16, 2003
Child
Care Linked To Assertive, Noncompliant, and Aggressive Behaviors.
Vast Majority of Children Within Normal Range.
- Masten AS, Sesma Jr. A.
Risk and Resilience Among Children Homeless in Minneapolis.
University of Minnesota Center for Urban and Regional Affairs
Journal.
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