Handbook of Resilience in Children

Sam Goldstein · Robert B. Brooks Editors

Second Edition Handbook of Resilience in Children

Sam Goldstein • Robert B. Brooks Editors

Handbook of Resilience in Children

Second Edition Editors Sam Goldstein Robert B. Brooks Neurology, Learning Department of Psychology and Behavior Center McLean Hospital and Harvard Salt Lake City, UT 84102, USA Medical School Belmont, MA 02498, USA

ISBN 978-1-4614-3660-7 ISBN 978-1-4614-3661-4 (eBook) DOI 10.1007/978-1-4614-3661-4 Springer New York Heidelberg Dordrecht London

Library of Congress Control Number: 2012940932

© Springer Science+Business Media New York 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com) This work is dedicated with love to my partner Sherrie. You never really know you’re unhappy until you are ﬁ nally happy.

Sam Goldstein With love and appreciation to my wife Marilyn, my sons Rich and Doug, my daughters-in-law Cybèle and Suzanne, and my grandchildren Maya, Teddy, Sophie, and Lyla, all of whom are a source of joy in my life.

Robert B. Brooks This volume is also dedicated to the memory of Dr. Howard Kaplan, a distinguished contributor to both editions of our Handbook. At the time of his passing he was a Distinguished Professor of Sociology at Texas A&M University, the Mary Thomas Marshall Professor of Liberal Arts, a Regents’ Professor, and Director of the Laboratory of the Studies of Social Deviance of the Department of Sociology. Among his accomplishments, Howard spent the last 37 years following the outcome of a group of seventh graders he began studying in 1971. His contribution to the ﬁ eld will be remembered and his wit and wisdom will be missed.

Robert B. Brooks Sam Goldstein

Preface

A 5-year-old child watched helplessly as his younger brother drowned. In the same year, glaucoma began to darken his world. His family was too poor to provide the medical help that might have saved his sight. His parents died during his teens. Eventually he found himself in a state institution for the blind. As an African American, he was not permitted to access many activities within the institution, including music. Given the obstacles he faced, one would not have easily predicted that he would someday become a world renowned musician. This man’s name is Ray Charles. His life story, similar to many other individuals who faced great emotional, physical, and environmental adversities, exempli fi es that some can and do survive and in fact thrive. Yet, many others who encounter similar patterns of problems struggle to transition successfully into their adult lives, often fi nding themselves adrift in poverty, despair, and psychiatric problems. A comparison of individuals who overcome numerous obstacles with those who do not invites several intriguing questions. What exactly do the survivors do that enable them to succeed? How do they think? What kinds of experiences do they have that may be absent in the lives of those who are not successful? Are some of these experiences unique to surviving in the face of adversity? How much of their survival can be predicted by genetics, parenting, education, mentoring, temperament, and/or mental health? In a world in which stress and adversity appear to multiply almost exponentially from one generation to the next, the answers to these and related questions have become increasingly important. This edited volume refl ects our efforts to address these questions. We met by chance at a national conference almost 20 years ago. The fi rst author was speaking about childhood disorders, including attention-defi cit hyperactivity disorder and learning disabilities. The second was discussing his increasing focus on the qualities that appeared to help children at risk overcome adversity. There was an instant connection as we realized after a combined 50 years of clinical practice that the best predictors of children’s functional outcome into adulthood lay not in relief of their symptoms, but rather in an understanding, appreciation, and nurturance of their strengths and assets.

vii viii Preface

In the past 20 years, our initial connection has evolved into a very close professional and personal friendship. We have spent countless hours elaborating ideas about the importance of a strength-based approach in our work and our lives. We have coauthored fi ve books focusing on the process of resilience across the life span, a school consultation text built on our resilience model, three texts incorporating the resilience model to help parents of children with problems such as anxiety, learning disability, and anger, and numerous trade and professional articles as well as the fi rst edition of this volume. We have developed a parenting curriculum for nurturing resilience in children and created an award-winning documentary. Throughout this work, we have come to realize the importance of thinking, feeling, and behaving in certain ways as a means of successfully and happily negotiating life. Increasingly these qualities of success have found themselves under an umbrella of resilience. A resilient mindset, the ability to cope with and overcome adversity is not a luxury or a blessing possessed by some, but increasingly an essential component for all. This emerging fi eld of study, which once focused only upon those who confronted and overcame adversity, has found universal appeal as researchers and clinicians examine how the qualities of resilience may be applied to all individuals, even those who have not experienced signi fi cant adversity. What we have learned and still must learn from studying children who have overcome great hardships can be applied to enhance the lives of all children. It is not diffi cult to understand and accept that helping individuals develop such characteristics of resilience as dealing effectively with stress and pressure, coping with everyday challenges, bouncing back from disappointments, adversity, and trauma, developing clear and realistic goals, solving problems, relating comfortably with others, and treating oneself and others with respect are important ingredients to a satisfying life. As this second edition volume will attest, numerous scientifi c studies of children facing great adversity in their lives support the basic premise that resilience is an important and powerful force, worthy of the attention it is receiving. Resilience appears to explain why some children overcome overwhelming obstacles, sometimes clawing and scrapping their way to successful adulthood, while others become victims of their early experiences and environments. Yet as you will read, there is still much to be understood about the processes that mediate and shape resilience. As we have written elsewhere, our belief as well as the belief of others in the signifi cance of resilience emerged slowly. This slow recognition resulted in many children and their families not being helped as effectively as they might have had a strength-based model been in place. Re fl ecting on our years of clinical practice, we realize that many children suffered because well- meaning parents and professionals expended time and energy to fi x defi cits rather than giving at least equal weight to building assets. The focus of parents, clinicians, and educators on fi xing children’s problems is not dif fi cult to understand. As professionals, we came by this bias honestly. It is how we were trained. We were taught to identify that which is different in a negative way and prescribe interventions to reduce symptoms or problems. Preface ix

The professional fi eld has come to increasingly realize that this “de fi cit model” is fi ne for identifying how and why individuals are different, even for prescribing strategies to improve those differences. However, we now believe and are setting out to scienti fi cally demonstrate that our highest goal, namely, to improve the future of all children, is best accomplished by identifying and harnessing their strengths and shaping resilient qualities. The defi cit model has fallen far short in helping to achieve this goal. Symptom relief has simply not been found to be robustly synonymous with changing long-term outcome. We have come to appreciate that the qualities of resilience examined scienti fi cally in this volume can in fact protect and insulate not only children at risk, but all of us. We are extremely pleased and honored about the success of the fi rst edition of this volume and the opportunity to create an expanded and revised second edition. As with the fi rst volume, we are pleased by the interest and willingness of our authors to share their knowledge and insight. This second edition has added seven new chapters, multiple new authors, and expanded and revised past chapters. Our contributors represent a great diversity of backgrounds and research interests, but share a vision of the importance of understanding and harnessing the power of resilience. As with the fi rst edition, Part I begins with a number of background chapters. We offer a basic overview of resilience and reasons why resilience should be studied. Other authors describe resilient processes, the basic concept of resilience, and the processes of resilience differentially between genders. Drs. Margaret Wright and Ann Masten provide a comprehensive review of the study of resilience and its advancement through three major waves of research over the past 3 decades. Dr. Kirby Deater-Deckard and colleagues offer an integrated review of the resilience literature from a biopsychosocial perspective. This theme is exemplifi ed in a translational framework in Chap. 13 as Drs. Shadi Houshyar and Joan Kaufman provide an overview of resilience in the maltreated child. We are exceptionally pleased that Dr. Emmy Werner, one of the earliest and most renowned researchers in the area of resilience, provides a revised overview of what we have learned from large scale, longitudinal studies about resilience. Dr. Jack Naglieri brings his expertise in assessment and offers a review of the current science in measuring resilience and the prospective future of evaluating resilience in clinical practice. Part II continues with a section on environmental issues, including poverty, domestic violence and mental illness in parents, families as contexts for children’s adaptation, and children as victims. Part III applies resilience as a phenomenon in more traditionally defi ned clinical disorders, including delinquency and other disruptive disorders, depression as it relates to learned helplessness, learning disability, and youth with impaired self-control. Drs. Jane Gilliam, Karen Reivich , Tara Chaplin, and Martin Seligman discuss their work at the University of Pennsylvania and the increasing focus on resilience as a means of creating an optimistic mindset and effective functioning in the face of stress. Part IV dealing with assessment offers three new chapters to this volume. An overview of efforts to measure resilience and resilience-related processes x Preface are discussed as well as a number of promising new assessment tools. Part V focuses on resilience in clinical and school settings, offering a blend of revised and new chapters. These chapters represent our efforts at the beginning to create an applied psychology of resilience. A number of authors focus on the ways in which resilience theory can be used to enhance parenting, build self- esteem, provide educational opportunity, reduce schoolwide violence, and improve effective thinking. New to this edition are chapters by Dr. Beth Doll and Dr. Jonathan Cohen focusing on resilience processes in the classroom and school environment and Dr. David Crenshaw illuminating the treatment of traumatized children from a resilience framework. Part VI includes four revised chapters focusing on resilience theory to shape the future of children and adults, including public health and developmental theories. Drs. Emily Winslow, Irwin Sandler, and Charlene Wolchik describe a program to build resilience in all children through a public health approach. Drs. Maurice Elias, Sarah Parker, and Jennifer Rosenblatt describe a model to facilitate educational opportunity as a means of strengthening resilience. Drs. Jennifer Taub and Melissa Pearrow describe schoolwide violence prevention programs as a means of strengthening resilient outcomes. This second edition volume will again address which and by what processes variables within the child, immediate family, and extended community interact to offset the negative effects of adversity, thereby increasing the probability of positive development rather than dysfunction. Some of these processes likely re fl ect genetically inherent phenomena. Others involve the interaction of genetics and immediate environment, while still others re fl ect the impact of the extended environment. Some of these processes may serve to protect against the negative effects of stressors, while others may simply act to enhance development independent of the presence of stress. It is our intent that this is the second edition of many volumes to change the foundation of applied psychology. It is our hope that this volume will provide readers with new ideas and theories and a more precise way of understanding and helping children. As we wrote in our fi rst jointly authored text, Raising Resilient Children (2001), our worries for our children and their future are well founded. Yet there is reason to be optimistic about counteract- ing the negative in fl uences in their lives. While advances in technology are taking place at an incredible pace, we believe strongly the future lies not in technology but in our children, children instilled by their parents, teachers, educators, and other adults with the resilient qualities necessary to help them shape a future with satisfaction and con fi dence.

Salt Lake City , UT , USA Sam Goldstein , Ph.D Needham , MA , USA Robert B. Brooks , Ph.D

Bibliography

Brooks, R. & Goldstein, S. (2001). Raising resilient children . New York, NY: McGraw-Hill. Happiness is not the absence of problems but the ability to deal with them. H. Jackson Brown I have been sustained throughout my life by three saving graces—my family, my friends, and a faith in the power of resilience and hope. These graces have carried me through difﬁ cult times and they have brought more joy to the good times than I ever could have imagined. Elizabeth Edwards Promise me you’ll always remember: You’re braver than you believe, and stronger than you seem, and smarter than you think. Christopher Robin to Pooh (by A. A. Milne)

Acknowledgments

We would like to express our appreciation to Judy Jones for her conﬁ dence that we could create a second edition of this volume better than the ﬁ rst. Thanks also to the many professionals worldwide willing to share their exceptional theories, research, and ideas. Finally, thanks always to Ms. Kathy Gardner for coordination of authors and exceptional preparation of this manuscript.

Robert B. Brooks Sam Goldstein

xiii

Contents

Part I Overview

1 Why Study Resilience? ...... 3 Sam Goldstein and Robert B. Brooks 2 Resilience Processes in Development: Four Waves of Research on Positive Adaptation in the Context of Adversity ...... 15 Margaret O’Dougherty Wright, Ann S. Masten, and Angela J. Narayan 3 Reconceputalizing Resilience ...... 39 Howard B. Kaplan 4 Resilience in Gene–Environment Transactions ...... 57 Zhe Wang and Kirby Deater-Deckard 5 Relational Resilience in Girls ...... 73 Judith V. Jordan 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? ...... 87 Emmy E. Werner

Part II Environmental Issues

7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach to Understanding and Enhancing Resilience in Contexts of Disadvantage and Developmental Risk ...... 105 Robert D. Felner and Melissa DeVries 8 Family Violence and Parent Psychopathology: Implications for Children’s Socioemotional Development and Resilience ...... 127 Sara R. Jaffee

xv xvi Contents

9 Understanding and Promoting the Development of Resilience in Families ...... 143 Susan M. Sheridan, Tara M. Sjuts, and Michael J. Coutts 10 Resiliency in Maltreated Children ...... 161 Shadi Houshyar, Andrea Gold, and Melissa DeVries

Part III Resilience as a Phenomenon in Childhood Disorders

11 Resilience and the Disruptive Disorders of Childhood ...... 183 Sam Goldstein and Richard Rider 12 From Helplessness to Optimism: The Role of Resilience in Treating and Preventing Depression in Youth ...... 201 Karen Reivich, Jane E. Gillham, Tara M. Chaplin, and Martin E.P. Seligman 13 Resilience and Self-Control Impairment ...... 215 Wai Chen and Eric Taylor

Part IV Assessment

14 Measuring Resilience in Children: From Theory to Practice ...... 241 Jack A. Naglieri, Paul A. LeBuffe, and Katherine M. Ross 15 Assessment of Social-Emotional Competencies Related to Resilience ...... 261 Jack A. Naglieri, Paul A. LeBuffe, and Valerie B. Shapiro 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application ...... 273 Sandra Prince-Embury

Part V Resilience in the Clinical and School Settings

17 Resilience and Positive Youth Development: A Relational Developmental Systems Model ...... 293 Richard M. Lerner, Jennifer P. Agans, Miriam R. Arbeit, Paul A. Chase, Michelle B. Weiner, Kristina L. Schmid, and Amy Eva Alberts Warren 18 A Resilience Framework for Treating Severe Child Trauma ...... 309 David A. Crenshaw 19 Resilience and the Child with Learning Disabilities ...... 329 Nicole Oﬁesh and Nancy Mather Contents xvii

20 Promoting Educational Equity in Disadvantaged Youth: The Role of Resilience and Social-Emotional Learning ...... 349 Jazmin A. Reyes, Maurice J. Elias, Sarah J. Parker, and Jennifer L. Rosenblatt 21 Resilience Through Violence and Bullying Prevention in Schools ...... 371 Jennifer Taub and Melissa Pearrow 22 Caring for the Caregiver: Promoting the Resilience of Teachers ...... 387 Jennifer L. Fleming, Mary Mackrain, and Paul A. LeBuffe 23 Enhancing Resilience in Classrooms ...... 399 Beth Doll 24 Creating a Positive School Climate: A Foundation for Resilience ...... 411 Jonathan Cohen

Part VI Shaping the Future of Children and Adults

25 Positive Adaptation, Resilience and the Developmental Assets Framework ...... 427 Arturo Sesma Jr., Marc Mannes, and Peter C. Scales 26 The Power of Parenting ...... 443 Robert B. Brooks 27 Building Resilience in All Children: A Public Health Approach ...... 459 Emily B. Winslow, Irwin N. Sandler, Sharlene A. Wolchik, and Colleen Carr 28 Enhancing the Process of Resilience Through Effective Thinking ...... 481 Myrna B. Shure and Bonnie Aberson

Part VII Conclusions

29 The Future of Children Today ...... 507 Sam Goldstein and Robert B. Brooks

Erratum...... E1 Index ...... 511

Contributors

Bonnie Aberson , Psy.D., ABN. Joe Dimaggio Children’s Hospital , Hollywood , FL , USA Jennifer P. Agans, M.A. Tufts University , Medford , MA , USA Miriam R. Arbeit, M.A. Tufts University , Medford , MA , USA Robert B. Brooks, Ph.D. Department of Psychology, McLean Hospital and Harvard Medical School , Needham , MA , USA Colleen Carr Department of Psychology, Arizona State University , Tempe , AZ , USA Tara M. Chaplin , Ph.D. University of Pennsylvania , Pennsylvania , PA , USA Paul A. Chase Tufts University , Medford , MA , USA Wai Chen , Ph.D. Ashurst Hospital, Lyndhurst Road, Southampton, MRC SGD, Institute of Psychiatry, King’s College London, UK Jonathan Cohen , Ph.D. National School Climate Center , New York , NY , USA Michael J. Coutts , M.Ed. University of Nebraska , Lincoln , NE , USA David A. Crenshaw , Ph.D., ABPP. Children’s Home of Poughkeepsie, Poughkeepsie, NY, USA Kirby Deater-Deckard , Ph.D. Department of Psychology , Virginia Polytechnic Institute and State University , Blacksburg , VA , USA Melissa DeVries Neurology, Learning and Behavior Center, Salt Lake City, UT , USA Beth Doll , Ph.D. Educational Psychology, College of Education and Human Sciences, University of Nebraska, Lincoln, 238 Mabel, Lee Hall Lincoln, NE, USA Maurice J. Elias , Ph.D. Department of Psychology , Rutgers, The State University of New Jersey , Piscataway , NJ, USA Robert D. Felner University of Louisville , Louisville , KY , USA

xix xx Contributors

Jennifer L. Fleming , Ph.D. Department of Psychology, Devereux Center for Resilient Children , Villanova , PA, USA Jane E. Gillham , Ph.D. Department of Psychology, Swarthmore College, Swarthmore , PA , USA Andrea Gold , Department of Psychology, Yale University, New Haven, CT, USA Sam Goldstein , Ph.D. Neurology, Learning and Behavior Center , Salt Lake City , UT , USA Shadi Houshyar , Ph.D. Yale University School of Medicine , New Haven , CT , USA Sara R. Jaffee , Ph.D. Institute of Psychiatry , Kings College London , London , UK Judith V. Jordan , Ph.D. Jean Baker Miller Training Institute and Harvard Medical School, Lexington, MA, USA Howard B. Kaplan , Ph.D. Department of Sociology , Texas A&M University , College Station , TX , USA Paul A. LeBuffe Devereux Center for Resilient Children , Villanova , PA , USA Richard M. Lerner , Ph.D. Tufts University , Medford , MA , USA Mary Mackrain , M.Ed. Devereux Center for Resilient Children , Villanova , PA , USA Marc Mannes , Ph.D. Booz Allen Hamilton , Minneapolis , MN , USA Ann S. Masten , Ph.D. University of Minnesota , Minneapolis , MN , USA Nancy Mather , Ph.D. University of Arizona , Tucson , AZ , USA Jack A. Naglieri , Ph.D. University of Virginia, Charlottesville, VA, USA Angela J. Narayan University of Minnesota , Minneapolis , MN , USA Nicole O ﬁ esh , Ph.D. Stanford University, Stanford, CA, USA Sarah J. Parker , Ph.D. Department of Psychiatry , Columbia University , New York , NY , USA Melissa Pearrow , M.S. University of Massachusetts Boston , Boston , MA , USA Sandra Prince-Embury , M.S. The Resiliency Institute of Allenhurst, LLC , West Allenhurst , NJ , USA Karen Reivich , Ph.D. University of Pennsylvania , Pennsylvania , PA , USA Jazmin A. Reyes Department of Psychology, Rutgers, The State University of New Jersey , Piscataway , NJ , USA Richard Rider , Ph.D. Bellin Psychiatric Center , Green Bay , WI , USA Jennifer L. Rosenblatt , Ph.D. New York University Child Study Center , New York , NY , USA Contributors xxi

Katherine M. Ross , B.S. Devereux Center for Resilient Children , Villanova , PA , USA Irwin N. Sandler , Ph.D. Department of Psychology, Arizona State University , Tempe , AZ , USA Peter C. Scales , Ph.D. Search Institute , Minneapolis , MN , USA Kristina L. Schmid Tufts University , Medford , MA , USA Martin E.P. Seligman , Ph.D. University of Pennsylvania , Pennsylvania , PA , USA Arturo Sesma Jr. , Ph.D. St. Catherine University , St. Paul , MN , USA Valerie B. Shapiro , Ph.D. University of California , Berkeley , CA , USA Susan M. Sheridan , Ph.D. University of Nebraskan, Lincoln , NE , USA Myrna B. Shure , Ph.D. Drexel University , Philadelphia , PA , USA Tara M. Sjuts , M.A. University of Nebraska , Lincoln , NE , USA Jennifer Taub , Ph.D. Boston Chinatown Neighborhood Center, Inc., Boston , MA , USA Eric Taylor , Ph.D. MRC SGDP, Institute of Psychiatry, King’s College London, UK Zhe Wang Department of Psychology, Virginia Polytechnic Institute and State University , Blacksburg , VA , USA Amy Eva Alberts Warren , Ph.D. Tufts University , Medford , MA , USA Michelle B. Weiner Tufts University , Medford , MA , USA Emmy E. Werner , Ph.D. University of California , Davis , CA , USA Emily B. Winslow , Ph.D. Department of Psychology, Arizona State University , Tempe , AZ , USA Sharlene A. Wolchik , Ph.D. Department of Psychology, Arizona State University , Tempe , AZ , USA Margaret O’Dougherty Wright , Ph.D. Miami University , Oxford , O H , U S A Part I

Overview Why Study Resilience? 1 Sam Goldstein and Robert B. Brooks

The study of resilience traces its roots back a number of adversities they faced appears to be scant 50 years. Early on, the fi eld of study was not increasing. More youth are at risk. Second, there extensive and the number of researchers devoting has been an accelerated interest in not only under- their careers to the examination of this phenome- standing risk and protective factors and their non was fairly small. The fi eld, as Michael Rutter operation, but in determining whether this infor- noted in 1987, refl ected not so much a search for mation can be distilled into clinically relevant factual phenomena but “for the developmental interventions (e.g., Fava & Tomba, 2009 ; and situational mechanisms involved in protec- Wolchik, Schenck, & Sandler, 2009 ) that may not tive processes” (p. 2). The interest was and is not only increase positive outcome for those youth just on what factors insulate and protect, but how facing risk, but also can be applied to the popula- they went about exerting their infl uence. tion of children in general in an effort to create, as Resilience studies were reserved for high-risk Brooks and Goldstein ( 2001 ) point out, a “resilient populations with a particular focus on those youth mindset” in all youth. demonstrating resilience or the ability to over- The importance of such a mindset goes hand come the emotional, developmental, economic, in hand with the perception that no child is and environmental challenges they faced growing immune from pressure in our current, fast-paced, up (Rutter, 1987 ) . stress- fi lled environment, an environment we The study of resilience has expanded have created to prepare children to become func- signifi cantly over the last 20 years. It is with a tional adults. Even children fortunate to not face greater sense of urgency that resilience research signi fi cant adversity or trauma, or to be burdened has accelerated. There are a number of reasons by intense stress or anxiety, experience the pres- for this phenomenon. First, as the technological sures around them and the expectations placed complexity of the late twentieth century increased, upon them. Thus, the fi eld has increasingly the number of youth facing adversity and the focused on identifying those variables that predict resilience in the face of adversity and developing models for effective application (Rutter, S. Goldstein (*) 2006) . The belief then is that every child capable Neurology, Learning and Behavior Center , of developing a resilient mindset will be able to Salt Lake City , UT 84102 , USA deal more effectively with stress and pressure, to e-mail: [email protected] cope with everyday challenges, to bounce back R. B. Brooks from disappointments, adversity, and trauma, to Department of Psychology, McLean Hospital develop clear and realistic goals, to solve prob- and Harvard Medical School , 60 Oak Knoll Terrace , Needham , MA 02478 , USA lems, to relate comfortably with others, and to e-mail: [email protected] treat oneself and others with respect.

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 3 DOI 10.1007/978-1-4614-3661-4_1, © Springer Science+Business Media New York 2013 4 S. Goldstein and R.B. Brooks

A number of longitudinal studies over the wellness included four basic concepts: competence, past few decades have set out to develop an resilience, social system modi fi cation, and empow- understanding of these processes, in particular erment. Cowen suggested that although wellness at the complex interaction of protective and risk the time continued to refl ect an abstract concept, factors with the goal of developing a model to the pursuit of research in each of these four areas apply this knowledge in clinical practice held promise in developing a scientifi c, reasoned, (Donnellan, Coner, McAdams, & Neppl, 2009 ; and reasonable model to ensure psychological Garmezy, Masten, & Tellegen, 1984 ; Luthar, health. In 1994, elaborating further on the concept 1991 ; Rutter, Cox, Tupling, Berger, and Yule, of wellness, Cowen again emphasized the impor- 1975 ; Rutter and Quinton, 1984; Werner and tance of resilience within the broader concept of Smith, 1982, 1992, 2001 ) . These studies have wellness. For Cowen a wellness framework made major contributions in two ways. First, assumes the development of healthy personal envi- they have identifi ed resources across children’s ronmental systems leading to the promotion of lives that predicted successful adjustment for positive well-being and the reduction of dysfunc- those exposed to adversity, and second, they tion. A wellness framework emphasizes the inter- began the process of clarifying models of how action of the child in the family, academic setting, these protective factors promote adaptation with adults outside of the home and with peers. (Wyman, Sandler, Wolchik, and Nelson, 2000 ) . Clearly, Cowen suggests a personÐenvironmental Whether these processes can be applied to all interaction, one that ultimately predicts the strength youth in anticipation of facing adversity remains and power of an individual’s resilience in the face to be demonstrated (Ungar, 2008 ) . Masten (2001 ) of adversity (Cowen, 1991 ) . suggests that the best recent evidence indicates Additionally, the absence of pathology does that resilience processes are not only effective but not necessarily equate with psychological well- can be applied, as demonstrated in the recovery ness. This concept continues to represent a chal- to near-normal functioning found in children lenge for many mental health disciplines adopted away from institutional settings, charac- (Lorion, 2000 ) . Mental health professionals are terized by deprivation. The positive outcome for trained to collect data through a variety of means many Romania adoptees appears to refl ect this to measure symptoms. Such symptoms are process (Beckett, et al., 2006 ; Kreppner, et al., equated with poor adaptation, inadequate adjust- 2007 ; Masten, 2001 ) . Aames (1997), as cited in ment, distress, and life problems. Emphasis on Rutter and the English and Romania Adoptees the negative equates with the perception that Study Team ( 1998 ) , documents a signi fi cant symptom relief will ultimately lead to positive degree of developmental catch up cognitively and long-term outcome. In fact, the accepted nosol- physically in many of these children. ogy of the mental health system is a model that The process of creating a clinical psychology of refl ects assessment of symptoms and severity resilience must begin with an understanding of the packaged into what at this point are weakly factor- relevant variables and an appreciation and acknowl- analyzed frameworks (American Psychiatric, edgement of certain key phenomena. The process 2000) . Still unavailable, however, is a nosology of resilience fi rst and foremost, for example, repre- and system to measure adaptation, stress hardi- sents a biopsychosocial process. Such a process ness, and the qualities necessary to deal suc- takes into account a range of biological, psycho- cessfully with and overcome adversity. Yet in logical, and social factors each with multidirec- clinical practice, it is increasingly recognized tional infl uence in contributing to adequate that it is these phenomena rather than relief of functioning over time (Sameroff, 1995; Sroufe, symptoms or the absence of certain risk factors 1997 ) . Such a model must also begin with a basic that best predicts adaptation, stress hardiness, foundation examining and appreciating the concept and positive adult adjustment. of wellness. In 1991 Emery Cowen, writing on the As Cowen pointed out in 1994, mental health as concept of wellness in children, suggested that a a discipline must expand beyond symptom-driven comprehensive approach to the promotion of treatment interventions if the tide of increasing 1 Why Study Resilience? 5 stress and mental health problems in children are adult behavior further in fl uence that behavior. to be averted. There must be an increased focus on This model is consistent with artifi cial intelli- ways of developing an understanding of those gence researcher, Gary Drescher’s observation, factors within individuals, in the immediate envi- suggesting that human beings are “choice- ronment, and in the extended environment that machines.” That is, they act partly in response to insulate and prevent emotional and behavioral dis- genetically driven imperatives but generate rea- orders. Understanding these phenomena are as sons for acting as they do. These reasons are not important as developing “an understanding of the hard wired but are responsive and modifi able to mechanisms and processes de fi ning the etiological the environment and help guide future behavior path by which disorders evolve and a theory of the (Dennett, 2003 ) . solution, conceptual and empirically supported or Finally, with a strong genetic infl uence, chil- supportable intervention that alters those mecha- dren consistently move towards attempting to nisms and processes in ways which normalize the develop normal homeostasis. In this model, a underlying developmental trajectory” (Cowen, 1994 , single potential traumatic experience would not p. 172). be expected to lead to a chronically poor out- Meta-analytic studies of preventive interven- come. Instead it would be the cumulative, persis- tion effectiveness have generated increasing evi- tent, and pervasive presentation of stressors that dence of the ability to reduce the numbers of promote risk. Within this type of conceptualiza- youth with certain emotional and psychiatric tion, risk falls within three dimensions: (1) exter- problems through an understanding of the forces nal risk as opposed to protection, (2) vulnerability that shape life outcome. As Emmy Werner has as opposed to invulnerability, and (3) lack of pointed out, “beating the odds” is an attainable resilience as opposed to resilience (Greenbaum goal. Researchers have made an effort to address & Auerbach, 1992 ) . Within such a model, a the complex biopsychosocial phenomena that number of assumptions are made. These include: infl uence the incidence and prevalence of emo- (1) early nurturing and age-relevant stimulation tional and behavioral problems in youth with an that provides protection by decreasing vulnera- eye towards developing a “science of prevention” bility (Bakermans-Kranenburg, van Ijzendoor, (Coie et al., 1993 ) . Pijlman, Mesman, & Juffer, 2008 ) and (2) risk- Resilience is suggested as but one of a number protection factors that are interactive. That is, of constructs that protect or reduce vulnerability. factors within the child will interact and augment Lösel, Bliesener, and Köferl ( 1989 ) suggested factors within the environment. This is likely that other protective factors include hardiness, true for risk factors as well; (3) vulnerability can adaptation, adjustment, mastery, good fi t between be reduced and resilience increased by the intro- the child and environment, and buffering of the duction of additional protective factors; (4) risk environment by important adults in the child’s and protective factors interact with a number of life. As Sameroff (2000 ) points out, a transac- variables such as length of exposure, time of tional view of development suggests that a com- exposure, contributing to outcome; and (5) limited bination of factors within the child and exposure to risk may in fact increase but not environment are mutually interactive over time. guarantee stress hardiness. Within these theo- With appropriate responsive and adequate care retical models, all of which will be discussed taking and environment in which mutual adapta- and reviewed in this text, the concept of resil- tions can occur, the odds favor good outcome ience appears to play a major role. Within a (Campbell, 2002 ) . In such a model, development wellness model, therefore, it is deserving of an is assumed to be discontinuous, characterized by identity and fi eld of study. qualitative change and reorganization. Children The concept of resilience is fairly straight- are viewed as active organizers of their experi- forward if one accepts the possibility of develop- ences and their interactions with others are ing an understanding of the means by which viewed as bidirectional. Children’s responses to children develop well emotionally, behaviorally, 6 S. Goldstein and R.B. Brooks academically, and interpersonally either in the and protective factors that combines to predict face of risk and adversity, or not. Such a model outcome (e.g., Kim-Cohen & Gold, 2009 ) . would offer valuable insight into those qualities Within this framework, resilience can be that likely insulate and protect in the face of de fi ned as a child’s achievement of positive wide and varied types of adversities, including developmental outcomes and avoidance of mal- children experiencing medical problems (Brown adaptive outcomes under adverse conditions and Harris, 1989 ) , family risks (Beardslee, 1989 ; (Rutter, 2006 ; Wyman et al., 1999 ) . Within a clin- Beardslee & Podorefsky, 1988; Hammen, 1997 ; ical framework, a resilient mindset may be Worsham, Compas, & Ey, 1997 ) , psychological defi ned as the product of providing children with problems (Hammen, 1997 ; Hauser, Allen, & opportunities to develop the skills necessary to Golden, 2006 ) , divorce (Sandler, Tein, & West, fare well in the face of adversity that may or may 1994 ) , loss of a parent (Lutzke, Ayers, Sandler, not lie in the path to adulthood for that individual. & Barr, 1999 ) , as well as school problems The study of resilience has overturned many neg- (Skinner & Wellborn, 1994 ) . Competent, appro- ative assumptions in de fi cit-focused models about priate parenting, for example, that which pro- “the development of children growing up under vides a democratic or authoritative model, the threat of disadvantage and adversity” (Masten, parental availability, monitoring, and support, 2001 , p. 227). are powerful protective factors reducing the risk Finally, within the broader framework, the of antisocial behavior (Dubow, Edwards, & incorporation of resilience research into clinical Ippolito, 1997 ; Masten et al., 1999) . In fact, it practice may be based on four key assumptions appears to be the case that youth functioning as described by Benard, Burgoa, and Whealdon well in adulthood, regardless of whether they ( 1994) . First, resilience helps to build communi- faced adversity or not, may share many of the ties that support human development based upon same characteristics in regards to stress hardi- caring relationships. Second, resilience meets ness, communication skills, problem solving, youth’s needs for belonging and stability. Third, self-discipline, and connections to others. resilience is supported in the lives of practitioners Though the earliest studies of resilience sug- as well. Fourth, resilience validates the wisdom gested the role of “exceptional characteristics” of the heart or an intuitive, innate set of practices within the child that led to “invulnerability” to guide clinical intervention. (Garmezy & Nuechterlein, 1972 ) , it may well be that resilience re fl ects very ordinary development processes to explain adaptation (Masten, A Cascade of Risk 2001 ; Masten & Coatsworth, 1998) . Though, as noted, a focus on symptoms and symptom Though children by their very nature have been relief, that is one assessing risk alone, may be vulnerable to a variety of risks throughout satisfactory for identifi cation of immediate needs recorded history, perhaps advanced technological and diagnoses within a psychopathology model, societies create new and different risks for chil- such data are necessary though not suf fi cient dren. Poverty, for example, has likely been a risk to improve future functioning. It has been factor for children throughout history, yet the well documented that not all children facing manner in which it impacts children may be dif- signi fi cant risk and adversity develop serious ferent as times change. Beginning with the work adolescent and adult psychiatric, lifestyle, and of Pavenstedt (1965 ) , examining children reared academic problems. Risk factors also do not in poverty and well articulated by Garmezy and appear to be specifi c to particular outcomes but Nuechterlein (1972 ) , researchers have questioned relate to more broad developmental phenomena. the processes by which individuals at risk for It is likely, as noted, that there is a complex, mul- psychiatric conditions might be buffered or insu- tidimensional interaction between risk factors, lated developing these conditions or experiencing biological functioning, environmental issues, them to a greater degree of severity should they 1 Why Study Resilience? 7 present. Epstein ( 1979 ) wrote of children exposed States live in low-income families. This comprises to trauma in the Holocaust, examining the vari- 27 million children. Forty percent of children ables that helped some survive. In many of these under the age of six live in homes with an income studies, positive, yet unexpected outcomes were below $27,000 per year for a family of four. considered interesting anomalies but not neces- Sixteen percent of children or over 11 million sarily important data. Over time came growing live in homes that are below the federal poverty recognition and acceptance that the ability to level. Six percent of children or fi ve million live remain competent under adversity is not a ran- in extreme poverty. Finally, the poverty rate is dom occurrence but one that can be investigated, highest among African Americans (30%) and understood, and instilled in others (Garmezy & Latinos (28%). Rutter, 1983 ) . According to the Center for Disease Control Researchers have identi fi ed two distinct types and Prevention National Household Survey of of risk factors facing youth. The fi rst kind refl ects Drug Abuse, homicide is the second-leading cause the at-risk status of the general population such of death for all 15Ð24-year-olds. It is the leading as a child raised in a family with a depressed cause of death for adolescent African Americans mother or absent father. The second kind of risk and the second-leading cause of death for Hispanic includes those factors that distinguish more or youth. More than 400,000 youth in 2000 between less positive outcomes among either groups with the ages of 10 and 19 were injured as a result of specifi ed risks or those with seemingly little risk. violence. Over 800,000 children were documented In every case, each risk factor must be studied, victims of child abuse nationwide. understood, and then placed within a context of According to the Children’s Defense Fund other risk and protective variables. It is for this ( 2002) , an American child was reported abused reason that the scientifi c research of resilience is and neglected every 11 s. Over a half million so complex. This too is perhaps a consequence children in the United States are in foster care. of a complex, technologically advanced culture. An American child is born without health insur- A quick review of multiple risk statistics makes a ance every minute. Millions of children are strong case for developing a clinical psychology reported to lack safe, affordable, quality child of resilience. care and early childhood education while their According to the Center for Disease Control parents are at work. Seven and one-half million (2002 ) , at least 12% of students have considered children are at home alone without supervision suicide, with suicide being the third leading cause after school and almost 80% of children living at of death between the ages of 15 and 24, rare but or below the poverty level are in working house- increasing between the ages of 10 and 14. Three holds (U.S. Census, 2000 ) . million teenagers struggle at any given time with The Committee for Children at the National depression. Only one-third receive mental health School Safety Center (2002) reports that one out of services. every seven children reports being bullied at school. According to the Center for Disease Control In an average classroom there are at least three to and Prevention and the Substance Abuse and four victims or bullies. Many victims report self- Mental Health Services Administration ( 2002 ) , imposed isolation in response to bullying. one half of motor vehicle accidents in teens are According to Children’s Defense (2002 ) and associated with alcohol and drugs. Thirty percent the Youth Risk Behavior Surveillance System at of adolescent suicides are associated with alcohol the Centers for Disease Control ( 2002 ) , births to and drugs. Further, children and teens who abuse girls ages 15Ð19 have steadily declined in the alcohol and drugs engage in a variety of risk- past decade, but sexually transmitted diseases taking behaviors at a signi fi cantly higher rate among teenagers have increased. These statistics, than the general population. only a sample of an emerging trend, make a According to the National Center for Children strong case of the need to develop a clinical of Poverty (2002 ) , 37% of children in the United psychology of resilience. 8 S. Goldstein and R.B. Brooks

Individuals are not considered resilient if they Towards Defi ning a Clinical have not faced and overcome signifi cant adver- Psychology of Resilience sity considered to impair normal development. The second assumption involves an inference Within the materials sciences, resilience is about how one assesses good or adequate out- defi ned as the ability of a material to resume its come in the face of adversity. This continues to original shape or position after being spent, be a complex issue that is just now being stretched, or compressed. In part resilience within addressed empirically (Masten, 1999 ) . It contin- this framework is de fi ned by those properties that ues to be the case that most clinical practitioners contribute to the speed and amount of possible defi ne resilience on the basis of a child meeting recovery after exposure to stress. As previously the major requirements of childhood successfully discussed, the initial application of resilience into (e.g., school, friends, family) despite facing the clinical fi eld focused on the absence of clini- signifi cant life stress. Yet one must also consider cal diagnoses or psychiatric problems over time that a child facing multiple developmental adver- in the face of stress and adversity (Radke-Yarrow sities who does not develop signifi cant psychopa- & Brown, 1993 ) . Rutter ( 1990 ) suggested that thology but who may not demonstrate academic within the clinical realm resilience and vulnera- or social achievements may be resilient as well bility may be at the opposite ends of a continuum, (Conrad & Hammen, 1993 ; Tiet et al., 1998 ) . re fl ecting susceptibility to adverse consequences Bronfenbrenner and Crouter (1983 ) describe a at one end and neutral or positive consequences functional model for understanding the process of upon exposure to risks at the others. This concept resilience that may lend itself well to building a was further echoed by Anthony ( 1987 ) . As foundation for the clinical psychology of resil- Masten (2001 ) notes, “Early images of resilience ience. Their model contains four domains of in both scholarly work and mass media implied infl uence and two transactional points between there was something remarkable or special about domains. The four domains refl ect: (1) the acute these children, often described by words such as stressor or challenge, (2) the environmental con- invulnerable or invincible.” One of the fi rst popu- text, (3) an individual’s characteristics, and (4) the lar press articles dealing with resilience appeared outcome. Points of interaction re fl ect the con fl uence in the Washington Post on March 7, 1976. The between the environment and the individual as headline read, “Troubles a Bubble for Some well as the individual and choice of outcome. Kids.” Thus, within the clinical realm, the idea of These authors raise questions as to the exact mech- resilience re fl ected a process that was not neces- anisms by which stressors or challenges interact sarily facilitated through traditional psychothera- with the environment, the internal set of character- peutic or related intervention but rather was istics, both genetic and acquired, of the individual, refl ective of children who faced great adversity and the short-term processes individuals use to and in some internal way were special or remark- cope with stress and adversity. Interestingly, these able, possessing extraordinary strength to over- processes most likely re fl ect skills learned by the come adversity. The belief was that these individual through gradual exposure to increasing internalized qualities were somehow absent in challenges or stressors. This “stress inoculation others. Yet as Masten notes, resilience may be a model” (Richardson, Neiger, Jensen, & Kumpfer, common phenomenon resulting in most cases 1990 ) re fl ects Brooks and Goldstein (2001, 2003 ) from the operation of “basic human adaptational concept of building stress hardiness by helping systems.” When these operate, development is children develop a “resilient mindset.” successful even in the face of adversity. If these Within clinical populations, three types of pro- systems are impaired, children struggle. tective factors emerge as recurrent themes in most Masten and Coatsworth ( 1998 ) suggest that studies (Werner & Johnson, 1999 ) . The fi rst resilience within a clinical realm requires two re fl ects dispositional attributes of the individual major judgments. The fi rst addresses threat. that elicit predominantly positive responses from 1 Why Study Resilience? 9 the environment (e.g., easy temperament of the Youth demonstrating high competence despite child within a family facing signi fi cant stress). facing strong adversity, when compared to youth The second re fl ects socialization practices within equally competent facing low adversity, as well the family that encourage trust, autonomy, initia- as groups of youth with low competence facing tive, and connections to others. The third re fl ects equal adversity, re fl ect this process. Competent, the external support systems in the neighborhood low adversity as well as resilient youth appear to and community that reinforce self-esteem and possess average or better academic outcome, self-ef fi cacy. Werner and Smith ( 1993) point out conduct, and social histories. They appear to pos- from their longitudinal work the large number of sess very similar psychosocial resources, includ- variables, such as age, birth order, ages of siblings, ing better intellectual functioning, parent mental family size, and gender of the child that must be health, parental availability, and more positive taken into account when assessing the relative self-concepts. Though a heatedly debated phe- vulnerability or resilience of an individual grow- nomenon, strong intellect has been found to be a ing up in a family context of psychopathology or protective factor (Hernstein & Murray, 1995 ) . other risk. Such protective factors “moderate Intellectual aptitude appears to represent an against the effects of a stressful or stress situation important protective factor against the develop- so that the individual is able to adapt more suc- ment of conduct problems for children growing cessfully than they would have had the protective up in highly disadvantaged settings or with high factor not been present” (Conrad & Hammen, exposure to adverse life events (Masten et al., 1993 , p. 594). Protective factors thus represent the 1999; White, Moffi tt, & Silva, 1989 ) . However, opposite pole of vulnerability factors. there is no consensus on what de fi nes intellectual As discussed, the concept of resilience has not ability (Masten, 2001 ) . A strong performance on traditionally encompassed the potential of indi- tests of intellectual functioning could re fl ect viduals to survive risks should they arise. Anthony related neuropsychological factors, such as atten- (1987 ) , Brooks and Goldstein (2001 ) , and Rutter tion, memory, executive functioning, or, for that (2006 ) suggest that some individuals may appear matter, motivation. Strong performance on intel- resilient because they have not faced signi fi cant lectual and many of which are highly loaded on vulnerability, while others can be assessed for achievement tests, are also contributed to by the their potential to be resilient were they to face quality of the child-rearing environment . adversity. Defi ning risks and protective factors is A clinical psychology of resilience must also not a simple process. They are likely variable in be capable of defi ning and understanding the their presentation and in their impact on speci fi c multiple pathways by which outcome is achieved. individuals. Cicchetti and Garmezy ( 1993 ) point Cicchetti and Rogosch (1996 ) describe this pro- out that it is diffi cult at times to distinguish cess through the concepts of equi fi nality and between factors that place an individual at risk multi fi nality. Children may reach the same end and factors that happen to distinguish between point, in this case pathology or survival by dif- good or poor outcome but have no clear causal ferent routes. Children with apparently similar signifi cance. These authors caution, for example, risks and histories can have different outcomes. that “a child with a mother who has been As Rutter (1994 ) pointed out in 1994, outcome depressed will not necessarily experience poor is determined in part by the relative balance and quality of care giving” (p. 500). Competent youth interaction of risk and protective factors. The differ from those lacking competence, regardless more risk factors present, the more likely the of the level of adversity faced. Thus, even though outcome will be adverse (Greenberg, Lengua, resilient and maladaptive groups may experience Coie, & Pinderhughes, 1999 ) . It remains unclear, similar life histories of severe negative life expe- however, whether risk factors are equally potent rience, outcome for those who are resilient in their adversity or protective factors equally appears more similar to those who have not faced stress resistant in their presentation (Shaw & adversity (Masten et al., 1999 ) . Vondra, 1993 ) . We have yet to develop a science 10 S. Goldstein and R.B. Brooks to explain the manner by which biological fac- fact insulated or protected, seemingly invulnerable tors such as stress during pregnancy, premature from risks likely to overcome most others. It may birth, and genetic variations leading to learning be that these resilience qualities are the best pre- or related problems interact with family risk fac- dictors of positive adult outcome (Brodsky, 1996 ; tors such as neglectful or harsh parenting and Masten & Coatsworth, 1998 ) . inconsistent child care, with physical phenomena such as poor nutrition and educational and community experiences. It has yet to be truly The Synthesis of a Model understood the means by which a child growing up with learning disability in a poverty stricken In a review of successful prevention programs, home, in a high-risk neighborhood , with parents Schorr ( 1988 ) suggests that effective programs exhibiting mental illness can and does overcome for youth at risk are child centered and based these adversities and transitions successfully upon the establishment of relationships with into adult life. adults who are caring and respectful and who On a basic level it is still debated as to how build trust. In writing about single mothers and nature and nurture interact. How do genes and their children, Polakow (1993 ) suggests that ulti- environment in fl uence each other? How might a mately connections to people, interests, and to child’s genetically driven temperament in fl uence life itself may represent the key component in parent behavior, thus, in part, forming the basis resilient processes. This phenomenon is well for a child’s attachment and ultimately affecting articulated by Hallowell (2001 ) . As Michael parental behavior? Whether a continuous or dis- Rutter has pointed out, “Development is a ques- continuous process, children’s development is tion of linkages that happen within you as a per- impacted by a host of phenomena. The study of a son and also in the environment in which you clinical psychology of resilience will allow for the live” (as cited in Pines, 1984 , p. 62). “The com- examination of the means by which biological, plexity of risk and resilience processes operating environmental, and related factors interact. For in multiple embedded systems of development in example, children who are active or irritable tem- diverse contexts calls for the expertise of more peramentally may be more likely to continue to than one discipline whether the goal is to advance respond maladaptively in the face of ineffective empirical knowledge or to change the course of parental behavior than children who do not dem- development through intervention” (Masten, onstrate these patterns of temperament. Such chil- 1999 , p. 254). dren may be more sensitive to environmental risk Yet, if challenges are too severe normal pro- factors (Belsky, Woodworth, & Crnic, 1996 ) . cesses break down (Baldwin et al., 1993 ) . Finally, a clinical psychology of resilience Baldwin et al. describe resilience as “a name for must incorporate an understanding of the process the capacity of the child to meet a challenge and of human development. Many of the great devel- to use it for psychological growth” (p. 743). In opmental theorists have assumed that human their description of an applied resiliency model, growth is in part driven by a need to cope, adapt, stressors are life challenges that if not balanced and develop a health homeostasis (Lorion, 2000 ) . by external protective processes or resiliency fac- Across theoretical models resilience as encom- tors within the individual lead to a disruption in passed within a wellness model is characteristic functioning. Flach ( 1988 ) suggests that this proof positive adaptation. Thus, the absence of symp- cess is not unidirectional but individuals can toms should not be equated with resilience or for recover and function better as risks reduce and that matter good functioning (Luthar & Brown, protective factors are introduced. It may well be, 2007 ) . Studies of youth capable of overcoming a as Tarter (1988 ) noted, that vulnerability is “a variety of unfavorable environmental phenomena characteristic that predisposes an individual to a are con fi rmatory that resilience in fact operates negative outcome” (p. 78). Thus, a particular fac- for some but not for others. Some youth are in tor creates vulnerability but does not necessarily 1 Why Study Resilience? 11 defi ne the level of vulnerability experienced by a poverty. These researchers and others have noted particular individual. Shared and nonshared envi- a diverse set of protective factors that often relate ronments likely also play moderating roles in to close relationships with prosocial and caring determining risk and protective factors for par- adults (Masten, Best, & Garmezy, 1990 ) . Finally, ticular individuals. Resilience perhaps is best there is increasing research refl ecting primarily understood as a product of phenotypeÐenviron- genetic-driven phenomena that either predispose ment interaction (Tarter & Vanyukov, 1994 ) . This individuals to stress hardiness or risk in the face phenomenon, referred to as epigenesis, likely of adversity. These types of cumulative risk and offers the best understanding of the individual protection models form the basis of what is hoped effects risk and protective factors have in shaping to be the future state of clinical psychology of resilience. Such a phenomenon must be under- resilience and treatment for youth at risk stood if it is to be applied effectively in a clinical (Yoshikawa, 1994 ) . framework. This volume addresses which and by what Given the complexity of the human species processes variables within the child, immediate and the culture we have created, there is a need to family, and extended community interact to off- view the accomplishment of wellness and resil- set the negative effects of adversity, thereby ience from a multifaceted developmental and increasing the probability of positive develop- dynamic perspective (Masten & Coatsworth, ment rather than dysfunction. Some of these pro- 1998 ) . The behavioral and emotional problems of cesses may serve to protect the negative effects of children, the nature of our culture, risks such as other stressors while others simply act to enhance emotional or physical abuse all present as development regardless of the presence of stress. signi fi cant challenges. None have single or sim- As Seligman has pointed out (1998a, 1998b ) , ple etiologies or solutions. All appear to arise attending to those issues that are preventative and from a complex interaction of biological, envi- that create a resilient mindset and wellness will ronmental, and cognitive in fl uences. All of these require a signifi cant paradigm shift in mental in fl uences to some extent are idiosyncratic to the health professionals and the community at large. individual. Seligman has suggested the shift will not be easy Many risk factors such as poverty or neighbor- to make. While professionals may be “ill- hood adversity cannot easily be ameliorated. equipped to do effective prevention” (1998a , p. 2) Though the process of resilience may refl ect “the at this time the development of a clinical psychol- power of the ordinary” (Masten, 2001 ) , there ogy of resilience would appear to offer the best must be an increasing focus on understanding the hope of forming a cornerstone for the develop- protective variables that allow some children to ment of a “positive social science.” function well in these environments and continue to function well in the future. Just as risk factors are not speci fi c to particular adverse outcomes, References protective factors may also not be equally speci fi c. The “ordinary magic” that Ann Masten so elo- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., quently writes about becomes an elusive phe- text revision). 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Margaret O’Dougherty Wright , Ann S. Masten , and Angela J. Narayan

How do children and adolescents “make it” when disease-oriented biomedical model that located their development is threatened by poverty, the source of illness within the individual. neglect, maltreatment, war, violence, or exposure However, the fi rst investigators to explore the to oppression, racism, and discrimination? What phenomenon of resilience realized that models protects them when their parents are disabled by based primarily on predicting psychopathology substance abuse, mental illness, or serious physi- were limited in scope and usefulness, providing cal illness? How do we explain the phenomenon little understanding of how good outcomes were of resilience—children succeeding in spite of achieved by many of the children identi fi ed as “at serious challenges to their development—and put risk.” Such information was vital to the goal of this knowledge to work for the bene fi t of children intervening to improve the odds of good develop- and society? The scientifi c study of resilience mental outcomes among children at risk. One of emerged around 1970 when a group of pioneer- the great contributions of the early investigators ing researchers began to notice the phenomenon was their recognition and championing of the of positive adaptation among subgroups of chil- idea that understanding positive developmental dren who were considered “at risk” for develop- pathways in the context of adversity is funda- ing later psychopathology (Masten, 2001, 2012 ) . mentally important for preventing and treating The resilience research pioneers led a revolu- problems, particularly among children at risk for tion in thinking about the origins and treatment of psychopathology. psychopathology. The primary focus of earlier The study of resilience has advanced in four clinical research on children at high risk for psy- major waves of research. In this chapter we high- chopathology had been either to observe the con- light the concepts and fi ndings resulting from sequences of adversity or the unfolding of risk these waves to date, as they have shaped an processes accounting for the etiology of disor- emerging resilience framework for research and ders. Research efforts were directed towards practice. The fi rst wave of work yielded good understanding pathology and defi cits, rather than descriptions of resilience phenomena, along with on how problems were averted, resolved, or tran- basic concepts and methodologies, and focused scended. The fi eld of mental health at the time on the individual. The second wave yielded a was dominated by psychoanalytic theory and a more dynamic accounting of resilience, adopting a developmental systems approach to theory and research on positive adaptation in the context of M. O’Dougherty Wright (*) Miami University , Oxford , OH , USA adversity or risk, and focused on the transactions e-mail: [email protected] among individuals and the many systems in which A. S. Masten • A. J. Narayan their development is embedded. The third wave University of Minnesota , Minneapolis , MN , USA focused on creating resilience by intervention

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 15 DOI 10.1007/978-1-4614-3661-4_2, © Springer Science+Business Media New York 2013 16 M. O’Dougherty Wright et al. directed at changing developmental pathways. typically referred to a pattern of positive adapta- The fourth wave, now rising, is focused on under- tion in the context of past or present adversity. standing and integrating resilience across multi- Later de fi nitions have become broader and more ple levels of analysis, with growing attention to dynamic, in keeping with efforts to integrate the epigenetic and neurobiological processes, brain concept across levels of analysis and across disci- development, and the ways that systems interact plines (Masten, 2007, 2012) . An example of a to shape development. systems-oriented de fi nition of resilience follows: The capacity of a dynamic system to withstand or recover from signifi cant challenges that threaten its The First Wave: Identifying Individual stability, viability, or development (Masten, 2011 ) . Resilience and Factors that Make a Resilience was also recognized as an inferen- Difference tial concept that involved two distinct judgments (Luthar & Cicchetti, 2000 ; Masten & Coatsworth, Initial research in this area was dominated by a 1998) . First, one judges by some criteria that strong cultural ethos in the United States that there has been a signifi cant threat to the develop- glori fi ed rugged individualism—that Horatio ment or adaptation of the individual or system of Alger ability to “pick oneself up by one’s own interest. Second, one judges that, despite this bootstraps” and succeed solely through one’s threat or risk exposure, the current or eventual own efforts. Early on, investigators as well as adaptation or adjustment of the individual or sys- journalists referred to children who functioned tem is satisfactory, again by some selected set of well despite the odds as “invulnerable” (Anthony, criteria. 1974; Pines, 1975) and tended to focus on their There has been considerable confusion personal traits and characteristics. Such children throughout the past four decades on the precise were thought to be impervious to stress because meaning of many terms used by resilience of their inner fortitude or character armor. As researchers (Luthar, Cicchetti, & Becker, 2000 ; research extended across time and across types of Masten, 2001, 2012 ; Rutter, 2000 ) . Nonetheless, trauma endured, the term of “invulnerability” there is some consensus on a working vocabulary was replaced by more qualifi ed and dynamic for this domain of inquiry, as presented in terms such as stress-resistance and resilience. Table 2.1 . Much of that vocabulary (e.g., adver- These concepts were thought to more appropri- sity, life events, risks, and vulnerability ) was ately capture the interplay of risk and protective already familiar from studies of psychopathology. processes occurring over time and involving indi- Resilience studies, however, underscored some vidual, family, and larger sociocultural infl uences concepts that had been omitted or underem- (Masten, Best, & Garmezy, 1990 ; Rutter, 1987 ; phasized in earlier work, most particularly the Werner & Smith, 1982, 1992 ) . concepts of assets, compensatory (promotive) factors, protective factors, and competence or developmental tasks. Key Concepts Resilience de fi nitions always consider the threats to good adaptation (or perturbations in a During the fi rst generation of research on resil- system), conceptualized in terms like risk, ience in development, these phenomena were adversity, and negative life events. As illustrated studied in a variety of different contexts through- in Table 2.1 , risk most basically signi fi es an out the world (Glantz & Johnson, 1999 ; Luthar, elevated probability of a negative outcome. It is 2006 ; Masten, 2012 ; Masten, Best, and Garmezy, a group or population term, in that a risk factor 1990 ) . A consensus emerged on key concepts, does not identify which individual or individu- though controversies continue to this day and als in a group considered at risk will eventually there have been changes in emphasis over the display diffi culties in adaptation, but rather that years. For example, in early work, resilience the group of people with this risk factor is less 2 Resilience Processes in Development… 17

Table 2.1 De fi nition and illustration of key concepts Term De fi nition Examples Adversity Disturbances to the function or viability Poverty; homelessness; child maltreat- of a system; experiences that threaten ment; political con fl ict; disaster adaptation or development Resilience Positive adaptation in the face of risk or Child from violent family does well in adversity; capacity of a dynamic system school, has friends, behaves well, and to withstand or recover from disturbance gets along well with the teacher; earthquake survivor recovers to normal function and development Risk An elevated probability of an The odds of developing schizophrenia undesirable outcome are higher in groups of people who have a biological parent with this disorder Risk factor A measurable characteristic in a group Premature birth; parental divorce; of individuals or their situation that poverty; parental mental illness; child predicts a negative outcome on a maltreatment speci fi c outcome criteria Cumulative risk Increased risk due to: (a) the presence Children in homeless families often have of multiple risk factors; (b) multiple many risk factors for developmental occurrences of the same risk factor; or problems, including a single parent who (c) the accumulating effects of ongoing hasn’t graduated from high school, a adversity history of poor health care, poor schooling, inadequate nutrition, and exposure to many negative events, such as family or community violence Vulnerability Individual (or system) susceptibility to Anxious children fi nd school transitions undesirable outcomes; the diathesis in more stressful; compromised immune diathesis-stressor models of function increases susceptibility to psychopathology infectious diseases Proximal risk Risk factors experienced directly by the Witnessing violence; associating with child delinquent peers Distal risk Risk arising from a child’s ecological High community crime rate; inaccessible context but mediated through more health care; recession proximal processes Asset, resource, on A measurable characteristic in a group Cognitive skills; competent parenting; compensatory or of individuals or their situation that high social class promotive factor predicts a positive or desirable outcome, similarly for low and high levels of risk Protective factor A predictor of better outcomes Airbags in automobiles; 911 services; particularly in situations of risk neonatal intensive care; health insurance or adversity Cumulative protection The presence of multiple protective A child in a poor neighborhood has factors in an individual’s life attentive parents, a safe home, supportive kin, a school tutor, and connections to prosocial peers or community organizations Psychosocial Effectiveness or capabilities in the Active engagement of intellectual ability competence adaptive use of personal and contextual and positive relationships with teachers resources to accomplish age-appropriate results in school success developmental tasks Developmental tasks Psychosocial milestones or Walking; talking; learning to read; accomplishments expected for people of developing friendships; following rules; different ages in a given historical or taking care of one’s children cultural context, often serving as criteria for judging how well a person is doing in life 18 M. O’Dougherty Wright et al. likely overall to do well in some regard. There is has ended (Masten & Obradović, 2008 ; Wright, often a lack of precision regarding risk factors, Masten, Northwood, & Hubbard, 1997 ) . related to their complex and cumulative nature Risk terminology has undergone signi fi cant (Obradović, Shaffer, & Masten, 2012) . Many re fi nement in recent years, inspired by a series of broad risk indicators or “markers” encompass infl uential articles by Helena Kraemer and col- great heterogeneity in outcome within the group. leagues (Kraemer et al., 1997 ; Kraemer, Stice, For example, children born prematurely vary Kazdin, Offord, & Kupfer, 2001 ; Kraemer, greatly in circumstances, birth weight, accom- Wilson, Fairburn, & Agras, 2002 ) . Their work panying complications, family socioeconomic underscored the importance of distinguishing situation, and access to medical care. A closer correlates of poor outcomes from risk factors that analysis often provides clues to the processes clearly predate the onset of the problem from accounting for the overall risk of the group. In causal risk factors that can be shown (perhaps the case of prematurity, knowing details about through experimental manipulation) to contribute intracranial bleeding or delivery complications to the bad outcome of interest. This work not may not only improve prediction about out- only has led to greater speci fi city in risk termi- comes but also lead to better understanding nology but also provided a conceptual framework of the actual processes producing the risk for research needed to identify a causal risk fac- (O’Dougherty & Wright, 1990 ) . tor (see decision tree in Kraemer et al., 1997 ) and It soon became apparent that risk factors rarely to test hypothesized mediating and moderating occur in isolation. More typically, children with infl uences through experimental intervention high risk are exposed to multiple adversities designs (Kraemer et al., 2002 ) . extending over time, sometimes for very long The second key aspect of judging resilience in periods of their lives (Dong et al., 2004 ; Finkelhor, the lives of individuals involves decisions about Ormrod, Turner, & Holt, 2009 ; Masten & Wright, how well a person is doing in life or, in other 1998 ; Obradović et al., 2012) . Outcomes gener- words, the quality of their adaptation or develop- ally worsen as risk factors pile up in children’s ment. A variety of criteria have been utilized to lives, and concomitantly, resilience becomes less judge positive adaptation in the literature, includ- common. Thus, it has become critical to examine ing criteria focused on the absence of pathology, cumulative risk factors in order to more accurately successes in age-salient developmental tasks, predict and understand developmental outcomes subjective well-being, or all of these (see Table 2.1 (Sameroff, Gutman, & Peck, 2003 ) . Divorce, for for examples). In the developmental literature, example, has been a commonly studied stressor many investigators have defi ned good outcomes but research has revealed considerable heteroge- on the basis of the child’s observed or reported neity in outcome for children whose parents have competence in meeting the expectations for chil- divorced. The concept of cumulative risk helps to dren of a given age and gender in their particular clarify this diversity in outcome. Divorce is not a sociocultural and historical context. Competence single, time limited risk factor or stressor, but is typically assessed by how well the child has rather an often lengthy process of multiple stres- met, and continues to meet, the expectations sors and life changes. The extent and duration of explicitly or implicitly set in the society for chil- these stressors vary considerably from family to dren as they grow up. This is often referred to as family, and can occur before, during, and after the the child’s track record of success in meeting divorce itself. Finally, some forms of adversity are developmental tasks, age-related standards of so chronic and massive that no child can be behavior across a variety of domains, such as expected to be resilient until a safe and more nor- physical, emotional, cognitive, moral, behavioral, mative environment for development is restored. and social areas of achievement or function Thus, in cases of catastrophic trauma, such as (McCormick, Kuo, & Masten, 2011 ) . While these those resulting from war or torture, resilience may vary from culture to culture, they typically typically refers to good recovery after the trauma refer to broad tasks that guide the development 2 Resilience Processes in Development… 19 and socialization of children (see Table 2.1 for & Cicchetti, 2010 ; Masten, Obradović, & Burt, examples). Children judged to show resilience 2006 ). In developmental theory, good function- have typically negotiated these developmental ing in developmental tasks provides a platform tasks with reasonable success despite exposure to on which future success is built. It is becoming signi fi cant risks and adversities. more evident that promoting such competence During the fi rst wave of research, controver- may be crucial to preventing some kinds of sies emerged about how to defi ne resilience and problem outcomes among high-risk populations many of these debates concerned the criteria for of children (see section “The Third Wave: adaptation by which resilience would be judged Intervening to Foster Resilience ”). (see Masten & Reed, 2002 or Luthar et al., 2000 The fi rst wave of resilience studies focused on for overviews of these debates). There was identifying the correlates or predictors of positive debate, for example, about whether a child who adaptation against a background of risk or adver- was adapting well in terms of observable social sity. Thus, these investigators were also interested behavior (academic achievement, work, relation- in assessing individual or situational differences ships, etc.) but suffering internal symptoms of that might account for differential outcomes distress was showing resilience. There were among children sharing similar adversities or risk debates about not only the “inside” vs. “outside” factors. Two major kinds of correlates were con- picture on adaptation but also on how many sidered: (1) positive factors associated with better domains should be considered and when to assess adaptation at all levels of risk, including high-risk “outcome.” We would argue, for example, that levels, which were often termed assets or com- resilience does not necessarily mean that one is pensatory factors (e.g., Garmezy, Masten, & unaffected or untouched by the trauma one has Tellegen, 1984 ; see also Benson, Scales, Leffert, endured nor does it mean that one always func- & Roehlkepartain, 1999 ) , and more recently, pro- tions well. It is also possible that a child may motive factors (Sameroff, 1999 ) ; and (2) factors show resilience at one point in life and not at that seemed to have particular importance for another, or in one domain and not another. Such positive adaptation at high levels of risk or adver- debates linger in the literature (see Masten, sity, which were typically termed protective fac- 2012 ) . Nonetheless, it is clear that the criteria by tors (e.g., Rutter, 1979 ) . The key difference in the which resilience is judged in a population and two types of concepts was whether the factor how comprehensively it is assessed across played a special kind of role under hazardous domains of functioning will impact the preva- conditions. lence of resilience in high-risk groups and the When a positive predictor is designated a pro- nature of the processes identifi ed as relevant to tective factor , some type of shielding from the resilience. effects of risk or adversity is implied. Thus, pro- One of the most important emerging domains tective factors are assets that particularly matter of study concerns the linkage among multiple or only matter when risk or adversity is high. For domains of adaptation, positive and negative, and example, airbags in automobiles or antibodies to what this may mean for understanding resilience speci fi c disease agents are viewed as protective and psychopathology. Internal and external factors because they operate to protect individu- symptoms are related over time, as is adaptive als from the dangers of accidents or infections. functioning across different domains of compe- Protective factors moderate the impact of adver- tence and symptoms (Masten, Burt, & Coatsworth, sity on adaptation. The examples of airbags and 2006; Masten & Curtis, 2000 ) . Symptoms can antibodies are causal protective factors in that contribute to problems negotiating developmen- they provide demonstrable and explainable pro- tal tasks, and failure in such tasks can lead to tection to a living system in the course of an symptoms, with snowballing consequences that unfolding experience. Similarly, a parent who have been referred to as developmental cascades jumps in front of a child to take the brunt of a (Masten, 2001 ; Masten, Burt, et al., 2006 ; Masten physical assault clearly is protective in the sense 20 M. O’Dougherty Wright et al. of shielding the child from worse harm. Yet many the same continuum. That is, the attribute or presumed protective factors in studies of resil- variable in question is associated with poor adap- ience are far less easy to specify. tation at one end of the range and good adapta- It has proven to be quite dif fi cult to distinguish tion at the other end. For example, when poverty assets from protective factors in human develop- is present it is identifi ed as a risk factor for ment because many of the most important corre- negative outcome whereas high socioeconomic lates of good adaptation are themselves complex status is observed to be a compensatory or pro- systems or relationships that serve multiple func- motive factor associated with positive outcomes. tions. Parents, who could be viewed as “Mother Eventually, we may learn “where the action is” Nature’s Protective Factor,” clearly comprise a for a particular attribute or factor, but in many protective system of immense complexity for cases, we may learn once again that adaptation child development. One fi nding that has emerged arises from complex processes not easily labeled. and been re-confi rmed time and time again is that Certainly, it is conceivable to think about a pure resilient adaptation rests on good family (or sur- “risk factor” that has a clear negative in fl uence on rogate family) relationships. For very young chil- development when it occurs (e.g., foot amputated dren, early relationships with caregivers provide in an accident) but no in fl uence when it does not the foundation for developing secure attachments occur. It is also conceivable to think about pure to others (Bowlby, 1988 ; Sroufe, Carlson, Levy, “asset” factors that have a positive in fl uence & Egeland, 1999 ) . If this early infant-caregiver when they occur (e.g., musical talent) but have relationship is warm, attentive, and responsive, little impact on development in their absence. But the child develops confi dence that his or her most factors currently studied as potential causal needs will be met, learns positive ways of relat- predictors of adaptation or good vs. poor devel- ing to others, becomes more able to regulate opment re fl ect continuously distributed variables emotions, and develops feelings that the self is that may operate in many ways at many levels worthy and valued. Thus, a responsive, caring, (e.g., poor attentional skills vs. good attentional and competent caregiver is a very powerful asset skills). for fostering the child’s healthy growth and development in any context. In the face of signi fi cant adversity, such parents also know how to respond Developmental Perspectives effectively to threat and are able to adaptively shift their responses to provide protective modes Resilience studies quickly revealed that children of behavior. Similarly, the human brain is capable might have different vulnerabilities and protective of many functions and responds to life situations systems at different times in the course of their in a multitude of adaptive ways. Thus it is not development (Masten et al., 1990 ; Wright & surprising to learn that IQ scores, a general esti- Masten, 1997) . Infants, because of their total mate of adaptive problem solving abilities, pre- dependence on caregivers, are highly vulnerable dict a multitude of good outcomes regardless of to the consequences of loss of their parents or risk or adversity level (meeting the defi nition of mistreatment by caregivers. Yet infants are more asset) and also have been shown to function as protected from experiencing the full impact asso- moderators of risk or adversity, mattering even ciated with war or natural disasters because they more under threatening circumstances (Masten lack understanding of what is happening. As chil- et al., 1999 ) . dren mature, their school milieu and neighbor- There has been considerable debate over the hood can increasingly contribute to their exposure years about labeling a continuous variable that to traumatic events. Older children engage in correlates with adaptation as a risk factor or an more unsupervised activities and their involve- asset or compensatory factor, when it could be ment with peers can be protective or risk enhanc- viewed as either or both. Often these constructs ing. Thus, while older children are much more are composed of bipolar opposites that exist on capable of coping in the world on their own, their 2 Resilience Processes in Development… 21 independence from the protection of their Table 2.2 Examples of promotive and protective factors caregivers can also contribute to their trauma Child characteristics exposure. Adolescents are also vulnerable to a Social and adaptable temperament in infancy different type of loss or betrayal, such as loss or Good cognitive abilities, problem solving skills, and devastation concerning friends, faith, schools, and executive functions governments. They understand what these losses Ability to form and maintain positive peer relationships mean for their future, a realization well beyond Effective emotional and behavioral regulation strategies the understanding of young children. Positive view of self (self-confi dence, high self-esteem, self-ef fi cacy) Positive outlook on life (hopefulness) The “Short List” of Resilience Faith and a sense of meaning in life Correlates Characteristics valued by society and self (talents, sense of humor, attractiveness to others) The fi rst wave of research on resilience included Family characteristics both person-focused and variable-focused Stable and supportive home environment approaches. Person-focused approaches identi fi ed Harmonious interparental relationship resilient individuals in an effort to determine how Close relationship to sensitive and responsive caregiver they differed from other individuals facing simi- Authoritative parenting style (high on warmth, lar adversities or risks who were not faring as structure/monitoring, and expectations) well. Variable-focused approaches, in contrast, Positive sibling relationships examined the linkages among characteristics of Supportive connections with extended family individuals and their environments that contrib- members uted to good outcome when risk or adversity was Parents involved in child’s education high. This method focused on variables that cut Parents have individual qualities listed above as protective for child across large, heterogeneous samples, and drew Socioeconomic advantages heavily on multivariate statistics. Across many Postsecondary education of parent studies from each of these perspectives and across Faith and religious af fi liations widely divergent methodologies, the fi rst wave of Community characteristics research revealed a striking degree of consistency High neighborhood quality in fi ndings, implicating a common set of broad Safe neighborhood correlates of better adaptation among children at Low level of community violence risk for diverse reasons. This consistency was Affordable housing noted early by Garmezy ( 1985 ) , and has been Access to recreational centers corroborated repeatedly over the years. Masten Clean air and water (2001, 2007) has referred to these correlates as Effective schools “the short list” (see Table 2.2 ) and argued that Well-trained and well-compensated teachers they may re fl ect the fundamental adaptive sys- After-school programs tems supporting human development. As investi- School recreation resources (e.g., sports, music, art) gators began to consider the processes that might Employment opportunities for parents and teens account for why these correlates are repeatedly Good public health care found, the second wave of resilience work began. Access to emergency services (police, fi re, medical) Connections to caring adult mentors and prosocial peers While the fi rst wave produced many ideas, con- Cultural or societal characteristics structs, methods, and fi ndings about correlates of Protective child policies (child labor, child health, and resilience (as well as many controversies), it was welfare) soon evident that more sophisticated models were Value and resources directed at education needed to consider the complex processes that Prevention of and protection from oppression or were implicated by the initial fi ndings (see Glantz political violence & Johnson, 1999 ) . Low acceptance of physical violence 22 M. O’Dougherty Wright et al.

Luthar, 2006 ; Masten, 2001, 2007, 2011, 2012 ) . The Second Wave: Embedding As a result, studies of resilience are more contex- Resilience in Developmental and tualized in multiple ways, including both how the Ecological Systems, with a Focus individual interacts with many other systems at on Processes many levels throughout life and greater care about generalizing conclusions about risk and Early studies delineated a number of important protective factors from one context to another or factors that were associated with later resilience, one period of development to another. The early but did not provide an integrative understanding pioneers certainly recognized the complex, of the processes leading to resilience in develop- dynamic nature of naturally occurring resilience ment. As noted in a review of the fi rst wave of (see Masten et al., 1990 for this history), but the work, “it is the task of future investigators to por- basic descriptive data of the initial wave of stud- tray resilience in research questions that shift ies was a necessary empirical fi rst step before from the “what” questions of description to the research could begin to address the complexity of “how” questions of underlying processes that the phenomena. in fl uence adaptation” (Masten et al., 1990 , p. 439). The fact that many of the promotive and pro- Subsequent research and theory has focused tective factors that were identifi ed in the fi rst more specifi cally on understanding the complex, wave appeared to facilitate development in both systemic interactions that shape both pathologi- high and low risk conditions suggested the impor- cal and positive outcomes, emphasizing resil- tance of fundamental, universal human adapta- ience as a phenomenon arising from many tion systems; these systems keep development on processes (Cicchetti, 2010 ; Egeland, Carlson, & course and also facilitate recovery from adversity Sroufe, 1993 ; Masten, 1999, 2007 ; Yates, (Masten, 2001, 2007 ) . Examples of these adap- Egeland & Sroufe, 2003 ) . Wyman, for example, tive systems include the development of attach- described resilience in the following way: ment relationships; moral and ethical development; “Resilience re fl ects a diverse set of processes that self-regulatory systems for modulating emotion, alter children’s transactions with adverse life arousal, and behavior; mastery and motivational conditions to reduce negative effects and promote systems; and neurobehavioral and information mastery of normative developmental tasks” processing systems. Other systems involve the (Wyman, 2003 , p. 308). broader cultural context and consist of extended The second wave of resilience work refl ects a family networks, religious organizations, and broader transformation occurring in the sciences other social systems in the society that offer adap- concerned with normative and pathological tive advantages. These systems are versatile and development that has accompanied the emer- responsive to a wide range of challenges, both gence of developmental psychopathology normative and non-normative. If the major threats (Cicchetti, 1990, 2006; Masten, 2006, 2007 ; to children’s adaptation are stressors that under- Sroufe & Rutter, 1984 ) . Resilience research over mine the development of these basic protective the past decade increasingly has focused on con- systems, then it follows that children’s ability to textual issues and more dynamic models of recover and to be resilient will be highly depen- change, explicitly recognizing the role of devel- dent on these systems being restored. opmental systems in causal explanations The in fl uence of developmental systems the- (Cicchetti, 2010 ; Cicchetti & Curtis, 2007 ; ory (DST) is also evident in the multicausal and Masten, 2007, 2011 ) . This has led to greater dynamic models of resilience characteristic of emphasis on the role of relationships and systems the second wave of work. Second wave theory beyond the family, and attempts to consider and and research often encompasses the language of integrate biological, social, and cultural processes DST, with concepts such as equi fi nality and into models and studies of resilience (Charney, multifi nality , developmental pathways and tra- 2004 ; Cicchetti, 2010 ; Cicchetti & Curtis, 2007 ; jectories that capture the dynamic, interactional, 2 Resilience Processes in Development… 23 reciprocal, multicausal, and multiple-level such confl ict. A transactional model of infl uence models typical of DST (Bronfenbrenner, 1979 ; captures this dynamic pattern and highlights the Cicchetti & Rogosch, 1996 ; Ford & Lerner, importance of examining reciprocal patterns of 1992 ) . The focus of many second wave studies interaction that shape development over time has been on the processes that may lead to resil- (Sameroff, 2000 ) . ience. Studies have attempted to explore moder- Finally, the impact of the social context on ating processes that would explain protective the child is mediated in part through the child’s effects that seem to work only for some people perception and interpretation of his or her expe- under some conditions as well as mediating riences (Boyce et al., 1998 ) , and some investiga- processes that explain how risk or protection tors have focused on such internal processes actually works to undermine or enhance (Compas, Connor-Smith, Saltzman, Thomsen, adaptation. & Wadsworth, 2001 ) . Although important, such An ecological, transactional systems approach assessments are inherently diffi cult to obtain, to understanding resilience marks a dramatic particularly in very young children who lack the shift from a traditional focus on the individual to verbal skills and conceptual framework needed a broader focus encompassing family and com- to describe the impact of their traumatic experi- munity relational networks (Cowen, 2000 ; ences. There are likely to be signifi cant changes Cummings, Davies, & Campbell, 2000 ; Masten in the meaning the child assigns to different & Obradović, 2008 ; Walsh, 1998) . Developmental experiences at different ages and thus the mean- outcome is determined by complex patterns of ing and the impact of a traumatic experience can interaction and transaction. Wave two research change considerably over time. For example, studies incorporate design and analytic tech- some victims of childhood sexual abuse are so niques and strategies that allow for detection of young at the time of the initial abuse that they do such multilevel in fl uences. This dynamic not understand the full meaning of the perpetra- approach emphasizes the need to formulate dif- tor’s actions. However, when they become older, ferent research questions in order to understand the extent of betrayal and the shame and humili- the process of positive or negative adaptation fol- ation they experience can intensify and lowing stress. Rather than asking questions about signi fi cantly enhance the stressfulness of the why a child is resilient, questions are asked about experience (Wright, Crawford, & Sebastian, bidirectional connections between the child and 2007 ) . While children’s subjective experience his or her context. These child–context relation- and other internal cognitive and affective coping ships and interactions become the focus of study. responses to traumatic experiences are still Such an approach fosters research designs that sparsely researched areas, these may be critical more adequately refl ect individual differences in areas to pursue in order to fully understand indi- developmental pathways and contextual varia- vidual variability in response to traumatic stress tion within families, communities, societies, cul- (Park & Folkman, 1997 ) . tures, and historical periods. Wave two research studies also provided a more complex assessment of family and environmental infl uences. Parents Contextual Specifi city of Protective do not respond in identical ways to each of their Processes own children, nor is the family environment experienced in an identical way by different chil- With closer attention to processes that might dren in the family (Plomin, Asbury, & Dunn, account for resilience, second wave investigators 2001 ) . Even when there is signi fi cant con fl ict and also began to note that protective processes could disharmony within a family, the negativity be contextually specifi c. This research high- expressed by the parents may focus more on one lighted the importance of paying careful attention child than on another and the children themselves to the ways in which specifi c groups exposed to may be differentially reactive to and affected by diverse stressors differentially adapt, and also to 24 M. O’Dougherty Wright et al. exploring which factors were protective for associated with academic disengagement among which individuals in these contexts. Cicchetti and those participants who also displayed conduct Rogosch (1997 ) , in their follow-up study of mal- problems. Overall, these fi ndings suggest that treated children, provide intriguing evidence in individual child characteristics such as high self- this regard. Whereas many studies of high-risk esteem or positive future expectations may be children have found that close interpersonal rela- associated with resilience for some children but tionships and social support predict better long- not for others. It may be quite important to pay term outcome, Cicchetti and Rogosch found that attention to whether the child’s beliefs and expec- the maltreated children in their study who dis- tations are congruent with his or her ability to played positive long-term adjustment actually reach the goals set. drew on fewer relational resources and displayed more restrictive emotional self-regulation styles than did comparison controls who were not Stability and Change in Resilient maltreated. In a similar vein, both Werner and Adaptation Smith (1992 ) and Wyman (2003 ) found that interpersonal and affective distancing and low As resilience research developed, more nuanced expectations for parental involvement were perspectives emerged. It was clear that the same related to later resilience, not poor adjustment. child could be diagnosed “resilient” at one point Expanding upon this, Werner and Smith reported in development but not another, that a child that later in life many of their resilient adults might be adaptive in one context but not another detached themselves from parents and siblings, at the same point in development, and that chil- perhaps to prevent being overwhelmed by their dren were often adaptive in some aspects of families’ emotional problems. These results high- their life but not others. Moreover, wave two light the distinctive challenges faced by children research gave far more consideration to multiple who come from highly dysfunctional families levels of context interacting to produce resil- and emphasize the importance of avoiding ience. Consequently, the most complex models premature conclusions about what constitutes of resilience focus on healthy vs. maladaptive positive coping. pathways of development in the lives of children The Rochester Child Resilience Project exposed to adversity over time. These models (Wyman, 2003 ; Wyman, Cowen, Work, & Kerley, provide an opportunity to attend specifi cally to 1993 ) has shed additional light on the issues of turning points in individual’s lives, and to con- context-speci fi c adaptation and the processes sider the complex, holistic interactions of a underlying resilience. In their follow-up study of changing person and context (Masten, 2012 ; urban children growing up in the context of Masten & Reed, 2002 ; Rutter, 2000 ) . adversity (high rates of poverty, violence, family To date, much of the discussion of develop- discord, and substance use problems), factors mental pathways has been drawn from case considered to be “protective” differed in their examples and composite data obtained in longitu- effect, depending on additional characteristics of dinal studies (e.g., Cairns, & Cairns, 1994 ; the child and the context. For example, although Furstenberg, Brooks-Gunn, & Morgan, 1987 ; positive future expectations and perceptions of Hawkins et al., 2003 ; Masten et al., 2004 ; Masten, personal competence have often been found to be Obradović, & Burt, 2006 ; Rutter & Quinton, protective, this positive effect was only evident 1984 ; Sampson & Laub, 1993 ; Werner & Smith, among participants in their study when these per- 1992, 2001) . This longitudinal data allows us to ceptions were realistic. If the adolescent had an examine changes within-individuals over time unrealistic perception of his or her competence, rather than focusing on between-individual analy- this was associated with an elevated risk of seri- ses. Such data speak to the enduring capacity for ous conduct problems. Furthermore, in their sam- change that exists throughout development, and ple, positive future expectations were actually also provide valuable insight into the possible 2 Resilience Processes in Development… 25 processes that may operate to produce either characterized by extreme deprivation (Rutter & stability or change in functioning. For example, the English and Romanian Adoptees (ERA) study studies identifying and attempting to account for team, 1998 ) , child soldiers (e.g., Betancourt et al., desistance trajectories in delinquency and crimi- 2010 ) and refugees exposed to massive war nal behavior based on longitudinal data (e.g., trauma (Wright et al., 1997 ) also suggest a Hawkins et al., 2003 ; Mulvey et al., 2010 ; remarkable capacity for developmental recovery Sampson & Laub, 1993 ) suggest that complex when normative rearing conditions are restored. interactions of youth with parents, peers, and All of these studies reveal the critical importance other adults in the home, neighborhood, schools, of turning points in the lives of those exposed to and workplace contribute to positive and negative severe adversity. These turning points, often trajectories across the transitions from childhood occurring in conjunction with substantial changes to adolescence and early adulthood. Such studies in status or context (e.g., adoption, immigration, also suggest that there are critical turning points postsecondary education, rescue, securing stable in response to speci fi c developmental challenges employment, successful marriage), may indicate (such as entering school or the transition to ado- lasting alterations in an individual’s developmen- lescence) that may shape the nature and course of tal pathway. Laub, Nagin, and Sampson ( 1998 ) future adaptation. have described these phenomena in terms of Three studies that have followed a high-risk “knifi ng off” in the long-term follow-up of the sample well into adulthood provide some very Glueck and Glueck cohort of antisocial youth, encouraging information about the potential for and there are many anecdotal accounts of such recovery. Werner and Smith (1992 ) report that dramatic turns in the life course. the majority of their high-risk youths with seri- The impressive recovery patterns observed in ous coping problems in adolescence had recov- many individuals later in life, however, do not ered by the time they reached their 30s, and this mean that all children will recover. A signifi cant was particularly true for the women in their percentage of the children from the Romanian sample. Only one in six troubled high-risk teens orphanages as well as from the refugee studies became a troubled adult. Furstenberg and col- have serious and chronic emotional, behavioral, leagues (1987 ) found a similar pattern of later and/or cognitive problems that appear to be last- recovery among their sample of black adolescent ing effects of their experiences (Gunnar, 2001 ; teenage mothers. Also, among antisocial youth, Masten & Hubbard, 2003 ; Rutter & the ERA large scale desistance is reported over time, so team, 1998 ; Wright et al., 1997 ; Zeanah, Smyke, that by mid-life, the majority of antisocial youth & Settles, 2006 ) . Both Werner and Smith’s ( 1992 ) have desisted (Sampson & Laub, 1993 ) . Across and Sampson and Laub’s (1993 ) longitudinal all three studies, strong ties to work and to one’s studies (Laub & Sampson, 2002 ) revealed that if spouse were associated with eventual positive there were several problem areas at an early age, adaptation and strongly implicated in “turn such as school failure, serious mental health around” cases. Activities which facilitated these problems, and repeated problems with delin- ends, such as developing personal resources, quency, the pattern of maladjustment and deviant obtaining further education, marrying an accept- behavior was more stable. This fi nding sheds ing and supportive spouse, joining the armed light on a pattern replicated by other longitudinal forces to gain vocational skills, and subsequent studies that there is stronger support for develop- fertility control and family planning, were critical mental continuity of poor adaptation when mul- components promoting positive within-individual tiple areas of competence have been compromised. changes over time. For other high-risk individu- Compounding or cascading problems may als, supportive extended family and friendship explain why intervention becomes more chal- networks or becoming a member of a church lenging as individuals advance further along facilitated positive change. Follow-up studies of pathways of maladaptation, or problems show children adopted away from institutional rearing cascading effects, spreading across domains 26 M. O’Dougherty Wright et al.

(Masten & Cicchetti, 2010; Masten & Powell, also underplays the extensive role of context in 2003 ; Yates et al., 2003 ) . individual resilience. Because adaptation is Another important consideration is the possi- embedded within a context of multiple systems of bility that the effects of early adversity might not interactions, including the family, school, neigh- be evident immediately, but might emerge much borhood, community, and culture, a child’s resil- later in development (a kind of “sleeper effect”). ience is very dependent upon other people and Some types of early adversity, such as living with other systems of in fl uence (Masten & Obradović, a depressed mother (Goodman, 2007 ) or experi- 2008 ; Riley & Masten, 2005 ) . The processes that encing neglect or abuse (DiLillo & Damashek, foster resilience or vulnerability need to be under- 2003 ) , might impair the child’s later ability to stood within this holistic context. Children who function successfully in intimate family roles. do not “make it” often lack the basic support, pro- For example, female survivors of child sexual tection, and respect they need for successful devel- abuse can display a wide range of later interper- opment, whereas children who succeed typically sonal problems, including problems with intimate have suffi cient external support to continue for- partner relationships, disturbed sexual function- ward. The same forces that may constrain the ing, and dif fi culties in parenting (DiLillo, 2001 ) . child’s development—poverty, discrimination, Longitudinal data on interpersonal functioning inadequate medical care, or exposure to commu- over time is particularly needed to understand the nity violence—also often impact and constrain the infl uence of early traumatic relationship experi- entire family. Economically impoverished fami- ences on later attachments and to explore the lies, or parents ravaged by their own struggles timing and types of subsequent interpersonal with alcoholism or mental illness, are often poorly experiences that can counteract adverse effects equipped to provide the necessary resources and (Egeland, Weinfi eld, Bosquet, & Cheng, 2000 ) . basic protections their children need. All individ- Understanding resilience in terms of processes uals need the support and assistance of the soci- that alter children’s transactions with adverse life ety in which they live. The degree of success one conditions, enabling them to reduce the negative has in surmounting these obstacles is a complex effects of such experiences, and fostering mas- combination of personal strengths and vulnera- tery also avoids the type of damaging labeling bilities, as well as ongoing transactions with that sometimes occurs when resilience is referred one’s family and community network (Cowen, to as an individual outcome. Children who expe- 2000 ; Riley & Masten, 2005 ; Walsh, 1998 ) . rience adversity, particularly severe and long lasting trauma, should be expected to have distress symptoms of some sort. For this reason it is par- Cultural Infl uences on Resilience ticularly helpful to think of a “continuum of resilience” as well as a “continuum of vulnerability” Another critical component in understanding across multiple domains (physical, psychologi- processes in resilience is the role of culture. cal, interpersonal, and occupational) and to be Just as biological evolution has equipped human alert to the ever changing dynamic of the child’s individuals with many adaptive systems, cul- functioning over time. tural evolution has produced a host of protec- There are potentially damaging consequences tive systems. Protective factors are often rooted of viewing resilience as an individual trait (Masten, in culture. Cultural traditions, religious rituals 2012 ) . Foremost among these is the tendency to and ceremonies, and community support ser- view those children who do not adapt successfully vices undoubtedly provide a wide variety of as somehow lacking the “right stuff” and some- protective functions, though these have not how personally to blame for not being able to sur- been studied as extensively in resilience mount the obstacles they have faced. This focus research. Moreover, there may well be cultur- minimizes the overwhelming social stressors and ally specifi c traditions, beliefs, or support sys- chronic adversities that many children face and tems that function to protect individuals, 2 Resilience Processes in Development… 27 families, and community functioning in the these dimensions might mediate resilience in context of adversity within those cultures. different ways for different groups (Gaines Speci fi c healing, blessing, or puri fi cation cere- et al., 1997 ; Kim, Triandis, Kagitcibasi, Choi, monies, such as those found among American & Yoon, 1994 ) . Our intervention efforts might Indian tribal cultures (Gone, 2009 ; LaFromboise, be signifi cantly enhanced by consideration of Oliver & Hoyt, 2006a, 2006b ) , as well as in these and of other cultural dimensions. many cultures and religions around the world (Crawford, Wright, & Masten, 2006 ) , may serve to counteract or ameliorate the impact of The Third Wave: Intervening devastating experiences among people in a cul- to Foster Resilience ture. Similarly, among minority groups in society, factors such as strength of ethnic identity, From inception, a compelling rationale for the competence and comfort in relating to members systematic study of naturally occurring resilience of different groups, and racial socialization are was to inform practice, prevention, and policy particularly important in dealing with chal- efforts directed towards creating resilience when lenges that arise due to experiences of oppres- it was not likely to occur naturally. The second sion and discrimination within the context in wave focused on a better understanding of medi- which they live (Szalacha et al., 2003 ; Wright ating and moderating processes that might explain & Littleford, 2002 ) . To date there has been sur- the links between adversity and developmental prisingly limited systematic investigation of competence, as an intermediate step toward the culturally based protective processes (Luthar, ultimate goal of intervening to promote resilience 2006 , Masten & Wright, 2010 ) . The movement and positive development. Research on such pro- away from an individually based conceptual- cesses continues to be important. However, using ization of resilience and towards a contextually lessons from the fi rst two waves, investigators of situated framework has been a welcome one the third wave began to translate the basic science from the perspective of many cross-cultural of resilience that was emerging into actions researchers (Aponte, 1994 ; Boyd-Franklin & intended to promote resilience. These investiga- Bry, 2000 ; Hill, 1999 ) . Whereas some of the tors recognized that experiments to promote posi- factors and processes that have been identi fi ed tive adaptation and prevent problems among as fostering resilience focus on individual func- individuals at high risk for developing problems tioning (such as good cognitive skills, socio- represented a powerful strategy for testing resil- emotional sensitivity, ability to self-regulate), ience theory and hypothesized adaptive processes the shape and function of these processes may that were targeted in the theory or logic model of be culturally infl uenced or may interact with the experimental intervention. Initially, this work cultural demands and expectations in ways that took the form of theory-driven intervention are poorly understood. Moreover, many other designs and subsequently, with growing fre- factors have been identi fi ed within the collec- quency, third-wave research has taken the form tive network of the family and the community. of experiments with randomized control or com- As the study of resilience continues, it will be parison groups with explicit models of change. critical to explore the extent to which factors Such experiments represent the “gold standard” found to promote resilience in one group will of evidence about change processes. also be replicated across cultural groups and Historically, the third wave represented a also how the same factor found across multiple confl uence of goals, models, and methods from groups may function differently in different prevention science and studies of naturally occur- cultural contexts. For example, for various cul- ring resilience (Cicchetti, Rappaport, Sandler, tural/ethnic groups there can be a great deal of & Weissberg, 2000 ; Coie et al., 1993 ; Cowen & difference in the relative importance placed on Durlak, 2000 ; Masten, 2007 ; Masten & individualism, collectivism, and familism, and Coatsworth, 1998; Weissberg & Kumpfer, 2003 ; 28 M. O’Dougherty Wright et al.

Yoshikawa, 1994 ) . Multifaceted intervention Strategic timing of intervention also holds studies designed to prevent or reduce risky behav- great interest for third wave research because evi- iors, delinquency, and other problems in children dence suggests that there are windows of oppor- (e.g., FAST Track or the Seattle Social Development tunity for changing the course of development, Project) and also early childhood interventions when systems may be more malleable or there is developed to improve the odds of children growing a higher likelihood of potentiating a positive cas- up in poverty or disadvantage (e.g., Abecedarian, cade (Cicchetti, 2010 ; Masten & Cicchetti, 2010 ; Head Start, Perry Preschool Project, Chicago Masten, Burt, et al., 2006 , Masten, Obradović, Longitudinal Study) encompassed multiple strate- et al. 2006, Masten, Long, Kuo, McCormick, & gies designed to promote success in developmental Desjardins, 2009 ; Steinberg, Dahl, Keating, tasks at the same time they reduced risk for prob- Kupfer, Masten, & Pine, 2006 ) . Timing an inter- lem behaviors (Ramey & Ramey, 1998 ; Reynolds vention well may lead to more lasting effects, & Ou, 2003 ; Weissberg & Greenberg, 1998 ) . As broader effects, and/or higher returns on invest- the data on assets, promotive, and protective fac- ment (Heckman, 2006 ; Masten et al., 2009 ; tors began to accumulate in natural resilience stud- Masten & Cicchetti, 2010 ; Reynolds & Temple, ies, data was mounting in prevention science based 2006; Shonkoff, Boyce, & McEwen, 2009 ) . For on randomized clinical trials that promoting com- example, during a developmental transition or petence was a key element of programs that worked turning point, targeted interventions can be criti- and the mediators and moderators of change bore a cally important in activating developmental cas- striking resemblance to the processes implicated cades (i.e., progressive effects) that enhance by the “short list” in resilience research (Cicchetti multiple domains of functioning or deterring et al., 2000 ; Luthar & Cicchetti, 2000 ; Masten, negative cascades of maladaptive behavior that 2001, 2007; Masten, Burt, et al., 2006; Masten & could undermine adjustment (Masten, Burt, Coatsworth, 1998; Masten, Obradović, et al., 2006 ; et al., 2006; Masten & Cicchetti, 2010 ; Masten, Reynolds & Ou, 2003 ) . Obradović, et al. 2006 ) . For example, the long- Over the past decade, there has been a pro- term effects of the Parent-Management Training- found change in the models for intervention, par- Oregon (PMTO) model to promote parents’ ticularly in prevention models, that likely refl ects positive involvement and deter coercive aggression the growing in fl uence of resilience theory and included cascading pathways of adaptive devel- research (Masten, 2011 ) . Numerous strength- opment for both parents and children. A follow-up based models and resilience frameworks for study revealed a higher standard of living and practice and policy have been articulated healthier social interactions 9 years after the (e.g., Cicchetti et al., 2000 ; Galassi & Akos, 2007 intervention (Patterson et al., 2010 ) . Luthar & Cicchetti, 2000 ; Masten, 2001, 2006, Experimental intervention designs can pro- 2011 ; Nation et al., 2003 ) . In the prevention sci- vide a powerful test of hypotheses about how ence fi eld, intervention models are routinely resilience occurs, particularly when the process described in terms of protective processes to proof change is speci fi ed (e.g., parenting or attribu- mote resilient development (McLain et al., 2010 ; tional style), the intervention is tailored for Patterson, Forgatch, & DeGarmo, 2010 ; Toth, specifi c needs and targets changes in this pro- Pianta, & Erickson, 2011 ; Weissberg, Kumpfer, cess, and the change processes affect subse- & Seligman, 2003; Wyman, 2003 ; Wyman, quent change in the targeted behavior of an Sandler, Wolchik, & Nelson, 2000 ) . Intervening individual or system. For example, possessing to alter the life course of a child potentially at risk the executive functioning capacity of strong for psychopathology or other problems, whether inhibitory skills was demonstrated to be cen- by reducing risk or adversity exposure, boosting trally important for school achievement in resources, nurturing relationships, or mobilizing homeless children (Obradović, 2010) . Also other protective systems, can be viewed as a pro- important was high quality parenting to buffer tective process. these children from further adversity and to 2 Resilience Processes in Development… 29 serve as a mediator of risk and achievement mothers in this case) and for the role of parental (Herbers et al., 2011 ) . These studies emphasize functioning in causal processes related to child the need to promote competence as well as to outcomes during the course of negotiating adver- reduce risk. Boosting fundamental skills for sity. The dynamic capacities afforded by close learning and school success and nurturing relationships to foster development and protect parent−child relationships are also promising individuals and social groups in the face of adver- pathways to adaptive development for young, sity has led many to conclude that relationships disadvantaged children (Diamond, Barnett, are the most critical protective factor for young Thomas, & Munro 2007 ; Masten & Gewirtz, people at risk (e.g., Luthar, 2006 ) . The children of 2006 ) . parents who already function well during adver- Kraemer et al. ( 2002 ) provided an illustration sity or parents who mobilize what is needed to of how experimental intervention designs can test protect their children as a result of personal change, such mediating and moderating effects, with the enlisting help, or other adaptive processes fare intervention serving as the hoped-for moderator of better during and following adversity in many the hypothesized mediating process. Experimental situations studied around the globe. designs are also particularly well suited for identi- Research on interventions to create resilience fying who bene fi ts most from what aspect of treat- is gaining momentum as evidence builds from ment, mediated by which changes, thereby testing basic research and experimental data that resil- additional moderating and mediating effects. The ience processes can be identifi ed and changed, Seattle Social Development Project provides an and that intervention methods are vital for excellent example of an experiment designed to testing resilience theory (Masten, 2011 ) . It is test whether and how an intervention worked to still the case, as noted by Weissberg and Kumpfer reduce problem behaviors (see Hawkins, Catalano, ( 2003) some time ago, that much work remains Kosterman, Abbott, & Hill, 1999 ; Hawkins et al., to be done to understand resilience processes 2003 ) . For example, a comprehensive intervention (e.g., mediating, moderating, promoting, com- package (delivered to a group of children in pensating, and cascading processes) well enough schools serving high crime neighborhoods when to manipulate them most effectively and they were in elementary school) produced demon- ef fi ciently to bene fi t children and society. strable change in school bonding which was asso- However, the evidence base is growing and a ciated with better outcomes in the secondary good case can also be made that progress would school years, assessed by less antisocial behavior be accelerated by concerted efforts to span the and better high school grades. Another excellent translational divide through collaborative trans- example is provided by Sandler, Wolchik, Davis, lational research that engages basic researchers Haine, and Ayers ( 2003 ) , who designed a preven- and community partners in intervention trials tive intervention for families going through a that refl ect current knowledge but also explicitly divorce, with the goal of moderating a key media- focus on testing theories of change (see Masten, tor in the child’s life, the parent’s behavior. Six- 2011 ; Toth et al., 2011 ) . These are ongoing tasks year follow-up data for this randomized prevention of third wave resilience research. Only by identi- trial elucidated multiple cascading pathways to fying the multifaceted processes underlying suc- adaptation in adolescence. Mothers’ more positive cessful adaptation under adverse conditions will relationships with children and use of effective we fi nd ways to intervene successfully in the discipline activated positive trajectories of less lives of those who remain vulnerable. internalizing problems leading to higher self- Analyses of current preventive programs that esteem, and less externalizing problems and sub- work for children underscore the importance of stance use leading to higher academic achievement theory-driven approaches that embrace a develop- (McLain et al., 2010 ) . Such studies offer compel- mental, ecological systems approach and capital- ling evidence both for the effectiveness of a par- ize on windows of opportunity in development. ticular intervention (the manualized program for Salient features of successful prevention programs 30 M. O’Dougherty Wright et al. include many of the factors that have been to resilience at other levels of analysis (e.g., described in this chapter. These include a focus on Curtis & Cicchetti, 2003 ) , but earlier waves of strategically timed, culturally relevant, compre- resilience research were dominated by psycho- hensive programs across multiple settings, prosocial studies emphasizing individual behavior grams that are of suf fi cient length and depth to and development, with some attention to other address the magnitude of the problem, and strive levels, such as relationships, families, peers, and to maximize positive resources and the bene fi t-to- schools or other community systems (Cicchetti, cost ratio of implementation. Additionally, 2010 ; Luthar, 2006 ; Masten, 2007 ) . because the effects of interventions might be Over the past decade, research aiming to elu- delayed, unexpected, or indirect, it is important to cidate the biology or neuroscience of resilience consider more complex models of change and has burgeoned (Cicchetti, 2010 ; Feder et al., monitor outcome appropriately, over time, in mul- 2009 ) . At the same time, once independent and tiple domains and possibly at multiple-system disparate fi elds of research on resilience at dif- levels. Such comprehensive prevention approaches ferent levels in different disciplines (e.g., ecol- acknowledge the multiplicity of risks and the ogy, engineering, public health, management, cumulative trauma that many children face and emergency services) are coming together in emphasize the importance of promoting compe- response to urgent national and global threats tence and building protection across multiple that require integrative solutions, such as natural domains in order to achieve a positive outcome. disasters, terrorism, global warming, and fl u pandemic (Masten & Obradović, 2008 ; Masten & Osofsky, 2010 ; Norris, Steven, Pfefferbaum, The Fourth Wave: Resilience Research Wyche, & Pfefferbaum, 2008 ) . on Multiple-Systems Levels, Fully describing the exciting and interdisci- Epigenetic Processes, and plinary directions in the fourth wave of resilience Neurobiological Processes research is beyond the scope of this chapter. However, as examples, there is considerable activ- The fourth wave in resilience research is focused ity and interest in the following research areas: on multilevel dynamics and the many processes • Gene X environment moderating effects linking genes, neurobiological adaptation, brain including intervention moderating effects (for development, behavior, and context at multiple illustration see Kim-Cohen & Gold, 2009 ; levels. It is predicated on the idea that develop- Brody, Beach, Chen, & Murry, 2009 ) . ment arises from probabilistic epigenesis, • Programming, biological sensitivity to con- involving many processes of interaction across text, differential susceptibility, bidirectional multiple levels of function, with gene–environ- infl uences, and calibration of adaptive systems ment interplay and co-action playing key roles crucial for adaptive response to adversity (see (Gottlieb, 2007 ) and explicit recognition that Boyce & Ellis, 2005 ; Del Giudice, Ellis, & adaptation is inherently multilevel (Masten, Shirtcliff, 2011 ; Meaney, 2010 ) . 2007 ) . This wave began to rise as new methods • Reprogramming and interventions to normal- for research became more widely available to ize poorly regulated adaptive systems in the study these processes, including the assessment organism, such as stress or immune function, of genes, gene expression, brain structure and executive function skills, and emotion regula- function, social interaction, and statistics for tion (see Dozier, Peloso, Lewis, Laurenceau, modeling growth, change, and interactions in & Levine, 2008 ; Fisher, Van Ryzin, & Gunnar, complex systems (Charney, 2004 ; Cicchetti, 2011; Meaney, 2010; Yehuda, Flory, 2010 ; Cicchetti & Curtis, 2006, 2007 ; Feder, Southwick, & Charney, 2006 ) . Nestler, & Charney, 2009 ; Masten et al., 2004 , • Assessment of biomarkers, gene expression, or Masten, 2007, 2012 ; Masten & Obradović, 2008 ) . neural function in intervention studies to tailor There had been many calls for greater attention the intervention or assess its effectiveness 2 Resilience Processes in Development… 31

(see Blair, 2010; Brody et al., 2009 ; Cicchetti, area has focused very productively on the 2010 ) . psychological and interpersonal arenas, but • Integrating models and research on resilience efforts to include biological and cultural levels in ecosystems, social systems, and individual of analysis are just beginning. The thrust of biology or neural systems (see Longstaff, future research needs to attend more directly 2009; Masten & Obradović, 2008 ; Norris and explicitly to context and transactional, bidi- et al., 2008 ) . rectional analyses over time, clarifying the con- This wave of resilience research is just begin- ditions under which interventions may and may ning but it promises to transform the science and not work, identifying the most strategic and the application of resilience. cost-effective targets and timing for interventions, and exploring natural reparative processes. Although there is clear evidence that Conclusion resilience in young people is highly dependent on other people and multiple systems of In conclusion, the past 40 years of research on infl uence, there is limited knowledge of how resilience have shed much light on the funda- these multiple levels of in fl uence operate syner- mental adaptive systems supporting human gistically and how best to incorporate the bio- development and on identifying complex, mul- logical, psychological, interpersonal, and tisystemic interactions that might shape both cultural levels of analysis into our research and positive and pathological outcomes following models for clinical intervention. Integrative adversity. A strong knowledge base has accrued approaches, spanning levels and disciplines, are on the processes implicated in resilience, par- needed to apply the expanding knowledge based ticularly on factors that increase vulnerability on resilience in human development with and those that afford protection. However, much ef fi ciency and effectiveness to foster positive remains to be done, and as evident in the rising adaptation among the most vulnerable children, fourth wave of research, there is much uncharted youth, and families in our communities. territory. It will take time to unravel and understand these multiple levels of in fl uence and Acknowledgments The work of the authors on resil- build a stronger bridge between science and ience has been supported over the years by grants from the practice. It is essential at this juncture not to National Institute of Mental Health, the National Science Foundation (NSF), the William T. Grant Foundation, the lose sight of the goals for this work—to enhance University of Minnesota, and the Ohio Department of understanding of key mechanisms leading to Mental Health. Preparation of this chapter was supported risk reduction, to determine the key ingredients in part by a grant to Ann Masten from NSF (No. 0745643) of successful interventions, and to apply what and a predoctoral fellowship to Angela Narayan from the National Institute of Mental Health (NIMH; we are learning in prevention and intervention 5T32MH015755). The fi rst two authors also express their efforts to foster resilience among vulnerable deep and abiding appreciation for the wonderful mentor- children and their families. Clinical interven- ship of Norman Garmezy. Any opinions, conclusions, or tions and primary preventions with known recommendations expressed in this chapter are those of the authors. effectiveness currently exist and need to be made accessible in more diverse community settings and evaluated. This will allow for criti- References cal exploration of factors that promote or interfere with resilient processes in different cultural Anthony, E. J. (1974). The syndrome of the psychologi- contexts. Collaborative work across diverse cally invulnerable child. In E. J. Anthony & C. contexts is urgently needed to re fi ne resilience- Koupernik (Eds.), The child and his family (Children based models of intervention and change, and at psychiatric risk, Vol. 3, pp. 529–544). New York, NY: Wiley. also to inform the design of primary prevention Aponte, H. (1994). Bread and spirit: Therapy with the and social policy programs. Past work in this new poor . New York, NY: Morton. 32 M. O’Dougherty Wright et al.

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The deceptively simple construct of resilience is conceived set of phenomena to compose an in fact rife with hidden complexities, contradic- integrative explanatory theory of adaptation to tions, and ambiguities. These have been recog- life stress. The more focused set of concepts that nized in earlier reviews of the relevant literature is equated with resilience, and the theoretical (Kaplan, 1999 ) . More recent reviews have framework that derives from concepts, relate to reaffi rmed many of these diffi culties and have four sets of self-referent processes: self-cognition; offered suggestions in some cases for resolution self-evaluation; self-feelings; and self-enhancing of these problems (Luthar, Cicchetti, & Becker, and self-protective mechanisms. 2000 ; Olsson, Bond, Burns, Vella-Brodrick, & Sawyer, 2003 ) . By and large, however, problematic aspects of the concept of resilience persist. (Mis)Understanding Resilience Concepts by their nature are not true or false. However, they may be evaluated with regard to Arguably, any consensus that exists regarding the their usefulness. The utility of the construct of nature of resilience rests upon the ideas of resilience in the study of adaptation to life stress achievement of positively (or the avoidance of depends upon resolving the confusion surround- negatively) valued outcomes in circumstances ing the concept that has led many scholars to where adverse outcomes would normally be question whether the idea of resilience helps to expected. A close examination of this idea, how- advance theory, research, or clinical practice ever, reveals a number of unresolved questions (Bartelt, 1994 ; Kaplan, 1999 ; Liddle, 1994 ) . In that at best render the concept less than useful, this chapter I outline what I perceive to be the and at worst, impede progress in understanding sources of confusion surrounding the concept of human adaptation. Among the more salient issues resilience and offer suggestions regarding the are the following: conditions that must be fulfi lled in defi ning resil- 1 . Does resilience refer to characteristics and ience if that concept is to be useful in under- outcomes of individuals (children, adults, vari- standing human development and adaptations. ous categories of persons differentiate accord- These conditions implicate (1) equating resil- ing to gender, race/ethnicity, or other ience with a more narrowly focused set of phe- psychosocial variables), or does it refer to nomena than is currently associated with the characteristics and outcomes of more inclu- concept and (2) the use of this more narrowly sive systems such as groups in general or particular kinds of groups, communities, or ecosystems? The literature fi nds the concept applied to a bewildering array of categories of † H. B. Kaplan (Deceased) individuals and systems. Regarding categories

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 39 DOI 10.1007/978-1-4614-3661-4_3, © Springer Science+Business Media New York 2013 40 H.B. Kaplan

of individuals, resilience has been studied with adaptation, adjustment, mastery, plasticity, reference to women (Humphreys, 2003 ) , chil- person-environment fi t, or social buffering” dren referred for learning problems (Sorenson (p. 187). Thus, resilience has been character- et al., 2003) , and adolescents (Olsson et al., ized as the positive counterpart of vulnerabil- 2003 ) , to name but a few. Other discussions ity (Rauh, 1989) ; and resilience has been focus on higher-order interpersonal systems likened to salutogenesis in that both address and refer to social and ecological resilience how people adapt in the face of adversity (Adger, 2000 ) , cultural-community resilience (Lindström, 2001 ) . (Clauss-Ehlers & Levi, 2002 ) , or collective 3 . Is resilience the opposite of nonresilience or resilience, referring to look to reconstruct and of vulnerability? In the former case it is pos- maintain social relationships that have suf- sible to lack resilience but still not be invul- fered trauma (Hernandez, 2002 ) . More nerable as when the person has not speci fi cally, the term resilience has been experienced disvalued outcomes but is never- applied frequently to couples (Conger, Rueter, theless vulnerable to unwelcome effects of & Elder, 1999 ) or families (Haan, Hawley, & adversity should they arise. In the latter case, Deal, 2002 ; Oswald, 2002 ; Patterson, 2002 ; the absence of resilience implies vulnerabil- Schwartz, 2002 ; Walsh, 2002 ) as units that are ity to adversity. Thus, resilience and vulner- more or less resilient in the face of adversity. ability are often viewed as opposite poles of Although it is conceivable that the term might a continuum refl ecting susceptibility to usefully be applied to interpersonal as well as adverse consequences or benign conse- individual-level systems, the context for usage quences upon exposure to high risk circum- should be clarifi ed in each instance. Certainly the stances (Anthony, 1987 ) . Ego-resilience is nature of the outcomes in which resilience is regarded as one pole of a dimension, the manifested or the kinds of resilience mechanisms other end of which is ego-brittleness (Block which in fl uence benign outcomes would be & Block, 1980 ) : expected to vary with the nature of the unit to Ego-resiliency, when dimensionalized, is fi rst which the term resilience is applied (Radke- defi ned at one extreme by resourceful adaptation Yarrow & Sherman, 1990 ) . to changing circumstances and environmental contingencies, analysis of the “goodness of fi t” At a societal level, successful coping behaviors between situational demands and environmental are those that contribute to the survival and well contingencies, and fl exible invocation of the avail- being of others. At a psychological level, we able repertoire of problem-solving strategies regard positive coping as the exercise of behaviors (“problem solving” being de fi ned to include the that contribute to the well being of the self. social and personal domains as well as the cogni- A child who becomes a survivor is one who is tive). The opposite end of the ego-resilience con- happy about one’s self, who is physically healthy, tinuum (ego-brittleness) implies little adaptive whose behavior is masterful, and who is learning fl exibility, an inability to respond to the dynamic to be a positive contributor to one’s immediate requirements of the situation, a tendency to perse- society. (p. 100) verate or to become disorganized when encountering changed circumstances or when under 2 . Is resilience isomorphic to, partially overlap- stress, and a dif fi culty in recouping after traumatic ping, or orthogonal to a variety of other terms experiences. (p. 48) that appear to be functionally equivalent to Occasionally, however, the negative pole is that term? The functional equivalence of resil- defi ned in terms of nonresilience rather than vul- ience and other terms has been recognized by nerability. Radke-Yarrow and Brown (1993 ) use numerous researchers, each selecting one of these terms: the terms and indicating the functional equivalence of the other terms. For example, Lösel, Resilience was de fi ned as having no diagnoses and Bliesener, and Köferl (1989 ) observe: “There not being on the borderline of reaching criteria for a diagnosis. Nonresilience was de fi ned as the pres- is a multitude of constructs that are related to ence of one or more diagnoses of a serious nature, invulnerability, such as resilience, hardiness, with problems persisting over time. (p. 583) 3 Reconceputalizing Resilience 41

Whether or not positive and negative out- latter case, resilience would be de fi ned in terms comes should represent polar opposites or the of the presence of desirable outcomes and the nature of the range between polar opposites absence of undesirable outcomes. In the for- remains problematic in the literature. Each desir- mer case, resilience would be de fi ned in terms able state does not necessarily have an undesir- of the characteristics that moderate the effect able state as a polar opposite. The presence of an of risk factors on benign outcomes and, less undesirable state (illness) implies the absence of directly, the in fl uence upon these factors. a desirable state (health). However, the absence Resilience is frequently de fi ned in terms of the of an undesirable state does not necessarily imply fact or process of approximating valued outcomes the presence of a desirable one. One may be in the face of risk or adversity. Resilience refers asymptomatic without having fulfi lled his or her to the fact of “maintaining adaptive functioning potential for health. In studies of adaptation to in spite of serious risk hazards” (Rutter, 1990 , p. life crisis, investigators typically equate a good 209). Consistent with the de fi nition, Lösel et al. outcome with the absence of physical symptoms ( 1989 ) state, “Our main interest is in resilient and psychopathology. They usually fail to con- adolescents who are (still) psychologically sider the possibility of a new and better level of healthy despite high multiple exposure to stress- adaptation that refl ects personal growth rather ful life events and circumstances” (p. 194). than a return to the status quo (Schaefer & Moos, Individuals are considered as vulnerable to 1992 , p. 149). particular negative outcomes or to the absence The way these issues are resolved has important of positive outcomes by virtue of being at risk. implications for the defi nition of resilience and the Vulnerable individuals are those who turn out other components of paradigms of resilience. poorly, while invulnerable individuals turn out Should positive factors associate with the reduc- well (Seifer & Sameroff, 1987 ) . As one team tion of risk and vulnerability be considered as lead- operationalized the concepts, children who are ing to optimal development and thus be considered being reared in chaotic and threatening condi- as bene fi ts to the growing child, or should one tions by emotionally ill parents are labeled assume that they contribute primarily to adequate development, and should thus be seen proactive? “invulnerable” or “resilient” if they have no One view would hold that the possible infl uence of psychiatric diagnoses, relate well to peers and positive and negative factors could affect develop- adult authorities in school and at home, have a ment on a full continuum running from poor to positive self-concept, and are performing at optimal functioning. The other possibility is that positive and negative factors affect the organisms grade level in school (Radke-Yarrow & on a continuum ranging from poor to adequate Sherman, 1990 ) . For Masten (1994 ) , resilience functioning only but do not affect optimal func- relates to “how effectiveness in the environment tioning. (Greenbaum & Auberbach, 1992 , p. 12) is achieved, sustained or recovered despite 4 . Is resilience to be de fi ned in terms of the nature adversity” (p. 4). of the outcomes in response to stress or in Resilience, in addition to, or instead of, being terms of factors which interact with stress to de fi ned in terms of the fact of having benign or produce the outcomes? Is resilience the valua- less malignant outcomes in the face of life stress tion of good outcomes among individuals who may be thought of as a general construct that are at risk for bad outcomes, or is resilience the refl ects specifi c characteristics and the mecha- qualities possessed by individuals who are at nisms through which they operate that moderate risk for bad outcomes, or is resilience the the relationships between risk factors and out- qualities possessed by individuals that enable come variables. One construct that is the func- them to have good outcomes? Is resilience a tional equivalent of resilience used in this sense is phenomenon that moderates the in fl uence of hardiness. risk factors on more or less benign outcomes? The implication that resilience re fl ects charac- Or is resilience the fact of having achieved teristics of the person or environment that benign outcomes in the face of adversity? In the in fl uences (other) desirable outcomes is apparent 42 H.B. Kaplan in Cohler’s ( 1987) comments about the nature of who are doing wellÐso-called resilient children. resilience: The personal and environmental factors that characterize them are assumed to be protective factors. In sum, the children of psychiatrically ill parents Presumably, children of nondiagnosed parents who who are better able to cope with the adversity of are coping as well do not deserve the resilient label, unreliable and often emotionally inaccessible care- nor are the personal and environmental factors that takers have innate ego strength, creative abilities, characterize them labeled protective. Why, then, and increased personal and physical attractiveness; are these concepts deemed so necessary to explain these traits enable children to continue to reach out well-functioning children of psychiatrically ill par- to others for support…Finally, these children often ents? (p. 78) have greater intelligence and come from families higher in social status; in turn, these qualities foster Anthony ( 1987 , pp. 27Ð28) highlights the increased instrumental mastery and greater social issue of potential resilient or vulnerable individu- skills. (p. 395) als by referring to “pseudovulnerables who are In many instances it is dif fi cult to determine vulnerable or extremely vulnerable individuals which of the two defi nitions, resilience as outcomes who have been ‘blessed’ with an overprotective vs. resilience as in fl uential quality, is intended by environment (particularly the maternal portion of the researcher. Indeed, outcomes in one context it), and are relatively unchallenged and thriving may be treated plausibly as in fl uences upon out- until the environment fails, and they fail along comes in another context (Schuldberg, 1993 ) : with it.” 6. Where resilience is de fined in relationship to The same current indices can be viewed either as signs of positive adjustment or as protective or the prior experience of distressful life experi- compensatory factors; in both cases the variables ences, the further question is raised as to will predict future good outcomes. (pp. 139Ð140) whether resilience is re fl ected in the ability to bounce back from adversity or is caused by 5 . What is the relationship between resilience adversity. In the former case, a person’s resil- and the experience of distressful life experi- ience is manifest in the person’s ability to ences? Is a person said to be resilient because function adequately following adversity. The he or she bounces back from adversity? An person’s ability to function was fi rst disrupted af fi rmative response implies that a person can- by the adversity but was subsequently restored. not be resilient in the absence of preexisting In the latter case, the adversity challenged the experiences of adversity. One has to suffer person (or system) to fi nd strength that might before the consequences of suffering can be not otherwise have been discovered. The per- assuaged. However, it might be asserted that son is better off because of the adversity than individuals are resilient because they are capa- if the adversity had not been experienced: ble of recovering from adversity even if they have not yet experienced adversity. Should Life crises are viewed as constructive confronta- they experience disvalued life experiences tions that spur development. Personal growth can be fostered by the disruption that crises generate they most likely would recover. Indeed, the and the subsequent reorganization that occurs in very experience of risk might be forestalled by their wake. Stressors are a natural and potentially the characteristics that make a person or sys- positive part of life; resilience develops from contem resilient. fronting stressful experiences and coping with them effectively…The process of confronting The issue of the applicability of the concept of these experiences can promote a cognitive differ- resilience to “well-functioning/low-risk individu- entiation, self-con fi dence, and a more mature als” has been raised by many researchers or clini- approach to life. A person who experiences pain cians. Richters and Weintraub ( 1990 ) , for and loss may develop a deeper understanding and empathy for others with similar problems. Exposure example, assert that for: to novel crisis situations may broaden a person’s those who study the offspring of psychiatrically ill perspective, promote new coping skills, and lead to parents, the search for protective factors seems to new personal and social resources. (Schaefer & stem from surprise at fi nding high-risk offspring Moos, 1992 p. 150) 3 Reconceputalizing Resilience 43

7. Where resilience is de fi ned in terms of out- Further, outcomes are ordinarily defi ned in comes, should resiliency be de fi ned in terms of terms of arbitrary normative judgments regarding some overall criterion or in terms of particu- appropriate intrapsychic and behavioral lar context-specifi c favorable outcomes? responses, taking into account culture, environ- Resilience is often defi ned in general terms of mental circumstances, and stage of development. the forestalling of adverse developmental out- This is a major limitation of utility of the con- comes in the face of characteristics of the indi- struct since normative judgments are so variable. vidual or the individual’s environment that Bartelt (1994 ) offers the following example: would have led to the prediction of the adverse Several representatives of Hispanic community developmental outcome. However, except for organizations have put the following question to this similarity, variation in the nature of the me: If family income is lower for Puerto Rican desirable or undesirable developmental out- communities, the day-to-day needs of the household for additional economic resources are strongly comes had led to widely different de fi nitions present; and if there is a strong pro-family ideol- of resilience. ogy within the community that is threatened by The subject may be manifesting resiliency continued poverty; why should we not expect that according to one criterion, but not according to our teenagers will seek to leave school and obtain full-time employment as soon as possible? In turn another. For example, Spencer, Cole, Dupree, I must ask myself, isn’t this is a form of resilience Glymph, and Pierre (1993 ) , conceptualizing as we have come to de fi ne it? How do we distin- resilience as adaptive coping, tested a model of guish academic success as resilience from drop- risk and resilience to examine coping methods ping out as resilience? (p. 103) and competence outcomes as measured by aca- 8. Where resilience is de fi ned in terms of protec- demic performance and academic self-esteem. It tive factors, which general or speci fi c protec- is possible that those individuals may be judged tive factors are equated with resilience? to be resilient by these criteria but not according Where vulnerability is de fi ned in terms of the to the criteria representing competence in other protective factors or related phenomena that spheres (per relations, family). The fact that indi- permit the approximation of desirable out- viduals may vary in adjustment depending upon comes, a good deal of defi nitional variability the domain under consideration has implications can be observed. Variability in defi nition is for the conceptualization of resilience. Luthar observed because the causes of resiliency vary (1993 ) concludes: according to the causes of diverse outcomes. The current evidence indicates, then, that notions Since the same factors may not cause one out- of overall resilience are questions of utility. In come as opposed to another outcome, factors future research, it would be more useful if discus- which mitigate the effects of stressors on one out- sions were presented in terms of speci fi c domains of successful coping (e.g. academic resilience, come may be expected to be different from those social resilience, or emotional resilience), along that mitigate the effect of stressors on another with those areas in which apparent survivors show outcome. The implication of this is that “differ- high vulnerability. (p. 442) ences across spheres of adjustment must be care- Even within the same sphere of operation, fully appraised and discussions on resilience judgments of resiliency can vary as outcome should be presented in terms of the specifi c measures vary. spheres of successful (and less successful) adaptation” (Luthar, 1993 , p. 442). While a child may appear to be adapting positively within the school arena if outcome mea- 9. Where resilience is de fi ned in terms of benign sures focus solely on cognitive abilities, the outcomes or responses to adversity, stress or same child may manifest impaired social rela- risk factors, how does it determine the nature tionships. Unless multiple domains of develop- of the factors that place an individual or sys- ment are assessed, only a partial picture of adaptation can be formulated. (Cicchetti & tem at risk? The defi nitions of resilience that Garmezy, 1993 , pp. 499Ð500) have reference to risk factors have been widely 44 H.B. Kaplan

and justifi ably criticized. There are not defi nite However, a review of the literature on resilience criteria by which a particular variable may be offers some hope of focusing this concept on a de fi ned as a risk factor. Therefore, no clear cri- more narrow set of phenomena namely, those terion exists by which particular behaviors or relating to self-referent processes. outcomes may be de fi ned as resilient. Judgment is always made after the fact and is based on the assignment of risk to particular conditions. Resilience and Self-Referent Processes Seifer and Sameroff ( 1987 ) also note: There is currently no criterion by which a particu- Various conceptualizations of resilience, as we lar variable is determined to be a risk factor, a pro- have noted above, focus on different appeals of a tective factor, or merely a measure that is related to general process including, but not limited to: the outcome in question. This issue of defi ning (absence of) subjective distress and more or less “risk” might be a trivial matter except for the fact that what determines vulnerability or invulnerabil- dysfunctional sequelae of such distress, risk (pro- ity is dependent upon the initial determination of tective) factors that increase the likelihood of risk. To some extent, this is a logical dilemma. One adverse (benign) outcomes; circumstances that could assume that any factor shown to affect child mediate the infl uence of putative (protective) risk outcomes adversely should be considered a risk factor. But then there would be no possibility of factors on (benign) adverse outcomes; and per- fi nding a set of measures that consistently differen- haps most importantly given to frequency with tiate vulnerable from invulnerable, since anything which they are discussed in the resilience litera- that differentiates children with good outcomes ture, factors that moderate the degree to which from those with poor outcomes would be considered a risk factor. (pp. 64Ð65) hypothetical (protective) risk factors eventuate in more or less adverse outcomes. An examination Cicchetti and Garmezy (1993 ) observe the of the theoretical and empirical literatures utiliz- dif fi culty of distinguishing between the factors ing the notion of resilience and one or more of that indeed place the individual at risk and factors these components suggests that they have in com- that happen to distinguish between good and poor mon the manifest refl ection of self-referent pro- outcomes but have no causal signifi cance. cesses as operationalizations of these components, Frequently risk factors are stated in terms of or are interpretable in these terms. It is unfortu- marker variables rather than in terms of marker nate that the conceptualization of some of the variables rather than in terms of underlying con- self-referent processes suffer from many of the structs. Therefore, the assumption of being limitations that characterize the resilience con- exposed to risk may be faulty. The individual struct. For example, frequently it is dif fi cult to may have been exposed to the marker variable determine from the context if “self-esteem” refers but not to the underlying construct that is said to to self-image, self-evaluation, or self-feeling. be represented by the marker variable. Thus, peo- However, as we will develop in the next sections, ple may be labeled resilient even though they these diffi culties are more easily soluble for the have not in fact been exposed to the situation self-referent construct than for resilience-related considered to be a stressor. concepts. In any case, an overview of the resil- The idea of resilience has then a plethora of ience literature admits of the following general- different meanings, many of which are vague and izations regarding the relevance of self-referent contradictory. The absence of specifi city is trace- responses for virtually all elements of what have able to several issues, many of which were cate- been discussed frequently as part of the resilience gorized and described brie fl y above. So daunting phenomena. is the number of such issues that have been raised 1. In virtually all theoretical discussions or with regard to the concept that one might despair reports of empirical fi ndings relating to resil- of ever being able to resolve these various issues ience, the hypothetical protective and risk and offer a defi nition or, having offered a factors, and/or the more or less benign out- de fi nition, to gain consensus on its usage. comes of these factors, either manifestly 3 Reconceputalizing Resilience 45

re fl ect or are interpretable in terms of self- These observations regarding the relevance of referent processes. a range of self-referent processes for resilience This conclusion holds for a wide variety of have important implications for social policy and factors, outcomes, and subject populations. planned interventions. Implicit in the observation Considering those reports that deal with protec- that self-referent processes are implicated in the tive factors and/or benign outcomes, the follow- development of resilience is the expectation that ing studies serve to illustrate this generalization. resilience can be increased by, for example, facil- If not invariably, self-esteem and/or related itating participation in relationships that offer the self-referent constructs often are presented as cri- promise of enhancing such processes, including a terion outcome variables that are predicted by sense of empowerment, worth, and competence constructs said to refl ect resilience for those out- (Hartling, 2008 ) . comes (e.g., Filbert & Flynn, 2009 ) . Thus, in an Conversely, considering those reports that deal investigation of the resilience of foreign American with risk factors and/or undesirable outcomes, college students in the face of perceived ethic dis- the following studies serve to illustrate the near crimination self-esteem was observed to be an universal recognition that self-referent processes outcome of fi rst order effects of ethnic identity are manifestly or implicitly germane to the ante- pride and low perceived discrimination, the one cedents and/or outcomes of the resilience pro- precursor of high self-esteem, and the others the cesses. Thus, the loss of personal control absence of a threat to self-esteem (Lee, 2005 ) . associated with aging-related loss of functions Similarly, self-esteem, which along with opti- among those elderly individuals in a psychologi- mism composed of a core construct of resilience, cal autopsy study whose self-esteem appeared to was inversely related to “mental distress” over a be contingent on being productive and in context 1-year period (Mäkikangas, Kinnunen, & Feld, were said to develop an intolerable sense of vul- 2004 ) ; and among adolescents with sickle cell nerability that leads to suicide (Kj¿lseth, Ekeberg, disease, higher levels of self-esteem were associ- & Steihaug, 2009 ) . It is the pervasive sense of ated with lower levels of depression and anxiety vulnerability, caused by threats to salient self- (Simon, Barakat, Patterson, & Dampier, 2009 ) . evaluative standards and concomitant low self- A variety of self-referent processes have been esteem that defi nes the low resilience/at risk implicated in the resilience process. For example, person. among subjects who have suffered abuse as chil- In a three wave longitudinal study, the estima- dren, in addition to self-esteem, such self-relevant tion of structural equation models revealed that, processes include regulation of self-feelings and controlling for early levels of self-esteem, ado- self-reliance as contributors to adaptive coping lescents who reported peer victimization tended (Cicchetti & Rogosch, 2009 ) . to have lower self-esteem across 1-year intervals Others have measured resilience exclusively (Overbeek, Zeevalkink, Vermulst, & Scholte, in terms of such self-referent constructs such as 2010) . Presumably, the experience of peer vic- self-esteem, self-con fi dence, and self-transcen- timization serves to communicate to the victims dence (Phillips-Salimi, Haase, Kintner, Monahan, that (s)he is held in low regard by her(his) peers, & Azzouz, 2007 ) . Thus, self-esteem, personal which in turn adversely affect her(his) self- control, and optimism, conceived of as compo- esteem. Moreover, it was observed that lower nents of resilience, have been observed to self-esteem tended to invite peer victimization, in fl uence outcomes that are less dysfunctional for but only among a subgroup of overly self-con- organizations in which the person participates. trolled individuals. Among the explanations of Resilience, so de fi ned, was related to willingness this fi nding that present themselves is that which to accept change which, in turn, was inversely suggests that bullying peers are not inhibited related to job dissatisfaction, intention to quit the from their victimizing behaviors since their over job, and feeling of irritation in the workplace controlled intrapunitive victims are not likely to (Wanberg & Banas, 2000 ) . assert themselves and retaliate. 46 H.B. Kaplan

Among the outcomes of antecedent self- experimentally induced uncertainty threat led referent responses are dysphonic affective states. individuals with high self-esteem to manifest Thus, in a cross-sectional national sample of increased “Relative Left Frontal (F7/F8) 16Ð19 year old adolescents in Iceland, low self- Electroencephalographic Activity” which is esteem was observed to be related to a higher commonly understood to be a neural manifesta- probability of depressed mood and anger. tion of resilient approach-motivation. The same Further, these effects were stronger for students normal pattern was observed in the effect of the who were sexually abused, a fi nding that is to be interaction of self-esteem and threat on a variety expected if the experience of sexual abuse of antisocial defenses (McGregor, Nash, & refl ects a self-devaluing experience that exacer- Inzlicht, 2009 ) . bates the distressful self-feelings that follow In the latter case, the simultaneous consider- upon the intensifi ed need to attain or restore self- ation of risk and protective factors in the same esteem (Asgeirsdottir, Gudjonsson, Sigurdsson, study is illustrated by the observed indirect effects & Sigfusdttir, 2010 ) . of trait anxiety and trait resilience (via their Self-threatening experiences, in addition to infl uence on positive and negative affect) that are having effects on intrinsically undesirable out- interpretable in terms of their implications for comes such as low self-esteem and other dys- threats to self-esteem : trait anxiety refl ecting functional/deviant adaptations, often lead to the sensitivity to the prevalence of such threats, and loss of resources, the acquisition or possession of trait resilience re fl ecting the presence of self- which might forestall such outcomes. Such protective mechanisms that forestall or reduce resources might include learned interpersonal the distress associated with self-threatening skills and material resources and other social circumstances (Benetti & Kambouropoulos, supports provided by one’s interpersonal net- 2006 ) . works, the availability of which might be dimin- 2. Whether or not self-referent processes are ished by self-threatening circumstances. A case refl ected as risk/protective factors and/or as in point is the observed inverse relationship more or less benign outcomes in studies or the- between earlier “protective self-cognitions” (self- oretical discussions of resiliency, such self- effi cacy and self-esteem) and later resource loss referent processes have been widely reported to observed in a sample of women who experience mediate and/or moderate these relationships. childhood abuse and were at risk for contracting With regard to their mediating functions, a sexually transmitted diseases (Walter, Horsey, number of studies previously cited as illustra- Palmieri, & Hobfoll, 2010 ) . tive of relationships between risk/protective Although to this point the citations refl ect factors and more or less adverse outcomes that exclusively positive or exclusively negative out- refl ect self-relevant processes also illustrate the comes, and exclusively risk or protective factors, mediating role of such processes. Thus in a pro- it should be noted quite frequently self-referent spective study of women at risk for contracting processes may be refl ected in both positive and sexually transmitted disease and who suffered negative outcomes, and/or as proactive and risk childhood abuse, symptoms of posttraumatic factors in the same study. In the former case, for stress disorder (PTSD) associated with experi- example, high self-esteem is observed to have ences of childhood abuse were observed to be benign effects on outcomes of personal threats, inversely related to a latent construct re fl ected that is, manifest resiliency, while frequently in measures of self-ef fi cacy and self-esteem. evoking extreme and antisocial defensive These “protective self-cognitions,” in turn were responses. What these counterveiling responses inversely related to a latent construct, “resource may have in common is “reactive approach- loss” measured at a later point in time, re fl ected motivation processes” that are evoked by threat in measures of family resources, energy in high self-esteem individuals. In support of this resources, material resources, and interpersonal hypothesis, are the results of a study in which resources (Walter et al., 2010 ) . 3 Reconceputalizing Resilience 47

Reports that positive and negative affect medi- higher levels of discrimination stress, and so is ate the infl uence of self-threatening (anxiety) or more motivated to restore or attain self-esteem, self-protective (resilience) personal traits on self- the adoption of primary continual engagement esteem are interpretable in terms of the mediat- coping patterns (direct coping with the source of ing in fl uence of other self-referent processes stress of one’s emotions) in fl uences higher levels (Benetti & Kambouropoulos, 2006) . In this of self-esteem. instance, scores on mediating positive and nega- Level of self-esteem moderates the effect of tive affect measures may re fl ect the ability to failure on responses to such failure. Individuals self- protectively regulate the negative/positive characterized by low self-esteem, by de fi nition, self-feelings that are the outcome of self-threat- have a stronger need to restore or attain self- ening or self-enhancing circumstances indicated esteem than characteristically high self-esteem by measures of trait anxiety and resilience, people. Consequently, low self-esteem people respectively, and that, in turn, in fl uence self-es- who have their self-esteem on a particular domain teem, that is, a measure of perceived self-worth. (e.g., academic competence) would be more Also relevant is the cross-sectional study of a prone than high self-esteem individuals to national sample of adolescents in Iceland, in respond to failure self-protectively by losing which self-esteem was observed to indicate the motivation to achieve academically while devalu- in fl uence of such variables as parental support ing the evaluative signifi cance of such achieve- and attitudes toward school on depressed mood ment (Park, Crocker, & Kiefer, 2007 ) . More and anger (Asgeirsdottir et al., 2010 ) . speci fi cally, low self-esteem people who experi- Consistent with the results of these studies, ence failure in domains on which they base their data collected by questionnaire from the munici- self-esteem would be prone to respond to intima- pal Police Of fi ce of Florence indicated that cumu- tions of failure in those domains by reducing their lative exposure to perceived personal threat that motivation to appear competent in those areas. was a risk factor for posttraumatic stress is medi- In a study of homeless youth self-esteem has ated by greater social support and by lower levels been observed to be a salient protective factor of perceived personal threat and peritraumatic against loneliness, suicidal ideation, and feelings distress (Pietrantoni, Prati, & Lori, 2009 ) . of being trapped (Kidd & Shahar, 2008 ) . In addi- Even more prevalent than studies manifesting tion, self-esteem is protective against the adverse the mediating role of self-referent processes in effect of fearful (as opposed to secure) attach- relationships between risk/protective factors and ment on loneliness. Similarly, opportunities adverse/benign outcomes are those investigations afforded to individuals to engage in activities that that describe how circumstances that manifestly increased self-esteem among those residing in re fl ect or are interpretable as re fl ecting self-refer- impoverished households apparently mitigated ent processes moderate these relationships. In the expected adverse consequences of material particular the moderating in fl uence of self-esteem deprivation (Canvin, Marttila, Burstrom, & on resilience has been observed for a wide variety Whitehead, 2009 ) . of putative risk factors, adverse consequences, A variety of medical conditions are taken to and populations. For example Edwards and refl ect a concatenation of risk factors, the effects Romero (2008 ) observed that Mexican descent of which are somewhat mitigated by high self- adolescents who were experiencing high levels of esteem. Thus, for children with dyslexia (pre- stress from discrimination and who reported par- sumably a risk factor for adverse outcomes) the ticular coping patterns were able to protect their children who scored higher on a measure of self-esteem from the adverse effects of prejudice global self-worth (as well as their parents) mani- and discrimination. In effect an interaction fested more positive attitudes toward the between level of discrimination and category of diffi culties in reading. Further, they were less coping mechanisms in fl uenced subsequent level likely to report a negative impact on relationships of self-esteem. When the youth experiences (Terras, Thompson, & Minnis, 2009 ) . 48 H.B. Kaplan

In this regard, frequently self-esteem related increased mortality salience was associated with constructs are viewed, not only as a component increased endorsement of positive personality of resilience, but rather as the essential elements descriptions suggesting an increased need to of this construct. Thus, Yi and associates (Yi, defend against self-threatening circumstances Vitaliano, Smith, Yi, & Weinger, 2008 ) de fi ned by people who are particularly sensitive to self- resilience in terms of a factor score consisting of criticism (Schmeichel et al., 2009 ) . self-esteem, self-ef fi cacy, self-mastery, and optimism. Resilience, thus defi ned, was observed to moderate the effect of diabetes-related distress on Toward an Integrative Explanatory glycosylated hessoglobin among patients with Framework diabetes. Patients with low or moderate resilience levels manifested a strong association between The importance of establishing a linkage rising distress and worsening glycosylated hes- between resilience-related constructs and a set soglobin. Those with high resilience did not dem- of mutually infl uential self-referent constructs is onstrate the same association. Nor did low twofold. On the one hand, it is possible to resilience patience engage in self-care behaviors replace a diffuse and ambiguous resilience- to the same degree as others in response to rising related literature with a more narrowly focused distress. group of concepts that appears to offer greater Finally, to further illustrate the moderating opportunities for conceptual clarity. At the same in fl uence of self-esteem, according to the terror time, on the other hand, these self-referent con- management theory (TNT) self-esteem buffers cepts offer the promise of constituting the core the anxiety—producing effects of increased of an explanatory theoretical framework that awareness of one’s mortality. Those with high addresses the sources of life stress, the (in) self-esteem have successfully internalized and direct and moderating infl uences of stressors on conformed to a system of self-values shared by more or less adverse outcomes and the recipro- an interpersonal network. Bolstered by these cal infl uence of these outcomes on the afore- resources it is possible to manage what would mentioned factors. otherwise be paralyzing terror evoked by mor- Over a period of more than 50 years I have tality salience. However, low self-esteem indi- formulated a general theory of behavior that viduals have failed to meet the culturally focuses upon the antecedents and consequences prescribed demands that allow full participation of four classes of self-referent responses, the in their social system and the garnering of relations among the self-referent responses, resources normally afforded to such participants. and the mediators and moderators of these rela- Consequently, for low self-esteem individuals tions (Kaplan, 1972, 1975, 1980, 1984, 1986, increased awareness of one’s mortality would 1996, 2001) . Although initially formulated and evoke intensifi ed feelings of death-related anxi- tested as a general theory of deviant behavior ety and the concomitant need to defend against (see Kaplan, 1980, 2003; Kaplan & Johnson, such anxiety. Consistent with this reasoning, 2001 for an overview of several analyses), the among individuals low in implicit (presumably theory has since been applied as an integrative true) self-esteem, but not those high in implicit framework for the literature in several other self-esteem, increased mortality salience was (partially overlapping) substantive areas, associated with increased defensive responses. including psychosocial stress (Kaplan, 1996 ) , In addition to the foregoing an increase in the sociology of emotions (Kaplan, 2006 ) , implicit self-esteem reduced the effect of mor- social psychology (Kaplan, 1986 ) , and the sev- tality salience on the defensive response. Finally, eral disciplines constituting the humanities unique to a subset of individuals characterized (Kaplan & Kaplan, 2004 /2005). Most recently by low implicit/high explicit self-esteem (sug- the general theory was applied to the medical gesting highly vulnerable or defensive persons) sociology literature (Kaplan, 2007 ) . 3 Reconceputalizing Resilience 49

Building upon the seminal observations of To begin with the process of self-cognition, others regarding the re fl exive nature of human how an individual responds to himself along any behavior, social infl uence on self-conception and of a number of cognitive dimensions is infl uenced self-evaluation, and the motivational force of by the person’s attributes, behavior, and experi- self-feelings (see in particular Cooley, 1902 ; ences in interaction with the situational context in James, 1915 ; Mead, 1934 ) , the theoretical state- which they appear, the system of concepts that ment delineates: (1) structural and interactional the person has learned to use to structure stimuli, effects on self-conceptions (cognitive responses and the motivation to evaluate himself positively. directed toward one’s own person, including self- The person’s traits, behaviors, and experiences perception, self-imagination, self-awareness, (including the individual and collective responses etc.); (2) the infl uence of self-cognition on self- of others that purposely or otherwise have an evaluation (a subcategory of self-conception impact on the person’s outcomes) are social in whereby persons judge themselves to be more or nature, both in the sense that their meanings are less proximate to or distant from self-relevant, provided by the current situation and in the sense situationally appropriate, hierarchically oriented that they have their origins in the course of past evaluative standards); (3) the infl uence of self- social interactions. evaluation on self-feelings (emotional responses The most direct route by which personal traits, to internalized needs stimulated by salient self- behaviors, or experiences may infl uence self- evaluations); (4) the in fl uence of (negative) self- referent cognitive responses is by immediately feelings on initiation of self-enhancing and becoming objects of self-awareness. The per- self-protective responses (behavioral change to sonal traits, behaviors, and experiences of which approximate self-evaluative standards, distortion one becomes aware may be conceived of in terms of self-concept, reformulation of self-evaluative of their objectively given forms or in terms of hierarchy, suppression of distressful self-feelings) other, perhaps unobserved or unobservable, per- evoked by the intensifi ed need to diminish nega- sonal traits, behaviors, or experiences that are tive (and increase positive) self-feelings, occa- suggested by the immediate object of awareness. sioned by negative self-evaluations; and (5) the The person’s traits, behaviors, and experi- impacts of self-enhancing and self-protecting ences are mutually infl uential, whether over a responses on behavior that is directed toward relatively long or short period of time. Therefore, approximating salient self-evaluative standards, any particular trait, behavior, or experience may or directly diminishing the experience of distress- have an indirect effect on self-referent cognition ful self-feelings (Kaplan, 1986 ) . Although it is by, fi rst, infl uencing others’ personal traits, beyond the purpose of this paper to present a behaviors, or experiences that, in turn, directly detailed description of an integrative explanatory stimulate self-awareness and self-conceiving theoretical framework, perhaps the following responses. Traits, behaviors, and experiences synopsis will serve to convey the utility of this vary to the extent to which they may directly approach in systematically encompassing the stimulate self-conceiving responses as opposed range of constructs that are normally considered to indirectly in fl uencing such responses through in the resilience-related literature, including those their mediating effects on other infl uential traits, that are regarded as risk or protective factors and behaviors, and experiences. a range of more or less (un)desirable outcomes, The nature of the in fl uence of personal traits, as well as the variables that mediate or moderate behaviors, and experiences on self-referent cog- the relationships between them. Again, the con- nitive responses is moderated by the situational structs that compose the theoretical framework, context, the person’s system of concepts that he in large measure, relate to the relevance of self- habitually uses to structure the world and him- referent processes for explaining sociodevelop- self, and the person’s motivation to acquire self- mental or contemporaneously socially structured enhancing experiences. The situational context phenomena. provides symbolic cues that (1) specify the 50 H.B. Kaplan relevance of particular traits, behaviors, and with reference to the situationally applicable experiences for the person’s current life situa- personal evaluative standards. The most inclu- tion from among the many traits, behaviors, and sive self-value in the person’s system of self- experiences in the person’s repertoire and (2) values is positive self-evaluation. The person’s provide a range and distribution of values along overall self-evaluation is a function of self- speci fi c dimensions that allow and stimulate the perceptions of approximating speci fi c self- person to discern the particular values that char- evaluative standards that are more or less salient acterize himself along these dimensions. The (central, important) in the personal hierarchy person uses a relatively stable, more or less con- of values. sensual system of concepts to guide the selective Depending on the degree to which the person cognitive structuring of personal attributes—a judges himself to be distant from positive self- system of concepts that is derived both from evaluation, he will experience more or less nega- regularities in the person’s responses and from tive self-feelings that motivate him to behave in the reinforcement value of (1) other’ sanctions ways that appear to reduce the likelihood of nega- for the use of particular concepts and (2) the tive self-feelings and to maximize the probability usefulness of the consensual concepts in antici- of experiencing more positive self-feelings. pating other’s responses to the person’s behav- Self-feelings re fl ect the activation of need dis- iors. The person’s need for positive self-evaluation positions that are stimulated by the person’s self- motivates him to be sensitive to his own personal evaluative responses, that is, by self-judgments traits, behaviors, or experiences that are relevant of being more or less distant from valued or dis- to self-attitudes and to perceive and defi ne them valued states. Need dispositions are internaliza- in ways that will enhance self-evaluation. tions of self-values and refl ect the readiness to Self-referent cognitive responses have direct behave in ways that will permit approximation of consequences, both for the person’s own traits, valued, and distancing from disvalued, states. behaviors, and experiences and for other modes of Self-feelings as the experience of needs stimu- self-referent responses. The acts of responding to lated by self-evaluative responses are experi- oneself cognitively in particular ways are them- enced as more or less intense and more or less selves behaviors and may become personal attri- durable affective or emotional responses to self- butes that, in turn, stimulate other self-referent evaluative responses. The feelings are experi- cognitions. Self-cognitions, conjointly with the enced as more or less distressful, depending on individual’s need-value system, in fl uence self- the self-evaluations of being more or less distant evaluative responses and self-enhancing responses. from the valued or disvalued states, and the cer- Self-evaluative responses are personal judg- tainty and immediacy of approaching these states. ments of the extent to which the person approxi- The most inclusive of the needs is the need for mates desirable states. The initiation of a positive self-evaluation. The stimulation of this self-evaluative response is a function of the per- need is a function of the more or less salient self- son’s self-awareness and self-conceptualization evaluative responses of more speci fi c personal and of the person’s learned disposition to evalu- traits, behaviors, or experiences and of the cor- ate himself when becoming aware of himself. responding, more speci fi c self-feelings that are The nature (content) of the self-evaluative evoked by self-referent evaluative responses to response is a function of the nature of the per- personal traits, behaviors, or experiences. son’s self-perceptions and of the personal sys- Affective or emotional responses to self- tem of evaluative standards (in particular, that evaluation (i.e., self-feelings) become part of the aspect of the personal value system that encom- repertoire of personal traits, behaviors, and expe- passes self-values), according to which he riences. As such, they stimulate self-awareness judges that which he perceives about himself. and self-conceptualization, and thereby stimulate The speci fi c self-perception, in conjunction with self-evaluative responses relating to the propriety social situational cues, stimulates self-judgments of the self-feelings. 3 Reconceputalizing Resilience 51

Self-feelings, the experience of need, stimulate in the attainment of, or intrinsically re fl ect, salient the person to behave in ways that will permit the self-values. person to satisfy his needs. These needs relate to Responses that directly impact self-feelings the approximation of self-values, the most inclu- may involve the use of pharmacologic substances sive of which is overall positive self-evaluation. that increase euphoric or decrease dysphoric self- In view of this, the responses oriented to the satis- feelings, or may implicate involuntary central faction of needs, stimulated by self-values and and autonomic nervous system responses that expressed as self-feelings, are collectively consid- preclude the experiences of unwelcome feelings. ered to be self-protective and self-enhancing The responses in all of those categories may be responses. These responses to self-feeling take expressed in ways that, in varying degrees, the form of changes in: self-referent cognition; approximate conventional or deviant standards. the person’s need-value system; and other per- The occurrence and form of self-protective or sonal traits, behaviors, and experiences that self-enhancing responses are determined by the have self-evaluative signi fi cance. Additionally, nature of the person’s self-feelings, the person’s the responses may directly affect the experience beliefs about himself in relation to his environ- of negative (positive) self-feelings. ment, and the person’s evaluation of the pro- Self-protective and self-enhancing responses jected self-protective and self-enhancing are behaviors by the person that are more or less responses as more or less closely approximating consciously oriented toward the goal of (1) fore- self-evaluative criteria. To the extent that the stalling the experience of self-devaluing judg- individual variously experiences chronic self- ments and consequent distressful self-feelings rejecting feelings or situational exacerbation of (self-protective patterns) and (2) increasing the self-rejecting feelings, the person will be moti- occasions for positive self-evaluations and self- vated to adopt self-protective or self-enhancing enhancing responses that may take any or all of responses. The experience of positive self- four forms relating to the person’s self-referent feelings tends to reinforce those specifi c or gen- cognitive responses, the person’s revision of the eral purposes that the person associates with the need-value system, the person’s responses that experience of positive self-feelings. Within these are oriented to the approximation of salient self- constraints, the specifi c forms of the self- value, and responses that directly impact the protective and self-enhancing patterns are experiences of positive or negative self-feelings. in fl uenced by the person’s beliefs about his own Self-referent cognitive responses serve self- capabilities in relationship to the mutability of protective functions by permitting the person reality. The person will tend to adopt those (1) to perceive himself as having positively valued response patterns that, based on earlier experi- qualities; (2) to deny negative attributes; and ences, are believed to be within the person’s (3) to be sensitive to those personal attributes, capabilities and that are expected to serve self- behaviors, and experiences that have self-evaluative protective or self-enhancing functions. The form relevance. This last function orients the person of the self-protective or self-enhancing responses to responses that are likely to forestall self-deval- is in fl uenced, further, by the personal evaluation uing and to facilitate self-enhancing experiences. of responses that are expected to serve these Revisions in the need-value system permit indi- functions. Although a person may anticipate that viduals to selectively order self-values so that certain responses will serve self-enhancing func- they are compatible with the person’s present tions, he may not perform those behaviors if they and anticipated traits, behaviors, and experi- are judged to re fl ect or to be instrumental in the ences. A third major form of self-protective and approximation of disvalued states. Those behav- self-enhancing responses encompasses the per- iors will be acted out to the extent that such judg- son’s purposive behaviors that are oriented to the ments are not made, whether because they were approximation of self-evaluative standards. That already compatible with the person’s self-values is, the person behaves in ways that are instrumental or because the person reorders his self-values in 52 H.B. Kaplan such a way that the projected self-enhancing In sensitizing us to the need to understand the patterns are no longer incompatible with the mutual effects of antecedents of more or less posi- person’s self-evaluative criteria. tive outcomes, the conditional nature of these effects, and the fact that proximal and conditional variables have their own causes, the concept of Conclusion resilience has served an important function. The concept has alerted us to the fact that people who Although I have criticized the concept of resil- according to conventional wisdom should have ience because it is so diffuse and ambiguous in its experienced adverse outcomes, do not in fact expe- meanings it might be argued that the concept of rience them. Having so alerted us to the phenom- resilience is useful precisely because it instigates ena, however, resilience may have served its so many conceptual or theoretical issues. The purpose. In place of this concept, we must now word evokes so many rich intellectual issues redirect our attention to creating more general the- regarding intrapsychic and interpersonal resil- oretical structures that take into account individual, ience-related processes that increased under- environmental, and situational factors that in fl uence standing of human or higher-order systemic each other and interact with each other to infl uence adaptive responses in all their ramifi cations must other variables in different ways at different stages follow necessarily. Perhaps it is in serving this of the developmental cycle and of the evolution of sensitizing function that “resilience” fi nds it rai- social structures to affect outcomes, the evaluative son d’etre. When it ceases to serve this function, signi fi cance of which is only incidental to the pur- if it has not already done so, because of the sev- pose of explaining the phenomena in question. eral contradictions and ambiguities inherent in the concept, it may be necessary to move beyond Acknowledgments This work was supported by research the de fi nition of the concept. grants (R01 DA 02497 and R01 DA 10016) and by a “Moving beyond” involves both reconceptual- Research Scientist Award (K05 DA 00136) from the National Institute on Drug Abuse to the author. ization and theoretical integration. In the former case, resilience must be more precisely equated to constructs that re fl ect adversity and the psy- References chosocial processes that mediate and moderate the reciprocal relations between them. Based on a Adger, W. N. (2000). Social and ecological resilience: Are review of the resilience-related theoretical and they related? Progress in Human Geography, 24 (3), empirical literatures, I suggest that such precision 347Ð364. and equivalency may be found in a concentration Anthony, E. J. (1987). Risk, vulnerability and resilience: An overview. In E. J. Anthony & B. Cohler (Eds.), The of self-referent constructs. invulnerable child (pp. 3Ð48). New York: Guilford. In addition, however, for resilience to serve a Asgeirsdottir, B., Gudjonsson, G., Sigurdsson, J., & useful purpose it must be located in the context Sigfusdttir, I. (2010). Protective processes for of a coherent theoretical framework. I argue that depressed mood and anger among sexually abused adolescents: The importance of self-esteem. such a framework should be grounded in a Personality and Individual Differences, 49 , 402Ð407. matrix of interrelated propositions asserting (in) Bartelt, D. W. (1994). On resilience: Questions of validity. direct (non) recursive linear and moderative In M. C. Wang & E. W. 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Zhe Wang and Kirby Deater-Deckard

Resilient children are not simply “born that way,” research that demonstrate the integrative inter- nor are they “made from scratch” by their experi- play between nature and nurture in the predic- ences. Genetic and environmental factors operate tion of individual differences in resilience. We conjointly as protectors against a variety of risks begin by considering several aspects of individu- to healthy development, ranging from resistance ality that are critical to resilience in childhood, to bacteria and viruses to resistance to maltreat- with an emphasis on temperament, cognitive ment and rejection. The key question is how skills, and social cognitions. We then turn to genes and environments work together to pro- consideration of the resilience-building transac- duce resilient children and adults. tions that connect the individual and the environ- Resilience in childhood is de fi ned as typical ment, with emphasis on warm, supportive social development in the face of adverse circum- relationships. stances that propel others to deleterious outcomes. The risks for minor or serious problems in mental and physical health are real and for a Nature and Nurture segment of the human population, are ever present. Nearly every child faces occasional adver- Humans share a genome and live in environments sity, and many experience chronic stressors such that have many structural similarities. For numer- as abuse, poverty, or disease. However, even ous outcomes of interest to developmental scien- within populations of children who have or who tists, the variation between people arises not from experience powerful predictive risks for behav- the presence or absence of genes or environ- ioral and emotional problems, there is wide vari- ments, but from functionally distinct forms of ation in outcomes. Some will succumb to the genes and environments. A variety of techniques vicissitudes of life, but many will thrive in spite are used to estimate the effects of these distinct of them. Our goal is to highlight several areas of forms on individual differences, based on quantitative and molecular biology models (Plomin, DeFries, McClearn, & McGuf fi n, 2008 ) . * This chapter is an updated and modi fi ed version of the chapter from the fi rst edition (Deater-Deckard, Ivy, & Molecular genetic techniques for the collection, Smith, 2004 ). The majority of the modi fi cations involved storage, and analysis of DNA permit the exami- inclusion of recent research on molecular genetic studies nation of association and linkage between speci fi c and fi ndings. Some portions of the chapter were not regions of chromosomes or speci fi c genes, and modi fi ed from the prior edition. human variation in measured attributes. Using Z. Wang • K. Deater-Deckard ( ) these molecular approaches, scientists identify Department of Psychology , Virginia Polytechnic Institute and State University , Blacksburg , VA 24061 , USA the genes that are involved in complex pheno- e-mail: [email protected] ; [email protected] types (i.e., observed characteristics)—a level of

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 57 DOI 10.1007/978-1-4614-3661-4_4, © Springer Science+Business Media New York 2013 58 Z. Wang and K. Deater-Deckard specifi city not afforded by traditional behavioral are mediated by brain mechanisms, are modi fi ed genetic techniques. by experience and situational factors, and change Quantitative behavioral genetic techniques do with development (Prior, 1999 ; Rothbart & Bates, not require DNA analysis, but instead rely on 1998 ) . Temperament forms the foundation of mathematical models based on population genet- personality dimensions (e.g., neuroticism, con- ics to estimate the relative strength of genetic scientiousness, agreeableness) that have patterns and environmental contributions to individual of heritable and environmental variance that are differences. These are based on data from quasi- similar to temperament and are implicated in the experimental designs involving identical and development of resilience (Campbell-Sills, fraternal twins, adoptive and nonadoptive sib- Cohan, & Stein, 2006 ; Carver & Connor-Smith, lings, adoptive and biological parent–child pairs, 2010; Costa, Somerfi eld, & McCrae, 1996 ; and stepfamily members. If family member simi- Matthews, Deary, & Whiteman, 2003 ; Rothbart, larity on a variable of interest is predicted by Ahadi, & Evans, 2000 ) . Rothbart’s theory of tem- genetic similarity, then genetic variance or heri- perament is particularly helpful as an organizing tability is present. If family member similarity framework for considering connections between remains after genetic similarity is controlled, then individual differences, resilience, and gene– shared environmental variance is present. Shared environment transactions (other prominent theo- environmental in fl uences are the nongenetic ries include Buss & Plomin, 1984 ; Thomas & effects that lead to family member similarity. Chess, 1977) . According to this theory, there are Nonshared environmental variance is what multiple dimensions of temperament that repre- remains—the nongenetic in fl uences that do not sent reactivity to stimuli and the regulation of account for family member similarities (Reiss, those reactions. Neiderhiser, Hetherington, & Plomin, 2000 ) . Extraversion /surgency . The fi rst dimension is Extraversion /surgency and includes activity level, positive affect, low shyness, and positive antici- Individual Differences and Resilience pation/approach. Activity level represents amount and pacing of physical movement. A moderate There is ample quantitative behavioral genetic activity level is optimal for resilience (e.g., research (e.g., twin, adoption designs) that pro- Mendez, Fantuzzo, & Cicchetti, 2002) . If too low, vides a basis for investigating the interplay the child is sluggish and prone to weight gain, between genes and environments. Some of the and if too high then the child is hyperactive and speci fi c genes that may be involved in complex more diffi cult to manage. Between one-third and gene–environment transactions in development three-quarters of the variation in activity level is have also been identifi ed. To exemplify this accounted for by genetic factors, with the remain- burgeoning literature, we describe fi ndings from ing variance attributable to nonshared environ- research on temperament and cognitive factors— ment and error (Braungart, Plomin, DeFries, & both of which are strongly implicated as protec- Fulkner, 1992; Gagne, Vendlinski, & Goldsmith, tive factors in development. 2009; Oniszczenko et al., 2003 ; Plomin, Pedersen, McClearn, Nesselroade, & Bergeman, 1988 ; Saudino, 2005 ; Wood, Rijsdijk, Saudino, Temperament and Personality Asherson, & Kuntsi, 2008 ) . Surgency also includes positive emotionality, which shows Temperament includes individual attributes that genetic and nonshared enviornmental variance are de fi ned as being moderately stable across sit- (Eid, Reimann, Angleitner, & Borkenau, 2003 ) . uations and over time, are biologically infl uenced, Children who often experience and express posi- and are observable from infancy. Individual dif- tive moods (e.g., happiness, excitement, interest) ferences in temperament arise from transactions are less likely to suffer the consequences of expo- between genetic and environmental infl uences, sure to risk factors. Lengua (2002 ) found that 4 Resilience in Gene–Environment Transactions 59 positive emotionality predicted resilience in (COMT; one major enzyme that is involved 8–10-year-olds, consistent with an earlier study degrading catecholamines) are associated with by Masten et al. ( 1999 ) —although this effect was variation in anxiety and fear-related traits (Enoch, limited to females in the earlier study. Shyness Xu, Ferro, Harris, & Goldman, 2003 ; Hariri represents slow or inhibited approach in novel or et al., 2002 ; Melke et al., 2001 ; Sen, Burmeister, uncertain situations. Children who are less shy & Ghosh, 2004 ; Woo et al., 2004 ) . The COMT and more sociable may be protected against stres- gene also has been associated with anger and sors (e.g., Lösel & Bliesener, 1994 ) , although hostility (Rujescu, Giegling, Gietl, Hartmann, & they also may be at greater risk for problems in Moller, 2003 ; Volavka et al., 2004 ) . coping with family confl ict (Tschann, Kaiser, Effortful control. This dimension includes Chesney, Alkon, & Boyce, 1996 ) . Genetic vari- enjoyment of low-intensity stimulation, greater ance in twin studies, and a serotonin neu- perceptual sensitivity, and more control over rotransmitter gene in molecular genetic studies, impulses and attention. Effortful control is has been implicated in the development of important to resilience. Children who are higher in shyness (Arbelle et al., 2003 ) . Positive effortful control show less negative affectiv- anticipation /approach represents the extent to ity, indicating an important connection between which the child seeks out and enjoys having new attentional control and the regulation of nega- experiences. Children who are high in positive tive emotions (Rothbart et al., 2000 ) . Thus, anticipation/approach may be protected from those who are better able to control cognitive negative events through their exploration of new and perceptual processing of information also strategies, but may also be more easily frustrated may be better at regulating their emotions and when their anticipation is not ful fi lled (Deater- behaviors so that they are less likely to develop Deckard et al., 2010 ) . Heritability accounts for psychopathologies that are associated with one-fourth to three quarters of the variance, with poor self-regulation (Buckner, Mezzacappa, & some studies showing modest shared environ- Beardslee, 2009 ; Gardner, Dishion, & Connell, mental variance (Eid et al., 2003 ; Plomin & 2008 ; Posner & Rothbart, 2006 ) . In addition, the Rutter, 1998 ; Schmitz, 1994 ) . Molecular genetic tendency to persist with challenging tasks is a studies have indicated a functional role of the protective factor among at-risk youth, for a vari- dopamine receptor 4 gene (DRD4) in individual ety of outcomes (Lösel & Bliesener, 1994 ; Wills, differences in novelty-seeking behaviors (Ebstein, Sandy, Yaeger, & Shinar, 2001 ) . Thus, children 2006 ) . with more effortful control tend to have better Negative affectivity . This dimension includes academic achievement (Ponitz, McCleliand, sadness, anger, fear, discomfort, and problems in Matthews, & Morrison, 2009 ; Smith, Borkowski, soothing when upset. Consistent with studies of & Whitman, 2008 ) . trait neuroticism in adolescents and adults, chil- Effortful control and its underlying attributes dren who are low in negative affectivity are less are heritable, and some include shared environ- likely to show maladjustment in the face of mental variance as well (Goldsmith et al., 1997 ). dif fi cult circumstances. For example, Kilmer, For task orientation and persistence, heritability Cowen, and Wyman ( 2001 ) found that negative estimates are moderate to substantial in early and affectivity best discriminated resilient from middle childhood (Braungart et al., 1992 ; Deater- maladjusted children in their study of highly Deckard & Wang, 2012 ; Manke, Saudino, & stressed inner-city youth. Genetic factors account Grant, 2001 ) . Molecular genetic studies have for one-third to two-thirds of the variance in identifi ed the DRD4 and 5-HTTLPR genes as negative affectivity (Goldsmith, Buss, & Lemery, being involved in the regulation of sustained 1997 ; Oniszczenko et al., 2003 ; Plomin et al., attentive behavior (Canli et al., 2005 ; Fan, 1988 ) . Molecular genetic studies have indicated Fossella, Sommer, Wu, & Posner, 2003 ; that the serotonin transporter 5-HTTLPR gene Krakowski, 2003 ) . In addition to genetic infl uence, and the catechol- O -methyltransferase gene a portion of the variation in task persistence arises 60 Z. Wang and K. Deater-Deckard from shared environmental effects that are pre- are better at regulating their behaviors and emo- dicted by household socioeconomic status (SES) tions and therefore are protected against various and maternal warmth (Petrill & Deater-Deckard, externalizing and internalizing problems 2004 ) . (Greenberg, 2006 ) . Intelligence and its compo- In sum, there are various aspects of tempera- nent skills include moderate to substantial ment that are indicative of good self-regulation genetic variance that increases in magnitude and resilience. Persistence may help a child fi nd with development. Shared environmental varia- appropriate coping strategies. Positive emotion- tion is present in early childhood, but by adoles- ality may increase proactive efforts to deal with cence this component of variance dissipates, so stress and can promote the belief that the efforts that all of the nongenetic variance becomes non- will be successful. Furthermore, children who are shared (McCartney, Harris, & Bernieri, 1990 ; easy to manage (i.e., adaptable, self-regulated, Plomin et al., 2008 ). and happy) and who enjoy engaging in social Self - referent social cognitions . Although cog- interaction are more able to attract the care and nitive processing skills and abilities are impor- attention of others who can assist them in coping tant, the content of children’s cognitions also are with stressful situations. They may have “double critical to resilience—in particular, social cogni- protection,” both in terms of their temperaments tions about the self, and control over things that and the qualities of their social relationships with threaten the integrity or safety of the self. Self- caregivers and others (Prior, 1999 ; Smith & Prior, effi cacy is the belief that goals can be accom- 1995 ) . In contrast, children who are irritable, eas- plished, even when frustrations lie in the way. ily distressed by changes in the environment, and Self-worth or esteem stems from feeling valued more distractible may be less able to cope with by, and valuable to, other people. Anticipated adversity and more likely to attract or elicit harsh outcomes also are important, with optimism and rejecting parenting—particularly if the parent defi ned as the anticipation of good outcomes, and is distressed (Hetherington, 2006 ) . pessimism de fi ned as the anticipation of negative outcomes (Matthews, Schwean, Campbell, Saklofske, & Mohamed, 2000 ) . These self-refer- Cognitive Factors ent cognitions include moderate amounts of heritable and nonshared environmental variance, with Cognitive factors are also important in resilience some evidence of shared environmental infl uence processes. Research in this area of developmental in optimism and pessimism (Zuckerman, 2000 ) . science also exemplifi es some of the ways genes Twin and adoption studies of self-esteem yield and environments work together in promoting heritability estimates in the 30–60% range, with optimal development under nonoptimal condi- the remaining variance accounted for by non- tions. Two broad domains of theory and research shared environmental variance (Kamakura, Ando, to consider include individual differences in chil- & Ono, 2007 ; Kendler, Gardner, & Prescott, dren’s cognitive abilities and their self-referent 1998; McGuire et al., 1999 ; Neiderhiser & social cognitions. McGuire, 1994 ; Neiss, Sedikides, & Stevenson, Cognitive ability . Cognitive ability is a strong 2002 ; Raevuori et al., 2007 ) . and consistent predictor of resilience in child- The development of self-concept and self- hood and adolescence. Children who are more worth begins early in life. After gaining aware- facile with information sources and strategies ness of our own distinct qualities, we begin for solving problems not only are more likely to comparing ourselves to others. These cognitions succeed academically, but have broader and become an integral part of how we perceive our- more sophisticated repertoires of coping strate- selves and how we think others perceive us. If we gies at their disposal (Buckner et al., 2009 ; believe that we are valuable to others and that we Kumpfer, 1999 ; Masten, 2001 ) . In addition, chil- can control our circumstances, we are more adept dren who have better cognitive executive function at planning coping strategies as well as evaluat- 4 Resilience in Gene–Environment Transactions 61 ing and changing strategies that are not working mood. The identical twin who received more (Zimmerman, 2000 ) . Thus, high self-esteem and maternal warmth was more compliant, less self-ef fi cacy are effective protection against del- aggressive, and happier. This differential process eterious effects of a wide variety of risk factors could not be attributed to sibling differences in (Buckner et al., 2009 ; Kumpfer, 1999 ; Neiderhiser genes because in this design the siblings were & McGuire, 1994 ) . In addition, those who believe identical twins. A few other studies have used that the worst will happen are less likely to adapt this and other methods for identifying nonshared well when diffi cult circumstances arise. In con- mechanisms. The effort is worthwhile, although trast, those who are optimistic are more able to these mechanisms are dif fi cult to fi nd because save and use their resources when they need nonshared nongenetic variance also includes them, and to be protected from subsequent stres- effects arising from measurement error and non- sors (Aspinwall, 2001 ) . systematic idiosyncratic factors (Reiss et al., In sum, there are a host of child attributes 2000 ; Turkheimer & Waldron, 2000 ) . (including but not limited to temperament and Shared environmental variance factors also personality, cognitive abilities, and self-referent can be identi fi ed using quantitative genetic meth- social cognitions) that contribute to children’s ods. These refl ect nongenetic factors that lead to resilience. These attributes vary widely across family member similarity in attributes. For exam- children and emerge from the interplay between ple, consider the link between child cognitive genetic and environmental in fl uences. ability and maternal warmth—both of which are implicated in the development of resilience. Cognitive ability includes moderate levels of Nongenetic Factors: Shared shared nongenetic variance in early childhood, and Nonshared and there is some evidence that a substantial portion of that effect in childhood is accounted for Quasi-experimental behavioral genetic studies by maternal warmth and the family’s SES (Petrill provide some of the clearest evidence of the role & Deater-Deckard, 2004 ) . of nongenetic in fl uences in the development of Although a useful fi rst step, testing mathemat- individual differences, particularly when com- ical models of potential genetic and nongenetic pared to traditional family studies that lack quasi- factors on individual differences in resilience experimental designs (Plomin, 1994 ) . Of the lacks precision in specifi cation of the mecha- ample nongenetic variance that typically is found nisms linking genes, environments, and chil- in behavioral genetic studies, most is nonshared dren’s resilience. On their own, these studies do within families. This means that nongenetic fac- not inform us about how it is that environmental tors contribute to attributes of each individual protective factors such as warm supportive par- within the family in ways that do not make them enting operate in conjunction with speci fi c more alike to one another. This nonshared nonge- genetic factors on risk and resilience. We turn netic variance is pervasive, and its effects are now to a consideration of some of these gene– often substantial. It is possible to identify poten- environment transactions. tial nonshared factors using genetically informative designs (Reiss et al., 2000) . Most of the prior work in this area has focused on sibling children’s Resilience as Process: Gene– differential experiences with their parents. This is Environment Transactions exempli fi ed in a study of same-sex 3-year-old twins (for an overview see Deater-Deckard, There are a host of environmental factors that 2009 ) . Identical twin differences in mothers’ contribute to resilience in the home, the neigh- expressed warmth accounted for 6–25% of the borhood, the school, and beyond. We focus here identical twin difference in behavior problems on warm, supportive parenting, because this is a (e.g., aggression, noncompliance) and positive consistent predictor of resilience in a wide range 62 Z. Wang and K. Deater-Deckard of populations and types of studies, and because genetic and environmental factors interactively parenting is the most frequently studied environ- in fl uence aggression, conduct disorder, and adult mental domain in genetic studies of child devel- antisocial behavior, such that adverse home envi- opment. Children who are at risk for developing ronments increase the likelihood of these behav- behavioral and emotional problems are protected ioral outcomes in the presence of genetic risk against those outcomes if their parents are sensi- factors (Cadoret, Yates, Troughton, Woodworth, tive and responsive, warm and accepting, and & Steward, 1995 ) . involved (Conger & Conger, 2002 ) . These chil- As molecular genetic techniques have become dren are more likely to believe that others can be available to researchers, more studies are being trusted, and that they are loved and accepted conducted that examine the potential interactions regardless of the dif fi culty of their circumstances. between speci fi c environmental factors and These are keys to children’s developing self- speci fi c genes. Nonhuman primate studies pro- ef fi cacy and social competence, and to ameliorat- vide preliminary models for human research. ing the effects of risks to mental health (Rohner, A series of studies have demonstrated an interac- Khaleque, & Cournoyer, 2005 ) . tive effect between the serotonin transporter gene These environmental factors operate in trans- 5-HTTLPR and early attachment relationships on actions with genetic in fl uences. There are two resilience and vulnerability on various negative types of gene–environment transactions: gene– behavioral outcomes in rhesus monkeys (Barr environment interaction and gene–environment et al., 2003 ) . A particular form of this gene is correlation. associated with reduced serotonin expression and function. This genotype along with poor early caregiving experiences has been associated with Gene–Environment Interaction higher rates of conduct problems including aggression and alcohol consumption, whereas Through gene –environment interaction , the effect secure attachment relationships in early child- of a gene or genes on an outcome is conditioned hood appear to buffer against genetic risk for on or moderated by an environmental factor or fac- these outcomes (for reviews see Bennett, 2007 , tors, or vice versa. This defi nition of gene–envi- and Suomi, 2006 ) . ronment interaction fi ts well with most current Humans have the same functional serotonin de fi nitions of resilience. Accordingly, children transporter gene, and a similar interactive effect who have genetic risks for maladaptive outcomes between this gene and adverse life experiences will show fewer and less severe symptoms if cer- has been found in the prediction of depression tain environmental factors are present that func- (Caspi et al., 2003 ; Eley et al., 2004 ; Kaufman tionally reduce or eliminate altogether the genetic et al., 2004 ; Kendler, Kuhn, Vittum, Prescott, & effect. Furthermore, children who have more Riley, 2005; but see Risch et al., 2009 , regarding environmental risks for disturbances in develop- nonreplication of this effect). Individuals with ment will have fewer adjustment problems if they the “risk” genotype have been found to exhibit also have forms of particular genes that reduce or higher amygdala activity in response to fear- eliminate the environmental risk effect. related stimuli (Hariri et al., 2002; Heinz et al., Behavioral genetic studies have provided pre- 2005 ; for a review see Wurtman, 2005 ) , with liminary evidence suggesting the effect of gene– related weakened or strengthened connections to environment interaction on development of other neural systems involved in cognitive pro- resilience. For example, studies have found that cessing of emotion (Heinz et al., 2005 ; Pezawas genetic in fl uences in depression and anxiety are et al., 2005 ) . These neural characteristics are moderated by negative life events (Silberg, Rutter, associated with increased sensitivity to adverse Neale, & Eaves, 2001 ) , whereby risk for anxiety experiences through which they potentially exert is enhanced by more exposure to life stress their in fl uences on development of depression (Eaves, Silberg, & Erkanli, 2003 ) . Similarly, and anxiety under conditions of life stress. 4 Resilience in Gene–Environment Transactions 63

These gene–environment interaction processes ance response (Enoch et al., 2003 ) . These clearly implicate malleability in the in fl uences of fi ndings suggest that those individuals who have environments and genes on development. two copies of the met allele have an enhanced Furthermore, their effects very likely depend in affective sensitivity to negative experiences and part on effects of still other genetic and environ- are at greater risk for developing behavioral and mental factors. For example, positive social sup- emotional problems such as anxiety and depres- port is a strong protective factor that guards sion when faced with stress and adversity. children against depression and anxiety, even for Several other genes involved in regulation of those who may be genetically and environmen- the neuroendocrine stress response (i.e., the tally at risk (Kaufam et al., 2006 ; Kaufman et al., hypothalamic-pituitary-adrenal or HPA axis) 2004 ) . Furthermore, the presence of a particular have been examined as well. These include the form of a gene for brain-derived neurotrophic fac- corticotrophin-releasing hormone receptor gene tor or BDNF may minimize the interactive effect (CRHR1), the FKBP5 gene (involved in gluco- between the serotonin transporter gene and early corticoid signal transduction), and the glucocorti- life adversity (described above) on the develop- coid receptor gene. These have been implicated ment of depression (Kaufam et al., 2006 ) . in the prediction of behavioral and emotional Another interesting area of inquiry can be maladjustment in adulthood among those who found in research on the gene for monoamine also have histories of child abuse and maltreat- oxidase A (MAOA) and interaction with adverse ment (Binder et al., 2008; Bradley et al., 2008 ) . life experiences. MAOA is an enzyme that This gene–environment interaction may operate metabolizes a neurotransmitter that contributes in part through impaired regulation of the HPA to the regulation of mood and behavior. For males axis. When functioning in an adaptive way, the with forms of the gene that are indicative of HPA axis is activated in response to stress but is suffi cient production of MAOA, family adversity also regulated by a feedback loop. Impaired func- (e.g., abuse or maltreatment) is only modestly tion of HPA axis regulation has been associated associated with behavioral problems in child- with stress-related disorders, such as depression hood and adulthood (Caspi et al., 2002 ; Cohen and posttraumatic stress disorder (Ising et al., et al., 2006 ; Foley et al., 2004 ) , whereas the effect 2008 ; Koenen et al., 2005 ; Kumsta et al., 2007 ; of early adversity on these outcomes is substan- Van Rossum et al., 2006 ; Van West et al., 2006 ; tial among those with forms of the gene indica- for a review, see Gillespie, Phifer, Bradley, & tive of insuf fi cient MAOA production. This Ressler, 2009 ) . fi nding has been replicated with females as well Finally, genetic factors also interact with the and with respect to a variety of behavioral malad- prenatal environment to in fl uence the develop- justment outcomes (Ducci et al., 2008 ; Widom & ment of various externalizing problems in child- Brzustowicz, 2006 ) . hood such as attention defi cit hyperactivity Yet another area of interest lies in investiga- disorder (ADHD). Studies have demonstrated tion of the COMT gene, which is involved in that particular forms of the dopamine transporter the metabolism of dopamine and other neu- DAT1 gene and the dopamine receptor DRD4 rotransmitters. The “valine” (val) form is asso- gene increase the risk of ADHD for children who ciated with lower levels of dopamine, while the have been exposed to alcohol and tobacco prena- “methionine” (met) form is associated with tally (Asherson, Kuntsi, & Taylor, 2005 ; Becker, higher levels of dopamine. Studies have found EI-Faddagh, Schmidt, Esser, & Laucht, 2008 ; that compared to individuals with two copies Kahn, Khoury, Nichols, & Lanphear, 2003 ; of the val allele, individuals with two copies of the Neuman et al., 2007 ). met allele show higher level of fi xation on nega- All the above examples demonstrate how tive affective stimuli (Drabant et al., 2006 ) , genetic and environmental factors can interact in higher sensory and affective response to pain the prediction of individual differences in children’s (Zubieta et al., 2003 ), and higher harm avoid- resilience or susceptibility to developing various 64 Z. Wang and K. Deater-Deckard forms of psychopathology. Identifying speci fi c may also arise from shared genes between parents gene–environment interaction processes in resil- and children (Petrill & Deater-Deckard, 2004 ) . ience is important for the future of genetics Nonpassive r g − e includes at least two mecha- research in psychology, because it informs us not nisms, including active and evocative (or reac- only about bio-environmental processes but also tive) effects (Deater-Deckard, 2009 ) . Active r g − e informs us about ways to improve assessment and is environment selection, whereby an individual intervention. is more likely to experience certain things as a result of selecting into speci fi c environments that are most consistent with her or his own attributes. Gene–Environment Correlation For example, children who are highly sociable and gregarious—behaviors that are genetically Individual differences in resilience emerge infl uenced and implicated in resilience—are from gene–environment interactions. However, more likely to seek out and reinforce interaction these interactions do not arise as random trans- with other people, in contrast to shy or socially actions. Genetic and environmental factors can anxious children. Evocative r g − e occurs when a be correlated (gene –environment correlation , child’s genetically in fl uenced attribute or behav- or r g− e ). Two general classes of gene–environment ior elicits a particular response from other peo- correlation (r g − e ) have been described and ple—a response that can then serve to reinforce identifi ed in quantitative genetic studies—pas- that attribute or behavior. For example, children’s sive and nonpassive forms (Plomin, 1994 ) . genetically in fl uenced externalizing behavior Quantitative genetic models can be used to problems (e.g., aggression, conduct problems) identify r g −e , when variables representing the tend to evoke harsh, critical responses including environmental factors of interest are incorpo- rejection and hostile treatment from parents and rated into the statistical model that estimates peers (Burt, McGue, Krueger, & Iacono, 2005 ; genetic, shared environmental and nonshared Larsson, Viding, Rijsdijk, & Plomin, 2008 ; environmental sources of variance in the outcomes O’Connor, Deater-Deckard, Fulker, Rutter, & of interest. Plomin, 1998 ) . Another source of evidence of

Passive r g− e arises when a child is exposed to an evocative r g − e comes from studies of differential environmental factor that a biological parent pro- parental treatment to his or her multiple children. vides and that is correlated with their genotypes. When examining a parent’s relationship with her Consider the example of the link between cogni- or his two children (i.e., sibling differences), the tive skills and achievement. Variation in these warmth and acceptance in each parent–child dyad skills arises in part from genetic infl uences. At the differs (Coldwell, Pike, & Dunn, 2008 ; Dunn, same time, parents who value and enjoy experi- 1993 ; Kowal, Kramer, Krull, & Crick, 2002 ) . The ences that challenge their minds are more likely to differential parental treatment of siblings emerges provide stimulating environments for their chil- in part as a result of evocative r g − e . In our research, dren that promote resilience (e.g., books, reading, we have found that mothers’ self-reports of challenging toys, and puzzles). These parents are warmth toward each of her children, as well as more likely to have children who have better cog- observers’ ratings of maternal warm and respon- nitive skills and who succeed in school. The sive behavior (based on ratings from brief mechanisms linking stimulation in the home mother–child dyadic interactions), yield data that and child cognitive skills typically are tested using implicate evocative r g − e. Identical twins experi- correlations in family studies of biologically ence very similar levels of maternal warmth and related parents and children. However, because responsiveness from their mothers, whereas fra- parents also are providing genes to their chil- ternal twins and nontwin full siblings experience dren, the enriched environment and genetic moderately similar levels of maternal warmth. in fl uences are confounded. What may appear to be In contrast, genetically unrelated adoptive siblings environmental causation based on family studies are only modestly correlated in the maternal 4 Resilience in Gene–Environment Transactions 65 warm supportive behavior that they experience. genes, and their transactions with environments, This evocative gene–environment correlation occur at many levels (within and outside of cells), effect probably operates through genetic and in real time. Although the form of a gene infl uences on children’s responsiveness to and within an individual may not change, its function social engagement with their mothers (Deater- and effects on the individual can, and this may Deckard, 2009 ) . depend entirely on changes in the function of It is important to note that gene–environment other genes and changes in environments. transactions are not deterministic. For example, There are numerous and complex transactions children with higher cognitive performance operating—between genes and genes, environ- scores may seek and elicit more stimulation from ments and environments, and genes and environ- caregivers and their physical environments, but ments. Humans are not closed systems; the experiments demonstrate that manipulating environment and the genome change, sometimes adults’ perceptions of children’s intellectual randomly. The “story” describing a gene–envi- capacities causes improvements in children’s ronment process in resilience may depend on the achievement outcomes (Rosenthal & Jacobson, population being studied and the environmental 1968 ) . Similarly, children who are more diffi cult context in which that population exists. The suc- to care for because their behavior distresses and cess of future research on gene–environment annoys their parents (e.g., irritable, aggressive, transactions in human development will depend oppositional) are more likely to elicit harsh par- on the extent to which these developmental trans- enting. However, evaluation of parenting interactions between genes and environments are ventions show that parents can be taught strategies taken seriously in research design, assessment, for responding differently to their children’s aver- and data analysis. sive behaviors, which in turn promotes reductions in children’s emotional and behavioral problems (Deater-Deckard, 2004 ) . Gene–environment Your Risk Factor Is My Protective Factor transactions linking protective infl uences and children’s outcomes are fl exible and can change What may be protective in some contexts may when environments change. have no effect or further increment problematic outcomes in others (Rutter, 2006 ) . For example, high levels of surgency can be adaptive in the Closing Comments face of adversity, because extraverted individuals are more likely to have access to and to seek out In closing, we address some implications of the social support from other people. However, research on gene–environment interplay and approach behavior predicts social withdrawal resilience. when there is a high degree of confl ict in the family (Tschann et al., 1996 ) . Another example comes from studies of peer relations and antiso- Resilience Is a Developmental Process cial behavior. For most children and adolescents in most social groups, having one or several sta- Rutter ( 2006) has emphasized a focus on risk or ble close friendships predicts social competence protective mechanisms and processes , rather than and scholastic achievement. However, when the identifying risk and protective factors. The goal youth in question are antisocial and violent, and should be to test for processes in development, their peer group consists of other antisocial chil- because risk and protective in fl uences are not dren or teenagers (a common scenario in natural static. This may be particularly important when environments as well as treatment settings), those genetic in fl uences are being considered, given who are least embedded in their peer network that there is a tendency to view genes as being and friendships show the most improvement in somehow fi xed in their effects. The actions of behavior over time (Berndt, 2007 ; Lösel & 66 Z. Wang and K. Deater-Deckard

Binder, 2003 ) . For a child or adolescent with As speci fi c gene–environment interactions are conduct problems, fi nding a close, supportive identifi ed for psychological outcomes in child- friend can greatly reduce or increase her or his hood and beyond, we may see similar kinds of antisocial symptoms, depending on whether or effects where the genes involved as protection not the friendship is formed and maintained against one outcome confer some risk for a dif- because of a shared interest in breaking the law ferent problematic outcome—but only under cer- and mistreating others (Gifford-Smith, Dodge, tain environmental conditions. This prediction Dishion, & McCord, 2005 ) . does not sit well with defi nitions of resilience That a genetic risk factor can also have protec- involving static deterministic protective factors. tive effects, depending on the environment or Rather, it is consistent with the idea that resil- context, is essentially required by evolutionary ience is a dynamic developmental process (Belsky explanations for species change and adaptation. & Pluess, 2009 ) . Genes that confer only deleterious effects are far more likely to drop in prevalence over time as affected individuals die before reproducing. The Environment of the Mind However, genes that confer risks as well as protective infl uences are far more likely to remain The reality of resilience in development is thrust over time, because individuals with those genes upon us when we fi nd that within populations are able to produce offspring who themselves that apparently are homogeneous in terms of risk reproduce. Sickle cell anemia illustrates this factors (e.g., poverty, family violence, low birth point. This is a single gene recessive trait, in weight), children’s outcomes are anything but which its presence leads to malformation of red uniform. Considering, assessing, and testing for blood cells, rendering them ineffective and prone protective mechanisms using objective measures to clotting. Individuals who have both copies of of the environment is essential, but only tells half the trait gene (one from each parent) have a wide of the story. The other half requires venturing variety of physical maladies due to problems in into the environment of the child’s mind—her or circulation, and the disease is life threatening. his subjective reality. Although the research on Those who have only one copy of the disease resilience and self-concept and other self-relevant form of the gene are carriers and are mildly social cognitions (described earlier) is relevant to affected by comparison. Furthermore, they are this end, what is needed are studies examining protected against contracting malaria. This gene–environment transactions underlying chil- explains why the disease form of this gene is far dren’s interpretations of their environments and more prevalent in areas of the world where experiences, and how these subjective experi- malaria is a constant threat, such as West Africa. ences in fl uence developmental outcomes. The very same disease-inducing form of this gene There has been interest in the past 2 decades protects carriers from a common threat to health. in establishing robust empirical methods for If malaria were reduced or eradicated, carrier sta- assessing children’s subjective experiences, at tus would no longer confer a known protective younger and younger ages. This emerging litera- effect in those regions of the world. The preva- ture shows that children’s social information lence of the disease form of the gene would likely processing biases—in particular, the attributions drop off, as has been happening in successive that they make regarding others’ intentions, and generations of African Americans (Connor & their evaluations of alternative responses to prov- Ferguson-Smith, 1997 ) . Thus, a genetic risk fac- ocations in social situations—help explain why tor for a life-threatening and painful disease pro- some at-risk children become more aggressive vides remarkable protection against a common over time, while others do not (Arsenio, 2010 ; external threat to health, but this protective effect Crick & Dodge, 1994 ) . Results also point to becomes moot if the external biological threat is comparable or better predictive validity for chil- removed. dren’s social cognitions compared to parents’ 4 Resilience in Gene–Environment Transactions 67 reports of children’s rearing environments differences in misbehavior (i.e., the less favored (Kraemer et al., 2003 ) . child is getting what she or he deserves). In those There are several hints from theory and empir- families, the differential treatment does not ical data from genetic studies, suggesting that the appear to be associated with increases in problem environment of the mind should be studied more behaviors in the less favored child. In contrast, often. First, in theory, all experiences in the objec- some children view differential treatment as tive sense are fi ltered through the brain via per- unjust, and it is these children who are most likely ceptual and cognitive mechanisms. Although to show behavioral and emotional problems as a there are species typical brain pathways involved result of differential treatment. A complete pic- (e.g., visual systems feeding into memory sys- ture requires consideration of both the objective tems), there also are individual differences in (differential treatment of siblings) and the sub- what it is that people attend to in their environ- jective (children’s perceptions of whether the dif- ments, what it is they store in memory and recall, ferential treatment is fair or not). and so forth. Theoretically, individual differences A third fi nding that points to subjective factors in information processing biases or preferences is that individual differences in concurrent and are just as likely as variations in behaviors retrospective self-reports of rearing environments (e.g., temperament) to arise from gene–environ- show clear evidence of genetic in fl uence. Siblings ment transactions. The work to test this idea who are more similar genetically also report more needs to be done and requires social cognition similar childrearing environments and experi- experiments using genetically informative designs. ences (Plomin, 1994) . The most common inter- A second fi nding implicating subjective expe- pretation of this fi nding is that active and evocative rience is that the majority of environmental vari- gene–environment correlations cause this effect, ance in quantitative genetic studies is nonshared; whereby siblings who are more similar geneti- it is possible that much of the nongenetic infl uence cally actually do have more similar experienc- on developmental outcomes is idiosyncratic. It es—and their self-reports re fl ect this reality. follows logically that these idiosyncratic experi- Another interpretation that has not been rigor- ences need not arise solely from differences in ously investigated is that there are genetically “actual” experiences in the objective sense, but in fl uenced information processing mechanisms also can arise from idiosyncratic subjective expe- that lead to similarity in interpretations of events riences that differ between two people who have even when the “actual” events are distinct. Again, had the same “actual” experience. This type of testing this idea will require experiments using research remains largely unexplored and requires genetic research designs. experiments using genetically informative One empirical implication concerning the designs. However, one line of research suggests environment of mind is how data on environmen- that studies like this will lead to some promising tal protective mechanisms in the home should be fi ndings. Several studies examining sibling chil- assessed and analyzed. More of the emphasis dren’s differential experiences with the same par- should be on child-speci fi c factors within fami- ent (a likely source of nonshared environmental lies, both in an objective and subjective terms, infl uence) show that this differential treatment is rather than on global measures of the home envi- associated with problem behaviors in the less ronment. For example, a researcher can focus on favored child when he or she perceives the situa- measuring a mother’s control, warmth, and nega- tion as being unfair (Coldwell et al., 2008 ; Kowal tivity with two or more of her children rather than et al., 2002 ; McHale, Updegraff, Jackson- with only one child. Often, the same mother’s Newson, Tucker, & Crouter, 2000 ) . Within fami- feelings about and behaviors toward her two (or lies in which one child is treated more punitively more) children will differ, depending on the child than another, some children view this as being in question. In addition, measures other than par- fair because the differential treatment refl ects ent self-report should be utilized to assess various parents’ fair and appropriate responses to sibling aspects of parenting. Speci fi cally, child report is 68 Z. Wang and K. Deater-Deckard of great importance because it serves as an index psychology: Intraindividual processes (pp. 591–614). of each child’s subjective perception of parenting Malden: Blackwell. Barr, C. S., Newman, T. K., Becker, M. L., Parker, C. C., behavior. After all, it is not only what the parent Chamoux, M., Lesch, K. P., et al. (2003). 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This chapter, mainly theoretical in orientation, stress; and (3) recovery from trauma (Hartling, also reviews recent research on resilience and 2003; Masten, Best, & Garmezy, 1990 ) . In these gender. The theoretical orientation represented models resilience is most often seen as residing here is known as relational-cultural theory (RCT). within the individual, in such traits as: tempera- At the core of this work is the belief that all psy- ment (Rutter, 1978 , 1989 , 1990 ) , hardiness (Kobasa, chological growth occurs in relationships and that 1979 ) , or self-esteem (Schwalbe & Staples, 1991 ) . movement out of relationship (chronic disconnec- Temperament and hardiness are usually depicted as tion) into isolation constitutes the source of much involving innate physiological variables. It is note- psychological suffering. Moving away from a worthy that the hardiness research which empha- “separate self” model of development, RCT also sized commitment and control, however, was suggests that resilience resides not in the individ- conducted on White male middle-to-upper level ual but in the capacity for connection. A model of business executives and then generalized to all peo- relational resilience is presented. Mutual empa- ple (Hartling, 2003 ) . Contrary to these fi ndings, thy, empowerment, and the development of cour- Sparks (1999 ) described relational practices rather age are the building blocks of this resilience. than internal traits as contributing to the resilience While this chapter seeks to explicate the impor- of African-American mothers on welfare. Internal tance of relational resilience for girls, it also sug- locus of control is an individual characteristic, gests that growth-fostering connections are the which has also been associated with resilience source of resilience for both boys and girls. (Masten et al., 1990 ) . “Children who take responsi- Resilience is traditionally de fi ned as the ability bility for their own successes and failures are said to “bounce back” from adversity, to manage stress to have an internal locus of control” (Roediger, effectively and to withstand physical or psycho- Capaldi, Paris, & Polivy, 1991 , p. 352). logical pressures without showing major debilita- Recently, research in the fi eld of neuroscience tion or dysfunction (Benard, 2004 ; Brooks & has opened new ways of understanding resilience, Goldstein, 2001 ; Hartling, 2003 ; Herrman et al., providing hopeful data about the lifelong malle- 2011 ; Jordan & Hartling, 2002 ) . Often resilience is ability of the brain, and hence, of behavior. described as (1) good outcomes in high-risk chil- Davidson’s research on resilient health indicates dren; (2) sustained competence in children under that a secure relationship history provides people with the resources to bounce back from emotional setbacks and losses (Goleman, 2006 ) . J. V. Jordan (*) When the left prefrontal cortex has time to recover Jean Baker Miller Training Institute and Harvard from distress and thus remains robust, we con- Medical School , 114 Waltham St, Suite 17, Lexington, MA 02421, USA tinue to develop strategies for emotional regula- e-mail: [email protected] tion and recovery throughout life. Cozolino

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 73 DOI 10.1007/978-1-4614-3661-4_5, © Springer Science+Business Media New York 2013 74 J.V. Jordan

(2006 ) has written that the greatest contributor to urgent at a biological level as hunger, thirst or pain neural plasticity is love; good relationships avoidance. A cultural system that denies the rework the circuitry of the prefrontal cortex. importance of connection for growth and healing Siegel and Bryson ( 2011 ) , in writing about inter- interferes with our ability to acknowledge our personal neurobiology, suggest that curiosity, need for others and thus impedes our ability to openness, acceptance, and love support neural turn to others when in distress. To the extent that integration and openness to the present. Resilience dependency and need of others is devalued (Jordan, is in part the ability to be present in the moment, 2010 ) , our capacity to form supportive and resil- responding rather than reacting, thus exhibiting ience building relationships is challenged. Girls emotional fl exibility. The capacity for relational and women are especially impacted by the nega- repair depends on fl exibility, respect, safety, trust, tive cultural messages about our yearnings for and courage (Jordan, 2010 ) . If the amygdala alert connection. Despite the values and pressures in system has been overstimulated by abuse, neglect, our culture that block the natural fl ow of discon- or other signals of danger, however, a child’s ner- nection–connection and healing in connection, vous system will be overstressed and excessive our brains exhibit a robust ability to change. cortisol will be released. We know that cortisol Neuroscience studies using functional MRIs has a negative impact on our bodies and our in particular have given us the data that estab- brains; it contributes to diabetes, depression, anx- lishes beyond a doubt that the brain is changed iety, and heart disease. If we seek comfort when throughout the lifespan—neuroplasticity. People stressed (Schore, 1994 ) and we participate in can move out of isolation and dysfunctionality mutual empathy and regulation (Jordan, 2010 ) , throughout their lives (Cozolino, 2006 ; Goleman, our systems will not be overwhelmed by adverse 2006) . Even when children have grown up in hormonal/chemical reactions and we will demon- families where they have suffered terror or great strate some measure of resilience. What some instability, there is the opportunity to achieve have called “allostatic load” (Goldstein & Thau, more secure attachment by fi nding safe enough 2011 ) represents a physiological response to connection with therapists, teachers, professors, social con fl ict that persists over time. This cre- mentors, and friends (Cozolino, 2006 ; Farber & ates enormous wear and tear on the body and Siegel, 2011 ; Goleman, 2006 ) . Love, connected- contributes to chronic stress. A reactive amygdala, ness, secure attachment, responsiveness from overstimulated by unrelenting threats of danger, others, etc. actually resculpt the brain. Acute dis- hijacks a person’s response in a context that feels connections, reworked back into healthy connec- unsafe. In this case, more considered responsive- tion, begin to shift underlying patterns of isolation ness is overridden by impulsive, disorganized and immobilization. The amygdala can be qui- responding. These patterns of reactivity often eted; the prefrontal cortex can function more leave a person more cut off and therefore less effectively. Some researchers have looked at the able to fi nd support and repair in safe, sustaining effect of early experience on glucocorticoid and relationships. Isolation can become chronic, catecholamine levels that infl uence neural activ- keeping people from participating in healing ity in areas of the brain associated with executive relationships. This is especially stressful for girls function (Blair, 2010 ) . Empathy can create because girls and women experience connection change in the prefrontal cortex and blocks the as central to their well-being (Hossfeld, 2008 ) . production of certain hormones (glucocorticoids) Social pain overlap theory (Eisenberger & that kill neurons in the hippocampus (Goldstein Lieberman, 2004 ) provides additional insights & Thau, 2011 ). regarding resilience. Research shows that social Toning the vagal nervous system also pain travels the same neuronal pathways to the signi fi cantly impacts relational responsiveness. same place in the brain—the anterior cingulate The vagal nerve plays a part in modulating emo- cortex . This model con fi rms how core our need for tional reactivity and particularly intervenes to connection is: being excluded is experienced as move a person out of sympathetic (arousal) and 5 Relational Resilience in Girls 75 parasympathetic (withdrawing, shutting down) such as traits or intrapsychic structure, is seen as patterns. What some have called the “smart fundamentally determining an individual’s well- vagus” allows us to stay in relationships even being and psychological adjustment. There are when we are angry or shamed (Banks, 2011 ) , now studies and models of development that crucial skills for maintaining connection. We do question this separate self bias (Jordan, 2010 ; not have to move into all or nothing, black or Jordan, Kaplan, Miller, Stiver, & Surrey, 1991 ; white reactivity. If we have poor vagal tone aris- Spencer, 2000 ). ing from a neglectful, abusive, or risk- fi lled child- A study of 12,000 adolescents suggested that hood, we can achieve more resilient functioning the single best predictor of resistance to high- by experiencing more modulated patterns of risk behaviors (violence, substance abuse, and organization and disorganization, the ebb and suicide) is “having a good relationship” with one fl ow of connection and disconnection (Goldstein adult, such as a teacher, parent, or mentor & Thau, 2011 ) . More recent resilience research (Resnick et al., 1997 ; Resnick, Harris, & Blum, has pointed to the dynamic nature of resilience 1993) . Connections “fortify” kids. I would sug- throughout the lifespan (Herrman et al., 2011 ) . gest that growth-fostering connection is at the core of the notion of resilience; I would also like to address the additional factor of resistance , Gender which points to the importance of contextual factors in resilience. By resistance, I refer to the The effects of gender or context on resilience capacity to resist the destructive and disempow- have not been well documented in traditional or ering messages regarding gender, race, and sex- neuropsychological approaches. In much of the ual orientation coming from many sources such resilience research, issues of control and power as immediate familial context and/or larger soci- tend to be decontextualized; in particular there is etal controlling images (Collins, 2000 ) . While a failure to recognize realities of racism, sexism, resistance is not always included in the concept and heterosexism or other forces of discrimina- of resilience, for a member of any marginalized tion and social bias which render certain people group (i.e., nondominant, less powerful groups powerless and realistically lacking control. such as girls, people of color, homosexuals) the Brown, however, studies the impact of culture on capacity to develop resistance to the distorting girls’ ability to speak up with their anger ( 2003 ) . and hurtful infl uences impinging on them as a She suggests that “relational aggression” function of their marginality (and also contribut- (Simmons, 2002; Wiseman, 2003 ) results not ing to their marginality) is essential (Brown, from girls’ essential meanness (the mean girl 2003; Ward, 2002) . Gilligan, Lyons, & Hammer phenomenon), but because girls are not provided (1990 ) noted that there is a gender disparity with with more direct ways to register their protests respect to times in development when children’s and anger. A contextual approach might recon- resilience is at heightened risk: early in child- sider the concept of internal sense of control, hood in boys and in adolescence for girls. She examining a person’s engagement in mutually suggests it is important for all children to be empathic and responsive relationships as the joined by adults in their resistance. In RCT the more likely source of resilience. While social primary indicator of psychological development support is often cited in studies of resilience, it is is an increasing capacity for signi fi cant and typically studied as a one-directional process in meaningful connection with others (Jordan, which one person is supported by another 2010; Miller & Stiver, 1997 ). Relationships are (Spiegel, 1991 ) . The tradition in western psy- at the heart of growth, healthy resistance, and chology of studying individual traits and internal resilience. The societal or cultural context largely characteristics exists within a paradigm of “sepa- determines the kinds of relationships that are rate self.” Separation is seen as primary and relat- likely to occur for anybody and these determine edness as secondary. What is inside the individual, one’s capacity to respond to stress 76 J.V. Jordan

Most models of child development are framed Girls blame themselves far more than boys do by the notion of growth toward autonomy and and take less credit for success. Studies have separation. The cultural mandate and myth is one shown that freedom from self-denigration is a of “standing alone,” the lone ranger, the lone powerful protector against stress-related debili- hero, the fully individuated person who is inde- tation (Peterson, Schwarz, & Seligman, 1981 ) . pendent, separate, and autonomous. Resilience Self-denigration is seen as contributing to poor then is viewed as an internal trait or set of traits, self-esteem which in turn is thought to contrib- the lone resilient individual recovering from the ute negatively to resilience (Dumont & Provost, impingements of an adverse environment. The 1999 ) . Self-esteem tends to be thought of as a job of socialization in this model is to bring the core, internal trait. But self-esteem is a compli- dependent child into a place of separate, indepen- cated concept. Self-esteem has been constructed dent adulthood. These standards apply to all chil- in Western cultures based on a separate-self, dren but especially to boys. hyperindividualistic model of development As Bill Pollack ( 1998 ) notes, the “boy code” (Jordan, 1994 ) . One “possesses” self-esteem pushes boys towards extremes of self-contain- and in a competitive culture often comparisons ment, toughness, and separation. Men are encour- with others (better than or worse than) are at the aged to dread or deny feeling weak or helpless. core of self-esteem. As Harter (1993 ) notes Shame-based socialization for boys directs them “how one measure up to one’s peers, to societal towards being strong in dominant-defi ned ways: standards, becomes the fi lter through which unyielding, not showing vulnerability, and dis- judgments about the self pass” (p. 94). Groups playing a narrow range of affect (i.e., anger). The that are “outside” the dominant de fi nitions of standards for maturity involve being indepen- merit, who may have differing standards of dent, self-reliant, autonomous. Yet these hall- worth, are thus disadvantaged by these privi- marks of successful maturity and “strength” are leged standards (e.g., being emotionally respon- generally unattainable since we are ultimately sive and expressive in a culture that overvalues interdependent beings. These hyperindividualis- the rational or being relational in a culture that tic standards then create stress, shame, and enor- celebrates autonomy). Yvonne Jenkins has sug- mous pain for all who are affected by them. gested that we think of social esteem which Furthermore, the importance of connection with implies a group-related identity that values others is omitted in these models. Context and interdependence, affi liation, and collaterality socially de fi ned identity issues such as race and ( 1993) . Social esteem, then, may be more rele- gender clearly impact resilience and yet they, too, vant to psychological well-being than self- are overlooked. esteem, particularly in more communal cultures With regard to some unexamined gender and subcultures. Feeling good about oneself issues, Seligman’s concept of “learned helpless- depends a lot on how one is treated by others ness” is seen as contributing to poor outcome and whether one can be authentic and seen and (poor psychological health) and optimism is heard in relationships with important others. seen as leading to resilience and good outcome Data suggest that girls are more depressed (Seligman, 1990) . Yet gender may play a crucial and self-critical in adolescence than boys. Girls’ role in the development of pessimistic or opti- rates of depression begin to climb in adoles- mistic coping strategies (Dweck, 2006; Dweck cence. Girls and women are twice as likely to & Goetz, 1978) . Girls’ expectations of future develop depression throughout their lives performance are affected more by past or pres- (Gillham, Chaplin, Reivich, & Hamilton, 2008 ; ent failures than by successes (Dweck & Gladstone & Beardslee, 2009; Hankin & Reppucci, 1973) . Girls attribute failure to inter- Abramson, 2001 ; Lewisohn & Essau, 2002 ) nal factors and success to chance or external “For girls to remain responsive to themselves factors, while boys tend to attribute failure to they must resist the convention of female good- external factors and success to internal factors. ness; to remain responsive to others, they must 5 Relational Resilience in Girls 77 resist the values placed on self suffi ciency and independence in North American culture” Relational Resilience (Gilligan, 1990 , p. 503). Girls lose connection with themselves and authentic connection with Theorists at the Stone Center, Wellesley College, others during this period. Researchers have have created a relational model of development noticed that women’s coping styles are more and resilience. The model was originally devel- relational (i.e., talking about personal distress oped by listening to women’s voices and study- with friends, sharing sadness) (Lazarus & ing women’s lives, but it is increasingly seen as Folkman, 1984 ) . Men’s styles are more prob- applicable to men as well. Most developmental lem-focused or instrumental, taking action to and clinical models have been biased in the direc- solve the problem and seeking new strategies. tion of overemphasizing separateness, particu- Emotion-focused coping may be more adaptive larly the separate self. This new model, called in situations where one has little real control and RCT, posits that we grow through and toward problem-focused coping is useful where one can connection; that a desire to participate in growth- realistically expect to effect change. Those with fostering relationship is the core motivation in less power and less real control (members of life (Jordan, 1997, 2010; Jordan, et al., 1991 ; nondominant and marginalized groups) may Miller & Stiver, 1997 ) . Growth-fostering con- develop more relational or “externalizing” ways nections are characterized by mutual empathy of coping. and mutual empowerment and produce the fol- One of the core ideas of traditional Western lowing outcomes: zest, a sense of worth, produc- Psychology is the notion of “fi ght or fl ight” in tivity, clarity, and a desire for more connection the face of stress. This knowledge has been (Miller & Stiver, 1997 ) . All relationships arise passed along for generations and is quite rele- within particular contexts and the socioeco- vant to the way we understand resilience. nomic/cultural context powerfully shapes the Prevailing studies have consistently suggested connections and disconnections that exist in peo- that when we are stressed we either mobilize ple’s lives. Isolation is viewed as the primary aggressive, self-protective defenses ( fi ght) or source of pain and suffering. In a stratifi ed soci- we fl ee (run away and avoid the possible con- ety, difference is always subject to distortions of frontation with our own vulnerability). But a power (Walker, 2002 ) . When one group is domi- recent analysis by (Taylor et al. 2000; Taylor, nant and possesses the power to defi ne what is 2002 ) points out that all the studies on “ fi ght or valuable, the less powerful group is left having to fl ight” were completed with males (i.e., male “fi t in,” to “make do” with rules of conduct and albino rats and monkeys, men, etc.). In replicat- behavior that may not represent their experi- ing some of these experiments with females, ences. Thus, Jean Baker Miller once said, Taylor noted a very different response to stress, “authenticity and subordination are totally which she and her colleagues called the “tend- incompatible” (1986 , p. 98). In order to enjoy and-befriend” response. In times of stress they full authentic and growth-fostering interaction, noted females engage in caretaking activities or one cannot be in a position of subordination. The in the creation of a network of associations to role of power is to silence difference, limit protect themselves and others from a threat. authenticity, and to defi ne merit. Women respond relationally to stress; they seek RCT proposes we think of “relational resil- connection. Belle ( 1987 ) has also noted that ience” as the capacity to move back into growth- women are more likely to mobilize social sup- fostering connections following an acute port in times of stress and turn to female friends disconnection or in times of stress (Hartling, more often than males. These data suggest it is 2003; Jordan, 1992, 2010 ) . RCT suggests that imperative that we attend to social identity relationships that enhance resilience and encour- issues, particularly gender, when we seek to age growth are characterized by a two-way expe- understand resilience. rience of connection, involving mutual empathy, 78 J.V. Jordan mutual empowerment, and movement toward or resist disconnection. Characteristics such as mutuality. For instance, we would suggest that temperament, intellectual development, self- real courage, real growth, and real strength all esteem, locus of control, and mastery can be occur in a relational context, not in a state of iso- reframed from a relational perspective. The most lation or independent assertion. In short, resil- important contribution of temperament to resilience is not an internal trait. The dominant North ience may be the means by which a child is American culture does not support the notion of placed at risk or protected in terms of relational interdependence among people. Yet there is an consequences. For instance, a hard to soothe inevitable human need to turn to others for feed- child may contribute to a sense of helplessness back, both appreciative and corrective, and to and frustration in the parent which could lead to provide support to others as we make meaning of avoidance or neglect. Similarly “intellectual our lives. We all need to be responded to by oth- development” which is typically thought of as an ers throughout our lives. This is different from internal trait largely deriving from genetic load- one person needing support or approval from ing is now understood as formed to a great extent another person; we need to engage with others in relational contexts. Siegel ( 1999 ) notes that and to be engaged with, to participate in relation- interpersonal relationships are the primary ships that create growth for each person involved. source of experience that shapes how the brain It is about mutuality. develops. “Human connections create neuronal What is needed is a relational model of resil- connections” (Siegel, p. 85). ience which includes a notion of: (1) supported Self-esteem can also be thought of in a more vulnerability; (2) mutual empathic involvement; contextual way by examining what Jordan ( 1999 ) (3) relational con fi dence or the ability to build has called relational confi dence . Thus rather than relationships that one can count on; (4) empower- emphasizing “the self” and its esteem, we suggest ment which involves encouraging mutual growth; that one’s capacity to develop growth-fostering and (5) creating relational awareness alongside of relationships, which engender confi dence in our personal awareness. Relational resilience empha- connections with others, might be a more impor- sizes strengthening relationships rather than tant variable for study than some supposed increasing an individuals’ strength (Hartling, internal trait of self-esteem (Burnett & Denmar, 2003 ) . In this model the ability to ask for help is 1996 ). Similarly, internal locus of control de fi ned reframed as a strength. When we are stressed, as a source of resilience may be understood better personal vulnerability increases. Finding a way when we take context into account. In a culture to tolerate vulnerability and turn toward others is that so values control and certainty one can a signi fi cant sign of resilience. When we turn understand why this might be seen as central. But away from others and move toward isolation, we studies have indicated that locus of control is are likely to become more infl exible, getting infl uenced by cultural context and the realistic stuck in dysfunctional patterns. In order to reach power that a group exercises in their culture. out for support, we must have some reason to Locus of control may be seen as the ability to believe that a dependable, mutual relationship is in fl uence one’s experience, environment, or rela- possible in which putting oneself in a more vul- tionship (Hartling, 2003 ) . nerable position does not pose a danger. A part of Social support has also been viewed as vital to relational resilience, then, involves discerning the resilience (Masten & Coatsworth, 1998 ). Social growth-fostering potential of a particular interac- support has been defi ned as emotional concern, tion or relationship. instrumental aid, information, and appraisal. Relational resilience involves movement Most social support studies have emphasized toward mutually empowering, growth-fostering one-way support, getting love, getting help. A connections in the face of adverse conditions, relational perspective points to the importance of traumatic experiences, and alienating social-cultural engaging in relationship that contributes to all pressures. It is the ability to connect, reconnect, and/ people in the relationships. Data suggests that it 5 Relational Resilience in Girls 79 is as rewarding to give to others as to be given to Mutual empathy is not about reciprocal, back and (Luks, 1992 ) . The power of social support is more forth empathizing although that happens in about mutuality than about getting for the self. But growth-fostering relationships as well. Mutual the mutuality is often obscured in the ways social empathy is the process in which each person support is construed; this appears to be true of the empathizes with the other in mutual growth; I see twelve step programs, misleadingly called self- that I have moved you and you see that you have help groups when they actually are about mutual- moved me. We matter to each other, we reach help and growth. In other words, we all have a each other, we have an effect on one another. need to be appreciated, valued, validated, and We can produce change in one another and in the given to, but we also have a need to participate in relationship. This ultimately brings about a sense the development of others. of relational competence. It brings us into the warmth of the human community where real resilience resides. And it contributes to the devel- Mutuality opment of community, the ultimate source of resilience for all people. At the core of relational resilience is the move- The literature on competence motivation ment toward mutuality. The social support litera- addresses the intrinsic need to produce an effect ture points to the importance of being given to on our environment (White, 1959 ) ; the usual and receiving support from others (Ganellen & research looks at the way a child manipulates the Blaney, 1984; Spiegel, 1991) . But recently physical world and how that enhances a child’s research has uncovered the importance of “giv- sense of competence (“I made this happen”). ing” to others (Luks, 1992 ) . The research com- While there is no doubt that physical ability and munity has moved into the study of altruism as a task competence serve to increase one’s sense of way of understanding the bene fi ts of giving to effi cacy and worth, it is clear that an equally, if not others. RCT would suggest that it is actually more, important source of competence is in the mutually growth-fostering relationships that cre- world of interpersonal effectiveness, being able to ate the benefi cial effects for individuals not a trait evoke a sought for response in another person. such as altruism. That is, there is a need to give, Let us take the example of a child and parent to matter, to make a difference; we fi nd meaning where the child is not understood, heard, or in contributing to the well-being of others (Jordan, responded to (Dunham et al., 2011 ). There may be 2010 ; Jordan, et al., 1991 ; Jordan, Walker & an empathic failure and the child attempts to rep- Hartling, 2004 ). But we also need to feel cared resent her hurt to the parent. If the parent responds for, given to, and treated with respect. We need to and lets the child see that it matters to the parent feel that we matter, that we can have an impact on that she has hurt the child, that she is affected the other person and on the relationship. by the impact (in this case hurtful) that she has on Imbalances in mutuality are the source of pain the child, and the parent communicates this to the for many people. And when we feel “outside” child, the relationship is strengthened and the mutual connection, we often experience isola- child’s sense of relational competence is strength- tion. To give to others in a situation where we are ened. The child feels seen, heard, and cared about; not being respected, responded to, and appreci- she feels she matters, her feelings matter. If on ated in the long run can lead to demoralization, a the other hand, the parent does not respond to the drop in resilience. It is not that we need to be child’s pain with empathy or caring, but denies “thanked” or valorized for our giving. We must the child’s feelings or attacks the child in some feel that we are part of a respectful, mutual sys- way or simply does not respond at all (neglect), tem. Mutual empathy holds the key to what we the child will experience a sense of not mattering, mean by mutuality. It is important that we see of having no impact on the other person or on the that we have had an impact on each other; we relationship. She will begin to keep these aspects know, feel, see that we have made a difference. of herself out of relationship and will move into 80 J.V. Jordan isolation and inauthenticity. When this happens used to change an individual’s or a group’s repeatedly, the child moves into chronic discon- behavior. Sometimes it is used to disempower nection. She develops strategies of disconnection and silence. Dominant societal groups often for survival. In the most egregious cases of chronic shame the subordinate groups into silence as a disconnection and violation such as physical or way of exercising social control. The implica- sexual abuse of a child, these strategies of discon- tion often is that “your” reality (nondominant nection lead to a massive sense of isolation, immo- individual or group) is de fi cient or deviant. This bilization, self-blame, and shame, what Jean Baker applies to any marginalized group, whether it is Miller calls “condemned isolation” (Miller & girls, people of color, gays, and lesbians. To the Stiver, 1997 ) . This state of condemned isolation is extent that an individual or group feels shame, a state of minimal resilience. The person maintains they will in fact be less resilient and less empow- rigid and overgeneralized relational images that ered, less able to give voice to difference. maintain isolation and mistrust of others. The person is not free to move back into connection following current disappointments and disconnection. Building Relational Resilience New learning and growth is blocked or limited. in Girls and Women The biochemistry may also be altered in such a way so that dissociation, amygdala reactivity, and Resilience exists to the extent that empathic pos- startle responses interfere with reestablishing con- sibility is kept alive. To the extent that girls feel nection (Banks, 2000 ) . they are a part of mutually growth-fostering relationships in which they care about others and are cared about as well, they will experience a sense Shame of fl exibility, worth, clarity, creativity, zest, and desire for more connection, what Jean Baker Often these disconnections occur in a climate of Miller has called the “ fi ve good things” of good shame. Shame moves people into isolation and connection (Miller & Stiver, 1997 ) . We grow and thus disempowers and immobilizes people. learn, expanding the quality of our relationships. Shame is the experience of feeling unworthy of In isolation we repeat old patterns, are caught in love, of feeling outside the human community repetitive cognitions, and often are disempow- (Jordan, 1989 ). In shame one doubts that another ered. Resilience implies energy, creativity, person can be empathically present. One feels fl exibility to meet new situations. Sometimes it that one’s very being is fl awed in some essential involves courage, the capacity to move into situa- way. While in guilt we can hope to make amends, tions when we feel fear or hesitation. Courage is in shame we anticipate only rejection and scorn. not an internal trait; it is created in connection. Our very “being” feels de fi cient. Shame is an As human beings, we en-courage one another, intensely interpersonal effect, one of the original create courage in an ongoing way. Just as there is effects delineated by Tomkins (1987 ) . Because it no such thing as an internal state of “self-esteem” leads to silencing and isolation, shame is a major that resides in a separate person, feelings of deterrent to resilience, particularly if one frames worth, strength, and creativity are also supported resilience as an interpersonal, relational phe- or destroyed in relationships. At a societal level, nomenon. To the extent that one moves away those at the margins, de fi ned by the dominant from relationship in the face of shame, the oppor- “center” (Hooks, 1984 ) , are often disempowered tunity for restorative and corrective connection is by the dominant group’s defi nition of what lessened. de fi nes them, their “defective differentness.” Shame arises spontaneously when one feels Resilience becomes especially salient for girls unworthy of love or connection, at the same in adolescence, a time when according to Carol time that one is aware of one’s yearning for Gilligan ( 1982 ) girls begin to “lose their voices.” connection. Shaming is also done to people, Between the ages of 11 and 13, Caucasian girls 5 Relational Resilience in Girls 81 show massive drops in self-esteem (Gilligan, For instance, a person resisting racism could take Lyons, & Hanmer, 1990 ) . Rates of depression a stand for fairness and justice. increase. As Gilligan suggests, girls begin to be These steps can be applied to many situations silenced and less authentic in relationships. They that typically undermine the sense of strength appear to lose their relational intelligence. They and worth of an individual (Franz & Stewart, take themselves out of relationship (authentic 1994 ). It is interesting that members of margin- relationship) in order to “stay in relationship” alized groups are encouraged to internalize (appearance of relationship). They lose a sense of blame. For instance there was a “psychiatric effectiveness and feel they must accommodate to diagnosis” of drapetomania in the days of slav- other’s needs (Jordan, 1987 ) . Janie Ward has ery which was applied to slaves who had “a need written with great insight about the importance to run away from their masters.” Their desire for for adolescent girls of color to fi nd a way to resist freedom was pathologized and given a medical the disempowering stereotypes that the dominant diagnosis. In a less extreme way, girls are taught culture imposes on girls of color. This capacity to to take responsibility for failure and are patholo- resist the controlling images (Collins, 2000 ) is a gized for their relational longings. And there is signi fi cant contributor to resilience. abundant data that indicate girls internalize fail- Janie Ward (2002 ) has suggested in working ure and externalize success while boys do the with African-American girls that we help them opposite. If the default explanation for failure is build healthy resistance, originally called “resis- self-blame, assuming that “I am the problem,” tance for liberation” (Robinson & Ward, 1991 ) . depression, immobilization, and shame ensue. She suggests four processes to help these girls If, on the other hand, one assumes that failure remain strong and resilient. First she suggests we results from chance factors or external forces help these girls “read it .” By this she means and success is a result of one’s ability or effort, examine the message and the immediate context one feels more empowered to act and more sense and larger sociopolitical context. Thus with dis- of worth. The context plays a large role in creat- empowering messages, one does not get caught ing these styles of attribution. up in reacting, but examines and thinks carefully about the evidence for the message or stereotype. After reading it, it is important to name it : in this Courage in Connection we acknowledge the presence of racism, sexism, or class bias. It involves “knowing what you In addition to resisting the forces of disempow- know” and confronting the issue. It may involve erment (sexism, racism, classism, heterosex- keeping silent until safety is reached (e.g., bring- ism), resilience involves the development of ing it to a trusted adult to get support and seek courage. While courage has also been con- clari fi cation). A failure to name can lead to inter- structed within a separate self-model, with nalization of the negative identity and shame. images of lone heroes scaling mountains or Naming gives one a sense of agency and strength. jumping from airplanes in individual death defy- The third step is to oppose the negative force . As ing acts, courage also might be considered to be Janie Ward suggests, one engages in the action to an interpersonal experience. Courage develops defy or circumvent or avoid the negative force, in connection; we are en-couraged by others such as racism. It involves opposing self-hatred, (Jordan, 1990 ) . Courage, like resilience, is not a despair, contempt, hopelessness, anger, and com- trait that exists within the individual. As human placency. And fi nally she suggests we support beings we are constantly in interactions that are girls in replacing it. This means that one can hold either encouraging or discouraging. Growth- fast to a belief or value a sense of reality that is fostering relationships which promote zest, clar- different from the one that is being promoted and ity, a sense of worth, productivity, and desire for then put something new in the place of the feel- more connection are intrinsically encouraging. ing, attitude, or behavior that is being opposed. They help us feel energetic, focused, strong, and 82 J.V. Jordan seeking growth and connection. Much of parent- expressive, or spontaneous. In all relationships ing, teaching, and therapy is about en-couraging we must act and speak with awareness of our others, literally helping people develop a sense possible impact on others. And if we value good of courage, feeling the capacity to act on one’s relationships, we will use anticipatory empathy values and intentions. to avoid hurting others when possible. But anger For young adolescent girls, there is probably is a signal that something is wrong, that some- nothing more important than supporting the thing hurts, that there has to be a shift or change growth of courage. Girls in early adolescence in the relationship. If girls are asked to suppress begin to lose their voice, begin to lack confi dence, their anger, they are invited into accommoda- and their self-esteem plummets. The early energy, tion, subordination, and inauthenticity. Helping con fi dence, and feistiness (Gilligan, 1990 ; Pipher, an adolescent girl learn how to speak up, espe- 1994 ) that researchers have written about in cially how to channel her anger, how to be stra- young girls evaporate for many. A part of this tegic in her use of her anger, will support her arises around heterosexual relationships where courage and her sense of who she is. The mes- girls begin to feel objectifi ed, lose touch with sages from the culture, however, silence and dis- their own body experience, and feel that they tance girls from these interpersonal signals. must accommodate to others, often boys’, desires Girls then become cut off from themselves and and defi nitions of them. A preoccupation with from authentic connection with others. body image (where one feels eternally de fi cient) Promising interventions have been developed and with control of sexuality and anger leaves in response to the research indicating that adoles- girls feeling constricted and inauthentic. Girls cent girls are at particular risk for depression, feel they cannot represent their experience fully; anxiety, losing their sense of worth, and becom- they fear rejection from boys and exclusion from ing less resilient. Girls de fi ne safety in terms of girls if they deviate from the group norms. The relationships (Schoenberg, Riggins, & Salmond, inclusion–exclusion factors (Eisenberger & 2003) . The “Girls Circle” model (Hossfeld, 2008 ; Lieberman, 2004 ; Simmons, 2002 ) that have Irvine, 2005 ) integrates relational theory, resil- weighed heavily on girls in social relationships ience practices, and skills training in an effort to heat up even more during these years. And as help girls increase their positive connections. It is they emulate boys’ models of success, girls feel meant to counteract social and interpersonal less and less able to show or share these feelings forces that impede girls’ growth and development. of fear and uncertainty. They’re supposed to be Girls Circle is a gender-specifi c program. Benard cool and tough. has indicated that providing caring and meaning- The prohibition on anger for girls (Brown, ful participation in communities increases 2003 ; Miller, 1976, 1985) is a great obstacle to empathic responsiveness and helps girls navigate their developing resilience. If a person cannot diffi cult peer relationships (Benard, 2004 ; represent her feelings as fully as possible, par- Hossfeld, 2008 ; Johnston, O’Malley, & Bachman, ticularly feelings that inform relational health, 2002 ; LeCroy & Daley, 2001 ; LeCroy & Mann, she will move into silence and isolation. Anger 2008; Steese et al., 2006) . Gender-specifi c pro- is a necessary and important signal in any rela- grams become increasingly important as modern tionship; it often marks a place of hurt or injus- adolescents are exposed to risky behavior at a tice. People need to be able to move into confl ict much earlier age. Another curriculum, “Go to avoid being silenced or subordinated (Jordan, Grrrls” is a program aimed at strengthening girls’ 1990 ) . By suggesting that anger is a necessary connections and friendships. Go Grrls was also part of change and growth in relationship, I am found to improve girls’ body images, assertive- not endorsing cathartic, expressive, impulsive ness, ef fi cacy, self-liking, and competence anger. Nor am I supporting the use of aggres- (LeCroy, 2004 ) . The Penn Depression Prevention sion, force, or dominance against others. program and the Penn Resiliency Program (PRP) Authentic anger is not about being totally reactive, address personal relationships and cultural pres- 5 Relational Resilience in Girls 83 sures in addition to cognitive change (Beck, In summary, all children experience a better 1976 ) . The Penn program is a manualized program outcome following adverse life conditions that can be delivered in schools, clubs, clinics, when they have a positive relationship with a and other community setting (Gillham et al., competent adult, engage with other people, and 2003; 2008). Given the sex differences in depres- have an area of competence valued by them- sion in adolescence, the Penn project underscores selves or society (Masten, et al., 1990 ) . Girls the importance of addressing girls’ depression tend to seek more help from others in childhood and resilience separately from boys (Le, Munoz, and offer more help and support in the preado- Ippen, & Stoddard, 2003 ; Lewisohn & Essau, lescent years (Belle, 1987 ) . For girls and women 2002 ) . It focuses on cognitive risk factors and in particular, mutuality is a key factor in how problem-solving strategies. Restriction of anger much protection a relationship offers. Lower may also be linked to depression in girls (Chaplin depressions scores are found in women who are & Cole, 2005 ) . Girls respond to the physical in highly mutual relationships (Genero, 1995 ; changes of puberty more negatively than do boys. Sperberg & Stabb, 1998 ) . The importance of Further, the internalization of negative cultural these relationships is not just that they offer messages increases girls’ vulnerability to depres- support, but they also provide an opportunity to sion (Stice, Spangler, & Agras, 2001 ) . A new ini- participate in a relationship, which is growth- tiative at the Penn Resilience project, “Girls in fostering for the other person as well as for Transition” (GT), highlights issues important to oneself (Jordan, 2010 ) . Participation in growth- girls in early adolescence. GT encourages girls to fostering connection and relational competence think critically about cultural messages that may well be the key to resilience in girls and demean women or impose impossible body image women. It is likely that understanding resil- standards (Chaplin et al., 2006 ) . Successful men- ience as a relational phenomenon rather than as toring programs are based on teaching skills, rela- a personality trait will lead us to deepen our tional competence, fostering relationships understanding of the signi fi cance of connection between mentor and mentee, and fostering con- for the well-being of all people. nection with community. They emphasize mutual support (Dubois et al., 2011 ) . As the research and many of the intervention References programs point out, helping girls value connec- Banks, A. (2000). Post-traumatic stress disorder : Brain tion and relationship is essential. Too often the chemistry and relationships (Project Rep. No 8). larger culture invalidates or pathologizes a girl’s Wellesley MA: Stone Center working Paper Series. desire for connection or her desire to participate Banks, A. (2011). The smart vagus. Webinar . Wellesley, in the growth of others (seen as a failure of “self- MA: Jean Baker Miller Training Institute. Beck, A. T. (1976). 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Schwalbe, M., & Staples, C. (1991). Gender differences in Circle as an intervention of perceived social support, sources of self esteem. Social Psychology Quarterly, body image, self effi cacy, locus of control and self 54 (2), 158–168. esteem. Adolescence , 41 , 55–74. Seligman, M. (1990). Learned optimism . New York: Stice, E., Spangler, D., & Agras, W. S. (2001). Exposure to Pocket Books. media-portrayed thin-ideal messages adversely affects Siegel, D. J. (1999). The developing mind: Toward a neu- vulnerable girls; a longitudinal experiment. Journal of robiology of interpersonal experience . New York: Social and Clinical Psychology, 20 , 270–288. Guilford Press. Taylor, S. (2002). The tending instinct: How nurturing is Siegel, D. J., & Bryson, T. P. (2001). The whole-brain essential to who we are and how we live. New York: child: 12 Revolutionary strategies to nurture your New York Times Books. child’s developing mind . New York: Delacorte Press. Taylor, S. E., Klein, L. C., Lewis, B. P., Greuenwarld, T. C., Simmons, R. (2002). Odd girl out: The hidden culture of Gurney, R. A., & Upfdegraff, J. A. (2000). Biobehavioral aggression in girls . New York: Harcourt Press. responses to stress in females: Tend-and-befriend, Sparks, E. (1999). Against the odds. Resistance and resil- not fight-or- fl ight. Psychological Review, 102 (3), ience in African American welfare mothers (Work in 411–429. Progress, No 81). Wellesley, MA: Stone Center Tomkins, S. (1987). Shame. In D. Nathanson (Ed.), The Working Paper Series. many faces of shame . New York: Guilford Press. Spencer, R. (2000). A comparison of relational psycholo- Walker, M. (2002). Power and effectiveness: Envisioning gies (Work in Progress, No. 5). Wellesley, MA: Stone an alternative paradigm (Work in Progress No 94). Center Working Paper Series. Wellesley, MA: Stone Center Working Paper Series. Sperberg, E. D., & Stabb, S. D. (1998). Depression in Ward, J. (2002). The skin we’re in: Teaching our children women as related to anger and mutuality in relation- to be emotionally strong, socially smart, spiritually ships. Psychology of Women Quarterly, 22, 223–238. connected . New York: Free Press. Spiegel, D. (1991). A psychosocial intervention and sur- White, R. (1959). Motivation reconsidered: The concept vival time of patients with metastatic breast cancer. of competence. Psychological Review, 66 , 297–333. Advances, 7 (3), 10–19. Wiseman, R. (2003). Queen bees and wannabees: Helping Steese, D., Dollete, M., Phillips, W., Matthews, G., Hossfeld, your daughter survive cliques, gossip, boyfriends and E., & Taormina, G. (Spring 2006). Understanding Girls other realities of adolescence . New York: Crown. What Can We Learn about Resilience from Large-Scale Longitudinal 6 Studies?

Emmy E. Werner

Since the mid-1980s, a number of investigators focused on the process of resilience at different from different disciplines—child development, points in time—from infancy to adulthood—and pediatrics, psychology, psychiatry, and sociol- that are much rarer than the numerous reviews ogy—have focused on the question why some and handbooks that have been devoted to this children cope successfully with major adversi- topic. A caveat is in order: resilience itself, as ties in their lives, while others develop severe Luthar and Zelazo (2003) remind us, is never and persistent psychopathology. The resilience directly measured in these studies—instead it is these children display is conceived as an end- inferred , based on the measurement of two com- product of buffering processes that do not elimi- ponent constructs: risk and positive adaptation. nate risks and stress in their lives, but that allow There are currently about a dozen large-scale the individual to deal with them effectively longitudinal studies of high-risk children in dif- (Rutter, 1987). ferent geographical regions of the United States Lately, there has been a lively debate that cen- that have reported their fi ndings from different ters on whether successful coping in the face of time periods in the life cycle. They include adversity is domain-specifi c, whether the protec- African American, Asian American, Caucasian tive factors that mitigate the effects of adversity and Hispanic youngsters who managed to cope tend to be universal or context-specifi c, and successfully, despite signi fi cant adversities in whether the factors that contribute to resilience their lives, such as poverty, parental mental ill- among children exposed to high levels of child- ness, child abuse, parental divorce, and/or an hood adversity are equally bene fi cial for those accumulation of multiple risk factors in their not exposed to these adversities. families. These questions are not easily addressed in the These longitudinal studies have (a) maintained existing literature. Much of the available evi- a core group of 100 to a 1,000 or more partici- dence is based on cross-sectional studies, retro- pants; (b) included both males and females in spective studies, short-term longitudinal studies their samples; (c) used multiple and age-appro- of only a few years duration (mostly in middle priate measures of adaptation; (d) followed the childhood), and studies with relatively small children at several points in time; (e) kept their samples without “low-risk” comparison groups. attrition rates low, and (f) collected data on “low- Nonetheless, there are lessons to be learned risk” comparison groups. from large-scale longitudinal studies that have This chapter will also draw on report from longitudinal studies from Great Britain, New Zealand, Australia, the Scandinavian countries, E. E. Werner (*) University of California , Davis , CA , USA and Germany whose fi ndings complement the e-mail: [email protected] results reported by American investigators.

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 87 DOI 10.1007/978-1-4614-3661-4_6, © Springer Science+Business Media New York 2013 88 E.E. Werner

continuing to participate in the study. When the Large-Scale Longitudinal Studies children were 10 years old, the sample was expanded to include 180 families. When the chil- U.S. Studies dren were 15 years old, it was expanded to include 300 families, and when the young people were 24 The Kauai Longitudinal Study : Beginning in the years old, it was expanded to include 450 fami- prenatal period, the Kauai Longitudinal Study lies (Hetherington, 1989). has monitored the impact of a variety of biological and psychosocial risk factors, stressful life The Hetherington and Clingempeel Study of events, and protective factors on the development Divorce and Remarriage: Begun in 1980, this of some 698 Asian, Caucasian, and Polynesian study examined the adaptation in stepfamilies of children, born in 1955, in the westernmost county adolescent children at 4, 17, and 26 months after of the United States. Some 30% of this cohort their parents’ remarriage. Participants in this were exposed to four or more risk factors that study were 202 white middle-class families liv- included chronic poverty, perinatal complica- ing in Philadelphia and its suburbs, with the non- tions, parental psychopathology, and family dis- divorced and stepfamilies studied at equal cord. Data on the children and their families were intervals (Hetherington & Kelley, 2002). collected at birth, in the postpartum period, and at ages 1, 2, 10, 18, 32, and 40 years. The most com- The Rochester Longitudinal Study: Begun in prehensive publication resulting from this study 1970, the study included a core sample of 180 out is the book Journeys from childhood to midlife : of 337 women showing a history of mental ill- risk , resilience, and recovery (Werner & Smith, ness (and a normal control group) whose children 2001). A follow-up in the mid-50s is planned. were studied at birth, 4, 12, 30 months, 4 years, and through grades 1–12 (Sameroff, Gutman, & The Minnesota Parent – child Project: Begun in Peck, 2003). 1975, this project followed some 190 of 267 low- income women and their ﬁ rst-born children in A Study of Child Rearing and Child Development Minneapolis from the last trimester of pregnancy in Normal Families and Families with Affective to ages 7 and 10 days, 3, 6, 9, 12, 18, 24, 30, 42, Disorders : Begun in 1980, the study enrolled 80 48 months, and from grades 1, 2, 3, and 6 to age (Maryland) families where parents had affective 25 years (Yates, Egeland, & Sroufe, 2003; Sroufe, disorders, with two children each: a younger Egeland, Carlson, & Collins, 2005). child in the age range from 15 to 36 months, and an older child between the ages of 5 and 8 years, Project Competence: Begun in 1977–1978, this and 50 control families. There were three follow- study followed a normative school cohort of 205 ups at ages 42–63 months; 7–9 years, and 11–13 third to sixth graders in the Minneapolis public years (Radke-Yarrow & Brown, 1993). schools (ages 8–12) after 7, 10, and 20 years, with high retention rates. Some 90% of the origi- A Longitudinal Study of the Consequences of Child nal cohort participated in the 20-year follow-up Abuse: Begun in 1975, the study included a core (Masten & Powell, 2003; Masten et al., 2004). sample of 353 out of 439 children from Pennsylvania families served by abuse centers, and controls The Virginia Longitudinal Study of Divorce and drawn from daycare and Head Start programs. The Remarriage : Begun in 1971, the initial sample children were seen between 1 and 6 years, and fol- consisted of 144 white middle-class families, half lowed at 6–12 years, and in late adolescence divorced, half nondivorced, with a target child of (Herrenkohl, Herrenkohl, & Egolf, 1994). 4 years. Children and families were studied at 2 months, and 1, 2, 6, 8, 11, and 20 years after The Virginia Longitudinal Study of Child divorce. Of the original 144 families, 122 are Maltreatment : Begun in 1986, the study focused 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? 89 on 107 maltreated children, identi ﬁ ed from the of 7, but below age 17. The aim of the research statewide registry, and a normal control group was to explore sibling relationships in different of children attending public schools in family types (two-parent families, single-parent Charlottesville. The children were assessed in families, and stepfamilies) and the risk and pro- grades 1–3, grades 4–5, and grades 6–7 (Bolger tective factors that impact their development and & Patterson, 2003). adjustment (Gass, Jenkins, & Dunn, 2007).

The Notre Dame Adolescent Parenting Project (NDAPP ) focused on the fate of more than a hun- New Zealand Studies dred teenage mothers and their children—born in the late 1980s and early 1990s across the ﬁ rst The Dunedin Multidisciplinary Health and 14 years of their lives. The goal of the study was to Development Study: This is a longitudinal inves- understand the mechanisms and pathways through tigation of a cohort of infants, born between April which risk and protective factors in ﬂ uenced the 1, 1972, and March 31, 1973, in Dunedin, New children’s development at 6 months, 1, 3, 5, 8, 10, Zealand. The base sample comprised 1,037 chil- and 14 years of age (Borkowski et al., 2007). dren, followed at ages 3, 5, 7, 9, 11, 13, 15, 18, and 21 years, with 992 participating at age 21. In The Chicago Longitudinal Study: Begun in 1983, the latest follow-up, at age 26, 847 of the cohort this is a longitudinal quasi-experimental cohort were assessed (Caspi et al., 2003). design, including 989 low-income children who entered the Child–Parent Center programs (CPC) The Christchurch Health and Development Study : in preschool and 550 low-income children who Begun in the mid-1977s, this study consists of a participated in an all-day kindergarten program. birth cohort of 1,265 children, born in the The youngsters were followed at age 14 and age Christchurch urban region, and followed at 4 20 years, when 1,281 sample participants were months, 1 year, and annual intervals to age 16 still active (Raynolds & Ou, 2003). years, and at ages 18 and 21 years. In the last follow-up, 991 participants were assessed (Fergusson & Horwood, 2003). British Studies

The National Child Development Study (NCDS): Australian Studies This study has followed some 16,994 persons, born in Great Britain between March 3 and 9, The Mater -University of Queensland Study of 1958, until adulthood. Data were collected on the Pregnancy (Brisbane): This is a prospective study physical, psychosocial, and educational develop- of 8,556 pregnant women begun in 1981. The ment of the cohort at ages 7, 11, 16, 23, and 33 mothers and their offspring were assessed between years (Wadsworth, 1999). the third and ﬁ fth day postpartum and at 6 months, 5 years, and 14–15 years when 5,262 children The British Cohort Study (BCS70): This study has participated. A follow-up at age 21 is under way followed 14,229 children, born in the week between (Brennen, Le Brocque, & Hammen, 2002). April 5 and 11, 1970, for 3 decades. Follow-up data were collected when the cohort members were age The Australian Temperament Project (ATP) is a 5, 10, 16, and 26 years (Schoon, 2001, 2006). longitudinal study of the psychosocial development of a representative sample of 2,443 children born in The Avon Brothers and Sisters Study (ABSS): Is the Australian State of Victoria between September a longitudinal study of some 192 families, each 1982 and January 1983. DNA data were available with a child born between August 1991 and for 584 adolescents at age 15–16 years, and 544 December 1992 and an older sibling over the age at age 17–18 years (Chipman et al., 2007). 90 E.E. Werner

Danish Studies children, that is, they showed a main effect rather than an interaction effect in statistical analyses The Copenhagen High -Risk Study: This study (Fergusson & Horwood, 2003). has traced 207 children of schizophrenic mothers Children who coped successfully with adversity and 104 matched controls from age 15 to ages 25 tended to become less easily distressed than those and 42 years. More than half had exhibited no who developed problems and had an active, socia- psychopathology from mid-adolescence through ble, “engaging” temperament that attracted adults mid-life (Parnas et al., 1993). and peers alike. They possessed good communication and problem-solving skills, including the ability to recruit substitute caregivers; they had a talent Swedish Studies or special skill that was valued by their peers, and they had faith that their actions could make a The Lundby Study: This is a prospective longitudi- positive difference in their lives. nal study of the mental health of some 2,550 per- They also drew on external resources in the sons, including 590 children (mean age 8 years at family and community. Foremost were affec- fi rst assessment) living in southern Sweden. tional ties that encouraged trust, autonomy, and Cederblad (1996) followed a subsample of 148 indi- initiative. These bonds were often provided by viduals who had been exposed to three or more psy- alternative caregivers who were members of the chiatric risk factors (such as parental mental illness, extended family, such as grandparents or older alcoholism, family discord, or abuse) in childhood. siblings. There were also informal support sys- Three out of four were functioning well in midlife. tems in the community that reinforced and rewarded the competencies of such youngsters and that provided them with positive role models, German Studies such as teachers, mentors, and peer friends. The frequency with which the same predictors There are two longitudinal studies of risk and proof resilience emerge from diverse studies with tective factors in Germany: Losel and Bliesener different ethnic groups, in different geographic (1990) have studied adolescents in residential insti- and sociopolitical contexts, conveys a powerful tutions in Bielefeld; Laucht, Esser, & Schmidt message of universality (Masten & Powell, 2003). (1999) have followed a birth cohort of 347 children That does not preclude the possibility that some in Mannheim from 3 months to 8 years. Reports on protective factors are more age-, gender-, and the fi ndings of their studies are available in German context-speci fi c than others. For example, in the in the book Was Kinder starkt (What Makes Kauai Longitudinal Study we found some vari- Children Strong?) (Laucht et al., 1999). ables that discriminated signi fi cantly between positive and negative developmental outcomes only when there was a series of stressful life Individual Attributes and Sources of events or when children were exposed to poverty. Support Associated with Successful They did not discriminate between good and poor Coping Among High-Risk Children outcomes among middle-class children whose lives were relatively secure, stable, and stress- Tables 6.1 and 6.2 summarize the individual attri- free (Werner & Smith, 1989). butes and sources of support in the family and Among such protective factors were autonomy community associated with successful coping and self-help skills in early childhood for the among high-risk children that have been repli- males and a positive self-concept in adolescence cated in a number of large-scale longitudinal for the females. Among protective factors in the studies in the United States of America and caregiving environment for both boys and girls abroad. In most cases the factors that contributed were a positive parent–child relationship observed to resilience among those exposed to high levels during the second year of life and the number of of childhood adversity also benefi ted “low-risk” sources of emotional support they could draw on 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? 91

Table 6.1 Individual attributes associated with successful coping in high-risk children-replicated in two or more large- scale longitudinal studies Childhood adversities Source Characteristics of Multiple (4+) Parental Child notes individual Time period studied risk factors Poverty mental illness abuse Divorce 1 Low distress; low Infancy–adulthood + + + + + emotionality 2 Active; vigorous Infancy–adulthood + + 3 Sociable Infancy–adulthood + + + + 4 Affectionate Infancy–childhood + + + + + “engaging” temperament 5 Autonomy; social Early childhood + + maturity 6 Average-above average Childhood–adulthood + + + + + intelligence (incl. reading skills) 7 High achievement Childhood–adulthood + + + motivation 8 Special talents Childhood– + + + adolescence 9 Positive self-concept Childhood– + + + + adolescence 10 Internal locus of Childhood–adulthood + + + + + control 11 Impulse control Childhood–adulthood + + + 12 Planning; foresight Adolescence– + + adulthood 13 Faith; a sense of Adolescence– + + + coherence adulthood 14 Required helpfulness Childhood–adulthood + + + Source notes: 1. Farber and Egeland (1987); Fergusson and Horwood (2003); Werner and Smith (1992, 2001) 2. Farber and Egeland (1987); Werner and Smith (1992, 2001) 3. Farber and Egeland (1987); Losel and Bliesener (1990); Werner and Smith (1992, 2001) 4. Farber and Egeland (1987); Hetherington (1989); Werner and Smith (1992, 2001) 5. Farber and Egeland (1987); Masten et al. (2004); Werner and Smith (1989, 1992, 2001) 6. Farber and Egeland (1987); Fergusson and Lynsky (1996); Hetherington and Elmore (2003); Losel and Bliesener (1990); Masten and Powell (2003); Masten et al. (2004); Seifer et al. (1992); Werner and Smith (1992, 2001) 7. Fergusson and Horwood (2003); Losel and Bliesener (1990); Masten and Powell (2003); Masten et al. (2004); Radke-Yarrow and Brown (1993); Schoon (2001); Werner and Smith (1992, 2001) 8. Anthony (1987); Werner and Smith (1992, 2001) 9. Cederblad (1996); Fergusson and Horwood (2003); Hetherington and Elmore (2003); Losel and Bliesener (1990); Radke-Yarrow and Brown (1993); Werner and Smith (1992, 2001) 10. Bolger and Patterson (2003); Cederblad (1996); Hetherington and Elmore (2003); Masten and Powell (2003); Seifer et al. (1992); Werner and Smith (1992, 2001) 11. Fergusson and Lynsky (1996); Fergusson and Horwood (2003); Masten and Powell (2003); Werner and Smith (1992, 2001) 12. Masten et al. (2004); Rutter (2000); Werner and Smith (1992, 2001) 13. Cederblad (1996); Hansson et al. (2008); Hetherington and Kelley (2001); Howard et al. (2007); Rumbaut (2000); Suarez-Oroczo (2001); Werner and Smith (1992, 2001) 14. Anthony (1987); Boyden (2009); Losel and Bliesener (1990); Werner and Smith (2001) 92 E.E. Werner

Table 6.2 Resources in the family and community associated with successful coping in high-risk children—replicated in two or more large-scale longitudinal studies Childhood adversities Source Multiple (4+) Parental Child notes Resources Time period studies risk factors Poverty mental illness abuse Divorce 1 Small family (<4 Infancy + + children) 2 Maternal competence Infancy–adolescence + + + + 3 Close bond with Infancy–adolescence + + + + primary caregiver 4 Supportive Infancy–adolescence + + + + + grandparents 5 Supportive siblings Childhood– + + + + + adolescence 6 Competent peer Childhood– + + + + friends adolescence 7 Supportive teachers Preschool–adulthood + + + + 8 Successful school Childhood–adulthood + + + + experiences 9 Mentors (elders) Childhood–adulthood + + 10 Prosocial Childhood–adulthood + + organizations: (youth clubs, religious groups) Source: 1. Cederblad (1996); Werner and Smith (1992, 2001) 2. Egeland, Carlson, and Stroute (1993); Masten and Powell (2003); Seifer et al. (1992); Werner and Smith (1992, 2001) 3. Cederblad (1996); Fergusson and Horwood (2003); Losel and Bliesener (1990); Masten et al. (2004); Mednick et al. (1987); Rumbaut (2000); Seifer (2003); Werner and Smith (1992, 2001) 4. Farber and Egeland (1987); Herrenkohl et al. (1994); Hetherington (1989); Howard et al. (2007); Radke-Yarrow and Brown (1993); Werner and Smith (1992, 2001) 5. Gass et al. (2007); Hetherington (1989); Wallerstein and Blakeslee (1989); Werner and Smith (1992, 2001) 6. Bolger and Patterson (2003); Fergusson and Horwood (2003); Hetherington (1989); Losel and Bliesener (1990); Rumbaut (2000); Suarez-Oroczo (2001); Wallerstein and Kelley (1980); Werner and Smith (1992, 2001) 7. Hetherington (1989); Losel and Bliesener (1990); Radke-Yarrow and Brown (1993); Reynolds and Ou (2003); Rumbaut (2000); Werner and Smith (1992, 2001) 8. Fergusson and Lynskey (1996); Hetherington (1987); Masten et al. (2004); Schoon (2001, 2006); Wadsworth (1999); Werner and Smith (1992, 2001) 9. Howard et al. (2007); Yates et al. (2003); Werner and Smith (2001) 10. Howard et al. (2007); Masten and Powell (2003); McGee (2003); Rumbaut (2000); Suarez-Orozco (2001); Werner and Smith (1989, 1992, 2001); Wyman (2003)

in early and middle childhood. Further, in the The Importance of Early Rochester Child Resilience Project, Wyman Developmental Competence (2003) reported context-speciﬁ c effects of and Support involvement in structured after-school activities among high-risk teens. Participation in pro-social Because the majority of research on resilience group activities lowered the risk for delinquent has focused on middle childhood and adoles- behavior for youngsters with many antisocial cence, an early history of developmental compe- friends, but not for those with few antisocial tence has received little attention in the literature friends. on resilience. Yet, both the Kauai Longitudinal 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? 93

Study and the Minnesota Parent–child Project events that heighten children’s vulnerability and have shown that an early history of positive adap- protective factors that enhance their resilience. tation, engendered by consistent and supportive The follow-up in adulthood in the Kauai care, is a powerful and enduring infl uence on Longitudinal Study, for example, found a few children’s adaptation, and it increases the likeli- offspring of psychotic parents who had managed hood that they will utilize both formal and infor- to cope successfully with a variety of stressful mal sources of support in their environment at life events in childhood or adolescence, but whose later stages in the life-cycle. mental health began to deteriorate in the third For example, Yates et al. (2003) found that decade of life (Werner & Smith, 1992). children with early histories of secure attachment Other high-risk children had grown into com- in infancy and generally supportive care in the petent, confi dent, and caring adults, but felt a per- fi rst 2 years demonstrated a greater capacity to sistent need to detach themselves from parents rebound from a period of poor adaptation when and siblings whose domestic and emotional prob- they entered elementary school compared to lems threatened to engulf them. This was espe- those with less-supportive histories. Likewise, cially true for the adult offspring of alcoholic children who exhibited positive transitions from parents, some of whom had been physically and maladaptation in middle childhood to compe- emotionally abused when they were young. The tence in adolescence were able to draw on a posi- balancing act between forming new attachments tive foundation of early support and positive to loved ones of their choice and the loosening of adaptation. old family ties that evoked painful memories That the process of resilience is manifested at exacted a toll in their adult lives. The price they later stages in the developmental trajectory paid varied from stress-related health problems became apparent to us in our follow-up studies in to a certain aloofness in their interpersonal early adulthood and midlife on Kauai (Werner & relationships. Smith, 1992, 2001). The majority of high-risk On the positive side, the Kauai study demon- children who had become troubled teenagers strated that the opening of opportunities at major (with delinquency records and mental health life transitions (high school graduation, entry into problems) recovered in the third and fourth the world of work, marriage) enabled the major- decade of life and became responsible partners, ity of the high-risk individuals who had a trou- parents, and citizens in their communities. The bled adolescence to rebound in their 20s and 30s. individuals who availed themselves of informal Among the most potent second chances for such sources of support in the community, and whose youth were adult education, voluntary military lives subsequently took a positive turn, differed service, active participation in a church commu- in signifi cant ways from those who did not make nity, and a supportive friend or marital partner. use of such options. They had been exposed to Likewise, Project Competence identi fi ed a num- more positive interactions with their primary ber of young people who did poorly in adoles- caregivers in the fi rst 2 years, that is, their early cence but turned their lives around in the transition rearing conditions fostered a sense of trust. to adulthood (Masten & Wright, 2009).

The Shifting Balance Between Protective Mechanisms: Vulnerability and Resilience Interconnections Over Time

Large-scale longitudinal studies that have fol- Just as risk factors tend to co-occur in a particular lowed boys and girls from birth to adulthood population (i.e., children of poverty) or within a (whether children of poverty, divorce, or children particular developmental period (i.e., adoles- coming from multirisk families) have repeatedly cence), protective factors are also likely to occur found a shifting balance between stressful life together to some degree (Gore & Eckenrode, 94 E.E. Werner

1994). The presence of a cluster of (interrelated) competence at age 10. Boys who were more auton- variables that buffer adversity at one point in omous at age 2 encountered fewer stressful life time also makes it more likely that other protec- events in the fi rst decade of life and had fewer health tive mechanisms come into play at a later period problems in childhood and adolescence. Girls who of time. were more autonomous as toddlers had fewer health There are only a few large-scale longitudinal problems in each decade of life and fewer coping studies that have demonstrated such interconnec- problems by age 40. tions over time. The highlights of the results of For both boys and girls, there was a positive the latent variable path analyses that were applied association between the number of sources of to the data from the Kauai Longitudinal Study at emotional support they were attracted in child- six points in the life cycle illustrate the complex- hood, their scholastic competence at age 10, and ity of the phenomenon of resilience. They show the quality of adaptation at age 40. Individuals how individual dispositions and outside sources who could count on more sources of emotional of support and stress are linked together from support in childhood reported fewer stressful life infancy and early childhood to middle childhood events at later stages of their lives than those who and adolescence, and how these variables in turn, had little emotional support. predict the quality of adaptation in young adult- For both sexes, scholastic competence at age hood and midlife (Werner & Smith, 1992, 2001). 10 was positively linked to self-effi cacy and the When the links between individual disposi- ability to make realistic plans at age 18. Males tions and outside resources were examined, men with higher scholastic competence at age 10 had and women who had made a successful adapta- fewer health problems in adolescence and higher tion at midlife—despite serious childhood activity scores on the EAS Temperament Survey adversity—had relied on sources of support at age 32. They also availed themselves of more within the family and community that increased sources of emotional support in adulthood. their competence and ef fi cacy, decreased the Females with higher scholastic competence at number of stressful life events they subsequently age 10 attracted more sources of emotional sup- encountered, and opened up new opportunities port in adolescence. For both boys and girls, the for them. number of sources of emotional support they The protective processes that fostered resil- could rely on in adolescence was positively linked ience manifested themselves early in life. Across to their self-effi cacy and ability to make realistic a span of several decades, maternal competence plans at age 18. in infancy was positively related to their off- Men and women who were more resourceful springs’ adaptation in adulthood (at 32 and 40 and more realistic in their educational and voca- years). Girls whose mothers interacted in a con- tional plans at age 18 received higher scores on sistently positive way with their infant daughters the Scales of Psychological Well-Being at age were more autonomous at age 2 and more com- 40. Their temperament was related to the quality petent at age 10. They also attracted more sources of their adult adaptation as well. Men who of emotional support in childhood and adoles- scored higher on the activity scale of the EAS cence and encountered fewer stressful life events Temperament Survey at age 32 coped better at than did the daughters whose mothers were less age 40 than did males with lower activity scores. competent caregivers. Males with more compe- Women with higher distress scores at age 32 had tent mothers were more successful at school at more health problems and lower scores on the age 10, more resourceful and effi cacious at age Scales of Psychological Well-Being at age 40. 18, and utilized more sources of emotional sup- Most of the variance in the quality of adapta- port in adulthood than did the sons of mothers tion at age 40 was accounted for by earlier pre- who were less competent caregivers. dictors of resilience (i.e., variables associated For both boys and girls there was a positive asso- with successful coping at ages 2, 10, and 18). ciation between autonomy at age 2 and scholastic Most was attributed to four clusters of protective 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? 95 factors that had been independently assessed in for males who successfully coped with adversities the fi rst decades of life: (1) maternal compe- in their lives. In contrast the sources of support tence (a cluster of variables that included moth- available in the family and community tended to er’s age and education and the proportion of make a greater impact on the lives of the men who positive interactions with her child, observed successfully overcame childhood adversities independently at home at age 1, and during (Werner & Smith, 2001). developmental examinations at age 2); (2) the number of sources of emotional support available to the child between ages 2 and 10 years Biological Aspects of Resilience (including members of the extended family); (3) scholastic competence at age 10 (a cluster of Most of the longitudinal studies reviewed here variables that included IQ scores and scores on were conducted by educators, psychologists, and the PMA reasoning test and the STEP reading sociologists, but there has been a growing inter- test); (4) the health status of the child (between est in biological and genetic variables that may birth and 2 years for females; between birth and mitigate or modify the impact of stress and child- 10 years for males). hood adversities on the quality of adaptation at Those fi ndings point to the importance of the different stages of the life cycle (Curtis & fi rst decade of life in laying the foundations for Cicchetti, 2008). later resilience—as has been also documented by Sroufe and his collaborators in the Minnesota Parent – child Project (Sroufe et al., 2005). Health

Surprisingly, the general health status of the indi- Gender Differences vidual tends to be overlooked in most studies concerned with resilience and vulnerability. Even All large-scale longitudinal studies of risk and in large-scale longitudinal studies, in which the resilience report gender differences that appear to original focus has been “health and develop- vary with the stages of the life cycle and the ment,” the variables that are included in complex demands made on each gender in the context of regression equations that look for “resiliency fac- the prevailing sex role expectations. tors” tend to denote psychological or sociological At each developmental period, beginning in constructs or are concerned with educational the prenatal period and infancy, more males than attainment rather than health (Fergusson & females perished. In childhood and adolescence, Horwood, 2003; Schoon, 2001). more boys than girls developed serious learning Path analyses of the data of the Kauai and behavior problems and displayed more exter- Longitudinal Study suggest that it might be nalizing symptoms. In contrast, in late adoles- worthwhile to explore the effects of good health cence and young adulthood, more girls than boys or debilitating illnesses or accidents on children’s were subject to internalizing symptoms, espe- ability to cope with stressful life events and cially depression (Caspi et al., 2003; Fergusson adversity. On Kauai, at each stage of the life & Horwood, 2003; Werner & Smith, 1989). cycle—from early childhood to adulthood—indi- But among the high-risk youths who had viduals who encountered more stressful life become “troubled teenagers,” more women than events also encountered more health problems. men managed to make a successful transition into Health problems in early childhood (a count of their 30s and 40s, at least on Kauai. Protective serious illnesses or accidents reported by the par- factors within the individual—an engaging tem- ents between birth and age 2; the number of perament, scholastic competence, and self- referrals to health care providers, and the pedia- effi cacy—tended to make a greater contribution trician’s low rating of the toddler’s physical sta- to the quality of adult adaptation for females than tus at age 2) were signifi cantly correlated with 96 E.E. Werner coping problems in adulthood, both at 32 and age observation supported by Belsky et al. (2007) 40 (Werner & Smith, 1992, 2001). who speculates that the anxiety displayed by fear- On the positive side, perinatal health (i.e., the ful children refl ects a highly sensitive nervous absence of pregnancy and birth complications) system on which experience registers power- was a signifi cant protective factor in the lives of fully—one that makes them especially suscepti- adolescents who were the offspring of mothers ble to both negative and positive rearing effects. who suffered from mental illness. These fi nding Research on differential susceptibility has only have been replicated in the Copenhagen High- just begun. Studies that include twins and other Risk Study (Parnas et al., 1993) and in a study of siblings from the same family (such as the 15-year-old-children of depressed mothers who Swedish Twin Registry) may prove especially were participants in the Mater-University Study powerful as they could distinguish genetically of Pregnancy and Outcomes in Brisbane, Australia and environmentally induced variations in sus- (Brennen et al., 2002). ceptibility (Hansson et al., 2007)

Biological Sensitivity to Context Gene-Environment Interactions

An exciting new avenue of research has focused There is ample evidence of the important role on the role of psychobiologic factors as modera- genetic factors play in the susceptibility of indi- tors of children’s vulnerability to stress. The con- viduals to psychopathology, such as alcoholism, cepts of “biological sensitivity to context” and antisocial behavior, and severe psychiatric ill- “differential susceptibility to environmental nesses (schizophrenia and bi-polar disorder). in fl uences” have been advanced to explore the Several studies, including the Copenhagen High- possibility that some children are more sensitive Risk Study (Parnas et al., 1993) and the Kauai to the infl uence of context than others, whether Longitudinal Study have reported fi ndings that the context is adverse or benefi cial (Belsky, suggest that adverse environments, including Bakermans-Kranenburg, & van Ijzendorn, 2007; serious pre- and perinatal stress, have the most Ellis, Essex, & Boyce, 2005). negative impact on individuals who are geneti- Biological reactivity to naturally occurring cally vulnerable, among them the offspring of stressors appears to be a robust, replicable phe- alcoholic and schizophrenic mothers (Werner & nomenon that involves a set of complex responses Smith, 2001). within the neural circuitry of the brain, and within It stands to reason that gene–environment peripheral neuro-endocrine pathways regulating interactions also play a signifi cant role in relation metabolic, immunologic, and cardiovascular to the phenomenon of resilience. Evidence of functions. Boyce and his collaborators (2005) gene–environment interactions in which an indi- have demonstrated in several studies that a dis- vidual’s response to the environmental insults proportionate number of preschool children in appears to be moderated by his or her genetic supportive home environments displayed high makeup has been reported by Caspi et al. (2002, autonomic reactivity. Conversely, a relatively 2003) from the 26-year follow-up of the Dunedin high proportion of children in very stressful fam- (New Zealand) Multi-Disciplinary Health and ily environments, followed from infancy to age 7, Development Study, in which 847 Caucasian showed evidence of heightened adrenocortical cohort members participated. and sympathetic reactivity. In both studies, chil- Individuals with one or two copies of the short dren from moderately stressful home environ- allele of the 5-HTTLPR gene (a serotonin trans- ments displayed the lowest reactivity levels. porter) exhibited signifi cantly more (self- These fi nding suggest that relations between reported) depressive symptoms in relation to four levels of childhood support/adversity and the or more stressful life events between the ages of magnitude of stress reactivity are curvilinear, an 21 and 26 than individuals homozygous for the 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? 97 long allele. Of special interest was the fi nding individual-level original data. Of a total of that childhood maltreatment in the fi rst decade of 14,250 participants, 1,769 were classi fi ed as life predicted adult depression only among indi- having depression. In the meta-analysis of pub- viduals carrying a short allele, but not among lished data, the number of stressful life events individuals homozygous for the long allelle was signi fi cantly associated with depression. No (Caspi et al., 2003). association was found between the 5-HTTLPR In another analysis of data from the Dunedin genotype and depression in any of the individual Study, Caspi and his associates found that a func- studies, and no interaction effect between geno- tional polymorphism in the X-linked gene encod- type and stressful life events on depression was ing the neurotransmitter-metabolizing enzyme observed. This meta-analysis yielded no evi- monoamine oxidase A (MAOA) was found to dence that the serotonin transporter genotype moderate the effects of childhood maltreatment alone or in interaction with stressful life events in males. Boys with a genotype conferring high was associated with an elevated risk of depres- levels of MAOA expression who had been mal- sion in men alone, women alone, or in both sexes treated in childhood were less likely to develop combined. antisocial problems (conduct disorders between Munafo et al. (2009), at the University of ages 10 and 18; convictions for violent crimes Bristol, carried out an independent meta-analysis by age 26) than those with low levels of MAOA on 15 studies that focused on gene x environment activity (Caspi et al., 2002). The authors wisely interactions at the serotonin transporter locus and suggested that “until this study’s fi ndings are rep- concluded that the main effects of the 5-HTTLPR licated, speculations about clinical implications genotype and the interaction effect between are premature” (p. 853). 5-HTTLPR and stressful life events on risk of Kim-Cohen and her associates (2006) were depression are negligible. Only a minority of able to replicate the original fi nding by showing studies (Kaufman, 2008; Kendler, 2005) report a that the MAOA genotype moderated the develop- replication that is qualitative comparable to that in ment of psychopathology after exposure to physi- the original report. In general, the positive results cal abuse in a cohort of 975 7-year-old British for the 5-HTTLPR x stressful life events interac- boys. Her meta-analysis of the results of fi ve tions were compatible with chance fi ndings. independent investigations (from Great Britain, Diversity of methods and approaches used to New Zealand and the U.S.A.) demonstrated that measure environmental risk may explain the across studies the association between childhood inconsistencies in results across G x E studies. maltreatment and mental health problems was Health practitioners, educators, and behavioral signi fi cantly stronger in the group of males with scientists need to recognize the importance of the genotype conferring low MAOA activity. replication of fi ndings from genetic analyses These fi ndings provide the strongest evidence to that seek to anchor in neurobiology individual date suggesting that the MAOA gene infl uences differences in resilience (Reiss, 2010; Stein vulnerability to environmental stress and that this et al., 2009). biological process can be initiated early in life. But that evidence so far is based only on samples of Caucasian males. Resilience in a Cross-Cultural Context Meta-analyses of studies of the interaction between the serotonin transporter gene Research on resilience needs to acquire a cross- (5-HTTLPR), stressful life events, and increased cultural perspective that focuses on children in risk of major depression have yielded mostly the developing world who have been exposed to negative results—though substantial resources many biological and psychosocial risk factors have been devoted to replication efforts. that increase their vulnerability far beyond that of Risch et al. (2009) conducted a meta-analysis their peers born in more stable and affl uent of 14 studies, using both published data and conditions. 98 E.E. Werner

Immigrant and refugee children are the fastest children and their families over a span of 15 growing segment of the U.S. child population. years. The children are in two age groups: The The Children of Immigrants Longitudinal Study older cohort was born in 1994–2010, the younger (CILS) have examined the aspirations, educa- in 2001–2002. Some of the overall trends across tional performance, and psychological adaptation the three rounds of available survey data (2002, of more than 5,000 teenage youths in two key 2006, 2009) are: areas of immigrant settlements in the United Maternal education is a signi fi cant correlate of States: southern California and south Florida an array of positive outcomes for poor children, (Rumbaut, 2000). The original survey (T1) con- especially their nutritional status. In turn, there is ducted in spring 1992 interviewed 2,420 students a strong relationship between nutrition and chil- enrolled in the eighth and ninth grade in the San dren’s cognitive achievement and psychosocial Diego Uni fi ed School District and 2,842 students well-being. in public and private schools in the Miami area. Intergenerational interdependency is crucial Three years later, from 1995 to 1996, a second to children’s well-being and resilience in poor survey (T2) of the same youths was conducted, families where children’s efforts are combined supplemented by interview with their parents. with parents and elders to meet family needs. The students from San Diego were mostly of Norms concerning what constitues a “good child” Mexican and Southeast Asian origin, the students tend to reinforce their work contributions. from Florida came mostly from Latin America. Evidence on children’s active contributions Regardless of their country of origin, immi- to the domestic economy suggests that it is not grant children with higher school achievement, just essential to household maintenance in poor aspirations, and self-esteem relied on high levels families, but can foster their sense of belonging of social support by their parents and the extended and responsibility, and ease their transition to family, and on competent peers from the same adulthood (Boyden, 2009). We found the same ethnic group. Among protective factors that to be true in our longitudinal study of multiracial enhanced their psychological well-being was families on Kauai (Werner & Smith, 2001). closeness with parents, religion, and social support from family, friends, and teachers. A 5-year Longitudinal Immigrant Student Evaluation Studies of the Adaptation (LISA) Study , directed by Carola and Effectiveness of Programs Designed Marcel Suarez-Oroczo (2001), reports similar to Foster Resilience fi ndings. The LISA study followed some 400 immigrant children (ages 9–14) who came from Scarr (1992) points out that it is not easy to inter- fi ve regions (China, Central America, the vene deliberately in children’s lives. We know Dominican Republic, Haiti, and Mexico) to the how to rescue children from extremely bad cir- Boston and San Francisco areas. cumstances and to return them to normal devel- Qualitative interview data and quantitative opmental pathways, but only within the limits of survey data employed in the LISA study illus- their own heritable characteristics, such as intel- trated the importance of supportive friends, coun- ligence, temperament (activity, excitability, selors, and members of the extended family in the sociability), and psycho-biologic reactivity (car- social world of immigrant youths, and the protec- diac and immunologic responses under stress). tive role of religion and church-based relation- Since the 1980s, many “competence enhance- ships in the lives of immigrant teenagers. ment” and “strength” or “asset” building pro- Young Lives is a longitudinal study of child- grams for high-risk children have been introduced hood poverty in four developing countries: in North America, most of which have focused Ethiopia, India (Andhra Pradesh), Peru, and on preschool and school-age children. So far, Vietnam (Hardgrove, Boyden, & Dornan, 2010). there have been very few evaluation programs So far, data have been gathered on some 12,000 that have examined their long-term effectiveness. 6 What Can We Learn about Resilience from Large-Scale Longitudinal Studies? 99

Some of these programs are discussed in other chapters of this book. Conclusions A notable example is the Chicago Longitudinal Study, begun in 1983, an ongoing investigation Large-scale longitudinal studies, extending from of the effects of the CPC, the oldest extended childhood to adulthood, have documented the childhood intervention program in the United shifting balance between stressful life events and States of America and the second-oldest feder- risk factors that increase children’s vulnerability, ally funded preschool program (after Head Start). and internal dispositions and outside sources of The program stresses center-based language support that enhance their resilience. This bal- learning and parent participation and provides ance may change at different stages in life for educational and family support services to disad- each gender and is affected by the cultural vantaged children from preschool to the early context. elementary grades (3–9 years). The data avail- The frequency with which the same predictors able on more than a thousand participants in the of resilience emerge from longitudinal studies Chicago public schools cover nearly 2 decades conducted with different ethnic groups and in dif- of life. ferent geographic settings is impressive. In most Reynold and Ou (2003) reported the results cases the factors that mitigated the negative of several path analyses that modeled the effect effects of childhood adversity also benefi ted chil- of preschool participation (from year 3 to 5), dren who lived in stable and secure homes, but cognitive skills (at age 5), parent involvement they appear to have particular importance when at school (in the years 8–12), quality of school adversity levels are high. (at ages 10–14), on school achievement and Large-scale longitudinal studies have demon- grade retention (at ages 14–15), and on the strated that an early history of developmental diminished likelihood of special education competence, engendered by consistent and sup- placement and dropping out of high school by portive care, is a powerful and enduring in fl uence age 20. on children’s adaptation at later stages of the life Effect sizes on measures of social competence cycle and increases that likelihood that they will averaged 0.70 standard deviations, modest, but rebound from a “troubled” adolescence. higher than those reported from several meta- The pathways that lead to positive adapta- analyses on the effectiveness of preventive men- tion, despite childhood adversity, are complex, tal health programs (average 0.34 SD) and of a and there is great need to map the interconnec- wide range of psychological and behavioral treat- tions between individual dispositions and out- ments (0.47 SD). Children who attended pro- side sources of support that increase competence grams in the poorest neighborhoods benefi ted and self-ef fi cacy, decrease negative chain most from the CPC programs. effects, and open up opportunities, whether in Because the pathways that lead to positive natural settings or in structured intervention adaptation despite childhood adversities are programs. infl uenced by context, it is not likely we will dis- Longitudinal research needs to focus more on cover a “magic bullet,” a model intervention pro- the role of gene–environment interactions that gram that will succeed every time with every moderate an individual’s response to stressful life youngster who grows up under adverse circum- events. It also needs to acquire a cross-cultural stances. Knowing this does not mean we should perspective that focuses on children from the despair. But it does mean, as Ruttrer (2002) developing world. We need to know more about admonishes us that “caution should be taken in individual dispositions and sources of support in jumping too readily onto the bandwagon of what- the family and community that enable these chil- ever happens to be the prevailing enthusiasm of dren to operate effectively in a variety of high- the moment” (p. 15). risk contexts. 100 E.E. Werner

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Environmental Issues Poverty in Childhood and Adolescence: A Transactional–Ecological Approach 7 to Understanding and Enhancing Resilience in Contexts of Disadvantage and Developmental Risk

Robert D. Felner and Melissa L. DeVries

The number of children in the United States who (cf. Felner et al., 1995 ; Felner, Silverman, & grow up in conditions of chronic poverty and Felner, 2000 ; Lipina & Colombo, 2009 ; Mrazek social disadvantage remains a tragedy of epidemic & Haggarty, 1994 ) . Summarizing these fi ndings, proportions. Currently, approximately one out of Schorr (1988 ) concluded “poverty is the greatest every fi ve children under age 18 lives in poverty risk factor of all. Family poverty is relentlessly (Proctor & Dalaker, 2003 ; DeNavas-Walt, Proctor, correlated with school-aged childbearing, school & Smith, 2008 ). Further, the overall numbers grew failure, and violent crime…. Virtually all other by approximately 400,000 from 2001 to 2002, to risk factors that make rotten outcomes more likely exceed 12 million children and youth who now are also found disproportionately among poor live below the poverty line. When those who are children” (p. xxii). Little has changed since Schorr considered “near poor”—calculated by the U.S. wrote those words to change the prognosis for Census as those who have household incomes of children in poverty. Indeed, as we will discuss less than 1.25 times the poverty income level—the below, because of changes in society many of the percentage of all children below the age of 18 in conditions that have been associated with poverty, the United States who experience serious eco- such as school failure, may be more likely to result nomic hardship each day of rates edges close to in other compounding, comorbid dif fi culties than one-quarter (22.3) of all children and youth. at any time in our nation’s history. Poverty rates among minority children are even Elsewhere in this volume there are extended higher, with this level of severe economic disad- discussions of approaches to building specifi c vantage affecting approximately 30% of both competencies, or speci fi c supports (e.g., parental Hispanic and African-American children (Proctor skills) to enable all children and youth, including & Dalaker, 2003 ; DeNavas-Walt et al., 2008 ). those in poverty, to better withstand stressors and Studies of the effects of poverty and other forms of challenges, including ones from both nature and socioeconomic disadvantage have underscored the nurture (Deater-Deckard, Ivy & Smith, 2005 ), potentially devastating impact that these condi- that they confront as they develop. It is neither tions can have on the emotional, physical, and the intent nor within the scope of the current intellectual development of children and youth chapter to cover that same ground in signi fi cant detail, except to refer to it as necessary. Rather, our intent is to offer a framework for more fully R. D. Felner understanding the pathways by which poverty University of Louisville , Louisville , KY , USA impacts and shapes the developmental course for M. L. DeVries ( ) children and youth, one that has shown promise Neurology, Learning and Behavior Center , Salt Lake City , UT , USA for guiding both policy and other interventions e-mail: [email protected] that may be effective in reducing the ongoing toll

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 105 DOI 10.1007/978-1-4614-3661-4_7, © Springer Science+Business Media New York 2013 106 R.D. Felner and M.L. DeVries of poverty among our young. To be sure, what is provide an important organizing theoretical offered here is but one element of what must be a framework for understanding the ways in which far more extensive and comprehensive approach conditions such as poverty and correlated forms to enabling children and youth to be resilient in of social and economic disadvantage (e.g., paren- the face of the myriad of developmentally hazard- tal educational and occupational attainment) may ous conditions that are associated with living in impact adaptational outcomes. Here, it is impor- poverty. Further, the discussion offered here, tant to distinguish poverty and related forms of although potentially making a useful contribu- socioeconomic disadvantage from other, conception to considering the impact of poverty in non- tually distinct aspects of the ecology of child and western countries would be vastly different both adolescent development (Bronfennbrenner, 1979 ; in its focus and recommendations, although the McLoyd, 1990, 1998 ) . In articulating this view, transactionalÐecological perspective is one that Felner et al. ( 2000 ) noted that social structural does generalize to the basic developmental pro- stress, major life events, and associated condi- cesses of all living organisms, and in that way tions from which they may derive, such as the may have some utility. forms of disadvantage noted earlier, are “distal” As we considered where to focus the discus- in that they do not directly describe the life cir- sion in this chapter, of such a vast area (poverty), cumstances and demands that result from them, about which so much has been written, perhaps nor the adaptive processes they require. That is, what was easiest to decide was what it did not although there may be some conditions for which need to do. Another chapter recounting all of the “poverty” may, for all children and youth, increase ills associated with poverty, or that had little util- the marginal probability of experiencing, to talk ity for guiding action, was one thing that we about the experience of “poverty” can be very clearly do not need. There are literally hundreds, misleading. if not thousands of government and public/pri- Illustratively, given poverty’s economic vate sector reports that recount the costs and defi nition, where the level of income for a family impacts of poverty for children, adolescents, is often the “yardstick,” a family where the pri- families, and others. This chapter does not do mary breadwinner is a well-educated, but new that. Similarly, it is not about the defi nitions of school teacher with several children can easily be poverty, and we leave that to the economists. seen as potentially meeting the standard for being Instead, our focus is on the ways in which chronic either “in poverty” or at least “near poverty.” disadvantage may act both directly, and through Similarly, within the group of children/youth in other social institutions, to negatively impact the poverty may be in families where the parent(s) is developmental course of children and youth, as very young, has little education, few other well as to offer some general understandings and resources, and yet have approximately the same speci fi c examples of how we may reduce the pop- income. ulation-level impacts of disadvantage. Families with the same income levels may also live in dramatically different communities where the developmental contexts experienced A Mediated Effects Approach by their children may vary signi fi cantly. Kozol to De fi ning and Understanding ( 1991 ) and others have talked about the “Savage the Experience of Poverty inequalities” that may be present in the educa- in Childhood and Adolescence tional settings that are provided to students in neighborhoods and communities where perva- Transactional (Felner & Felner, 1989 ; Sameroff sive poverty and social disadvantage are present. & Fiese, 1989 ) and ecological perspectives on At the “next level” of the ecology of communi- human development (Bronfennbrenner, 1979 ) , ties, Wilson ( 1987, 1996) and Xue, Leventhal, taken together as a transactionalÐecological Brooks-Gunn, and Earls (2005 ) have shown the perspective (Felner, Felner, & Silverman, 2000 ), way that neighborhoods with high levels of 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 107 unemployment, “dense” or “concentrated disad- disadvantage may, at least in part, exert their vantage” may be developmental contexts where impact on adaptational outcomes via their effects the effects of family poverty are potentiated and on the relatively more proximal environmental magni fi ed. Such neighborhoods often have sub- conditions and experiences that characterize the standard housing where high lead or other toxin lives of youth. The conceptual model implied by levels may be present, signi fi cantly greater levels this view is one in which conditions of socioeco- of crime, substance abuse and violence, fewer nomic disadvantage infl uence proximal environ- high quality after-school or childcare options, mental experiences, and the same proximal and they may also provide exposure to fewer experiences, in turn, have effects on child and positive models or opportunities that shape the adolescent adjustment. The model also allows for dreams and aspirations of youth. It is also clear the possibility of direct effects of conditions of from both the works of Wilson ( 1987, 1996) and socioeconomic disadvantage on adjustment. census reports that for some poverty or near pov- A second implication is that the more proxi- erty is a transitory experience, often persisting mal developmental contexts (e.g., schools, neigh- less than 1 year. For others, however, it may be borhoods, families) may provide and create ongoing, pervasive, and characterize much or all powerful “compensatory effects” (Abelev, 2009 ; of the developmental period from prenatal to Costello, Swendsen, Rose, & Dierker, 2008 ; maturity. What is clear from the work of Sameroff Felner et al., 1995 ) that are not only protective in and his colleagues (Masten & Sesma, 1999 ; their own right, but that provide developmental Sameroff & Chandler, 1975 ; Sameroff & Fiese, experiences that facilitate the development of 1989 ) is that exposure to additional conditions of individual level competencies in the children and risk is not simply additive in their impact but youth in them, and that then magnifi es the poten- may, in fact, exponentially increase the probabil- tial for positive outcomes. Here, we see the ity of developmental diffi culties. Hence, to dis- opportunity for the compliment to “rotten out- cuss resilience in the face of poverty requires a comes cluster.” That is, where developmentally framework that both refl ects a full awareness of enhancing, compensatory settings are provided, the “nested” and variable nature of poverty and “strengths may magnify in reciprocal ways that may guide action for affecting resilience in between through transactions that enhance both the vastly different contexts and conditions that protective features of the context and individual may be associated with it. strengths of the inhabitants.” According to this perspective, it is the more As noted, consistent with the hypothesized proximal personÐenvironment transactions and ecologicalÐmediational linkages in the proposed developmental circumstances that defi ne the model, numerous prior investigations have estab- particular experience of poverty by a child or lished both: (a) associations between indices of adolescent. And, it is those immediate, day-to- household socioeconomic disadvantage and the day experiences that most directly shape the relatively more proximal experiences of children adaptation of youth and the developmental chal- and youth in primary developmental contexts, lenges that they confront (Abelev, 2009 ; Felner, including, but not limited to, heightened levels Farber, & Primavera, 1980, 1983 ) . Many of us of parentÐchild con fl ict, family disorganization, know people who have said that they, “…were negative experiences in school, and greater poor as a child, but did not know it. We didn’t degrees of exposure to both acute and potentially know it because there was always food, the same chronic stressors (Garmezy, 1983 ; Mash & house (housing stability), a safe place to play, Dozois, 2003 ; McLoyd, 1998 ; Sameroff & Fiese, and clean clothes.” But, for others who have 1989 ; Sameroff, Seifer, Barocas, Zax, & grown up in poverty the developmental contexts Greenspan, 1987 ) , and (b) associations between were far more harsh. indices of proximal environmental experiences in There are several important implications of many of these same domains and various aspects this view. First, conditions of social and economic of child and adolescent adjustment including, but 108 R.D. Felner and M.L. DeVries again not limited to, relative levels of self-esteem, disadvantage the de fi ning parameters are often symptoms relating to depression and anxiety, inconsistent, not well articulated, or embrace a behavioral problems in home and school con- broad spectrum of what even the most casual texts, and academic achievement (Cicchetti, observer would agree are quite different condi- Rappaport, Sandler, & Wessberg, 2000 ; DuBois, tions (cf. Featherman, Spenner, & Tsunematsu, Felner, Brand, Adan, & Evans, 1992 ; Felner, 1988 ; Proctor & Dalaker, 2003 ) . Of particular Aber, Primavera, & Cauce, 1985 ; Mash & Dozois, concern in the present work are distinctions 2003 ; Nolen-Hoeksema, Girgus, & Seligman, between economic forms of disadvantage and 1992 ; Rowlison & Felner, 1988 ) . those that cooccur and are frequently combined Findings from the relatively few studies which with economic circumstances to create a single have examined patterns of association among all index of socioeconomic status (e.g., educational three types of variables provide some support for disadvantage). When combined to create single distal-proximal-adjustment mediated pathways indicators of socioeconomic status the differen- (see McLoyd, 1990 , for an excellent review of tial relationships among various forms of disad- this literature). In her review, which focused on vantage and child and adolescent adaptation may the effects of economic hardship among African- be obscured. Consistent with this view, American families and children, she concluded Hollingshead ( 1975 ) , in revising his classic scale that there was support for the hypothesis that the for the assessment of socioeconomic status lev- socioemotional functioning of children living els, argued strongly for the need to attend to disin poor families is mediated by the effects of tinctions between occupational and educational poverty on proximal contextual conditions in dimensions of socioeconomic disadvantage. children’s lives, such as the psychological func- Relatedly, there is also a need to address the tioning of parents and levels of distress in family ways in which relative levels of advantage and dis- interaction patterns. Of particular note for a medi- advantage are defi ned. One area requiring greater ated pathways perspective are those studies which attention in this regard is the extent to which, have found that measures of relatively distal envi- within each form of disadvantage, quantitative ronmental factors no longer relate signi fi cantly to (i.e., continuous) vs. qualitative (i.e., discrete adjustment outcomes after their shared variance “level”) assessments may differentially shape our with key proximal conditions is removed. For understanding of the nature and magnitude of example, in reviews of the literature concerning patterns of association between socioeconomic conduct disturbances several authors have, over disadvantage and adjustment. In most prior work, the years (Hinshaw & Lee, 2003 ; Rutter, 1979 ) indices of socioeconomic status typically have been noted that in at least some studies the correlation represented through interval scales or continua. between social class and conduct disturbance was An implicit assumption of this approach is that either no longer evident, or far reduced, after con- there is an equivalent level of “distance” between trolling for measures of family discord and disor- each pair of adjacent scale points on the indices of ganization that were associated with social class socioeconomic status employed. As a result, quali- differences. tative and/or unequal differences in the adaptive In pursuing the line of inquiry outlined ear- implications among various status levels, which lier, the manner in which relative levels of socio- may be important for understanding linkages economic disadvantage have been assessed is between socioeconomic disadvantage and adjust- critical to understanding and interpreting any ment, have largely been ignored in this work. fi ndings. Although this would appear to be a Illustratively, on some indices of socioeconomic straightforward issue, a consideration of prior status the “distance” or number of scale points work shows that it is anything but clear cut (Allen separating a “middle-class” background and an & Mitchell, 1998 ; Flouri, Tzavidis, & Kallis, upper-class one is roughly equal to the distance 2010 ; McLoyd et al., 2009 ; Ruggles, 1992 ; between the former and a highly impoverished Wilson, 1996 ) . Instead, in studies of socioeconomic one (see, e.g., Hollingshead’s (1975 ) nine-point 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 109 scale Occupational Status Scale). Although in Youth from families where there was more some ways this may be true, in others, such as their serious economic hardship experienced more association with increased exposure to risk-related problematic parenting, felt less connected to stressors, there may be a far greater “distance” school, and had greater exposure to other major between poverty and middle class than between stressful events—themselves repeatedly docu- the upper two points of the scale. mented as relating to developmental negative Felner et al. ( 1995 ) conducted one of the most outcomes (Mrazek & Haggarty, 1994 ; Vazsonyi, extensive studies both sought to attend to the Pickering, & Bolland, 2006 ) . But, a marker of above issues and that investigated all three aspects family disadvantage that is combined with occu- of the proposed mediated pathway simultane- pational status to create an aggregate indicator of ously, for example, household disadvantage, socioeconomic status—parental education—had proximal environmental conditions, and child a notably different and more pervasive pattern of and adolescent adjustment. Among youth whose association with the proximal risk experiences of families were relatively economically or socially youth. Students from homes in which neither disadvantaged, those who were from homes in parent had graduated from high school experi- which adults were employed in low-income, enced more “across the board” developmentally unskilled occupations were found to have lower negative experiences, including higher levels of levels of school performance and achievement rejection from parents, less social support and compared to those from homes in which adults emphasis on intellectualÐcultural issues in their were employed in semiskilled or skilled/profes- families, more negative feelings about school, sional occupations. Further, youth from families and heightened levels of exposure to both major in which neither parent had graduated from high and relatively minor stressors. school exhibited signifi cantly poorer socioemo- These fi ndings suggest that levels of parental tional and academic adjustment than did those education may be related to relatively greater or whose parents had higher educational levels, lesser levels of resilience among students, as well independent of family income levels. Youth who as to other developmental conditions that, even lived in relatively more disadvantaged homes for children and youth who are not experiencing also reported more negative experiences of proxi- economic hardship, have been linked to resilience mal environmental conditions relating to family and/or disorder. and school contexts and greater exposure to Collectively, the studies discussed earlier stressful life events. Most critically for a perspec- provide support for view that the effects of tive that an ecologicalÐmediational perspective is household disadvantage on socioemotional important for understanding patterns of linkage adaptation are mediated by the developing between socioeconomic disadvantage and levels child’s experiences at school, in the neighbor- of adjustment were the fi ndings that proximal hood, and in the other primary developmental environmental experiences were signifi cant pre- contexts that defi ne their life space. It seems dictors of adolescent adjustment, independent of clear that at least part of the impact that condi- their shared variance with conditions of house- tions of social and economic disadvantage have hold disadvantage, whereas conditions of disad- on developmental outcomes is accounted for by vantage in several instances were no longer the ways in which these larger, more distal related signifi cantly to indices of adjustment once conditions, shape the more proximal environ- their association with proximal environmental mental experiences of individuals. They suggest conditions was taken into account. that, as we move toward attempting to build and One of the more intriguing aspects of their enhance resilience among youth in poverty, the fi ndings was that economic and educational approach must address the multiple ecologically forms of disadvantage had somewhat differential mediated pathways linking conditions of family patterns of association with indices of adjust- occupational and educational disadvantage to ment and proximal environmental experiences. poorer child and adolescent adjustment. 110 R.D. Felner and M.L. DeVries

addressed if these understandings are to be useful A Transactional–Ecological Frame for guiding action. These tasks are: for Understanding and Building 1. Assessment of the ways in which poverty is Resilience About Children and Youth associated with disruption in normal develop- Experiencing Poverty and mental processes and contexts. Disadvantage 2. Identi fi cation of the ways that poverty and its correlates shape and impact the nature of dis- Given the above understandings what is now ruptions and distortions in developmental required is a broader, systemic framework for processes. understanding and predicting the differential 3. Design and implementation of policies and emergence of resilience among children and interventions whose goals are to modify and youth from households and backgrounds charac- “correct” these disrupted processes until they terized by poverty and disadvantage, as well as closely approximate those that lead to healthy, for guiding actions that may be useful for making resilient, developmental outcomes. signifi cant gains in the face of conditions of risk Hence, this developmentally based approach that are so widespread. starts by identifying those processes and contex- A TransactionalÐEcological perspective is tual conditions that relate to “healthy” forms of best suited for explicating pathways to disorder the outcomes of concern (e.g., academic success that are congruent with tasks of understanding instead of academic failure) even in the face of and building strengths and resilient outcomes for other challenges (e.g., economic hardship). They in children and adolescents in poverty (Felner & then consider the ways in which the proximal Felner, 1989; Felner et al., 2000; Lorion, Price, & conditions experienced by those in poverty are Eaton, 1989 ; Sameroff & Fiese, 1989 ; Seidman, different from those that would be desirable. 1987 ) . If the impact of poverty is mediated Resilience building strategies are then aimed at through the conditions that defi ne the contexts closing this “gap” in the desired direction. and transactions that children and youth experi- Critically when thinking about what makes for ence, and with which they must cope, then a “resilience,” problematic outcomes are now seen framework that enables us to consider both the as predictable and even “normal” results of the relationships between individuals and those envi- deviations in developmental conditions since the ronments, and the ways in which those environ- mechanisms and processes that lead to problem- ments and their experience may interact with atic developmental outcomes are the same as each other, across contexts, is required. Research those that lead to positive ones. It is only the levels on developmental psychopathology and preven- and forms of these processes that differ when tive interventions suggests that the principles of problematic outcomes emerge. Thus, a guiding “healthy or normal” development central for assumption of a developmentally based model is understanding the emergence of disorder as well that any “healthy” child, youth, or adult, if exposed as resistance to disorder and dysfunction (Felner to the problematic developmental process of et al., 2000; Mash & Dozois, 2003; Sroufe & concern, is likely to show the similar problematic Rutter, 1984 ) . Here, the focus is on understand- outcomes. Conversely, actions to attain resilient ing normal developmental trajectories as they are outcomes require that the disruptions in the shaped by the interactions between the individual proximal contexts of children and youth that have and the primary contexts in which they grow, as resulted from economic hardship be addressed. well as understanding the ways that contextual Adopting this broad “developmental” approach conditions may “bend” those pathways to build is an important fi rst step. But clearly such a broad competencies or increase vulnerability. developmental perspective does not possess Applying this developmental view to the issue suf fi cient speci fi city concerning the conditions of resilience among those in poverty we can and processes that shape “resilience” and the identify a critical set of tasks that must be emergence of one specifi c set of outcomes over 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 111 another. To attain such specifi city we need greater exposed to the condition(s) of risk under precision and agreement in our de fi nitions of the consideration. If the conditional probabilities of central concepts that mark potential points for disorder in a population are ‘X,’ it is not that all intervention in developmental pathways to resil- members of that group posses ‘X’ levels of pre- ience or disorder. Of particular concern are the disposition or ‘riskness’ for disorder.” …A risk ways in which we defi ne risk, vulnerability, resil- designation is no more than an actuarial state- ience itself, protective conditions, and onset, as ment about the members of a selected group the failure to draw clear distinctions among these (Felner et al. ). As discussed, there is perhaps no concepts may lead to ambiguity and confusions more widespread and pervasive set of conditions that hamper the systematic accumulation of a of risk to which children and youth are exposed body of knowledge for guiding our understand- than poverty and disadvantage. Efforts to build ing of “why some kids do well when they resilience have, as one implicit, if not explicit shouldn’t” or, more scientifi cally, for reducing goal, a focus on addressing the probabilistic ways the marginal probability of the emergence of disin which conditions of risk (poverty and its cor- order in the fact of serious economic hardship relates) disrupt developmental processes in the and disadvantage. lives of all children and youth in a cohort. What is also important to understand in this discussion is that it now makes the widespread Understanding Developmental view that children or youth in poverty are “high Pathways to Resilience: Disentangling risk” is completely inappropriate. They have Vulnerability, Risk, Protective Factors, clearly been potentially exposed to relatively and Onset of Disorder or Maintaining greater levels of conditions of risk, and they may Positive Developmental Trajectories also be seen to be a population “at risk.” But they are not “high-risk” individuals. Unfortunately, As is discussed elsewhere in this volume, most the term “risk” has been frequently applied to perspectives on disorder or health start with a imply that all individuals in a “high-risk” group fundamental “diathesis-stress” perspective. This are somehow more fragile or vulnerable than all model holds that individuals may have either of those in lower risk groups. This is simply not genetically based or otherwise acquired vulnera- the case. Indeed, from a resilience perspective, bilities to the onset of disorder. These vulnerabil- depending on other developmental attributes ities are the diathesis side of the equation. They individuals may have acquired (see below) or “set” the person’s threshold of susceptibility to proximal environmental conditions in their homes environmental conditions (e.g., stress; disadvan- or schools, on an individual basis they may be far tage) or hazards (e.g., high levels of contextual less likely—and therefore less at risk—than cer- disorganization, restrictive opportunity struc- tain speci fi c youth not in poverty. tures, sharp changes in developmental demands; This conceptual slippage stems, at least in part other forms of danger) that may precipitate the from the practice of individual-level variables, onset of disorder. especially when aggregated for a population or What is important to understand is that, group, being spoken about as risk markers (c.f. although often misused and misapplied, the con- Catalano, Haggerty, Hawkins, & Elgin, 2011 ; cept of risk is defi ned epidemiologically (Felner Hawkins, Catalano, & Miller, 1992 ; Mrazek & et al., 2000 ) . It is “a conditional statement about Haggarty, 1994 ) . For example, children who are the probability that any member of a given popu- shy, who show signs of behavioral problems in lation or subpopulation will develop later disor- the classroom, or who have reading/learning der. Often overlooked in discussions of risk is problems are often designated “at risk.” So, as a that the designation of being a member of an fi rst step to differentiating among critical elements ‘at risk’ group says little about any specifi c mem- of pathways to resilience for children/youth in ber of that group other than that they have been poverty it is important to avoid this terminology 112 R.D. Felner and M.L. DeVries creep and be clear that actuarial statements can- as individual-level risk conditions or as early not be made about particular individuals. signs of “onset ” of speci fi c disorders . As we move to understanding risk for those The levels of acquired competencies, strengths, exposed to poverty and disadvantage there are and vulnerabilities all infl uence the probability several corollaries of our de fi nition of risk that that an individual will be resilient in the face of are important. First, conditions of risk are pri- the experience of the more problematic contex- marily environmental in nature—disadvantage tual or conditions of risk that frequently de fi nes and poverty, as well as proximal disruptions in the developmental conditions that surround chil- developmental contexts clearly fall into this dren and youth whose families lack in economic category. This is not to say that being part of a resources. But, as we have seen, they are not population group that may have some genetic markers of individual risk nor are they typically risk characteristics would also qualify, so long as direct and inevitable markers of the onset of dis- we remember we are talking about a population- order. We must pause here to also note that to talk level attribute. about building resiliencies in individuals also Second, and critically for understanding the muddies these concepts. Resilience , in a popula- nature and emergence of resilience for children tion level framework , is an outcome , de fi ned by a and youth in poverty—such environmental con- person or population’s response to challenge and ditions can have two quite distinct roles—as pre- stress. Discussions of building “resiliencies” lose disposing conditions and as precipitating/ this essential de fi ning element and obscure compensatory conditions. When environmental important differences between such outcomes conditions act in a predisposing (or risk enhanc- and aspects of developmental pathways that pro- ing) fashion, vulnerabilities, which in our duce them. What is “built” or acquired are defi nition are always person-level variables, are strengths, vulnerabilities are acquired or avoided, acquired. This acquisition may result either from and environmental resources and stressors inter- problematic interactions with environmental act with those in very speci fi c ways so that even conditions that are present or the lack of expo- should a vulnerability be acquired, without exposure to important developmentally promoting sure to triggering conditions, no diffi culties may conditions and resources. For example, poor emerge. In this instance, resilience simply results early parentÐchild interactions may lead to the from the child avoiding exposure to certain development of vulnerabilities and delays in a developmental demands, even though heightened number of areas of child functioning. vulnerability levels have been acquired. Indeed, Strengths and personal competencies may also put this way, primary development contexts that be acquired from positive, more proximal and are resistant to being disrupted by poverty may primary developmental contexts and are again themselves be resilient, that is, have or maintain person-level variables. In keeping with the medi- positive developmental functioning in the face of ational model discussed earlier, one way of serious risk and challenge. enhancing resilience then is by supporting or Let us explore these issues a bit further. enhancing the ability of proximal conditions Environmental circumstances are now seen as (family patterns, opportunity-to-learn conditions potentially acting as precipitating or protective in schools) to withstand the frequent negative conditions, rather than simply predisposing ones. impacts that may result from a lack of economic They can interact with existing , previously acquired, resources and the stresses or paucity of resources vulnerabilities and competencies to trigger the that may accompany such economic hardships. onset of more serious dysfunction. Similarly, pro- Failure to accurately understand that these tective conditions in proximal environments and person-level characteristics are, in fact, “ fi rst- developmental contexts may act in a compensatory order” developmental outcomes (i.e., acquired fashion, reducing the likelihood that existing vulnerabilities and competencies/strengths) has, vulnerabilities will be “activated” when the child in the past, led to their being incorrectly labeled experiences conditions of risk. 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 113

Implicit in this view of unfolding pathways to on the above understandings of developmental disorder is that exposure to conditions of risk or pathways makes it far more possible to obtain the acquisition of vulnerabilities does not inevita- relatively rapid assessments of the degree to bly lead to the onset of disorder (see Fig. 7.1 ). which the program or policies, and their effects Neither does exposure to protective factors nor are “on course” and are likely to have the desired the acquisition of competencies always result in long-term effects. This can be done by assessing health and resilience. Rather, these are the sequen- the degree to which the initiative has produced tial, dynamically interactive elements of develop- changes in the desired directions in key condi- mental trajectories to dysfunction and well-being tions that are earlier in the developmental path- (Felner et al., 2000 ). And it is these elements of way, even when they are far distant from the time the developmental trajectory that are the appropri- when we might expect the onset of dysfunction. ate direct targets for change for efforts that seek to They also help us to better understand the levels enhance resilience and prevent disorder. Framed of change and program required to obtain the this way, resilience enhancement efforts for chil- desired effects. dren and youth whose lives are characterized by For example, our fi rst assessments of program poverty and disadvantage should include focused impact would focus on the degree to which levels strategies that (1) seek to reduce levels of condi- of risk have been reduced and levels of enhancing tions of risk or increase levels of protective fac- conditions increased. Next, we would assess the tors; (2) directly, or indirectly through the previous degree to which the incidence and prevalence of step, reduce the incidence rates of person-level vulnerabilities and competencies in the popula- vulnerabilities or the enhancement of personal tion have been changed. Finally, as population competencies and strengths; and (3) alter levels of members experience identi fi able conditions that conditions of risk and of protective factors that have been shown to have a high likelihood to act have been shown to interact with acquired vulner- as precipitants (e.g., school transitions; being abilities and strengths to trigger the onset of more approached by gangs) and/or moves through serious disorder or to produce resilience in the developmental periods when maximum onsets face of serious challenge. are expected, we would examine differential rates This conceptualization of developmental path- of the occurrence of adaptive diffi culties in order ways has direct implications for the evaluation of to assess the levels of resilience obtained. But, it resilience-focused initiatives. The initial assess- is also the case that when we have clearly ments of the effi cacy of such efforts may take identifi ed increased levels of strengths/reductions place far sooner than is often thought to be pos- of vulnerabilities (e.g., marked increases in the sible. Illustratively, for some efforts that seek to reading skills and levels of children in poverty enhance the resilience of children as the move and reductions in “equity gaps”) we would have through life it may be a number of years before clear evidence for the probability of having the primary conditions and disorders we seek to enhanced resilience in the population group impact are likely to develop. A perspective based (those in poverty) across the life span.

Mediating Conditions

Let us now revisit the issue of mediating conditions and mediated pathways as they ﬁ t within the current framework, so that we may link this perspective back to the initial studies we presented. Mediating conditions can now be seen Fig. 7.1 Felner risk/protective factors acquired vulnera- to be a subset of the conditions of risk we have bility/strength and competencies resilience/disorder discussed earlier. They are those proximal 114 R.D. Felner and M.L. DeVries

circumstances in the child’s developmental economic and not a psychological variable. Its contexts that most directly shape daily experi- implication for developmental outcomes lies in ences. For example, when children experience its association with the ways these economic “poverty” it is, as we have seen, the associated conditions relate to altered societal, commu- changes in the conditions of the child’s life that nity, material, and psychological conditions of are actually responsible for the impacts that have risk that mediates or translate the economic been observed. For example, within families, conditions to direct daily experiences (Felner, poverty and economic scarcity are often associ- 1992, 2000 ) . Based on epidemiological data we ated with negative changes in parenting patterns, can predict, with a high degree of certainty that parental depression, and intra-parental confl ict— children in economically distressed neighbor- conditions that have, themselves, been found to hoods (here the neighborhood variable further be frequently associated with multiple, comor- defi nes the nature of the poverty and disadvan- bid, and complex patterns of developmental tage with which the efforts will be concerned) diffi culties. From this perspective, poverty, will be exposed to substandard schooling, high disadvantage, and their correlates are seen as levels of environmental stresses, a paucity of markers of the potentially higher levels of these local conditions that lead to high expectations more proximal changes and mediating conditions and aspirations, and literally dozens of other in the person’s developmental context (Evans, negative mediators (Mrug & Windle, 2009 ; Eckenrode, & Marcynszyn, 2010 ; Felner et al., Wilson, 1987 ) . 1983 ) . In the model we have proposed in the cur- Efforts that address these and other risk or rent chapter, the direct focus of resilience build- developmentally promoting conditions, for all ing interventions would be on reducing the levels children living in such neighborhoods, will be far of these negative mediators (conditions of risk) as more cost effective and effi cient in reaching our experienced by the entire population. target group than would screening-based efforts that seek to target only some children and families (Felner, 1992, 2000; Felner et al., 2000 ) . Implications for the Nature and Illustratively, to screen all of the children in just Targeting of Resilience Enhancement- one public housing community in a city like Focused Programming and Policies Chicago for the presence of conditions that may mediate the development of problem social and Let us now consider the implications of the above emotional outcomes would be incredibly costly. framework to the targeting and appropriate shape It would almost certainly require all of the funds of programmatic efforts that seek to enhance resil- that are available for conducting the intervention. ience among those children and youth who live in Instead, interventions that target mediators that poverty. The fi rst implications are that an approach have a high probability of being of concern for that is based on individual screenings is neither the entire population would be far more cost advisable nor required to as we seek to identify effective and reduce the marginal probabilities of appropriate target populations for resilience disorder across the population group while build- enhancing efforts. Instead, we can employ epide- ing important strengths that further facilitate the miological data to focus accurately on entire popu- ability to deal with the range of challenges that lations whose members have a high probability of stem from economic and neighborhood disad- both experiencing the critical mediators and for vantage. For example, the intervention might be identifying the speci fi c vulnerabilities and strengths provided to all children and families strong pre- that may be the appropriate fi rst-order outcomes school programs, high quality educational envi- on which the programmatic efforts should focus to ronments, efforts to enhance the safety of the enhance resilience in that population. neighborhoods, and/or the modifi cation removal To this point we have built an argument that, of policies that create disincentives for family as Lamb ( 1992 ) has noted, poverty is an success, or that create barriers to access to quality 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 115 employment opportunities. Put otherwise, more 2 resilient outcomes. Interventions will thus decades ago, Zigler (1990 ) succinctly summa- involve systematic actions aimed at modifying rized the prospects and problems of early inter- the reciprocal and interactive in fl uences of convention programs and underscored the importance ditions of risk, strengths, vulnerabilities, and of efforts that target entire contexts by noting, resources, in shaping trajectories to the develop- “No amount of counseling, early childhood cur- mental outcomes of concern (c.f. Fig. 7.1 ). ricula, or home visits will ever take the place of Given these understandings about those jobs that provide decent incomes, affordable aspects of developmental pathways that are the housing, appropriate health care, optimal family direct and indirect, intermediate, targets of confi gurations, or integrated neighborhoods change, we turn to the question of “what are the where children encounter positive role models” appropriate long-term goals of resilience build- (p. xiii). For example, the New Hope intervention ing interventions?” The answer we select for this program which provided wage supplements, question is critical as it defi nes those specifi c work supports, and child-care and health insur- conditions earlier in developmental pathways ance subsidies to a low income working adults with which we will be concerned. It is to these has been shown to affect children directly, boys concerns that we now turn . in particular in this case, by increasing parents sense of control and confi dence in their ability to protect their children, and by reducing their stress Targeting Resilience Enhancing levels and use of discipline (Epps & Hutson, Efforts for Children and Youth in 2007 ) . Poverty: Issues of Outcome Speci fi city and Pathways to Disorder Outcome Specifi city Summary Elsewhere in this volume several authors raise In the model we have proposed thus far, the fi rst- the questions and issues of the appropriate level order, direct, or “immediate” targets of change in of the specifi city of the “targeting” of develop- resilience enhancement efforts will typically be mental dif fi culties. Some of the approaches in nonindividual level elements of developmental those chapters have focused on broad approaches trajectories to adaptation and disorder. Strategies to the enhancement of resilience, while others will focus on direct efforts to increase or decrease, have discussed more focused concerns, such as as appropriate, the levels of conditions of risk, issues of resilience as they relate to delinquency, protective factors, and developmentally enhanc- depression, self-control, and learning disabilities. ing experiences to which a population is exposed. In considering the question of what are the appro- Changes in levels of these fi rst-order elements of priate goals of resilience efforts for children and the developmental pathways of populations will, youth in poverty, we now turn to the issue of in turn, radiate to impact the degree to which whether programmatic efforts should have as second-order changes are accomplished. These their goal(s) the reduction of highly speci fi c dis- second-order elements of developmental path- orders or whether, at least when the issue of pov- ways should show changes, in desired directions, erty serves as the focal condition of risk, our relatively soon after attainment of the fi rst-order efforts should be focused on broad-based and changes. These “early intermediate outcomes” multiple outcomes. provide preliminary evidence that the strategy is Historically, a major dimension on which most on course for being effective in achieving its efforts to enhance resilience and resistance to risk, long-term goals. Second-order targets of change or prevent disorder, refl ects two quite different in developmental pathways include levels of assumptions about the specifi city and uniqueness acquired vulnerabilities as well as strengths and of developmental pathways. Single outcome competencies that may be required to attain focused programs, such as those targeted to 116 R.D. Felner and M.L. DeVries

substance abuse, delinquency, school failure, and an array of nonspeci fi c protective resiliency depression, teen suicide, and teen pregnancy factors (e.g., social support, sense of self-effi cacy, re fl ect a speci fi c disease / disorder pathway model hope) that all relate to the probability that persons that rests heavily on classic medical paradigms of in a population will develop an extraordinary disorder. These paradigms hold that dysfunction assortment of mental and physical disorders is caused by specifi able defi cits, disease agents, or (Allen & Mitchell, 1998 ; Mrazek & Haggarty, predispositions that interact with individual vul- 1994 ; O’Connell, Boat, & Warner, 2009 ; Sameroff nerabilities that can also be specifi ed. & Fiese, 1989 ; Silverman, 1989 ). Converging A contrasting perspective to this position is with this developmental evidence, the data on the one that holds that there is a need for a compre- epidemiology of serious disorders (Allen & hensive, multicausal and nonspecifi c develop- Mitchell, 1998 ; Mrazek & Haggarty, 1994 ; mental pathways/ root causes focused approach O’Connell et al., 2009 ) have also pointed to the (c.f. Felner & Felner, 1989 ; Mrazek & Haggarty, high levels of comorbidity among these more 1994 ) . This model recognizes that (1) most of severe instances and further underscored the fact the disorders we seek to prevent have a large that they appear to share a common constellation number of common risk factors; (2) that condi- of antecedent developmental experiences and tions that protect against one disorder generally root causes in their emergent pathways. also protect against many others; and (3) that The nonlinear and overlapping nature of path- there are nonspecifi c personal vulnerabilities that ways to disorder, particularly among those who increase a person’s susceptibility to the onset of may be exposed to a wide array of developmen- a wide array of dysfunction. The pathways to tal circumstances that are problematic such as most of the social, emotional, and adaptive those in poverty, is further underscored by a third diffi culties with which we are concerned are set of studies on the stability of the developmen- generally complex and shared by more than one tal course of such diffi culties (Cantwell & Baker, disorder. Hence, for a wide range of develop- 1989). Summarizing the early fi ndings pertain- mental outcomes and sociopathologies it appears ing to high levels of comorbidity of disorder, that efforts to identify speci fi c and unique etio- Rutter ( 1989) concluded, “Perhaps the most logical “causal” agents are not appropriate. striking fi nding to emerge from all developmen- For children and youth in poverty, given the tal epidemiological studies … has been the wide array of different elements of the develop- extremely high levels of comorbidity” (p.645). mental pathway that poverty may impact, and These fi ndings have only been reinforced in sub- that the condition of risk here is entirely outside sequent years, including major studies by such the control of individual, comprehensive, broadly groups as the Institute of Medicine (Mrazek & targeted approaches are clearly the most appro- Haggarty, 1994 ; O’Connell et al., 2009 ) . priate. Further, recent research from a number of Similarly, in discussing commonalities across converging research traditions shows the poten- root causes and the need to consider broadly tial ef fi cacy of such an approach to a population focused prevention approaches rather than that that has heightened probability of the onset of a focus on specifi c outcomes, Sameroff and Fiese broad array of disorder and dysfunction, that is so ( 1989) state that, “Whereas clear linkages have large, and that has such a broad set of potential been found between some ‘germs’ and speci fi c disruptions in the proximal, mediating contexts biological disorders, this has not been true for that defi ne the developmental experiences of the behavioral disorders….” (p.24). Less technically, focal population. Studies of the adaptive impact but more succinctly, Lisbeth Schorr ( 1988) has, of a wide array of developmental circumstances as noted, summarized the interconnectedness have shown that there are common develop- among social problems by noting that “Rotten mental antecedents, such as family resources outcomes cluster,” and that children from high- and interaction patterns, economic and social risk environments [such as severe, pervasive, deprivation, other life stresses, powerlessness, and/or dense poverty neighborhoods] encounter 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 117 developmental experiences that are so severe as The Transactional Model has been articulated to increase the rates of morbidity they will by Sameroff and Chandler ( 1975 ) and Sameroff develop across the full spectrum of human social, and Fiese (1989 ) as a guide for efforts to enhance emotional, and health problems. the developmental outcomes of children and To this point we have emphasized in our youth preventive efforts. The model emphasizes discussions sets of interrelated but still discreet the dynamic, reciprocal inter actions between issues and understandings that need to be woven the individual and their context, with bidirec- together for a more complete conceptual frame- tional infl uence being a fundamental element work to guide the enhancement of resilience in (Sarason & Doris, 1979 ) . For example, the the face of the multiple risks and challenge con- interactions between an infant and their parent, fronted by children and you in poverty. We now or between a youth and her peers, are thought to turn to a brief discussion of the application to be a result of the child’s infl uence on the parent this task of an integrative theoretical framework or group, and the reciprocal effect of the envi- that we have proposed for this purpose (Felner ronmental infl uence on the child. et al., 2000 ) that allows us to accomplish this A transactional perspective has, as its focal weaving. It is to a presentation of that framework targets for change, key developmental processes we turn next. that lead to strengths or disorder. But it is not suf fi cient for addressing the full range of conditions that must be considered by interventions Transactional–Ecological Models when the concern is the developmental course of for Prevention children and youth living in poverty. The transactional model is still, at best, dyadic. It can only The Transactional Ð Ecological model is a frame- deal with those proximal environments in which work that Felner and his colleagues (Felner et al., the person directly participates—and many of the 2001; Felner & Felner, 1989; Felner, Silverman, contexts that impact the life of children in pov- & Adan, 1992; Felner, Silverman, & Adix, 1991 ) erty, and others, extend well beyond their direct have both re fi ned and demonstrated its utility for experience. Further, since the transactional model guiding interventions and policy, over the past always views the sources of infl uence as bidirec- several decades, particularly as it applies to pre- tional (Sarason & Doris, 1979 ) , there are some vention, promotion, and resilience enhancement. proximal contexts on which individual behavior Other authors have also made important contri- has little infl uence (e.g., schools) for which it is butions to the model (c.f., Seidman, 1987, 1990 ) . not well suited for providing directions for inter- Felner (2000 ) has argued that the framework convention. To address these limitations and provide tains critical features for guiding strategies that for a comprehensive model of prevention, the have the necessary levels of comprehensiveness author of this chapter and his colleagues as well to address the range of issues raised earlier, while as others (Felner et al., 1992, 2000, 2001 ; Felner also providing for the degree of speci fi city & Felner, 1989 ; Seidman, 1987, 1990 ) have required for interventions that meet the test of advocated for the joining of an ecological model intentionality (Cowen, 2000 ). of development (Barker, 1968 ; Bronfennbrenner, This TransactionalÐEcological (T Ð E ) model 1979 ; Lewin, 1951 ) to the transactional one. obtains from a conceptual synthesis of two Combining the ecological and transactional other highly complementary frameworks, the perspectives to create a Transactional Ð Ecological transactional (c.f. Sameroff & Fiese, 1989 ) and ( T Ð E ) model broadens the focus of each in impor- ecological (c.f. Bronfennbrenner, 1979 ) models tant ways. Consistent with transactional perspec- of development. Full discussion of each of these tives, an ecological view holds that developmental approaches is beyond the parameters of this trajectories are shaped by, “Progressive, mutual chapter. But let us attempt to capture the key fea- accommodation between an active, growing tures of each for the issues of concern here. human being and the changing properties of the 118 R.D. Felner and M.L. DeVries settings in which the developing person lives” impact. These conditions may occur at several (Bronfennbrenner, 1979 , p.21). The ecological different system levels. The smallest system level framework also provides for the consideration of of this type is what have been termed microsys- additional elements of human contexts. It offers a tems (Bronfennbrenner, 1979 ) or immediate set- comprehensive and integrative means of viewing tings-level contexts. These systems are the the interactions between the various parts of total primary developmental contexts in which people ecological and psychological systems, not just live. They include such contexts as schools, reli- between individuals and their proximal environ- gious congregations, the family, the worksite, and ments. In particular, this perspective allows for peer groups. The regularities of these settings the consideration of infl uences that shape the may be only in fl uenced slowly, if at all, by the dynamic relationships between systems and the dyadic interactions that take place within them. ways in which being part of these multiple sys- For example, the overwhelming fl ux and disorga- tems in fl uence human development. Given the nization that accompanies the transition to a high breadth of the impact of poverty, typically both school “fed” by multiple middle schools is a con- on all or most of the systems in which the child dition that may seriously disrupt many of the may participate directly and on those in which dyadic patterns that are taking place within the their parents/primary caregivers function, a per- school and peer groups (De Wit, Karioja, & Rye, spective that considers the reciprocal infl uences 2010 ; Felner & Adan, 1988 ; Felner, Ginter, & of proximal systems across both the individuals Primavera, 1982) . Similarly, the social regulari- who inhabit them and on each other is critical to ties of a school or workplace, its resource pat- fully appreciating the challenges and outcomes terns, and other formal system regularities may that are confronted by youth in poverty and in go far to shape the nature of the interpersonal these systems. interactions that take place within it (Sarason, There are at least three important ways in 1982, 1996) . But, in neither case will the dyadic which the synthesis of ecological and transac- interactions rapidly nor necessarily impact the tional models enables us to address these con- system regularities that are shaping them. cerns. First, it enables us to consider the etiological At the level of macrosystems (i.e. , social struc- signifi cance of conditions with which the child tural conditions and regularities) (Bronfennbrenner, comes into direct contact, but on which their 1979) , the individual’s behavior often has little behavior does not have a signi fi cant bidirectional effect. But, with more proximal settings (micro- in fl uence. Included in this category of conditions systems), these conditions have signifi cant adap- are such “social structural conditions” as the den- tive implications for individual behavior, both sity and distribution of poverty and social disad- directly and through their impact on the other vantage (Iceland, 2006 ; Jencks & Perterson, system relationships that a person experiences. 1991 ; Schorr, 1988 ; Wilson, 1987 ) , shifting eco- For example, when considering the defi nition of a nomic conditions that infl uence both the progno- resilient outcome for those in poverty it is impor- sis of poverty and motivation (Halperin, 1998 ; tant to understand that shifts in macrosystemic Judy & D’Amico, 1997 ; W.T. Grant Foundation, conditions have both “raised the bar” both about 1988 ) and the regularities or structures of such what is expected, and shifted the value of what primary developmental contexts as schools was, in the past, a motivating goal with clear (Sarason, 1982, 1996 ) . rewards associated with it. Illustratively, due to Of particular interest for the current chapter is societal changes the earning potential of a high that this level allows us to consider those system- school graduate has dropped more than 40% in the wide conditions that distort, in pathogenic ways, decades between 1970 and 1990 and has contin- all of the dyadic transactions that take place ued to decline (Halperin, 1998 ; Judy & D’Amico, within their reach. Clearly poverty, particularly 1997; National Academy of Science, 2010 ; when dense and persistent, is one of those W.T. Grant Foundation, 1988 ) . This is a structural systemwide conditions with such pervasive condition over which the individual has little 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 119

control. But this shift may have profound effects individuals and each other is perhaps even more both on the nature of those behaviors students view important than it is for adults, who may at least as adaptive. When this condition is coupled, for more easily “opt out” of settings that are poor example, with others that indicate to youth that matches for the other in their lives. they have little hope for attending college—even if These mesosystemic relationships also add to they complete high school—this fundamental shift our understanding of pathways to resilience and in the economic meaning of graduation may make efforts to enhance it. They bring attention to con- alternative, societally undesirable behaviors, such ditions that surround resilience promoting efforts as early school leaving, early parenthood, and/or that may play a limiting role in the impact of such involvement in illicit activities to earn money, efforts and, if not adequately considered, may appear to be intelligent and attractive choices. lead to false conclusions that a program effort, or A second enhancement for efforts to under- the building of a particular set of skills that is rel- stand and promote resilience in children and evant to resilience is ineffective when, in fact, it adolescents that derives from joining ecological is a necessary but not a suf fi cient element of a views to transactional ones is that this synthesis more complete resilience development strategy. allows for consideration of the ways in which There are a number of instances where this interactions between individuals and any specifi c may occur. Illustratively, the impact of a resil- setting are in fl uenced by differences and simi- ience-focused emotional and social/behavioral larities between that setting and others that make problem-solving skill building curriculum will up their life context (i.e., it allows for consider- certainly be attenuated if the school context in ation of cross-contextual effects). Such relation- which it takes place does not also provide ade- ships between microsystems have been labeled quate academic experiences to enable the students mesosystems (Bronfennbrenner, 1979 ) . The need to develop necessary skills in these critical aca- to consider transcontextual infl uences rests on demic areas. Even with the best decision-making the understanding that persons have a number of skills, and the motivation to make prosocial deci- primary settings which comprise the ecological sions, outcomes will be limited if the student is map of their life context. Each of these settings unable to read. Likewise, parent training programs has unique demands that shape the nature of the for parents who have few economic resources transactions required by them. The solutions, may enable parents to gain important knowledge skills, and abilities required by one context may, and skills, but, the degree to which they apply this when applied in other settings, be complimen- new knowledge in their interactions with children tary, antagonistic, and/or irrelevant. Illustratively, may be infl uenced by conditions in other systems for students in poverty, the skills and interaction in their lives. If they are experiencing severe stress styles required to be adaptive in an inner-city from economic hardship, or concerned over the environment where safety may be an issue, when adequacy and safety of the school, they may not applied to a school setting, be maladaptive or be as likely to use those new skills at the requisite irrelevant. Such conditions may result in chil- levels of quality and intensity. As the most highly dren from inner-city environments being misla- trained developmental psychologists can tell you, beled as lacking in social competence or other when it has been a “bad day” outside the home, abilities when, in fact, the actual problem is not the quality of their parenting may be sharply that these children are defi cient; rather, there is a diminished. Such “bad days” are, unfortunately, poor match in the skills required among the the stark day-to-day reality for parents with few different developmental contexts that make up economic resources, those in negative job sur- their lives. For children and adolescents, who roundings, those in poverty, and other groups with often have little ability to impact or select the chronic stressors. These conditions will all cer- primary settings that defi ne their lives, under- tainly reduce the degree to which newly acquired standing the dynamics among those settings as parenting skills are translated to action. Thus, an they act reciprocally to shape both adaptation of ecological analysis of the interrelated systems of 120 R.D. Felner and M.L. DeVries the lives of those we seek to impact is critical for acquisition of important strengths and reducing ensuring that change efforts are adequately com- the acquisition of vulnerabilities that may have prehensive and that research on them does not resulted in the case of more problematic family lead to the incorrect conclusion that intervention functioning. elements which may be necessary, but not To brie fl y summarize, joining an ecological suf fi cient, do not have utility for the building of perspective to a transactional one to create a TÐE resilience. model expands our focus to include the ways in Third, a comprehensive model for understand- which person-setting interactions are impacted by ing the adaptation and resilience of children and relationships between settings, as well as the youth must provide for consideration of the broader, macrosystemic contexts in which they impact of settings on individuals with which they may be nested. Equal weight is given to under- do not come into direct contact. Again, this is standing dyadic transactions and to the analysis of particularly important for children and youth who the impact of and interactions among various set- caregivers, throughout the day, are often parts of tings, mesosystems, and macrosystems that may systems in which the child does not participate at signifi cantly infl uence developmental pathways. all but which may shape the transactions of those There is an important corollary of the above caregivers with the child (e.g., parental work- features of the TÐE model that makes it particu- places; social welfare offi ces; teacher unions). larly useful for providing a more fully contextu- Bronfenbrenner (1979 ) has referred to these as alized de fi nition of resilience than might exosystems . Illustratively, a child may never have otherwise be developed. That is, the TÐE model direct contact with the neighborhoods and condi- affords us the ability to view the defi nition of tions in which their parents or grandparents were resilience as one that must be considered, and raised, or with the workplaces of their parents. often can only be understood, in context. Some But traumas suffered in these earlier develop- behaviors and outcomes that we would seek to mental contexts (Garbarino, 1990 ) , values learned reduce or promote do not require the assump- in them (Sarason, 1982) , or conditions within the tion that there are defi cits or defect in the per- workplaces must all be part of a broader analysis sons/population targeted—a core factor in of in fl uences that contribute to the nature of the victim blaming and disorder-focused approaches parentÐchild interactions that occur. And, of to interventions. The TÐE framework allows us course, for those in children living in poverty, the to consider the ways in which the target “disor- likelihood that those caring for them are experi- ders” may, in fact, be adaptive solutions to con- encing stressful or even problematic interactions textual conditions that are disordered or at least elsewhere in the settings that defi ne their lives is incongruent with broader societal expectations clearly elevated (e.g., high stress levels; high lev- and demand . Hence, an important understand- els of job instability and underemployment; ing here is that acquired strengths that might dif fi cult, exhausting work). These setting level enable a child to be resilient in a dysfunctional regularities would then be directly targeted by or problematic context—for example, where introducing systemwide conditions (e.g., on-site, peer values and rewards may be at odds with child care centers that promote parent involve- those of the broader society requirements—may ment; linking parents to appropriate employment well be, in those other contexts (those same opportunities) that reduce workers’ stresses and strengths are) vulnerabilities that lead to a lack enhance well-being and family support of resilience. By utilizing the lens of a TÐE resources—thereby enhancing the resilience of perspective, many of the target conditions with children and youth in poverty without ever which we are concerned can be seen to be the directly engaging them. These changes would result of highly appropriate and adaptive efforts also be expected to radiate to the family/micro- in disordered or alternative contexts. That is, system level interactions of all workers in the set- “what might appear to be deviant outcomes may ting for enhancing the probability or the be those that any healthy child would exhibit in 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 121 the environments and systems that de fi ne their (Moynihan, 1986 ) . These conditions may have lives … what might have been seen as disorder led welfare recipients to behave in ways that soci- or disease may be better understood as a result ety viewed as inappropriate (e.g., not saving; not of the child’s appropriate, predictable, and seeking employment). Instead, the recipients highly adaptive attempts to adjust to contexts were actually showing intelligent and adaptive and conditions that require responses which are problem solutions in the face of disordered con- incompatible with those in other contexts in textual demands. To avoid the confusion that which they live.” That is, … what might have places the locus of such diffi culties inside the been seen as a disorder or disease may be better person, particularly when dealing with individu- understood as the child’s appropriate, predict- als in communities where dense poverty and a able, and highly adaptive attempts to adjust to lack of positive employment opportunities are contexts and conditions [that are developmen- pervasive, we might better refer to these and other tally inappropriate or disordered] (Felner & positive adaptations to disordered contexts—that Felner, 1989 , p. 21). are dysfunctional in later or other developmental Applying this view to understanding and settings—as “socio ” pathology rather than psy- defi ning resilience and children’s efforts to adapt chopathology, with the latter’s inherent individual in the contexts of poverty, the fi rst, fundamental focus. This view further sharpens our focus on questions that must be asked are: “In what ways the characteristics of contexts that systematically were the conditions and adaptive patterns distort normal developmental pathways to pro- (e.g., behavior, belief system, etc.) that we wish to duce what appears to be a deviant outcome—but modify adaptive at the time they developed?” and, which are, in fact, better understood as positive, “Are there factors that are associated with poverty resilient, and often highly adaptive efforts to dys- or its correlates in the contexts of the child’s life functional contexts when considered in their full that make the interaction patterns, or the lack of ecologicalÐdevelopmental context. them, continue to be adaptive?” A basic assumption of this model is that any adaptive pattern — however problematic —originated as an attempt to Creating Resilience Enhancing positively adapt to conditions that existed at the Contexts time . Given this assumption, efforts to understand or change any developmental pathway or outcome As should be clear from our discussion, broad- cannot take place independent of a consideration based, population-level programs are those that of the full set of historical, familial, economic, hold the most promise for being adequate to the social, and political contexts that provide meaning challenge of addressing the levels of need and the to a person’s life experiences. And, as is clear, for forms of adaptive challenges confronted by chil- children and youth in poverty, particularly when dren and youth in poverty. It is also the case that coupled with racial or ethnic disadvantage, such such resilience developing approaches may be consideration in the understanding of resilience well served by shifting their attention to, or at and its enhancement are essential. Such an least making certain to include in their design, approach will allow us to see that many of the strategies and programmatic elements that impact behaviors or interaction patterns we may have the contexts in which children and youth in viewed as “not resilient” actually re fl ect high levels poverty grow, even if those contexts never directly of resilience as they were simply intelligent, effec- engage the children. Indeed, a failure to attend to tive attempts at adaptive solutions to disordered modifying these contexts, in ways that “natu- contexts. rally” build strengths and help youth avoid the Illustratively, in the case of families in pov- acquisition of vulnerabilities, may limit the erty, until recently social welfare policies often ef fi cacy of any efforts that focus more directly on punished recipients for earning income, acquir- skill building or other individual-level enhance- ing savings, and attempting to accumulate equity ment approaches. 122 R.D. Felner and M.L. DeVries

The most promising of these initiatives are families in poverty and economically disadvan- those that seek to understand the ways in which taged neighborhoods and communities, compre- elements of the school, community, peer, or home hensive efforts that target changes throughout the environment may be structured or reorganized to context are not only advisable but necessary for improve their match to the developmental needs almost any more individually focused efforts to and competencies of the populations that inhabit be viable. Parents who are concerned about their them, as well as to increase the degree of congru- children cannot and will not go to work or to ence in the developmental demands and expecta- obtain additional education if it means leaving tions across the multiple settings inhabited by their children without adequate adult supervision children in poverty. Such approaches promise to and support in high-risk neighborhoods. Hence, build resilience in a comprehensive and highly although clearly not typically thought of as impactful way and to more full re fl ect the recom- enhancing resilience, initiatives that provide child mendations of the Institute of Medicine that state, care may act to do so both directly, through their “… The ultimate goal to achieve optimal preven- impact on the children who participate, but also tion should be to build the principles of preven- indirectly, through the profound effects that such tion into the ordinary activities of everyday life access may have on the lives of the parents of and into community structures to enhance devel- children in poverty. Indeed, it is important to opment over the entire life span.” Marazk & understand that social programs and polices that Haggarty, IOM, pp.298Ð299, p.323. require parents to go to work or pursue training To correct this overly narrow view of resil- without providing for high-quality child care are, ience and its development, particularly if we are in fact, asking parents to engage in what may to deal with the enormity of the task of dealing well be chargeable neglect. These are precisely with the epidemic levels of disorder and failure the kinds of problematic policies that may emerge associated with poverty, what must be recognized without suffi cient attention to the way in which is that legitimate efforts will include a focus on what appear to be dysfunctional behaviors are, in changes in social and educational policies and fact, found to be adaptive ones when contextual programming that increases the developmental regularities are considered. Indeed, given the appropriateness and resources, and reduce the changing nature of society quality child care and conditions of risk, in all signifi cant human con- afterschool programming that provides both texts. School and welfare reform and transforma- supervision as well as social and educational tion efforts; restructuring of work sites to increase development aspects may be one of the most worker participation, satisfaction, access, and powerful setting-level interventions that may be productivity; community development efforts to mounted, for all families, under the “fl ag” of change opportunity structures, safety, sense of resilience enhancement and the promotion of community, and resource patterns for families; positive outcomes. Additional family-support and family support programs, including and programs, such as those that provide homeless social and recreational “youth development pro- families and/or those who are socially and educa- gramming” (Carnegie Council on Adolescent tionally disadvantaged with coordinated and nec- Development, 1989 ; Shinn & Yoshikawa, 2008 ) essary residential stabilization, medical, human are but a few of the domains of initiatives that service, and food resources also fall into this seek to change the ecology of the peoples’ lives category. and that have, in the past, not been adequately recognized for their potential as core strategies in resilience development. Concluding Comments There are numerous other such efforts that may be targeted to children and families that are We have presented what we see as a framework more ecologically congruent with the existing that can guide the development of the next gen- regularities and systems of their lives than those eration of efforts to enhance the live outcomes of of the earlier generations of such efforts. For children and youth in poverty. As such efforts 7 Poverty in Childhood and Adolescence: A Transactional–Ecological Approach… 123 move toward their next generation of efforts, the Cowen, E. L. (2000). Psychological wellness: Some hopes contributions of those who provide the shoulders for the future. In D. Cicchetti, J. Rappaport, I. Sandler, & R. P. Weissberg (Eds.), The promotion of wellness on which we stand in gaining our current vision in children and adolescents (pp. 477Ð503). Thousand should not be underestimated or underappreci- Oaks, CA: Sage. ated. Given this perspective and their “boost,” we Deater-Deckard, K., Ivy, L., & Smith, J. (2005). Resilience hope that the perspective provided in this chapter in gene-environment transactions. In S. Goldstein & R. B. Brooks (Eds.), Handbook of resilience in chil- further changes our ways of “think about what dren (pp. 49Ð63). New York: Kluwer Academic/ we are thinking about” in the continued evolution Plenum. of approaches that seek to ensure that all children DeNavas-Walt, C., Proctor, B., & Smith, J. (2008). have the developmental experiences and circum- Income, poverty, and health insurance coverage in the United States: 2007. (Current Population Report. U.S. stances that allow them to grow to fully empow- Census Bureau). Washington, DC Government Printing ered adults, with all of the choices and Of fi ce. opportunities that enable them to live satisfying De Wit, D. J., Karioja, K., & Rye, B. J. (2010). 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Sara R. Jaffee

Family violence, which refers to child maltreat- intimate partner violence had also been victims ment and intimate partner violence, is a wide- of maltreatment in the past year and 56.8% who spread problem in the United States. In 2009, the had ever witnessed intimate partner violence had most recent year for which fi gures are available, been victims of maltreatment at some point in 702,000 children were found to be victims of their lives (Hamby, Finkelhor, Turner, & Ormrod, maltreatment, including physical, sexual, and 2010 ) . Reviewing data from community and psychological abuse, and neglect (U.S. Department clinical samples, Edleson ( 1999 ) estimated that of Health and Human Services, 2010 ) . A survey among those who were exposed to one form of of 16,000 men and women in the United States family violence (i.e., child maltreatment or part- found that the lifetime prevalence of intimate ner abuse), 30Ð60% were exposed to the other partner violence was 17% and approximately 1.3 form of family violence as well. million women and 834,732 men had been the Children who are exposed to intimate partner victims of partner violence in the 12 months prior violence and children who are maltreated are at to the survey (Tjaden & Thoennes, 2000 ) . risk for a range of adverse outcomes in child- Worldwide, the lifetime prevalence of intimate hood and adolescence, including conduct prob- partner violence ranges from 15 to 71% (Garcia- lems, anxiety and depression, cognitive Moreno, Jansen, Ellsberg, Heise, & Watts, 2006 ) . dysfunction, poor school performance, low self- Many victims of partner violence live with esteem, and dif fi culties with peers (for reviews, children. A Bureau of Justice Statistics Special see Holt, Buckley, & Whelan, 2008; Margolin & Report found that between 1993 and 1998, the Gordis, 2000) . Thus, child maltreatment and average number of victims of intimate partner intimate partner violence constitute signifi cant violence who lived with children under the age of public health problems because of their high 12 was 459,590 (Rennison & Welchans, 2000 ) . prevalence and co-occurrence rates and because Child maltreatment and intimate partner violence of the adverse outcomes for parents and children co-occur in families (Appel & Holden, 1998 ; involved in family violence. Edleson, 1999 ; Hazen, Connelly, Kelleher, In their efforts to understand the etiology of Landsverk, & Barth, 2004 ) , with data from a family violence, researchers in different fi elds nationally representative sample of American have developed models that call on a subset of youth showing that 33.9% who had witnessed potential explanatory variables (Belsky & Vondra, 1989 ; Parke & Collmer, 1975) . For example, psychiatric models of family violence S. R. Jaffee ( ) emphasize the role that an individual’s rearing Institute of Psychiatry , Kings College London , London , UK history and psychological characteristics (e.g., e-mail: [email protected] low impulse control, alcohol and drug problems,

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 127 DOI 10.1007/978-1-4614-3661-4_8, © Springer Science+Business Media New York 2013 128 S.R. Jaffee depression or personality disorders) play in ciation between mental illness in parents and increasing risk for child (Kempe, Silverman, family violence, I do not advocate the psychiatric Steele, Droegemueller, & Silver, 1962; Spinetta model. Rather, as the following review of the & Rigler, 1972 ) or partner abuse (Dutton, literature will demonstrate, it is assumed that fam- 1995 ) . Sociological models of family violence ily violence has many causes and that the degree emphasize the degree to which social stressors to which parents’ psychopathology increases risk (e.g., unemployment, poverty) and societal for family violence depends on the balance of attitudes and values about violence undermine other potentiating and compensatory factors that family functioning and are thus implicated in may change over time (Cicchetti & Rizley, 1981 ) . child or partner abuse (Gelles, 1973 ; Sugarman Clearly, not all parents with a history of mental & Frankel, 1996 ; Tolan & Guerra, 1998 ) . disorder are involved in family violence and not Finally, the “child effects” model highlights the all of those involved in family violence have a his- degree to which the behavior of hard-to-manage tory of mental disorder. However, a focus on par- children (e.g., premature infants, children with ent psychopathology is worthwhile given the diffi cult temperaments) elicits harsh and abu- central role that parent personality plays in theo- sive discipline from adults (Hurme, Alanko, ries of the determinants of parenting (Belsky & Anttila, Juven, & Svedstrom, 2008 ; Kadushin Jaffee, 2005 ) . Personality is what links a parent’s & Martin, 1981 ; Wu et al., 2004 ) or causes dis- developmental history (e.g., early experience of agreements about how to manage children that caregiving) with his or her current functioning as result in intimate partner violence (Straus, a parent. Personality also in fl uences a range of Gelles, & Steinmetz, 1980 ) . contextual factors (marital quality, job satisfaction Working from a developmentalÐecological and stability) that increase or decrease risk for framework, Belsky (1980, 1993 ) proposed that family violence (Belsky, 1984 ) . maltreatment occurs as a result of interactions The goal of this chapter is to review the between “contexts of maltreatment.” Although literature on the association between parent Belsky’s developmentalÐecological model was mental illness and two forms of family violence: formulated to explain child maltreatment, it can violence against an intimate partner, referred to be generalized to other forms of family violence as partner violence, and violence against a child, like intimate partner violence. According to the referred to as child maltreatment. Although child developmentalÐecological model, factors that maltreatment comprises physical, psychological, in fl uence whether an individual will be abusive and sexual abuse as well as neglect, most of the towards a child or an intimate partner operate at studies reviewed in this chapter concern child and across several levels of the ecology from the physical abuse and neglect. most proximal to the most distal. These include A review of the literature on family violence the level of the individual (e.g., individual person- and parent mental illness is merited at this point in ality or mental illness), the level of the microsys- time because of the growing use of nationally rep- tem (i.e., family-level factors including poverty, resentative datasets to estimate the co-occurrence single parenthood, or unemployment), the level of of family violence and parent mental illness in the the exosystem (e.g., community-level violence, population vs. clinical samples where family vio- unemployment rates, or social cohesion), and the lence and parent mental illness may be correlated level of the macrosystem (e.g., cultural attitudes with a host of other psychosocial risk factors that to violence, regional policy on family violence). in fl ate co-occurrence estimates. Moreover, research The developmentalÐecological model under- based on nationally representative, longitudinal scores the fact that family violence is determined samples can address questions regarding the tem- by multiple factors and, as Belsky (1993 ) con- poral association between mental illness and fam- cluded, there appear to be no necessary or ily violence. The temporal nature of these data has suf fi cient causes of family violence. Thus, allowed researchers to explore whether parent although the focus of this chapter is on the asso- mental illness is a predisposing risk factor for 8 Family Violence and Parent Psychopathology: Implications for Children’s Socioemotional… 129 family violence or whether parent mental illness borderline personality organization and high arises from the experience of violence victimiza- scores on a number of Diagnostic and Statistical tion in the family, thus getting at the question of Manual (American Psychiatric Association, whether family violence occurs because parents 2000 ) Axis I scales including major depression, are mentally ill or whether mental illness occurs anxiety, posttraumatic stress disorder, and because parents have been victims of violence. symptoms of disordered thought. Over a third of In this chapter, I will review the evidence the violent men in the sample (36%) corre- linking parent mental illness to family violence. sponded to the family-only group and they were I will then review evidence on what accounts for indistinguishable from the nonviolent control the link between parent mental illness and family group in terms of psychopathology and criminal violence. Finally, I will discuss the implications behavior. for children’s well-being of growing up in a Consistent with the notion that clinically home where they are exposed to both family vio- signifi cant psychopathology may characterize lence and parent mental illness. Despite the risk only a subset of batterers, Gleason (1997 ) con- for poor adjustment associated with family vio- ducted a review of psychological and social dys- lence and with parent psychopathology, many function among battering men and identifi ed two children who are exposed to such adversities types of batterers: one group characterized by show remarkable resilience over time and across frequent alcohol abuse, antisocial personality a range of domains of functioning. I will con- disorder, low intelligence, and criminal behavior sider the degree to which the co- occurrence of and another group characterized by relatively low parent psychopathology and family violence levels of psychological and social dysfunction. may decrease the likelihood that children will Data from epidemiological studies of men and manifest resilience. women who perpetrate partner violence are consistent with data from clinical samples, showing that perpetrators (men, in most studies) have ele- The Prevalence of Psychopathology vated past-year rates of mood and anxiety disor- Among Perpetrators of Partner ders, substance use disorders, and antisocial Violence personality disorder (Danielson, Mof fi tt, Caspi, & Silva, 1998 ; Eiden, Leonard, & Morrisey, Personality disorders appear in up to 90% of 2001; Feingold, Kerr, & Capaldi, 2008 ; Magdol males in domestic violence treatment programs et al., 1997 ) . A childhood history of antisocial (Craig, 2003) and clinical elevations in passiveÐ behavior—and particularly early emerging anti- aggressive and antisocial personality disorders social behavior—has also been identi fi ed consis- best predict domestic violence (Dutton, 1994 ) . tently as a risk factor for partner violence However, batterers are a diverse group who dif- perpetration (Ehrensaft et al., 2003 ; Kerr & fer in terms of the frequency and severity of their Capaldi, 2011; Lussier, Farrington, & Moffi tt, violence, the extent to which they are violent 2009; Magdol, Moffi tt, Caspi, & Silva, 1998 ; outside of the family, and the degree to which Woodward, Fergusson, & Horwood, 2002 ) , with they are characterized by personality disorder at least one study fi nding that male perpetrators and psychopathology (Dixon & Browne, 2003 ; were more likely than nonperpetrators to also Holtzworth-Monroe & Stuart, 1994 ) . In an have a childhood history of any mental health or empirical test of their batterer typology, substance use problem (Magdol et al., 1998 ) . Holtzworth-Monroe, Meehan, Herron, Rehman, Finally, at least one study has shown that symp- and Stuart ( 2000 ) reported that the generally vio- toms of depression, poly-drug use, and antisocial lent antisocial group (16%) were characterized personality disorder differentiate male perpetra- by high levels of psychopathy, substance use and tors from male nonperpetrators more strongly abuse, and involvement in crime. The borderline- than they differentiate female perpetrators from dysphoric group (15%) were characterized by female nonperpetrators (Magdol et al., 1997 ) . 130 S.R. Jaffee

supports buffer women who experience intimate The Prevalence of Psychopathology partner violence from risk of depression and Among Victims of Partner Violence posttraumatic stress symptoms (Beeble, Bybee, Sullivan, & Adams, 2009; Coker et al., 2002b ; In a meta-analysis of the association between Escriba-Aguir et al., 2010 ; Mburia-Mwalili, intimate partner violence and mental health prob- Clements-Nolle, Lee, Shadley, & Yang, 2010 ) . lems, Golding ( 1999 ) reported that women’s violence victimization signifi cantly increased the odds of suicidality, posttraumatic stress disorder, Why Is Intimate Partner Violence and substance use/dependence in samples taken Correlated with Psychopathology? from psychiatric patient settings, battered women’s shelters, and emergency rooms. Although Research that establishes an association between Golding (1999 ) concluded that these results sup- intimate partner violence and mental illness can ported a model in which violence victimization be interpreted in at least three ways: (a) mental was a cause of mental disorder in women, the disorder causes individuals to perpetrate or fall analyses did not address the possibility that victim to intimate partner violence; (b) the expe- women who were victimized by their partners rience of having been abused by an intimate part- had a preexisting mental disorder that may have ner increases risk for mental disorder; (c) the in fl uenced their likelihood of entering abusive association between mental disorder and intimate relationships. partner violence is spurious and can be accounted Although the majority of research on victims for by a third set of variables (e.g., low socioeco- of partner violence concerns women, there is a nomic status). As longitudinal data on partner small literature on male victims. Similar to the violence and mental illness have become avail- fi ndings for women, a review of this literature able, researchers have begun to exploit the tem- found that men who were victims of intimate poral nature of these data to answer questions partner violence were at increased risk of symp- about whether the link between mental disorder toms of posttraumatic stress, depression, and and partner violence refl ects social selection suicide (Randle & Graham, 2011 ) . (individuals with a history of mental disorder are Again, consistent with data from clinical at increased risk of entering violent relation- samples, data from epidemiological studies show ships), social causation (partner violence causes that male and female victims of partner violence mental disorder), or a spurious association. are at increased risk for mood, anxiety, eating, In one longitudinal study of a New Zealand substance use, antisocial personality, and psy- birth cohort, individuals with a history of psychi- chotic disorders (A fi fi et al., 2009 ; Bonomi et al., atric disorder in adolescence were more likely 2006 ; Carbone-Lopez, Kruttschnitt, & than individuals without such a history to be vic- Macmillan, 2006 ; Coker et al., 2002a ; Coker, tims of clinically abusive partner violence—re- Smith, & Fadden, 2005 ; Danielson et al., 1998 ; sulting in injury or of fi cial intervention—in their Magdol et al., 1997 ) . The past-year prevalence mid-twenties (Ehrensaft, Mof fi tt, & Caspi, of psychiatric disorders among men and women 2006 ) . For male victims, a prior history of psy- who have been victims of partner violence ranges chiatric disorder explained why they were subse- from 25 to 66% depending on the severity of the quently at increased risk for psychiatric disorder. abuse (A fi fi et al., 2009 ; Danielson et al., 1998 ) . For female victims, however, the risk for psychi- As compared with male victims, female victims atric disorder associated with partner violence have been shown to have higher rates of anxiety remained signi fi cant after controlling for psychi- (Afi fi et al., 2009; Magdol et al., 1997) and to atric history (Ehrensaft et al. 2006 ). Thus, these have lower rates of disruptive and substance use data indicate that the experience of partner vio- disorders (Afi fi et al., 2009) . Findings from com- lence is not random—individuals with a history munity samples suggest that access to social of mental disorder are more likely to enter abusive 8 Family Violence and Parent Psychopathology: Implications for Children’s Socioemotional… 131 relationships than individuals without a history More longitudinal research is needed to further of mental disorder. However, for women at least, explore the question of (a) whether psychopatho- being victimized by a partner further increases logy arises from the experience of partner vio- risk for psychopathology. lence, (b) whether partner violence exacerbates Complicating this picture is the fact that most an underlying diathesis for psychopathology, or individuals who perpetrate violence against a (c) whether partner violence is a manifestation of partner have also been victims of violence stable individual differences as indexed by an (Anderson, 2002 ; Magdol et al., 1997 ) . Thus, individual’s history of psychopathology. Finally, mental health problems may predict violence per- relatively little research has explored whether petration because perpetrators have themselves “third variables” such as poverty, single parent- been victims of violence in the past and have hood, or unemployment account for the associa- developed mental health problems as a conse- tion between mental disorder and partner violence quence. Using data from the National Survey of or whether these factors moderate the relationship Families and Households, Anderson (2002 ) found such that mental disorders and partner violence that depressive symptomatology increased the are linked only under certain conditions. odds of partner violence perpetration, even controlling for a range of sociodemographic variables and controlling for violence victimization. Thus, Parental Psychopathology and Child individuals who reported symptoms of depression Maltreatment were at increased risk of violence perpetration, even accounting for the fact that they might have As is true for studies of mental disorder and inti- been victims of violence in the past. In contrast, mate partner violence, researchers who study the the authors detected a spurious association association between parent mental disorder and between drug and alcohol problems and violence child maltreatment have collected data from both perpetration. Drug and alcohol problems were clinic samples (e.g., studies of parents on protec- associated with the perpetration of partner vio- tive service caseloads) as well as from parents in lence because both stemmed from the experience population samples. of having been the victim of violence in the past. In summary, both clinical and nationally rep- Clinic samples . State child welfare records indi- resentative samples have established an associa- cate that substance abuse is one of the top two tion between partner violence perpetration, problems exhibited by families in 81% of reported victimization, and mental disorder, although a cases (Lung & Daro, 1996 ) . Among con fi rmed substantial number of individuals involved in cases of child maltreatment, 40% involve the use partner violence are not characterized by mental of alcohol or other drugs by a parent (Children of disorder (Holtzworth-Monroe et al., 2000 ) . Alcoholics Foundation Inc, 1996 ) . Crack cocaine Longitudinal studies have shown that social has been held responsible by researchers and selection and social causation are both at play social workers for skyrocketing child protective for female victims of partner violence, but that service caseloads in the 1980s and early 1990s processes of social selection primarily explain (Curtis & McCullough, 1993 ) . Children of alco- why male victims of partner violence have ele- holics may also be at increased risk of neglect as vated symptoms of mental health problems evidenced by research showing that such children (Ehrensaft et al., 2006) . Moreover, some forms suffer more injuries and poisonings than do chil- of disorder increase the risk of perpetration, dren in the general population (Bijur, Kurzon, regardless of an individual’s history of victim- Overpeck, & Scheidt, 1992 ) . ization whereas other forms of disorder appear Substance abuse may infl uence the course and to be associated with violence perpetration consequences of child maltreatment. In a com- because both stem from a history of victimization parison of drug and alcohol substance-abusing (Anderson, 2002 ) . and non-substance-abusing parents involved in 132 S.R. Jaffee over 200 child protective cases brought to court and Diagnostic Criteria for a lifetime diagnosis in Massachusetts, Murphy et al. ( 1991 ) reported of alcoholism (38% vs. 8%) and major depres- that parents with documented substance abuse sion (28% vs. 8%). histories were more likely than other maltreating The clinic studies reported earlier have esti- parents to be repeat offenders with regard to child mated rates of mental disorder among samples of maltreatment and to have longer histories with parents on child protective service caseloads. child protective services. Parents with substance Another approach to studying the link between abuse histories were rated by court investigators parent mental disorder and child maltreatment is as being at higher risk of continuing to maltreat to estimate the prevalence of maltreatment among their children, were more likely to reject court- parents who are receiving mental health services ordered services (71% vs. 39%), and were more or who have disclosed illicit drug use. At least likely to eventually lose care and custody of their four studies have detected elevated rates of physi- children (80% vs. 58%). These differences cal abuse and neglect among drug users compared between substance-abusing and non-substance- to sociodemographically matched controls abusing families remained signi fi cant even after (Kelley, 1992 ; McGlade, Ware, & Crawford, controlling for socioeconomic status, as indexed 2009 ; Street, Harrington, Chiang, Cairns, & Ellis, by receipt of welfare bene fi ts. Thus, in families 2004; Wasserman & Leventhal, 1993 ) . For exam- where maltreatment co-occurs with a parent’s ple, Kelley (1992 ) reported that nearly 60% of substance abuse problem, maltreatment is more the drug-exposed infants in her sample were the persistent, parents are more resistant to treatment, subject of subsequent substantiated reports of and children are more likely to be placed in care. abuse or neglect compared to just over 8% of the Although these studies show substantial rates control children. At 11 months of age, all of the of mental disorder among parents who maltreat control children were still living with their bio- their children, they do not clarify whether rates of logical mothers in contrast to just over half of the disorder are signi fi cantly higher among these drug-exposed children, 42% of whom had been parents than among sociodemographically placed by child protective services in foster care matched controls. In a study of 53 families who with relatives or others. had been reported (and indicated) to child protec- Finally, a recent study followed a sample of tive services, De Bellis et al. ( 2001 ) reported that 999 youth released from juvenile justice facili- prevalence rates of lifetime DSM-III and IV diag- ties in New York. By the time they were 28 years noses for any anxiety disorder, any mood disor- old, 62% of the girls and 17% of the boys had der, and alcohol and substance abuse/dependence been investigated by child welfare services for disorders were signifi cantly higher among mal- allegations of abuse or neglect (Colman, treating mothers compared to sociodemographi- Mitchell-Herzfeld, Kim, & Shady, 2010 ) . cally similar control mothers. Compared to Although this study lacked a demographically control mothers, mothers of maltreated children matched control group of nondelinquents, it were also more likely to have had a history of bears noting that rates of maltreatment perpetra- violent behavior towards other adult family or tion were higher among female former delin- community members, although the two groups quents than among individuals who themselves did not differ with respect to criminal arrests. have a history of child maltreatment, roughly a Famularo and colleagues (Famularo, third of whom are expected to maltreat their Kinscherff, & Fenton, 1992 ; Famularo, Stone, own children (Kaufman & Zigler, 1987 ) . Barnum, & Wharton, 1986 ) matched 50 court- In summary, when compared to sociodemo- referred maltreating parents with 38 parents graphically matched controls, the association whose children were inpatients at a general pedi- between child maltreatment and mental disorder atric hospital on age, income, race, and marital (including major depressive, personality, and status. Maltreating parents were signi fi cantly substance use disorders) is detected (a) in sam- more likely than control parents to meet Research ples where prevalence rates of mental disorder 8 Family Violence and Parent Psychopathology: Implications for Children’s Socioemotional… 133 are assessed in parents referred to child protec- mographic and psychiatric data measured at a tive services and (b) in samples where the preva- previous wave. In models controlling for socio- lence of child maltreatment is assessed demographic factors and psychiatric disorders, prospectively among mothers who abuse drugs or substance abuse remained a strong predictor of who have been released from juvenile detention subsequent child physical abuse and mediated facilities. Several caveats bear note. First, several the association between a range of sociodemo- samples included parents who were judged poten- graphic factors (e.g., parent’s age, number in tially unfi t to retain custody of their children household, marital status, race) and the emer- (e.g., Famularo et al., 1992; Murphy et al., 1991 ) . gence of neglect. These families may represent a particularly severe This pattern of fi ndings from the ECA study group of maltreating parents and prevalence rates has been replicated in other large population sam- of disorder in this group may not represent preva- ples. In a study of 1,200 unselected adults, the lence rates of disorder among maltreating parents odds of engaging in violence against a spouse or generally. Second, the over-representation of par- partner, against a child, against someone outside ents with substance abuse problems on child pro- the family or of engaging in child neglect were tective service caseloads may re fl ect detection from 1.6 to 4.7 times higher among those who had bias, wherein such parents are perceived as being a de fi nite or possible diagnosis of antisocial per- at greater risk to their children than other parents sonality disorder, alcohol abuse or dependence, or (Benjet, Azar, & Kuersten-Hogan, 2003 ) . recurrent depression (Bland & Orn, 1986 ) . Among individuals who were comorbid for two or more Population samples. Several studies have reported disorders, the odds of engaging in familial or on the association between child maltreatment extrafamilial violence were exponentially greater. and parents’ mental disorder using data from the Parent criminality and substance abuse were also representative St. Louis Epidemiological implicated in child maltreatment in a study of 644 Catchment Area (ECA) sample (Robins & Regier, families who were part of a larger, unselected 1991 ) . Dinwiddie and Bucholz ( 1993 ) reported sample (Brown, Cohen, Johnson, & Salzinger, that the lifetime rate of self-reported child physi- 1998) . The odds of physical child abuse, neglect, cal abuse among parents in the ECA sample was and sexual abuse were four to six times higher 4.1%. Compared to nonabusers, those who among mothers who reported involvement with reported perpetrating child physical abuse were drugs, alcohol, and/or the police. signifi cantly more likely to have a lifetime his- Similarly, retrospective data from the 8,548 tory of alcohol abuse/dependence, drug abuse, participants in the Ontario Mental Health antisocial personality disorder, major depressive Supplement showed that adults who reported a disorder, and panic disorder. history of childhood maltreatment were more Egami, Ford, Greenfi eld, and Crum ( 1996 ) likely to report that their own parents had psychi- explored the link between mental disorder and child atric disorders and substance use problems com- maltreatment among all adults in the ECA sample pared with adults who did not report a history of and found that a lifetime history of any mental dis- childhood maltreatment; a parent’s history of order increased the odds of child physical abuse by antisocial personality disorder increased the odds 2.72 times. A lifetime history of alcohol abuse or of child maltreatment by 7.5 (Walsh, MacMillan, dependence and a lifetime history of affective dis- & Jamieson, 2003 ; Walsh, McMillan, & Jamieson, orders increased risk for physical child abuse even 2002 ) . Finally, although the sample was small, at controlling for a range of sociodemographic vari- least one prospective, longitudinal study of 224 ables as well as other psychiatric diagnoses. low-income families followed for 10 years found Finally, Chaffi n, Kelleher, and Hollenberg that maternal drug use and maternal depressive (1996 ) utilized the prospective, longitudinal symptoms predicted which families would design of the ECA survey to predict the onset of become involved with child protective services child physical abuse and neglect from sociode- (Dubowitz et al., 2011 ) . 134 S.R. Jaffee

Summary. Clinic and population studies have an individual’s perceptions of an intimate partner’s detected an association between parent mental behavior (Noller, Beach, & Osgarby, 1997 ) . disorder and child maltreatment even controlling A parent’s depressogenic cognitive style for a range of sociodemographic factors that (e.g., Abramson, Metalsky, & Alloy, 1989) may might explain the association. Substance abuse, contribute to the perception that she or he is not affective, and antisocial personality disorders competent in the parenting role and may cause the have consistently been found to increase risk for parent to withdraw from interaction with the child. child maltreatment. In families where rates of parentÐchild interaction are low, children’s misbehavior may be reinforced because it elicits a reaction from the withdrawn Why Is Parent Psychopathology parent. These coercive exchanges may further Correlated with Child Maltreatment? undermine parents’ perception of their competency (Azar, 2002 ) . Low self-esteem and per- Very few studies have explored why it is that par- ceived control in parenting are characteristics of ents who have a history of mental illness are at abusive parents (Trickett & Susman, 1988 ) , sug- increased risk for family violence. Potential gesting the possibility that such parents have little explanations may be common across mental dis- faith in their ability to manage the child’s behav- orders or may relate to speci fi c disorders. Drawing ior through less power-assertive means. from the literature on social cognition, it is pos- A third hypothesis proposes that parents who sible that parent mental illness biases parents’ maltreat their children may have dif fi culties man- cognitions about their children’s behavior as well aging stress relative to other parents (Whipple & as their ability to recognize their children’s emo- Webster-Stratton, 1991 ) . Although exposure to tions. Moreover, parents who are experiencing social stressors may precipitate the onset or recur- depression or substance use problems because rence of mental disorder, a history of mental ill- they are also victims of partner violence may be ness may also increase the risk of experiencing a at elevated risk of abusing or neglecting children range of social stressors including marital confl ict, because of diffi culties in coping with social stres- relationship and job instability, and the erosion of sors. These hypotheses are reviewed below. social supports. Thus, a parent’s history of men- Social cognitive models of parenting posit that tal disorder may increase the probability of child negative emotions bias parents’ perceptions, inter- maltreatment because of the greater number of pretations, and evaluations of their children’s stressors to which the parent is exposed and the behavior (Azar & Twentyman, 1986 ; Dix, 1991 ; parent’s impaired capacity to manage stress Milner, 2003 ) . Parents who are characteristically (Abidin, 1992; McPherson, Lewis, Lynn, Haskett, angry, depressed, or anxious are more likely to & Behrend, 2009 ) . Given the co-occurrence of perceive children as acting in deliberately nega- partner violence and child maltreatment, partner tive ways (Dix, 1991 ) and, consistent with those violence itself may be a potent stressor that perceptions, to parent in a hostile, negative fash- impairs the ability to parent effectively (Slep & ion (Rueger, Katz, Risser, & Lovejoy, 2011 ) . O’Leary, 2001 ) . Indeed, research shows that maltreating parents are more likely to attribute children’s misbehavior to stable, global, and internal causes (for reviews Implications for Children’s see Azar, 2002 ; Milner, 2003 ; Seng & Prinz, Socioemotional Development 2008 ) and that parents who are at high risk for and Resilience maltreating children have more readily accessible negative child-related schema (Crouch et al., The fact that family violence and parental psycho- 2010; Milner et al., 2011) . Social cognitive mod- pathology tend to co-occur poses interpretive els may also be applied in the context of partner diffi culties for studies attempting to determine violence, where negative emotionality may bias whether family violence is a causal risk factor for 8 Family Violence and Parent Psychopathology: Implications for Children’s Socioemotional… 135 children’s problem behaviors. This co-occurrence antisocial behavior in childhood and adulthood raises the possibility that gene variants common than those who had not experienced childhood to parents and children explain the observed adversity. Among men who carried the high association between family violence and child activity variant, childhood adversity was not psychopathology. That is, family violence may associated with later antisocial behavior. In a simply be a marker for genetic risk that parents subsequent paper focused on a variant in the transmit to children (DiLalla & Gottesman, 1991 ) , serotonin transporter gene-linked polymorphic a phenomenon known as passive geneÐenviron- region (5HTTLPR) (Caspi et al., 2003 ) , they ment correlation (Plomin, DeFries, & Loehlin, showed that among men and women who were 1977 ) . Another possibility is that children inherit homozygous for the short form of the serotonin a genetic predisposition to engage in hard- transporter polymorphism, experiencing more to-manage behavior and that this behavior elicits adverse childhood events was associated with abusive reactions from adults, a phenomenon increased levels of depression in adulthood. This known as evocative geneÐenvironment correla- association was not observed among individuals tion (Plomin et al., 1977 ) . who were homozygous for the long form of the Several studies using genetically informative serotonin transporter polymorphism. research designs have ruled out these alternative There is plausible biological evidence from hypotheses (Jaffee, Caspi, Mof fi tt, & Taylor, animals and humans that these genotype x envi- 2004 ; Jaffee, Strait, & Odgers, in press ) . Twin ronment interactions capture real biological pro- studies have shown that maltreatment is not cesses (for a review, see Caspi, Hariri, Holmes, signi fi cantly heritable (Jaffee, Caspi, Mof fi tt, Uher, & Mof fi tt, 2010 ) . MAOA is involved in Polo-Tomas et al., 2004; Schulz-Heik et al., metabolism of monoamines in the brain and other 2009 ) , suggesting that genetically in fl uenced organs (Shih & Thompson, 1999 ) and 5HTTLPR characteristics of the child do not explain why is involved in the reuptake of serotonin at brain some children are more likely than others to synapses (Heils et al., 1995 ) . Results of studies experience maltreatment. Moreover, in models that either knock out or functionally excise these that estimate passive geneÐenvironment correla- genes support the involvement of MAOA in tions, adverse childhood events (including mal- aggressive traits (Cases et al., 1995 ; Shih, 2004 ) treatment and inter-parental con fl ict) have been and 5HTTLPR in anxious traits (Murphy & shown to have direct effects on youth antisocial Lesch, 2008 ) . Studies of nonhuman primates pro- behavior (Eaves, Prom, & Silberg, 2010 ) . vide evidence of GxE that is consistent with the Although genotype is unlikely to account for human fi ndings (for review, see Caspi et al., the effect of maltreatment on children’s risk for 2010) , and 5HTTLPR and MAOA have been psychopathology, genotype is likely to moderate associated with brain activity in regions impli- the effects of maltreatment (and other forms of cated in depression and aggression in response to victimization) on children’s outcomes. The fi rst negative stimuli (Buckholtz & Meyer-Lindenberg, evidence that a specifi c gene variant moderated 2008 ; Munafo, Brown, & Hariri, 2008 ) . the effect of maltreatment appeared in 2002 Subsequent efforts to replicate the original (Caspi et al., 2002 ) . This study involved a cohort fi ndings involving MAOA, 5HTTLPR, and fam- of 442 New Zealand men who had participated ily violence have been mixed, with meta-analy- from birth in the Dunedin Longitudinal Study ses identifying small, but signi fi cant interaction (Moffi tt, Caspi, Rutter, & Silva, 2001) . Among effects (Karg, Burmeister, Shedden, & Sen, men who carried the low activity variant of the 2011 ; Kim-Cohen et al., 2006 ; for negative monoamine oxidase A gene (MAOA), those who fi ndings, see Munafo, Durrant, Lewis, & Flint, experienced childhood adversities, including 2009 ; Risch et al., 2009 ) . If real, genotype x sexual and physical abuse, maternal rejecting environment (GxE) interactions provide impor- behavior, harsh discipline, and frequent care- tant clues to the biological basis of resilience. taker changes, had signi fi cantly higher levels of For example, the neuroimaging genetics literature 136 S.R. Jaffee has shown that individuals who are homozygous available to a child (Masten & Coatsworth, for the long form of the serotonin transporter 1998 ) , the co-occurrence of parental mental polymorphism show lower levels of amygdala illness and family violence is likely to decrease reactivity to negative vs. neutral stimuli, such as the probability of resilience. It is important to facial expressions of fear and sadness (Munafo consider how the course of a parent’s mental et al., 2008) . Amygdala reactivity may infl uence illness may alter this balance and, consequently, the cognitive processing of emotion expres- alter the child’s ability to maintain positive sions, with consequences for how individuals psychological functioning. Depression, for cope with their own or others’ negative emo- example, tends to recur throughout adulthood tions. Other studies have shown that individuals (Post, 1992 ) and the timing of a parent’s who are homozygous for the long form of the depressive episodes may in fl uence not only serotonin transporter polymorphism produce the likelihood that family violence will occur lower levels of cortisol—a stress hormone—in (e.g., partner violence is more likely to occur response to a socially stressful task (Gotlib, when a parent is experiencing an episode of Joormann, Minor, & Hallmayer, 2008) . Because depression; Capaldi & Kim, 2003 ), but also the cortisol hyper-reactivity has been implicated parent’s interactions with the child (Goodman & in the pathophysiology of depression (Parker, Gotlib, 1999 ) . For example, a parent may be Schatzberg, & Lyons, 2003 ) and cortisol better able to buffer a child against exposure to hypo-reactivity has been implicated in antisocial inter-parental violence when the parent is behavior (van Goozen, Fairchild, Snoek, & suffering relatively few symptoms of psychopa- Harold, 2007 ) , genetic in fl uences on stress thology than when a parent is experiencing a response systems may provide a biological basis clinical episode of disorder. Parents may be for resilience. However, because most studies of better able to handle psychosocial stressors and, GxE focus on a single outcome (e.g., depression consequently, use nonabusive forms of disci- or antisocial behavior) more research is needed pline when they are psychologically well vs. to determine whether risk for psychopathology when they are psychologically distressed. in general is reduced if an individual has a par- In summary, although family violence is ticular genotype or if genotype x environment multiply determined, the association between interactions involving specifi c gene variants family violence and parent mental illness is reduce risk for specifi c forms of psychopathology, robust across studies, particularly for mood dis- but not others. orders, antisocial personality disorder, and sub- Moreover, the fact that an individual is at stance abuse disorder. I argue that children’s genetic and environmental risk for maltreatment inherited vulnerability to disorder may be exac- is no guarantee that the individual will suffer erbated by exposure to family violence, chil- from mental health problems. At least one study dren’s risk for a range of adverse outcomes found that children who had high levels of social increases with the number of psychosocial risk support were at relatively low risk for depression factors to which the child is exposed, and vio- even if they carried the short form of the sero- lence in families where a parent has a history of tonin transporter polymorphism and had been disorder is likely to be more severe, persistent, victims of maltreatment (Kaufman et al., 2004 ) . and pervasive than in families where violence There is a substantial literature on protective and mental disorder do not co-occur. Clinicians factors for child victims of family violence working with victims or perpetrators of family (many of whom will also be at genetic risk for violence should be especially aware of the psychopathology) implicating child-, family-, and degree to which mental illness may be a cause community-level factors (for a review, see Afi fi or consequence of violence because the co- & MacMillan, 2011 ) . occurrence of family violence and mental illness However, given that resilience is likely to arise may jeopardize children’s chances of positive from the balance of risk and protective factors adjustment. 8 Family Violence and Parent Psychopathology: Implications for Children’s Socioemotional… 137

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and child maltreatment: Findings from the Ontario Whipple, E. E., & Webster-Stratton, C. (1991). The role Health Supplement. Child Abuse & Neglect, 27 , of parental stress in physically abuse families. Child 1409Ð1425. Abuse & Neglect, 15 , 279Ð291. Walsh, C., McMillan, H., & Jamieson, E. (2002). The Woodward, L. J., Fergusson, D. M., & Horwood, L. J. relationship between parental psychiatric disorder and (2002). Romantic relationships of young people with child physical and sexual abuse: Findings from the childhood and adolescent onset antisocial behavior Ontario Health Supplement. Child Abuse & Neglect, problems. Journal of Abnormal Child Psychology, 30 , 26 , 11Ð22. 231Ð243. Wasserman, D. R., & Leventhal, J. M. (1993). Wu, S. S., Ma, C. X., Carter, R. L., Ariet, M., Feaver, E. Maltreatment of children born to cocaine-abusing A., Resnick, M. B., et al. (2004). Risk factors for infant mothers. American Journal of Diseases of Children, maltreatment: A population-based study. Child Abuse 147 , 1324Ð1328. & Neglect, 28 , 1253Ð1264. Understanding and Promoting the Development of Resilience 9 in Families*

Susan M. Sheridan , Tara M. Sjuts , and Michael J. Coutts

Children spend the majority of their early lives from early childhood through adult years. Such within the context of the family. As the compo- experiences consist of (a) exposing a child to sition of the family system continues to change, ideas and activities that promote the acquisition the caregivers’ role has become increasingly of knowledge; (b) assisting in the socialization important in fostering healthy developmental of gender, cultural, and peer roles; (c) establish- trajectories for their children. Family relation- ing standards, expectations, and rules; and (d) ships and interaction styles are central to devel- delivering rewards and praise (Clark, 1988 ) . oping competence and promoting adaptive Parents also play an important role in the devel- educational, social, emotional, and behavioral opment of children’s behavioral, social, and functioning. Clearly, families serve a primary emotional skills. Parents can teach their chil- role in their children’s development. Families dren appropriate behaviors through everyday give a child an informal education (Turnbull, interactions and strategies, such as providing Turnbull, Erwin, & Soodak, 2006 ) , which is positive attention, encouragement, and praise; considered a prerequisite for successful experi- setting clear and consistent limits; using natural ences in the classroom (Adams & Christenson, and logical consequences for inappropriate 2000 ) . Whereas the school environment sets up behavior; and teaching problem-solving skills, developmental tasks for students, the family social skills, and emotion regulation skills serves as an important resource for the acquisi- (Webster-Stratton, 2005 ) . tion of these developmental tasks (Stevenson Unfortunately, some families face various & Baker, 1987 ) . Parents are considered to be forms of stress and adversity, thereby challeng- providers of linguistic and social capital by pre- ing their abilities to optimally support their chil- senting their child with learning experiences dren’s development. The purpose of this chapter is to articulate the concept of family resilience and its importance in helping families realize their fundamental responsibility of ensuring the *Portions of this chapter were published originally in healthy development and adaptation of children. Sheridan, S. M., Eagle, J. W., & Dowd, S. E. (2005). Following a brief discussion of realities facing Families as contexts for children’s adaptation. In S. families in contemporary society, the notion of Goldstein & R. Brooks (Eds.), Handbook of resiliency in family resilience will be deﬁ ned and couched in children (pp. 165–179). New York: Kluwer/Plenum Press. ecological theory. Characteristics of resilient S. M. Sheridan ( ) • T. M. Sjuts • M. J. Coutts families will be reviewed, and approaches for University of Nebraska , Lincoln , NE , USA e-mail: [email protected] ; [email protected] ; building family strength and resilience will be [email protected] presented.

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 143 DOI 10.1007/978-1-4614-3661-4_9, © Springer Science+Business Media New York 2013 144 S.M. Sheridan et al.

Census Bureau, 2003 ) . This decline has leveled De fi nition of Family since 2002, with 69% of children living with two parents in 2010 (U.S. Census Bureau, 2010 ) . The term “family” has been de fi ned in a variety Single-parent families and stepparent families of ways and has evolved over time with recent have become more common, despite the fact trends within today’s society. The U.S. Census that children from these families are at greater Bureau de fi nes a family household as consisting risk for low academic achievement and are more of at least two members related by birth, mar- likely to drop out of school or bear children at riage, or adoption (Kreider & Elliott, 2009 ) . an early age, as well as display psychological Although this restricted defi nition is practical for factors including depression, anxiety, stress, and collecting census data, it is neither inclusive nor aggression (Fields, Smith, Bass, & Lugaila, functional for many contemporary households. 2001 ) . Currently, 23% of children are living in Current conceptualizations of “family” no longer single-parent families headed by women com- consider a direct relation through birth, marriage, pared to only 3% of children living in single- or adoption to be a requisite condition for defi ning parent families headed by men (U.S. Census the term “family.” In contemporary society and Bureau, 2010 ) . Additionally, the average num- related research on the topic, families are viewed ber of people per household has waned from 3.1 from a holistic lens to include individuals who people per household in 1970 to 2.6 in 2007 fulfi ll important roles in one’s life that are tradi- (Kreider & Elliott, 2009 ) . tionally met by immediate family members, The cultural and educational climate of the regardless of a direct relation (Turnbull et al., American family has also changed over the years. 2006 ) . Thus, a family may best be viewed not as In 2010, 55% of all children in the United States a direct kinship, but as a group of people that were identi fi ed as White, non-Hispanic (U.S. together ful fi ll the roles and functions historically Census Bureau, 2010 ) . This is a sharp decline bestowed upon family members. For the purposes from the 64% reported in 2000 (U.S. Census of this chapter, we will use the following defi nition Bureau, 2000 ) . Currently, over 3% of children when discussing families: living in the United States are foreign born, with Families include two or more people who regard at least one foreign-born parent. Additionally, themselves as a family and who carry out the func- 33% of parents report the highest level of educa- tions that families typically perform. These people tion of either parent in the home as a high school may or may not be related by blood or marriage degree or less (U.S. Census Bureau, 2010 ) . Other and may or may not usually live together (Turnbull et al., 2006 , p. 7). realities facing families in today’s society include economic challenges and con fl icts overseas, such as that being experienced in the Middle East. The recent decline of the American economy The Evolving Family Structure has left many parents without jobs. In 2007, 91% of fathers and 68% of mothers were employed Over recent decades, the landscape of the family (Kreider & Elliott, 2009 ) ; however, in 2010, 67% structure has changed dramatically. The United of fathers and 63% of mothers were employed States has seen a decrease in the “traditional” (U.S. Census Bureau, 2010 ) . The dramatic drop family, which is composed of two biological in the number of working parents has led to pov- parents and consists of one parent in the work- erty-related challenges. In 2010, 21% of children force and the other in a caregiver role. The tradi- were living below the poverty line and 43% are tional family is now being replaced in many considered low income (living below 199% of instances by an increasingly diverse family the poverty line); 19% of children were living in structure. The population of children living with families that received food stamps; and 10% of two parents decreased from 77% in 1980 to 72% children were not covered by health insurance in 1990 and 69% in 2002 (Fields, 2003 ; U.S. (U.S. Census Bureau, 2010 ) . The negative impact 9 Understanding and Promoting the Development of Resilience in Families 145 that poverty can have on children has been well life circumstances (Seccombe, 2002 ) . Given the documented. Children living in poverty or socio- large percentage of American families facing economic disadvantage experience lower rates of serious hardships, it is important to understand cognitive functioning, academic achievement, factors associated with resilience and methods physical health status, and positive child adjust- for its promotion. ment, as well as increased rates of internalizing and externalizing symptoms (Conger et al., 2002 ; McLoyd, 1998 ; Petterson & Albers, 2001 ) . De fi nitions and Underpinnings Poverty is one but not the only persistent of Family Resilience social issue facing families in the United States. Due to the terroristic and military confl icts aris- Multiple defi nitions of resilience have been pos- ing around the world, current generations of ited in the literature, and several have extended children are also impacted by the deployment of beyond a focus on individuals to encompass parents for military service. It is estimated that aspects important for family functioning (i.e., family 700,000 children have had a parent deployed on resilience). Patterson ( 2002a ) suggested that military assignment since September 11, 2001 family resilience is “the processes by which (Johnson et al., 2007 ) . These deployments leave families are able to adapt and function compe- families and children devoid of one parent for tently following exposure to signi fi cant adversity extended periods of time, with the added stress or crisis” (p. 352). Similarly, Simon, Murphy, and of worrying about their parent’s safety. Risk fac- Smith ( 2005) defi ned family resilience as “the tors associated with a military family’s lifestyle ability of a family to respond positively to an (e.g., deployment, frequent relocation, exposure adverse situation and emerge from the situation to combat) have been theorized to have negative, feeling strengthened, more resourceful, and more indirect effects on child outcomes through confi dent than its prior state” (p. 427). Luthar, increases in parental stress and psychopathology Cicchetti, and Becker ( 2000) proposed resilience (Palmer, 2008 ) . When a parent leaves for deploy- as “a dynamic process encompassing positive ment, families are left with the responsibility of adaptation within the context of signifi cant adver- adapting to having one less member and are sity” (p. 543). Finally, Walsh ( 2003) offers a required to ful fi ll the missing member’s roles framework for family resilience as a process aimed within the family. This change can lead to ambi- at assisting families to “reduce stress and vulnera- guity and role confusion within families and bility in high-risk situations, foster healing and cause stress to the remaining family members growth out of crisis, and empower families to (McFarlane, 2009 ) . overcome prolonged adversity” (p. 5). The stress associated with issues such as pov- Common de fi nitions, such as those presented erty and deployment places a signi fi cant strain on herein, have features that embrace context, pro- parent–child relationships, which can have a det- cess, and outcomes collectively characterizing rimental impact on child development (Conger the construct of family resilience. From a contex- et al., 2002 ; Palmer, 2008 ) . The presence of pro- tual perspective, it is commonly thought that tective factors is related to families’ abilities to resilience takes place within the context of an successfully support their children’s development adverse situation or event within which the fam- even in the face of stress or adversity (e.g., pov- ily fi nds itself. Adversity may take several forms erty, military deployment). In times of family and arise through issues internal to the family or stress, protective factors take on an even greater its members (e.g., problems experienced by an importance. Therefore, promoting protective family individual, divorce) or within the broader society characteristics is crucial in helping families cre- (e.g., economic strife, military activity). The ate resiliency and perform their primary function: manner and degree to which a family develops building competence in their children and resiliency is typically considered a dynamic enabling them to deal effectively with challenging process requiring fl exibility and adaptation. 146 S.M. Sheridan et al.

The outcomes achieved as families develop strengths that can be leveraged to help build resilience include greater levels of resourceful- family resilience. Therefore, by virtue of being ness, con fi dence, and ability to avoid serious embedded within interacting ecological systems, problems in the future (Conger & Conger, 2002 ) . all families have the potential for resilience. The Thus, the notion of family resilience considers identifi cation of family strengths and their ability key processes that help families face challenges to take advantage of social supports and resources and that strengthen the family as a unit. from within their embedded systems provides For purposes of this chapter, we defi ne “resil- mechanisms for the development of resilience. ience in families” as the ability of the family to A developmental perspective is also relevant respond to stress and challenge in a positive and in our notion of family resilience. In contrast to adaptive manner, characterized by the demon- perspectives that view family resilience as a set stration of competence and confi dence among its of fi xed traits or attributes, a developmental van- members, with the intentional goal of socializing tage point views resilience as a process in which children. It includes concomitant attention to the interactions between risk and protective factors development of resilience in its individuals, while mediate a specifi ed outcome (Walsh, 1996 ) . at the same time embracing the resilience of the Within a developmental framework, a family’s entire family system. It is further conceptualized ability to adapt and cope with adversity is a pro- along a continuum. Families are not necessarily cess determined by many co-existing and evolv- “resilient” or not; rather, they demonstrate varying factors that occur over time and are developed ing degrees of resiliency in response to different in response to complex and changing conditions stressors and may be more or less capable to within and outside of the family. Furthermore, adapt depending on unique situations and their what is “resilient” at one point in time may be consequences. considered ineffective or inappropriate at another, Several theories have shaped contemporary depending on the developmental progression of understandings of family resilience. An integra- its members. tion of ecological systems and developmental The concept of family resilience, embedded theories has contributed to our conceptualization within ecological systems and developmental of the construct. An ecological-systems approach paradigms, is an ongoing and evolving process (Bronfenbrenner, 1979 ) considers both the char- occurring at multiple levels (Patterson, 2002b ) . acteristics of the family and the reciprocal inter- One level focuses on the interactions among indi- actions among the family and the broader systems vidual family members within the family unit, within which they function (e.g., workplace, and the second centers on interactions between community). Ecological theory posits that indi- the family unit and the broader ecology. This vidual family members (and by extension, family view of family resilience highlights the connec- units) exist in the context of multiple interacting tion between the family system and larger com- systems, and the experiences and interactions munity contexts, thereby emphasizing the within and among those systems both infl uence importance of both family and community efforts and are potentially infl uenced by each other. The in fostering resilience. multiple interacting systems in the life of a fam- Finally, cultural awareness is signifi cant when ily exist at both the immediate and proximal level conceptualizing family resilience. Traits or char- (i.e., microsystem, such as neighborhoods, church acteristics may vary in their relevance and group af fi liations) and at indirect or distal level salience in relation to family resilience. For (i.e., exosystem, such as governmental policies or example, varying levels of family cohesion may cultural norms). The ability of a family and its be valued differently in Eastern and Western members to develop resilience is thus in fl uenced cultures. Additionally, the strategies families by relationships, patterns of interaction, and use to cope with adversity may be relevant in one direct and indirect experiences within and across culture but considered inappropriate in another various systems. Further, all systems have culture. The resilient response of a family in the 9 Understanding and Promoting the Development of Resilience in Families 147 face of adversity is dependent upon the values family system” (p. 108). The degree of emotional present in a particular culture, how the members connectedness varies signi fi cantly between and of that culture conceptualize the adverse event, within families and is in fl uenced by the culture, and the cultural expectations regarding coping age, and stage of life of the family members. and adaptation. Within connected relationships, family members display emotional closeness and loyalty while maintaining some friendships and leisure activi- Characteristics of Resiliency ties outside the family unit. There is mutual support and emphasis on shared time, collaboration, An understanding of the characteristics that resil- and a commitment to work through struggles ient families may exhibit is necessary when together, but there is also a respect for individual determining methods by which to promote fam- needs and boundaries (Cohen, Slonim, Finzi, & ily resilience. Key characteristics that are often Leichtentritt, 2002 ; Walsh, 2003 ) . Behavioral present in resilient families include cohesion, outcomes highlight the importance of cohesion positive parenting, affective involvement, parent in a family. Behavioral problems are common in engagement, communication, problem solving, families with low levels of cohesion and high and adaptability (see Table 9.1 ). Together, these levels of internal con fl ict. Speci fi cally, Lucia and characteristics support families in times of chal- Breslau ( 2006 ) reported that level of family lenge and crisis, helping families respond in a cohesion was associated longitudinally with the positive and adaptive manner. extent of children’s internalizing and attention problems, as well as with their externalizing behavior problems. Cohesion between a parent Cohesion and child is enhanced by parent–child interactions; child outcomes are mediated by the affec- According to Turnbull and Turnbull ( 1997 ) , fam- tive nature of these interactions. Effective ily cohesion is de fi ned as “family members’ attachment, de fi ned as the affective bond between close emotional bonding with each other as well a child and his or her caregiver, provides the as the level of independence they feel within the child with a sense of security, assuring the child

Table 9.1 Characteristics of resilient families Characteristic De fi nition Cohesion Family cohesion is de fi ned as “family members’ close emotional bonding with each other as well as the level of independence they feel within the family system” (Turnbull & Turnbull, 1997 , p. 108) Adaptability Family adaptability or fl exibility refers to a family’s ability to modify its rules, roles, and leadership; thus, restoring balance between (a) family members and the family unit and (b) the family unit and the community (Olson, 1993 ; Patterson, 2002b ) Communication Communication is the exchange of information, ideas, or feelings from one person to another Affective involvement Affective involvement refers to the extent to which family members value and display interest in the activities of other family members (Epstein, Bishop, Ryan, Miller, & Keitner, 1993 ) Engagement Parent engagement is parents’ psychological, affective, and active commitment to experiences supporting children’s learning and development Positive parenting Five core components de fi ne positive parenting: ensuring a safe and engaging environment, creating a positive learning environment, using assertive discipline, having realistic expectations, and taking care of oneself as a parent (Sanders, 1999 ) Problem solving Problem solving can be de fi ned as a systematic process that allows individuals to formulate solutions to identi fi ed problems and involves objectively identifying and de fi ning a problem; generating potential alternatives; assessing, selecting, and implementing the best choice; and evaluating the outcomes in relation to its success at ameliorating the original problem 148 S.M. Sheridan et al. that the caregiver is available during times of set and discuss speci fi c ground rules, give age- adversity (Pianta & Walsh, 1996) . Formation of appropriate instructions in a clear and calm man- an affective bond is related to the quality and ner, and use behavioral consequences such as quantity of caregiver responses (Epstein et al., time out and planned ignoring. This manner of 1993 ) , and responses marked by warmth, nurtur- discipline serves as an alternative to harsh and ance, and sensitivity to the child’s needs facili- ineffective practices, and it promotes a positive tate resiliency and adaptive development parent–child relationship. Fourth, creating real- (Maccoby & Martin, 1983 ) . istic expectations involves choosing develop- The link between caregiver responsiveness mentally appropriate goals for the child’s and child functioning permeates numerous areas behavior. This reduces the risk of child abuse, of development. A highly connected response which often stems from unrealistic expectations. pattern is related to positive socioemotional out- The last core aspect of positive parenting focuses comes in children (Clark & Ladd, 2000 ) . on promoting a parent’s self-esteem and sense of Speci fi cally, parent–child connectedness is asso- well-being, so parents are able to develop and ciated with peer acceptance (Cohn, 1990 ) , qual- use coping strategies to address challenging ity friendships (Kerns, Klepac, & Cole, 1996 ) , emotions and stress. and altruism and moral development (MacDonald, Taken together, these fi ve core principles of 1992 ) . The nature of the affective bond also sets positive parenting promote family resilience and the stage for cognitive development and school reduce the risk of negative child outcomes. achievement. Children with secure attachment Negative effects that are correlated with poor bonds display problem-solving capabilities, parenting practices include outcomes such as emergent literacy skills, and overall school adjust- behavioral and emotional problems, substance ment (Pianta & Walsh, 1996 ) . In contrast, inse- abuse, antisocial behavior, and juvenile crime cure attachments have been linked to low levels (Sanders, 1999 ) . However, when parents proof mastery and peer competence in school set- vide age-appropriate rules and these rules are tings (Sroufe, 1989 ) . enforced in a predictable manner, family resilience is enhanced and child outcomes improve (Black & Lobo, 2008 ) . Kwok et al. (2005 ) Positive Parenting reported that positive parenting mediated the relationship between widowed parents’ psycho- Resilient families are also characterized by high logical distress and their children’s mental levels of positive parenting. According to Sanders health concerns. A longitudinal study (Conger ( 1999) , there are fi ve core aspects of positive & Conger, 2002 ) indicated that nurturing and parenting: ensuring a safe and engaging environ- involved parenting compensated for child dis- ment, creating a positive learning environment, tress related to economic hardship and inter- using assertive discipline, having realistic expec- parental confl ict. Additionally, positive outcomes tations, and taking care of oneself as a parent. of nurturing and involved parenting during First, in a safe and engaging environment, chil- adversity included positive school performance, dren are supervised while they explore, experiment, effective social relationships, and high self- and play. Next a positive learning environment is con fi dence. Low levels of antisocial behaviors established when parents respond positively and emotional distress, as well as few external- and constructively to child-initiated interactions izing and internalizing problems for adoles- through incidental teaching opportunities. In cents, were also correlated with positive environments that promote learning, children parenting practices. develop language, social, and problem-solving The parenting style and practices adopted by skills. The third aspect of positive parenting, primary caregivers play a critical role in the assertive discipline, is accomplished when parents growth and development of children. Parenting 9 Understanding and Promoting the Development of Resilience in Families 149 style is de fi ned as “a constellation of attitudes linked to student performance; optimal levels of toward the child that are communicated to the family involvement are positively related to child and that, taken together, create an emotional children’s scores on prereading (Hill, 2001 ) , climate in which the parents’ behaviors are reading (Clark, 1988) , and math tasks (Galloway expressed” (Darling & Steinberg, 1993 , p. 493). & Sheridan, 1994 ) . Whereas family involve- Authoritative parenting, which aligns with posi- ment may be conceptualized as involvement tive parenting (Kwok et al., 2005) , has been dem- with other family members, it can also be con- onstrated to be typically the most ef fi cacious style sidered in the context of connections to broad of parenting, and it is marked by predictable dis- support networks and community bases. Family cipline, mutual respect, warmth, affection, clear resilience is fostered when there are ties between expectations, and a level of fl exibility. Authoritative the family and the community, and when kin parenting has been positively linked to academic and social support are present (Cohen et al., achievement, positive peer relationships, and 2002; Walsh, 2003 ) . Black and Lobo (2008 ) independence in children (Keith & Christenson, describe family resiliency as an interaction 1997 ) . Further, parenting practices characterized between the family and community networks by positive, consistent discipline are correlated wherein the family receives information, com- with resiliency to stress in children (Wyman, panionship, services, and respite. This connec- Cowen, Work, & Parker, 1991) . Conversely, tion to the community is two way; the family authoritarian styles are less positively related to not only receives support, but they invest in child development and resilience. Authoritarian the community and give back. This connection or harsh, inconsistent parenting has been associ- to the community allows children to feel safe in ated with verbal aggressiveness and argumenta- their community and neighborhood, achieve tiveness (Bayer & Cegala, 1992 ; Grusec & higher grades, and exhibit fewer behavioral Goodnow, 1994 ) , conduct problems (Frick, 1993 ) , problems. Additionally, parents benefi t in and conduct disorders (Short & Shapiro, 1993 ) . domains including perseverance, hope, and companionship. An extension of family involvement, family Affective Involvement and Family engagement, is another characteristic of resilient Engagement families. Family involvement and family engagement are closely related, but a key distinction Another correlate of resilience is active and divides the two. Whereas family involvement can affective family involvement. Affective involve- be de fi ned in terms of activities, family engagement refers to the extent to which family mem- ment is concerned with the quality of interactions bers value and display interest in the activities between parents and children, and parents and of other family members (Epstein et al., 1993 ) . other caregivers as they participate or are involved An emphasis is placed on the amount of interest in those activities. Specifi cally, we defi ne family as well as the manner in which family members engagement as parents’ psychological, affective, demonstrate their interest and investment in one and active commitment to experiences support- another. Active family involvement fosters the ing children’s learning and development. development of resiliency and healthy adjust- Engagement is demonstrated through parents’ ment in children, and a key area in fl uenced by consistent and responsive interactions with their family involvement is educational outcomes. children, and between themselves and other care- Parent involvement in school is correlated with givers in their children’s lives. Key features of children’s positive attitudes toward school, this interaction might include attentiveness, school attendance, positive behaviors, and study warmth, sensitivity, enthusiasm, and positivity. and homework habits (Christenson & Sheridan, This interaction between parents and children 2001 ) . Further, family involvement is positively fosters family resilience. 150 S.M. Sheridan et al.

Communication and Problem Solving solving and communication. Alternatively, defi cits in family problem-solving skills are Another characteristic central to resilient families related to several types of childhood problems, is communication. Communication is de fi ned as including depression (Sanders, Dadds, Johnston, the exchange of information, ideas, or feelings & Cash, 1992 ) , delinquency in adolescence from one person to another. In families, clear (Krinsley & Bry, 1991 ) , and reduced psychoso- communication fosters family resilience by cial competence (Leaper, Hauser, Kremen, & allowing family members to develop a shared Powers, 1989 ) . sense of meaning regarding stressors or crises, as well as coping strategies, informed decision making, and collaborative problem solving (Walsh, Adaptability, Flexibility, and Stability 2003 ) . Clear communication also helps protect children because it discourages them from fi lling Every family faces situations throughout their in gaps in their knowledge or understanding with life course that present challenges to the manner inaccuracies. Communication allows families to in which family members relate to one another or achieve agreement and balance, as well as to be how the family unit functions within the commu- connected, fl exible, and able to organize resources nity (Patterson, 2002b ) . Family adaptability or (Bayat, 2007 ) . fl exibility refers to a family’s ability to modify Active problem solving is another character- and reorganize its rules, roles, and leadership; istic of families that demonstrate resilience in thus restoring balance between family members the face of a crisis or consistent adverse condi- and the family unit, and the family unit and the tions. Problem solving can be defi ned as a sys- community (Black & Lobo, 2008 ; Olson, 1993 ; tematic process that allows individuals to Patterson, 2002b ) . Walsh ( 2003 ) conceptualizes formulate solutions to identi fi ed problems. When fl exibility as providing families an opportunity to done effectively, it involves determining the bounce forward, as opposed to bouncing back. basis of the problem through analysis, objec- This distinction is made because a family can tively identifying and de fi ning a problem; gener- recover from a crisis, but they will not revert to ating potential alternatives; assessing, selecting, their previous state. Instead, with resilience, they and implementing the best choice; and evaluat- will improve and move forward. ing the outcomes in relation to its success at To function as a healthy system, families must ameliorating the original problem. Problem solv- be both adaptive and stable. Families that are able ing contributes to resiliency when the problem is to determine the appropriate times to maintain recognized by the family, lines of communica- stability or attempt change are more likely to be tion are open, and parents work together to coor- healthy, functional families (Black & Lobo, 2008 ; dinate each family member’s ideas and opinions Cohen et al., 2002; Olson, 1993 ) . Successful and (Black & Lobo, 2008 ) . Additionally, problem adaptive families are proactive in the socializa- solving builds family resilience when it involves tion and development of individual family mem- creative brainstorming among family members, bers and understand the importance of maintaining joint decision making, productive confl ict reso- the family unit (Patterson, 2002a ) . Accordingly, lution, and a plan to prepare for future challenges there are two central components of family adapt- (Cohen et al., 2002 ) . ability: adoption of optimal parenting styles and Parent communication during the problem- problem-solving practices, and developing a solving process has been linked to children’s shared set of beliefs or values within the family social functioning (O’Brien et al., 2009 ) , inter- unit. This is consistent with an ecological frame- personal skills, and confl ict resolution (Costigan, work that views both the interactions among fam- Floyd, Harter, & McClintock, 1997 ) . Addition- ily members and the relationship between the ally, there are strong links between the appro- family unit and the community as essential pieces aches parents and adolescents take in problem in developing family resilience. 9 Understanding and Promoting the Development of Resilience in Families 151

An important component for the development competencies. In addition, family-centered of family adaptability is the establishment of shared services promote resilience when they ensure beliefs within the members of the family. Shared positive and adaptive outcomes for families. values and beliefs are essential for family resilience These are described next, with emphasis on and reinforce speci fi c patterns in how a family their relevance for bolstering family resilience. reacts to new situations, life events, and crises (Antonovsky & Sourani, 1988 ; Walsh, 1996 ) . Base intervention efforts on family -identi fi ed When families have a strong set of shared beliefs, needs. From a family-centered perspective, fami- they may view their interaction with the world from lies are in the best position to identify their most a collective “we” vs. “I” orientation (McCubbin, salient needs. Thus, services are developed that McCubbin, & Thompson, 1993 ) . Resilient families are responsive to the priorities identifi ed by the often have a shared set of values for critical aspects family in collaboration with supportive profes- of family life, including fi nancial issues and time sionals. Likewise, commitment to change may be management (McCubbin & McCubbin, 1988 ) . greatest when families’ needs are self-determined. To build resilience, professionals can assist families as they strive to identify issues interfering Promoting Resilience in Families with optimal or desired levels of functioning, de fi ne them in manageable terms, establish shared Our conceptualization of family resilience is one and long-term goals, state clear objectives, deter- wherein family strengths and resources are lever- mine objectives essential to attaining short- and aged to overcome obstacles and challenges. The long-term goals, and clarify foci for intervention. ultimate function and purpose of families is to ensure the positive development and adaptation of Use existing family strengths and capabilities to children. Services or interventions intended to mobilize family resources. An overarching prin- build resilience realize this fundamental responsi- ciple of family-centered services is that all fami- bility. Thus, services that are family centered and lies have strengths and abilities. Circumstances strengths based (i.e., that support families as they causing a family stress or adversity may limit strive to become effective and self-suf fi cient in pro- their abilities to recognize, access, or use their moting positive child development) are the corner- strengths. Services based on family-centered stone of programs for building resilience. In other principles help family members to identify and words, the ultimate goal of services to promote mobilize their strengths and to use them to attain family resilience is to build caregivers’ competence goals that they articulate for enhanced familial and con fi dence in order to build competence and functioning (Garbarino, 1982 ) . con fi dence in their children (Sheridan, Marvin, Knoche, & Edwards, 2008 ) . Maximize social networks and supports . The Family-centered services are intended to development of collaborations and partnerships build family resilience based on the extensive within and across systems is essential to facilitate and seminal work of Dunst and colleagues families’ development of resilience. Positive, (Dunst & Trivette, 1987 ; Dunst, Trivette, & proactive linkages and networks help family Deal, 1988 ; Dunst, Trivette, & Deal, 1994 ) . members mobilize resources and supports that Four operating principles de fi ne family-cen- are available to them but that may have been per- tered approaches: (1) intervention efforts are ceived as inaccessible. An essential system inter- based on families’ needs; (2) existing strengths acting with children and families is that of the and capabilities of families are used to mobilize school. Schools and classrooms represent resources and promote abilities; (3) social net- signi fi cant contexts for development, and teach- works are used as a source of support; and (4) ers are meaningful individuals in a child’s life specifi c forms of helping behaviors on the part (Sheridan & Gutkin, 2000 ) . The establishment of of professionals promote acquisition of family partnerships between families and schools can be 152 S.M. Sheridan et al. critical for maximizing the growth potential for a on the fi nal outcome experienced by the family child. Positive, constructive relationships with system, but also the processes by which families other primary systems (i.e., schools) can be work toward the desired outcomes. In fact, it is instrumental in helping families develop compe- thought that the strengths-based empowering tencies and utilize resources on behalf of their process is the mechanism through which adaptive child’s development (Dunst et al., 1988 ; Sheridan outcomes are achieved. As a process that pro- & Burt, 2009 ) . The notion of “partnership” motes resilience through involvement, communi- implies that family members are co-equal part- cation, and adaptability, family-centered services ners in the identi fi cation of needs and goals, cre- assist family members to actively participate in ation of strategies and plans, and evaluation of enhancing their own lives. Families are engaged outcomes as programs and resources are utilized in identifying their own needs, mobilizing (Christenson & Sheridan, 2001; Welch & resources on their own behalf, and accomplishing Sheridan, 1995 ) . Thus, services are not delivered self-determined goals through the development “to” or “for” families, but “with” family mem- of personal capacities, strengths, and abilities. bers as active partners and decision makers. Through such processes, attainment of long-term, generalized positive outcomes is maximized. Use helping behaviors that promote the acquisition The strengths-based process by which profes- of competencies . When building resilience through sionals help families achieve their own goals is the a family-centered framework, professional roles cornerstone of family-centered service delivery. By focus on developing competence and con fi dence helping family members identify and prioritize among all family members. Capacity building needs, establish reasonable goals, and develop begins with an understanding and appreciation for appropriate plans, opportunities for positive family “where the family is.” Rather than utilizing strate- outcomes are maximized. Furthermore, strategies gies to “treat” problems or remediate defi ciencies, that are relevant and feasible for families, that result family-centered approaches strive to promote the in desired outcomes, and that provide new knowl- acquisition of family and child competencies. edge and skill will likely be used by family mem- Models focused on “correcting a problem” result in bers in the future when similar needs are present. a limited, often short-term resolution of one pre- Our work has focused on consultation models as senting concern. To build family resilience, ser- means for providing services promoting families’ vices must attend proactively to growth-producing acquisition of competencies and attainment of goals. behaviors. The development of strengths, assets, Although many forms of consultation exist in the and skills is expected to lead to generalization and literature (Gutkin & Curtis, 2009 ) , behavioral con- maintenance of resources to address a range of pre- sultation has received the most empirical support senting challenges in the future. (Martens & DiGennaro, 2008 ; Sheridan, Welch, & Ultimately, for families to be competent, Orme, 1996 ) . Conjoint behavioral consultation confi dent, and resilient, they must be empowered. (CBC; Sheridan & Kratochwill, 2008; Sheridan, Empowerment models support families in proac- Kratochwill, & Bergan, 1996 ) , an extension of tra- tively identifying needs, mobilizing resources, and ditional behavioral consultation, was developed accomplishing goals through the development of with the speci fi c goals of enhancing families’ skills personal capacities, strengths, and abilities. This is and developing cross-system partnerships. This contrasted to expert models, which often lead to model will be reviewed next, with attention to its dependency on the professional, fail to produce alignment with the goals of family resilience. personal resources (competence) and positive belief systems (con fi dence), and result in limited skills in assessing personal needs and mobilizing personal Conjoint Behavioral Consultation resources and support systems in the future. Based on an ecological-systems perspective, Concern is with process as well as outcomes . The CBC is a strengths-based service delivery model emphasis in family-centered services is not only acknowledging that families do not exist in a 9 Understanding and Promoting the Development of Resilience in Families 153 vacuum and that children function within and “…become better able to solve problems, meet across various systems in their environment needs, or achieve aspirations by promoting the (Bronfenbrenner, 1977 ; Sheridan, Kratochwill, acquisition of competencies that support and et al., 1996 ). The two primary systems in chil- strengthen functioning in a way that permits a dren’s lives are the home and school systems. greater sense of individual or group control over CBC recognizes that children, families, schools, its developmental course” (Dunst, Trivette, Davis, and other systems have a bidirectional, recipro- & Cornwell, 1994 , p. 162). Like family-centered cal infl uence over each other, and that the con- services, CBC is implemented in a manner that is nections among systems are essential for responsive to families’ needs, builds competen- facilitating positive outcomes for children. CBC cies and resilience within members, and promotes secures these connections by bringing together participation and collaboration among systems. families, schools, and other support systems in a The CBC process consists of four stages, collaborative manner to build social support implemented in a collaborative manner with fami- networks in efforts aimed at addressing the lies and school personnel working with the guid- needs of children. The process of CBC acknowl- ance of a consultant. Three of the four stages are edges the vital role of families and empowers initiated in the context of a structured interview them to be equal participants in the problem- with parents and teachers. The stages are (a) con- solving process. joint needs identi fi cation, (b) needs analysis, (c) CBC is defi ned as “a strength-based, cross- plan implementation, and (d) plan evaluation system problem-solving and decision-making (Sheridan & Kratochwill, 2008 ) . The objectives model wherein parents, teachers, and other care- of each stage, including objectives necessary for givers or service providers work as partners and both addressing concerns and enhancing relation- share responsibility for promoting positive and ships, are in Table 9.3 . During the needs consistent outcomes related to a child’s academic, identi fi cation stage, consultants work together behavioral, and social-emotional development” with parents and teachers to identify a child’s (Sheridan & Kratochwill, 2008 , p. 25). CBC can needs across the home and school settings, and be instrumental in promoting family resilience consultees decide upon target behaviors for inter- when challenges associated with children’s behav- vention. Consultants also assist parents and teach- ioral, academic, or social-emotional functioning ers in identifying valid procedures for collecting create hardships for the family system. In CBC, baseline data on the target behaviors across set- parents and teachers engage in a structured prob- tings. In the conjoint needs analysis stage of CBC, lem-solving process with a consultant to collab- parents and teachers evaluate the baseline data, oratively address the needs of children across decide upon behavioral goals for the child, and home and school settings. Parents and teachers discuss various factors that may infl uence the work as joint consultees to share in the child’s behavior (e.g., events functionally related identifi cation of children’s strengths and needs, to the target behaviors). Hypotheses are generated and to develop, implement, and evaluate interven- regarding the environmental or functional conditions to ameliorate those needs through proactive tions that may contribute to the occurrence of the intervention aimed at strengthening children’s target behaviors, and a plan is developed collab- skills and competencies. oratively to address the needs of the child. CBC services are based on several principles The third stage of CBC consists of plan imple- that parallel family-centered constructs (see mentation. During this stage, parents and teach- Table 9.2 ). The indirect nature of services allows ers implement the intervention procedures in the professionals to work with families and other home and school settings, supporting implemen- caregivers (e.g., teachers), who are ultimately tation across settings. The consultant remains in responsible for implementing programs and plans. close contact with parents and teachers through- By defi nition, consultation models (and CBC) out implementation of the intervention to provide strive to enable individuals (including families) to support, ensure understanding of the plan, offer 154 S.M. Sheridan et al.

Table 9.2 Characteristics of family-centered services and conjoint behavioral consultation Family-centered services (Dunst & Trivette, 1994) Conjoint behavioral consultation (Sheridan & Kratochwill, 2008 ) Help-giver Consultant Employs active and re fl ective listening Uses open ended questions and frequent summarizations to ensure understanding Helps clients clarify concerns and needs Provides help that is congruent with parents’ needs Pro-offers help in response to help-seeker Does not determine target behaviors and/or interventions indepen- needs dent of parents’ priorities Offers help that is congruent and matches the Develops data collection and intervention strategies based on what help-seeker’s appraisal of needs works in families’ environments Promotes acquisition of competencies to meet Focuses on existing skills, strengths, and competencies needs, solve problems, and achieve aspirations Allows locus of decision making to rest with Creates opportunities for families to acquire knowledge to manage the family member concerns (e.g., problem-solving approach, data-based decision making strategies, speci fi c interventions) Encourages skills learned in CBC to generalize for future problem solving Focuses on increased sense of self-ef fi cacy and empowerment among parents Promotes partnerships and parent- Promotes collaborative problem solving professional collaboration as the mechanism Promotes joint responsibility among home and school systems for for meeting needs problem and problem solutions Assists parents in learning strategies for working across systems to meet needs of the child Approaches systems work in a positive and proactive manner Focuses on common goals across systems rather than on problems within systems Adapted from: Sheridan, S. M., Erchul, W. P., Brown, M. S., Dowd, S. E., Warnes, E. D., Marti, D. C., et al., (2004). Perceptions of helpfulness in conjoint behavioral consultation: Congruity and agreement between teachers and parents. School Psychology Quarterly, 19 , 121–140 assistance, reinforce parents’ and teachers’ inter- of family-centered services, as the goals of CBC vention efforts, and determine the need for any directly address these important principles. immediate plan modifi cations. The fi nal stage of Paralleling the goals of family-centered services CBC is the conjoint plan evaluation. During this outlined earlier, important goals of CBC include: stage, parents and teachers examine the behav- (a) address the needs that family members have ioral data collected to evaluate the effects of the for children; (b) use family strengths to address treatment and determine if the goals of consulta- concerns; (c) establish partnerships; and (d) tion have been met across the home and school develop and enhance the skills and competencies settings. The team discusses plans for continua- of family members (Sheridan & Kratochwill, tion, modi fi cation, or termination of the interven- 2008 ) . These relevant CBC goals and family- tion based on the child’s progress towards his or centered principles are described below. her goal and the family’s and/or teacher’s ability to maintain that progress. Address the needs that family members have for children . The primary goal of CBC is to effectively address the needs that parents, teachers, Goals of CBC and other caregivers have for children. These needs comprise the focus of consultation and are The CBC process described earlier provides a the basis for the services provided across settings. logical format for operationalizing the principles CBC consultants do not make assumptions 9 Understanding and Promoting the Development of Resilience in Families 155

Table 9.3 Behavioral and relational goals and objectives by CBC stage Behavioral (child) goals/objectives Relationship goals/objectives Needs Identi fi cation Stage (Building on Strengths) Identify strengths of the child, family, teacher, systems Establish joint responsibility in goal setting and decision making Behaviorally de fi ne the concern or need as it is represented Establish/improve working relationship between across home and school settings parents and teacher Explore environmental conditions that may be contributing to or Validate shared goals of supporting the child motivating problem behavior Determine a shared goal for consultation Identify strengths of the child, family, and school Clarify speci fi c settings within systems that will be the focus for Increase communication and knowledge regarding intervention the child, goals, concerns, and culture of family Explore within- and across-setting environmental factors that may and school contribute to or in fl uence behaviors Establish and implement baseline data collection procedures to set the stage for careful, systematic, data-based decision making Needs Analysis/Intervention Planning Stage (Planning for Success) Explore baseline data collected across settings Use inclusive language to strengthen partnerships between home and school Identify setting events, ecological conditions, and cross-setting Encourage and validate sharing of parents’ and variables that may be impacting the target concerns teachers’ perspectives of the priority behavior Investigate trends across settings (e.g., home and school) and Foster an environment that facilitates “give- highlight when appropriate and-take” communication across settings Elicit and provide information about the function or motivating Promote collaborative decision making and shared features of the behavior that are based on environmental (rather responsibility for plan development than internal) explanations Collaboratively design an effective intervention plan across settings that is sensitive to setting-speci fi c variables Link assessment to intervention through the interpretation of concerns in terms of environmental conditions and not internal causes Discuss general strategies and plans to be included in a treatment package across home and school settings Summarize the plan, being clear about what is to be done, when, how, and by whom Plan Implementation Stage (No formal meeting) Implement agreed-upon intervention across home and school Increase continuity in addressing child’s needs settings across settings Address questions, provide feedback, make immediate Communicate about strategies as they are being modi fi cations to plan as necessary implemented across home and school Assess changes in student’s behavior Plan Evaluation Stage (Checking and Reconnecting) Analyze treatment data in relation to baseline data Continue to promote open communication; home-school collaborative decision making Determine if the shared goals of consultation have been attained Reinforce joint efforts in addressing needs Evaluate the effectiveness of the plan across settings Discuss parents’ and teachers’ perceptions Discuss strategies and tactics regarding the continuation, Reinforce parents’ and teachers’ competencies modi fi cation, or termination of the treatment plan across settings for addressing future needs Schedule additional interviews if necessary Establish means for parents and teachers to Discuss ways to continue conjoint problem solving or shared continue to partner decision making 156 S.M. Sheridan et al. regarding the needs of families (i.e., what will Use family strengths to address concerns . become the focus of consultation services); rather, Importantly, the CBC process allows for an exam- they provide opportunities for families to express ination of teacher and family strengths and com- their concerns and determine mutual goals with petencies to address children’s needs. In CBC, other caregivers. This is the central objective of consultants acknowledge that teachers have exper- the needs identifi cation stage of CBC. tise in educational interventions and families have Families are engaged and empowered to partici- expertise relevant to the home environment. pate in needs identi fi cation and goal development Families have knowledge (e.g., information about through intentional efforts by consultants as they supports in the home, interactions with children, build a partnership orientation. Consultants provide children’s developmental histories) that can be an opportunity for families to describe and priori- used to address children’s needs in consultation. tize their needs and co-select targets that are thought Throughout the consultation process, consultants to create optimal family functioning. In this way, af fi rm families’ strengths and contributions, fur- the needs addressed in CBC are those that are most ther promoting their involvement in identifying central to families, thus increasing the probability and developing intervention components. For that families will devote their resources of time and example, the consultant may assess and highlight energy to follow through on plan development, intervention procedures families are already using implementation, and maintenance of positive throughout their daily routines. Highlighting the change. Consultants also incorporate fl exibility and family’s existing strengths in the home setting responsiveness in the process of prioritizing con- provides a sense of self-effi cacy for parents by cerns for intervention. For example, through data acknowledging their abilities to affect positive collection, parents may learn that the initial needs change in their child’s life (Dunst et al., 1988 ) . were misidenti fi ed and identify new priorities later Rather than focusing on barriers or families’ in the CBC process. This fl exibility helps to ensure lack of resources to cope with problems or hard- that the family’s most essential needs are met. ships, CBC consultants provide an atmosphere Similarly, the consultant incorporates fl exibility that supports families and allows their existing in developing interventions and data collection resources to set the foundation upon which methods used throughout the CBC process, helping resilience can be developed. Such a strength-based families determine those that fi t within their culture approach ensures that the focus of consultation is and environment. Successful data collection is more on families’ capabilities rather than on what is lack- likely to occur if an effective, practical, and ef fi cient ing in parenting skills and resources. Building on method of information gathering is developed— existing family strengths is essentially a matter of one that fi ts within the family’s routine. The same “meeting the family where they are” (Dunst et al., principle applies to selecting and implementing an 1988) and viewing family members as having intervention. The likelihood that families will feel strengths to be utilized to address the child’s needs. both comfortable with and empowered by imple- In this way, consultants provide services that are menting a plan for their child increases as the plan congruent and consistent with consultees’ needs. matches the schedule and culture of the family. Consultants encourage families to assess the Maximize partnerships and support networks . various factors that may contribute to or infl uence Strengthening social supports and promoting the target behaviors and goals of consultation. This partnerships and collaboration among systems analysis allows the consultation team to examine is an important principle outlined in family- various systemic factors that contribute to chil- centered services (Dunst & Trivette, 1987 ) . dren’s behavior (e.g., negative interactions with the CBC’s focus on establishing home-school part- child, ineffective routines, and/or lack of resources) nerships operationalizes this principle directly. and develop strategies aimed at strengthening or In CBC, home and school systems work in col- restructuring environmental contingencies that may laboration with one another to address mutual support positive adaptation in the child. goals for children. The CBC process allows 9 Understanding and Promoting the Development of Resilience in Families 157 schools and families to share in decision making data on speci fi c targets and information regarding and adopt equal responsibility for both the assess- environmental conditions that may affect chil- ment of needs and development of solutions. dren’s behaviors. Consultants assist parents in Likewise, parents and teachers actively partici- using this information to develop meaningful pate in data collection procedures and implemen- interventions that address children’s needs. tation of the interventions developed in CBC. Similarly, data are used to develop socially valid As a team, consultants, parents, and teachers goals and monitor progress. Continued assessment examine and evaluate data to verify the nature throughout the consultation process provides par- and extent of children’s needs. The consultant ents with an understanding of the data-based deci- facilitates the process but ensures that the teacher sion-making process. Parents learn strategies for and parent jointly determine goals and develop determining if goals have been met based on exist- and implement plans. General agreement among ing data, rather than subjective perceptions. the home and school systems regarding a shared Additionally, team members learn procedures for goal for consultation helps ensure continued part- modifying plans when behavioral goals are not nership between primary caregivers (i.e., parents met. Through this process, families learn the value and teachers) in the child’s social support sys- of using data to guide decision making regarding tems (i.e., the home and school), thereby promot- the child’s progress and the ef fi cacy of the inter- ing the immediate and future success of children vention. Each of the aforementioned skills devel- and their families. oped through participation in the CBC process provides families with tools that can be used to Develop and enhance the skills and competencies address future family needs. Families are empow- of parents and teachers . Consistent with a fam- ered by recognizing their existing competencies, ily-centered principle toward building compe- strengthening their skills, and acquiring tools for tence among parents (Dunst, Trivette, Davis independence, which lessens their dependence on et al., 1994 ; Dunst, Trivette, & Deal, 1994 ), an professionals for assistance in the future. important goal of CBC is to promote parents’ acquisition of skills and knowledge (Sheridan & Kratochwill, 2008 ) . The CBC process achieves Conclusion this goal through supporting and guiding the families’ engagement in identifying needs and for- Families in today’s society face many challenges mulating solutions. Given their active involvement, that can impede them from ensuring the healthy parents, teachers, and other caregivers gather development and adaptation of children. Family essential knowledge about aspects of the process resiliency is a concept by which families meet these such as the importance of identifying and defi ning challenges in a positive and adaptive manner, thus the child’s or family’s needs, assessing factors allowing them to ful fi ll their primary function of that may contribute to maintenance of a speci fi c socializing children. Understanding how resiliency behavior, mobilizing the family’s strengths and is developed and fostered within the family context resources, and developing interventions to can play a central role in the development of effec- achieve positive outcomes. tive interventions as well as to help strengthen Through the CBC process, families learn to pri- families when life stressors disrupt family func- oritize their concerns for children. During needs tioning. Interventions that strengthen family resil- identi fi cation, consultants help parents identify iency can provide families with skills for enduring specifi c behaviors to target for intervention, allow- challenging situations as well as preparing families ing for a more focused approach to problem solv- for handling similar situations in the future. CBC ing. Likewise, detailed strategies for monitoring has been described in this chapter as an example of primary concerns are discussed (i.e., methods of how current interventions can be used to promote data collection and evaluation). Throughout the family resiliency through an ecological, develop- consultation process, parents and teachers collect mental, and multicultural framework. 158 S.M. Sheridan et al.

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Child abuse is a pervasive societal problem, with posttraumatic stress disorder (PTSD), depres- nearly one million substantiated reports of child sion, and behavioral disorders constituting the maltreatment each year (U.S. Department of common psychiatric sequelae of maltreatment Health and Human Services, 2001 ) , many reported in children (Briere, Berliner, Bulkley, reported cases of actual abuse that are not verifi ed Jenny, & Reid, 1996 ; Chu & Dill, 1990 ; de la (Kaufman & Zigler, 1996 ) , and countless other Vega, de la Osa, Ezpeleta, Granero, & Domènech, cases that are never brought to the attention of 2011 ; Famularo, Kinscherff, & Fenton, 1992 ; authorities (Wolfner & Gelles, 1993) . Extant Kaufman, 1991 ; McLeer, Callaghan, Henry, & research has identi fi ed a host of negative seque- Wallen, 1994 ; Pynoos, Steinberg, & Wraith, lae associated with child maltreatment, includ- 1995) and adults (Springer, Sheridan, Kuo, & ing defi cits in interpersonal relationships, affect Carnes, 2007 ; Windle, Windle, Scheidt, & Miller, regulation, and self-development (Beeghly & 1995 ) . Cicchetti, 1994; Crittenden, 1992 ; Egeland & Given the deleterious and long-term effects of Sroufe, 1981 ; Maughan & Cicchetti, 2002 ) , as maltreatment, there is a continued need for well as increased rates of multiple psychiatric research in this area. A resiliency framework can diagnoses (Ammerman, Cassisi, Hersen, & Van be especially productive in guiding maltreatment Hasselt, 1986; Cicchetti & Carlson, 1989 ; research given that resiliency research focuses on Cicchetti & Toth, 1995 ; Egeland, Sroufe, & (a) delineating the pathways to positive adapta- Erickson, 1983 ) . Although not all abused chil- tion in abused children and (b) examining how dren develop diffi culties, many experience a children who experience considerable risk fac- chronic course of psychopathology, with tors and stressors, including physical trauma and neglect within the family context, come to “beat the odds.” Resiliency research explores the pro- S. Houshyar cesses, moderators, and mechanisms that facili- Yale University School of Medicine , New Haven , CT , USA tate positive adaptation and can provide a guide e-mail: [email protected] for the development of targeted intervention A. Gold practices aimed at attenuating the deleterious Department of Psychology, Yale University, effects of maltreatment. P.O. Box 208205, New Haven, To date, pioneering investigators have set a CT 06520-8205, USA strong foundation for resiliency research in widely e-mail: [email protected] disseminated empirical and theoretical reports M. DeVries ( ) (Cowen & Work, 1988 ; Cowen, Work, & Wyman, Neurology, Learning and Behavior Center , Salt Lake City , UT , USA 1992, 1997 ; Garmezy, 1992, 1993; Garmezy, e-mail: [email protected] Masten, & Tellegen, 1984 ; Luthar, Cicchetti, &

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 161 DOI 10.1007/978-1-4614-3661-4_10, © Springer Science+Business Media New York 2013 162 S. Houshyar et al.

Becker, 2000 ; Luthar, Doemberger, & Zigler, basic behavioral and biological processes to 1993 ; Luthar & Zigler, 1991 ; Masten, 2001 ; inform clinical studies. This is becoming increas- Masten & Coatsworth, 1998 ; Masten et al., 1999 ; ingly plausible with the growth and integration of Rutter, 1990, 1995, 1996 ; Werner, 1992, 1993, brain and behavior research, the merging of the 1995) . Seminal works by resiliency researchers fi elds of developmental psychology and neuro- have led to considerable advancements in the conscience, advancements in neuroimaging and ceptualization, implementation, and dissemina- genetics research methodology, and fi ndings tion of resiliency research. Owing to notable from preclinical (e.g., animal) studies that exam- progress, researchers have identifi ed a host of pro- ine the impact of stress on behavior, physiologi- tective factors and mechanisms that contribute to cal reactivity, neural circuitry, and gene expression resiliency in high-risk populations. (Cicchetti & Tucker, 1994 ; Maier & Watkins, One protective or modifying factor that has 1998 ) . been recurrently associated with positive out- As an example of this approach, Field and comes in maltreated children is the presence of a her colleagues utilized fi ndings from studies of supportive and stable caregiver. The availability rat pups separated from their mothers to design of a caring and stable parent or alternate guardian an intervention for preterm infants that required has been identi fi ed as one of the most important extended incubator stays and prolonged periods factors that distinguish abused individuals with of motherÐinfant separation (Scafi di & Field, good developmental outcomes from those with 1997; Schanberg & Field, 1987 ) . Speci fi cally, more deleterious outcomes (Beeghly & Cicchetti, animal studies have long established that sepa- 1994 ; Cicchetti & Toth, 1995 ; Kaufman & ration of a rat pup from its mother is associated Henrich, 2000 ; Pynoos et al., 1995 ) . In children, it with a host of negative behavioral and biologi- decreases the likelihood of the development of cal consequences, including decreased growth PTSD and depressive disorders (Kaufman, 1991 ; hormone secretion. Through a series of studies, Pynoos et al., 1995 ) , reduces the risk for the devel- investigators were able to determine that it was opment of behavior problems (Newton, Litrownik, the absence of maternal tactile (e.g., Ucking) & Landsverk, 2000 ) , and is associated with better stimulation that was associated with decreased school achievement (Cook, Fleishman, & Grimes, growth hormone secretion during periods of 1991 ) . Adults who were maltreated in childhood separation (Hofer, 1987 ) , and they were able to who report the presence of a supportive parent or prevent separation-induced decrements in foster parent as a child have been found to have growth hormone levels by simulating maternal more years of education (Cook et al., 1991 ; tongue-licking behavior with a wet paintbrush Zimmerman, 1982 ) , greater housing stability during periods of motherÐinfant separation (Meier, 1965 ) , higher rates of self-support (Schanberg & Field, 1987 ) . These fi ndings were (Zimmerman, 1982 ) , decreased risk of persistent instrumental to the formulation of massage violent antisocial behavior (Widom, 1991 ) , therapy for preterm infants that require mater- decreased likelihood of early parenthood (Cook nal separation during incubator treatment. et al., 1991 ) , better parenting skills, and lower Massage treatment of preterm infants has been rates of problems in caring for the next generation found to increase growth hormone secretion, (Kaufman & Zigler, 1989 ; Zimmerman, 1982 ) . improve weight gain, decrease the time required for intensive care, and increase performance on measures of social and motor skill development Chapter Framework and Organization (Sca fi di & Field, 1997 ; Wheeden, Sca fi di, Field, & Ironson, 1993 ) . Cocaine- and HIV-exposed This chapter is organized using a translational preterm infants have also been found to bene fi t framework. Translational research in the behav- from massage therapy (Scafi di & Field, 1997 ; ioral and social sciences utilizes knowledge of Wheeden et al., 1993 ) . This example demon- 10 Resiliency in Maltreated Children 163 strates how basic research can be utilized to delineate mechanisms involved in producing Key Structures and Neurotransmitter different deleterious outcomes (i.e., an absence Systems Involved in the Stress of touch leading to a decrease in growth hor- Response: Overview mone secretion and blunted growth) and suggests novel intervention strategies for high-risk The brain responds to stress in a complex and populations (i.e., massage therapy for prema- orchestrated manner, with both general and stimuli- ture infants). It also highlights that even though speci fi c components to the stress response (Lopez, biological mechanisms may be responsible for Akil, & Watson, 1999 ) . However, knowledge about producing certain deleterious outcomes (e.g., the structural and functional components of the reduced growth hormone secretion leading to stress system is still evolving. The review of the blunted growth), psychosocial interventions stress response included in this section is not can still be effective. exhaustive. It focuses on key components of the This chapter on resiliency in maltreated chil- stress system and emphasizes the structures and dren is comprised of seven sections. The fi rst sec- neurotransmitter systems most extensively studied tion reviews key structures and neurotransmitter in preclinical studies examining the long-term systems involved in the stress response; the effects of early stress. The reader is referred to second section reviews preclinical studies of additional reviews for a more detailed discussion of the neurobiological effects of early stress; and the central and peripheral components of the stress the third section discusses factors that modify the system (e.g., Chrousos, 1998 ; Gold & Chrousos, impact of these experiences. The fourth section 2002 ; Heim & Nemeroff, 2001 ; Lopez et al., 1999 ; highlights similarities in the neurobiological cor- Manji et al., 2003 ; Vaidya & Duman, 2001 ) . relates of stress and PTSD in adults, the fi fth sec- Figure 10.1 depicts the functional connection discusses developmental issues in the tions among the different cortical and subcorti- application of these research fi ndings, and the cal brain regions involved in the stress response sixth section brie fl y discusses factors that modify (Kaufman, Plotsky, Nemeroff, & Chamey, 2000 ) . the impact of early maltreatment identifi ed in There is growing appreciation of the role of cor- clinical studies. The data reviewed in these sec- tical inputs, with medial prefrontal cortex (PFC), tions preliminarily suggest that (a) genetic fac- anterior cingulate, and orbital PFC currently tors infl uence outcomes of maltreated children, understood to play an important role in relaying (b) a positive supportive caregiver (i.e., attach- information from primary sensory and associa- ment) is a protective factor that minimizes neuro- tion cortices to subcortical structures involved in biological changes and other negative sequelae the stress response (Lopez et al., 1999 ) . The associated with child maltreatment, and (c) more medial and orbital PFCs are reciprocally inter- work is needed to understand geneÐenvironment connected, and each has connections with the interactions in determining developmental out- hypothalamus and amygdala (An, Handler, comes of maltreated children. Ongur, & Price, 1998 ; Bernard & Bandler, 1998 ; In the fi nal section of this chapter, the clinical Krout, Jansen, & Loewy, 1998; Ongur, An, & implications of this research are discussed in the Price, 1998 ) . These prefrontal regions appear to context of the Adoption and Safe Families Act be critical in restraining the acute stress response (P.L. 105-89), legislation aimed at promoting (Herman & Cullinan, 1997 ) . The mPFC is also secure and stable attachment relations for mal- reciprocally connected with the mediodorsal treated children. The objective of this chapter is thalamic nucleus (Groenewegen, 1988 ) and has to highlight the bene fi t of multidisciplinary extensive connections with the ventral tegmental research efforts in resiliency research with mal- area, substantia nigra, nucleus accumbens, raphe, treated children with foci that span from neurobi- locus coeruleus (LC), and brainstem autonomic ology to social policy. nuclei (Drevets, Ongur, & Price, 1998 ) .

Fig. 10.1 Key cortical and subcortical structures involved to the perdiaqueductal gray and parabrachial nucleus. The in the stress response. Medial prefrontal cortex (PFC), ante- mPFC is also reciprocally connected with the mediodorsal rior cingulate, and orbital PFC relay information from pri- thalamic nucleus and has extensive connections with the mary sensory and association cortices to subcortical ventral tegmental area, substantia nigra, nucleus accumbens, structures involved in the stress response. Medial and orbital raphe, locus coeruleus, and brainstem autonomic nuclei. PFC are reciprocally interconnected. The medical and These connections facilitate initiation and regulation of the orbital cortices provide direct inputs to the hypothalamus, endocrine response to stress that is mediated by the coer- and are reciprocally connected with the amygdala. Not show uleus. PFC = prefrontal cortex; straight line = stimulatory; in the diagram are indirect connections from these prefron- dotted line = inhibitory. Source: Reprinted from Kaufman, tal structures to the hypothalamus and amygdala via inputs Plotsky, Nemeroff, & Charmey, 2000

Fig. 10.2 Neurotransmitter systems utilized by subcorti- initiates the endocrine response to stress. CRH then cal structures involved in the stress response. The release promotes the release of ACTH from the pituitary, which of neurohormone CRH from the PVN of the hypothalamus initiates the release of glucocorticoids from the adrenals. 10 Resiliency in Maltreated Children 165

Figure 10.2 depicts in more detail the relation- 1999 ; Valentino, Curtis, Page, Pavcovich, & ship among subcortical structures involved in the Florin-Lechner, 1998 ) . The amygdala is activated stress response, and the neurotransmitter systems during stress by ascending catecholamine neu- involved in the transmission of information rons originating in the brainstem and by cortical between the different brain regions. Corticotropin association neurons involved in processing stress- releasing hormone (CRH) is the neurohormone ful stimuli via direct and indirect medial and that initiates the endocrine response to stress. It is orbital prefrontal cortical connections (Lopez secreted from the paraventricular nucleus (PVN) et al., 1999) . CRH neurons in the amygdala of the hypothalamus. Among the numerous inputs respond positively to glucocorticoids and activate to the hypothalamus, noradrenergic inputs are pri- the LC/NE component of the stress system mary in promoting the synthesis and release of (Lopez et al.). CRH (Plotsky, Cunningham, & Widmaier, 1989 ) . The hippocampus, in contrast, serves to inhibit The main noradrenergic inputs into the hypothala- the stress response via multiple direct and indirect mus appear to be derived from medullary sources, links with several of the brain structures activated the nucleus of the solitary tract (NTS), and the during stress (Lopez et al., 1999 ) . For example, ventrolateral medullary oblongata (Pacak, CRH synthesis in the amygdala is inhibited by Palkovits, Kopin, & Goldstein, 1995 ) . CRH then gamma-aminobutyric acid (GABA) inputs from binds to receptors at the anterior pituitary gland the hippocampus (Owens & Nemeroff, 1991 ) . and, through a cascade of intracellular events, The hippocampus also inhibits the LC via direct promotes the release of adrenocorticotropin connections and inhibits the hypothalamus via (ACTH). ACTH then promotes the synthesis and indirect inputs through the lateral septum and bed release of glucocorticoids (Cortisol in primates. nucleus of the stria terminalis (BNST). corticosterone in rats) from the adrenal cortex The stress response is further modi ﬁ ed by (Arborelius, Owens, Plotsky, & Nemeroff, 1999 ) . serotonin (5HT) inputs from the raphe to the Glucocorticoids regulate energy availability and amygdala, hypothalamus, and the hippocampus utilization and provide negative feedback to the (Lopez et al., 1999 ) . The latter 5HT neurons ter- stress system at the pituitary, hypothalamus, and minate on inhibitory GABA neurons. other central sites involved in the stress response. The LC appears to be the critical site in initiating the autonomic response to stress and promot- Neurobiological Effects of Early ing the release of norepinephrine (NE) and Stress: Preclinical Studies epinephrine (EPI) into the periphery. It receives endogenous CRH inputs from the central nucleus Building on the seminal work of Levine and col- of the amgydala (Jezova, Ochedalski, Glickman, leagues (Coe, Mendoza, Smotherman, & Levine, Kiss, & Aguilera, 1999 ; Page & Abercrombie, 1978 ; Levine, Wiener, & Coe, 1993 ; Wiener,

Fig. 10.2 (continued) Glucocorticoids provide negative raphe nuclei to the PVN, hippocampus, and amygdala. feedback at the pituitary and PVN, among other sites. The GABAergic interneurons located at each of the structures release of CRH from the PVN is modi ﬁ ed by mutliple likely further modify stress reactivity, as do connections neurotransmitters, but NE inputs from the medullary from multiple other brain regions including the PFC, thal- nuclei provide the primary stimulus for CRH synthesis amus, association cortex, and mesocortical and mesolim- and release. CRH also acts as a neurotransmitter to initiate bic structures. NE = norepinephrine; CRH = corticotropin the autonomic response to stress. The autonomic compo- releasing hormone; PVN = paraventricular nucleus; nent of the stress response is initiated by CRH inputs from CnAmy = central nucleus of the amygdala; GABA = gam- the CnAmy to the LC. Glucocorticoids provide positive ma-aminobutyric acid; 5-HT = serotonin; EPI = epineph- stimulation to the CnAmy, which promotes the synthesis rine; PFC = prefrontal cortex; L. Septum = lateral septum; and release of CRH. The hippocampus serves to inhibit BNST = bed nucleus stria terminalis; solid lines = stimu- the stress response via multiple direct and indirect latory inputs; dotted lines = inhibitory inputs. Source: GABAergic inputs to the PVN, amygdala, and LC. The Reprinted from Kaufman, Plotsky, Nemeroff, & Charney, stress response is further modi ﬁ ed by 5HT inputs from the 2000 166 S. Houshyar et al.

Johnson, & Levine, 1987 ) , numerous investigators the fi rst 3 weeks of life have been found in have documented long-term neurobiological adulthood to have reduced GABAA receptor bind- changes in animals subjected to multiple prenatal ing in the amygdala and the frontal cortex. They and postnatal stress paradigms (Graham, Heim, have also been found to have reduced central ben- Goodman, Miller, & Nemeroff, 1999 ; Takahashi zodiazepine binding in the amygdala, LC, and & Kallin, 1991) . This review focuses on long- NTS. These effects are associated with decreased term effects of early stress on hypothalamic pitu- expression of mRNA for the 72 subunit that itary adrenal (HPA) axis function and central encodes for the benzodiazepine site of the GABAA CRH, NE, serotonin (5-HT), and gamma-amin- receptor. In addition, adult rats separated from obutyric acid/benzodiazepine (GABA/BZ) sys- their mothers during the fi rst 3 weeks of life also tems. Structural brain changes associated with had increased mRNA expression for the a2 and a3 early and/or severe stress will also be reviewed. subunits and decreased expression of the a^ sub- Extensive research has been conducted exam- unit mRNA (Caldji et al., 2000 ) . This profi le is ining the neurobiological effects of early mater- associated with decreased GABA binding (Wilson, nal separation, with these experiences associated 1996) . It is likely that the dampened GABAergic with increased CRH and NE drive in adulthood tone in rats exposed to maternal separation con- (Francis, Diorio, Liu, & Meaney, 1999 ; Ladd, tributes to the enhanced CRH expression in the Owens, & Nemeroff, 1996 ; Liu, Caldji, Sharma, amygdala and the increased stress-induced activa- Plotsky, & Meaney, 2000 ) . Rat pups separated tion of the noradrenergic systems (Francis, Caldji, from their mothers 6 h/day during the fi rst 3 et al., 1999 ) . weeks of life have been found to have increased In an attempt to more closely parallel the basal and stress induced ACTH concentrations experience of neglectful parenting and exposure and decreased CRH binding in the anterior pitu- to stressful environments in young nonhuman itary (Ladd et al., 1996 ) . Maternal deprivation primate infants, Coplan et al. (1996 ) subjected has also been associated with increased CRH macaque infantÐmother dyads to variable forag- mRNA expression in the hypothalamus PVN ing demands. Primates in the low foraging and increased CRH concentration in the median demand condition had easy access to food, pri- eminence (Plotsky & Meaney, 1993 ) . It has mates in the high foraging demand condition had also been associated with increased CRH mRNA to work hard to fi nd food, but foraging demands expression in the central nucleus of the amygdala; and food supply were predictable, and primates increased CRH content in the parabrachial in the variable foraging demand condition experi- nucleus, a region that adjoins the LC; increased enced changing and unpredictable access to food. CRH binding in the LC; and increased NE con- In adulthood, consistent with the maternal depri- centration in the hypothalamus (Menzaghi, vation rodent studies discussed above, monkeys Heinrichs, Pich, Weiss, & Koob, 1993 ) . reared in the variable foraging condition had Nonhuman primates subjected to maternal sepa- higher cerebral spinal fl uid CRH concentration ration early in life have also been found to have than monkeys reared under the two other more elevated cerebrospinal fl uid NE in response to predictable and less-stressful experimental con- an acute stressor (Kraemer, Ebert, Schmidt, & ditions (Coplan et al., 1996 ) . The variable forag- McKinney, 1989 ) (for reviews see Francis, ing condition was also associated with overactivity Diorio, et al., 1999 ; Ladd et al., 2000 ) . of the NE system (Rosenblum et al., 1994 ) . The increase in CRH and NE drive in mater- In addition to the neurochemical alterations nally deprived rats is also associated with a associated with early stress, severe stress also is decrease in tone of the inhibitory GABA/BZ sys- associated with hippocampus volume loss. tem (Caldji, Francis, Sharma, Plotsky, & Meaney, Neuronal atrophy in the CA3 region of the hip- 2000 ; Francis, Caldji, Champagne, Plotsky, & pocampus can be caused by 3 weeks of exposure Meaney, 1999 ) . Specifi cally, adult rats subjected to stress and/or stress levels of glucocorticoids to repeat separations from their mothers during (Sapolsky, 1996 ; Woolley, Gould, & McEwen, 10 Resiliency in Maltreated Children 167

1990 ) . At this level, glucocorticoids produce a Accordingly, handled rats have reduced CRH reversible decrease in number of apical dendritic mRNA levels in the hypothalamus and reduced branch points and length of apical dendrites of basal CRH concentration in the median emi- suffi cient magnitude to impair hippocampal-de- nence. Handled rats also have reduced CRH pendent cognitive processes, with the number of mRNA concentrations in the amygdala and lower damaged cells in the CA3 region of the hip- CRH content in the LC (Francis, Caldji, et al., pocampus found to correlate with the severity of 1999 ; Ladd et al., 2000 ) . They also have attenu- defi cits in learning escape behaviors in a T-maze ated CRH-induced activation of the LC and (Watanabe, Gould, & McEwen, 1992 ) . More sus- smaller resulting increases in extracellular NE tained stress and/or glucocorticoid exposure can levels in the hypothalamus after acute restraint lead to neurotoxicity, which is actual permanent stress (Liu et al., 2000 ) . Handled rats have loss of hippocampal neurons. Adult rats exposed increased GABAA receptor levels in noradrener- to high concentrations of glucocorticoids for gic cell body regions of the LC and NTS, as well approximately 12 h/day for 3 months experience as increased central benzodiazepine receptor lev- a 20% loss of neurons speci fi c to the CA3 region els in the amygdala, LC, and NTS (Francis, of the hippocampus (Sapolsky, Krey, & McEwen, Caldji, et al., 1999 ) . In addition, as adults, han- 1985 ) . Evidence of stress-induced neurotoxicity dled rats have attenuated age-related cell loss in of cells in this region has been reported in mature the hippocampus and improved performance on nonhuman primates as well (Sapolsky, 1996 ; Uno hippocampal-mediated cognitive tasks (Meaney, et al., 1994 ) . Reductions in hippocampal volume Aitken, Bhatnagar, & Sapolsky, 1991 ; Meaney can also be affected by decreases in neurogenesis et al., 1993 ) (for additional reviews see Francis, (Gould & Cameron, 1996 ) . The granule cells in Diorio, et al., 1999 ; Ladd et al., 2000 ) . the dentate gyrus of the hippocampus continue to proliferate into adulthood, and neurogenesis in this region is markedly reduced by stress (Gould, Factors That Modify the Impact Tanapat, Rydel, & Hastings, 2000 ; McEwen & of Early Stress: Preclinical Studies Magarinos, 2001 ; Sapolsky, 2000 ) . In contrast to the negative effects of early The studies reviewed in the prior section demon- stress, rats that were given positive stimulation strate that early life experiences can have pro- via 15 min of handling per day during the fi rst 3 found effects on brain structure and function. weeks of life have been found to have reduced There are emerging data to suggest, however, that stress reactivity in adulthood when compared to the subsequent caregiving environment can mod- nonhandled or maternally separated rats (Plotsky erate the adverse effects of early stress. In con- & Meaney, 1993 ) . Speci fi cally, in adulthood, rats ducting the handling experiments, Meaney et al. handled in the fi rst 3 weeks of life show decreased noted that there were marked differences in the fearfulness in novel environments. The neurobio- maternal behavior of the mothers of handled and logical alterations associated with early handling nonhandled pups, with the former group spend- are essentially the opposite of those reported in ing signi fi cantly more time licking and grooming maternally separated rats. Handled rats show their offspring than the latter group (Woodside, reduced ACTH and corticosterone response to Meaney, & Jans, unpublished observation). exogenous stressors, with quicker return of corti- To determine if the differences in maternal costerone to baseline levels. They also show behavior were related to differences in stress reac- enhanced negative feedback of circulating gluco- tivity of handled and nonhandled rats, Meaney and corticoids, and increased glucocorticoid receptor colleagues examined multiple indices of stress mRNA expression and glucocorticoid receptor reactivity in adult rats reared by mothers with sim- number in the hippocampus and the frontal cor- ilar natural occurring differences in maternal tex, sites involved in the inhibitory control of behaviors (Caldji et al., 1998 , Liu et al., 1997, CRH synthesis in hypothalamic neurons. 2000 ) . They found that the adult offspring of 168 S. Houshyar et al.

high-licking and grooming mothers reared without normalize maternal behavior by the dams and the any experimental manipulations showed greater adult offspring that had been assigned to the exploration in novel environments and had reduced maternal separation condition appeared like han- plasma ACTH and corticosterone response to dled animals rather than like maternally separated acute stress. The animals also showed increased animals. These fi ndings are consistent with the hippocampal glucocorticoid receptor mRNA results of studies examining the effects of prenatal expression, enhanced glucocorticoid negative stress. In these studies “adoption” with “optimal feedback sensitivity, and decreased hypothalamic parenting” has also been found to reverse the HPA CRH mRNA levels. They also had decreased CRH axis alterations typically observed in these experi- mRNA expression in the amygdala, increased cen- ments (Barbazanges et al., 1996 ; Maccari et al., tral benzodiazepine receptor number in the 1995) . These results are consistent with emerging amygdala and LC, decreased CRH receptor den- data demonstrating the powerful role of different sity in the LC, and decreased stress-induced NE components of motherÐinfant interaction (e.g., secretion from the hypothalamus. These results tactile stimulation) in regulating physiological parallel the fi ndings observed in handled rats and systems involved in the stress response (Caldji suggest that maternal licking and grooming behav- et al., 1998 ; Feldman, Singer, & Zagoory, 2010 ; iors may “program” the development of the neural Kuhn & Schanberg, 1998 ) . systems that mediate reactivity to stress (Caldji These preclinical studies suggest that the et al., 1998 ) . These studies raised questions as to effects of early experiences can be modi fi ed by whether the neurobiological changes associated subsequent rearing experiences. As the infl uence with maternal separation and handling were due to of genetic factors or strain effects has been well the early experimental manipulation or to subse- established in preclinical studies of stress reactiv- quent differences in maternal behavior. ity (Dhabhar, McEwen, & Spencer, 1997 ) , the To determine if the neurobiological changes cross-fostering studies raise questions as to associated with early experimental manipulations whether manipulations in parenting can overcome could be altered by subsequent caregiving experi- genetic and/or breed differences in stress reactiv- ences, rat pups exposed to early handling or ity. To address this question, Anisman and col- maternal separation experiences were cross- leagues subjected BALB/cByJ and C57BL/6ByJ fostered with dams whose pups were assigned mice to early handling experiences and randomly the same or opposite condition (Gonzalez, Ladd, assigned them to BALB/cByJ or C57BL/6ByJ Huot, Owens, & Plotsky, 1999 ) . In the initial set mothers for subsequent rearing (Anisman, of experiments, handled pups were either cross- Zaharia, Meaney, & Merali, 1998 ; Zaharia, fostered to other dams assigned to the handled Kulczycki, Shanks, Meaney, & Anisman, 1996 ) . condition or to dams assigned to the maternal BALB/cByJ mice are inherently high reactors and separation condition. Similar cross-fostering was have elevated corticosterone and brain cate- performed on pups exposed to the maternal cholamine (NE) responses to acute stressors. In separation condition. When tested as adults, the addition, mice of this strain exhibit impaired per- handled pups cross-fostered to dams assigned to formance on a Morris water-maze, a hippocampal the maternal separation condition reacted to novel mediated memory task that is exacerbated by stressors like rats subjected to maternal separa- foot-shock (e.g., stress) application. Early han- tion during the neonatal period. Conversely, dling of BALB/cByJ mice reduced the learning maternally separated pups reared by dams impairments seen when mice were tested in the assigned to the handling condition looked more Morris water-maze as adults and prevented stress- like handled animals. induced elevations of corticosterone and distur- In a second set of experiments (Gonzalez et al., bances with task performance. Likewise, 1999 ) , dams assigned the maternal separation cross-fostering BALB/cByJ mice with conditions were provided with an age-matched C57BL/6ByJ dams prevented corticosterone foster litter during the period when their own pups hyperactivity and performance defi cits. However, were away. This simple manipulation seemed to cross-fostering and handling did not alter 10 Resiliency in Maltreated Children 169

stress-induced changes in NE concentration in the have been reported in adults with PTSD. For hypothalamus, LC, hippocampus, or PFC. Early example, adults with PTSD have been reported to handling and cross-fostering of the more resilient have multiple alterations of the HPA axis, includ- C57BL/6ByJ mice had no impact on maze perfor- ing: abnormal basal Cortisol secretion; altered mance, corticosterone stress reactivity, or brain negative feedback at the level of the pituitary; and NE. A similar set of fi ndings was reported by blunted ACTH secretion in response to adminis- investigators studying two different high- and tration of endogenous CRH (Arborelius et al., low-reactive rat species (Steimer, Escorihuela, 1999) . They have also been found to have Femandez-Teruel, & Driscoll, 1998 ) . Effects of increased central CRH drive, as evidenced by handling and cross-fostering were only observed reports of elevated concentrations of cerebrospi- in the high-reactive rats, and these experimental nal fl uid CRH (Baker et al., 1999 ; Bremner, manipulations only affected stress-induced corti- Licinio, et al., 1997) , increased central NE func- costerone levels, not central NE measures. tion, as evidenced by higher cerebrospinal fl uid These studies highlight the need for a better NE concentration (Geracioti et al., 2001 ) , and understanding of gene and environmental inter- altered activity in the orbitofrontal, prefrontal, actions in determining an individual’s stress reac- and temporal cortices after yohimbine adminis- tivity. They suggest that species with more tration, an NE antagonist (Bremner, Innis, et al., intrinsic reactivity are more responsive to the 1997) . Adults with PTSD also appear to have effects of environmental manipulations than spe- decreased GABA/BZ drive, as assessment with cies that are less intrinsically reactive, and that single photon emission computed tomography environmental manipulations have greater impact (SPECT) imaging of [ 123I] iomazenil binding on some (e.g., HPA axis), more than other (e.g., found adults with PTSD to have a reduced GABA/ central NE), neurobiological systems. Most BZ receptor number and/or binding in the PFC importantly they suggest the adverse effects asso- (Bremner et al., 2000 ) . ciated with early stress are not inevitable and can Structural changes have also been reported in be modi fi ed by intrinsic and extrinsic factors, adults with PTSD, with reduced hippocampal vol- with the quality of the subsequent caregiving ume in PTSD patients as compared to normal con- environment especially important in determining trols the most highly replicated fi nding (Bremner the long-term impact of early stress. et al., 1995 ; Bremner, Randall, et al., 1997 ; Driessen et al., 2000; Gurvits et al., 1996; Stein, Koverola, Hanna, Torchia, & McClarty, 1997 ; Villarreal et al., Similarities in the Neurobiological 2002; Vythilingam et al., 2002 ) , and magnitude of Correlates of Stress and Posttraumatic volume loss correlated with functional de fi cits in Stress Disorder in Adults verbal memory ability (Bremner et al., 1995 ; Bremner, Randall, et al., 1997 ) . In addition, in stud- PTSD is one of the most common sequelae of ies using magnetic resonance spectroscopy (MRS) early child maltreatment. As highlighted earlier, to assess neurochemical changes in the brain, indi- PTSD is but one of the many negative sequelae viduals with PTSD were found to have reduced associated with a history of abuse. This section A^-acetyl-l -aspartic acid (NAA) and creatine in focuses on the neurobiological correlates of PTSD the hippocampus region when compared to controls in adults to illustrate the utility of a translational (Freeman, Cardwell, Karson, & Komoroski, 1998 ; research approach in understanding the sequelae Schuff et al., 2001 ; Villarreal et al., 2002 ) . NAA of stress, as preclinical studies of the effects of reduction is typically interpreted as an indication of stress provide a valuable heuristic for thinking neuronal loss or damage (De Stefano, Matthews, & about the pathophysiology of PTSD and organiz- Arnold, 1995 ) , with associated loss in neuron num- ing fi ndings of the neurobiological correlates of ber, density, or neuronal metabolism (Birken & PTSD, in adults. Oldendorf, 1989 ) . Creatine reductions are sugges- Speci fi cally, many of the biological alterations tive of decreases in high energy phosphate metabo- associated with early stress in preclinical studies lism (Urenjak, Williams, Giadian, & Noble, 1993 ) . 170 S. Houshyar et al.

The neurobiological correlates reported in PTSD were noted to have reductions in integrity adults with PTSD are very similar to the neurobi- of the medial and posterior areas of the corpus ological changes associated with experiences of callosum (Jackowski et al., 2008 ) . early stress, with changes in key cortical and sub- Other areas of the brain that have been exam- cortical structures involved in the stress response ined for changes in children and adolescents with consistently reported in adults with PTSD. PTSD (De Bellis et al., 2002 ; De Bellis & Kuchibhatla, 2006 ) revealed that children and adolescents with PTSD had smaller overall cerebellar Developmental Factors volume as compared to children with generalized anxiety disorder and a group of nonabused healthy One very important caveat to add, however, is controls. De Bellis and Keshevan (2003 ) observed that there are important developmental issues that that adolescents with a history of maltreatment need to be better understood before preclinical and subsequent PTSD, and youth with PTSD and research fi ndings in this area can be optimally a history of suicidal ideation had larger pituitary informative in understanding the effects of stress volume when compared a control group. De Bellis on children. Although the preclinical studies et al. (2002 ) utilized magnetic resonance imaging examining the neurobiological effects of early to demonstrate that maltreated children and ado- stress provide a powerful heuristic for thinking lescents with PTSD had increased volume of the about the pathophysiology of PTSD in adults, the superior temporal gyrus as compared with con- application of this literature for understanding trols, possibly due to increased sensitivity to con- the neurobiology of PTSD in children is more ditioned auditory stimuli during development. limited. To the best of our knowledge, there is only one Speci fi cally there have been 13 structural neu- published structural MRI study in prepubescent roimaging studies to date in children with PTSD nonhuman primates that had been subjected to (Carrion et al., 2001 ; Carrion, Weems, & Reiss, early stress (Sanchez, Hearn, Do, Rilling, & 2007 ; De Bellis, Hall, et al., 2001; De Bellis & Herndon, 1998 ). Most preclinical studies of early Keshevan, 2003 ; De Bellis et al., 1999, 2002 ; De stress have examined the long-term impact of Bellis & Kuchibhatla, 2006 ; Jackowski et al., these experiences on brain development in adult 2008 ; Karl et al., 2006 ; Teicher et al., 2004 ; Tupler animals. Interestingly, the study with the young & De Bellis, 2006 ) with only two of the studies primates also failed to fi nd evidence of hippocam- reporting evidence of changes in hippocampal pal atrophy. Instead, consistent with the child and volume in children and adolescents with PTSD adolescent studies described above, the investiga- (Carrion et al., 2007 ; Tupler & De Bellis, 2006 ) . tors reported reductions in the medial and caudal Interestingly, Tupler and De Bellis observed portions of the corpus callosum in the juvenile, increases in hippocampal volume in children with nonhuman primates subjected to early stress PTSD that was positively correlated with age at (Sanchez et al., 1998 ). trauma and severity of psychopathology. The medial and caudal portions of the corpus While Carrion et al. noted reductions in hip- callosum contain interhemispheric projections pocampal volume in children with PTSD, their from the cingulate, posterior temporalÐparietal study did not include use of a comparison group. sensory association cortices, superior temporal Instead of hippocampal atrophy, children and sulcus, retrosplenial cortex, insula, and parahip- adolescents with PTSD were found to have a pocampal structures (Pandya & Seltzer, 1986 ). decreased area in the medial and posterior por- Several of the regions with interhemispheric tions of the corpus callosum (De Bellis & projections through the medial and caudal por- Keshevan, 2003 ; De Bellis et al., 1999, 2002 ; tions of the corpus callosum have direct connec- Karl et al., 2006 ; Teicher et al., 2004 ) . Consistent tions with prefrontal cortical areas and are with these reports, in a recent study using involved in circuits that mediate the processing of diffusion tensor imaging (DTI), children with emotion and various memory functions—core 10 Resiliency in Maltreated Children 171 types of disturbances observed in individuals the emerging clinical fi ndings suggest the adverse with PTSD. effects associated with early child maltreatment Given the prominence of corpus callosum are not inevitable and can be modifi ed by intrin- alterations in children and adolescents with PTSD, sic and extrinsic factors, with the quality of the our group has conducted a preliminary study subsequent caregiving environment especially using DTI in 14 maltreated children with PTSD important in determining the long-term impact and 16 normal controls (Jackowski, Douglas- of early abuse. Palumberi, Jackowski, Win, Schultz, Staib, Krystal, & Kaufman, 2008 ). DTI can be used to assess the integrity of white matter tracts in the Clinical Implications brain. Children with PTSD had signifi cantly greater mean diffusivity in the medial and poste- As discussed previously, the neurobiological cor- rior regions of the corpus callosum, a fi nding that relates reported in adults with PTSD are very is consistent with the possibility of reduced axonal similar to the neurobiological changes associated pruning early in development and decreased frac- with experiences of early stress. Translational tional anisotropy, a fi nding that is consistent with research approaches have been very productive in the possibility of reduced myelination in children delineating the pathophysiology of PTSD in with PTSD compared to aged-matched controls. adults and suggesting novel treatments for adults (Jackowski et al., 2008 ). with this disorder. The utilization of a developmental framework For example, the fi nding that administration in future preclinical and clinical studies will help of NE blocking agents immediately following an to enhance our understanding of the neurobio- acute stressor reduced the long-term neurobiological mechanisms that link child maltreatment logical effects of the stressor in rodents led to the with PTSD and other negative sequelae across trial of propranolol, a beta-adrenergic NE blocker, the life cycle. As noted above, most preclinical to prevent the onset of PTSD in adults who suf- studies of early stress have examined the long- fered an acute trauma (Pittman et al., 2002 ) . term impact of these experiences on brain devel- Preliminary positive fi ndings in the prevention of opment in adult animals. There is a need for more PTSD in adults administered propranolol follow- developmental work in this area. ing an acute trauma are very encouraging. The convergence of fi ndings in preclinical and clinical studies has also lead to the development of CRH Factors That Modify the Impact receptor type 1 antagonist drugs that are currently of Early Stress: Clinical Studies being tested for their effi cacy in treating PTSD (Arborelius et al., 1999 ) . In addition, as chronic As in the preclinical studies, emerging research antidepressant treatment with selective serotonin in clinical populations highlights the importance reuptake inhibitors (SSRIs) has been found to of examining gene and environmental interac- reverse hippocampal atrophy and promote neuro- tions in understanding the long-term impact of genesis in adult rodents (Duman, Nakagawa, & early child maltreatment. Work in this area is Malberg, 2001; Malberg, Eisch, Nestler, & still preliminary, and to date researchers have Duman, 2000) . SSRI medications have been primarily only documented the impact of famil- found to be effective treatments for PTSD in ial and genetic factors and the quality of the sub- adults, with chronic treatment associated with sequent caregiving environment on behavioral improvement of verbal declarative memory and clinical outcomes (Caspi et al., 2002 ; de fi cits and an increase in hippocampal volume Kaufman & Henrich, 2000 ) . The modifying (Vermetten, Vythilingam, Southwick, Chamey, effect of these factors on neurobiological & Bremner, 2003 ) . sequelae has been little explored (Kaufman et al., This section, however, focuses primarily on 1997 ) . However, as with the preclinical studies, the clinical implications of the stress research 172 S. Houshyar et al. for children and adolescents with a history of emerge, however, that provides preliminary child maltreatment. We currently know very lit- support for abuse prevention programs, and those tle about the pharmacological treatment of that aim to prevent the recurrence of abuse/neglect PTSD in children. For example, a small pilot and the deleterious effects of those maltreated study examining the effectiveness of propanolol youth (as reviewed by MacMillan et al., 2009 ) . in reducing PTSD symptoms in pediatric injury It has also been estimated that at least 50% of patients failed to reveal signifi cant main effects all child welfare cases involve substance abuse, for pharmacological intervention. Findings sug- with rates as high as 90% reported in some parts gested that gender may infl uence outcomes, of the country (National Center on Addiction and with boys showing nonsigni fi cant decreases in Substance Abuse, 1999 ). Birth parents cannot be PTSD symptoms when treated with propanolol. a viable attachment choice for children unless Girls, however, showed a signifi cant increase in they are given intervention to address their sub- PTSD symptoms when treated with the same stance abuse problems. medication (Nugent et al., 2010 ) . More work is Several states have developed innovative needed in this area, and, as discussed previously, approaches to increase services to address sub- more developmentally focused preclinical work stance abuse problems, including having adult is needed to guide research efforts with children addiction services liaisons work in child welfare and adolescents. of fi ces to facilitate client referral for treatment The extant preclinical and clinical literature (McAlpine, Marshall, & Doran, 2001 ) ; hiring reviewed, however, strongly suggests that facili- substance abuse counselors to work in child tating the formation of stable, secure, and posi- welfare offi ces to perform onsite evaluations tive relationships is essential to promoting good and identify appropriate resources for clients outcomes for children with a history of maltreat- (Semidei, Radel, & Nolan, 2001 ) ; and establishment (Kaufman & Henrich, 2000 ; Zielinski & ing family drug courts that provide a highly Bradshaw, 2006 ) . The Adoption and Safe structured venue within which treatment ser- Families Act (P.L. 105-89), passed in November vices are offered, sanctions are applied for non- 1997, was designed to facilitate permanency- compliance, and program progress is planning efforts on behalf of maltreated children. meticulously monitored allowing case planning Permanency planning involves the systematic decisions to be made more quickly on the basis implementation of interventions to secure a of better information (Semidei et al.). Dialectical caring, legally recognized, and continuous family behavior therapy (DBT) programs for substance for traumatized children (CWLA, 1994 ). These abusing parents can be an additional alternative efforts aim to maximize the likelihood of children promising approach worthy of evaluation with having at least one adult that they identify as a protective service cases, as DBT programs have psychological parent (Goldstein, Solnit, been found to be more effective than treatment- Goldstein, & Freud, 1996 ) . Permanency efforts as-usual for substance abusing patients with can result in family reunifi cation, placement with borderline personality disorder (Linehan et al., kin, or child adoption. 1999 ) —patients who exhibit many of the core Although the quality of child protection ser- dif fi culties observed among protective service vices departments varies from state to state, nation- clients (e.g., history of early childhood trauma, wide it is estimated that investigation is the only dissociative symptoms, intense unstable rela- “service” provided in response to reports of child tionships, dif fi culty tolerating distress, labile maltreatment in 40% of substantiated cases of affect, impulsiveness). child abuse and neglect (McCurdy & Daro, 1992 ) . There are several promising model programs In these cases, no interventions are provided to aimed at promoting permanency for maltreated reduce the risk of future maltreatment or alleviate children that warrant further systematic evalua- the effects of past abuse. Research is beginning to tion (Lieberman, 2003 ; Zeanah et al., 2001 ) . 10 Resiliency in Maltreated Children 173

Without permanency, the likelihood of positive outcomes is signi ﬁ cantly diminished. References

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Windle, M., Windle, R. C., Scheidt, D. M., & Miller, G. B. Genetic and maternal factors. Psychopharmacology, (1995). Physical and sexual abuse and associated men- 128 (3), 227Ð239. tal disorders among alcoholic inpatients. The American Zeanah, C. H., Larrieu, J. A., Heller, S. S., Valliere, J., Journal of Psychiatry, 752 (9), 1322Ð1328. Hinshaw-Fuselier, S., Aoki, Y., et al. (2001). Evaluation Wolfner, G. D., & Gelles, R. J. (1993). A proﬁ le of vio- of a preventive intervention for maltreated infants and lence toward children: A national study. Child Abuse toddlers in foster care. Journal of the American & Neglect, 17 (2), 197Ð212. Academy of Child and Adolescent Psychiatry, 40 , Woolley, C. S., Gould, E., & McEwen, B. S. (1990). 214Ð221. Exposure to excess glucocorticoids alters dendritic Zielinski, D. S., & Bradshaw, C. P. (2006). Ecological morphology of adult hippocampal pyramidal neurons. in ﬂ uences on the sequelae of child maltreatment: A Brain Research, 531 (1Ð2), 225Ð231. review of the literature. Child Maltreatment, 11 , Zaharia, M. D., Kulczycki, J., Shanks, N., Meaney, M. J., & 49Ð62. Anisman, H. (1996). The effects of early postnatal stim- Zimmerman, R. B. (1982). Foster care in retrospect. ulation on Morris water-maze acquisition in adult mice: Tulane Studies in Social Welfare, 14 , 7Ð13. Part III Resilience as a Phenomenon in Childhood Disorders Resilience and the Disruptive Disorders of Childhood 1 1

Sam Goldstein and Richard Rider

Given that the behavior of children with Introduction DBD’s are rarely viewed as benign by parents, teachers, and community professionals, it is not The Disruptive Behavior Disorders of childhood surprising that these conditions are comprised of (DBD) are comprised of Attention Defi cit patterns of impulsive, hyperactive, aggressive, Hyperactivity Disorder (ADHD), Oppositional and defi ant behaviors. These pose a signifi cant Defi ant Disorder (ODD), and Conduct Disorder adverse risk factor for a host of outcome vari- (CD) (APA, 2001 ) . These conditions are among ables into the late adolescent and young adult the most commonly treated in mental health set- years. In fact, even a single DBD compromises tings with epidemiological studies suggesting the probability of positive life adjustment into that between 3 and 16% of all youth meet the young adulthood. A combination of DBD’s diagnostic criteria for at least one, if not two or (e.g., ADHD and CD, ODD and CD) speak to more, of these conditions (Eiraldi, Power, & signifi cant adverse outcome in major life domains, Nezu, 1997 ; Loeber, Burke, Lahey, Winters, & including school, family, health, vocation, and Zera, 2000; for review see Barkley, 1998 and even activities such as driving (Barkley & Goldstein & Goldstein, 1998 ) . These conditions Gordon, 2002 ; Goldstein, 2002 ) . The DBD’s may have traditionally been referred to as “external- also act catalytically reducing a child’s opportu- izing disorders” as opposed to the “internalizing nity for normal life adjustment by precipitating a disorders” such as anxiety, depression, or learn- cascade of adverse outcomes into adulthood. ing disability. The former disrupt and disturb the A small percentage of children with ADHD immediate environment and are easily visible to and CD and an even greater percentage of chil- the observer. Symptoms and impairments of the dren with ODD alone manage to transition and latter are not as often observed nor are envi- adjust reasonably well into young adulthood ronments as disrupted by affected children and (Teeter Ellison, 2002 ) . Thus, if a speci fi c risk adolescents. such as chronically demonstrating a DBD signifi cantly contributes to adverse outcome, and current treatment efforts for DBD demonstrate that symptoms can be managed but symptom S. Goldstein () relief in the long-term doesn’t appear to Neurology, Learning and Behavior Center , Salt Lake City , UT 84102 , USA signifi cantly alter the adult outcome of these con- e-mail: [email protected] ditions, then researchers and clinicians must R. Rider identify and understand those variables within Bellin Psychiatric Center , Green Bay , WI , USA the child, immediate family, and community that e-mail: [email protected] predict better outcome. Thus, there has been an

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 183 DOI 10.1007/978-1-4614-3661-4_11, © Springer Science+Business Media New York 2013 184 S. Goldstein and R. Rider interest in studying resilience processes in chil- conditions, level of intellectual functioning, dren with DBD’s. If a group of children suffering family situations, such as, parental pathology, from one or more DBD’s can be identi fi ed who family adversity, socio-economic status, and treat- demonstrate the ability to transition successfully ment history (Goldstein, 2002 ) . These variables into the late adolescent and young adulthood are likely predictive for the other DBD’s as well. years, then perhaps the lessons learned from There is a broader literature available concern- studying these youth can generate a treatment ing the absence of certain negative phenomena in protocol of those thoughts, feelings, behaviors, predicting the outcome. For example, Herrero, experiences, attitudes, and opportunities enhance Hechtman, and Weiss (1994 ) demonstrated that resilience in a group of children whose adult out- females may experience less risk of adverse outcome have been demonstrated to be signi fi cantly come with DBD simply due to their gender. more risk- fi lled than those of others. Particularly Subtype differences in ADHD, speci fi cally chil- for youth with DBD’s, an increasing body of lit- dren with the inattentive type, may also reduce erature operating from a developmental pathways risk. The absence of impulsive behavior appears model has demonstrated that a number of child- to predict to better outcome. In fact, it has been hood variables can be used to predict risk of adult hypothesized that problems with self-control problems as well as to identifying insulating or characteristic of all three of the DBD’s may be the protective factors that reduce risk and increase best predictors of future adult outcome into young the chances of a satisfactory transition into adulthood when evaluating young children (for adult life (for review see Katz, 1997 ) . As a fi eld, review see Barkley, 1997 ) . researchers in the DBD’s are slowly beginning to Not surprisingly, aggressive behavior in gen- examine these protective factors. Though much is eral, is a diagnostic characteristic of ODD and CD, known about the risk factors, for the time being, as well as a common consequence of ADHD, has there is only limited data available about protec- been found to predict outcome into adulthood tive factors; however, it is quite likely that those (Loney, Whaley-Klahn, & Kosier, 1983 ) . Emotional factors that insulate and protect children from lability has also been highly correlated with aggres- other psychiatric conditions affect those with sion (Hechtman, Weiss, & Perlman, 1984 ) . It is DBD’s as well. Thus, living in an intact house- also likely that within the symptom listing for the hold, above the poverty level, with parents free of DBD’s, some may hold stronger positive or nega- serious psychiatric problems, consistent in their tive predictive power. Algorithmic research with parenting style, and available to their children these conditions has slowly begun to identify the whenever needed, appear to be among the most presence or absence of certain symptoms as not powerful factors predicting resilience in all chil- only predictive of condition presence but also dren as well as those with DBD’s (for review see speaking to outcome (Mota & Schachar, 2000 ) . Goldstein & Goldstein, 1998 ) . This chapter will provide an overview of the In a long-term follow-up studies, at least DBD’s, diagnostic symptoms, defi nition, and 70Ð80% of adolescents with a childhood diagno- prevalence. We will provide an overview of risk sis of ADHD or another DBD continue to meet and resilience factors that may contribute to the diagnostic criteria for at least one DBD with acquisition and exacerbation of these conditions at least 60% reporting impairing symptoms but over time. The chapter will conclude with a pro- fewer meeting the diagnostic criteria during the posed set of guidelines for the clinicians. adult years (for review Ingram, Hechtman, & Morgenstern, 1999) . These authors suggest that the decrease in prevalence is in part due to the Overview developmental nature of the diagnostic protocols for DBD’s. Prognosis for individuals with ADHD Over the past quarter century, multiple longitudinal in adulthood for example appears to be in fl uenced and retrospective studies have demonstrated that by the severity of their symptoms, comorbid youth exhibit two broad dimensions of disruptive 11 Resilience and the Disruptive Disorders of Childhood 185 behaviors. The fi rst dimension present for many appear to have a much worse prognosis than those children at a young age is characterized by a trinity demonstrating symptoms after that time (Moffi tt, of inattentive, hyperactive, and impulsive behaviors. 1990; Patterson, Debaryshe, & Ramsey, 1989 ) . Over the last 100 years this trinity fi rst described by Although some children demonstrate the onset of George Still (1902 ) as a disorder of defective moral CD and ODD simultaneously, the most serious control, has been described by various labels attest- symptoms of CD, including vandalism, repeating to hypothesized cause (minimal brain dysfunc- edly running away, truancy, shoplifting, break- tion), or key symptom (hyperactivity or inattention), ing, and entering, rape, assault and homicide, but is increasingly recognized as not so much a generally emerge at a later age than the symp- behavioral disorder but one of faulty cognitive func- toms of ODD. tioning (Barkley, 1997 ) . The second dimension of It can be easily argued that the DBD’s fall on disruptive behavior falls in two distinct groups. The a continuum from mild to severe beginning with fi rst, a group of oppositional and aggressive behav- ADHD then progressing through ODD and CD. iors, has consistently been found to be distinct from Though not all children with ADHD develop a second group of covert behaviors (Fergusson, ODD and CD, a signifi cant percentage of youth Horwood, & Lynskey, 1994 ; Frick, Lahey, & with CD have histories of ADHD. The younger a Loeber, 1993 ) . Overt behaviors include, but are not child progresses to CD, the more adverse is his or limited to, fi ghting, disobedience, tantrums, destruc- her outcome (Biederman, Faraone, Milberger, tion, bullying, and attention seeking. The second set Guite, et al., 1996 ; Campbell, 1991 ) . Further, of covert behaviors include, but are not limited to, boys experiencing CD in comparison to those theft without confrontation of the victim, choice of with only ODD, scored lower on tests of intelli- bad companions, school truancy, running away, gence, came from families of lower socio-eco- lying, and loyalty to delinquent friends (Achenbach, nomic status and had a history of greater confl ict Conners, Quay, Verlhulst, & Howell, 1989 ; Loeber with school and judicial systems (Robins, 1991 ) . & Schmaling, 1985 ) . Two aspects of this dimension Boys with CD demonstrated the strongest family have traditionally been thought to be strongly history of antisocial personality, a problem that in fl uenced by experience but likely also fi nd their could refl ect a combination of family, environ- roots in genetic vulnerability. Further, overt behav- ment, and shared family genetics. iors can be divided into those that are nondestruc- tive such as simply resisting adult authority and those that are aggressive towards others and destruc- Diagnostic Overview tive of property. The covert behaviors can be further divided into those again that do not confront vic- ADHD tims, such as vandalism and those that are nonde- structive such as truancy or running away from ADHD is described as a “persistent pattern of inat- home (Lahey, Frick, et al., 1990 ) . tention and/or hyperactivity” more frequent in Within the DBD’s, ADHD has consistently severity than is typical of children in a similar level been found as distinct from ODD and CD (for of development (APA, 2001 ). Some symptoms review see Barkley, 1998; Goldstein & Goldstein, must have been apparent before the age of 7 years, 1998 ; Hinshaw, 1987) . The DBD’s can also be although many children are diagnosed at later ages clearly distinguished from the internalizing dis- after symptoms have been observed for several orders of depression and anxiety (Taylor, years. Impairment must be present in at least two Schachar, Thorley, & Wieselberg, 1986 ) . ODD settings and interfere with developmentally appro- and CD appear to be distinct, although the two priate functioning in social, academic, or work set- disorders may well overlap in a number of ting. Assessment of impairment has been an behaviors such as mild aggression and lying. The increasing focus in making the diagnosis of ADHD . onset of ODD in comparison to CD appears to ADHD appears more common in males than be earlier. Children manifesting CD before age 10 females, a problem that may or may not be a function 186 S. Goldstein and R. Rider of the DSM fi eld studies and/or differences in prev- This pattern of behavior must have lasted for at alence and presentation (Goldstein & Gordon, least 6 months and be characterized by frequent 2003 ) . ADHD is characterized by developmentally occurrence of at least four of the following: loss inappropriate, often limited attention span and/or of temper, arguments with adults, de fi ance or hyperactivity and impulsivity. Six of nine inatten- refusal to comply with adults’ request or rules, tive symptoms must be present to con fi rm the inat- deliberately doing things that annoy people, tentive aspect of the disorder. DSM-IV-TR (2001) blaming others for personal failings, touchiness, did not delineate these symptoms by importance. anger, resentment, spite, or vindictiveness. CD is As noted, algorithmic research fi nds some symp- described in the DSM-IV-TR as a “repetitive and toms that may in fact demonstrate better negative or persistent pattern of behavior in which the basic positive predictive power than others (Mota & rights of others or major age appropriate societal Schachar, 2000 ) . The inattentive symptoms include norms or rules are violated.” ODD re fl ects an failing to give close attention to details, problems enduring pattern of negativistic, hostile, and with sustained attention, not listening when spoken defi ant behaviors in the absence of serious viola- to directly, failing to complete tasks, dif fi culty with tion of societal norms and the rights of others. organization, avoiding or reluctant to engage in Thus, children with ODD argue with adults, lose tasks requiring sustained mental effort, losing their temper, and are quick to anger. They fre- things, being easily distracted, and forgetful in daily quently defy reasonable requests or rules and activities. deliberately annoy others. They tend to blame Six of nine hyperactive-impulsive symptoms others for their mistakes. must be met to con fi rm the hyperactive-impulsive CD appears to refl ect an enduring set of behav- aspect of the disorder. The hyperactive symptoms iors that evolve over time. CD is characterized include fi dgeting, having trouble remaining seated, most often by signifi cant aggression and viola- demonstrating inappropriate activity, dif fi culty in tion of the rights of others. The average age of engaging in leisure activities quietly, acting as if CD is younger in boys than in girls. Boys may driven by a motor, and talking excessively. The meet the diagnostic criteria for CD if it is going to impulsive symptoms include blurting out answers develop by 12 years of age, whereas girls often before questions have been completed, diffi culty reach 14Ð16 before the diagnosis is made. Three waiting turn, and interrupting others. If in fact or more of the following behaviors must occur ADHD represents failure to develop effective self- within a 12 month period with at least one pres- discipline as evidenced by impulsive behavior, then ent in the past 6 months for youth to qualify for a 3 of 18 symptoms re fl ecting this phenomenon may diagnosis of CD: bullying, threatening or intimi- well be a problem (Barkley, 1997 ) . Diagnosis is dating others, initiating physical fi ghts, using a made by con fi rming six or more symptoms in the weapon that causes serious harm, stealing with inattention domain, hyperactivity-impulsive confrontation of the victim, physically cruel to domain or both. An individual may qualify for others, physically cruel to animals, forcible sex- ADHD Inattentive Type, Hyperactive-Impulsive ual activity with others, lying to avoid obligation, Type or Combined Type. It is important to note that staying out overnight without permission, steal- the diagnosis (Part D) requires that there must be ing items of nontrivial value, deliberately engag- “clear evidence of clinically signifi cant impairment ing in fi re setting with the intention of causing in social, academic, or occupational functioning.” harm, deliberately destroying others’ property, running away from home overnight, at least twice, truant from school, and burglary. The diag- ODD/CD nostic protocol for CD includes two different types, Child—Onset and Adolescent—Onset. ODD is described in the DSM-IV-TR as a recur- These are largely based on the classifi cation sys- rent pattern of negativistic, defi ant, disobedient, tem identi fi ed by Mof fi tt (1993 ) . Mof fi tt utilized and hostile behavior towards authority fi gures. a developmental approach to distinguish between 11 Resilience and the Disruptive Disorders of Childhood 187 individuals who engage in temporary vs. persis- problems appear to be predictive of later drug tent antisocial behavior. Life-course-persistent abuse and duress (Kellam, Simon, & Ensminger, individuals were thought to demonstrate risk fac- 1983 ) . Rose, Rose, and Feldman (1989 ) suggested tors such as neuropsychological abnormalities that early antisocial behavior predicts more than and poor home environments contributing to their the single well-established developmental path dif fi culty. Individuals classi fi ed as adolescent- that ends in delinquency. Early signs of DBD limited did not demonstrate these risk factors and among a preschool population, including tan- had no prior engagement in antisocial behavior. trums, defi ance and overactivity predicted the The life-course-persistent pattern might well diagnosis of a DBD by mid-childhood in 67% and equate with the juvenile court characterization of later delinquency (Campbell & Ewing, 1990 ) . delinquency. To test her dual trajectory theory, In 2001, Moffi tt and Caspi attempted to iden- Moffi tt examined a birth cohort of over 1,000 tify the childhood risk factors of life-course- children in New Zealand for trends in parent, persistent delinquence. Their results with the teacher, and self-reported antisocial behavior same 1,000 individuals found that males and biennially from ages 3 to 15 years. Five percent females classifi ed as life-course-persistent delin- of the sample accounted for nearly 70% of the quents were highly similar on most risk factors stability of crime across time. Despite these and had signi fi cantly higher levels of risk factors efforts at delineation there continues to be little in their adolescence-limited peers. With regard to consensus as to the distinction between CD as a childhood risk factors, life-course-persistent indi- clinical diagnosis and delinquency as a legal/ viduals demonstrated signifi cantly greater risk on societal description. 21 of the 26 factors measured. In contrast, the risk factors reported by adolescence-limited individuals were similar to their comparison peers The DBD’s and Delinquency with no history of juvenile court involvement on all but one of the factors measured. Thus, youth There is little consensus in de fi ning delinquency who exhibit rule violations that are limited to as a condition distinct from CD. In fact, most pro- their adolescent years tended to have fewer path- fessionals and lay persons use the terms CD, ological histories, personality problems, reading delinquency, and even antisocial behavior inter- problems, inadequate parenting, and broken changeably. However, in a legal sense a delinquent attachments and relationships than life-course is defi ned as someone who breaks the law, those persistent delinquents. Although Moffi tt and oth- that apply to youth as well as adults. Tremblay ers (Moffi tt, Caspi, Harrington, & Milne, 2002 ; ( 2003 ) suggests that the term “delinquent” should White, Bates, & Buyske, 2001 ) refer to both be used to describe youth in studies that specifi cally adolescence-limited and life-course-persistent focus upon legal issues. He suggests three classes youth problems as delinquency, it would appear of delinquent behavior from a legal perspective. that the latter group certainly provide a better These are: (1) vandalism and theft with or without working de fi nition of the community’s percep- confrontation of a victim; (2) physical, verbal or tion of the chronic, recurrent antisocial behaviors indirect aggression, predatory or defensive; and exhibited by delinquents. White et al. (2001 ) ’s (3) status offenses of underage youth (e.g., con- extension of Mof fi tt’s work demonstrated that suming alcohol prior to age 21). Aggression alone delinquents manifested higher disinhibition, has not always been found to predict delinquency impulsivity and parental hostility and lower harm (Anderson, Bergman, & Magnusson, 1989 ) . avoidance, and less intact family structure than These authors suggest that delinquency is best non-delinquents. predicted when aggression is accompanied by Perhaps a distinction between CD and delin- peer rejection and other problems, many of which quency should also focus upon persistence. CD, are present in most youth with ADHD. In young based upon DSM-IV fi eld studies tends to have children, a combination of aggression and social an average length of duration of 3 years. That is, 188 S. Goldstein and R. Rider most youth meeting the CD criteria recover pattern of behavior resulting from an impulsive within that period of time. CD may thus equate manner of dealing with thoughts, feelings, and with Mof fi tt’s conceptualization of adolescence- others (Milich & Landau, 1981 ; Milich, Landau, limited delinquency. It should be noted, however, Kilby, & Whitten, 1982 ) . Problems with language that receiving a diagnosis of CD is not a benign impairment may further contribute to poor inter- phenomena over time. Associations between par- personal relations, school achievement, and ent and teacher reports of conduct problems at developing self-regulatory patterns of behavior age 8 and psychosocial outcomes at 18 report (Cantwell & Baker, 1977 ; Cantwell & Baker, elevated rates of educational underachievement, 1989 ; Cantwell, Baker, & Mattison, 1981 ) . In a juvenile offending, substance abuse/dependence, vicious cycle, isolation from peers due to the and mental health problems at 18 even after combined effect of ADHD and its impact on the adjusting for social disadvantage, attention prob- normal course of development as well as other lems, and I.Q. (Fergusson & Lynskey, 1998 ) . adversities leads to reduced opportunity to develop Further, maternal communication/problem solv- appropriate social interaction, self-esteem, coping ing skills and family variables (e.g., marital sta- skills, academic progress, and likely resilience tus, maternal depressed mood, and interparental processes (Brooks, 1998 ) . The academic perfor- con fl ict) during early adolescence, both indepen- mance and achievement problems in youth with dently and interactively, predicts severe delin- ADHD have been reported to be well over 50% quent behaviors during early adulthood (Klein & (Fischer, Barkley, Fletcher, & Smallish, 1990 ; Forehand, 1997 ) . Semrud-Clikeman et al., 1992 ) . Poor persistence and limited motivation (Milich, 1994 ) , organizational defi cits (Zentall, Harper, & Stormont- Developmental Course Spurgin, 1993 ) , careless mistakes (Teeter, 1998 ) , and noncompliant behavior (Weiss & Hechtman, The greatest comorbidity for the DBD’s may be 1993) have all been implicated as contributing to with each other rather than other psychiatric the pervasive scholastic problems experienced by conditions. Comorbidity may in fact refl ect the youth with ADHD. Problems with independent differentiation in what begins as unitary pattern of seat work, school performance, defi cient study disruptive symptoms. For example, Bauermeister skills, poor test taking, disorganized notebooks, (1992 ) generated factor analytic data suggesting desks, and reports, as well as lack of attention to that at 4Ð5 years of age disruptive symptoms lectures and group discussions, are consistent appear to fall on a single dimension. themes for youth with ADHD (DuPaul & Stoner, 2003 ) . This pattern of impairment results in a variety of negative consequences in the social ADHD arena (Coie, Dodge, & Coppotelli, 1982 ) , poor test performance (Nelson & Ellenberg, 1979 ) , ADHD appears to develop relatively early in impaired working memory (Douglas & Benezra, childhood before the other DBD’s present. The 1990) , and poor overall success in school (DuPaul majority of children with ADHD are identi fi ed & Stoner, 2003) . As Teeter Ellison ( 2002 ) notes, within their fi rst year of school. Early signs of an inability to persist and be vigilant interferes inattention, hyperactivity, and impulsivity in with classroom behavior, especially when tasks children quickly cause impairment in multiple are repetitive or boring. These dif fi culties, unfor- settings leading to problems with social relations, tunately, present early and in particular when class- self-esteem and underachievement (Barkley, room expectations require sustained attention, Fischer, Edelbrock, & Smallish, 1990 ) . effort, and goal directedness. Many children with Interpersonal diffi culties with peers, adults, and ADHD, as Teeter Ellison notes, are “exquisitely family members often result in rejection and sub- attuned to the fact that they are not performing up sequent social neglect due to the inappropriate to their peer group, that they are not meeting the 11 Resilience and the Disruptive Disorders of Childhood 189 expectations of important adults in their lives and from controls. Seventy percent of a cohort followed that they are not well liked by their peers” (pg. over 20 years demonstrated signifi cant academic, 10). This cycle, described by others (Goldstein & social, and emotional dif fi culties relative to their Goldstein, 1990 ) creates increased vulnerability ADHD (Hechtman, 1999 ) . The emerging litera- limiting opportunities for youth with ADHD to ture suggests that adolescents with ADHD develop resilient qualities. Self-doubt and lack of demonstrate signi fi cantly greater than expected confi dence, combined with academic, social and presentation of comorbid disorders that during the avocational (e.g., sporting activities) failure, adolescent years also appear to in fl uence the impedes self-esteem, increasing vulnerability for development of adverse personality styles (e.g., conditions such as depression and anxiety. By late antisocial or borderline personality disorder). elementary, many youth with ADHD may disen- Further, adolescents with ADHD demonstrate gage from the learning environment as a means of signs of social disability and appear at signi fi cantly avoiding failure, choosing instead patterns of greater risk for mood, anxiety, disruptive, and inappropriate behavior, preferring to be labeled substance abuse disorders than comparison boys misbehaving rather than “dumb” (Brooks, 1991 ) . without social disability (Greene, Biederman, Because elementary experience provides the basis Faraone, Sienna, & Garcia-Jones, 1997 ) . In this foundational skills necessary to learn, including 4-year longitudinal study of boys with ADHD, basic achievement, study, test taking, and organi- the presence of social disability predicted poor zational skills, many youth with ADHD enters the social and psychiatric outcome including sub- middle school years ill-prepared for the increas- stance abuse and conduct disorder. The authors ing demands of autonomy required by the upper concluded that assessing social function in grades. This then fuels their problems leading to a adolescents with ADHD is critical to their treat- cycle of increased risk for drop out, school failure, ment. Once again, ADHD is demonstrated to strip academic underachievement, and signi fi cant risk away or limit the potential to develop critical, in transitioning successfully into adulthood resilient phenomena. These include the ability to (Barkley et al., 1990 ; Barkley & Gordon, 2002 ) . connect and maintain satisfying reciprocal rela- The preponderance of these data argue strongly tionships with others, achieve in school, and that symptoms of ADHD, in particular failure to maintain mental health facilitate resilience develop what can be referred to as self-discipline, (Brooks & Goldstein, 2001 ) . dramatically reduces positive outcome and thus opportunities to demonstrate resilience in the face of these adversities. Unfortunately, this pattern ODD and CD continues and intensifi es in the adolescent years. What is most disturbing about the increasing body Not surprisingly, with ODD and CD, less serious of research about ADHD in the adolescent years symptoms tend to precede moderate symptoms is the growing evidence of the widespread effects which precede the presentation of more serious of ADHD on all aspects of academic, interper- symptoms. Preschoolers demonstrate a single sonal, behavioral, emotional, and daily living disruptive pattern of behavior often composed of activities. Up to 80% of youth carrying a diag- oppositionality and mild aggression (Achenbach, nosis of ADHD continued to demonstrate clini- Edelbrock, & Howell, 1987 ) . These fi ndings are cally signifi cant symptoms into their adolescent consistent with the developmental view that ODD years (Barkley et al., 1990 ; Biederman, Faraone, usually precedes the onset of CD. The risk of Milberger, Guite et al., 1996 ; Biederman, Faraone, onset of CD was found to be four times higher in Milberger, Jetton et al., 1996 ; Weiss & Hechtman, children with ODD than in those without (Cohen 1993 ) . Even early studies examining outcome & Flory, 1998 ) . Multiple authors have investi- found only a signifi cant minority (between 20 and gated developmental pathways of these patterns 30%) of children with ADHD followed into their of behavior, identifying three often parallel adolescent years demonstrating limited differences pathways as (1) overt, (2) covert, and (3) authority 190 S. Goldstein and R. Rider confl ict (Kelly, Loeber, Keenan, & DeLamatre, Whitmore, 1970 ) to almost 7% of 7-year-olds 1997 ; Loeber et al., 1988 ; Loeber, Keenan, & (McGee, Silva, & Williams, 1984 ) . Based on a Zhang, 1997 ) . On the overt pathway, minor review of the existing literature, Kazdin in 1987 aggression leads to physical fi ghting and fi nally suggested a range of 4Ð10% for CD. The rate of violence. On the covert pathway, minor covert ODD in the general population has been reported behaviors such as stealing from home often lead as equally high (Anderson, Williams, McGee, to property damage (e.g., fi re setting) and then to and Silva, 1987). Oppositional, negativistic, moderate to serious forms of recurrent status and behavior may be developmentally normal in criminal behavior. On the authority con fl ict path- early childhood. However, epidemiological way, problems progress from stubborn behavior studies of negativistic traits in nonclinical popu- to defi ance and authority avoidance (e.g., truancy lations found such behavior in between 16 and and running away). Youth often start down this 22% of school age children (Loeber, Lahey, & pathway well before age 12, though it is not well Thomas, 1991 ) . Although ODD may begin as understood whether aggression in preschoolers early as 3 years of age, it typically does not in and of itself signi fi cantly increases risk to begin until 8 years of age and usually not later precede down one of these pathways (Nagin & than adolescence. In boys, aged 5Ð8 years, Tremblay, 1999 ) . fi ghting, temper tantrums, disobedience, nega- tivism, irritability, and quickness to anger appear to decrease with increasing age (Werry and Prevalence Quay, 1971 ). MacFarlane, Allen, and Honziak ( 1962 ) found similar decreases with age for both When DSM symptoms are used epidemiologi- sexes in the prevalence of lying, destructiveness, cally, an incidence rate of up to 15% is found for negative behavior, and temper tantrums. The ADHD. In a study of nearly 500 children evalu- greatest decline in these problems appeared to ated on an outpatient basis at a children’s hospi- take place during the elementary years. Tremblay tal, 15% received a diagnosis of ADHD based on ( 2003 ) reported a decline in oppositional behav- a comprehensive assessment (McDowell & ior in boys, particularly between the fi rst and Rappaport, 1992 ) . Field studies for the DSM-IV second grades. Anderson, Williams, McGee, identifi ed nearly 9% of the population as meeting and Silva ( 1987) report that mothers ratings of at least one of the diagnostic subtypes for ADHD aggressive behavior decreased for their children (Applegate et al., 1997 ) . When a careful analysis between the ages of 5 and 11 years in children is conducted, the rate of ADHD most likely without a reported history of psychiatric prob- falls between 3 and 6% (for review see Goldstein lems. In contrast, teacher rated aggression scores & Goldstein, 1998 ; Jensen & Cooper, 2002 ; for this same group increased for children with Boyle et al., 2011) . A higher incidence of ADHD histories of psychiatric problems. Certain covert as well as other DBD’s occurs in lower socio- disruptive behaviors such as alcohol and drug economic families. A variety of additional life use, as well as various forms of theft appear to variables appear to affect the prevalence of increase from late childhood to adolescence ADHD as well as the other DBD’s. For example, (Loeber & Schmaling, 1985 ). Lying, interest- among adopted or foster families the incidence of ingly enough appears to present at all age levels ADHD has been found to be twice as high as (Achenbach & Edelbrock, 1981 ) . Further, there among other children (Molina, 1990 ) . is little doubt that prevalence varies as diagnos- Few studies have generated consistent preva- tic criteria changes. For example, when compar- lence data for ODD or CD as a function of age. ing the revised third edition of the DSM with the Epidemiological studies estimating the occurrence original third edition ADHD criteria, the revised of CD in the general population vary from just criteria were found to identify 14% more chil- over 3% of 10-year-olds (Rutter, Tizard, & dren than the original criteria identi fi ed (Lahey, 11 Resilience and the Disruptive Disorders of Childhood 191

Loeber et al., 1990 ) . Lahey, Loeber, et al. (1990 ) concluded that boys are more likely to meet cri- Comorbidity teria for DSM de ﬁ nitions of CD than their female counterparts. ADHD co-occurs with other DBD’s as well as Table 11.1 , though a number of years old, multiple other developmental and psychiatric provide an overview of risk factors that increase disorders in children to such an extent that authors the probability of youth receiving a psychiatric have suggested subtypes of ADHD to include diagnosis, including the DBD’s. Although none combinations of ADHD with other DBD (e.g., of these studies assess variability of problems ADHD and CD) as well as with internalizing dis- across situations, a consistent set of diagnostic orders (e.g., ADHD and Anxiety) (Jensen, Martin, criteria were utilized. Further, educational risk & Cantwell, 1997 ) . ADHD coexists with other factors including lower cognitive skills, weaker disorders at a rate well beyond chance (Seidman, academic self-esteem, lower academic achieve- Benedict, Biederman, & Bernstein, 1995 ) . As ment, and school repetition appear to consis- described, impulsiveness likely acts as a catalyst, tently present in youth at increased risk for increasing risk for development of other prob- emotional and behavioral problems in these lems, especially in the face of additional risk fac- studies. Readers will note that many of these risk tors (e.g., family, developmental, educational). factors have been identi ﬁ ed as those which Goldstein and Goldstein ( 1998 ) posit that cer- increase vulnerability and adverse outcome in tain events instigate or increase the probability studies of resilience in childhood. that ADHD will be diagnosed. These include

Table 11.1 Other factors associated with increased risk for psychiatric disorder Factor Risk increased for Anderson et al. (1989 ) (age 11) Lower cognitive abilities ADD, multiple Lower academic self-esteem Emotional, ADDa , multiple Lower general self-esteem Emotional, ADD, multiple Poor health Any Poor peer socialization Multiple Family disadvantage Emotional, ADD Bird et al. (1988 ) (ages 4Ð16) Lower academic achievement Behavioral, depressed Poor family functioning Depressed High life stress Behavioral, depressed Velez et al. (1989 ) (ages 9Ð19) Family problems Behavioral Repeated school grade Any High life stress Behavioral, overanxious Costello (1989 ) (ages 7Ð11) Urban (vs. suburban) Behavioral Repeated school grade Behavioral High life stress Any No father in home Oppositional Offord et al. (1987 ) (ages 4Ð16) Family dysfunction Any Repeated school grade Behavioral Parental psychiatric problems Somatization (boys only) Parent arrested Conduct and oppositional Chronic mental illness Any (4Ð11) only for hyperactivity Source: Costello (1989 ) . Copyright, 1989. Used with permission of the author and publisher a ADD attention de fi cit disorder 192 S. Goldstein and R. Rider individual characteristics such as intellectual epidemiological or comorbidity samples (Szatmari, functioning, biological pre-disposition, and the Boyle, & Offord, 1989 ) . Children with ADHD and physical and psychosocial environment. Events comorbid ODD and CD exhibit greater frequen- in the school or home then either strengthen or cies of antisocial behavior such as lying, stealing, decrease the behavioral symptoms of ADHD. and fi ghting than those with ADHD who do not Once ADHD is diagnosed, the risk of depression develop the second disruptive comorbid disorder is increased as the result of social problems, (Barkley, 1998 ) . It has also been suggested that school failure, and possibly the side effects of this combined group is at greater risk for peer medication. The risk for CD is increased by rejection. These children may be neglected due to school and social problems as well as the presen- their lack of social skills and rejected due to their tation of antisocial role models which has been aggressive behavior. Common sense dictates that demonstrated as a critical risk factor. the comorbid group is going to require more inten- In a review of empirical studies, Biederman, sive and continuous service delivery. The comor- Newcorn, and Sprich ( 1991 ) attempted to de fi ne bid group also holds the greatest risk for later life the comorbidity of ADHD with other disorders. problems. In fact, it is likely the co-occurrence of The authors suggest that the literature supports CD with ADHD that speaks to the signi fi cant adult considerable comorbidity of ADHD with CD, problems a subgroup of those with ADHD appear ODD, mood disorders, anxiety disorders, learn- to develop. As Edelbrock (1989 ) noted more ing disabilities, and other disorders such as men- predictive of outcome than severity of ADHD tal retardation, Tourette’s disorder, and borderline symptoms is the development in children with personality disorder. The qualities of ADHD may ADHD of oppositional and aggressive behaviors. act as a catalyst: Leave them alone and they may Environmental consequences, including parent not be terribly aversive; mix them with negative psychopathology, marital discord, ineffective par- life events or risk factors and they appear to cata- enting, parent aggressiveness, and antisocial par- lytically worsen those events and the impact they ent behavior are better predictors of life outcome have on children’s current and future functioning for children with ADHD than the ADHD diagno- (Goldstein & Goldstein, 1998 ) . sis per se. In fact these factors become highly sta- In a community sample of over 15,000 ble over time and are resistant to change. Data also 14Ð18-year-old adolescents, Lewinsohn, Rhode, suggests that the comorbid conditions presenting and Seeley ( 1994 ) compared six clinical outcome before age 10 have a much worse prognosis than measures with four major psychiatric disorders the second behavior disorder develops after age 10 (depression, anxiety, substance abuse, and dis- (McGee & Share, 1988 ) . ruptive behaviors). The impact of comorbidity After careful review of the literature, Loeber was strongest for academic problems, mental et al. (1991 ) suggest that CD and ODD are strongly health treatment utilization, and past suicide and developmentally related but clearly different. attempts; intermediate on measures of role, func- Factor analyses indicate that distinct covarying tion, and con fl ict with parents and non-signi fi cant groups of ODD and CD can be identifi ed but that and physical symptoms. The greatest incremental certain symptoms relate to both disorders particu- impact of comorbidity was on anxiety disorders; larly, mild aggression and lying. As noted, age of the least was on substance abuse. Substance use onset for ODD is earlier than most CD symptoms. and disruptive behavior were more common in Nearly all youth with CD have a history of ODD males, depression, and anxiety in females. The but not all ODD cases progress to CD. Interestingly, effect of comorbidity was not due to psychopa- in some studies children with ODD demonstrate the thology. The authors conclude as others have that same forms of parental psychopathology and fam- there is a high rate of comorbidity in adolescence ily adversity but to a lesser degree than for CD. referred in clinical practice. Clearly the age of onset of some CD symptoms, In clinic referred populations, the comorbidity speci fi cally fi ghting, bullying, lying, and vandalism between ADHD and CD has been reported as high suggest that some youth with CD show nearly as 50% with an incidence of 30Ð50% reported in simultaneous onset of ODD and CD. However, the 11 Resilience and the Disruptive Disorders of Childhood 193 more serious symptoms of CD such as vandalism, considered genetics, intergenerational transmis- running away, truancy, shoplifting, breaking and sion, neuroanatomy, neurotransmitters, pre-auto- entering, rape, and assault appear to emerge at a nomic nervous system, pre- and perinatal problems much later age than ODD symptoms. Biederman, and neurotoxins as biological risk factors for the Faraone, Milberger, Jetton, et al. (1996 ) generated development of a DBD. While the evidence is not data suggesting two types of ODD which appear to conclusive, several studies suggest a moderate have different correlates, course, and outcome. One genetic in fl uence on DBD’s. Eaves et al. (2000 ) type appeared prodromal for CD the other sub-syn- concluded that there is a high genetic correlation dromal to CD and not likely to progress into CD in across gender in the liability for ODD and CD. later years. Not surprisingly, the higher risk form of Several researchers, for example, Lahey et al. ODD was characterized by a stronger profi le of ( 1998) have found that a history of parental anti- negative, provocative, spiteful, and behavior. social behavior disorders is associated with pre- There is a growing body of literature suggest- adolescent onset of CD. Loeber, Green, Keenan, ing that DBD’s and anxiety disorders are often and Lahey ( 1995) concluded that parental sub- comorbid. Loeber and Keenan ( 1994 ) found that stance abuse, low socio-economic status, and CD and anxiety disorders are comorbid substan- oppositional behavior are key factors in boys’ tially higher than chance during childhood and progression to CD. adolescence. Epidemiologically the overlap between ADHD and depression occurs at a beyond chance level Biological with some studies suggesting nearly 30% (McClelland, Rubert, Reichler, & Sylvester, Frontal lobe dysfunction has been associated 1989 ) . While Capaldi (1992 ) found that CD is with the increased risk of violent behavior likely a precursor to depression in some children, (Pliszka, 1999 ) . Impairments in the functioning Biederman, Faraone, Mick, and Lelon (1995 ) of the amygdala are associated with de fi cits in the questioned the psychiatric comorbidity among reading of social cues and the connection between referred juveniles with major depression. In a the amygdala and prefrontal cortical regions sample of 424 children and adolescents consecu- serves to aid in the suppression of negative emo- tively referred to a psychiatric facility, nearly tion (Davidson, Putnam, & Larson, 2000 ) . 40% were identifi ed with a depressive disorder. Low levels of serotonin in cerebral spinal fl uid They had a history of chronic course and severe have been linked to aggression (Clark, Murphy, psychosocial dysfunction. They also demon- & Constantino, 1999 ; Kruesi et al., 1990 ) . Mof fi tt, strated a high rate of CD, anxiety disorder, and Brammer, and Caspi ( 1998 ) found that in men ADHD. Seventy-four percent with severe major metabolites of serotonin in the general popula- depression and 77% with mild major depression tion sample of 21-year-olds was related to past received a diagnosis of ADHD compared to 74% year self-reported and life time court recorded of the psychiatric controls and none of the normal violence. Burke et al. ( 2002 ) concluded that the controls. The authors hypothesized that major link between serotonin and aggression refl ects a depression was more likely the outcome rather complex relationship between neuroanatomical than the cause of co-occurring disorders based on and neurochemical interconnectivity, executive an analysis of age of symptom onset. brain function, and behavioral dysregulation. Pliszka ( 1999 ) reported that individuals with DBD experienced general physiological under- Risk for Acquisition and Exacerbation arousal. Lower heart rates have been reported to be associated with adolescent antisocial behavior Biological, psychological, and psychosocial fac- (Mezzacappa, Tremblay, & Kindlon, 1997 ) and tors are all posited to be risk factors for the develop- predictive of later criminality (Raine, Venables, ment of a DBD. Burke, Loeber, and Birmaher ( 2002 ) & Williams, 1990 ) . 194 S. Goldstein and R. Rider

Evidence exists of the contributions of genetic discipline have been correlated with children’s factors to DBD as well as the contributions of pre- disruptive or delinquent behavior (Frick, 1994 ; natal and early developmental exposure to toxins, Wasserman, Miller, Pinner, & Jaramilo, 1996 ) . other perinatal problems and physical damage to Coercive parenting behaviors appear to lead to brain structures (Burke et al., 2002 ) . Maternal aggressive behaviors in younger girls as well as smoking during pregnancy has been found to pre- boys (Eddy, Leve, & Fagot, 2001 ) . dict CD in boys (Wakschlag et al., 1997 ) . Pregnancy Fergusson, Lynskey, and Horwood (1996 ) and birth complications have also been shown to reported that harsh or abusive parenting style such be associated with the development of behavior as sexual or physical abuse signifi cantly increased problems in offspring (Raine et al., 1990 ). the risk of CD. Childhood victimization of boys Environmental toxins such as lead have also been and girls, including abuse and neglect is predictive implicated in the development of DBD’s. Elevated of later antisocial personality disorder (Luntz & levels of lead in bones of children at age 11 are Widom, 1994) . Peer effects also appear to be associated with greater parent and teacher ratings importantly related to potential development and of aggressiveness, higher delinquency scores, and maintenance of DBD symptoms. The stability of greater somatic complaints (Needleman, Riess, peer rejection in children identifi ed as having con- Tobin, Biesecker, & Greenhouse, 1996 ) . The psy- duct problems is signi fi cant (Coie & Dodge, 1998 ; chological substrates of temperament, attachment, Coie & Lenox, 1994 ) and related to aggressive neuropsychological functioning, intelligence, aca- responding (Dodge, Price, Bachorowski, & demic performance, and social cognition have all Newman, 1990 ) . Association with deviant peers been found to in fl uence an individual’s propensity appears to lead to the initiation of delinquent behav- to develop a DBD. Sanson and Prior ( 1999 ) con- ior in boys (Elliott & Menard, 1996 ) . Exposure to cluded that early temperament (speci fi cally nega- delinquent peers may enhance preexisting delin- tive emotionality, intense, and reactive responding quency (Coie & Miller-Johnson, 2001 ) . and in fl exibility), is predictive of externalizing Disruptive behaviors among children are par- behavior problems by late childhood. ticularly associated with poor and disadvantage Low intelligence is often considered a precur- neighborhoods (Loeber et al., 1995 ) . Wickström sor to DBD. However, as Loeber et al. (1991 ) and Loeber (2000 ) found that the effects of living point out, the issue of the association between in public housing countered the impact of any indi- CD, ADHD, and IQ is not well understood. vidual protective factors that were present. Specifi c Additionally, IQ appears to be related to low social and economic risk factors such as unemploy- achievement and school failure which are also ment (Fergusson, Lynskey, & Horwood, 1997 ) , related to later antisocial behavior (Farrington, neighborhood violence (Guerra, Huesmann, Tolan, 1995 ) . Moreover, high intelligence does not pre- Van Acker, & Eron, 1995 ) , family poverty, and clude conduct problems. Boys with psychopathic children’s aggression (Guerra et al., 1995 ) , low characteristics, parental antisocial personality dis- SES and duration and poverty (McLoyd, 1998 ) are order, and conduct problems were found to have associated with antisocial behavior. Finally, expo- IQ’s equivalent to those of controls and higher sure to daily stressors may add to the risk for DBD than those with boys with conduct problems but in children and as noted can be exacerbated by life without psychopathology and parental APD circumstances caused having a DBD. (Christian, Frick, Hill, Tyler, & Frazer, 1997 ) .

Are Some Youth with DBD More Psychological and Psychosocial Factors Resilient Than Others?

Several aspects of child rearing practices such as The biological bases of resilience have yet to be degree of involvement, parentÐchild conﬂ ict man- studied, but likely will be found to play a role in agement, monitoring, and harsh and inconsistent predicting outcome. Traditionally, within the 11 Resilience and the Disruptive Disorders of Childhood 195

DBD’s the study of positive outcome has focused 4. Teach effective communication through model- on reduction of symptom severity over time and ing and instruction. Effective communication the reduction of exposure to signi fi cant adverse includes an appreciation for both understand- family, educational and environmental phe- ing as well as seeking to be understood. nomena. Yet, there is an increasing interest in 5. Help youth with a DBD accept themselves studying individuals who suffered from DBD’s, without feeling inadequate or like second class in particular CD and manage to transition suc- citizens. cessfully into adult life despite struggling through 6. Facilitate connections to others, including adolescence and at times young adulthood. providing opportunities for youth with DBD Stories collected by the Offi ce of Juvenile Justice to help and serve as teachers for others. and Delinquency Prevention (Offi ce of Juvenile 7. Youth with DBD’s view mistakes as chal- Justice and Delinquency Prevention, 2000 ) exem- lenges to appreciate and overcome rather than plify that efforts focusing upon rehabilitation, signs of inadequacy. providing mentors and individual attention and 8. Help every youth with a DBD experience suc- most importantly, providing youth with a second cess and develop an island of competence, an chance, can and have been demonstrated to be a area of strength in which success is experi- part of the formula that leads to resilience. enced and appreciated by others. 9. Patiently help youth with a DBD develop self- discipline and self-control. Enhancing Resilience in Youth with DBD: Guidelines for Clinical Practice Summary What are the factors that help some youth and adults bounce back while others become over- The DBD’s encompass the most common and whelmed with feelings of helplessness and disruptive childhood symptom composites. They hopelessness. Some attain success that could affect wide percentage of children, often present have never been predicted by early life circum- in combination and are catalytic in fueling a vari- stances, fi nding the inner strength to overcome ety of adverse outcomes. The DBD’s act to reduce obstacles in their paths. Those who fi nd success protective infl uences, decreasing the opportunity are viewed as resilient. Their positive outcome in to develop a resilient mindset and a resilient out- the face of adversity precisely refl ects the come into adulthood. An increasing body of scienti fi c studies that have demonstrated positive research is providing an understanding of those outcome in the face of variety of youthful prob- protective factors that may mitigate and insulate lems, including those related to DBD’s. A number youth with DBD’s. Efforts at clinically applying of later chapters in this volume are devoted to the qualities of resilience and strategies to developing and applying a clinical psychology of enhance a resilience mindset offer the promise of resilience. The remainder of this chapter provides helping youth with DBD’s overcome the adverse a very brief overview of nine proposed guidelines odds as they transit into adulthood. for clinical practice. 1. Develop strategies with these youth to help them learn to rewrite negative scripts. Negative References scripts are those words or behaviors that are followed day after day with predictable nega- Achenbach, T. M., Conners, C. K., Quay, H. C., Verlhulst, tive results. F. C., & Howell, C. T. (1989). Replication of empiri- 2. Provide youth with a DBD opportunities to cally derived syndromes as a basis for taxonomy of child/adolescent psychopathology. Journal of develop stress management skills. Abnormal Child Psychology, 17 , 299Ð320. 3. Take the time to nurture and develop the Achenbach, T. M., & Edelbrock, C. S. (1981). Behavioral capacity for empathy in youth with DBD’s. problems and competencies reported by parents of 196 S. Goldstein and R. Rider

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Karen Reivich , Jane E. Gillham, Tara M. Chaplin, and Martin E. P. Seligman

Some of the most common psychological disorders in children and adolescents are internalizing dis- Depression in Children and orders such as depression and anxiety. Research Adolescents on the development of depression and anxiety suggests that internalizing disorders can be At any point in time, approximately 2–3% of reduced, even prevented, by promoting more children and 6–9% of adolescents have a major accurate cognitive styles, problem-solving skills, depressive disorder (Cohen et al., 1993 ; Lewinsohn, and supportive family relationships. Several Hops, Roberts, & Seeley, 1993 ) . Approximately cognitive–behavioral interventions have shown one in fi ve adolescents will have had a major promise in treating and preventing depression depressive episode by the end of high school and anxiety. We review the Penn Resiliency (Lewinsohn et al.). Anxiety disorders, which often Program (PRP) as an example of such an interven- precede and co-occur with depression, are found in tion. We suggest that most of the skills covered in 10–21% of children and adolescents (Kashani & the PRP and similar preventive interventions are Orvaschel, 1990 ; Romano, Tremblay, Vitaro, not speci fi c to depression or anxiety and can Zoccolillo, & Pagani, 2001 ) . It is notable that be useful for increasing young people’s resil- rates of depression increase as children enter iency more generally. Interventions that teach adolescence (Hankin, Abramson, Mof fi tt, Silva, and reinforce these skills can help children & McGee, 1998) , indicating that the transition to to navigate a variety of diffi cult situations adolescence is a particularly vulnerable develop- they are likely to encounter during adolescence mental period for depression. In addition, several and adulthood. studies indicate that rates of depression and anxiety have increased dramatically over the past 50 years (Klerman et al., 1985 ; Twenge, 2000 ) , so that young people today are much more likely to suffer from depression and anxiety than their parents or grandparents were. This chapter focuses on unipolar depression, 1 K. Reivich () • T. M. Chaplin • M. E. P. Seligman University of Pennsylvania , Pennsylvania , PA , USA one of the most common types of internalizing e-mail: [email protected] ; disorders, because our research program focuses [email protected]; [email protected] J. E. Gillham 1 We will not focus on bipolar disorder, or manic-depression, Department of Psychology, Swarthmore College , which is relatively rare in children and which appears Swarthmore , PA , USA to be more heavily biologically based (Hammen & e-mail: [email protected] Rudolph, 2003 ) .

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 201 DOI 10.1007/978-1-4614-3661-4_12, © Springer Science+Business Media New York 2013 202 K. Reivich et al. primarily on the prevention of this disorder and They are more likely to smoke cigarettes, use its symptoms. We will also discuss anxiety symp- other substances, and attempt suicide (Covey, toms since there is considerable co-occurrence of Glassman, & Stetner, 1998 ; Garrison, Addy, depression and anxiety among children and most Jackson, McKeown, & Waller, 1991 ) . Despite the of the cognitive–behavioral risk and resilience often severe concomitants of depression, it is factors and interventions discussed here in the underdetected and undertreated in adolescence— context of depression also apply to anxiety disor- only about 20–25% of adolescents who are clini- ders and symptoms (Kendall, 1994 ) . cally depressed receive adequate treatment Unipolar depression, also known as major (Hirschfeld et al., 1997 ) . Given the seriousness of depression, is characterized by intense sadness or depression and the number of children and ado- irritability, disrupted concentration, sleep, eating, lescents who experience it, the identifi cation, and energy levels, and feelings of hopelessness treatment, and prevention of depression in youth and suicidal thoughts. Major depression in youth have become important areas for research. is not simply a phase of development; rather, it is a serious psychological problem that shows stability over time and can signi fi cantly interfere Cognitive–Behavioral Models of the with children’s ability to function. Depressed Development of Depression youth have a lowered ability to function in daily life, with 85–87% of adolescents with depressive Developmental psychopathologists theorize that disorders rated as having “major” impairments in depression is caused by a complex interaction of functioning (Whitaker et al., 1990 ) . Moreover, a biological, cognitive, emotional, and interper- signi fi cant portion of children with major depres- sonal risk factors (Sroufe & Rutter, 1984 ) . The sion continue to show depression in adulthood. focus of this chapter is mainly on cognitive and For example, Harrington et al. found that 60% of behavioral factors involved in the development of children treated for major depression had at least depression, although we acknowledge the impor- one bout of major depression in adulthood tance of other systems and the interactions of (Harrington, Fudge, Rutter, Pickles, & Hill, those systems with cognitive and behavioral systems. 1990 ) . Depression is not only burdensome to the For example, the interpersonal risk of fi ghting individual but it is also very costly for society. In with a parent can interact with a child’s negative the United States, the yearly expenditure for cognitive style (“It was all my fault. I am a bad major depressive disorder is about $43 billion, kid.”) and the presence of a biological risk factor including loss of productivity, premature death, such as shyness or an anxious temperament to and cost of treatment (Hirschfeld et al., 1997 ) . produce depression. The problems associated with depression The Learned Helplessness Model was one of extend beyond those meeting diagnostic criteria the fi rst cognitive–behavioral models of depres- for a depressive disorder. Many children and ado- sion (Seligman, 1975 ) . Seligman observed that lescents have elevated, but subclinical, levels of individuals who were exposed to uncontrollable internalizing symptoms. For example, 10–15% negative events often overgeneralized from this of middle school children may report moderate to experience and became passive in other situations severe levels of depressive symptoms (Nolen- that were in fact controllable. These individuals Hoeksema, Girgus, & Seligman, 1986 ) . Research exhibited apathy, decreased appetite, despair, and suggests that children with high levels of depressive other symptoms of clinical depression. The expe- symptoms experience the same kinds of dif fi culties rience of uncontrollable negative events seemed as do children with depressive disorders (Gotlib, to produce expectations of helplessness. That is, Lewinsohn, & Seeley, 1995 ) . Children and adoles- the individuals believed they could not control cents who suffer from high levels of depressive future negative events in their lives. Seligman symptoms or depressive disorders are more likely also observed that some individuals seemed resis- to have academic and interpersonal dif fi culties. tant to helplessness. These individuals remained 12 From Helplessness to Optimism: The Role of Resilience in Treating… 203 persistent and hopeful even when exposed to & Hankin, 2008 ; Gladstone & Kaslow, 1995 ; uncontrollable negative events. Further cogni- Robins & Hayes, 1995 ; Sweeny, Anderson, & tive–behavioral theories were developed to Bailey, 1986 ) .” explain these individual differences. Other interpretive styles and problem-solving More recent cognitive–behavioral theories defi cits have also been implicated in the develop- generally posit that a tendency to view one’s self, ment of depression. For example, Quiggle, the world, and the future in overly negative ways, Garber, Panak, and Dodge (1992 ) found that combined with a lack of behavioral coping skills, depressed children show a hostile attributional puts one at risk for depression and anxiety (Beck, bias; that is, they tend to see actions of others as 1976 ) . Conversely, a realistic thinking style and hostile, even when the action is actually ambigu- positive coping skills promote resilience and may ous. This may help to explain the overlap between buffer children from internalizing problems. The depression and conduct disorder that is often seen Reformulated Learned Helplessness (RLH) during adolescence (Rhode, Lewisohn, & Seeley, model was introduced to explain why some peo- 1991) . In addition to diffi culties with interpreting ple exhibit helplessness and depression in the social cues, depressed children may also lack face of adversity while others are more resilient. behavioral skills for coping with social situations According to this theory, over time, people and regulating emotions (for review, see Kaslow, develop cognitive styles for explaining the events Brown, & Mee, 1994 ) . For example, Altmann in their lives. Individuals who develop a pessi- and Gotlib (1988 ) found that depressed fourth- mistic explanatory style attribute negative events and fi fth-grade children spent more time alone to internal, stable, and global factors and positive and had higher numbers of negative interactions events to external, unstable, and specifi c factors with peers in their school playground than their (Abramson, Seligman, & Teasdale, 1978 ) . More nondepressed classmates. Longitudinal research recently, the hopelessness theory of depression indicates that reliance on maladaptive coping posits that pessimistic explanatory style is one of strategies increases risk for depression. For three cognitive styles that can lead to depression. example, children and adolescents with rumina- The others are the tendency to view the self as tive response styles (who dwell on negative emo- fl awed and defi cient following negative events tions and negative experiences) are at increased and the tendency to catastrophize the conse- risk for depression (Abela, Aydin, & Auerbach, quences of negative events (Abela, 2001 ; 2007 ; Abela & Hankin, 2011 ) . In contrast, chil- Abramson, Metalsky, & Alloy, 1989 ) . Taking the dren and adolescents who engage in problem- Reformulated Learned Helplessness and solving or adaptive coping are at lower risk for Hopelessness theories together, an adolescent depression (Abela et al., 2007 ; Auerbach, Abela, with a hopeless cognitive style who fails a math Zhu, & Yao, 2010 ) . test might think to him- or herself ‘Math is impos- Developmentally, cognitive–behavioral fac- sible,’ ‘I’m stupid,’ or ‘I’m never going to do tors associated with depression appear to become well.’ Following a success, this adolescent might more important as children mature and become think ‘that was lucky’ or ‘the test was easy.’ This more cognitively sophisticated. In early child- pattern of thoughts leads to helplessness (the stu- hood, occurrences of depression are relatively dent expects failure to continue and believes that rare and tend to be reactions to overwhelming there is nothing he or she can do to improve per- life events, such as the loss of a caregiver or a formance). When this kind of interpretive style is prolonged period with inadequate caregiving used to explain multiple events over time, it can (e.g., Bemporad, 1994 ; Spitz, 1946 ) . As children lead to a more generalized sense of helplessness, mature, depression occurs at higher rates and which, in turn, leads to passivity, hopelessness, increasingly involves cognitive interpretations of and despair. Numerous studies have linked a pes- events (Garber & Flynn, 1998 ; Garber, Quiggle, & simistic or hopeless interpretive style to depres- Shanley, 1990 ) . By middle childhood, pessimis- sion in adults and children (for reviews, see Abela tic explanatory styles can be reliably measured 204 K. Reivich et al. and are related to symptoms of depression Lewinsohn, Clarke, Rohde, Hops, & Seeley, (e.g., Blumberg & Izard, 1985 ; Nolen-Hoeksema, 1996 ) . Lewinsohn et al. tested this program both Girgus, & Seligman, 1992 ) . The increases in with and without a complementary parent training abstract thinking, self-consciousness, and thinking program and found that both forms of the program about future possibilities that occur in adolescence decreased depression signi fi cantly more than a can intensify pessimistic explanatory styles, help- wait-list control. Similar cognitive–behavioral less expectations, and, in turn, depressive symp- therapies have also been successful in treating toms. Socially and biologically, adolescents face anxiety disorders in children (e.g., Flannery- a number of transitions, including physical Schroeder & Kendall, 2000; Kendall, 1994 ; changes associated with puberty, changes in peer Muris, Meesters, & van Melick, 2002 ) . and family relationships, and changes in school structure from elementary school to middle school (Eccles & Midgley, 1990 ; Petersen & Hamburg, Cognitive–Behavioral Prevention 1986 ) . These events are often quite stressful and of Depression require adolescents to utilize resilient coping and problem-solving strategies. Children who enter There is growing evidence that cognitive–behav- adolescence without solid problem-solving skills ioral techniques can be effective in preventing can be at increased risk for depression. depression as well as treating it. For example, adults treated with cognitive–behavioral therapy are less likely to experience a recurrence of Cognitive–Behavioral Therapies depression than adults treated with medication for Depression in Children and (Shea et al., 1990 ) . Additionally, several cogni- Adolescents tive–behavioral interventions have shown promise in preventing depressive symptoms or depressive Cognitive–behavioral therapies for depression disorder in adults and children (see Cjuipers, van and anxiety target cognitive styles and problem- Straten, Smit, Mihalopoulos, & Beekman, 2008 ; solving skills. Clients are taught to identify their Horowitz & Garber, 2006 ; Stice, Shaw, Bohon, negative interpretations, to consider the evidence Marti, & Rohde, 2009 ) . The intervention with the for and against these interpretations, and to gen- best results to date was developed by Clarke et al. erate alternative interpretations that are more ( 1995 ) . Clarke et al. evaluated their prevention realistic. Additionally, clients are often taught program with 13–18-year-olds with high but sub- speci fi c coping and problem-solving skills, clinical levels of depressive symptoms. including relaxation and assertiveness techniques Adolescents who participated in this intervention (e.g., Beck, Rush, Shaw, & Emery, 1979 ) . were signifi cantly less likely to develop depres- Several studies have demonstrated the ef fi cacy sive disorders than controls (Clarke et al., 1995, of cognitive–behavioral therapies in treating 2001; Garber et al., 2009 ) . depression in adults (e.g., Elkin et al., 1989 ) . More recent research indicates that cognitive– behavioral therapies can be effective for treating The Penn Resiliency Program depression in children and adolescents (for reviews, see Weisz, McCarty, & Valeri, 2006 ) . Our research group has developed a cognitive– For example, Lewisohn and colleagues developed behavioral intervention, the PRP, for younger a cognitive–behavioral group treatment for adolescents. PRP has 12 90-min intervention ses- depressed adolescents, which focuses on decreas- sions designed to be delivered by school coun- ing automatic negative thoughts, increasing selors and teachers who are trained and supervised engagement in positive activities, and enhancing in intervention delivery. The techniques we used behavioral coping skills and interpersonal skills have been adapted from adult cognitive–behavioral (Lewinsohn, Clarke, Hops, & Andrews, 1990 ; therapy (Beck, 1976 ; Beck et al., 1979 ; Ellis, 1962 ) 12 From Helplessness to Optimism: The Role of Resilience in Treating… 205 and are incorporated in many other intervention one’s relationships and gain support through programs. Our emphasis is on helping the stu- dif fi cult times. dents to use the skill set to improve their problem PRP builds on the ABC model developed by solving and to enhance their ability to navigate Ellis ( 1962 ) , which suggests that different people the daily stressors of life, as well as to bounce feel and respond differently to the same event back from major setbacks such as parental loss or because of idiosyncratic beliefs about those divorce. In this section, we describe several tech- events. In Ellis’s model, A stands for activating niques included in PRP that may be especially event. The As are not the direct cause of the con- important for building and promoting resilience sequences (Cs, emotions and behaviors) that we and preventing anxiety and depression. experience. Rather, according to Ellis, it is our Based on our work, and the resilience literature thoughts and beliefs about the event (our Bs) that more broadly, we have identi fi ed seven key intrap- mediate the effects of events on our behavior and ersonal factors or abilities that appear to increase feelings. We teach adolescents in our program overall resilience (see Reivich & Shatte, 2002 for how to identify the link between their thoughts full description of these factors). We will show and feelings/behaviors, and in this process they how the skills of PRP impact each of these abili- come to understand that their belief systems may ties (see Table 12.1 ). Brie fl y, the seven abilities not be wholly accurate. Practicing ABC is par- are: (1) emotion regulation—being able to iden- ticularly important for children and adolescents tify, label, and express emotions and control emo- who are struggling with anxiety and depression tions when it is appropriate to do so; (2) impulse issues because it serves as the fi rst step toward control—the ability to identify impulses and resist changing the beliefs that are fueling their mal- impulses that are counterproductive for the situation adaptive emotional reactions. More generally, the at hand or for long-term goal attainment; (3) causal ABC model helps to build emotion awareness, a analysis—being able to identify multiple and accu- central component of emotion regulation, because rate causes of problems; (4) realistic optimism— through the use of this skill, adolescents practice thinking as optimistically as possible within the identifying their emotional reactions, differenti- bounds of reality; (5) self-ef fi cacy—being con fi dent ating among emotions, and assessing the inten- in one’s ability to identify and implement coping sity of the emotion they feel. In addition, we and problem-solving skills that are well suited to the believe this skill helps promote empathy by help- situation; (6) empathy—being able to accurately ing adolescents learn how to anticipate, identify, identify and connect with the emotional states in and label the emotions that others experience in a others; (7) reaching out—being comfortable and variety of common stressors and adversities. willing to connect with others in order to deepen We fi rst teach students the ABC model with three-panel cartoons. In some instances, they are Table 12.1 Summary of PRP skills and the resilience presented with an adversity and the emotional abilities targeted consequences, and they must fi ll in a thought PRP skill Resilience ability targeted bubble with a belief that fi ts the logic of ABC. In ABC Emotion regulation and others, they are provided the adversity and the char- empathy acter’s beliefs and they must identify the emotional Explanatory style Realistic optimism and reaction that the belief would likely generate. For casual analysis example, in one cartoon, the fi rst frame depicts a Self-disputing Self-ef fi cacy student being yelled at by a coach. The third Putting it in perspective Realistic optimism and self-ef fi cacy frame has an illustration of the student feeling Goal setting Impulse control extremely sad. The adolescents are asked to iden- Assertiveness and Reaching out tify what the boy is feeling and then to suggest negotiation what the boy might be saying to himself that is Decision making Self-ef fi cacy, impulse causing him to feel that emotion (e.g., “I’m never control, empathy going to be good enough” or “I stink at sports,” etc.). 206 K. Reivich et al.

Once the students are able to accurately link Bs We teach adolescents to identify their explanatory and Cs in the cartoon worksheets, the students style (using the terms “me versus not me,” practice identifying their own self-talk in current “always versus not always,” “everything versus problem situations and the emotions and behav- not everything”) and, most important, to question iors generated by that self-talk. We have found the accuracy of their beliefs. Although pessimistic that it is helpful to the adolescents to liken their explanations tend to lead to helplessness, depres- Bs to an internal radio station (one that plays sion, and anxiety, our goal is to teach the students nothing but you, you, you 24/7) and we help them how to think accurately about the causes and to turn the volume of this radio station up so that implications of the problems they face, not to it is loud enough for them to hear what it is they swap a pessimistic style for an optimistic one. are saying to themselves, particularly during This reattribution training speci fi cally targets times of adversity or stress. In so doing, the realistic optimism and causal analysis. Our aim is adolescents become more aware of their beliefs to help students to think more fl exibly about the as well as the effect their beliefs have on their multiple and varied causes of problems, instead mood and behavior. We emphasize that negative of merely replacing negative thoughts with emotions are not “bad”—that instead, they are a “happy thoughts.” In fact, some of the adoles- healthy part of life and serve an important function cents we have worked with have had explanatory from an evolutionary perspective. We also make styles that were too optimistic. These adolescents clear that the goal is not to eradicate all negative believed that others were always to blame for emotion from one’s life. Rather, we guide the their problems, and that they had complete control students in thinking about whether they tend to to change any aspect of a situation they did not overexperience certain emotions and to identify like. We helped these students to understand how the patterns in their thinking that might be leading this very optimistic view might actually be hin- them to experience one emotion much more dering their resilience and problem solving rather frequently than others. than bolstering it. The ABC skill represents a glimpse into one’s We call this skill of generating more accurate thoughts or beliefs during a particular activating beliefs “self-disputing.” Adolescents are guided event. Although this is useful, it is also important in using the three dimensions of explanatory style for the adolescents to begin to notice patterns in for generating other ways of understanding the how they think about the events in their lives. It has causes of the event. In essence, we help them to been well documented that our automatic thoughts “think outside the box” that their explanatory are in fl uenced by our styles (or schemas) of pro- style puts them in. For example, if they tend to be cessing information, which, to some degree, pre- overly internal, they are encouraged to generate determine our responses to any given event. Our plausible explanations about how other people or goal is to help the adolescents detect patterns in circumstances contributed to the problem. their thinking and emotions that may be counter- Similarly, if their explanations indicate that they productive for them. As one seventh-grade boy put believe the causes of the problem are wholly it, “I never really thought about how much of the unchangeable, they are encouraged to think about time I feel embarrassed. I guess I kind of thought other explanations that focus on more change- all kids feel embarrassed all the time. Now I’m able, controllable, and temporary causal factors. starting to see that maybe I don’t have to feel this We have found that using the knowledge of one’s way so much; that maybe I’m worrying too much explanatory style in the process of generating about what other kids are thinking of me—when alternatives is quite important. When students are they probably aren’t even thinking about me!” not aware of their tendency to explain the causes One example of a style or schema is explanatory of events in a set pattern, the alternatives they style, our habitual and re fl exive way of explaining generate tend to fall within their pattern rather the events in our lives (Abramson et al., 1978 ) . than become more inclusive. So, an adolescent 12 From Helplessness to Optimism: The Role of Resilience in Treating… 207 who tends to be highly external can generate four from their beliefs and are better able to start to alternatives to the belief “I fought with my parents consider the likelihood of the feared events. because they are too strict,” but the alternatives These thoughts tend to come in chains of ever are each as external as that initial belief (for increasing severity; for example, imagine a stu- example, “They’re old-fashioned,” “They don’t dent who does not get asked to a school dance. understand me,” “They’re control-freaks,” etc.). “If I don’t get asked to the dance then everyone There are several problems with this, none the least will talk behind my back. If they’re all talking of which is that this process serves to reinforce about me, then I’ll become the joke of the school the adolescent’s style rather than broaden it. and everyone will make fun of me. If that hap- After the students have generated alternative pens I’ll have to switch schools because I’ll never beliefs, they are taught how to use evidence to be able to put it behind me. But if I switch schools, determine which beliefs are most accurate and to then I’ll be the new kid and the outcast at that identify potential solutions that their new, richer school too!” The causal link between not getting understanding of the situation affords them. We asked to a dance and becoming a social outcast have found self-disputing is a powerful tool for across schools is extremely weak, but the connec- overcoming the negative beliefs that often fuel tion from link to link seems more plausible, par- hopelessness and depression, and we believe that ticularly for the anxious adolescent. the process of self-disputing increases adoles- To stop the process of catastrophizing, we cents’ self-ef fi cacy because they have learned a guide children out of their dreaded fantasy by skill that enables them to more effectively solve teaching them to estimate the probability of each problems. As we often tell the participants in our link given that only the initial adversity (not being program, you cannot solve a problem until you asked to the dance) has occurred. Participants are know what caused it. then taught to generate equally improbable best- PRP also teaches a skill called “putting it in case scenarios (for example, “Everyone will real- perspective,” which can be used when beliefs are ize that the mailman made a mistake and failed to about the implications of an activating event, or deliver an engraved invitation to the dance from what we call “what next” beliefs. At this point in the most popular boy”). This step is important the program, we begin to focus on beliefs about because the very silliness of the best-case sce- the future rather than beliefs about the causes of nario helps to jolt the adolescent out of his or her problems. Like self-disputing, putting it in per- catastrophic thinking and tends to lower anxiety spective helps students to view the future with and increase positive affect. The next step is to greater realistic optimism, and it also increases use worst-case and best-case scenarios as anchors their self-ef fi cacy for dealing with anticipated to arrive at most-likely outcomes. Once the most- negative events. We have found this skill to be likely outcomes have been identifi ed, the adoles- particularly helpful for children and adolescents cents are taught to develop a plan for dealing with who are at risk for depression and anxiety them. The skill of putting it in perspective not because, as ABC predicts, catastrophizing is only reduces adolescents’ anxiety, but it also often the consequence of unrealistic beliefs about helps them to develop strategies for dealing with the likelihood of horrible things happening in the the real-world outcomes of the problems they future. For adolescents prone to anxiety, small face—and thus, increases optimism and self- problems are seen as insurmountable and dreaded ef fi cacy. In PRP we also teach goal setting, a skill outcomes are feared. that is important for all adolescents and particu- Putting it in perspective encourages adoles- larly valuable for those who feel pessimistic or cents to identify and list their worst-case thoughts hopeless about their futures. Adolescents who about the implications of adversity. By getting learn to set obtainable goals and to develop plans these thoughts out of their heads and onto a piece for reaching their goals have developed a of paper, the adolescents begin to have distance valuable system for combating the impulsiveness 208 K. Reivich et al. that can undercut resilience. In PRP, we teach the program. Given their initial reluctance, it is realistic goal setting and the “one step at a time” important to continue to identify their beliefs technique for making large projects more man- about trying the skill and to help them to use the ageable by breaking the project into doable steps. basic cognitive skills of the program to challenge We also help adolescents to identify beliefs that any pessimistic beliefs. can fuel procrastination or impulsiveness and We also teach decision making and creative derail them from their plan, and we apply the problem solving as part of the PRP skill. Both skill of self-disputing to test the accuracy and skills work to increase students’ self-effi cacy, usefulness of these beliefs. optimism, impulse control, and empathy. As with PRP also includes assertiveness and negotia- assertiveness and “one step at a time,” our goal is tion training. We have found that these skills, par- fi rst to identify beliefs that might be pushing the ticularly assertiveness, help adolescents to feel adolescent toward counterproductive and nonre- more hopeful about approaching others with their silient decisions or solutions. Once students are concerns, needs, or requests. From a resilience able to evaluate the accuracy and usefulness of perspective, assertiveness helps to foster reaching these beliefs, we then provide them with deci- out by helping adolescents to connect with others sion-making and problem-solving models. In in ways that will maximize the likelihood that both decision making and creative problem solv- their needs will be heard by others. Because ing, we emphasize the importance of slowing the depression-prone adolescents often underesti- process to make sure they are not responding mate the likelihood that a situation can be impulsively. We guide them in identifying their improved, they tend to respond to interpersonal goals, gathering thorough information about the problems with passivity. In PRP, we fi rst apply situation, and then work with them to generate a the skills of self-disputing and putting it in per- series of possible routes to achieve the goal. We spective to beliefs that fuel passivity such as: also help them to consider the plusses and “She won’t listen to me anyway,” or “If I ask her minuses associated with each potential decision, to stop she’ll think I’m a nag.” Other adolescents both from a time perspective (short term versus often have beliefs that fuel aggressiveness, such long term) and a self–other perspective (How will as: “The only way to get respect is to come on this affect me? How will this affect the other peo- strong,” or “If I don’t fi ght for what I want, no ple in the situation?). By focusing on how their one will listen to me.” Regardless of whether the decisions and solution strategies can affect oth- adolescent is relying on passive or aggressive ers, we help them to build empathy for the other interaction styles, our goal is to help the adoles- people involved in the situation. As the students cent evaluate how well the strategy is working start to see real-world differences in their ability and to challenge the beliefs that may be fueling to handle dif fi cult, complex situations we hear counterproductive behaviors. In addition, we them share stories about increased con fi dence, make explicit that speaking up and asking for greater hope for the future, and a sense of feeling help is a valuable coping strategy that is helpful more in control of their actions. when dealing with adversities and trauma. After the adolescents have challenged the beliefs that fuel nonassertive behaviors, we teach Penn Resiliency Program Findings them a four-step approach to assertiveness. This skill is particularly challenging for adolescents— In our initial studies of PRP, we evaluated PRP as especially those feeling hopeless—so we include a depression prevention program among students assertiveness practice in many of the sessions. who reported higher than average symptoms of We have found that many adolescents are initially depression, family con fl ict, or both. Students who reluctant to practice assertiveness, but that with participated in the intervention were compared practice, they fi nd assertiveness to be one of the with a matched control group. Our fi ndings indi- most useful and potent skills they have learned in cated that the intervention improved explanatory 12 From Helplessness to Optimism: The Role of Resilience in Treating… 209 styles and that this effect lasted 3 years following However, this study followed a very small sample, the intervention. The intervention group also which may have limited the researchers’ ability to reported lower levels of depressive symptoms fi nd effects. Our research group is currently con- through 2 years of follow-up, and the group ducting further evaluations of PRP that focus on members were less likely than controls to report ways to boost the intervention’s effectiveness. moderate to severe levels of depressive symptoms (Gillham & Reivich, 1999 ; Gillham, Reivich, Jaycox, & Sehgman, 1995 ) . Yu and Including Parents in Resilience Seligman (2002 ) replicated these fi ndings through Training 6 months of follow-up with a sample of Chinese school children. Roberts, Kane, Thompson, One of the ways we are enhancing the PRP is by Bishop, and Hart ( 2003 ) attempted to replicate including parents in the intervention. Depression these fi ndings with 11–13-year-olds in rural in youth can be best prevented by interventions Australia who reported elevated depressive symp- that include parents. Children of depressed par- toms. In this study, PRP signifi cantly reduced ents are at greatly increased risk for depression anxiety symptoms but not depressive symptoms themselves (Downey & Coyne, 1990 ) . The link relative to a standard health curriculum. We are between parental and child depression appears to continuing to evaluate PRP as an intervention for be due to several factors that tend to co-occur or high-risk participants. However, we have also result from parental depression, but also can begun to evaluate PRP as a universal interven- occur in parents who are not depressed. Parents tion, an intervention that is offered to all students who are depressed have been found to have fewer regardless of risk level. We believe that the cogni- positive interactions with their children (Field, tive and problem-solving skills covered in PRP 1984) . Depressed parents are also more likely to are important for increasing resilience more gen- display and model negative interpretive styles erally and are bene fi cial to most children. In sup- and passive or maladaptive coping skills. When port of this, a recent meta-analytic review of PRP parents give pessimistic explanations for events studies found signifi cant benefi ts of PRP when in their own lives, children can adopt these same tested with both high risk and universal samples types of interpretive patterns when confronting (Brunwasser, Gillham, & Kim, 2009 ) . In addi- problems of their own. They might expect that tion, in some studies, we have found that PRP negative events will be long lasting and diffi cult prevents depressive symptoms in children with or impossible to overcome. When parents give low levels of symptoms (as well as in children pessimistic explanations for child-related events with high levels of symptoms) (Gillham et al., (for example, “You failed the test because you’re 1995 ) , although fi ndings have not always been lazy”), children can internalize these explana- consistent. For example, Cardemil, Reivich, and tions and interpret future adversity through a Seligman (2002 ) evaluated the PRP as a universal similar lens. Garber and Flynn ( 2001 ) found that program for inner-city students. In an inner-city children’s explanatory styles are correlated with Latino sample, PRP participants reported parents’ explanatory styles, particularly parents’ signifi cantly fewer symptoms than controls fol- explanatory styles for child-related events. lowing the intervention. However, in an inner- The Penn Resiliency Program for Parents city African American sample, depressive (PRP-P) was designed with two major goals in symptoms fell dramatically in both the interven- mind: (1) to increase the parents’ overall resil- tion and control group, and the difference between ience by teaching them the core skills of PRP the groups was not signi fi cant. Pattison and Lynd- (adapted for adults), and (2) to teach parents how Stevenson (2001 ) evaluated PRP as a universal to model the skills effectively for their children intervention with children in rural Australia. and to coach their children in the skills taught in They found that PRP did not signifi cantly reduce PRP. PRP-P meets for six 90-min sessions, facili- depression or anxiety relative to a control group. tated at the schools by school guidance counselors, 210 K. Reivich et al. social workers, and psychologists who have been including parenting components. Results of other certifi ed through a 30-h training with senior programs have also been positive. Beardslee et al. members of our research team. ( 1997 ) developed an intervention for families in The sessions are comprised of two components. which one or both parents suffered from unipolar The fi rst, and central, component focuses on teach- or bipolar depression. The major goal of the ing the parents how to use the skills in their own intervention was to educate parents about the lives. Parents discuss adversities ranging from pro- effects of depression, to improve family commu- fessional issues to marital issues to speci fi c chal- nication, and to increase children’s understand- lenges confronted by parents with children at risk ing of parental depression so they would be less for depression. The second component addresses likely to blame themselves for parental symptoms how to model/coach the skills with their own chil- and behavior. Beardslee et al. found that partici- dren. Our emphasis here is on helping parents to pants in the family intervention reported improved notice “teachable moments” and to help them communication relative to participants in a lec- become comfortable sharing their own practicing ture intervention condition. Children in the fam- of the skills in ways that are both appropriate and ily intervention reported greater understanding of nonintrusive for their adolescents. parental depression and greater global function- The fi rst fi ve sessions of PRP-P are devoted to ing. Children in the family intervention were less the core cognitive resilience skills: ABC (the link likely than those in the lecture intervention to between thoughts and feelings/behaviors); self- develop depressive disorders, although this dif- disputing (challenging inaccurate beliefs), put- ference was not statistically signifi cant. Dadds ting it in perspective (challenging catastrophic et al. ( 1997 ) found that a cognitive–behavioral beliefs), real-time resilience (disputing counter- school-based intervention that included a parent productive beliefs in real time), and assertiveness. component was effective in preventing anxiety in The fi nal session is devoted to reviewing the skill children and adolescents. Recently, Compas et al. set, reinforcing ways to effectively promote the found that their cognitive–behavioral family- skills in the context of the family, and identifying based prevention program signi fi cantly reduced upcoming stressors and the skills that could be depression and anxiety symptoms in children and used to deal with these stressors. adolescents (Compas et al., 2009 ) . We conducted a small pilot study of the combined parent and adolescent PRP intervention. Forty-four middle school students and their par- Discussion, Limits, and Future ents were randomly assigned to the combined Directions intervention or a control condition. Students who were assigned to the intervention condition par- Making Interventions More Powerful ticipated in the PRP for adolescents; their parents participated in the PRP for parents. Results indi- Research on the psychological interventions that cated that the combined intervention prevented treat and prevent depression and anxiety has depression and anxiety symptoms through the identifi ed several promising interventions. 1-year follow-up. Findings were particularly However, intervention success rates are often far strong for anxiety; controls were almost fi ve times from ideal. Although effective for many partici- more likely than intervention participants to report pants, a sizable minority of participants in cogni- moderate to severe levels of anxiety (Gillham tive–behavioral therapy do not improve et al., 2006 ) . Although promising, these fi ndings signi fi cantly. For example, in a large study on should be interpreted with caution since this was a therapy for depression, 65% of depressed adults pilot study with a very small sample. We are cur- who were treated with cognitive–behavioral ther- rently conducting a large-scale evaluation of the apy showed a full improvement in symptoms, but PRP for parents as an added component to PRP. 35% continued to show fairly high levels of Surprisingly, only a few other programs have depression even after completing the intervention attempted to prevent depression or anxiety by (Elkin et al., 1989 ) . Similarly, some participants 12 From Helplessness to Optimism: The Role of Resilience in Treating… 211 in prevention programs develop clinical depres- Over the past decade, we have come to believe sion or anxiety, despite efforts in the program to that cognitive–behavioral interventions, like the promote resilience. Future research should focus PRP, can have important applications as universal on strengthening interventions and making them interventions. The shift in our thinking is re fl ected effective for more people. in the change to the name of the program, from One way to strengthen the effects of interven- the Penn Prevention Program to the PRP. All tions is to incorporate other parts of the adoles- children and adolescents encounter challenges cent’s world as targets of interventions. and stressful events in their lives. Most of the Historically, psychological treatments have skills covered in PRP and other programs are focused on the individual child or adolescent. useful for responding to these day-to-day chal- However, children’s lives are imbedded within lenges, as well as more serious events that chil- family, school, peer, and neighborhood systems dren encounter. These cognitive–behavioral skills (Bronfenbrenner, 1986 ) . Thus, it is important to (e.g., thinking realistically about problems, per- understand how resiliency is built within family spective taking, considering a variety of solutions systems and larger communities. In the PRP inter- to a problem, considering consequences when vention, initial fi ndings suggest that providing an making decisions) overlap with competences that intervention for parents in addition to the adoles- are discussed in the resilience literature (e.g., cent groups can be an effective way to increase Brooks & Goldstein, 2002 ) . Some of these skills effectiveness of the intervention. In addition, are also taught in problem-solving programs and efforts could be made to incorporate interventions interventions designed to reduce or prevent into the larger community through neighborhood aggression, substance abuse, and other maladap- programs or schoolwide programs that work to tive behaviors (Caplan et al., 1992 ) . Interventions create more positive relationships and more hope- that incorporate these skills should be relevant to fulness for communities as a whole. most students and could have effects on a variety of positive and negative outcomes. We believe that the development and evaluation of such Universal Versus Targeted broad-based interventions will equip children to Interventions respond resiliently to the challenges they will no doubt encounter in their future. One of the debates within the prevention literature concerns the feasibility and effectiveness of Acknowledgment Research on the effectiveness of the targeted versus universal interventions. Targeted Penn Resiliency Project is funded by a grant from the interventions, like Clarke et al.’s ( 1995 ) preven- National Institute of Mental Health (MH52270). The Penn Resiliency Program is owned by the University of tion program and our initial evaluations of PRP Pennsylvania. The University of Pennsylvania has licensed discussed earlier, are provided to at-risk partici- this program to Adaptive Learning Systems. Drs. Reivich pants, such as participants with elevated levels of and Seligman own Adaptive stock and could pro fi t from symptoms. In contrast, universal interventions the sale of this program. are administered broadly to the entire population regardless of risk. In general, effects for the average participant are larger in targeted interventions References than universal interventions. This is because tar- Abela, J. R. Z. (2001). The hopelessness theory of depres- geted intervention participants are more likely to sion: A test of the diathesis-stress and causal mediation develop the disorder or problem and there is thus components in third and seventh grade children. greater room for change in each individual. Journal of Abnormal Child Psychology, 29 , 241–254. However, universal interventions that have small Abela, J. R. Z., Aydin, C. M., & Auerbach, R. P. (2007). Responses to depression in children: Reconceptualizing effects for the average participant can have large the relation among response styles. Journal of effects for society (Offord, 1996 ) . Abnormal Child Psychology, 35 , 913–927. 212 K. Reivich et al.

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Wai Chen and Eric Taylor

such as gambling, bulimia, or kleptomania, sub- Introduction stance abuse, oppositional and conduct disorders, and the complex tics of Tourette disorder The Concept of Self-Control and ADHD (Strayhom, 2002a) ; or it can be seen as a part of those disorders or the result of them. The ability Self-control has been a pervasive idea in develop- to control oneself can be seen as a protective factor mental psychology. At a neurocognitive level, the in an even wider range of disorders—either organism’s control (or lack of it) over its own because one can use self-control to avoid acquir- responsiveness to stimuli has been regarded as a ing even greater developmental risks, such as central topic in attention/executive function substance abuse, or because the ability to control research and attention defi cit (e.g., Taylor, 1995 ) . oneself is a necessary condition for the success of Behavioral control is a more complex idea: some forms of treatment, such as cognitive ther- clearly, a planned and rule-governed organization apy (Strayhom, 2002b ) . of activity can have many advantages and has This widespread use of the idea already points arguably been a crucial acquisition in the evolu- to a dif fi culty. If the idea is applicable to so many tion of man. Emotional control relates to the idea sorts of problem, perhaps it should not be seen as that it is adaptive to moderate the immediate an explanatory concept, but rather as a somewhat affective reaction and to respond in a willed rather nonspeci fi c description. There is a certain circu- than a passionate fashion. larity in it: if the only evidence needed for poor Self-control and its absence are appealing behavioral self-control is the presence of undesir- concepts for explaining a wide variety of psycho- able behavior, then it cannot also be used to pathological presentations. Impaired self-control explain that behavior. It constitutes, in effect, a can be seen as a risk for nearly all the disorders theory about the cause of behavior disorders. In presenting with unruly or undesirable behavior— this case, independent evidence for its presence is hyperactivity, attention defi cit, impulse disorders essential. Operational de fi nitions have been hard to achieve. The dif fi culty is akin to that inherent W. Chen () in the closely related idea of the will: if an act is Ashurst Hospital, Lyndhurst Road, Southampton, caused by a volition, what causes the volition? MRC SGDP, Institute of Psychiatry , When considered as a theory of cause, then King’s College London , UK impaired self-control must compete with others. e-mail: [email protected] Consider a group of children in a classroom who E. Taylor are behaving riotously. Some may be doing this MRC SGDP, Institute of Psychiatry , King’s College London , UK in a planned and willful fashion; for instance, e-mail: [email protected] they may prefer to impress their peers rather than

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 215 DOI 10.1007/978-1-4614-3661-4_13, © Springer Science+Business Media New York 2013 216 W. Chen and E. Taylor please their teacher. This may be regrettable, but Milich, Loney, & Landau, 1982 ) . Overactivity it is not uncontrolled; it is a different organization implies an excess of movements, and this cannot be rather than a lack of organization. Others may simply reduced to impulsiveness or inattentiveness have no idea that they are infringing serious (Porrino et al., 1983 ) . Impulsivity means acting expectations; their egotism is so great that they without re fl ecting, and it can be conceptualized as are following their own inclinations without overrapid responsiveness, sensation seeking, regard to the reactions of others. Another child excessive attraction to immediate reward, aversion would, in re fl ecting on it, realize that his or her to waiting, and a failure to plan ahead. DSM-IV interests would better be served by being less classifi cation of ADHD contains three subtypes: unruly; but the child either will not or cannot take (1) predominantly inattentive; (2) predominantly the time to re fl ect and translate the understanding hyperactive–impulsive; and (3) combined. The into action. It is this latter child who could be third variant is comparable to the European diag- described as “lacking in self-control” or “impul- nosis of hyperkinetic disorder and the syndrome sive” or “lacking in inhibition”; but it is not an of pervasive hyperactivity. The validity of this operational de fi nition of behavior—rather, it is separation, however, has not been empirically based on inferences about the current and other established. At the time of writing, the draft for possible states of mind. DSM-V has retained the subtypes (though admit- In this chapter, we will focus on the most ting their dubious nosological status) but has clearly operationalized behaviors that can be seen added a fourth: “restrictive inattentive.” The as evidence for impaired self-regulation: overac- notion behind this is the clinical suspicion that tivity and impulsiveness. Within this narrow children with inattention but no trace of hyperac- operationalized de fi nition, attention de fi cit hyper- tivity are different from the “predominantly activity disorder (ADHD) represents a classic inattentive” subjects who enter studies—and who paradigm. ADHD is characterized by age-inap- are often just sub-threshold for hyperactive– propriate levels of inattentiveness, hyperactivity, impulsive symptoms. ADHD is a disabling condi- and impulsivity, with an onset in early to middle tion, associated with increased risk for learning childhood. We describe the behaviors as they disabilities, educational failure, impaired social have emerged from observational studies and functioning, relationship problems, employment brie fl y summarize a large literature on their neu- dif fi culties, delinquencies, and multiple psychiat- rocognitive basis, which has suggested an altered ric disorders, including conduct disorder, and in function of brain structures involved in self-orga- later life, substance abuse, personality disorders, nization. The outcome studies will then be and mood disorders. reviewed, to the effect that the resulting behavioral changes are indeed a risk factor for later psychological adjustment. This leads to a consid- Neuropsychological Correlates of ADHD eration of the factors that can promote resilience in the face of this risk, including what can be In the fi eld of ADHD research, the hypotheses of achieved by treatment. de fi cits in response inhibition and self-control as the core psychopathology have been gaining attention. Though the apparent inattentiveness Core Problems in ADHD and distractibility are prominent observed features of ADHD, research of neuropsychological In ADHD, symptoms and impairments should be correlates has consistently failed to detect defi cits persistent over time and pervasive across settings. in selective attention or attention fi lter. That is, Inattentiveness denotes a reduced length of time the defi cit appears not to lie in sensory inputs or spent on a task or toy; an increase in the number screening out unwanted information, but rather in of orientations away from a centrally presented response outputs. In other words, ADHD is more task; and more rapid changes between activities a disorder of inhibition and of maladaptive (Dienske, de Jonge, & Sanders-Woudstra, 1985 ; response patterns than a disorder of attention. 13 Resilience and Self-Control Impairment 217

There are several theoretical accounts of this set up experimental arrangements in which children change in response organization, and they compete with ADHD do not demonstrate impulsiveness. to give the closest representation of the problems: In short, it cannot be assumed from the cognitive (1) response inhibition theory (Barkley, 1997 ) ; (2) studies so far that we are dealing with a de fi cit of delay aversion theory (Sonuga-Barke, Taylor, & inhibitory control rather than an alteration in the Heptinstall, 1992 ; Sonuga-Barke, Taylor, Sembi, ways that decisions about inhibition are made. & Smith, 1992 ) ; (3) state regulation theory (Van Either notion could apply. They are not mutually der Meere, 2002 ) ; (4) working memory de fi cit exclusive; in fact, they could give rise to each other. theory (Castellanos & Tannock, 2002 ) ; (5) cogni- A de fi cit of inhibition can cause children to be tive-energetic theory (Sergeant, 2000 ) ; and (6) averse to delay because they have suffered many temporality (perception of time) de fi cits theory. experiences of failure in delay situations. Delay More recently, a dual pathway model has been aversion will discourage children from experienc- proposed, combining response inhibition theory ing situations in which delay is involved, and can with delay aversion theory (Sonuga-Barke, 2003 ) . therefore hold them back from learning the skills of The contention of response inhibition theory inhibition. Indeed, we do not see the theories of is that the core defi cit of ADHD resides in inhibition and delay aversion as competing for the impaired inhibition of unwanted outputs, for sole explanation of impulsive behavior. Rather, they instance, in inhibition of a prepotent response; describe two possible pathways into impulsiveness, withholding an established ongoing response pat- resulting either in two subgroups of children with tern (thus permitting a delay for a decision); and ADHD or in the problems for the same individual. protecting this period of delay from interference In the model of volitional control presented by or disruptions from extraneous events. These give Taylor (1999 ) , the two theories represent changes at rise to other secondary impairments in executive different stages of the formulation of a planned and functions involved in self-control. intended response—the executive planning and State regulation theory gives more emphasis to decision of what to do, the elaboration of the intent the contextual factors; the poor performance of into a plan, the choice of one plan over others, and children with ADHD on certain tasks is believed the suppression of competing plans. to refl ect a nonoptimal state of energetic pools, All these abnormalities of inhibitory control arousal, activation, and effort. By introducing, for could follow directly from genetically determined example, reward or a faster event rate, the states of changes in the microstructure and metabolism of these ADHD children can be optimized so their the brain. The brain structures that are involved performance can be potentially brought to the in the suppression of inappropriate responses level of control children. This theory offers an (e.g., right frontal and striatal areas) are rich in explanation for the observed variability or incon- dopamine and dopamine receptors. Their activity sistency in response in ADHD subjects; and also, could well be impaired by genetically determined that the degree of their variability is altered under reductions in the ef fi ciency of synaptic transmis- different experimental situations of stimuli pre- sion. It would, however, be too simple to assume sentation, such as improvements under reward that this direct route must be the key one; interac- conditions and under a fast rate of stimuli tions with the psychological environment also presentation. need to be considered. There are strong genetic Delay aversion theory proposes that impulsive, infl uences on hyperactive behavior, but much and therefore uncontrolled, behavior does not less is known about the inheritance of the puta- stem from an inability to withhold response, but tive cognitive abnormalities. Experience may from a motivational change: a deep-rooted dislike infl uence both simple and complex processes, but for waiting and therefore a reluctance to delay. it is perhaps easier to see how complex processes The in fl uence of context is even stronger in this can be modi fi ed by learning and motivation. The formulation because if the delay characteristics decision to inhibit—to withhold a prepotent are controlled—if the child has to wait no matter response or one known to lead to immediate which choice he or she makes—then it is possible to grati fi cation—must be determined in part by the 218 W. Chen and E. Taylor organism’s previous history. A child, for example, to establish the reliability and stability of test whose experience favors the idea that delayed results, but it looks as though we may be moving reinforcers will never in fact arrive (as might be towards more objective assessment and more the case in the children of some impulsive par- prescriptive education. ents) may well not evolve a style of preferring to wait. Similarly, the decision to allocate protracted consideration and analysis to a problem is likely Resilience, Outcome Studies, to be conditioned by the extent to which doing and Methodological Issues just that in the past has been rewarded by success or by the reactions of caregiving adults. In theory, Taylor, Chadwick, Heptinstall, and Danckaerts this opens the way to cognitive and self-instruc- ( 1996 ) described a follow-up study of children tional methods of intervening; in practice, they with pervasive hyperactivity who were identifi ed have not yet proven their clinical value. by parent and teacher ratings in a large commu- Kuntsi et al. ( 2010 ) conducted a multivariate nity survey of 7- and 8-year-olds. Nine years familial factor analysis to examine whether the later, at the age of 17, they were reassessed with apparent multiple neuropsychological impair- parental ratings, as well as a detailed interview ments share common or separate etiological path- using Parent Account of Childhood Symptoms ways. The goal was to examine and identify (PACS) rating system. Hyperactivity was a risk common latent familial factors which underlie factor for later maladjustments, even after allow- the slow and variable reaction times, impaired ing for the coexistence of conduct disorder prob- response inhibition, and choice impulsivity asso- lems and excluding children who showed the ciated with ADHD. The study used an ADHD problems of emotional disorder. Nearly half of and control sibling-pair design. The results of the the affected children had developed a psychiatric fi nal model consisted of two familial factors. The diagnosis, and more showed problems such as fi rst larger factor captured the familial infl uences persisting hyperactivity, violence and other con- on mean reaction time and reaction time variabil- duct problems, and social and peer problems. ity. This factor explained 98–100% of the famil- Although hyperactivity presents as a chronic and ial in fl uences of these measures. The second, debilitating disorder, a minority of the children smaller factor, captured 62–82% of the familial interestingly seemed to escape complications and infl uences on commission and omission errors. grew out of the disorder, so that their young adult Choice impulsivity was excluded in the fi nal outcome was not severely compromised. In other model because of poor fi t. The fi ndings suggest words, resilience in the presence of pervasive the existence of two familial pathways to cogni- hyperactivity does indeed exist. Yet resilience tive impairments in ADHD. among children with ADHD has not been a major The idea that there are several different neu- focus of research. rocognitive routes into dysregulation implies that In the fi eld of resilience, a number of studies it could be useful—both for research and clinical have been conducted on children exposed to early practice—to distinguish subtypes on this basis adversities and deprivations. The researchers and offer separate approaches to remediation. examined predictors of good adjustments in later Indeed, studies which discriminate those with life as indicators of resilience. Though one could ADHD from controls on the basis of combining infer similar predictors are applicable to ADHD tests of different processes look very promising. children, nevertheless, direct and robust empiri- Solanto et al. ( 2001) achieved a much stronger cal evidence is still lacking. Furthermore, empirical discrimination with a combination of inhibitory studies sometimes can yield counterintuitive control and delay aversion tests than with either type fi ndings, that is, results opposite to what one may of test alone; Gupta, Kar, and Srinivasan ( 2010 ) logically predict. This subject is discussed in a have achieved better than 90% correct classi fi cation review article by Hechtman (1991 ) and Chap. 6 . I t using a set of four tests. More research is needed is important to emphasize here that the large-scale 13 Resilience and Self-Control Impairment 219 resilience studies were not conducted on children a categorical de fi nition). The latter category with ADHD or hyperactivity. In order to avoid comprises children who have been diagnosed to confusion, we will not review their fi ndings here. have a clinical disorder (i.e., ADHD) by clini- However, we have included studies that have cians or by researchers using validated diagnostic touched on these issues that had been conducted instruments. These subjects are usually ascer- on hyperactive or ADHD subjects. tained through specialist clinics. On the other In ADHD psychological treatment, in relation hand, study subjects with hyperactivity are often to resilience, a new trend has emerged, challeng- derived from community samples and classifi ed ing the conventional conceptualization of resil- according to the level of activity (plus or minus ience based on the de fi cit or weakness-based inattentiveness). These perceived hyperactive model (Brooks & Goldstein, 2001 ) . In the de fi cit subjects represent the extreme end of a continuous or weakness-based model, a disorder is conceived dimension but may not necessarily have the to embody symptoms, abnormalities, defi cits, clinical disorder of ADHD. and weaknesses; resilience is conceptualized as Research on ADHD children is often subject to factors that reduce symptoms and thereby referral bias, that is, children who are referred improve outcome. As an alternative, a strength- to doctors may have more severe symptoms or based model has been proposed. This model comorbid conditions that are troublesome to places emphasis on the development of skills, adults, such as aggression and conduct problems, strengths, and “islands of competence,” in spite which are more common among boys. Furthermore, of the disorder (Brooks & Goldstein ). In essence, results from these studies are heavily in fl uenced the new approach demarcates “abilities” from by whether the control or comparison groups have “disabilities”; and it advocates the development been well chosen and representatively selected. of “abilities” and the “talents” associated with A comparison group can be overmatched, leading the condition. In contrast to the traditional para- to underdetection of differences, and undermatching digm, the new paradigm also postulates that can lead to detection of false differences. “strengths” can minimize the negative impacts of On the other hand, research on hyperactivity, “symptoms” in promoting resilience. the extreme end of the dimensional spectrum, is There is no substantive intervention trial that usually conducted on community samples. They evaluates the ef fi cacy of this novel paradigm, that are less subject to selection bias. But the qualities is, to test whether promoting development of abili- of the data gathered often lack details and preci- ties or ADHD-associated strengths or islands of sion. Often they are con fi ned to rating scale mea- strengths, in the absence of reducing symptoms, sures, recording behaviors over a short time improves outcomes in ADHD. In this review, we frame, and completed by parents or teachers who shall therefore examine the available published are not trained to distinguish normality from dis- evidence on (1) the natural history of the condition order. The information gathered is therefore vul- and its implication on resilience; (2) predictors of nerable to measurement errors, rater bias, and resilience and predictors of adverse outcomes in information bias, leading to misclassi fi cation of ADHD; (3) predictors of treatment response; and subjects. Furthermore in the analysis, the cut-off (4) whether an emphasis on strengths in the between “normality” and “abnormality” can be absence of symptom reduction is likely to promote arbitrarily de fi ned, for example, with a cut-off resilience in children with ADHD. threshold made at the top 5, 10, 20, or 25%. Thus Before this main review, we would like to a child can be designated as a “case” for a range draw attention to some methodological issues in of reasons: he or she has been overrated by an evaluating published evidence in this fi eld. overstrict parent, going through a bad phase at Research evidence on ADHD broadly derives the time of data collection, or having an activity from two groups: those conducted on subjects at the upper end of normality but below the lower with hyperactivity (on a dimensional scale) and boundary of a disorder. Birth cohorts are sometimes those with ADHD or a comparable diagnosis (by too small to contain adequate numbers of children 220 W. Chen and E. Taylor who meet the criteria for the presence of disorder This fi nding was confi rmed by the Cambridge and thus lack statistical power to identify the true cohort, which Farrington reanalyzed to evaluate effects of a disorder. The inferred relevance of the the effect of childhood inattention/hyperactivity fi ndings of these studies to ADHD needs to be on later criminal outcome (Farrington, Loeger, & taken with caution. van Kammen, 1990 ) . Four hundred and eleven males were derived from a working-class area in London and followed-up at age 8, 10, 14, 16, 18, Natural Outcomes of Hyperactivity 21, and 25. He found that inattention/hyperactiv- and ADHD ity predicted later criminality, and this was partly independent of conduct problems, especially for Evidence from Community Samples early conviction and multiple offending before of Subjects with Hyperactivity age 25. His analysis indicated that hyperactivity and conduct problems were discrete, but overlap- The natural course of the undiagnosed and ping, predictors for delinquency. untreated disorder can be inferred from longitu- Only a few studies have been able to base dinal studies of epidemiologically ascertained their conclusions about natural history on cases community samples, that is, subjects drawn from of disorder. Schachar, Rutter, and Smith (1981 ) large-scale surveys of unreferred individuals such reanalyzed the Isle of Wight longitudinal epide- as birth cohorts. These longitudinal epidemio- miological study and concluded that hyperactiv- logical studies are diffi cult and expensive to carry ity, if it was pervasive across situations and out, and have generally been reported from cohort informants, strongly predicted the persistence of studies that were designed for other purposes. psychological deviance between the ages of 9 The classi fi cation of hyperactivity may be derived and 14. However, the initial stratifi cation of cases from proxy measures, which often lack precision had been studied for other types of disorders, so and specifi city for ADHD. The key studies are their cases of hyperactivity were particularly derived from fi ve major cohorts: Dunedin, likely to show comorbid disorder. It is therefore Christchurch, Isle of Wight, East London (Taylor possible that their prediction resulted, not from et al., 1996 ) , and Cambridge. hyperactivity being a speci fi c risk, but from its Fergusson, Lynskey, and Horwood ( 1997 ) being a marker to increased severity of psycho- have analyzed the Christchurch birth cohort logical disturbance. with parent and teacher rating scales ascer- The East London cohort delineated a diagnos- tained at different time points of development. tic syndrome in an urban community sample by a They found no signi fi cant association between two-stage process of screening followed by hyperactive/inattentive behavior and later detailed assessment of high-risk and a proportion offending, once coexisting conduct problems of low-risk subjects. This brings the advantages were adjusted in the analysis. The former only of having precise clinical details on subjects appeared as a risk because of its prior associa- derived from a sample unaffected by clinic refer- tion with conduct disorder, which, they sug- ral bias. Taylor et al. (1996 ) found that initial gested, was the true risk. However, the negative hyperactivity predicted later conduct problems, consequence of hyperactivity was not trivial, violence, and also covert antisocial behaviors, for it did predict educational underachievement. even after allowing for baseline coexisting con- Furthermore, a very strong correlation exists duct symptoms. between the two conditions. Moffi tt ( 1990 ) On balance, the evidence from community analyzed the Dunedin birth cohort and came to samples indicates that hyperactivity is associated different conclusions. Even when early aggressive with later maladjustments, ranging from poor behavior (at age 5) was statistically controlled, academic achievement to antisocial behaviors, hyperactive behavior predicted antisocial behav- violence, and overt and covert conduct problems. iors in adolescence. We can now turn to the fi ndings from individuals 13 Resilience and Self-Control Impairment 221 with syndromic diagnosis of ADHD or its suffered from ADHD in early adolescence; 27% equivalents and examine their outcomes and had conduct problems, and 20% had multiple implications. convictions (Gittelman, Mannuzza, Shenker, & Bonagura, 1985; Mannuzza, Klein, Konig, & Gismpino, 1989 ). Gittelman et al . identi fi ed the Evidence from Diagnosed ADHD continuing presence of hyperactivity, not the Samples baseline hyperactivity at early childhood, as the best prediction for later risk of conduct prob- On syndromal persistence, a meta-analysis lems and delinquency in adolescence, suggesting (Faraone, Biederman, & Mick, 2006 ) combined that chronic persistence of hyperactive symptoms the fi ndings of published longitudinal studies and is the key risk factor for adverse outcomes estimated an approximate persistent rate of 15%. (Gittelman et al., 1985 ) . In adulthood, only 4% When the adult phenotype included “ADHD in still fulfi lled the criteria for ADHD diagnosis, but partial remissions” (that is, symptomatic cases more of the hyperactive subjects had antisocial below the threshold for childhood syndrome), the personality disorders and nonalcohol drug use persistence rate increased to 65%, indicating that (Mannuzza, Klein, Bessler, Malloy, & Lapadula, about two-thirds of childhood cases continue to 1998 ) . Their low rate of persistence of diagnosis show signi fi cant symptoms and impairment in may be due to the artifacts of diagnostic thresh- adulthood, despite a smaller proportion ful fi lling old for adult condition or high attrition rate. It is the strict diagnostic de fi nition. well known that those who refused or were lost at A consistent fi nding across follow-up studies follow-up tend to have more problems. A follow- of children with ADHD is that they continue to up study was carried out when the subjects have persistent problems with restlessness, overreached 18 years of age (Mannuzza, Klein, activity, impulsive behavior, and inattention. Abikoff, & Moulton, 2004 ) ; the authors found Much of the published data on natural history of that low levels of CD-type problems are not the disorder was derived from six major cohort innocuous, because they predict later CD among samples (with representative authors in parenthe- children with ADHD but without a comorbid CD ses): New York (Gittelman & Mannuzza), diagnosis at baseline. When the subjects reached Montreal (Weiss, Hechtman, & Milroy), 39 years of age, Mannuzza, Klein, and Moulton Wisconsin (Barkley, 1997 ; Fischer, Barkley, ( 2008) found that even in the absence of comor- Smallish, & Fletcher, 2002 ) , California (Lambert), bid conduct disorder in childhood, ADHD East London (Taylor et al., 1996 ) , and Sweden increased the risk of developing antisocial and (Rasmussen & Gillberg, 2000 ) . Other clinic substance use disorders (SUDs) in adolescence, cohorts with a shorter follow-up period included which, in turn, increases the risk for criminal Harvard (Biederman, Mick, & Faraone, 2000 ) , behavior in adulthood. Pittsburgh (Molina & Pelham, 2003 ) , Portland In the Montreal cohort, Weiss, Minde, Werry, (Satter fi eld, Swanson, Schell, & Lee, 1994 ) , and Douglas, and Neneth (1971 ) compared 91 clinic- Iowa (Loney, Kramer, & Milich, 1981 ) . The East referred hyperactive subjects with a control group London and Swedish cohorts are unique in that matched for age, sex, IQ, and social class. At the the diagnosed cohorts were ascertained through 5-year follow-up, they found that the hyperactive epidemiological samples by screening. The other adolescents had lower self-esteem and more aca- cohorts were clinic patients and thus subjected to demic problems. Most continued to be distract- selection bias. ible, impulsive, and emotionally immature, In the New York cohort, Gittelman et al. pro- although less hyperactive. In addition, 25% of the spectively followed 101 hyperactive males in hyperactive subjects had delinquent behaviors. adolescence and adulthood and compared them Similar results were found by Akeman, Dykman, with matched normal controls. They found that and Peters (1977 ) ; the hyperactive subjects had the majority (68 out of 101) of the subjects still more oppositional or delinquent behavior and 222 W. Chen and E. Taylor lower self-esteem when compared with a group (2002 ) conducted a self-report survey on psychi- of normal controls and other comparison group atric and personality disorders in a follow-up with learning diffi culties. Satterfield et al. (1994 ) study on the Wisconsin ADHD cohort (then in found a fi ve times higher rate of arrest among the their early 20s) and examined a number of pre- hyperactive subjects compared with matched dictors for psychiatric morbidity. About 21% of controls in committing a felony (burglary, theft, hyperactive probands qualifi ed for antisocial per- or assault with a weapon). At a 10- to 12-year sonality disorder (ASPD), a fi vefold increase follow-up of the Montreal cohort, at approxi- compared with the control group. Their fi ndings mately age 19, Weiss, Hechtman, Perlman, were in keeping with previous studies at New Hopkins, and Werner (1979) found them to have York (27% vs 8% of controls), Montreal (23% vs less education, have had more car accidents, and 2.3%), and Sweden (18% vs 2.1%). They all sug- to have made more geographical moves when gest hyperactivity in childhood predisposes a per- compared with normal matched controls. son to ASPD in adulthood. Fischer’s study, Hyperactive subjects had less friends, completed however, has extended the fi nding further by fewer years of education, failed more grades, and demonstrating that this elevated risk for ASPD is received lower marks. They also had more court substantially infl uenced by severity of childhood referrals, had tried nonmedical drugs more often, conduct problems (odds ratio [OR]; OR = 4.54 and had more personality trait problems, most with 95% con fi dence interval of 1.44–14.31), as frequently of “impulsive” and “immature-depen- well as teenage conduct problems (OR = 1.56 dent” types. They were more impulsive on cogni- with 95% confi dence interval of 1.20–2.02), even tive style tests. During face-to-face research after controlling for the severity of childhood interviews, they reported more feelings of rest- symptoms as covariants. Their fi ndings provided lessness and exhibited more signs of restlessness. support to Lynam’s (1996 ) view that coexisting At the 15-year follow-up when the same cohort hyperactivity and conduct problems in the same was in their early 20s (Weiss et al., 1985 ), they child constitute a greater risk for antisocial out- found 66% of hyperactive subjects still had at comes in adulthood than when either problem least one disabling symptom of ADHD and 23% occurs alone. Another interesting fi nding was suffered from an antisocial personality disorder. that histrionic and passive-aggressive personality There had also been more suicide attempts in the disorders were also signifi cantly overrepresented hyperactive group. According to Hechtman, among their subjects (12% and 18% respec- Weiss, Perlman, and Tuck (1981 ), there are three tively); and these disorders were not a function of categories of outcome. The fi rst group had a fairly childhood conduct problems. However, elevated normal outcome. The second group consist of borderline personality disorder (14%) was asso- those with persistent attentional, social, emo- ciated with teenage conduct disorder (OR = 1.32 tional, and impulse problems; and as adults, they with 95% con fi dence interval of 1.05–1.66). continued to have diffi culties with work, inter- Major depression was signi fi cantly greater in the personal relationships, low self-esteem, impul- hyperactive than control group, especially in the sive behavior, irritability, anxiety, and emotional presence of ASPD (OR = 3.59) and borderline PD lability. The majority of young adults fell into (OR = 5.56). In this study, they found no evidence this group. The third group included those with of increase in substance abuse. more serious psychiatric compUcations, includ- Research has been inconsistent with regards to ing heavy dependence on drugs or alcohol, severe increased risk for substance abuse. Some found a depression with suicidal problems, and an fi social greater prevalence of alcohol or drug use in New personality pathologies. Their last fi nding pub- York (16% vs. 3% by age 18) (Gittelmanet al., lished some 20 years ago has recently been repli- 1985 ) , 12% vs. 4% at age 24 (Mannuzza et al., cated in other studies. One recent follow-up study 1998 ) , and 16% vs. 4% at age 26 (Mannuzza, extended the analysis further to identify predic- Klein, Bessler, Malloy, & LaPadula, 1993 ) . In the tors of antisocial personality disorder. Fischer et al. Swedish sample, only alcohol misuse disorders 13 Resilience and Self-Control Impairment 223 occurred more often (24% vs. 4%) (Rasmussen associated with an increased risk of substance & Gillberg, 2000 ) . In the Montreal sample, use problems in males. Biederman, Wilens, Mick, signi fi cant differences were found for “use of Faraone, and Spencer (1998 ) , however, found narcotics in last 5 years” (14% vs. 4%), “use of ADHD to be associated with substance abuse nonmedical drug” (74% vs. 55%), and “sold non- independent of comorbid conditions. In their medical drug” (18% vs. 5%); while no signifi cant study of a clinic-referred ADHD adult sample, difference was found for “use of hash, speed, and they found twofold increased risk for psychoac- barbiturates” (Weiss, Hechtman, Perlman, tive substance use disorder (PSUD) and an Hopkins, & Werner, 1979 ) . In Fischer et al.’s increased likelihood of progressing from alcohol (2002 ) study, the rate of “any drug disorder” use disorder to a drug use disorder (hazard among hyperactive subjects was 43%, which is ratio = 3.8) for ADHD subjects. The authors sug- high compared with controls of other studies. But gested that individuals who used drugs for psy- in their study, this rate was not signifi cantly dif- chopathological reason (i.e., ADHD symptoms ferent from their normal control (31%). The and pathologies) were more likely to progress to authors believed that this was due to an elevated dependence and abuse after exposure and were rate of substance use in their control group, per- less likely to abstain than those who used drugs haps re fl ecting a secular trend in more prevalent for social or recreational reasons. In another substance misuse in the U.S. population, leading study on adults with ADHD, the researchers to no increase in relative risk (Fischer et al., found a slower remission rate, longer duration of 2002 ) . It is likely that the risks in development of PSUD, and slower recovery in their hyperactive substance abuse among hyperactive subjects is subjects compared with nonhyperactive users in fl uenced by both exposure to and availability of (Wilens, Biederman, & Mick, 1998 ) . Recently, illegal drugs, which in turn are related to the time, Flory, Milich, Lynam, Leukefeld, and Clayton country, and urban or nonurban settings in which ( 2003 ) reported that ADHD and conduct disorder they live. Hence, prevalence of substance abuse (CD) symptoms interacted to predict marijuana as an outcome is more variable across studies. dependence symptoms as well as hard drug use Molina and Pelham ( 2003 ) evaluated the cor- and dependence symptoms. They concluded that relates and predictors of substance use in a fol- individuals with comorbid ADHD and CD are at low-up study of 142 children with ADHD into a greater risk for substance abuse than either con- adolescence (13–18 years old) comparing with dition occurring alone. 100 same-aged non-ADHD controls. They found Overall, studies suggested three different paths associations between hyperactive subjects with leading to substance abuse: conduct problems, higher levels of alcohol, tobacco, and illegal drug core pathology of ADHD, and unique interaction use. They identi fi ed three correlates: fi rst, sever- between comorbid ADHD and conduct problems. ity of childhood inattention symptoms predicted As persistent ADHD is highly correlated with later multiple substance use; second, childhood CD, family history of ADHD, and psychosocial oppositional defi ant disorder/conduct disorder adversity, these fi ndings suggest that the subgroup symptoms predicted later illegal drug use; and exposed to both a high dose of ADHD genetic third, persistence of ADHD and adolescent con- loading and a high dose of environment insults are duct problems correlated with elevated substance most likely to be at risk and thus least resilient. use behaviors. Their fi ndings suggested that elevated risks of subsequent drug use were mediated via both oppositional/conduct problems and Summary severity of inattentive symptoms. Lynskey and Hall ( 2001 ) suggested that the Several themes emerge from the reviewed longi- key mediator for substance abuse in ADHD is the tudinal studies. First, ADHD is not a benign con- presence of conduct problems. In other words, in dition, it is a chronic illness with signifi cant the absence of conduct disorder, ADHD is not psychological, social, and emotional morbidity. 224 W. Chen and E. Taylor

Second, for the majority of cases, signi fi cant or internal locus of control, and more positive self- residual ADHD symptoms will persist and result esteem. They have better ego strengths and cop- in serious academic, social, and emotional prob- ing skills. They can ask help of others and are lems in adolescence and in adulthood, even in the generally more optimistic about themselves and absence of more severe complications. Third, their futures, along with showing better capacities certain patterns are more indicative of a malignant for empathy, good peer relationship, and sense of course: persistence of symptoms over time, the humor. Protective family characteristics include presence of conduct problems and aggression, and closer supervision, higher social status, and a the emergence of substance abuse and personal- warm, cohesive, and supportive family atmo- ity diffi culties in adolescence and early adult life. sphere, where emotional expression, open com- The coexistence of conduct problems with ADHD munication, and independence are encouraged. appears to represent the strongest risk factor for Parental mental health and physical health are severe maladjustments in later life. The implications associated with the presence or absence of such a of these fi ndings are that (1) adequate control of positive environment. Positive factors in the net- ADHD symptoms (i.e., reducing persistence of work of extended family, friends, school, and symptoms) and (2) controlling aggression and church can provide support that is lacking at factors leading to conduct problems can improve home and can also confer protection. In this case resilience. study of an ADHD subject, Hechtman reported the subject to have a high IQ, a good sense of humor, and charm. His family was middle class, Predictors of Resilience and Adverse stable, loving, and supportive. There were Outcome in ADHD signifi cant fi gures in his life who believed in him. He thrived and coped well in his early adulthood, In a review paper, Hechtman (1991 ) examined a despite signi fi cant impairments and setbacks range of factors associated with resilience among experienced at higher education and at work at-risk children (though not ADHD subjects), and related to persistent symptoms of hyperactivity, related these factors to ADHD in a single case restlessness, impulsivities, and inappropriate report. Factors reviewed included child character- talkativeness. This was a single case report with istics (health, temperament, IQ, autonomy, psy- evident methodological limitations. It neverthe- chological parameters) and family characteristics less suggests that similar resilient predictors for (socioeconomic status, emotional warmth and at-risk children can be applied to ADHD subjects. support, family size, and characteristics of the There is no ADHD research that systematically wider community). Research on at-risk children examines whether this wide range of predictors (though not ADHD subjects) shows that resilient for resilience for at-risk children also applies to children are healthier. They have fewer health ADHD subjects. Nevertheless, our review of pub- problems in utero, perinatally, and in infancy. lished evidence suggests that child, family, and Their temperaments are more likely to be active, environmental factors can infl uence resilience adaptable, and socially responsive, eliciting a in ADHD. Favorable child-predictive factors more positive response from their caretakers and include: (a) lack of perinatal complications, (b) environment. They are more able to fi nd solace higher baseline IQ, academic, emotional, and and satisfaction. They also have more re fl ective social functioning, (c) childhood temperament, vs. impulsive cognitive styles and more able to frustration tolerance and emotional stability, (d) control their feelings appropriately. Children with desisting symptom trajectory or symptom reduc- higher IQs fare better in diffi cult circumstances, tion as response to treatment, (e) lower baseline much as those with more advanced self-help abil- symptoms, and (f) lack of baseline aggressive and ities and more problem solving capacities and conduct disorder symptoms, all predicting better language development and communication skills. subsequent adjustments. Favorable family and Resilient children had a greater sense of autonomy, environmental factors include: (a) lower family 13 Resilience and Self-Control Impairment 225 confl ict, (b) lower parental negative expressed effect size—37%). “Offenses against person” emotions, (c) higher socioeconomic status, (d) was predicted by parental control, the presence of emotional health of family members and emo- neurological signs, and aggression at baseline tional climate of the home and child-rearing prac- (combined effect size—36%). “Involvement with tices, (e) parental supervision and control, and (f) illegal drugs” was predicted by baseline aggres- nonurban dwelling, which appear to modify the sion, age of referral, urban dwelling, and response risk of exposure to drugs, deviant peers, and to drug treatment (negative) (combined effect criminal activities. Weiss et al. ( 1971 ) found that size—40%). For academic achievement domain, children with initial high IQs and lower initial they examined reading, arithmetic, and spelling scores of hyperactivity and distractibility fared abilities. Reading scores were predicted by better academically in adolescence. Furthermore, past reading and response to drug treatment a quarter of hyperactive adolescents with (combined effect size—63%). Arithmetic skills signi fi cant antisocial behavior had higher initial were predicted by past academic ability, response ratings of aggressive behaviors. This fi nding was to treatment, family size (negative direction), also replicated by Loney et al. ( 1981 ) who dem- maternal hostility, reading abilities, and perinatal onstrated that initial aggression predicted aggres- compactions (combined effect size—69%). sion and antisocial behavior in adolescence. Spelling was predicted by past academic ability, Loney’s sample was derived from 124 children maternal control, hyperactivity, and family size (ages 2–12) with the diagnosis of hyperkinetic/ (combined effect size—79%). minimal brain dysfunction syndrome who had To put the results another way, their fi ndings been referred to an Iowa child psychiatry clinic. In suggest that response to treatment (symptom their follow-up at age 12–18, they measured three reduction) promotes resilience in lowering the broad domains of outcomes: (1) symptoms at out- risk of later drug use and improving later aca- come, (2) delinquent behaviors, and (3) academic demic achievement. Parent control confers resil- achievement. They carried out multiple regressions, ience by increasing academic skills and reducing expressing effect size of the predictors as “squared negative effect. However, perinatal complications multiple correlation,” which can be transformed predicted aggression, persistence of hyperactiv- to represent a percentage that accounts for the ity, and lower arithmetic skills. Urban dwelling total variation of the outcome measure. increases the risk of drug use and offenses against For the symptoms outcome domain, they property. Large family size increases the risk of examined three separate variables: (1) adolescent offenses against property and lowered later aca- hyperactivity and inattention, (2) aggression, and demic achievement. Thus, lack of the latter fac- (3) negative effects at follow-up. For adolescent tors would increase resilience, in a similar way hyperactivity scores (rated by the mother), they that the absence of conduct and aggressive prob- found three predictors to account for about 20% lems at baseline would improve outcome. of the outcome measure: (1) parental socioeco- A prospective study of 123 hyperactive chil- nomic status, (2) baseline aggression, and (3) a dren also examined similar predictive factors history of perinatal complications. Interestingly, (Fischer, Barkley, Fletcher, & Smallish, 1993 ) . baseline hyperactivity scores did not predict later For positive predictors they found that childhood hyperactive symptoms. Inattention was predicted cognitive and academic competence predicted by age of onset (effect size—5%). Adolescent adolescent academic skills; and parental personal negative effects were weakly predicted by competence predicted social competence in ado- response to medication and parental control lescence. For negative predictors they found that (combined effect size—9%). For delinquency family stress at baseline predicted conduct prob- outcome domain, they examined aggression/ lems; and the combined effects of paternal anti- offenses and illegal drug use. “Offenses against social tendencies and the severity of childhood property” were predicted by urban dwelling, size impulsivity–hyperactivity predicted later opposi- of family, and baseline aggression (combined tional de fi ant behaviors. Child de fi ance, but not 226 W. Chen and E. Taylor hyperactivity, predicted later arrests. Overall, the struct in childhood-related measurement is study suggested that no single predictor cut across questionable. EOI has thus not been included in all domains. most childhood studies of expressed emotions. In the Montreal cohort at 10- to 12-year fol- Rutter et al. ( 1997 ) conducted a longitudinal low-up (Weiss et al., 1979 ) , hyperactive subjects follow-up study on pervasively hyperactive sub- (around age 20) were asked what had helped jects ascertained in a community epidemiological them most during their childhood. The most com- sample and examined the effect of expressed mon response was a positive relationship with a emotions on disruptive behaviors. Hyperactive signifi cant adult; for instance, one parent (nearly children who were exposed to a high level of always the mother) who believed in their fi nal negative expressed emotions from parents exhib- success or a teacher who seemed to turn the tide ited more antisocial and disruptive behaviors at of failure. Another response was discovering that follow-up compared with the hyperactive coun- they had some special talents. When asked what terparts exposed to a low level. The pathogenic made things worse, the most common responses effect of negative child–parent relationship were family fi ghts (usually concerning the hyper- applied also to nonhyperactive subjects in the active subject), feeling different (inferior, same study, though the effect was less marked, that “dumb”), and being criticized. Signifi cantly more is, the rates of antisocial and disruptive behaviors hyperactives than controls rated their childhood were also raised in the nonhyperactive children as unhappy. However, the authors did not report exposed to a high level of negative expressed emo- whether these factors were correlated with out- tion; but the overall rates were lower than in the comes in their study. hyperactive counterparts. The fi ndings suggest a In a later publication by the same group, possible causal relationship between expressed Hechtman, Weiss, Perlman, and Amsel (1984 ) emotions and antisocial/disruptive behaviors. examined a range of childhood predictors of out- The impact of emotional dysregulation on come in early adulthood. The outcome measures adjustments has recently received attention. studied include: (1) emotional adjustment, (2) aca- Barkley and Fischer ( 2010 ) published a study, demic performance, (3) police involvement, (4) which followed-up 135 hyperactive children into car accidents, and (5) substance and alcohol adulthood and measured their Emotional misuse. The authors identi fi ed baseline personal Impulsiveness (EI) symptoms. Of the hyperactive characteristics such as IQ, aggressiveness, children now adults, 55 were classifi ed as having emotional stability, and low frustration tolerance, persistent ADHD (ADHD-P); and 80 as having and family characteristics, such as socioeconomic nonpersistent ADHD (ADHD-NP). They were class, child-rearing practices, home emotional atmo- also compared with a community sample of 75 sphere, and parental mental health, to be signi fi cant subjects followed-up concurrently. They found predictors of successful adult outcome. signifi cantly more EI symptoms in ADHD-P sub- Within family measures, the specifi c effect of jects, than their nonpersistent and community con- parental negative expressed emotions in fl uencing trol counterparts. EI was measured with seven the development of antisocial behaviors in hyper- items: (1) fi nd it diffi cult to tolerate waiting— active children has been studied by Rutter et al. impatient; (2) quick to get angry or become upset; (1997 ) . Negative expressed emotions denote crit- (3) easily frustrated; (4) overreact emotionally; (5) icism, disapproval, negative attributions, as well easily excited by activities going on around me; (6) as rejecting and hostile attitudes toward the child. lose my temper; (7) am touchy or easily annoyed They are coded independently of emotional by others. EI was found to contribute uniquely to warmth. Emotional over involvement (EOI) was major impairments in multiple domains—occupa- originally conceptualized as a component of tional, educational, criminal, driving, fi nancial and “expressed emotion” in the Camberwell Family social relationship—after adjusting for the con- Interview for adults. As dependency is age- founding effects of inattention and hyperactivity/ appropriate for children, the validity of this con- impulsivity symptoms. The authors concluded that 13 Resilience and Self-Control Impairment 227

“EI is as much a component of ADHD as are its To investigate biological factors that promote two traditional dimensions and is associated with resilience, Nigg, Nikolas, Friderici, Park, and impairments beyond those contributed by the two Zucker ( 2007 ) examined two independent sam- traditional dimensions.” ples: children were classifi ed as resilient if they Wilmshurst, Peele, and Wilmshurst ( 2011 ) avoided developing ADHD, oppositional de fi ant found that subjects with a diagnosis of ADHD who disorder (ODD) or conduct disorder (CD) in the nevertheless became college students represented face of family adversity. The fi rst sample consisted an especially resilient group. This group reported of ADHD-combined subtype, ADHD-inattentive signifi cantly higher paternal support and greater subtype and controls. The second replication support from friends than non-ADHD college stu- sample was a prospective cohort of children from dents. The authors suggested that college students high-risk families with high levels of alcohol and with ADHD should form a focus of research, as drug misuse. Adversity was indexed by low they had achieved success against the odds. socioeconomic status, parental psychopathology, Mikami and Hinshaw ( 2003 ) found a complex marital con fl ict, and exposure to stressful events. relationship between protective factors and Resilience was defi ned as being below the diag- adaptive behaviors in girls with and without nostic threshold for attention, oppositional, and ADHD. Peer rejection was related to higher lev- conduct problems despite adversity. Two specifi c els of aggressive behavior and depressed/anxious biological protective factors were examined, behavior, con fi rming peer problems as a risk fac- given their potential relevance to prefrontal brain tor. For all girls, popularity with adults predicted development. These were (1) neuropsychological lower levels of aggression while goal-directed response inhibition, as assessed by the Stop task, solitary play predicted lower levels of anxiety/ and (2) a composite catecholamine genotype risk depression. Popularity with adults was most score. Resilient children were characterized in protective among the peer-accepted subgroup, both samples as displaying more effective whereas solitary play was most protective among response inhibition. A composite high-risk geno- the peer-rejected subgroup. For ADHD girls (not type index was developed by summing the pres- controls), engaging in meaningful solitary play ence of high-risk allele markers on three genes was a stronger predictor of lower levels of anx- expressed in prefrontal cortex: dopamine trans- ious/depressed behavior. In the follow-up study, porter (SLC6A3), dopamine D4 receptor (DRD4), Mikami and Hinshaw ( 2006 ) hypothesized and noradrenergic alpha-2 receptor (ADRA2A). protective factors to be childhood measures of Homozygous insertion genotype was classi fi ed self-perceived scholastic competence, engage- as high risk for DRD4. High-risk SNP (single ment in goal-directed play when alone and popu- nucleotide polymorphism) alleles were “G” (A/G larity with adults. In adolescents the authors or G/G) for SLC6A3, and “T” (C/T or T/T) for examined a range of outcomes, including exter- ADRA2A. The authors found that a low score in nalizing and internalizing symptoms, academic risk genotype was a reliable resilience indicator achievement, eating pathology, and substance use against development of ADHD and CD—but not as outcomes. ADHD and peer rejection predicted ODD—in the face of psychosocial adversity. an increased risk for all these outcome measures Amidst moderate or moderate-to-high adversity, except for substance use, which was predicted by biological characteristics of the child provided ADHD only. ADHD and peer rejection predicted broad protection, if the child had protective geno- lower adolescent academic achievement but not types or had strong response inhibition or both. adolescent externalizing and internalizing behavior. Notably, genotype and response inhibition were As a buffer, self-perceived scholastic competence uncorrelated and did not interact; the authors in childhood (with control of academic achieve- suggested these to be two distinct neurobiologi- ment) predicted resilient adolescent functioning. cally based protective mechanisms. The cate- However, the protective effect of meaningful soli- cholamine genes analyzed are expressed primarily tary play was not detected in adolescents. in prefrontal cortex and involved in executive 228 W. Chen and E. Taylor functions; whereas response inhibition is associ- 45% for persisters vs. 33% for late desisters vs. ated with the integrity of basal ganglia and stria- 10% for early desisters. The persistent form of tum as well as prefrontal–subcortical network, ADHD also differed in the family history (34% infl uenced by other putative factors. The authors vs. 11% vs. 10%). This suggested a stronger suggest that moderate to high levels of family effect of familiality and perhaps a heavier genetic adversity, which disrupt socialization experiences loading in the persisters. As an indicator of psy- and prefrontal cortical functions necessary for chosocial adversity, persisters were exposed to a adjustment and regulation, could be one route in higher level of family con fl ict. Subjects’ own a multipathway causal model of ADHD. characteristics also differed. Among the persist- Furthermore, stress events alter neural developers, there were more severe inattentive and hyper- ment in regions involving hippocampus, amygdala active symptoms and a greater level of functional and frontal cortex, important in inhibitory con- impairments at both baseline and follow-up. trol. The results provided preliminary evidence Persisters also had more symptoms of oppositional/ for key biological factors linked to prefrontal cor- de fi ance disorder and depression and anxiety tex function, which may enable children to avoid problems. Furthermore, the persisters showed a developing ADHD and CD in the presence of trend of having a lower IQ at baseline, but the psychosocial adversity. differences did not reach statistical signi fi cance In summary, studies on predictors of outcomes (109.2 vs. 110.8 vs. 111.7; p = 0.063). The GAF in hyperactive subjects suggest that factors in the (global assessment functioning) scores were child, family, and environment can all in fl uence signi fi cantly lower for the persisters at baseline later resilience and maladjustments. We now turn (47 vs. 53 vs. 53; p = 0.0001) and at follow-up to examine the issues of resilience and develop- (52 vs. 60 vs. 64; p = 0.0001). Overall, the per- mental trajectories. sisters had higher exposure to family con fl icts, a stronger family history of ADHD, and were more severely affected and impaired by ADHD at both Developmental Trajectories and baseline and follow-up. In other words, resilience Resilience: The Effects and Predictors (better functioning and escaping impairments at of Remitting and Persistent Life outcome) was associated with a desisting life Course and Normalization of Function course, which in turn was predicted by lower for Persisters symptom levels, better adjustment, lack of family history, and lack of family confl ict at the baseline. In a prospective study on a clinic sample of Chen and Simonoff (unpublished) studied a ADHD subjects, Biederman et al. ( 1996 ) exam- U.K. birth cohort with parental and teacher rating ined the rate of desistence and persistence over scales and found that hyperactivity (HA) exerted a time, and identifi ed the predictors for desistent relatively weak and nonenduring antecedent effect and persistent life course of ADHD. Their sample on conduct problems, a moderate dose–response consisted of Caucasian boys aged 6–17 with IQs effect (length of exposure as dosage), and a very over 80 and who had an intact nuclear family. At strong proximity effect of HA on the development 4-year follow-up, they identifi ed a high rate of of conduct problems. This fi nding offers support persistence of 85%, with only 15% remitted. The to the idea that it is the maintenance and chronic high rate of persistence found was likely due to course of HA, rather than its simple presence in the broad defi nition of persistence they used (see earlier childhood, that leads to conduct problems later). Of the 15% whose ADHD was a transient with their ensuing complications. In the same disorder, half of the remission occurred in child- study, it was also suggested that declining HA life hood and the other half in adolescence. Predictors trajectories were protective against conduct prob- of persistence included family history, severity of lems at age 16. Furthermore, a shorter exposure to ADHD, psychosocial adversity, and comorbidity HA was associated with a lower risk of conduct with conduct, mood, and anxiety disorders. problems at age 16 in the longitudinal follow-up ADHD in the family history infl uenced persistence: study. This would mean that a short course and 13 Resilience and Self-Control Impairment 229 discontinuity of HA symptoms was associated at baseline and follow-up: school, social, and with a low level of conduct problems and their emotional. At follow-up, the persistent ADHD ensnaring consequences. It was not clear whether sample fell into three groups: 20% functioning treatment and therapeutic reduction in symptoms poorly in all domains, 30% functioning well, and would confer the same benefi t. 60% with intermediate outcomes. They found With regards to the defi nition of persistence, that impulsivity reduced the likelihood for nor- Biederman et al. (2000 ) identi fi ed a shift in the malization of functioning (odds ratio [OR] for patterns of symptoms and impairments with age. normalization of functioning = 0.7 with 95% CI The symptoms of inattention remitted for fewer of 0.5–0.9). That is, among those persistent ADHD subjects than did symptoms of hyperactivity or subjects, those with a high level of impulsivity impulsivity. To some extent, it seemed the pro- had more impaired function. Likewise, psychiatric portion of subjects experiencing remission varied comorbidity (OR = 0.3 with 95% CI of 0.1–0.7), considerably with the de fi nition used (highest for exposure to maternal psychopathology (OR = 0.3 syndromatic remission, lowest for functional with 95% CI of 0.1–0.8), and larger number of remission). This fi nding was also supported by an siblings (OR = 0.5 with 95% CI of 0.3–0.9) all earlier longitudinal follow-up study of 106 boys predicted lower adjustments. Learning diffi culties with DSM-III-R ADHD (Hart, Lahey, Loeber, impeded normalization of school functioning Applegate, & Frick, 1995 ) . Hyperactivity/impul- (OR = 0.15 with 95% CI of 0.05–0.53). The con- sivity symptoms declined with increasing age, verse was also true, that is, the absence of these but inattention symptoms did not. Inattention risk factors was associated with improved function- declined only from the fi rst to the second assessing despite persistence of ADHD. Furthermore, ment and remained stable thereafter in boys of all improvement in one area of functioning had a ages. The rate of decline in hyperactivity–impul- snowball effect, increasing the chance of improve- sivity symptoms was independent of the amount ment in other areas. Good baseline functioning and type of treatment received. Furthermore, they also predicted normalized functioning at follow-up. found that boys who still met the criteria for Good emotional functioning at baseline predicted ADHD at follow-up were signi fi cantly more normalized function of both emotional function- hyperactive/impulsive and more likely to exhibit ing (OR = 5.6 with 95% CI of 2.2–14.6) and conduct disorder at baseline than boys who no school functioning (OR = 2.4 with 95% CI of longer met the criteria at follow-up. The fi ndings 1.01–5.8). Good social functioning at baseline suggest possible heterogeneity in the childhood predicted normalized emotional functioning at form of ADHD, with one subtype traversing a follow-up (OR = 3.1 with 95% CI of 1.05–9.3). symptom-declining trajectory and another a more Good school functioning at baseline predicted symptom-persistent trajectory. normalized school functioning at follow-up So far we have examined maladjustment in (OR = 3.6 with 95% CI of 1.4–9.1). In short, good relation to persistent ADHD trajectory and resil- baseline functioning and lack of adverse predic- ience in relation to desisting trajectory. We now tors confer relative resilience despite persistence turn to the interesting question on predictors of of ADHD. This suggests that normalization of resilience despite persistence of symptoms. That functioning and syndromic persistence of ADHD is, can resilience exist in spite of persistent may be partially independent. ADHD, and if it does, what are they? In a follow- up study of a clinic sample comprised of 85 boys with persistent ADHD diagnosed by DSM-III-R Genetic Infl uence: The Role of Gene criteria, Biederman, Mick, and Faraone (1998 ) and Environment Interaction attempted to disentangle syndromic persistence from functional outcome in ADHD youths. The There is only scanty published evidence in the subjects were followed prospectively into mid- fi eld of ADHD demonstrating the effect of gene adolescence and compared with 68 non-ADHD and environment interaction in moderating resil- boys. Three domains of functioning were recorded ience. As already mentioned, a study examined 230 W. Chen and E. Taylor the effect of psychosocial adversity and genetic 5-HTT promoter polymorphism exhibited more risks in developing ADHD, ODD and CD. A depressive symptoms, diagnosable depression, composite catecholamine genotype risk score and suicidality following exposure to stressful was used by summing presence of risk across life events than individuals homozygous for the markers on three genes expressed in prefrontal long allele. This study again provides another cortex: dopamine transporter, dopamine D4 piece of early evidence that an individual’s receptor, and noradrenergic alpha-2 receptor. A response and resilience to environmental insults low score in risk genotype was reported to be a can be moderated by his or her genetic makeup. reliable resilience indicator against development In the fi eld of ADHD, there is early evidence of ADHD and CD, but not ODD, in the face of that comorbid ADHD and CD may be an etio- psychosocial adversity (Nigg et al. 2007 ). We logically distinct disorder entity as suggested by anticipate this topic to be an area of interest for analysis of familial history and aggregates ADHD research. For non-ADHD subjects, two (Faraone, Biederman, Jetton, & Tsuang, 1997 ; highly cited publications have demonstrated that Thaper, Harrington, & McGuf fi n, 2001 ) ; and also genetic factors can in fl uence resilience following that adult ADHD may be a more homogenous exposure to childhood abuse and life stress. condition with stronger familial etiological risk Caspi et al. ( 2003 ) investigated the role of factors than the childhood form (Biederman genetic contribution to account for why some et al., 1995 ) . Within the childhood form, there are children who are maltreated grow up to develop likely to be subtypes of persistent and nonpersis- antisocial behavior, whereas others do not. tent variants, possibly mediated by different A functional polymorphism in the gene encoding genetic and environmental infl uences. A transient the neurotransmitter-metabolizing enzyme mono- course of ADHD is associated with better prog- amine oxidase A (MAOA) was found to moder- nosis; in contrast, both persistent ADHD and the ate the effect of maltreatment. Subjects with a comorbid form of ADHD/CD are associated with genotype conferring high levels of MAOA greater maladjustment. If genetic factors are expression (associated with an increased level of proven to be associated with these varying sub- this enzyme in the brain) were less likely to types of clinical phenotypes, genetic makeup will develop antisocial problems following exposure also infl uence resilience and vulnerability in the to childhood maltreatment. Those with a geno- presence of ADHD. We anticipate that genetic type conferring low levels of MAOA expression research and gene–environment interaction had an increased risk of developing antisocial research in the near future may provide interest- behaviors. Their fi ndings suggested that the gen- ing insights into the biological and environmental otype associated with a high level of MAOA substrates that confer resilience. expression can also confer resilience following exposure to childhood abuse. They also provided early evidence that genotypes can moderate chil- Resilience, Treatments, and Lessons dren’s sensitivity to environmental insults. from the MTA In the second study by the same group, Caspi et al. ( 2003) investigated why stressful experi- Here, we examine the effects of treatment and ences led to depression in some people but not in medication in terms of symptom reduction and others. They used a prospective longitudinal “normalization” of behaviors. In particular, we study of a representative birth cohort and investi- summarize some of the key relevant fi ndings gated the moderating effects of a functional poly- from the recent publications from the Multimodal morphism in the promoter region of the serotonin Treatment of Attention-De fi cit Hyperactivity transporter (5-HTT) gene. There are two com- Disorder (MTA, 1999 ) study. A reader may refer mon variants of this gene: a short and a long form to an overview summary paper on the MTA (or allele). They found that subjects who are (Jensen, Hinshaw, Swanson, et al., 2001 ) and one homozygous or heterozygous (with one or two on the effect of comorbidities in the MTA (Jensen, copies respectively) of the short allele of the Hinshaw, Kraemer, et al., 2001 ) . 13 Resilience and Self-Control Impairment 231

There are in excess of 200 published studies ADHD Symptoms reporting the ef fi cacy and effectiveness by stimu- In the MTA, subjects were randomized to four lant treatment on inattentive and hyperactive arms: community care (CC), intensive behav- symptoms. More interestingly, there are other ioral treatment (Beh), state-of-the-art medica- studies examining the effects of stimulants on tion management (Med), and a combination of symptomatic impulsivity, aggression, and conduct Beh and Med (Comb). The key initial fi nding problems, as well as on executive function and the was that for core ADHD symptoms, the Comb impacts on parental negative expressed emotions. and Med treatments were more effective than In both laboratory and naturalistic settings, Beh and CC (i.e., Comb ~ Med > Beh – CC, with stimulants have been found to be effective in an effect size [ES] of 0.50–0.60). Ninety percent reducing aggression and impulsivity. Improve- of children on Comb and 88% on Med no longer ments in social and interpersonal functioning as met the full criteria for ADHD at the study end a result of reduction in aggression and impulsi- point. Two more recent secondary analyses (one vity have been con fi rmed in naturalistic studies. using a composite outcome measure and another In other words, the effects of stimulants are not using a categorical outcome measure) identi fi ed only con fi ned to attention, they also affect a signi fi cant but marginal superiority of Comb emotional and social processing and can correct over Med in additional to the initial fi ndings disruptive, intrusive, and aggressive behaviors, (i.e., Comb > Beh ~ CC, with ES = 0.70; and which often render hyperactive children unpopu- Comb > Med with ES = 0.28). lar among their peers. In nonhyperactive children The difference between Med and CC was with CD, a study (Klein et al., 1997 ) reported striking. Interestingly, two-thirds of CC subjects improvements in conduct symptoms with stimu- also took medication. But there were important lant treatment, confi rming the effect of stimulants differences between the community practice and on nonhyperactive symptoms. study protocol in medication management. The positive effects of stimulant medication on Subjects in the Med arm were given a detailed social functioning within the family have been initial dose titration over 28 days. This was fol- demonstrated. In a double-blinded crossover treat- lowed by monthly review, with adjustment of ment study, Schachar, Taylor, Wieselberg, Thorley, dosage, or change of medication if indicated. and Rutter ( 1987 ) found that the family function The prescribing clinicians also contacted the and relationships improved in children who teachers before each monthly review. responded to methylphenidate treatment: there was Adjustments of medication after initial dose a reduction in negative sibling encounters and a titration were common, and only about 30% of reduction of parental negative expressed emotions. the children remained on the initial dose estab- Treatment response was de fi ned as 50% or greater lished by initial titration by the end of the reduction in hyperactive symptoms while on stimu- 14-month trial period. This means that about lant treatment. Measures of maternal warmth, criti- 70% of the children needed continuing monitor- cism, contacts with parents, parental coping, and ing and dose adjustment to obtain the optimal positive/negative encounters with siblings were treatment response. Interestingly, most of the gathered by raters blinded to the treatment and dose adjustment was toward a higher dosing, response status. Among responders, methylpheni- especially for those starting on a low and inter- date was signifi cantly associated with more mediate posttitration dose. Med subjects were expressed maternal warmth, less criticism, increased on three times daily dosing, with a higher aver- contact between mother and child, and fewer nega- age daily dose (average total daily dose = 32.8 mg) tive encounters between the child and his siblings. and 12 visits per year; in contrast, CC subjects If symptom control by treatment can improve were on twice daily dosing, with a lower average social, interpersonal, and cognitive functioning, daily dose (average total daily dose = 18.7 mg) then it is important to identify the most effective and an average of 2.3 visits per year. It appears form of treatment. The MTA study compared the that initial dose titration followed by close moni- effects of different modes of treatment. toring and effective dosing with careful adjustment 232 W. Chen and E. Taylor to maintain response over time and to avoid side measures on (1) parent-reported hyperactivity and effects will markedly improve the immediate inattention, (2) parent–child relationship, and (3) ef fi cacy of stimulants. teacher-rated social skills. Perhaps children with anxiety symptoms are biologically more sensitive Non-ADHD Symptoms and hence responsive to conditioning. About 33% The study also examined non-ADHD outcome of subjects met DSM-III-R criteria for an anxiety measures. These measures included parent–child disorder excluding simple phobias. Moderating relationship, teacher-rated social skills, anxiety/ effect of anxiety favors the inclusion of psychoso- depression symptoms, and oppositional/de fi ance cial treatment for them. This positive effect was symptoms as well as academic achievement and also identifi able in parent-reported outcome mea- functioning. Comb had a small but statistical sures on disruptive behavior, internalizing symp- signi fi cant superiority to Beh for (1) academic toms, and inattention (March et al., 2000 ) . functioning, (2) WIAT reading scores, (3) con- Family socioeconomic status (SES) can be trolling internalizing, and (4) oppositional/ fractionated into two independent measures: de fi ance symptom (with ES range 0.26–0.28). parental education and parental occupation. The Comb was also superior to CC in improving par- key departures from the primary fi nding ent–child relationship, additional to the above (Comb ~ Med > Beh ~ CC) due to moderating four measures. Med was located in between effect of SES were for disruptive behavioral, inat- Comb and CC, not statistically different from tentive, and hyperactive symptoms. For families either. The nonsignifi cant differences should not with a low SES, Comb was more effective than all be regarded as “no difference” as MTA was three other treatments (Comb > Med ~ Beh ~ CC) designed to have 80% power to detect ES of 0.4 for oppositional/defi ance symptoms only. There or greater; so any real difference of a magnitude is no additional advantage of Comb for ODD smaller than this ES is less likely to be detected. symptoms among children from families with higher occupational status. For the high educa- Moderators tional status group, Comb is more effective than Factors whose presence alters the likelihood of Med (Comb > Med > Beh ~ CC) for hyperactive treatment response are known as moderators. and inattentive symptoms. One explanation for Moderators identi fi ed by the MTA were: (1) these fi ndings is that perhaps ODD symptoms in comorbid anxiety disorder and patterns of comor- children from advantageous background were bidities, (2) socioeconomic status and educational more biologically determined, whereas in chil- background of the parents, and (3) comorbidity dren from disadvantageous backgrounds the same status. These factors were already present prior symptoms were more attributable to poor parent- to the randomization, so the in fl uences of mod- ing. Correcting parenting skills in low SES fami- erators on the outcome of the study are protected lies thus had a more marked effect than the other by the randomization process. They should be group. Second, core ADHD symptoms could be distinguished from “mediators,” which are fac- more recalcitrant to behavioral treatment, requir- tors that occur after the randomization process, ing parents with higher educational backgrounds such as clinic attendance, compliance, adherence to implement the program more effectively. In to treatment, and therapeutic alliance with the recommending treatment, clinicians should iden- therapists; and the latter are thus not protected tify target symptoms and familial characteristics by the randomization process. and offer the optimal intervention plan accord- Children with comorbid anxiety are more ingly (Rieppi et al., 2002 ) . likely to respond to Beh. That is, Beh appeared Finally, the presence of comorbid conditions more effective than indicated in the primary anal- also moderates treatment response. Jensen, yses. First, it diverged from CC, and converged Hinshaw, Kraemer, et al. ( 2001 ) found that the with Med. Second, Comb treatment was also presence of anxiety symptoms (ANX) with more effective, diverging from Med. Differences ADHD regardless of CD status increased the in treatment effects were most evident in outcome likelihood of response to behavioral treatment. 13 Resilience and Self-Control Impairment 233

ANX status confers bene fi ts on ADHD children practical conclusions of this equifi nality can be regardless of the presence of oppositional argued over. Some will say that this calls for de fi ance/conduct disorder symptoms (ODD/CD). extending intensity of treatment delivery over a Its presence exerted ameliorating effects on con- longer time span. Others will consider that current ODD/CD (i.e., ADHD + ANX + ODD/ equifi nality is only to be expected, given that CD vs. ADHD + ODD/CD). As a simple rule for randomization stopped at the 14-month point. predicting treatment response, ADHD plus ANX The self-selection that followed would mean that subjects were likely to respond to any of the three families chose whichever therapy was best for treatments: behavioral alone, medication alone, them, and would imply that they mostly chose and combination of medication and behavioral wisely. The main implication for this chapter is intervention. In other words, all interventions are that a period, even as long as 14 months, in which likely to be effective for them. In contrast, ADHD symptoms are intensively controlled is not only and ADHD plus ODD/CD subjects usually suf fi cient to promote resilience. responded only to interventions that included medication. That is, for these two groups, medication appeared especially indicated, and behav- Resilience, Stimulant Treatment, ioral intervention alone seemed contraindicated. and Subsequent Substance Abuse However, for the doubly comorbid group with ADHD plus ANX plus ODD/CD, combination Data from more than 200 randomized clinical tri- interventions appeared to offer substantial advan- als have consistently found stimulants an effec- tages over other treatments. tive treatment for children and adults with ADHD. In summary, the MTA study identi fi ed that One study reported that childhood treatment with management with state-of-the-art medication stimulants for ADHD increased the risk for sub- alone is—at least over 14 months—more effec- sequent cigarette smoking and nicotine and tive than conventional medication management cocaine dependence in adulthood (Lambert & and behavioral management combined. The addi- Hartsough, 1998 ) . This study received much tional benefi t of combination treatment should be media attention, and public concerns have been reserved for special cases, such as children with raised whether early exposure to stimulant medi- double comorbidities (ADHD + ANX + CD/ cation predisposes to subsequent substance abuse ODD) and children from low SES background and dependency. with severe ODD/CD symptoms. Children with This study, however, represents the only study comorbid anxiety disorder can be given behav- so far reporting such an association. Twelve other ioral management as the fi rst line of treatment, studies have not found evidence that childhood- especially if they are from high SES background stimulant treatment for ADHD leads to an and targeted for inattentive and hyperactive symp- increased risk for substance experimentation, toms. Behavioral treatment alone is not as effec- use, dependence, or abuse by adulthood. Wilens, tive for children with ADHD only and ADHD Faraone, Biederman, and Gunawardene ( 2003 ) plus CD (but of course some families will prefer conducted a meta-analysis on six of the larger the option, knowing that adverse effects are prob- published studies, two studies with follow-up in ably less likely in behavioral treatment). Treatment adolescence and four in young adulthood. The should be tailored according to the psychosocial analysis comprised 674 medicated and 360 and clinical pro fi les of a child. There is no single unmedicated subjects. The combined estimate of treatment strategy that would confer universal the odds ratio using random-effect meta-analysis benefi ts for all subtypes of ADHD. indicated a 1.9-fold reduction in risk (95% CI The 3- and 8-year follow-ups of the MTA 1.1–3.6) for SUD for those exposed to childhood- subjects have, however, found no superiority of stimulant treatment compared with those not the intensively medicated group to that receiving exposed. The age effect showed that studies with only behavioral approaches or, indeed, to the follow-up into adolescence showed a greater pro- routinely treated community control group. The tective effect (OR 5.8) than studies with follow-up 234 W. Chen and E. Taylor to adulthood (OR 1.4). It was possible that the emotions, and the presence of parental psycho- extended follow-up period to adulthood increased pathologies also increase risks. The presence of the likelihood of exposure to drug experimenta- conduct problems in conjunction with ADHD tion and hence misuse. Alternatively, this might represents a particularly strong predictor of be due to higher dropout in stimulant treatment in adverse outcome, in terms of subsequent antiso- early adulthood, leading to loss of risk protec- cial behaviors, social and occupational impairments, tion. However, data on duration of exposure to substance abuse, antisocial personality disorders, pharmacotherapy were not available and did not and associated mood problems. Positive endow- allow further analysis to test the hypothesis. ments such as high IQ, emotional stability, Another explanation was that enhanced parental minimal impairments of functioning, and favor- supervision for youths receiving medication able family background with the presence of sup- might have confounded the analysis. portive adults all confer resilience. Symptom Furthermore, there were major methodological reduction, associated with either a desisting hyper- problems with the study by Lambert et al. They active symptom trajectory or response to treat- found that stimulant treatment increased the risk ment, predicts better outcomes. Behavioral of subsequent drug use in young adults. In par- modifi cations can sometimes be enough in them- ticular, they found that exposure to earlier stimu- selves, in milder cases, without recourse to medi- lant treatment was linearly related to nicotine and cation: given without medication they can be cocaine abuse, with similar trends to alcohol helpful particularly for preschool children, chil- abuse. There were, however, signi fi cant differ- dren with anxiety symptoms, and children with ences on baseline characteristics between the very resourceful parents. They are nearly always medicated and unmedicated subjects, conduct desirable in conjunction with medication, and disorder was overrepresented in the medicated especially for comorbid children and those in dis- group. Prospective studies have consistently advantaged families. Strengths and skills develop- identifi ed conduct disorder as a major risk factor ment by cognitive methods alone have not been for the development of SUD among ADHD sub- shown to confer protection against social impair- jects. Conduct disorder, therefore, represents an ment. Social skills training however (together with important confounder in their analysis, which parent training and the use of behaviorally ori- was likely to give rise to a false association. ented recreational camps) has received support in Overall, the evidence indicates no harmful asso- controlled trials (reviewed by Fabiano et al., ciation between childhood exposure to stimulant 2009 ) . The use of “neurofeedback” in training treatment to ADHD and subsequent substance components of the EEG has also obtained recent abuse in adolescence and adulthood. There is evi- trial evidence (Arns, De Ridder, Strehl, Breteler, dence from the pooled estimates derived from & Coenen, 2009 ) . The role of genetic and environ- meta-analysis to suggest that effective treatment mental contributions to resilience is likely to rep- reduces the risk of subsequent substance abuse, resent an area of expanding research interest, and and thus confers resilience. may well generate new ideas about what the targets of intervention should be.

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Assessment Measuring Resilience in Children: From Theory to Practice* 1 4

Jack A. Naglieri , Paul A. LeBuffe , and Katherine M. Ross

a reliable and valid way, then application in clinical Introduction and educational settings becomes possible. This is an ideal sequence for the development tools The concept of resilience, like all psychological for testing new concepts, but it is not how many constructs, must have certain characteristics in concepts and tests used in education and psychol- order to be subjected to experimental testing so as ogy have been promulgated. to be effectively applied to benefi t our constituency. In practice, there is great emphasis on helping A primary characteristic is that resilience must be clients and pressure to implement new approaches operationally defi ned in a way that is reliable even if they have only been minimally tested. If across time, subjects, and researchers. Once a an idea appears logical and appears to help clients concept is operationalized in a reliable manner, then it seems reasonable to believe that the con- then its validity can be examined. When we have struct possesses validity, however ill-de fi ned that suf fi ciently operationalized the concept of resilience, may be. Unfortunately, what seems logical and and there is evidence that it can be measured in consistent with clinical experience may not be true. As noted by Garb ( 2003 , p. 32), “Results * We write this chapter in order to provide essential from empirical studies reveal that it can be sur- information about measurement of resilience and the tools prisingly dif fi cult for mental health professionals that are currently available for that purpose. It is important to learn from clinical experience.” This sobering for the reader to recognize that the fi rst two authors of this point suggests that we should weigh empirical chapter are authors of several of the scales included here. In order to provide as complete a view as possible of all the fi ndings more heavily than clinical experience not scales currently available for measuring protective factors, vice versa. Science should temper enthusiasm. we also included scales developed by other authors. We This is especially true when a new approach to have, therefore, limited any evaluative comments about treatment or a new concept is introduced. these scales but do provide a factual presentation of their characteristics. It is our expectation that this information There is a natural and desirable interplay will provide readers suf fi cient information to arrive at between scienti fi c research and applied practice their own conclusions regarding the relative advantages in psychology because of the very nature of the and disadvantages of these tools . fi eld. We can assume that ultimately the fi eld will advance because of the mutual respect and col- J. A. Naglieri () laboration of those that emphasize science more University of Virginia, Charlottesville, VA, USA than practice, and practice more than research. e-mail: [email protected] The need for the balanced contribution of science P. A. LeBuffe • K. M. Ross and practice is well illustrated by the study of fac- Devereux Center for Resilient Children , Villanova , PA , USA tors related to resilience. Clearly, this area of study e-mail: [email protected] ; [email protected] has benefi ted from the outstanding contributions

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 241 DOI 10.1007/978-1-4614-3661-4_14, © Springer Science+Business Media New York 2013 242 J.A. Naglieri et al. made by those professionals whose goal has been risk and adversity, a measure of daily hassles is to help children and adults survive and thrive in recommended. Daily hassles denotes sources of risk the face of adversity and by those researchers that have lower acuity, but greater chronicity who have studied the complex interrelationships when compared to major life events. Examples for of variables that may be predictive of good out- young children might include frequent changes come. All of these individuals, however, must be in caregivers, poor quality childcare, and inconsis- able to clearly de fi ne their constructs and measure tent or overly harsh discipline. The Daily Hassles them reliably before the validity of the concept can Scale (Kanner, Coyne, Schaefer, & Lazarus, 1981 ) be assessed. That is the focus of this chapter— is a good example of this approach. the challenge of reliable and valid measurement After having ascertained the risk in an individu- of factors related to resilience. al’s life, developmental outcomes can be assessed. This may consist of the attainment of developmental milestones or the accomplishment of Resilience: Measurement Issues major developmental tasks within normal limits. Positive outcome has also been characterized as De fi ning the Concept: What Is Resilience? the absence of psychopathology in an at-risk population. If the individual has attained typical Although resilience has been studied and or superior outcomes in the presence of risk or described since the 1950s, it has been only in adversity, then resilience is inferred. about the past 2 decades that some consistency has emerged in the de fi nition of this construct. Most contemporary researchers now agree that Challenges in Measuring Resilience resilience refers to positive outcomes, adaptation or the attainment of developmental milestones or Measurement of those variables that allow some competencies in the face of signifi cant risk, children to cope successfully with adversities in adversity, or stress. As Masten ( 2001 ) points out, their lives is not simple. This is especially so the claim of resilience in an individual requires because resilience is assessed on an inferential two judgments. First, that the individual has been basis by an examination of risk and positive exposed to signi fi cant risk or adversity and, sec- adaptation factors (Luthar & Zelazo, 2003 ). ond, that the individual has attained at least typi- Resilience is an outcome, rather than a psycho- cal or normal developmental outcomes. logical construct in and of itself that can be The paradigm for resilience research therefore defi ned and, perhaps, measured. This has led to consists fi rst of enumerating or measuring the risks efforts to identify variables that lead to, and there- and sources of adversity in individuals’ lives. Two fore, can be used to predict, resilience rather than general approaches have been used to ascertain measuring it directly. These factors that lead to and measure risk. The major life events approach resilient outcomes are referred to as protective focuses on episodic, highly traumatic events such factors and are defi ned as characteristics or as the death or divorce of a parent. Typically, major processes that moderate or buffer the negative life events are measured using checklists that effects of stress resulting in more positive behav- assess a wide range of traumatic events that have ioral and psychological outcomes than would have occurred in the individual’s lifetime. Examples been expected in their absence (Masten & Garmezy, include the Sources of Stress Inventory (Chandler, 1985 ) . Rather than measuring resilience per se, 1981 ) or the Life Events Checklist (Work, Cowen, assessments have instead focused on measuring Parker, & Wyman, 1990 ) . these protective factors that predict resilience. Although major life events are clearly impor- Further complicating the situation is the fact tant sources of risk and adversity, a reliance on that researchers in this fi eld (e.g., Werner, 2005 ; this approach in isolation has been criticized as Wright & Masten, 2005 ) have found that risk and incomplete. To gain a more complete picture of protective factors occur at multiple levels including 14 Measuring Resilience in Children: From Theory to Practice 243 the community (e.g., dangerous neighborhoods/ history (physical attributes); status of the home quality after school programs), the family (e.g., environment (socioeconomic status, parents, domestic violence/effective parenting), and char- siblings, etc.); current academic performance (class acteristics of the child (e.g., diffi cult tempera- grades, standardized achievement test scores); ment/good coping skills). Although resilience is intelligence test scores, behavioral and emotional a function of the complex interaction of these status (parent and teacher rating scales, interviews, multiple level protective and risk factors, and measures of self-concept, clinical classifi cations). therefore, most likely is a multivariate construct, The goal of casting such a broad net has been to most assessments have focused only on the per- determine which of these many variables are most sonal characteristics, often referred to as “within- important. This assessment, however, is compli- child” protective factors. Moreover, this complex cated by the fact that not all of these variables share interaction may differ from person to person; that equal psychometric qualities. is, the impact of risk factors and the protection The use of both formal and informal measures afforded by speci fi c protective factors may be of protective factors offers a means of studying very person-specifi c. As an example, being part the fi eld but the disadvantage of leading to incon- of a faith community is widely regarded as an sistencies within and across research investiga- important protective factor, yet the impact of a tions. For example, social status can be assessed faith life in moderating risk and adversity differs using interviews, unstandardized questionnaires, from person to person. Given this complexity, and peer nominations but the extent to which such how can these variables be reliably measured? methods can be reliably reproduced by other How can these variables be aggregated to yield a researchers should also be studied. Moreover, the reliable predictor of resilience? transition from research setting to practical appli- Measurement of the wide variety of variables cation will require more re fi ned instrumentation used to study resilience in children has been than is currently available to practitioners. While accomplished using a variety of experimental these methods may assist in the development of methods as well as formal and informal tests, the research base for the study of resilience, well including both standardized and unstandardized developed, reliable and valid measures are methods. The list ranges from published behavior required if the important theoretical contributions rating and self-concept scales to informal ratings made thus far can be utilized in applied settings so based on clinical criteria; sociometric ratings to that children and other consumers may benefi t. social skills rating scales; tests of achievement to In order to advance instrumentation and mea- yearly grades and IQ test results; parent interviews surement in the fi eld of resilience, we will present to parenting quality questionnaires; and positive some suggestions to researchers and practitioners. and negative emotionality, to name just a few. The In the sections that follow, we will discuss some fi eld is awash in variables that have been studied. basic measurement issues and illustrate their rel- It appears that measures of most of the major psy- evance to clinical practice. Our emphasis is on the chological and educational constructs have been application of concepts of resilience by child- included in one study or another as putative pro- serving professionals including both teachers and tective factors. It leads one to ask the question: mental health professionals. “What has not been included in the study of protective and risk factors?” Is there any variable or variables that are unique to this line of research? How a Test of Resilience Could Be The inclusion of such a wide variety of variables Developed used to assess the potential for resilience suggests that researches have taken a case study approach to Development of a system for measuring variables the research question. The typical list of measures related to resilience is a task that requires impor- of protective factors reads like a psychological tant and well-established test development proce- report that includes major areas such as the child’s dures be followed. The many methods and issues 244 J.A. Naglieri et al. are amply described, for example, by Crocker and psychometric qualities of the items and their corre- Algina ( 1986 ) , Nunnally and Bernstein ( 1994 ) , spondence to the constructs of interest. This phase and Thorndike ( 1982 ) . Essentially, the typical is repeated until the author has suffi cient confi dence test development process involves a series of that the items and the scales have been adequately steps designed to yield a defensible and usable operationalized and the constructs adequately sam- measure of a construct or constructs. The process pled. In each of the many iterations, experimental begins with a clear operational de fi nition of the evidence is used to answer questions such as: construct or constructs to be measured. This • What is the mean and standard deviation (SD) means that all variables of interest must be defi ned of each item? with such clarity that they can be evaluated via • Do items designed to measure the same con- some method, be that a rating scale, observational struct correlate with each other? method, or performance test. In the area of resilience, • Do items designed to measure the same con- concepts such as sociability, negative affectivity, struct correlate with other items designed to adaptability, self-referent social cognitions, which measure that same construct at higher levels have been invoked to explain or understand than they correlate with items designed to resilience, would have to be de fi ned with clarity measure different constructs? because without a clear defi nition, hopes for reli- • What is the internal reliability of those items able and valid measurement would be diffi cult at organized to measure each construct? best. De fi nitional clarity is the sine-qua-non for the • What effect does elimination of each item development of psychometrically sound assess- have on the reliability of the scale on which it ment measures and approaches. This requirement is temporarily included? is made considerably more diffi cult because of • What is the factor structure of the set of items the evolving nature of the fi eld of resilience. and how can item elimination be used to clar- After clearly de fi ning the construct or constructs ify the factor structure? to be measured, the next step is the development of • Does the scale seem to have validity (de fi ned an initial pool of items to measure those con- in a number of different ways)? structs, followed by pilot testing of the items. This phase, sometimes referred to as a “tryout” A key consideration at this stage is adequate sam- stage is repeated until the scale has demonstrated pling of the various behaviors related to the con- at least minimally acceptable reliability and valid- struct under consideration to ensure adequate ity to warrant proceeding with standardization. breadth of coverage, that is, content validity. The The number of actual data collection efforts items also need to be clear, one-dimensional (that depends on the quality of the original concepts, the is, describe only one behavior) and, to the extent quality of the initial pool of items, the quality of possible, free of cultural bias. The subsequent pilot the sampling used to obtain the data used to exam- tests are designed to evaluate the clarity of the ine these questions, and the results that are found. items as well as the general approach to obtaining The goal is to produce a version that is ready to be scores. At this initial stage the ways the items are subjected to large-scale national standardization. presented on the page, size of the fonts, clarity of The idea is that the cost of standardization is so the directions, colors used on the form, position of great that the current status of the instrument must the items on the sheet of paper, and so on, are con- be of high enough quality that the risk of the fi nal sidered. Questions like reliability and validity are assessment failing to meet demonstrates adequate not usually examined at this point because sample reliability and validity is greatly reduced. size typically precludes adequate examination of The next to the last step in development of a such questions. The goal of pilot testing is very measure for use in clinical settings is standardiza- simple—to quickly and effi ciently determine if the tion and data collection to establish the reliability form seems to work, if the users understand what and validity of the fi nal measure. This process they need to do, are we on the right track? fi rst requires that a sample of persons who repre- The next step is to conduct experiments with sent the population with whom the measure will larger samples that allow for an examination of the be used is administered the measure so that (a) a 14 Measuring Resilience in Children: From Theory to Practice 245

fi nal group of items and scales is determined This list represents some of the issues that and (b) normative values can be computed. need to be addressed and is not intended to Typically, this is a nationally representative sam- describe all the issues that should be examined. ple. Development of norms is an art as much as a In the fi eld of resilience, we believe that there are science and there are several ways in which this some particularly salient validity issues. For task can be accomplished (see Crocker & Algina, example, can variables related to resilience be 1986 ; Nunnally & Bernstein, 1994 ; Thorndike, operationalized into some measurable system? 1982 ) . The second task at this stage is collection How effective is the measure for differentiating of data for the purpose of establishing reliability between children who are at risk and those who (internal, test–retest, inter-rater, intra-rater) and are not? How many variables need to be mea- validity (construct, criterion, and content, for sured to maximally predict resilience? Is a com- example). Of these two, validity is clearly the bination of variables related to protective factors more diffi culty psychometric quality to assess. in the environment, the family, and the child, the There are many types of validity and, there- best way to predict resilience? Do protective fac- fore, validity is not established by any single tors enhance outcomes only for children who are study. According to the Standards for Educational at signi fi cant risk, or all children? Can the exten- and Psychologist Testing (AERA, APA, & NCME, sive lists of child protective factors be reduced to 1999) evidence for validity “integrates various a few key characteristics that predict which chil- strands of evidence into a coherent account of the dren may be resilient? The answers to these ques- degree to which existing evidence and theory sup- tions will help de fi ne the future of this fi eld. port the intended interpretation of test scores for Once development of an instrument is com- specifi c uses” (p. 17). It is important to note that it pleted then the important task of documentation is not the test that is valid (as is commonly thought) begins. There is wide variation in the extent to but rather the interpretations and uses of test which test authors document the development, scores. In other words, the authors of the assess- standardization, reliability, and validity, of their ment have to demonstrate that the inferences measure. Some test manuals provide little if any about the construct (e.g., the strength of the indi- information of the types we have described above, vidual’s protective factors) and the decisions others provide ample descriptions. We refer the that are made (e.g., the individual is at risk) based reader to examples such as the Kaufman on the interpretive guidelines presented in the Assessment Battery for Children—Second manual are supported by evidence. That book Edition (Kaufman & Kaufman, 2004 ) , the provides 24 standards that relate to validity issues Devereux Student Strength Assessment (LeBuffe, that should be addressed by test developers. This Shapiro, & Naglieri, 1999), and the Cognitive includes, for example, the need to provide Assessment System (Naglieri & Das, 1997 ) . We evidence: use these examples because not only do these • That evidence exists to support interpretations authors provide detailed discussion of the various based on the scores the instrument yields phases of development, but they provide exten- • About the internal structure of the test sive discussion of how the tests should be used • About the organization of scales and compos- and the scores the tests yield interpreted. ites within a test Development of a measure does not end with • Of the relationship between the scores the the writing of the sections in the manual that instrument yields and one or more criterion describe the development, standardization, and variables reliability/validity of the instrument. The authors • For the utility of the measure across a wide have the added responsibility to inform the users variety of demographic groups or its limita- about how the scores can be used to enhance tions thereof practice and improve outcomes for the individual • That the measure differentiates between being assessed (AERA, APA, & NCME, 1999 ) . groups as intended This may include how the scores on various 246 J.A. Naglieri et al. scales should be compared with one another and SEM=´- SD 1 reliability with scores from other tests (if appropriate) to gain a better understanding of the relative The SEM is considered the average standard strengths and needs of the individual. Increasingly deviation (68% of the normal curve is in this range) important in this era of evidence-based practice is of the theoretical distribution of a person’s scores guidance on the use of scale scores from pretests around the true score. Thus, if we add and subtract and posttests to document growth, change, or 1 SEM from an obtained score, we can say that response to treatment in the individual. It is there is a 68% chance (the percentage of scores con- essential that the authors provide the users with tained within ± 1 SD) that the person’s true score is the values needed for determining signifi cance contained within that range. Recall that 68% of when the various scores a measure provides are cases in a normal distribution fall within +1 and −1 compared. The test manuals should provide a standard deviation. Second, the SEM is multiplied thorough discussion of interpretive methods to by a z value of, for example 1.64 or 1.96, to obtain a guide the practitioner. This will enable the user to con fi dence interval at the 90 or 95% levels, respec- interpret the scores from an instrument in a man- tively. The resulting value is added to and subtracted ner that is consistent with the intent of the authors from the obtained score to yield the confi dence and the reliability and validity evidence that was interval. For example, the 95% con fi dence range for accumulated. a test score with a reliability of 0.95 and an obtained score of 100 is 93 (100 − 7) to 107 (100 + 7). It is important to note that the higher the reliability the The Importance of Psychometric smaller the interval of scores that can be expected to Characteristics include the child’s true score. The smaller the range, the more precise practitioners can be in their inter- Why Reliability Matters pretation of the results, resulting in more accurate decisions regarding the child. The relationships Good reliability is essential for all measurements between reliability and confi dence intervals are pro- used for research as well as in applied settings to vided in Fig. 14.1 for T -scores (M = 50; SD = 10) ensure accuracy. Reliability is important to and IQ scores (M = 100; SD = 15). the practitioner because it refl ects the amount The SEM is, of course, most important when of error in the measurement. Recall that any individual decisions are made because the larger the obtained score is comprised of the true score SEM the more likely scores will differ as a function plus error (Crocker & Algina, 1986 ) . Because of low reliability. The lower the reliability, the more we can never directly determine the true score, likely there will be disparity among scores, for we describe it on the basis of a range of values example on a variety of measures of protective fac- within which the person’s score likely falls with tors. These inconsistent results can complicate the a particular level of probability. The size of the interpretation of fi ndings and make a clear under- range is determined by the reliability of the mea- standing of a child’s strengths and needs more surement with higher reliability resulting in dif fi cult. Without reliable measures of strengths and smaller ranges. This is why in practice we say, needs, planning effective support strategies or inter- for example, that a child earned an IQ of 105 ventions becomes problematic and ultimately child (±5); meaning that there is a 90% likelihood that outcomes may be adversely impacted. the child’s true IQ score falls within the range of Reliability of speci fi c scores also in fl uences 100–110 (105 ± 5). The range of scores (called the comparisons among scores. For example, if a the confi dence interval) is computed by fi rst researcher or practitioner is concerned with deter- obtaining the standard error of measurement mining if a particular protective factor score (SEM) from the reliability coeffi cient and the received by a child is signi fi cantly higher than the standard deviation (SD) of the score in the fol- scores received on other protective factor scales lowing formula (Crocker & Algina, 1986 ) : and therefore represents a signi fi cant strength for 14 Measuring Resilience in Children: From Theory to Practice 247

Fig. 14.1 Relationship between reliability and con ﬁ dence intervals

Fig. 14.2 Differences required for signi ﬁ cance when comparing IQ or T -scores based on scale reliability

the child, the ability to make that determination is reliability of 0.70 from two different teachers directly related to each factor’s reliability would have to differ by 15 points to be signi fi cant coeffi cient because the calculation of the SEM is at the 95% level. This means that test scores with based on the reliability. In fact, the formula for the higher reliability reduce the infl uence of mea- difference between two scores earned by an indi- surement error on the different scores. Clearly, in vidual is calculated using the SEM of each score. both research and clinical settings, variables with high reliability are needed. Difference=´ Z SEM 122 + SEM 2

Applying this formula to IQ test scores and How Much Reliability Is Needed? T-scores as shown in Fig. 14.2, we see that as the reliability goes down, the differences needed Bracken (1987 ) provided suggested thresholds when comparing two scores increase dramati- for acceptable levels of test reliability. He sug- cally. This means that scores from measures with gested that individual variables should have at 248 J.A. Naglieri et al. least an internal reliability estimate of 0.80 or of each variable demonstrated. Much of the greater and total scales an internal consistency of research conducted in this area has attempted to 0.90 or greater. These guidelines should be fur- examine these issues to varying degrees. The ther considered in light of the decisions being fi eld has increasingly focused on identifying made. For example, if a score is used for screen- those variables that predict resilience in the face ing purposes where over identi fi cation is pre- of adversity. ferred to under identifi cation, a 0.80 reliability Validity of a measure of resilience is, there- standard for a total score may be acceptable. If, fore, more complicated than demonstrating the however, important decisions are made, for validity of an achievement test or measure of example, dealing with special educational place- depression, for example. The number of variables ment, then a higher (e.g., 0.95) standard should that has been examined is substantial, there is be deemed more appropriate (Nunnally & considerable inconsistency in the psychometric Bernstein, 1994 ) . quality of the variables studied, and the research In summary, it is advisable that researchers on the relative importance of the many variables and clinicians who examine scores from mea- is still evolving. This makes for an exciting area sures of protective factors look for scores that of research but one that clinicians should approach have internal reliability estimates of 0.80 or with appropriate cautions. higher and composite scores comprised of sev- Our view is that practitioners have a responsi- eral variables that have an internal reliability esti- bility to use measures that have been developed mates of 0.90 or greater. If a rating scale’s score in the manner we have brie fl y outlined above and has not been constructed to meet these require- that nonstandardized approaches should be ments, then its inclusion in research and applied avoided. We believe that the quality of the deci- practice should be questioned. This is particu- sions made based on any assessment tool is larly important because the extent to which two directly related to the quality of the assessments variables can reliably correlate is in fl uenced by themselves. Responsible practitioners should be the reliability of each variable. Clinicians are aware of the psychometric attributes of any tools advised not to use measures that do not meet that are used. We will, therefore, discuss the psy- these standards because there will be too much chometric characteristics of a number of mea- error in the measurement to allow for confi dence sures available to practitioners so that the relative in the result. This is especially important because advantages and limitations of the tools can be the decisions clinicians make can have signi fi cant understood. impact on the life of a child. We therefore urge the reader to carefully examine the reliability fi ndings of any tool they choose to use. Tools to Measure Variables Related to Resilience

Why Validity Matters The assessment of factors related to resilience in clinical practice is in its early stages. Although Validity refers to the extent to which empirical informal, nonstandardized tests and procedures evidence and theory supports the recommended are valuable as initial approaches to assessment, uses and interpretations of scores derived from an they lack the needed research and development assessment. Researchers who study resilience are base as well as norms calibrated on a representa- faced with the fi rst responsibility of carefully and tive national standardization sample to make them clearly defi ning the construct they intend to eval- useful in research and defensible in practice. To uate. Given the inferential nature of the study of assist educational and clinical professionals who resilience, one of the greatest validity questions would like to incorporate the assessment of resil- concerns which variables are associated with or ience in their professional practice, we provide a predictive of resilience and how is the relevance review of the tools currently available for this 14 Measuring Resilience in Children: From Theory to Practice 249 purpose that meet certain criteria. To be included Psychometric characteristics: The ASQ-SE in this listing, the evaluation tools must: (1) be was standardized on a sample of 2,633 children published so as to be readily available to practitio- with approximately 175 cases in each age group. ners, (2) be a standardized, norm-referenced tool, Cronbach’s alpha coef fi cient was reported to (3) have a technical manual or other accessible range from 0.67 to 0.91. The level of agreement source of psychometric information including between the total scores over two time intervals standardization sample, reliability and validity, (1–3 weeks) was reported as 94%. The overall (4) be intended for use with children, defi ned as sensitivity (the ability to accurately identify chil- birth to 18 years. The tools that met these criteria dren with social–emotional disabilities) was are presented in alphabetical order. reported as 78%. The authors also measured the utility of the ASQ-SE by surveying parents. The results indicated that 97% of parents thought the Ages and Stages Questionnaire: assessment was “easy to understand and appro- Social Emotional priate” (Squires et al., 2003 ) .

Purpose : The Ages and Stages Questionnaire: Social Emotional (ASQ-SE; Squires, Bricker, & Behavioral and Emotional Rating Scale Twombly, 2002 ) was developed for early identifi cation and remediation of social and emo- Purpose: The Behavioral and Emotional Rating tional de fi cits in young children. The ASQ-SE Scale, Second Edition (BERS-2; Epstein, 2004 ) was designed for cost-effective large-scale measures behavioral and emotional strengths in screening of children aged 6–60 months. There children aged 5–19 years using parent, teacher, are separate questionnaires for each 6-month age and a youth self-report rating scales. The BERS-2 interval. The main purpose of the ASQ-SE is to is intended to identify protective factors related act as a screening test, but, according to the to the child and the child’s family, relying on authors, it can also be used to monitor progress, resilience theory (King, Swerrdlik, & Schneider, plan for intervention, and conduct research within 2005) . Other purposes outlined in the manual are a comprehensive community-based program. to identify children who lack strengths and who may be in need of further intervention. The Scale description: Each of the eight ASQ-SE BERS-2 scores can also be used to guide interven- questionnaires is designed for a speci fi c age tion, monitor progress, and evaluate the effective- range. The number of questions ranges from 22 ness of instructional programs (Epstein, 2004 ) . to 36 depending on the age. The ASQ-SE items cover seven concepts: self-regulation, compli- Scale description : The BERS-2 has 52–57 items, ance, communication, adaptive functioning, depending on the rating form. The items are autonomy, affect, and interaction with people. divided into fi ve scales: Interpersonal Strength, There is also a section to identify general con- Family Involvement, Intrapersonal Strength, cerns and comments. Responses are calibrated School Function, and Affective Strength. There is using a multiple point format (most of the time , a Career Strength scale on the youth and parent sometimes, or never or rarely). The rater can also form as well. The BERS-2 uses a Likert-type for- indicate if a particular item is of particular con- mat where the rater is asked to refl ect on the cern. The ASQ-SE yields a total raw score, by child’s behavior from the last 3 months and answer adding the item scores; a high score is problem- “not at all like the youth” to “very much like.” In atic. Children who receive a total score above addition, there are eight open-ended questions to a recommended cut-off should be referred for capture additional information that may aid fol- further evaluation. The ASQ-SE can only be low-up assessments or interventions (King et al., completed by a parent rater. The reading level is 2005) . The results of the BERS-2 yield percentile that of a fi fth to sixth grader (Squires, Bricker, & ranks and standard scores for each scale, with a Twombly, 2003 ) . mean of 10 and standard deviation of 3. The 250 J.A. Naglieri et al.

summation of the fi ve scales yields the Strength preschool mental health, and early childhood Index. The rater also receives a summary form special educators to evaluate protective factors that can be used to compare results with other rat- related to resilience in children aged 2–5 years. ers (Epstein, 2004 ) . One of the main goals of the DECA is to help determine if children have developed adequate Psychometric characteristics: The BERS-2 uti- skills in three areas (Initiative, Self-control, and lized the same standardization sample from the Attachment) that are related to resilience. original BERS to create the norms for the teacher Children who receive comparatively low scores form. These norms were based on a sample of in these three strength-based, within-child pro- 2,176 normally developing children and adoles- tective factors may be at risk for developing cents, and 861 children and adolescents with social and emotional challenges or disorders. By emotional/behavioral disorders (King et al., identifying these at-risk children early, strategies 2005 ) . The parent and youth forms were created can be implemented at school and at home to and normed with the new standardization sam- help develop these protective factors, increasing ples of 927 and 1,301 youth, respectively. The the odds that the child will be able to successfully standardization sample closely matched the 2002 adapt to current and future risk and adversity. U.S. census data, although slightly under- or The rating scale also includes a brief rating of over-representing: females, Hispanics, and cer- behavioral concerns. tain family income levels. The authors reported alpha internal consistency with coef fi cients rang- Scale description: The DECA uses a behavior ing from 0.79 to 0.96. Test–retest reliability stud- rating scale format which evaluates the frequency ies yielded correlations of 0.87–0.99 for the with which a child aged 2–5 years demonstrates Strength Index. Inter-rater reliability studies indi- speci fi c behaviors over the past 4-week interval. cated correlations of 0.98 for teacher–teacher and A family member or early care and educational 0.54 for parent–child for the Strength Index. The professional completes the 37 items which are subscales were slightly less reliable with correla- scored using a 0 (Never) to 4 (Very Frequently) tions of 0.85–0.96 for teacher–teacher, 0.50–0.63 scale. The DECA items are organized into two for parent–child, and 0.20–0.67 for parent– dimensions: protective factors and behavioral teacher. Validity was examined by comparing the concerns. The Protective Factors included are BERS-2 to the Walker-McConnell Scale of Social Initiative (11 items), Self-Control (8 items), and Competence and School Adjustment—Adolescent Attachment (8 items). A screener for behavioral Version (Walker & McConnell, 1995 ), the concerns (10 items) is included to help identify Systematic Screening for Behavior Disorders children with emerging problem behaviors. Items (SSBD; Walker & Severeson, 1992 ), the Scale on the Initiative scale assess the child’s use of for Assessing Emotional Disturbance (SAED; independent thought and action to meet his or her Epstein & Cullinan, 1998 ), the Social Skills needs. The Self-Control scale includes items Rating System (SSRS; Gresham & Elliot, 1990 ), about the child’s ability to experience a range of and the Achenbach Teacher Report Form (TRF; feelings and express them appropriately using Achenbach, 1991 ). Correlations are reported in words and actions. Attachment items determine the form of a table contained in the Examiner’s if the child has developed mutual, strong, and manual (Epstein, 2004 ) . long-lasting relationships with other children and adults. In addition, a Total Protective Factors Scale is provided. The Behavioral Concerns items Devereux Early Childhood Assessment measure a wide variety of problem behaviors seen in some young children. Separate norms Purpose : The Devereux Early Childhood are provided for parent and teacher raters and Assessment (DECA: LeBuffe & Naglieri, 1999 ) is yield both percentile ranks and T -scores. a nationally standardized rating scale designed to Recommended descriptive terms are provided to be used by preschool program directors, teachers, aid in communication with parents, teachers, and 14 Measuring Resilience in Children: From Theory to Practice 251 other professionals. The term “Strength” is used to evaluate social–emotional skills in infants for protective factor T -scores of 60 or above. and toddlers. The DECA-I/T assesses three pro- “Typical” is used to describe T -scores of 41–59 tective factors related to resilience: Attachment/ inclusive. “Concern” is used to describe low Relationships, Initiative, and Self-Regulation. protective factor scores of 40 or below. The results of this assessment can be used to identify young children’s social–emotional skills Psychometric characteristics : The DECA was and to help identify children who may be at risk or standardized on a national sample of 2,017 chil- need additional assistance. The DECA-I/T can also dren aged 2–5 years. The Total Protective Factors be used as an outcome measure for early childhood Scale reliabilities for Parents and Teachers is programs and be used as a research tool. 0.93. The average reliabilities across raters for the separate scales are as follows: Initiative Scale description : The DECA-I/T is a behavior (0.87), Self-Control (0.88), Attachment (0.81), rating scale for children aged 1 month up to 36 and Behavioral Concerns (0.76). The validity of months. The Infant form has 33 items comprised the DECA was studied by comparing children from two protective factor scales: Initiative (18 who varied in their social and emotional health. items) and Attachment/Relationships (15 items). Two samples of children were compared: one The Toddler form has 36 items comprised from group with known emotional/behavioral prob- three protective factors scales: Attachment/ lems (N = 95) and another that were considered Relationships (18 items), Initiative (11 items), typical ( N = 86). The results showed that the chil- and Self-Regulation (7 items). The DECA-I/T dren with emotional/behavioral problems earned asks family members and early care and educa- lower scores (less desirable) on the measures of tion providers to rate the child’s behavior from Initiative (effect size (ES) of 0.78), Self-Control the past 4-week interval using a 0 (Never) to 4 (ES = 1.01), Attachment (ES = 0.47), Total (Very Frequently) scale. The Attachment/ Protective Factors (ES = 0.89), and higher scores Relationship scale assesses if a mutual, strong, (also less desirable) on the measure of Behavioral long-lasting relationship has developed between Concerns (ES = 1.08). These results and others the infant or toddler and a signi fi cant adult. The presented in the DECA Technical Manual Initiative scale determines the infant or toddler’s (LeBuffe & Naglieri, 1999 ) indicated that the ability to use independent thought or actions to children with demonstrated emotional and behav- meet his or her needs. The Self-Regulation scale ioral problems earned scores that refl ect the assesses the toddler’s ability to gain control of behavioral diffi culties they have and their need and manage emotions, and sustain focus and for stronger factors that are associated with resil- attention. A Total Protective Factors scale is pro- ience. See Chap. 10 for more information. vided, in addition to T -scores and percentile ranks It is important to note that at the time of this for each scale. writing, the second edition of the DECA is in the fi nal stages of development. The second edition Psychometric characteristics: The DECA-I/T has a larger standardization sample and new was standardized on a national sample of 2,183 norms. More information about this edition can infants and toddlers between 4 weeks and 3 years be found in the manual that will be published of age. The internal reliability coeffi cients for the along with the rating scale. Infant form on the Total Protective Factors scale ranged from 0.90 to 0.94 for parents, and 0.93 to 0.94 for teachers. The reliabilities for the Devereux Early Childhood Assessment Attachment/Relationships scale ranged from 0.80 for Infants and Toddlers to 0.92 for parents and 0.89 to 0.93 for teachers. The reliabilities for the Initiative scale ranged Purpose : The Devereux Early Childhood from 0.86 to 0.90 for parents and 0.87 to 0.91 for Assessment for Infants and Toddlers (DECA-I/T; teachers. The internal reliability coef fi cients for Mackrain, LeBuffe, & Powell, 2007 ) was created the Toddler form on the Total Protective Factors 252 J.A. Naglieri et al. scale was 0.94 for parents and 0.95 for teachers. A family member or early care and educational The reliabilities for the separate scares are as fol- professional completes the items which are lows: Attachment/Relationships (0.87 for parents scored using a 0 (Never) to 4 (Very Frequently) and 0.90 for teachers), Initiative (0.92 for parents scale. The DECA-C is organized into three scales and 0.94 for teachers), Self-Regulation (0.79 for related to resilience (Initiative, Self-control, and parents and 0.83 for teachers). The validity of the Attachment) and four scales about behavioral DECA-I/T was investigated by a contrasted concerns. These are: Attention Problems (7 items groups approach, examining the scale scores for which assess diffi culties with focus, distractibil- an identifi ed vs. community samples. Results ity, impulsivity, and hyperactivity); Aggression from both the infant and toddler forms indicate (7 items used to measure hostile and destructive signi fi cant and meaningful differences between acts); Emotional Control Problems (8 items the identifi ed and community samples on all which measure the child’s dif fi culties in modify- scales (d -ratios range from 0.75 to 1.52). These ing the overt expression of negative emotions); results are presented in the Technical Manual and Withdrawal/Depression (9 items which (Powell, Mackrain, & LeBuffe, 2007 ). address behaviors related to social isolation and lack of reciprocal interactions as well as depressed affect). Like the Total Protective Factors scale, Devereux Early Childhood these four Behavioral Concerns scales are com- Assessment—Clinical Form bined into a Total score. The DECA-C was standardized on a national Purpose: The Devereux Early Childhood sample of 2,017 children aged 2–5 years and Assessment—Clinical Form (DECA-C; LeBuffe normed to yield T -scores set at a mean of 50 and & Naglieri, 2003 ) is designed to assess factors SD of 10. The Total Protective Factors Scale reli- related to both resilience and emotional/behav- abilities for Parents and Teachers is 0.93 and the ioral problems. DECA-C is intended to be used average reliabilities across raters for the separate as part of a larger assessment of emotional health scales are: Initiative (0.87), Self-Control (0.88), and to develop intervention plans that may be Attachment (0.81), and Behavioral Concerns needed. For this reason, the DECA-C is intended (0.76). The average Behavioral Concerns scale to be used by those professionals (e.g., psycholo- internal reliabilities across parent and teacher rat- gists, counselors, and those with clinical training) ers are as follows: Withdrawal/Depression (0.73), who have the necessary quali fi cations to interpret Emotional Control Problems (0.83), Attention and use this clinical tool as part of child assess- Problems (0.83), and Aggression (0.82) and the ment. The information about both protective fac- Total Behavioral Concerns Scale (0.91). tors and behavior concerns provides at least three important advantages to the clinician. First, a bal- Psychometric characteristics : The validity of the anced examination of the child from both posi- DECA-C was examined in a series of research tive and concern perspectives is achieved. Second, studies summarized in the Manual. In summary, the examination of the relationships between the DECA-C effectively differentiated the groups these dimensions leads to a more complete under- of children who had known emotion and behav- standing of how they individually and jointly ior problems with a matched comparison group in fl uence the child’s behavior. Third, the inclu- of typical preschool children (see LeBuffe & sion of both dimensions provides important infor- Naglieri, 2003 ) ; children with known emotional mation for intervention planning. See Chap. 10 and behavioral problem showed more signs of for more information. behavioral concerns and fewer signs of strong protective factor scores than the DECA-C norma- Scale description : The DECA-C uses a behavior tive sample; and that the children with docu- rating scale format to evaluates the frequency mented emotional and behavioral problems in with which a child aged 2–5 years demonstrated this study had needs in the Protective Factors speci fi c behaviors over the past 4-week interval. and Behavioral Concerns Scales of the DECA-C. 14 Measuring Resilience in Children: From Theory to Practice 253

The validity of the DECA-C was assessed using environments, and time to monitor progress and several other studies which are reported in the evaluate outcomes. Manual by LeBuffe and Naglieri ( 2003 ) and in Chapter 15 in this volume. Psychometric characteristics: The DESSA was standardized on a national sample of 2,494 children in grades K through 8 by teachers and parents Devereux Student Strengths using both paper and pencil and online versions of Assessment the scale. The DESSA standardization sample closely approximated the K–8 population of the Purpose: The Devereux Student Strengths United States with respect to age, gender, geo- Assessment (DESSA; LeBuffe, Shapiro, & graphic region of residence, race, ethnicity, and Naglieri, 2009 ) is a rating scale designed to assess socioeconomic status based on the 2008 U.S. cen- social–emotional competencies that serve as pro- sus bureau. The DESSA reliability coef fi cients for tective factors for children in kindergarten the Social–Emotional Composite for parent raters through the eighth grade. The DESSA is com- (0.98) and teacher raters (0.99) both exceed the pleted by parents, teachers, or staff at schools and 0.90 value for a total score suggested by Bracken child-serving agencies, including after-school, (1987 ). The internal reliability coef fi cients for the social service, and mental health programs. The eight social–emotional competence scales vary assessment is comprised entirely of 72 items that from 0.82 (Optimistic Thinking and Self- are described as strength-based (e.g., how well Awareness—Parent Raters) to 0.94 (Relationship does the child get along with others). The DESSA Skills—Teacher Raters). The median reliability is intended to provide a psychometrically sound, coeffi cient across these eight scales was 0.86 for strength-based, measure of social–emotional parent raters and 0.92 for teacher raters. These competence in children and youth that can be values well exceed the 0.80 minimum suggested by used to identify individuals at risk of developing Bracken (1987 ). The validity evidence provided in social–emotional problems before those prob- the scale’s Manual suggested that DESSA scores d lems emerge and identify the strengths and needs differentiate between groups of children with and of individuals already been identifi ed as having without the special education designation of seri- social, emotional, and behavioral concerns. ous emotional disturbance, that the scales do show strong convergent validity with similar measures, Scale description : The DESSA is organized into and that the Social–Emotional Composite can be eight conceptually-derived scales that provide considered a measure of within-child protective information about social–emotional competen- factors. See LeBuffe, Shapiro, and Naglieri (2009 ) cies. They are: Self-Awareness (7 items), Social- for more details or Chapter 15 in this volume. Awareness (9 items), Self-Management (11 items), Goal-Directed Behavior (10 items), Relationship Skills (10 items), Personal Devereux Student Strengths Responsibility (10 items), Decision Making Assessment—Second Step Edition (8 items), and Optimistic Thinking (7 items). The combination of these scales is used to obtain a Purpose: Devereux Student Strengths Social–Emotional Composite score. This com- Assessment—Second Step Edition (DESSA- posite score provides an overall indication of the SSE; LeBuffe, Naglieri, & Shapiro, 2011) is a strength of the child’s social–emotional compe- 36-item, standardized, norm-referenced behavior tence and the eight DESSA scales are used to cre- rating scale that assesses the social–emotional ate pro fi les for individuals as well as the entire competencies that serve as protective factors for classroom that describe the strengths and needs children in kindergarten through the fi fth grade. of the student and/or groups of students as com- Developed on the basis of the social–emotional pared to national norms. This information can content covered in the Second Step curriculum also be used to compare ratings across raters, (Committee for Children, 1997 ) , the DESSA-SSE 254 J.A. Naglieri et al. can be completed by parents, teachers, or staff at is comprised entirely of strength-based items schools and child-serving agencies, including (e.g., get along with others) which are scored on a after-school, social service, and mental health 5-point scale about how often the student engaged programs. Like all the other scales in this line in each behavior over the past 4 weeks. from the Devereux Center for Resilient Children, the assessment uses only strength-based items. Scale description: The DESSA-mini is comprised The DESSA-SSE was developed to provide a of four 8-item forms which were developed to be way to evaluate those speci fi c social–emotional highly correlated with the full DESSA and equal competencies taught in the Second Step curricu- in reliability and very similar in overall mean lum. Speci fi cally, the DESSA-SSE has been scores. The standardization and normative sam- designed to describe the social–emotional comple was comprised of a total of 1,250 children petence of groups of children so that children’s and youth in kindergarten through eighth grade progress through the Second Step social–emo- who closely approximated the K–8 population of tional learning program can be evaluated using a the United States with respect to age, gender, psychometrically sound, nationally normed tool. geographic region of residence, race, ethnicity, and socioeconomic status according to the 2008 Scale description : The DESSA-SSE is organized U.S. census. Each DESSA-mini form yields a into fi ve scales: Skills for Learning (9 items), T -score from the sum of the 8-item ratings. Empathy (9 items), Emotional Management (9 items), Problem Solving (9 items), and a Social– Psychometric characteristics : The internal reliabil- Emotional Composite based on all 36 items. Raw ity of the four 8-item DESSA-mini forms range scores on each scale are converted to T -scores and from 0.91 (mini 4) to 0.92 (mini 3). Each of the corresponding percentile ranks and categorical DESSA-mini reliability coef fi cients exceed the descriptions. The DESSA-Second Step Edition 0.90 value for a total score suggested by Bracken was standardization and normed on a sample of a (1987 ). Validity evidence presented in the manual total of 1,250 children in kindergarten through fi fth indicates that the DESSA-mini can be used with grades who closely approximated the U.S. popula- con fi dence as a screener for social–emotional com- tion with respect to age, gender, geographic region petence because (a) DESSA-mini Social–Emotional of residence, race, ethnicity, and socioeconomic Total scores are strongly correlated with the Social– status according to the 2008 U.S. census. Emotional Composite scores on the full DESSA; (b) there is considerable agreement between identi fi cation rates based on the DESSA and each Devereux Student Strengths DESSA-mini form; (c) the DESSA-mini T -scores Assessment—Mini differentiate groups of children with and without known social–emotional problems; and (d) the Purpose: The Devereux Student Strengths DESSA-mini and the DESSA identify children Assessment—Mini (DESSA-mini) (Naglieri, similarly regardless of race or ethnicity. LeBuffe, & Shapiro, 2010 ) is a universal screening tool developed to measure social–emotional skills that are related to mental, emotional, and Hierarchical behavioral disorders in order to make early intervention more possible. The DESSA-mini can be Penn Interactive Peer Play Scale used by professionals with or without clinical training to offer a brief summary of a child’s cur- Purpose: The Penn Interactive Peer Play Scale rent overall social–emotional competence to (PIPPS; Fantuzzo, Coolahan, et al., 1998 ; determine if additional skill development should Fantuzzo et al., 1995 ) was developed on the idea be provided. The scale can also be used for ongo- that children’s play interactions are highly indica- ing progress monitoring during the course of tive of their social and emotional health and pre- social–emotional interventions. The DESSA-mini dictive of future social and academic success. 14 Measuring Resilience in Children: From Theory to Practice 255

This behavioral rating scale was developed with correlated with the SSRS. The PIPPS also demon- Head Start teachers and parents, assessing peer strates reliability and validity in low-income play interactions with high-risk urban youth. preschool children, utilizing the same comparisons There is a teacher form, which is utilized in the as articulated above (Hampton & Fantuzzo, 2003 ) . classroom and on the playground, and there is a parent form, which is utilized in the home and neighborhood (Fantuzzo et al., 1995 ) . The PIPPS Preschool Behavioral and Emotional aims to measure children’s play strengths in kin- Rating Scale dergarten and is intended to be used for screening, assessment, informing curriculum, and promoting Purpose: The Preschool Behavioral and Emotional communication between parents and teachers Rating Scale (PreBERS; Epstein & Synhorst, (Fantuzzo & Hampton, 2000 ) . The PIPPS is also 2009) is an assessment that measures the emo- only intended to be used with urban, low-income, tional and behavioral strengths in preschool chil- minority children. The PIPPS was developed to dren aged 3–5 years. The preBERS can be used to identify resilient children in high-risk situations, identify children with low levels of emotional and differentiate children with positive peer interac- behavior strengths, inform IEPs or IFSPs, guide tions from those who were less successful, and to intervention, and monitor progress. This rating inform interventions (Fantuzzo et al., 1995 ) . scale can be completed by any adult with adequate exposure to the child and can be scored and inter- Scale description : The PIPPS was originally stan- preted by any professional adult who had appro- dardized on a group of 312 African American priate training in tests and measurement. The high-risk children aged 38–63 months. The par- preBERS is entirely strength-based and grounded ticipants included 38 teachers from fi ve different in resilience research. The overarching goal of Head Start programs. Fantuzzo et al. utilized an this assessment is early identifi cation of children exploratory factor analysis of the original items to who may need additional support or interventions uncover three constructs: Play Interaction, Play (Epstein & Synhorst, 2009 ) . Disruption, and Play Disconnection. Both the teacher and the parent versions consist of 32 items. Scale description: The preBERS has 42 items that This behavior rating scale is in a Likert-type for- are divided into four dimensions: Emotional mat ( never , seldom , often, or always ) revealing Regulation (13), School Readiness (13), Social how often the teacher or parent witnessed the child Con fi dence (9), and Family Involvement (7). There displaying a certain behavior. The Play Interaction are seven open-ended questions that aim to capture scale measures the child’s play strengths, the Play any additional social, family, or community Disruption scale measures antisocial behaviors strengths. The assessment is written at a fi fth-grade that can interrupt play interactions, and the Play reading level and was created to be completed in Disconnection scale measures withdrawal from 10 min. Each item is rated on a Likert-type scale play. The PIPPS is not intended to categorize stu- (0 = not at all like the child, 1 = not much like the dents. If the results indicate that a child has poor child, 2 = like the child, and 3 = very much like that play interactions, further evaluation is recom- child) (Drevon, 2011 ) . The subscales each yield a mended in addition to efforts to bolster the child’s raw score, a percentile rank, and scaled standard skills in that area (Fantuzzo et al., 1995 ) . scores. The summation of the subscales yields the total scaled score or Strength Index, which is Psychometric characteristics: The PIPPS demon- also reported in a percentile rank and a descrip- strates reliability and validity in urban, low- tive term (Very Superior , Superior , Above Average , income, African American, Kindergarten youth. Average , Below Average , Poor, or Very Poor ) Cronbach’s alpha for the three scales ranges from (Epstein & Synhorst, 2009 ) . 0.87 to 0.91. The construct validity of the PIPPS was determined using exploratory factor analysis. Psychometric characteristics : The preBERS has The PIPPS was reported to be signifi cantly a set of norms for three different standardization 256 J.A. Naglieri et al. samples: typical preschool children, Head Start Likert-type scale 0 (never ) to 4 (almost always) to preschool children, and Special Education pre- measure three global scales: Sense of Mastery (20 school children. The sample size for these groups items), Sense of Relatedness (24 items), and was 1,471, 962, and 1,103, respectively. Each Emotional Reactivity (20 items), for a total of 64 sample was compared to the U.S. census by items. Each global scale consists of a group of sub- region, race, ethnicity, gender, parental educa- scales—sense of mastery: optimism, self-effi cacy, tion, family income, and disability status. The and adaptability; sense of relatedness: trust, per- samples were mostly representative, but with ceived social support, comfort, and tolerance; some regional discrepancies in both the Head emotional reactivity: sensitivity, recovery, and Start and Special Education groups (Drevon, impairment. The raw scores of the RSCA are con- 2011 ) . The preBERS reported good internal converted to T -scores (Prince-Embury & Steer, 2010 ) . sistency for the Strength Index, with correlations ranging from 0.96 to 0.98. Correlations were Psychometric characteristics : The RSCA was good for each subscale, as well, ranging from standardized on a group of 200 children aged 0.84 to 0.97. Short-term test–retest data for the 15–18 years. The sample was compared to the Strength Index indicated high corrected correla- U.S. census on both parent education and ethnic- tions, equaling 0.80 in teachers and 0.95 in parity within each year of age and also by gender ents. The subscale correlations ranged from 0.81 (Prince-Embury, 2008 ). All three global scales to 0.89 in teachers and 0.88 to 0.97 in parents. displayed good internal consistency scores, with Long-term test–retest data revealed a corrected alpha coeffi cients ranging from 0.83 to 0.95. The correlation of 0.79 in teachers and 0.85 in parents RSCA indicated test–retest reliability through a for the Strength Index and subscale correlations 12-day interval (on average), yielding correlations ranging from 0.72 to 0.89 in teachers and 0.83 to of 0.70–0.92. To establish validity, the RSCA was 0.92 in parents. The preBERS reported teacher correlated with the Reynolds Bully Victimization and paraprofessional inter-rater corrected corre- Scale (Reynolds, 2004 ), the Brown ADD Scales lations between 0.71 and 0.85 for the subscales, for Children (Brown, 2001 ), and then Beck Youth with a 0.72 corrected correlation in the Strength Inventories (BYI-II; Beck, Beck, Jolly, & Steer, Index (Epstein & Synhorst, 2009 ) . 2005 ; Sink & Mvududu, 2010 ) . Psychometric properties for the RSCA were further explored in clinical samples of children (n = 110) and adoles- Resiliency Scales for Children cents (n = 178) revealing good internal consistency and Adolescents among the three global scales with alpha coef fi cients ranging from 0.82 to 0.90 in the child Purpose : The Resiliency Scales for Children and population and from 0.92 to 0.94 in the adolescent Adolescents (RSCA; Prince-Embury, 2008 ) aims population (Prince-Embury, 2010 ) . to identify and measure personal qualities and vulnerabilities related to resiliency in youth aged 9–18 years. The RSCA is a screener, but can also be Conclusions utilized to plan and monitor progress and outcomes. The scales are available only in a self-report format Initial conceptualizations of psychological con- and can be administered by quali fi ed supervi- cepts have a history of being retained across gen- sors who are professionals, knowledgeable of psy- erations of psychologists. Once an idea is chological tests and assessments (Prince-Embury proposed, and especially if it is operationalized in & Steer, 2010 ) . The RSCA can be used to evaluate a practical method, it can become widely used children and adolescents’ personal resiliency. before researchers have adequately determined the ultimate value and utility of the concept. Scale description : The RSCA items are written on a Perhaps one of the best examples is the Stanford- third-grade reading level and use a 5-point Binet and Wechsler IQ tests which have changed 14 Measuring Resilience in Children: From Theory to Practice 257 Match to US population No Yes Yes preschool, head start, populations living in high-risk, populations living income urban populations low and early childhood special education 2,176 2,000 National sample 2,000 National sample National sample Yes Yes Yes 1,471 Typical Comparison sample size Sample description 2,183 2,500 National sample 1,250 National sample 1,250 National sample Yes 312 National sample Yes African American Head Start Yes Yes 650 National sample No -score -score -score -score -score -score -score -score percentiles, scales scores T T scores Scores for scales T T T T T T 1–36 months Parents and teachers 5–14 years Teachers Varies Varies 52 3–66 months Parents 37 6–9 62 years 33 Teachers, (infant parents, self 2–5 form) and 36 years Raw Raw score scores, (toddler form) 2–5 years Parents and teachers 2,633 Parents and teachers National sample No 42 3–6 years Parents and teachers Scaled 72 8 item Four forms 36 items 5–14 years Parents and teachers 5–14 years Teachers 64 9–18 years Self report Psychometric characteristics of scales used to measure variables related to resilience related to resilience Psychometric characteristics of scales used to measure variables Ages and Stages Questionnaire: Social–Emotional (ASQ-SE) and Emotional Rating Behavioral Scale (BERS) Early Childhood Devereux Assessment (DECA) Early Childhood Devereux Assessment—Clinical (DECA-C) Early Childhood Devereux Toddler Assessment—Infant (DECA-IT) and Preschool Behavioral Emotional Rating Scale (preBERS) Devereux Student Strengths Devereux Assessment (DESSA) Student Strengths Devereux Assessment—Mini (DESSA-mini) Student Strengths Devereux Assessment—Second Step Edition (DESSA-SSE) Play Scale Penn Interactive 32 preK & K and teachers Parents Table 14.1 Rating scale No. of items Age range Informants Resiliency Scales for Children Resiliency and Adolescents (RSCA) 258 J.A. Naglieri et al. little since they were fi rst published in the early preferred and used within the boundaries 1900s. Similarly, because initial conceptualiza- specifi ed by the authors. The use of well-devel- tions have such an important infl uence on the oped, psychometrically sound assessments will fi eld, advocates of a concept such as resilience greatly enhance the likelihood that we will be and the variables that lead to it should be mindful able to (a) obtain good information about the of the power of initial conceptualizations. variables related to resilience and (b) develop Researchers and practitioners need to be mind- and evaluate ways to improve social and emo- ful that the various tools summarized in Table 14.1 tional outcomes for children. of this chapter have both defi nitional and operational in fl uence. Although there is a growing number of new methods for assessing the likelihood References of resilience there is, as yet, much more work has to be accomplished just to adequately defi ne the Achenbach, T. M. (1991). Teacher Report Form. concept and the methods used in the assessment Burlington: Department of Psychiatry, University of Vermont. process. The use of any one of the tools described American Educational Research Association, American in this chapter may provide useful information Psychological Association, & National Council on about a child, but such information needs to be Measurement in Education. (1999). Standards for integrated into a larger picture. Each of the tools educational and psychological testing . Washington, DC: American Educational Research Association, summarized in this chapter provides a limited American Psychological Association, National examination of the child and they should be used Council on Measurement in Education. accordingly. This is particularly important because Beck, J. S., Beck, A. T., Jolly, J. B., & Steer, R. A. (2005). the list of variables that in fl uence resilience is very Beck Youth Inventories (2nd ed.). San Antonio, TX: Pearson. large and diverse, including the child’s characteris- Bracken, B. A. (1987). Limitations of preschool instru- tics (psychological and physical), the family, both ments and standards for minimal levels of technical immediate and extended, as well as the community adequacy. Journal of Psychoeducational Assessment, 5, and larger societal factors. Additionally, the deter- 313–326. Brown, T. E. (2001). Brown Attention-De fi cit Disorder mination of which combination of variables best Scales for Children and Adolescents. San Antonio, predicts resilience and the complex interactions of TX: Pearson . these variables is still evolving. Chandler, L. A. (1981). The source of stress inventory. 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Devereux Early Childhood Assessment for Infants and (1990). Stress resilient children in an urban setting. Toddlers (DECA-I/T) assessment, Lewisville, NC: Journal of Primary Prevention, 11 (1), 3–17. Kaplan. Wright, M. O., & Masten, A. S. (2005). Resilience Masten, A., & Garmezy, N. (1985). Risk, vulnerability, and processes in development: Fostering positive adap- protective factors in developmental psychopathology. tation in the context of adversity. In S. Goldstein & In B. Lahey & A. Kazdin (Eds.), Advances in clinical R. Brooks (Eds.), Handbook of resilience in chil- child psychology . New York: Plenum Press. dren. New York, NY: Kluwer. Assessment of Social-Emotional Competencies Related to Resilience 1 5

Jack A. Naglieri , Paul A. LeBuffe , and Valerie B. Shapiro

some of the fi elds of research and practice that Introduction have guided the incorporation of a strength-based approach to children’s mental health into the In the past 50 years there has been a growing DCRC resources. Next, this chapter focuses on interest in promoting, sustaining, and restoring the speci fi c resources within the DCRC collec- the well-being of young people by nurturing their tion that were designed to help practitioners positive attributes and assets. This strength-based collect relevant, empirical information about a approach is predicated on the belief that “every- child’s strengths. It concludes by providing body has knowledge, talents, capacities, skills, examples of how these assessment tools can be and resources that can be used as building blocks used to plan and monitor interventions that toward their aspirations, the solution of their promote resilience in children. problems, the meeting of their needs, and the boosting of the quality of their lives” (Saleebey, 2008 ) . A strength-based orientation suggests that, Positive Youth Development even in the face of adversity, individuals can overcome the odds and achieve better-than- The DCRC resources can be used as part of a expected outcomes (Masten, 2001 ) . Studies of comprehensive program to promote positive children that have beaten the odds suggest that youth development (PYD). PYD, as defi ned by these children share common characteristics— the United States Department of Health and many of which can be nurtured in their natural Human Services, is an orientation toward providing environments (Werner & Smith, 1992 ) . The services and opportunities that support all young Devereux Center for Resilient Children (DCRC) people development a sense of competence, use- has transformed the fi ndings from this body of fulness, belonging, and empowerment (National research into resources that parents and profes- Clearinghouse on Families & Youth, 2007 ) . The sionals can use to promote these characteristics concept of PYD is not a single intervention, but a in children and youth. This chapter fi rst describes policy perspective that uses both prevention and intervention strategies in an integrated fashion to provide opportunities, develop skills, and J. A. Naglieri () University of Virginia , Charlottesville , VA , USA reinforce prosocial behavior. The United States e-mail: [email protected] government has embraced PYD since the 1960s P. A. LeBuffe as a means to deal with crime and poverty. When Devereux Center for Resilient Children , Villanova , PA , USA such programs are aligned with the science of V.B. Shapiro human development and behavior change, PYD University of California , Berkeley , CA , USA has been shown to improve mental health

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 261 DOI 10.1007/978-1-4614-3661-4_15, © Springer Science+Business Media New York 2013 262 J.A. Naglieri et al.

outcomes, prevent violence and delinquency, and procedure clarifi cation), prosocial skill instruc- and reduce the onset of early sexual activity tion, and behavior-modifi cation techniques to rein- (Catalano, Hawkins, & Toumbourou, 2008 ). force prosocial behavior. The aspect of PYD in There are several explanations for the positive which children and adolescents receive direct skill effect of PYD. Although many theories have been instruction to promote social and emotional com- proposed, the Social Development Model petencies is often referred to as Social-Emotional (Catalano & Hawkins, 1996 ) is an example that Learning (SEL ), the topic of a later section in this has in fl uenced preventative interventions for over chapter. While many DCRC resources can be used 30 years. This approach posits that youth fi rst need to create opportunities, support engagement, and opportunities for involvement in prosocial activi- identify reinforcers, the assessment tools in parties. Once provided with opportunities for involve- ticular have been primarily designed as a tool to ment, they need the skills to realize the potential of support the implementation and progress monitor- these opportunities. When skills are used, the ing of competence-building interventions. The behavior needs to be reinforced. Youth form emo- PYD movement in fl uenced the DCRC assess- tional attachments to the source of the reinforce- ments to be strength-based, or more speci fi cally, ment, and then internalize the values of the person measures of the frequency of desirable or positive or institution to which they are bonded. This expla- behaviors in children. This re fl ects a recent nation can explain why some youth feel bonded to clari fi cation of the goal of PYD, to not only be the their families and their schools, while other youth reduction of problem behavior, mental illness, and develop a sense of attachment to neighborhood delinquency, but also to promote mental health and gangs. Gangs can also provide leadership opportu- engagement in a way that expands upon our vision nities, skill training, and tangible rewards, but for health and quality of life. This has been result in quite different, and often antisocial, re fl ected in the movement of many human service behaviors. disciplines towards positive psychology (Keyes, In PYD initiatives, the Devereux Center for 2007 ; Seligman et al., 2005 ) , strength-based prac- Resilience Children assessment tools help practice (Clark & Whitaker, 2002 ; Nickerson, 2007 ) , titioners identify which skills (referred to as asset building (Benson, Scales, Hamilton, & competencies) a youth already has and which Sesma, 2006 ) , and whole-child education (ASCD ones need development. The assessments then Commission on the Whole Child, 2007 ) . serve as goal-setting tools to direct attention and resources toward promoting skills that the child needs in order to cope with set-backs and make Risk Factors, Protective Factors, the most of opportunities. When the develop- and Resilience ment of social-emotional competencies occurs within an environment that is abundant with The Devereux Center for Resilience Children engaging opportunities and is plentiful in recog- resources utilizes a risk and protective factor nition, bonding and the internalization of proso- framework. This emphasis re fl ects the fi eld’s cial values occurs. improved understanding of the etiology of health When a PYD model is put into place within a and behavior problems, which give PYD coali- school building, it is often called School-wide tions a re fi ned ability to identify and target the Positive Behavior Support (PBS ) (Sawka-Miller & predictors and precursors of problem behavior Miller, 2007 ) . PBS involves the “careful assess- and, therefore, enhance the effectiveness of their ment and reengineering of whole school environ- prevention and early intervention work (Catalano ments to effect positive and lasting behavior et al., 2008 ) . The identi fi ed predictors of develop- change in the student population” (McCurdy, mental outcomes are commonly called risk and Mannella, & Eldridge, 2003 , p. 160). This is done protective factors. through the implementation of school-wide Risk Factors are those environmental or proactive behavior management strategies (e.g., rule individual attributes that are associated with neg- 15 Assessment of Social-Emotional Competencies Related to Resilience 263 ative developmental outcome (e.g., truancy, mental assists the public in identifying such ef fi cacious illness, delinquency). Risk factors in contempo- approaches to promote social-emotional well- rary American society may include a history of being and positive functioning. The site currently abuse and neglect, a developmental disability, lists 18 programs (e.g., Promoting Alternative experiences of poverty, discrimination, academic Thinking Strategies, Second Step, Guiding Good failure, neighborhood crime, and substance Choices) that have demonstrated the achievement abuse. Children that have numerous risk factors, of these goals in populations of children aged in the absence of protective factors, are described 6–12, through a randomized control trial with at as vulnerable (Masten et al., 1999 ) . least one replication. In the context of Positive Protective Factors are those environmental and/ Youth Development and a Risk and Protective or individual attributes that counter the impact of Factor Framework, SEL is an effort to give stu- risk and decrease the likelihood of negative out- dents the individual capacities to moderate the comes. Protective factors for children include con- impact of stress and make the most of opportuni- sistent caregivers, a positive school climate, good ties. SEL has been demonstrated to impact a social-emotional skills, and a bond with a prosocial broad array of important outcomes (Greenberg adult. Children who have strong protective factors et al., 2003 ) . that help them to overcome risk and adversity are The Collaborative for Academic, Social and known as resilient (Werner, 1984 ) . Emotional Learning (CASEL) has grouped these The implementation of programs that promote capacities into fi ve categories: self-awareness, protective factors within a resilience framework social-awareness, self-management, relationship require the ability to reliably assess protective fac- skills, and responsible decision making (Devaney, tors in children. The DCRC resources provide O’Brien, Tavegia, & Resnik, 2005 ) . A review of users with a practical and psychometrically sound after-school programs teaching these skills means of assessing protective factors as part of reported that SEL programs have the potential to (1) their efforts to gather information, plan interven- improve feelings of self-confi dence and self-esteem, tions, and evaluate efforts. Risk and protective fac- (2) promote school bonding (positive feelings tors exist on societal, community, familial, and and attitudes toward school), (3) improve school individual (also known as within-person) levels. grades, (4) reduce aggression, noncompliance, Although the DCRC assessments target malleable and conduct problems, and (5) reduce recreational within-child protective factors, child-serving agen- drug use (Durlak & Weissberg, 2007 ) . A second cies will best serve their target populations by meta-analysis reported that when SEL programs reducing risk and promoting protection simultane- were implemented in schools, they were found to ously on as many levels as pragmatically possible, (1) increase social and emotional skills, (2) within the scope of their organization’s mission. improve student attitudes about themselves, others, By building protective factors, we may be able to and the school, (3) enhance social and classroom prevent or minimize the negative outcomes caused behavior, (4) reduce emotional distress related to by unmediated stressors and achieve a more posi- stress and depression, and (5) promote academic tive developmental trajectory for our children. achievement. Durlak and colleagues further connected SEL to academic achievement by reporting that, when SEL programs were well implemented, Social-Emotional Learning students experienced meaningful increases on standardized achievement tests as compared to stu- SEL programs and practices are curricula and dents uninvolved in the SEL programming (Durlak, instructional techniques that promote the devel- Weissberg, Dymnicki, Taylor, & Schellinger, 2011 ; opment of social-emotional competencies, such Zins, Bloodworth, Weissberg, & Walberg, 2004 ) . as those measured by the DCRC Assessments. Noting the impact of SEL programs on student’s The National Registry of Evidence-Based capacities for learning (Abbott et al., 1998 ; Programs and Practices ( http://nrepp.samhsa.gov ) Domitrovich, Cortes, & Greenberg, 2007 ) , pol- 264 J.A. Naglieri et al. icy-makers have begun to recognize SEL as an between 4 weeks and 3 years of age. The DECA- important part of the school curriculum. In 2004, I/T Infant form has 33 items and yields two pro- Illinois adopted SEL learning standards at the tective factor scales; Initiative (18 items) and state level, requiring each school district to Attachment/Relationships (15 items). The develop an instructional plan, and other states Toddler form has 36 items comprising three pro- (e.g., New York) and local educational agencies tective factors scales; Attachment/Relationships (e.g., Anchorage, Alaska) have followed suit. The (18 items), Initiative (11 items), and Self- need for user-friendly, scienti fi cally sound, child- Regulation (7 items). The DECA-I/T items are centered measurement tools to assess the indi- rated by family members and early care and edu- vidual and aggregate social-emotional capacities cation providers based on behaviors observed of students has hindered the implementation of over the past 4 weeks using a 0 (Never) to 4 (Very SEL programs in the years since these policies Frequently) scale. The Attachment/Relationship have been adopted. The DCRC resources have scale assesses if a mutual, strong, long-lasting been designed for this purpose and thus support relationship has developed between the infant or the widespread adoption of social-emotional toddler and a signifi cant adult. The Initiative learning programs and practices. scale determines the infant or toddler’s ability to use independent thought or actions to meet his or her needs. The Self-Regulation scale assesses the From Theory to Practice toddler’s ability to manage emotions and sustain focus and attention. A Total Protective Factors The Devereux Center for Resilience Children scale provides a summary score across these (DCRC) assessment tools were designed to help scales. Each scale and total score is reported in practitioners collect relevant, empirical informa- T -score units as well as percentile ranks to facil- tion about a child’s strengths, and then plan for— itate interpretation and give meaning to the and monitor the results of—interventions designed score. to promote resilience in children. A variety of assessment tools have been created to meet the needs of children at various developmental stages Preschoolers that fi t into the organizational contexts and practice routines of the systems that serve them. In the The Devereux Early Childhood Assessment sections that follow, we will briefl y discuss each (DECA: LeBuffe & Naglieri, 1999 ) measures proof these rating scales as designed for infants and tective factors related to resilience and was stan- toddlers, preschool children aged 2 through 5 dardized on a national sample of 2,017 children years, and school-aged students in kindergarten aged 2 through 5 years of age. Like the DECA-I/T, through the eighth grade. Readers should refer to the DECA uses a behavior rating scale format Chap. 14 for a more thorough description of the which evaluates the frequency with which a child six scales from the DCRC. demonstrates speci fi c behaviors over the past 4 weeks. A family member or early care and educational professional completes the 37 items which Infants and Toddlers are scored using a 0 (Never) to 4 (Very Frequently) scale. The DECA items are organized into The Devereux Early Childhood Assessment for Protective Factor (Initiative, Self-Control, and Infants and Toddlers (DECA-I/T; Mackrain, Attachment) Scales and also include a brief screener LeBuffe, & Powell, 2007 ) evaluates social-emo- for Behavioral Concerns. Similar to the DECA-I/T, tional skills in infants and toddlers up to 36 the items on the Initiative scale assess the child’s months of age. The DECA-I/T was standardized use of independent thought and action to meet his on a national sample of 2,183 infants and toddlers or her needs, and the Self-Control scale includes 15 Assessment of Social-Emotional Competencies Related to Resilience 265 items about the child’s ability to experience a range School Age Children of feelings and express them appropriately using words and actions. The Attachment Scale items There are three rating scales that are appropriate determine if the child has developed mutual, strong, for students aged 5–14 years. The fi rst is the and long-lasting relationships not only with adults, Devereux Student Strengths Assessment but also with other children. In addition, a Total (DESSA; LeBuffe, Shapiro, & Naglieri, 2009 ) , Protective Factors Scale is provided. The brief which is designed to assess social-emotional Behavioral Concerns Screener provides an initial competencies that serve as protective factors for look at a wide variety of problem behaviors seen in children in kindergarten through the eighth grade. some young children. Separate norms are provided The DESSA was standardized on a national sam- for parent and teacher raters and yield both percen- ple of 2,494 children in grades K through 8 by tile ranks and T -scores. At the time that this chapter teachers and parents using both paper and pencil is being written, the DECA is being revised. The and online versions of the scale. The DESSA is revised version will be known as the Devereux completed by parents, teachers, or staff at child- Early Childhood Assessment for Preschoolers— serving agencies, including after-school, social Revised (DECA-P2) and is scheduled to be pub- service, and mental health programs. The assess- lished in 2012. ment is comprised of 72-items that are entirely The Devereux Early Childhood Assessment— strength-based. The DESSA is organized into Clinical Form (DECA-C; LeBuffe & Naglieri, eight conceptually derived scales that provide 2003 ) is a modi fi ed version of the DECA. This information about social-emotional competen- rating scale is designed to fully assess factors cies. They are self-awareness, social-awareness, related to both resilience and emotional/behav- self-management, goal-directed behavior, rela- ioral problems. Therefore, the DECA-C is appro- tionship skills, personal responsibility, decision priate for use with children with signi fi cant making, and optimistic thinking. The total of known social and emotional needs as part of a these scales is used to obtain a Social-Emotional larger assessment of emotional health and to Composite score. guide the development of intervention plans. The The second scale for this age group is the DECA-C uses a behavior rating scale format to Devereux Student Strengths Assessment—Mini evaluate the frequency with which a child aged 2 (DESSA-mini; Naglieri, LeBuffe, & Shapiro, through 5 years demonstrated specifi c behaviors 2011) . The scale was standardization on a sample over the past 4-week interval according to a of 1,250 children and youth in kindergarten family member or early care and educational through the eighth grade rated by teachers or pro- professional. The protective factor scales of the gram staff. The DESSA-mini is a series of four DECA-C were standardized on a nationally rep- brief (8 item), parallel forms comprised of entirely resentative sample of 2,000 children aged 2 strength-based items which are scored on a fi ve- through 5 years of age. The Behavioral Concerns point scale about how often the student engaged Scale was standardized on a nationally represen- in each behavior over the past 4 weeks. The tative sample of 1,108 children aged 3 through 5 DESSA-mini can be used to obtain a snapshot of years. The DECA-C is organized into three a child’s overall social-emotional competence to scales related to resilience (initiative, self-control, determine if additional assessment or skill devel- and attachment) and four scales about behavioral opment should be a provided. The four different concerns (attention problems, aggression, emo- forms are designed for ongoing progress monitor- tional control problems, and withdrawal/depres- ing (OPM) during the course of social-emotional sion). The three scales related to resilience interventions. Each DESSA-mini form yields a and the four scales related to behavioral con- single T -score, the Social-Emotional Total cerns are respectively combined into two total (SET), from the standardized sum of the 8-items. scores, Total Protective Factors and Total Because the four forms are equivalent, the SET Behavioral Concerns. scores from each form can be directly compared. 266 J.A. Naglieri et al.

Fig. 15.1 Scales for assessing social-emotional skills developed by the Devereux Center for Resilient Children

This enables the use of the various DESSA-mini forms to monitor progress in acquiring social- The DESSA Comprehensive System for emotional competence across time. Ages 5–14 Years The third scale for this age group is the Devereux Student Strengths Assessment— The DCRC assessments have each been designed Second Step Edition (DESSA-SSE; LeBuffe, to help practitioners collect relevant, empirical Naglieri, & Shapiro, 2011 ) . This scale of strength- information about a child’s social-emotional based items was developed on the basis of the competencies, giving careful consideration to social-emotional skill areas covered in the Second how these assessment tools can be used to plan Step program (Committee for Children, 2011 ) in for and monitor interventions that promote resil- order to facilitate assessment and evaluation as ience in children. This implies developing part of the use of that SEL program. The scale resources that re fl ect and enhance the organiza- was standardized and normed on the same sample tional practices that occur in child-serving set- as the DESSA. The DESSA-SSE is organized tings. For example, there is increasing interest in into four scales: Skills for Learning, Empathy, schools in the use of brief universal screening Emotion Management, and Problem Solving, and procedures for academic subjects such as reading includes a composite score based on all 36 items. and math in order to prevent academic failure and The DESSA-SSE is especially useful for the promote the attainment of educational standards assessment of those specifi c social-emotional for school-aged children. The use of screening skill areas taught in the Second Step program. In tools for all students in a class enables educators addition, the DESSA-SSE can be used for evalu- to effectively and effi ciently identify those chil- ating the gains in social-emotional skills as a dren who are currently showing poor progress result of the Second Step program at both the and therefore are at risk of continued and future individual child and group (e.g., classroom, academic failure. Once identi fi ed as at-risk, these school) levels (Fig. 15.1 ) . students are given a more thorough assessment to 15 Assessment of Social-Emotional Competencies Related to Resilience 267 determine their specifi c areas of need as well as range ( T-scores of 60 or higher). These children academic strengths. This information is then used will benefi t from universal (i.e., Tier 1) social to identify targeted strategies to address any aca- and emotional learning programs and a safe and demic needs. We have designed the school-aged supportive school climate. DCRC assessments in a way that helps schools to Those students who obtain a DESSA-mini extend this approach to promoting the social- T-score that is in the Need for Instruction range emotional competence of children, which is also ( T-scores of less than or equal to 40) should be essential for academic success. provided targeted social-emotional instruction. The DESSA Comprehensive System is a prac- In order to better understand the students’ tice model that integrates the use of the DESSA- specifi c areas of need, these children should be Mini and the DESSA to encourage universal assessed with the full 72-item DESSA to help social-emotional skill instruction, school-wide determine the nature of the targeted interven- screening and monitoring of the entire student tions that should be provided. These interven- body, and comprehensive assessment and plan- tions should be based on speci fi c social-emotional ning for students who need more targeted instruc- scores on the eight DESSA scales and an exami- tion than what is available in the standard nation of individual item scores as speci fi ed in curriculum. In this way, the social-emotional the DESSA Manual. competence of all children is being promoted, As noted above, children who were not identi fi ed and the social-emotional competence of no child at Time 1 will continue to benefi t from the universal slips through the cracks. By adopting a primary social-emotional instruction and a healthy school prevention, strength-based approach, we can climate. If at any time a teacher or parent should intervene before the emergence of emotional and become concerned about a child’s social-emotional behavioral problems occurs and individualize the status, however, a full DESSA should be com- school environment and instructional supports pleted. If warranted, based on DESSA results, the and programs to increase the likelihood of suc- child could move from Tier 1 (standard, universal, cess in school and life for all children. school-wide practice) to a higher Tier (individual- Three resources are required to implement the ized support) at any point during the year. DESSA Comprehensive System. These are (a) the four alternate forms of the DESSA-mini; (b) the full 72-item DESSA and DESSA Classroom Tier 2: Ongoing Progress Monitoring Pro fi le; and (c) the DESSA-mini OPM form. Utilization of these resources is summarized in The services at Tier 2 apply only to those children the text that follows. who were identi fi ed as needing targeted social- emotional instruction and related supports. The goal of OPM at Tier 2 is to use alternative Time 1: Universal Screening DESSA-mini Forms 2, 3, and 4 to provide feed- and Selective Assessment back to the teacher, student support personnel, student, and caregivers on the progress that the The implementation of the DESSA Compre- child is making on acquiring social-emotional hensive System begins with universal screening competencies. Typically, the alternate forms of of all children using Form 1 of the DESSA-mini. the DESSA-mini are administered at 30–90 day This will most likely occur near the beginning of intervals, depending on the needs of the student. a school year, after the required 4-week observa- If necessary, the DESSA-mini forms can be used tion period has occurred. It can be expected that repeatedly throughout the year. The results of most children will obtain a DESSA-mini SET each administration are recorded and graphically T-score of 41 or higher, placing them in the displayed using the DESSA-mini OPM form. Typical ( T -scores of 41–59 inclusive) or Strength This form allows the user to record changes in 268 J.A. Naglieri et al.

T-scores from one DESSA-mini administration The Use of the DESSA at Tier 3 to the next. Guidelines are presented in the The DESSA also provides valuable information DESSA-mini manual on how to interpret changes for children who are being evaluated for, or have and modify targeted interventions and supports already been deemed eligible for special education based on the student’s progress. services. In particular, the individual item analysis technique described in the DESSA manual can identify empirically grounded and instructionally Time 4: Documenting Outcomes relevant strengths to be incorporated into the and Preparing for the Next School Year child’s Individualized Education Plan (IEP). A review of the scale scores on the DESSA can also At the end of the year, we recommend a second provide insights on how the disability is affecting DESSA be completed for all those children that the child’s social and emotional competence. have been receiving Tier 2 supports. Using the pretest–posttest comparison procedure Contemporary Debates described in the DESSA manual, the child’s Some professionals (e.g., Shinn, Tindal, & Stein, growth or decline on each of the eight DESSA 1988 ) have suggested that determining which scales can be determined. This information can students in a class should be considered “at-risk” be useful for both documenting outcomes, plan- and quali fi ed for targeted services should be ning for sustaining growth over the summer based on local rather than national norms. This break, and preparing for the next school year. If presumes that local norms can more accurately the analysis indicates that a child failed to identify students who may be at risk based upon respond to targeted interventions, a referral for the comparison of a student directly to other more intensive services (Tier 3) in the next children in his or her immediate environment. school year should be considered. A counter ideology suggests that high hopes and In addition to evaluating the outcomes for expectations should be maintained for all stu- individual students, the results of the pretest– dents, even those in local environments where posttest comparison technique can be aggregated low achievement is prevalent. In other words, this across students who have been receiving Tier 2 viewpoint suggests that “at risk” status should be supports. These data can indicate areas where determined by comparing a student to a well- staff have, on the whole, been more or less suc- defi ned reference point rather than to an artifi cial cessful at promoting specifi c competencies. For (and changing) standard determined in part by instance, this analysis might reveal that 75% of the availability of local resources rather than children receiving targeted supports to address authentic student need. This interesting debate social skills showed improvement, whereas only places two ideological approaches in contrast to 25% of children receiving supports for self- each other, but the impact of such a decision is awareness showed improvement. This informa- not often examined empirically. tion can readily inform professional development In order to shed light on the differences strategies for staff, resource acquisition and between the way in which local and national mobilization in the school or community, and norming practices could impact the assessment summer safety planning for youth. of resilience in children, we analyzed data from A Time 4, all children who have not been reas- the DESSA standardization sample. The data sessed with the DESSA as described above should used for this illustration (see Table 15.1 ) re fl ect be rescreened with the DESSA-mini. This is in three levels of DESSA scores. One group with an recognition that risk and protective factors can average T score around 40 (a student body with wax and wane over the course of the school year. signifi cant needs), another with an average around A child who had a Typical score in the fall may 50 (a typical student body), and one with an aver- have experienced additional risk and adversity age around 60 (a student body with signifi cant and now scores in the Need for Instruction range. competence). The tabled values for these three 15 Assessment of Social-Emotional Competencies Related to Resilience 269

Table 15.1 Comparison of national and local norms T -scores based on national norms T -scores based on local norms Student Classroom 1 Classroom 2 Classroom 3 Classroom 1 Classroom 2 Classroom 3 1 44 48 60 53 48 51 2 26 31 39 37 34 32 3 26 38 46 37 40 38 4 34 41 52 44 42 44 5 48 58 66 57 56 56 6 21 27 38 32 30 31 7 26 35 45 37 37 37 8 49 58 69 58 56 59 9 28 41 50 38 42 42 10 38 50 58 48 50 49 11 48 57 66 57 55 56 12 42 50 60 51 50 51 13 42 53 58 51 52 49 14 53 66 74 62 63 64 15 40 53 60 50 52 51 16 38 50 58 48 50 49 17 24 33 45 35 35 37 18 40 53 60 50 52 51 19 58 68 76 66 65 65 20 37 50 54 47 50 46 21 49 64 67 58 61 57 22 53 68 74 62 65 64 23 42 48 60 51 48 51 24 53 68 76 62 65 65 25 44 50 56 53 50 47 26 40 50 62 50 50 53 27 56 68 76 65 65 65 28 28 38 46 38 40 38 29 56 64 69 65 61 59 30 29 37 48 39 39 40 Mean 40.4 50.5 58.9 50.0 50.0 50.0 SD 10.7 12.0 11.1 10.0 10.0 10.0 N < 41 15 7 2 8 7 7 Note : Shaded cells include values less than 41, the recommended cutoff for being at risk and in need of social-emotional instruction groups, based on the DESSA national norms, The scores in the right side of the table are appear in the left portion of the table. The scores those that were calibrated based on local norms for each of the 30 cases across the three groups that were constructed by transforming the original are provided. Using our rule that a score of 40 or scores to z scores based upon the means and stan- less (−1 standard deviation; 16th percentile) dard deviations for each group. For example, the would indicate that the child is in need of social- score for student #1 based on the DESSA nor- emotional instruction we would conclude that 15 mative sample is 44. In order to compute a local students in Group A, 7 in Group B, and 2 in normative value for that student, the following Group C are in need of targeted services. formula was used: ((44−40.4)/10.7) × 50 + 10. 270 J.A. Naglieri et al.

When converted to a local normative value, stu- need for social-emotional skills in Group A will dent #1’s score of 44 now becomes a score of 53 be overlooked through the use of local norms. (T score based on Group A mean and standard This analysis raises concerns about the capacity deviation). The values in this table show the of local norms to accurately access students and national and local norm values for three groups of allocate resources in the most equitable way 30 cases. The fi ndings illustrate the differences possible. between these methods. As seen in Table 15.1 , the mean scores for the three Groups differed considerably. The average Conclusions for Group A is very low (40.4) and for Group C quite high (58.9). As an artifact of the local norm- All of the assessments developed by the DCRC ing process, each of the group T -score means on share certain key features. First, they are the right side will be 50. Because the student strength-based. In order to support primary pre- body in Group B is typical, meaning that their vention and mental health promotion, it is essen- average is close to the national average, there is tial that a strengths orientation is utilized. More little difference between the local and national traditional de fi cit or problem-oriented scales norm values. This is not the case for those groups can only identify children in need of services that have an average score that deviates from 50. after the challenging behaviors have exceeded The scores in Group 1 go up (from 40.4 to 50.0) some threshold. The goal of the DCRC assess- and the scores in Group 3 go down (from 58.9 to ments are to promote healthy social and emo- 50.0). Importantly, the number of students who tional development and to identify children who are identi fi ed as at risk goes down for Group 1 are at risk of developing emotional and behav- and up for Group 3. That is, 7 (47%) of the 15 ioral problems due to low protective factors cases in Group 1 that were at risk on a national before the problem behaviors emerge. Second, basis are no longer identifi ed. For example, case all of the assessments meet or exceed profes- #16 has a T score of 38 when compared to the sional standards for well-developed assess- national mean, but a score of 48 when compared ments. Because teachers, staff, and parents have to the rest of the cases in Group 1. That means many demands upon their time, we should only that a child who is about one standard deviation expect individuals to complete, score, and use below the national mean could be treated as a assessments if those tools provide valid, reli- typically developing child and disquali fi ed from able, and useful information. Third, quality receiving services if the scores of the other chil- assessment should precede and guide interven- dren in his local community are very low. tion. All of the DCRC assessments have been The cases which comprise Group 3 are gener- developed to help guide effective interventions ally high, and as a group, the students are almost to support the social and emotional competence one standard deviation above the national mean. of children. For this reason, many of the assess- Using the cut score of 40, the national norm ments (DECA, DECA-I/T) are accompanied by would lead to the conclusion that two students strategy guides for parents and teachers and the are at risk. When the local norm is calculated, DESSA-SSE was developed to support the fi ve additional students are identi fi ed as being at Second Step social and emotional learning pro- risk. Those students in schools where the mean is gram. We have developed these tools to give high will earn comparatively low scores based on professionals who work in infant and toddler the local mean, and may be treated differently programs, preschools, schools, after-school pro- and allocated resources, despite actually being grams, and child welfare and mental health quite typical on a national basis. Beyond mis- facilities a way to make data-based decisions to leading, it is concerning that these students will promote the social-emotional competencies of likely receive supports that they may not need children in order to facilitate their success in while other students who are in considerable school and life. 15 Assessment of Social-Emotional Competencies Related to Resilience 271

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Sandra Prince-Embury

What qualities buffer youth who are faced with to internal or external stress. It is also assumed more than the average burden of hardship? Do that this relationship may be expressed as a these qualities strengthen children generally in Personal Resiliency Profi le unique to each child times of greater uncertainty and exposure? Are or adolescent. they the same qualities that characterize children Although resilience has been the focus of and adolescents who can weather the transitions much discussion and research over the past and upheavals that frequently accompany normal decades, the operational de fi nition has varied development? Accumulating research and theory considerably over time as hardiness, optimism, suggest that it is possible to objectively measure competence, self-esteem, social skill, achieve- qualities of resiliency although many forces may ment, or the absence of pathology in the face of shape them. The Resiliency Scales for Children adversity. Resilience in the face of adversity has and Adolescents ™ (Prince-Embury, 2007 ) is been studied extensively by developmental psy- based on the fi ndings of previous research of per- chopathologists for the past 50 years. This body sonal resiliency in children and adolescents and of work has generally defi ned resilience as the are grounded in developmental theory. The ability to weather adversity or to bounce back Resiliency Scales were designed to systemati- from a negative experience and has focused on cally identify and quantify core personal qualities success de fi ned as having observable assets, of resiliency in youth, as expressed in their own achievement, developmental milestones, or words about their own experience. The function absence of symptoms. Much of resilience research of the scales is to theoretically and empirically has examined the interaction of protective factors provide sound assessment of core characteristics and risk in high-risk populations. The focus of underlying personal resiliency in children and this work has been the identi fi cation of factors adolescents (ages 9–18). The purpose of the that were present in the lives of those who thrived scales is to allow for easy communication of this in the face of adversity as compared to those who information to youth and their caregivers for the did not (Garmezy, Masten, & Tellegen, 1984 ; purpose of education, screening, prevention, and Luthar, 1991, 2003 ; Masten, 2001 ; Rutter, counseling. The scales are based on the assumption Harrington, Quinton, & Pickles, 1994 ; Werner & that personal resiliency re fl ects adequate personal Smith, 1982, 1992, 2001 ) . resources that match or exceed emotional reactivity Protective factors identi fi ed in previous research include personal qualities of children that may have allowed them to cope with various types S. Prince-Embury ( ) of adversities. The personal qualities identi fi ed The Resiliency Institute of Allenhurst, LLC , West Allenhurst , NJ , USA include intellectual ability (Baldwin et al., 1993 ; e-mail: [email protected] Brooks, 1994; Jacelon, 1997; Luthar & Zigler,

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 273 DOI 10.1007/978-1-4614-3661-4_16, © Springer Science+Business Media New York 2013 274 S. Prince-Embury

1991, 1992 ; Masten & Coatsworth, 1998 ; Rutter, individual attributes, such as attachment, defi ned 1987 ; Wolff, 1995 ; Wright & Masten, 1997 ) , as systems underlying close relationships in easy temperament (Jacelon, 1997 ; Luthar & Zigler, development; mastery motivation, defi ned as 1991 ; Rende & Plomin, 1993 ; Werner & Smith, pleasure from mastering developmental tasks; 1982 ; Wright & Masten, 1997; Wyman, Cowen, self-regulation, de fi ned as emotional and behav- Work, & Parker, 1991 ) , autonomy (Jacelon, 1997 ; ioral regulation and impulse control; and cognitive Werner & Smith, 1982 ) , self-reliance (Polk, 1997 ) , development and learning. Masten also suggested sociability (Brooks, 1994; Luthar & Zigler, that the dominance of a medical model that 1991 ) , effective coping strategies (Brooks, 1994 ; emphasizes de fi cits has impeded the development Luthar & Zigler, 1991 ) , and communication skills of good measures of positive aspects of behavior (Werner & Smith, 1982 ) . (Masten & Curtis, 2000 ) . Another group of protective factors identi fi ed Other researchers and clinicians have in previous research pertains to the child’s social expressed a need for a further shift toward clinical environment, including family. Included in this application. If resiliency, as suggested by Masten group of factors are family warmth, cohesion, ( 2001 ) , is part of normal development, why structure, emotional support, positive styles of should not psychology focus on developing these attachment, and a close bond with at least one qualities in all children? Goldstein and Brooks caregiver (Baldwin et al., 1993 ; Brooks, 1994 ; ( 2005) and Brooks and Goldstein ( 2001 ) have Cowen & Work, 1988 ; Garmezy, 1991 ; Gribble called for a clinical psychology of resiliency. et al., 1993 ; Luthar & Zelazo, 2003 ; Luthar & Zigler, These authors focus on the interaction between 1991 ; Masten & Coatsworth, 1998 ; Rutter, 1987 ; the child and the child’s social environment. Werner & Smith, 1982; Wolff, 1995 ; Wright & Brooks and Goldstein have written on the impor- Masten, 1997 ; Wyman et al., 1991, 1992 ) . tance of the mindset of a resilient parent in rais- Environmental protective factors outside the ing a child with a resiliency mindset and the immediate family have been identifi ed and importance of teaching parents how to identify and include positive school experiences (Brooks, foster these qualities. These authors focus on 1994 ; Rutter, 1987 ; Werner & Smith, 1982 ; changing the family environment to be more Wright & Masten, 1997 ) , good peer relations supportive of the child’s resiliency. (Cowen & Work, 1988 ; Jacelon, 1997 ; Werner & Seligman (1995, 1998, 2000 ) has written on Smith, 1982 ; Wright & Masten, 1997 ) , and posi- the need for developing a systematic science of tive relationships with other adults (Brooks, positive psychology to offset the prevailing focus 1994 ; Conrad & Hammen, 1993 ; Garmezy, 1991 ; on pathology. He points out that the major strides Werner, 1997 ; Wright & Masten, 1997 ) . For an in prevention have come from a perspective of extensive review of research and fi ndings pertain- systematically building competency, not on cor- ing to resilience, see Luthar (2006a, 2006b ) . recting weakness. Seligman’s approach, based on Conceptually, the fi ndings of earlier research cognitive theory, is to provide structured interin developmental psychopathology seemed to ventions designed to build resilient attitudes that imply that resilient youth were extraordinary and will then buffer against symptoms of depression. that this quality was not accessible to every child. The creation of the Resiliency Scales began More recently, resiliency has been identi fi ed as a with the identifi cation and operationalizing of characteristic of normal development and not personal qualities that are critical for resiliency applicable in adverse circumstances only (Masten, adaptation of youth (Prince-Embury, 2006b ) . 2001 ; Masten & Powell, 2003 ) . Masten (2001 ) While acknowledging the critical importance of suggested that fundamental systems, already environmental forces, the scales are predicated identi fi ed as a characteristic of human function- on the knowledge that what youth bring to their ing, have great adaptive signi fi cance across environments is also highly in fl uential for their diverse stressors and threatening situations. She overall well-being. The focus here, therefore, is recommends that these systems would include on the types of personal attributes that generally 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 275 allow some youth to do better than others in the tions about their future predicted lower anxiety, face of adversities. The dimensions of personal higher school achievement, and better classroom strength captured in the Resiliency Scales overlap behavior control in these children (Wyman, conceptually with the notion of ego resiliency as Cowen, Work, & Kerley, 1993 ) . a personal integrative characteristic in adults presented by Block and Block (1980 ) . The Blocks’ notion of ego resiliency encompasses a set of traits Resiliency and Sense of Relatedness re fl ecting general resourcefulness and sturdiness of character and fl exibility in functioning in A second body of literature links a youth’s rela- response to varying environmental circumstances. tional experience and ability with personal resil- Personal resiliency as presented in the RSCA is iency. Bowlby ( 1969 ) and Ainsworth and Wittig described in terms of three developmental systems ( 1969 ) systematically studied and established the that are recognized as beginning early in develop- importance of the interaction between a mother ment and maintaining saliency across the lifespan. and her infant in the development of attachment. Masten and Coatsworth ( 1998 ) identi fi ed the signi fi cance of an attachment system to the resil- Resiliency and Sense of Mastery iency of an organism. Luthar and Zelazo (2003 ) argued that strong, supportive relationships lie at A child’s sense of mastery and self-effi cacy is the core of resilient adaptation. The implication recognized by most experts as a core characteris- from this body of literature is that social related- tic of resiliency in children and adults. White ness allows external buffering in several ways. (1959 ) introduced the construct as a sense of First, the youth may view relationships as gener- mastery/effi cacy in children and adolescents that ally available as needed. In addition, the youth provides the opportunity for them to interact with may view relationships as available for specifi c and enjoy cause and effect relationships in the supports in speci fi c situations. On another level, environment. According to White, a sense of internal mechanisms refl ecting the cumulative competence, mastery, or effi cacy is driven by an experience of previous support may in some way innate curiosity, which is intrinsically rewarding shield the child from negative psychological and the source of problem-solving skills. Other impact. Research and theory regarding internal- theories have emphasized learning rather than ized mechanisms of relatedness suggest more intrinsic motivation. Bandura and others ( 1981, than one pathway for this in fl uence. 1977, 1993, 1997) spent many years studying the mechanisms by which self-effi cacy is learned and developed. Bandura’s theory focuses on the inter- Relationships as Buffers nal mediating mechanism of learned expectation through direct and indirect interaction with the Relationships and relational ability as mediators social environment. The critical implication of of resiliency have been supported in research by Bandura’s work is that self-effi cacy experiences developmental psychopathologists such as Emmy can be systematically structured for students to Werner. Throughout her writing, Werner has maximize the likelihood of their learning to have stressed the importance of children having rela- greater belief in their own self-effi cacy. Several stud- tionships with caring adults other than, or in addi- ies conducted as part of the Rochester Child tion to, their parents. In Vulnerable but Invincible , Resiliency Project supported the hypothesis that Werner and Smith (1982 ) noted that resilient positive expectation is related to resiliency. Positive youth sought support from non-parental adults ef fi cacy expectations in 10–12-year-olds predicted more often, especially teachers, ministers, and better behavioral adaptation and classi fi ca tion of neighbors, and that these supports were seen as the child as stress resilient (Cowen, Pryor-Brown, infl uential in fostering resiliency. Werner’s Hightower, & Lotyczewski, 1991 ) . Positive expecta- research suggests that it is not only the presence 276 S. Prince-Embury of supportive individuals at the time of adversity situations, orientation to social resources, and that protects the child, but also the internal cognitive resourcefulness than insecurely mechanism of being able to relate to others in a attached children. Success in relationships has meaningful and long-lasting way that constitutes been de fi ned as a source of modifying stress resiliency. (self-comforting ability) and effecting positive Previous research has indicated that perceived outcome, such as social competence, social skill, support, as distinguished from actual support, is and positive self-esteem (Cicchetti & Toth, 1997 ) . the dimension of social support that is most Allen, Hauser, and Borman-Spurrell (1996 ) strongly related to psychological well-being examined the long-term sequalae of severe ado- in adults and children (Barrera, 1986 ; Cohen & lescent psychopathology from the perspective of Wills, 1985 ; Jackson & Warren, 2000 ; Sarason, adult attachment theory. These authors reported Shearon, Pierce, & Sarason, 1987 ) . According fi ndings that supported a substantial and endur- to Thompson, Flood, and Goodvin ( 2006 ) ing connection between attachment organization “confi dence in the availability and helpfulness and severe adolescent psychopathology. A molec- of social partners is crucial to maintaining a ular genetics study by Kaufman et al. ( 2004 ) sense that assistance is available and the hope indicated that social support may moderate the that can ensue even in diffi culty (this is what is effects of biological vulnerability and a history of meant by a secure attachment relationship early maltreatment on children’s proneness to depres- in life)” (p. 13). sive symptomatology. Social support is likely not only to have a direct relationship to the development of psychopathology, but it also mediates the Internal Mechanisms of Relatedness effects of other risk factors in complex ways. Research suggests a complex interaction between Psychosocial theories of development, such as early attachment and the development of the that of Erikson ( 1963 ) , identi fi ed the fi rst devel- capacity for self-regulation. The presence of a opmental psychosocial process that occurred in secure relationship in infancy mediates the regu- infancy through interaction between the child and lation of affect and models that regulation for the the primary caregiver as the development of trust child. Self-regulation then impacts the child’s vs. distrust. The signi fi cance of trust was identi fi ed development in many ways, including the ability by Erikson ( 1963 ) as the fi rst stage of social– to relate to others. emotional development, upon which all other social development is built. Erikson de fi ned basic trust as the ability to receive and accept what is Resiliency and Emotional Reactivity given. A number of theorists observing the interaction between the infant and primary caregiver Much research in the fi eld of developmental psy- conceptualized this early social interactive pro- chopathology has found that whether a child cess as the development of attachment, which develops pathology in the presence of adversity is they claimed has implications for the individual’s related in some way to the child’s emotional reac- ability to relate to others throughout their life- tivity and his/her ability to modulate and regulate time. Neurophysiologists claim that the presence this reactivity. Strong emotional reactivity and of an adequate attachment experience in infancy associated dif fi culty with self-regulation has been and childhood impacts more basic functioning of strongly linked with behavioral dif fi culty and vul- the individual, such as the ability to self-regulate. nerability to pathology. Conversely, the ability to Fonagy, Steele, Steele, Higgitt, and Target (1994 ) modulate or otherwise manage emotional reactiv- cited other researchers who have found that chil- ity has been found to be a signi fi cant factor in fos- dren identifi ed as securely attached at age 2 later tering resiliency. Reactivity has been labeled score higher on measures of social behavior, alternately as vulnerability, arousability, or thresh- affect regulation, endurance in challenging task old of tolerance prior to the occurrence of adverse 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 277 events or circumstances. Rothbart and Derryberry Sense of Mastery Scale and Subscale (1981 ) indicated that reactivity is the speed and intensity of a child’s negative emotional response, A sense of mastery in children and youth pro- and that regulation is the child’s capacity to modu- vides the opportunity for them to interact with late that negative emotional response. Relative and enjoy cause and effect relationships in the reactivity may have physiological basis, such as environment. As described previously, the con- temperament (Thomas & Chess, 1977 ), genetic struct of mastery has been discussed by different predisposition, learning disability, physical impair- theorists in slightly different ways. The Sense of ment, or congenital anomaly, but it may also be Mastery scale consists of 20 items and distin- modi fi ed by adverse experience. Developmental guishes three personal characteristics that com- psychology has focused on self-regulation as the bine to form the underpinnings of a youth’s organism’s way of maintaining the delicate balance sense of mastery—Optimism, Self-Ef fi cacy, and or homeostasis required for functioning. Within Adaptability. The purpose of this distinction is to this context, self-regulation has been defi ned in include these aspects and to potentially assess the several ways: a set of abilities that allow children relative contribution of each to a youth’s sense of to regulate their own attention, emotions, and mastery or lack thereof. Sense of Optimism is behavior (Cicchetti & Tucker, 1994 ; Pennington de fi ned as a positive attitude(s) about the world/ & Welsh, 1995 ; Rothbart & Bates, 1998 ) ; and the life in general and about an individual’s life intra- and extra organismic factors by which emo- specifi cally, currently, and in the future. Self- tional arousal is redirected, controlled, modulated, ef fi cacy is de fi ned as the sense that one can mas- and modi fi ed so that an individual can function ter his or her environment and is manifested by adaptively in emotionally challenging situations the presence of problem-solving strategies and a (Cicchetti, Ganiban, & Barnett, 1991 ; Thompson, sense of accomplishment. Adaptability is con- 1990 ) . Emotion regulation may be de fi ned as a ceptualized as the ability to learn from one’s mis- part of self-regulation, which in turn refers to a takes and to accept feedback from others. set of tools that allow children to regulate their own attention, emotions, and behavior (Cicchetti & Tucker, 1994 ; Pennington & Welsh, 1995 ; Sense of Relatedness Scale Rothbart & Bates, 1998 ) . and Subscales

The Sense of Relatedness scale consists of 24 Resiliency Scales for Children items and includes four component aspects that and Adolescents (RSCA) contribute to a sense of relatedness: sense of trust, perceived access to support, comfort with others Conceptually, the RSCA draw from the three and tolerance. These aspects are conceptually core theoretical areas described above. Each and developmentally interrelated but are at the scale is designed to re fl ect one of these core same time conceptually distinct. Sense of Trust is areas and the implied system of underlying conceptualized as the extent to which others are mechanisms that mediate between the environ- perceived as reliable and the extent to which one ment and the child’s internal experience of can be authentic in relationship with others. sense of mastery, sense of relatedness, or emo- Access to support is conceptualized as the extent tional reactivity. The three self-report scales to which a youth believes that there are others are written at a third-grade reading level and who care and to whom he/she can go for help in the consist of 20–23 items each with a total of 64 face of adversity. Comfort with others is concep- items. Response options for each item are rated tualized as being at ease with others, having on a 5-point Likert scale: 0 (Never), 1 (Rarely), friends, spending time with friends and generally 2 (Sometimes), 3 (Often), and 4 (Almost being liked by others. Tolerance of differences is Always). conceptualized as being able to express and 278 S. Prince-Embury experience differences in relationship with others. allows strengths and vulnerabilities to be considered This would manifest itself in assertiveness and in relation to each other for each youth. In addition, forgiveness in relationships. the pro fi le may be compared to what is normative for children of a specifi c age and gender and/or be compared with profi les that have been observed Emotional Reactivity Scale for specifi c population. Kumar, Steer, and Gulab and Subscales ( 2010 ) and Mowder, Cummings, and McKinney ( 2010 ) provide examples of Personal Resiliency Emotional reactivity may be viewed as pre-existing Profi les in clinical and juvenile detention vulnerability, arousal, or threshold of tolerance to populations. stimulation prior to the occurrence of adverse events or circumstances. Relative reactivity may have physiological bases, such as temperament, Resource and Vulnerability Indexes genetic predisposition, learning disability, physical impairment, or congenital anomaly. Siegel ( 1999 ) The need to condense information for the pur- proposed a conceptual framework of self-regula- pose of initial screening led to the development tion in which he identifi ed some basic components: of the Resource and Vulnerability Indexes. The regulation of intensity, sensitivity, speci fi city, Indexes are not intended to replace the informa- windows of tolerance, recovery, access to con- tion provided by the Resiliency Scales and/or the sciousness, and external expression. The Sensitivity Resiliency Pro fi le, as these provide rich informa- subscale assesses how easily upset or triggered the tion with which to develop intervention strategies child is and the intensity of the reaction. The for children and adolescents. The indexes are Recovery subscale is designed to assess the per- meant to identify students in universal preventive ceived time it takes for emotionality to dissipate. screening for additional monitoring or for proac- The Impairment subscale measures the degree to tive intervention (see Prince-Embury, 2010a, which a child’s emotional reactivity overwhelms 2010b for more information). his or her capacity to function effectively. In this way, the Emotional Reactivity Scale refl ects the extent to which the youth experiences him or her- The Resource Index self as maintaining an even keel when emotionally aroused. The Resource Index takes into consideration both the individual’s Sense of Mastery and Sense of Relatedness Scale scores. Although these core Personal Resiliency Profi les dimensions of resiliency have distinct developmental pathways, these are highly inter-related. Scholars now underscore the need to consider the Therefore, for screening purposes, combining unique pro fi les and associated intervention needs assessment of these qualities is an expedient way of youth (Luthar, 2006a, 2006b; Luthar & Zelazo, of summarizing the positive strengths available to 2003 ; Zucker, Wong, Puttler, & Fitzgerald, 2003 ) . the individual. The Resource Index score is the The second phase of the development of the standardized mean of the sum of the Sense of RSCA included an examination of the relation- Mastery and Sense of Relatedness Scale scores. ship between the three core constructs of the model underlying the RSCA. The three global resiliency scales, converted to a common metric, The Vulnerability Index may be plotted together to form a unique Resiliency Pro fi le for each child or adolescent. Personal vulnerability is quantifi ed and estimated This Resiliency Pro fi le allows the user to see the by the discrepancy between the youth’s Emotional youth’s relative strengths and vulnerability at a Reactivity Scale score and his or her Resource given point in time. The Resiliency Pro fi le also Index score described above. The Vulnerability 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 279

Index is consistent with a notion of resiliency as is good for the Index and global scale scores. having personal resources which match or exceed As expected, adolescents evidenced more con- one’s emotional reactivity, and vulnerability as sistency over time than children (for more detailed having personal resources which are signiﬁ cantly information on RSCA reliability, see Prince- below one’s level of emotional reactivity. Embury, 2007 ) .

Reliability Evidence Developmental Consistency of Constructs Cicchetti ( 1994 ) suggests that coef fi cient alphas at or above 0.70 are adequate, at or above 0.80 Although the Resiliency Scales were originally are good, and at or above 0.90 are excellent. developed and normed for use with adolescents Alphas of 0.90 are thought of as adequate for (Prince-Embury, 2006b) , they were designed at a tracking individual scores over time. Alphas of third-grade reading level so that the same instru- 0.80 or more are considered adequate for track- ment could be used across a wide age range ing group scores over time. Using these criteria, extending from childhood through adolescence. reliability evidence was excellent for the RSCA Before extending the scales downward, the ques- Index Scores, good for the three global scale tion of whether the core constructs salient for scores, and adequate for most subscales (see adolescents would be the same for younger chil- RSCA technical manual for details, Prince- dren was considered. At different ages and devel- Embury, 2007) . The RSCA index and global opmental levels, optimism, self-effi cacy, mastery, scale scores show good or excellent internal con- and personal competencies may be exhibited dif- sistency across age and gender groups and, as ferently. Preschoolers may reveal these strengths expected, greater internal consistency was evi- in their play, whereas elementary-school-age denced with increased age (Prince-Embury). For children may do so verbally, and adolescents may children aged 9–11, the RSCA Index scores and do so cognitively, leaving parents to witness only the Emotional Reactivity Scale score meet the the outcome. Preliminary analysis examined the criterion of alpha >0.90 for individual-level developmental consistency of the core constructs tracking. The Sense of Mastery and Sense of underlying the Resiliency Scales on two levels. Relatedness Scale scores meet the criterion of The more global level of analysis confi rmed that alpha >0.80 for group level tracking. For children the three-factor structure was a better fi t than a aged 12–14, the RSCA Index scores and all three one or two factor structure across the entire nor- global scores meet the criterion for individual- mative sample 9–18 (Prince-Embury, 2007 ; level tracking. Six of the RSCA subscales met the Prince-Embury & Courville, 2008a ) . The second criterion for group-level tracking. For youth aged level of analysis examined measurement invari- 15–18, both Index scores, three global scale ance of the three-factor structure across age band. scores, and three subscale scores meet the crite- Prince-Embury and Courville ( 2008b ) found rion for individual-level tracking. All scores meet support for measurement invariance of this the criterion for group-level tracking. Hence, the three-factor structure across three age bands. RSCA demonstrates good to excellent internal consistency, supporting the empirical derivation of the scale, subscales, and indices. Validity Evidence

Protective Factors: Self-Concept Test–Retest Reliability Construct validity evidence for the RSCA as a Most RSCA scales have at least adequate test– measure of resiliency may be explored in the rela- retest consistency across 2 weeks for both the tionship between RSCA scores and measures of child and adolescent sample. Test–retest reliability related protective factors. Previous theorists have 280 S. Prince-Embury suggested that resiliency is associated with examined by the Inventory of Parent and Peer positive self-concept or self-esteem (see Rutter, Attachment (IPPA; Armsten & Greenberg, 1987 ) . Luthar, & Brooks). Research by Dumont and The IPPA was developed in order to assess the Provost ( 1999) and others have previously pro- adolescents’ perceptions of the positive and vided support for this assumption. Prince-Embury negative affective/cognitive dimensions of rela- ( 2007 ) described the relationship between the tionships with the parents. Three broad dimen- positive Self-Concept score of the Beck Youth sions are assessed: degree of mutual trust, quality Inventory—Second Edition (BYI-II) (Beck, Beck, of communication, and extent of anger and Jolly, & Steer, 2005 ) and the RSCA protective factor alienation. The overall attachment score com- scores for children and adolescents. Signi fi cant bines these three. One study of 157 adolescents positive correlations were found between a positive attending high school in a low socio-economic BYI-II Self-Concept score (Beck et al.) and the area of Connecticut correlated overall attachment RSCA Resource Index (0.78, 0.79), Sense of scores for mother and father with RSCA Index Mastery (0.74, 0.80), and Sense of Relatedness and global scale scores (Luthar, 2006b ) . The (0.70, 0.70) Scale scores for child and adolescent overall attachment score with mother was groups, suggesting convergent validity for these signi fi cantly and positively correlated with the scores as refl ective of protective factors. The RSCA RSCA Resource Index Score (0.52), Sense of Self-Ef fi cacy subscale was most signi fi cantly Mastery Scale score (0.48), and Sense of related to positive self-concept for both children Relatedness Scale score (0.50). The overall (0.75) and adolescents (0.77) supporting the idea attachment with father was related to a lesser that self-effi cacy is an important aspect of resil- extent to the three RSCA protective scores (0.36, iency as well as positive self-concept. 0.29, and 0.33). Moderate convergent construct The relationship between personal resiliency validity was provided by the positive and and positive self-concept was explored in a sepa- signifi cant relationships between RSCA protective rate study using the Pier-Harris Children’s Self- scores and mother and father attachment scores. Concept Scale, Second Edition (Piers-Harris 2; Correlations between the Sense of Relatedness Piers, 2002 ) (Prince-Embury, 2007 ) . The RSCA Scale scores and attachment scores are slightly Sense of Mastery, Sense of Relatedness Scale, but not signi fi cantly higher than those between and Resource Index scores were positively corre- Sense of Mastery scores and attachment. The lated with the Pier Harris 2 Total Score (0.60, Resource Index Score correlates most strongly 0.55, 0.59). The Behavior Adjustment Domain with parental attachment suggesting that com- subscale of the Piers Harris 2 was most strongly bined resources are most related to strength of related to the RSCA scores (0.70, 0.61, 0.69). The parent attachment. RSCA subscale most strongly correlated with Piers Harris 2 Total and Domain scores was the Optimism subscale of the Sense of Mastery Scale. Vulnerability, Emotional Reactivity In summary, these fi ndings suggest that positive and Measures of Negative Affect, self-concept is strongly related to but not identical and Behavior to the Sense of Mastery Scale of the RSCA. Prince-Embury (2007, 2008) reported strong positive correlations between the Vulnerability Protective Factor: Parent Attachment Index Score and the Emotional Reactivity score and all BYI-II (Beck et al., 2005 ) scores of nega- Developmental theory has identi fi ed positive tive affect and behavior for the standardization parental attachment as a far-reaching protective sample of 200 adolescents. This sample was the factor. Construct validity of the RSCA and normative sample for both the RSCA and the the Sense of Relatedness Scale in particular may BYI-II and consisted of 100 males and 100 be explored in relation to parental attachment as females, each group strati fi ed to represent the US 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 281

Census by parent education level and race/ethnicity. Victimization Scales (Reynolds, 2004) for 47 The Vulnerability Index score had signifi cant children aged 9–14 suggested some gender positive correlations with the BYI-II scores; 0.65 differences between the relationship of these with Anxiety, 0.66 with Disruptive Behavior, behaviors with vulnerability and resources in 0.75 with Depression, and 0.77 with Anger. children (see Prince-Embury, 2007 ) . For boys, Similarly, high positive correlations were found the Vulnerability Index and Emotional Reactivity between the Emotional Reactivity Scale score Scale score were signi fi cantly positively related and scores on all BYI-II scores; 0.65 with to self-reported bullying (0.60, 60) and victim- Anxiety, 0.67 with Disruptive Behavior, 0.74 ization (0.54, 0.45). Resource Index scores were with Depression, and 0.76 with Anger. These less signi fi cantly related to bullying (−0.21 to fi ndings support the hypothesis that a high degree −0.38) and victimization (0.02 to −0.21) for of emotional reactivity is associated with nega- boys. For girls, on the other hand, a lower tive affect and behavior. It might be noted that the Resource Index score was most signi fi cantly Vulnerability Index score and the Emotional related to both bullying and victimization. For Reactivity Scale scores correlate with BYI-II girls, the Resource Index, Sense of Mastery, and scores across affective domains in adolescents Sense of Relatedness Scale scores were nega- and are not limited to any one affective domain tively correlated with self-reported bullying and although depression and anger showed the victimization in the following manner: (Resource strongest correlations. There are also high nega- Index, −0.75, −0.57), (Sense of Mastery, −0.77, tive correlations between the Resource Index −0.44), and (Sense of Relatedness, −0.63, −0.61). score and the BYI-II scores: −0.51 with Disruptive Emotional Reactivity was less related to bullying Behavior, −0.53 with Anxiety, −0.61 with and victimization for girls (0.26, 0.08). It must Depression, and −0.62 with Anger. Similarly, be noted that these results are preliminary and high negative correlations were found between should be replicated and expanded upon in larger the Sense of Mastery (−0.51 to −0.61) and the studies of bullying and victimization. However, Sense of Relatedness (−0.45 to −0.57) Scales and if replicated these results would suggest that all BYI-II scores of negative affect and behavior. bullying is related to aspects of personal resil- Similar results were found in correlational iency and that prevention programs might differ studies of the RSCA with other assessments of for males and females. Interventions might focus problem behaviors such as the Connors more on managing emotional reactivity for males Adolescent Symptom Scale (CASS; Conners, and on enhancing sense of mastery and related- 1997 ) (see Prince-Embury, 2007 ) . In a sample of ness for females. 89 children aged 9–14, conduct problems as assessed by the CASS were positively correlated with the RSCA Vulnerability Index score (0.62) Personal Resiliency and Risk Behavior and the Emotional Reactivity Scale score (0.59). Conversely, the CASS conduct problems score A normative adolescent sample of 100 males was negatively correlated with the RSCA and 100 females, aged 15–18, responded to the Resource Index (−0.56), the Sense of Mastery Adolescent Risk Behavior Inventory (ARBS; Scale score (−0.51), and the Sense of Relatedness Prince-Embury, 2006b ) which consists of item Scale score (−0.57). clusters tapping frequency of alcohol and drug abuse, sexual behavior, self-harm ideation, and sensation seeking, as well as completing the Personal Resiliency, Bullying, RSCA (Prince-Embury, 2006a , unpublished and Victimization study). The sample which comprised the normative adolescent sample for the RSCA was A study correlating RSCA scores with bullying strati fi ed by race/ethnicity and parent education and victimization scores of the Reynolds Bully level within gender and age (see Prince-Embury, 282 S. Prince-Embury

2007, for details of the sample). The results for females and male adolescents were the follow- Personal Resiliency Profi les ing: Emotional Reactivity was positively correlated with self-reported frequency of substance The RSCA Personal Resiliency Pro fi le employs use (0.51), sexual behavior (0.42), self-harm scores on the three global scales, Sense of ideation (0.67), and sensation seeking (0.33). Mastery, Sense of Relatedness, and Emotional Sense of Relatedness was negatively correlated Reactivity, to be charted with respect to each with frequency of substance use (−0.40), sexual other for the purpose of graphically displaying behavior (−0.29), self-harm ideation (−0.53), the relative strengths and vulnerabilities of and sensation seeking (−0.24). Sense of Mastery individuals or groups of individuals. Personal was negatively correlated with frequency of Resiliency Profi les have been described for nor- substance use (−0.40), sexual behavior (−0.22), mative samples (Prince-Embury & Steer, 2010 ) , self-harm ideation (−0.53), and sensation sek- clinical samples (Kumar et al., 2010 ; Prince- ing (−0.19). Correlations above 0.30 were Embury, 2007) , and youth in juvenile detention signi fi cant at the p < 0.001 level and correlations (Mowder et al., 2010 ) . above 0.20 were signi fi cant at the p < 0.05 level. Characteristic Personal Resiliency Profi les in These fi ndings suggest that higher Emotional the RSCA standardization sample were identifi ed Reactivity is related to higher frequency of risk using cluster analysis, a statistical technique for behavior and ideation in non-clinical adoles- summarizing the variability of profi les into cents. This was particularly true for ideation of profi les that most characterize the sample (Prince- self-harm and use of drugs or alcohol. The pro- Embury & Steer, 2010 ) . This method produced tective factors of Sense of Relatedness and three Personal Resiliency Pro fi les that most char- Sense of Mastery have modest relationships acterize the normative sample of children and with lower frequency of risk behavior, particu- adolescents. These profi les are displayed in larly use of drugs or alcohol. These fi ndings Fig. 16.1. Profi le A suggesting High Resiliency support the relevance of aspects of personal represents 31% of the normative samples and is resiliency to behaviors of concern among ado- characterized by high Sense of Mastery and Sense lescents and the relevance of screening for resil- of Relatedness along with a low Emotional iency and vulnerability among non-clinical Reactivity Scale score. Profi le B suggesting samples. Adequate Resiliency represents 44% of the normative samples and is characterized by all three global scale scores in the average range. Profi le C Evidence of Criterion Group suggesting High Vulnerability represented 25% Differences of the normative samples and is characterized by low mean Sense of Mastery and Sense of Prince-Embury ( 2007 ) reported signifi cant differ- Relatedness Scale scores along with a high mean ences between mean scores of clinical groups Emotional Reactivity Scale Score. These three and matched control groups for children and Personal Resiliency Profi les lend support to adolescents across several diagnostic groupings. Masten’s concept of resiliency as “ordinary The non-clinical groups scored consistently magic.” In that 75% of the normative samples higher on the Resource Index score, Sense of would have at least adequate resources to handle Mastery, Sense of Relatedness Scales, and sub- most of life’s ordinary adversities. The extent to scales. The clinical samples scored consistently which a high resiliency pro fi le is an advantage higher on the Vulnerability Index, Emotional remains a question to be examined in future Reactivity Scale, and subscale scores. Effect research. The 25% of the normative samples sizes were large for all differences (see Prince- characterized by Low Resiliency have Personal Embury, 2007 for details). Resiliency Profi les similar to those of clinical 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 283

Fig. 16.1 Pro fi les of personal resiliency in a 65 normative sample, n = 641 (Prince-Embury & 60 Steer, 2010 ) 55 50 45 40 T Score A 35 B 30 C 25 20 Sense of Mastery Sense of Emotional Relatedness Reactivity Scales samples studies although these individuals were Emotional Reactivity Scale for adolescents undiagnosed at the time of testing. We may specu- diagnosed with clinical disorders. The Depressive late that these youth with Low Resiliency Pro fi les Disorder, Anxiety Disorder, Conduct Disorder, are symptom free because they have not encoun- and Bipolar Disorder groups scored below aver- tered suf fi cient adversity to precipitate the emer- age or low on the Sense of Mastery and Sense of gence of symptoms. On the other hand, it may be Relatedness Scales. These groups scored in the that this 25% of the normative samples are symp- above average or high range for the Emotional tomatic but undiagnosed. Preventive screening Reactivity Scale. The Nonspecifi c group, which using the RSCA would potentially identify those had been in treatment and/or on medication for youth with Low Resiliency for preventive psycho- over a month, indicated a profi le that was within social intervention. the average range unlike the other clinical groups but still distinct from the nonclinical sample. This group manifested Sense of Mastery and Sense of Resiliency Profi les of Adolescent Relatedness Scale scores in the low average range Clinical Disorder Groups and Emotional Reactivity in the high average range. In summary, the adolescent clinical disor- Figure 16.2 displays Resiliency Profi les for fi ve der groups have a tendency to report low Sense of adolescent clinical groups and the nonclinical Mastery and Sense of Relatedness, on one hand, adolescent sample based on the mean T scores for and high Emotional Reactivity, on the other, rela- the Sense of Mastery, Sense of Relatedness, and tive to the nonclinical samples. Differences in the Emotional Reactivity scales for each diagnostic shape of the profi les are also notable. The shape group (see technical manual for description of of the Resiliency Pro fi le of the nonclinical sam- samples, Prince-Embury, 2007 ) . As anticipated, ples is fl at and in the average range. In contrast, the pro fi le for the nonclinical group is relatively the pro fi les of the clinical groups have reverse fl at with mean T scores close to 50 on all three slopes or elbow shapes with similar reports of scales. This profi le is similar to Profi le B in Sense of Mastery and Sense of Relatedness, and Fig. 16.1 characterizing 44% of the normative a large discrepancy between these strength scores samples. In contrast, the pro fi les for the clinical and an elevated Emotional Reactivity Scale score. groups slope up to the right on the chart. This The shape of the clinical Resiliency Pro fi les profi le is due to characteristically low scores on is consistent with the construction of the the Sense of Mastery and Sense of Relatedness Vulnerability Index as the discrepancy between Scales and characteristically high scores on personal resources and emotional reactivity. 284 S. Prince-Embury

Fig. 16.2 Pro ﬁ les of personal resiliency in adolescent clinical and non-clinical samples (reprinted Table 3.2 on page 29 of the RSCA Manual, Prince-Embury, 2007 )

outpatient setting. Also illustrated is use of the Preventive Screening Using the RSCA RSCA to assess treatment outcome with respect Index Scores to changes in general and specifi c strengths and vulnerabilities. The relationships between the three global RSCA Figure 16.3 displays the RSCA Personal scores illustrated in the profi les in Figs. 16.1 and Resiliency Pro fi le and Index Scores for Ellen, a 16.2 above may be quantifi ed and expressed in the 17-year-old girl, at her initial therapy session. On two Index scores described earlier in this chapter. the right-hand side of the chart, we see that The Resource Index combines the Sense of Ellen’s Vulnerability Index score is extremely Mastery and Sense of Relatedness Scale scores. high ( T80) and her Resource Index score is The Vulnerability Index score quantifi es the differ- extremely low ( T26). On the left-hand side of the ence between the Emotional Reactivity scale score chart, Ellen’s Emotional Reactivity Scale score is and the Resource Index score. As illustrated in extremely high (T 80) and her Sense of Mastery Fig. 16.2, the graphic presentation of the resiliency ( T30) and Sense of Relatedness Scale score (T 25) profi le allows us to view this discrepancy across are both extremely low. This pro fi le expresses clinical groups. Validity evidence discussed earlier severe vulnerability and was in fact accompanied in this chapter suggests that the Vulnerability Index by subjectively reported distress and extremely is correlated with negative affect and discriminates elevated scores on various symptom measures. signifi cantly between clinical and non-clinical This protocol called for referral for psychiatric samples (Prince-Embury, 2007, 2008 ) . Therefore, and medication consultation and ruling out the preventive screening may use the Vulnerability possible need for hospitalization. From a treat- Index to identify students who may be at risk for ment planning perspective, this protocol indi- developing clinical symptoms and other dif fi culties cated a need to reduce Emotional Reactivity before the emergence of disabling symptoms. followed by interventions to increase Sense of Students who have Vulnerability Index T -scores in Relatedness and Sense of Mastery. Examination the high ranges (T 60 or above) may be screened of subscale scores discussed below elaborates on for further examination. See Prince-Embury the issues indicated above in Ellen’s pro fi le. (2010a, 2010b ) for additional information on use Ellen’s subscale scores on the Emotional of the RSCA in preventive screening. Reactivity Scale were the following: Sensitivity (17), Recovery (14), and Impairment (20) based on a scale of 1–19 with a mean of 10 and standard A Clinical Case Study deviation of 3. These subscale scores are consistent with parent reports that Ellen had shown Below is an example of how the RSCA may be Impairment as poor judgment in her behavior by used to assess a youth’s relative strengths and skipping school, driving without a license, and vulnerabilities as a guide for treatment in an other risk-taking behaviors. She manifested high 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 285

Fig. 16.3 Ellen’s Personal Resilency Profile Index Scores Resiliency Pro ﬁ le and Index Scores, 80 80 80 80 January 2010 75 75 70 70 65 65 60 60 55 55 50 50 45 45 40 40 35 35 30 30 30 25 25 25 26 20 20 MAS REL REA RES VUL

REA Subscale REL Subscales MAS Subscales 19 19 19 18 18 18 17 17 17 16 16 16 15 15 15 14 14 14 13 13 13 12 12 12 11 11 11 10 10 10 9 9 9 8 8 8 7 7 7 6 6 6 5 5 5 4 4 4 3 3 3 2 2 2 1 1 1 Optim Self-Effic Adaptab Sense Recov Impair Turst Support Comfort Toleran

Fig. 16.4 Ellen’s subscale scores at ﬁ rst session in January 2010

Sensitivity in reaction to her parents and any Ellen’s subscale scores on the Sense of Mastery attempts to restrict her behavior. This extreme Scale were the following: Optimism (4), Self- Emotional Reactivity was dealt with by explain- ef fi cacy (5), and Adaptability (5). These subscale ing emotional reactivity to Ellen and her parents scores were consistent with the fact that Ellen who and discussing ways to control it using time outs was customarily a good student had begun doing and avoiding trigger events. Speci fi c attention poorly recently. Discussion with Ellen’s family was paid to illustrating the role of emotional who emphasized good grades focused on the need reactivity in impairing Ellen’s functioning. This to help Ellen lower her emotional reactivity and was important in helping the family understand experience more support as necessary in order to that not all of Ellen’s behaviors were informed by help her improve her functioning. Item level rational choice. Referral for medication evalua- examination of Ellen’s Adaptability score indi- tion was also initiated (Fig. 16.4 ). cated that she did not ask others for help or accept Ellen’s subscale scores on the Sense of help when offered. Exploration of these themes Relatedness Scale were the following: Trust (6), revealed that there was a perceived culture of self- Support (0), Comfort (7), and Tolerance (3). reliance within the family within which asking for These subscale scores underlined the con fl ict help was viewed as weakness. Family sessions and lack of support experience by Ellen in rela- focused on disputing and changing this family tion to her parents. Discussion of these scores culture. Subsequent therapy sessions and main- led to discussion of ways that Ellen’s parents tained medication regime for depression and mood could communicate more support to her. It was stabilization were aimed at controlling emotional noted that Ellen’s comfort with others was a reactivity. Therapy and increasing support led to strength which was manifested in the fact that improvement over a 3-month period. Ellen’s she had several friends. RSCA Profi les 3 months later are shown below. 286 S. Prince-Embury

Fig. 16.5 Ellen’s Personal Index Scores Resiliency Pro ﬁ le and Index Scores, Resilency Profile 80 80 April 2010 75 75 70 70 65 65 60 60 55 55 52 52 52 50 50 48 45 44 45 40 40 35 35 30 30 25 25 20 20 MAS REL REA RES VUL

REA Subscale REL Subscale MAS Subscale 19 19 19 18 18 18 17 17 17 16 16 16 15 15 15 14 14 14 13 13 13 12 12 12 11 11 11 10 10 10 9 9 9 8 8 8 7 7 7 6 6 6 5 5 5 4 4 4 3 3 3 2 2 2 1 1 1 Optim Self-Effic Adaptab Sens Recov Impair Trust Support Comfort Toleran

Fig. 16.6 Ellen’s subscale scores at ﬁ rst session in April 2010

Ellen’s Personal Resiliency Pro fi le and Index understanding of the Emotional Reactivity scores in April after 3 months of therapy indicate concept helped her to understand the potentially positive change with decreased overall impairing effect of uncontrolled reactivity, and Vulnerability (T 52) and Emotional Reactivity the importance of compliance to her medication ( T 52) to within the average range. Also shown regime. In addition, repeated emphasis on the are increases in Sense of Mastery (T 52) to the importance of communication in the family ses- average range and increase in Sense of Relatedness sions was needed as the family tended to return to ( T44) to slightly below average. Subscale scores more familiar patterns of non-communication. In indicate more detail about these more global this case, achieving adequate personal resiliency changes (Fig. 16.5 ). in order to support adequate functioning was the Ellen’s subscale scores when tested in April after goal of therapy . 3 months of therapy were all in the average range (Fig. 16.6 ). The lowering of Ellen’s Emotional Reactivity Scale score with the aid of medication Conclusion helped relieve her distress and helped her to regain academic functioning. Therapy sessions In summary, this chapter has presented the helped to improve communication within the Resiliency Scales for Children and Adolescents family which in turn increased Ellen’s Sense of as an assessment tool designed to tap core devel- Support. It should be noted that Ellen’s func- opmental processes underlying personal resiliency tioning in the average range was supported as experienced by children and adolescents and by continued medication to help her in control- expressed in their own words. Reference has been ling her Emotional Reactivity. Ellen’s increased made to three major bodies of theory and literature 16 The Resiliency Scales for Children and Adolescents: Constructs, Research and Clinical Application 287 related to the three global scales of the RSCA Bandura, A. (1997). Self-ef fi cacy: The exercise of control . although a thorough review of this literature New York: Freeman. Bandura, A., & Schunk, D. H. (1981). Cultivating compe- would be beyond the scope of this chapter. tence, self-effi cacy, and intrinsic interest through Reliability and validity evidence for the RSCA proximal self-motivation. Journal of Personality and have been referenced although a more extensive Social Psychology, 41 (3), 586–598. understanding of this work may be found in the Barrera, M. (1986). Distinction between social support concepts, measures and models. 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Part V Resilience in the Clinical and School Settings Resilience and Positive Youth Development: A Relational 1 7 Developmental Systems Model

Richard M. Lerner , Jennifer P. Agans , Miriam R. Arbeit , Paul A. Chase , Michelle B. Weiner , Kristina L. Schmid, and Amy Eva Alberts Warren

Adolescents are not resilient. Resilience is also student–teacher ratios involving engaged students not a functional feature of the ecology of adoles- and high quality institutions; and access to com- cent development (e.g., as may be represented by petent, caring, and committed mentors in out-of- the concept of “protective factors”). Rather, resil- school-time [OST] youth development programs, ience is a concept denoting that the relationship respectively). between an adolescent and his or her ecology has Resilience is, then, a dynamic attribute of a adaptive signifi cance. That is, the relationship relationship between an individual adolescent involves a fi t between characteristics of an indi- and his or her multilevel and integrated (rela- vidual youth and features of his or her ecology tional) developmental system. We represent this that re fl ects either adjustment (change) in the face mutually in fl uential relation between a youth and of altered or new environmental threats, chal- the context as individual ¬® context relations. lenges, or “processes,” or constancy or mainte- In our view, the process of individual ¬® nance of appropriate or healthy functioning in the context relations involved in resilience is not dis- face of environmental variations in the resources tinct from the relations involved in human func- needed for appropriate or healthy functioning. As tioning in general. What is distinct, however, is such, the individual–context relationship summa- that exchanges involving resilience are located at rized by the term “resilience” re fl ects individual a portion of a theoretical probability distribution well-being at a given point in time, and thriving of these relations that may be described as involv- across the adolescent period, in the face of fea- ing nonnormative levels of risk or high levels of tures within the ecological context that challenge adversity (see Fig. 17.1 ). In short, the process we adaptation. In turn, this relationship also implies study in seeking to understand resilience differs that, for the ecology or context, there are actions from the other instances of individual ¬® that could maintain or further the quality of its context relations only in regard to location in this structure (e.g., the family, schools, or community distribution. 1 programs for youth development) or its function Accordingly, since resilience is not a charac- in the service of supporting healthy adolescent teristic of either component of the individual behavior and development (e.g., parenting that refl ects warmth and appropriate monitoring; low 1 Clearly, the translation of this theoretical probability distribution into empirical reality will vary in relation to individuals across the course of adolescence, as well as in R. M. Lerner () • J. P. Agans • M. R. Arbeit • P. A. Chase relation to group differences and diverse contexts. In • M. B. Weiner • K. L. Schmid • A. E. A. Warren short, there is intraindividual variability, and between- Tufts University , Medford , MA , USA group differences in intraindividual changes in the empiri- e-mail: [email protected] cal probability distribution pertinent to resilience.

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 293 DOI 10.1007/978-1-4614-3661-4_17, © Springer Science+Business Media New York 2013 294 R.M. Lerner et al.

This discussion will afford speci ﬁ cation of the dynamic, relational character of resilience.

The Developing Context of the Concept of Development Resilience Low Moderate High Developmental psychology has been transformed Continuum of Risk/Adversity into developmental science. As richly illustrated by the chapters across the four volumes of the Fig. 17.1 Theoretical probability distribution of instances Handbook of Child Psychology, 6th edition of adaptive individual ¬® context relations in the face of differing levels of risk and adversity (Damon & Lerner, 2006 ) , as well as in other major publications in the fi eld (e.g., Bornstein & Lamb, 2010; Lamb & Freund, 2010 ; Lerner, Easterbrooks, & Mistry, in preparation; Overton, ¬®context relationship (i.e., resilience is not 2010 ) , the study of human development has an attribute of the adolescent or of the context), evolved from being either a psychogenic or a bio- it should be studied within a nonreductionist genic approach to conceptualizing and studying theoretical frame and through the use of the life span, to a multidisciplinary approach that change- sensitive and multilevel (and hence seeks to integrate variables from biological multivariate) developmental methods, includ- through cultural and historical levels of organiza- ing longitudinal designs that involve measure- tion into a synthetic, coactional system (Elder, ment models that are sensitive to change and 1998; Gottlieb, 1997, 1998; Hood, Halpern, diversity (e.g., Collins, 2006; Lerner, Schwartz, Greenberg, & Lerner, 2010 ) . As such, reduction- & Phelps, 2009a ; Little, Card, Preacher, & ist accounts of development that adhere to a McConnell, 2009 ) . To approach the conceptu- Cartesian dualism, and that pull apart facets of alization, study, and measurement of resilience the integrated developmental system, are rejected in this manner entails the use of contemporary by proponents of relational, developmental sys- relational developmental systems theoretical tems theories (Mistry, 2011 ; Mistry & Wu, 2010 ; models of human development, which— Overton, 2010 ) . These reductionist views typi- today—are at the cutting-edge of developmen- cally raise as key developmental issues such split tal science (e.g., Lerner, 2012 ; Overton, 2006, formulations as nature vs. nurture, continuity vs. 2010 ; Overton & Mueller, in press). discontinuity, stability vs. instability, or basic vs. Indeed, the scientifi c study of resilience within applied. the developmental system is an excellent sample We eschew such thinking. In turn, we favor case of the utility of such theoretical models as post-postmodern, relational models stressing the frames with which to elucidate the basic, rela- integration of different levels of organization as a tional processes of adolescent development and, means to understand and to study life-span human as well, for the application of developmental sci- development (Overton, 2010 ; Overton & Mueller, ence to promote positive youth development in press). Thus, as exemplifi ed by the focus of (PYD; Lerner, 2006 ; Masten, 2009 ; Masten & inquiry in the contemporary study of resilience, Obradović, 2006 ; Wachs, 2006 ; see, too, Lerner, the conceptual emphasis of relational develop- Weiner, Arbeit, Chase, Agans, Schmid, Warren, mental systems theory is placed on the nature of 2012 ). Accordingly, to understand the nature and mutually in fl uential individual ¬® context rela- signifi cance of basic and applied facets of the tions, that is, the focus is on the “rules,” the pro- developmental science of adolescence to the cesses that govern exchanges between individuals study of resilience, it is useful to specify the fea- and their contexts. Brandtstädter ( 1998 ) terms tures of current developmental systems models. these relations “developmental regulations” and 17 Resilience and Positive Youth Development: A Relational Developmental Systems Model 295 notes that where developmental regulations between youth and settings. With this stance, involve mutually benefi cial individual ¬® con- diversity becomes the necessary subject of inquiry text relations, they constitute adaptive develop- in developmental science, and in the study of mental regulations. As suggested earlier, we resilience. believe that adaptive developmental regulations We defi ne resilience here as relations refl ecting are the essence of resilience. Table 17.1 summa- the maintenance or enhancement of links that are rizes the set of de fi ning features of relational mutually bene fi cial to individual youth and con- developmental systems models. texts.2 In order to understand the bases of and, in The combined ideas presented in the table sug- turn, to promote individual ¬® context relations gest that the possibility of adaptive developmental that may be characterized as resilient among relations between adolescents and their contexts, diverse youth, scholars must ask a complex, multi- and the potential plasticity of human development part question. They must ascertain: what funda- that is a defi ning feature of ontogenetic change mental attributes of individual youth (e.g., what within the relational developmental system, are features of cognition, motivation, emotion, abil- distinctive features of this approach to youth ity, physiology, or temperament); among adoles- development. As well, the core features of rela- cents of what status attributes (e.g., youth at what tional developmental systems models—including portions of the adolescent period, and of what integration and mutual infl uence of levels of sex, race, ethnic, religious, geographic location, organization, plasticity, and diversity—provide a etc. characteristics); in relation to what charac- rationale for making a set of methodological teristics of the context (e.g., under what conditions choices that differ in design, measurement, sam- of the family, the neighborhood, social policy, the pling, and data analytic techniques from selec- economy, or history); are likely to be associated tions made by researchers using split or reductionist with what facets of adaptive functioning, or PYD approaches to developmental science (Overton, (e.g., maintenance of health and of active, positive 2010 ) . For example, the emphasis on how the contributions to family, community, and civil individual acts on the context to contribute to society)? the plastic relations within it fosters an interest Addressing such a set of interrelated questions in person-centered (as compared to variable- requires, at the least, a systematic program of centered) approaches to the study of human research. Nevertheless, the linkage between the development. ideas of plasticity and diversity that gave rise to Adding to the complexity of the study of this set of questions provides a rationale for human development is the fact that the array of extending relational developmental systems individual and contextual variables involved in thinking to an optimistic view of the potential to person–context relations constitutes a virtually apply developmental science to promote individ- open set. Estimates are that the odds of two ual ¬® context exchanges that may re fl ect and/ genetically identical genotypes arising in the or promote health and positive, successful youth human population is about 1 in 6.3 billion, and development; in other words, that may re fl ect each of these potential human genotypes may be resilience. Accordingly, employing a relational coupled across life with an even larger number of developmental systems frame for the application life course trajectories of social experiences of developmental science affords a basis for forg- (Hirsch, 2004 ) . Thus, the number of human phe- ing a new, strength-based vision of and vocabu- notypes that can exist is fundamentally equiva- lary for the nature of youth development and for lent to infi nity, and the diversity of development specifying the set of individual and ecological becomes a prime, substantive focus for developmental science. This diversity may be approached 2 with the expectation that positive changes can be Individual actions that are not supportive of the institutions and agents of the ecology (that are acting to support promoted across all instances of variation, as a the individual) are ultimately not re fl ective of resilience consequence of health-supportive alignments and, as well, are not sustainable (Lerner, 2004 ) . 296 R.M. Lerner et al. plinary

¬® ideally, interdisci ideally, ligning the strengths (operationalized as potentials for gns, methods of observation and measurement, procedures for gns, methods of observation ns) to enhance (e.g., through social policies or community-based othetic) phenomena. The range of interindividual differences in differences othetic) phenomena. The range of interindividual tudy of diversity of fundamental substantive signi fi cance for the fi signi of fundamental substantive tudy of diversity s the life span and history. Nevertheless, the potential for plasticity Nevertheless, s the life span and history. on comprising the ecology of human development, the developmental the developmental on comprising the ecology of human development, multiple levels of the context on the individual (individual (individual on the individual of the context multiple levels may vary across time and place as a consequence of such plasticity may vary basis of the developmental process will vary at least in part across process will vary basis of the developmental ltiple disciplines. Multidisciplinary knowledge and, ltiple disciplines. Multidisciplinary knowledge f diversity f diversity es, between continuity and discontinuity, or between stability and instability. or between stability and instability. es, between continuity and discontinuity, the ecology of human development are integrated, or fused. These levels or fused. These levels are integrated, the ecology of human development viduals and of their ecologies that, together, can be arrayed to promote viduals and of their ecologies that, together, framed by a relational metamodel for human development. There is, then, a framed by a relational metamodel for human development. context relations is not limitless, and the magnitude of plasticity (the context tory. These mutually in fl uential relations may be represented generically as Level 1 uential relations may be represented generically as Level fl These mutually in tory. s among all levels of the developmental system, ranging from genes and cell physiology of the developmental s among all levels ¬® context ¬® context relations context ¬® ) context relations, are the basic unit of analysis within human development relations, are the basic unit of analysis within human development context Community) and, in the case of ontogeny may be represented as individual may be represented as individual Community) and, in the case of ontogeny 2006 ¬® ¬® De fi ning features of relational developmental systems theories systems theories ning features of relational developmental fi De Level 2 (e.g., Family 2 (e.g., Family Level : Adapted from Lerner ( ( : Adapted from Lerner range from the biological and physiological through cultural historical context)—constitute the fundamental unit of analysis in the study of the basic process of human development the fundamental unit of analysis in study basic process human development context)—constitute change trajectories of intraindividual Observed system is characterized by the potential for systematic change, plasticity. acros conditions) may vary in contextual trajectory occurring in relation to variation probability of change in a developmental constitutes a fundamental strength of all human development levels and contextual at both individual and generic (nom produced by idiographic, group differential, is systematic and lawfully and groups. This diversity individuals the s system, and makes of the plasticity developmental point in time is evidence at any change observed intraindividual and optimization of human development description, explanation, science in planned attempts (i.e., interventio across life. Through the application of developmental human development positive by a may be achieved human development trajectories, the promotion of positive programs) the character of humans’ developmental and contexts change) of individuals positive knowledge is sought. The temporal embeddedness and resulting plasticity of the developmental system requires that research desi is sought. The temporal embeddedness and resulting plasticity of the developmental knowledge of analysis trajectories of change at multiple levels and able to integrate data analysis be change-sensitive rejection of all splits between components of the ecology of human development, e.g., between nature- and nurture-based variabl rejection of all splits between components the ecology human development, system replace dichotomizations or other reductionist partitions of the developmental Systemic syntheses or integrations through individual mental and behavioral functioning to society, culture, the designed and natural ecology and, ultimately, his culture, the designed and natural ecology and, ultimately, functioning to society, mental and behavioral through individual ¬® Table 17.1 A relational metamodel systems theories are that transcends Cartesian dualism, developmental Predicated on a post-modern philosophical perspective The integration of levels of organization of organization of levels The integration within of organization Relational thinking and the rejection of Cartesian splits is associated with idea that all levels uential individual fl mutually in involves across ontogeny regulation Developmental uential connection fl occurs through mutually in of development the regulation of levels, As a consequence of the integration Integrated actions, individual actions, individual Integrated and of the on the context of actions—of the individual means that the integration regulation The character of developmental and plasticity in human development Temporality of organizati of analysis—and therefore temporality—within the levels As a consequence of the fusion historical level Plasticity is relative and constrain opportunities for change. Thus, change in individual may both facilitate regulation Developmental cance o fi signi change, and the fundamental substantive in intraindividual differences change, interindividual Intraindividual the system that provide within the developmental of organization levels across the integrated The combinations of variables human development science, and the promotion of positive Optimism, the application of developmental search for characteristics of indi an optimistic and proactive The potential for and instantiations of plasticity legitimate methodologies Multidisciplinarity and the need for change-sensitive analyses by scholars from mu system require collaborative comprising the developmental of organization levels The integrated Source 17 Resilience and Positive Youth Development: A Relational Developmental Systems Model 297 conditions that, together, may refl ect resilience. (e.g., families, schools, and communities) that The plasticity-diversity linkage within relational possess such assets, and there is abundant research developmental systems theory and method pro- supporting this idea (e.g., see Benson et al., 2006 , vides the basis for the formulation of a PYD 2011 ; for reviews). perspective, one where the potential for adoles- For instance, Theokas and Lerner (2006 ) have cent resilience is ubiquitous across this period of identi fi ed four types of ecological developmen- life (and indeed across the life span). tal assets. Other individuals constitute the ecological asset most likely to be linked to PYD (Theokas & Lerner, 2006 ). While the peers of Key Facets of a PYD Perspective adolescents represent important instances of the individuals that may serve as resources for PYD The key feature of a PYD perspective predicated (Brown & Larson, 2009 ) , across adolescence the on relational developmental systems theory is an social support provided by adults constitute a emphasis on individual strengths (e.g., the posses- major source of such developmental assets sion of relative plasticity) and the presence of (Rhodes & Lowe, 2009 ) . For example, authorita- resources within the adolescent’s ecology (termed tive parents, who provide high quantities of high “developmental assets”; Benson, Scales, Hamilton, quality time with their adolescent children & Sesma, 2006 ; Benson, Scales, & Syvertsen, (e.g., involving high monitoring and warmth; 2011 ) that, when coupled across adolescence with Bebiroğlu, 2009 ) , may foster thriving among the strengths of an individual, foster thriving (posi- them (Laursen & Collins, 2009 ) . In addition, tive and healthy functioning). Given the ubiquity of adults may serve as effective mentors of adoles- relative plasticity across the life span (Lerner, cents, particularly when they are competent, 1984 ) , the PYD perspective posits that all youth committed, and continuously present (for at least have the potential to develop more positively by 1 year; Rhodes, 2002 ) . Teachers or coaches can enhancing adaptive (mutually bene fi cial) develop- also enhance, of course, the academic and extra- mental regulations. We emphasize here that resil- curricular behavior and development of students ience is, in fact, adaptive developmental regulation. (Elmore, 2009 ) , and spiritual leaders or guides From a relational developmental systems perspec- can promote senses of mattering and meaning in tive, all adolescents have the potential to be in rela- the lives of youth (King, Carr, & Boitor, 2011 ; tions with their context that re fl ect resilience. The Oman, Flinders, & Thoresen, 2008 ) . goal of the developmental science of adolescence Three additional developmental asset catego- is, then, to identify the individual and ecological ries were identi fi ed by Theokas and Lerner conditions that refl ect resilience and to then apply ( 2006) . They pointed to institutions (e.g., librar- this information in ways that optimize the chances ies, parks, or community-based OST programs); that diverse youth will manifest these adaptive to opportunities for interpersonal interaction and developmental regulations. collaboration (e.g., as in community programs As implied in an earlier discussion of our involving adults and youth working together on defi nition of resilience, of relational developmen- food drives or in soup kitchens); and to accessi- tal systems theory, and of adaptive developmen- bility (e.g., local OST programs for youth, or the tal regulations, such mutually benefi cial individual availability of transportation to reach recreational ¬® context relations occur when the strengths activities or facilities). of youth are aligned with those resources (the Accordingly, within the PYD perspective, as developmental assets) present in the ecology of well as within relational developmental systems adolescent development that maximize the prob- models that give rise to this view of human ability that the individual’s strengths are linked to development, the ubiquity of both human instances of positive functioning or healthy devel- strengths and contextual developmental assets opmental outcomes. A key idea within the PYD means that both adolescents and their ecolo- perspective is that youth are embedded in contexts gies are active contributors to the developmen- 298 R.M. Lerner et al. tal process and to the possible promotion of the actions required for turning life goals into healthy youth development. Resilience is likely reality, that is, into successful personal adjustment to occur when individual youth possess the and ecological adaptation (Baltes, 1997 ; Baltes, capacities, or skills, to align themselves with Lindenberger, & Staudinger, 2006) . These adap- developmental assets in the face of individual tive tasks—developing links between thinking ¬® context relations that vary from normative and action in the service of adaptation—must or expected exchanges between the adolescent occur in the face of a changing body (associated and his or her ecology and that may be marked with pubertal maturation; Susman & Dorn, 2009 ) by atypical levels of risk or high levels of adver- and a changing world. During adolescence, these sity. Considerable research has identi fi ed the individual and ecological changes may necessi- individual contributors to adaptive individual tate a rapidly evolving developmental trajectory. ¬® context relations that enhance the likeli- Such trajectories involve changing neurological, hood of resilience. This research pertains to the cognitive, emotional, somatic, and behavioral topic of self-regulation (e.g., Geldhof, Little, & characteristics that evolve in relation to normative Colombo, 2010 ; Lerner et al., in press; and often nonnormative changes in key contexts McClelland, Ponitz, Messersmith, & Tominey, of life, including families, peer groups, schools, 2010 ) . and communities (Bronfenbrenner, 1979, 2005 ) . The foundational and developmental knowledge acquisition and skill attainment required for thriv- The Role of Self-Regulation ing across adolescence, and the embeddedness of in Resilience these requirements in multiple and complex trajectories across the developmental system, are Across the life span, individuals live in complex enormous (and arguably ontogenetically distinct) physical, social, cultural, and historical contexts. across the adolescent period. To be resilient—indeed to thrive (acting in man- ners that optimize one’s chances for a life marked by health and positive exchanges with one’s Organismic and Intentional world)—individuals make decisions about how Self-Regulation to act in ways that meet personal needs and environmental demands (Brandtstädter, 2006 ; Developmental science has recognized the theo- Lewontin, 2000 ) . In other words, youth must act retical importance across life of establishing and in ways that support their own healthy function- maintaining adaptive developmental regulations ing and, as well, are of bene fi t to their context. for individual thriving and, as well, for under- Accordingly, across the adolescent period, youth standing the contribution of individuals to the need to accomplish several adaptive tasks involv- quality of their contexts. For instance, Posner and ing self and context. First, they must establish Rothbart ( 2000) have stated that “understanding and then build knowledge about the evolving self-regulation is the single most crucial goal for requirements for personal adjustment, given their advancing an understanding of development” particular characteristics of physiological, physi- (p. 427). Not surprisingly, then, in the last decade, cal, psychological, and behavioral individuality; there has been a focus in theory and research on they must learn also the demands for adaptation self-regulation, that is, on the ways in which the present in their speci fi c ecological niche. Second, developing physiological, psychological, and a foundation must be established and then behavioral attributes of individuals coalesce to enhanced for attaining the cognitive and behav- provide the means for them to actively contribute ioral skill sets needed for setting goals necessary to mutually bene fi cial individual ¬® context for survival and, even more, for thriving. relations. Within this literature, self-regulation is To accomplish these ends, strategic thinking a term that encompasses multiple forms of func- and executive functioning need to be coupled with tioning, ranging from physiological functions to 17 Resilience and Positive Youth Development: A Relational Developmental Systems Model 299 complicated, intentional thought processes. intentional efforts of the person to regulate his or Self-regulation also involves actions designed to her individual ¬® context exchanges. either enact strategies for attaining the goals for Both organismic and intentional self-regula- selected transactions with the context or for com- tion processes must be integrated across life for pensating effectively when goals are blocked or adaptive developmental regulations to exist and initial actions fail (Baltes, 1997 ; Geldhof et al., for the developing person to thrive, not only 2010 ; Gestsdóttir & Lerner, 2008 ; McClelland within particular developmental periods but, as et al., 2010 ) . well, across the transitions into and out of succes- As such, self-regulation pertains to all aspects sive portions of ontogeny. The development of of adaptive developmental regulation, as individ- and interindividual differences in organismic uals alter their behaviors—as well as thoughts, self-regulation infl uence the individual’s contri- attention, and emotions—to react to different butions to adaptive individual ¬® context rela- contexts and modulate their reactions to and tions, both directly and in connection to intentional actions aimed at infl uencing their contexts self-regulation (a point to which we will return (Shonkoff & Phillips, 2000 ) . Thus, self-regula- later in this chapter). Moreover, across the life tion may be defi ned as “the ability to fl exibly span, changes in the nature of intentional self- activate, monitor, inhibit, persevere and/or adapt regulation are arguably the major means through one’s behavior, attention, emotions and cognitive which the active individual contributes to the strategies in response to direction from internal adaptive developmental regulations that mark cues, environmental stimuli and feedback from resilience. others, in an attempt to attain personally-relevant Baltes, Freund, and colleagues agree (e.g., goals” (Moilanen, 2007 , p. 835). Baltes, 1997 ; Baltes & Baltes, 1990 ; Freund & Clearly, these conceptions of self-regulation Baltes, 2002 ; Freund, Li, & Baltes, 1999 ) . These encompass two integrated but nevertheless dis- scholars have found that individuals’ capacities tinguishable processes: ones involving either pri- for intentional self-regulation are important, marily physiological, or organismic, processes, indeed key, strengths enabling individuals to and ones involving primarily intentional pro- access the resources needed to optimize the cesses. Gestsdóttir and Lerner (2008 ) have chances that the positive goals they select are explained that intentional self-regulations are attained or to compensate effectively when opti- contextualized actions that are actively aimed mization skills (such as resource recruitment, towards harmonizing demands and resources in executive functioning, or strategic tracking) fail the context with personal goals in order to attain or when goal-oriented behaviors are blocked. better functioning and to enhance self-develop- Scholars whose work is focused on adolescence ment. Intentional self-regulation is characterized also place a prominent emphasis on the impor- by goal-directed behaviors. Processes of inten- tance of processes of intentional self-regulation tional self-regulation are more readily available for adaptive developmental regulations. to consciousness than processes and structures of Geldhof and Little ( 2011 ) underscored the organismic regulation, which are broad, ontoge- idea that self-regulation represents a core aspect netically consistent (i.e., relatively continuous) of human functioning that infl uences positive attributes of a person that involve biologically development in adolescence. Consistent with the based, physiological structures and functions that ideas of Baltes ( 1997) , Freund and Baltes ( 2002 ) , contribute to the relationship an individual has Brandtstädter (1998, 2006) , and Heckhausen with the environment. Such organismic charac- (1999 ) , Geldhof and Little discuss self-regula- teristics, including hypothalamic control of body tion within the context of what they term an temperature, circadian rhythms, pubertal timing, action-control model. They regard such a model and temperamental attributes such as threshold of as a fundamental facet of self-regulation during response or quality of mood, are under no or lim- the fi rst 2 decades of life, in that it links cogni- ited control of the person, and do not involve tions (beliefs) about the sources of control over 300 R.M. Lerner et al. behavior with the actions of individuals. In par- However, Napolitano, Bowers, Gestsdóttir, ticular, they discuss the development of action- and Chase (2011 ), note that other fi ndings from control beliefs. They note that there are at least the 4-H Study data set suggest that an adoles- several action-control beliefs involved in the cent’s SOC skills undergo signifi cant change relationships among agents (self or others), throughout adolescence while nevertheless play- means, and outcomes/ends, and that research has ing an important, positive role in promoting his primarily focused on means-ends, agency, and or her thriving. For instance, research indicated control-expectancy beliefs. As such, they focus that in fi fth and sixth graders, SOC existed as a on action-control beliefs and their links to posi- global construct, rather than as the tripartite con- tive development. They explain that action-construct found in adult and aged samples and as trol beliefs are related to physiological well-being, described above (Gestsdóttir & Lerner, 2007 ) . and thus point to the interrelation between organ- This globality of the SOC structure suggested ismic and intentional facets of self-regulation. that younger adolescents, while still possessing They provide ideas about how the integration of intentional self-regulation strategies in some the action-control model with other theories of sense, had not yet fully developed the distinct and self-regulation can inform understanding of self- independent components that comprise the SOC regulation processes across the life span. model. Younger adolescents had simply “strong Data derived from the 4-H Study of Positive SOC” or “weak SOC,” rather than a complex Youth Development (e.g., Lerner, Almerigi, combination of these skills. Results indicated that Theokas, & Lerner, 2005 ; Lerner, von Eye, higher SOC scores were positively related to Lerner, & Lewin-Bizan, 2009b ; Lerner, von Eye, PYD and negatively related to risk or problem Lerner, Lewin-Bizan, & Bowers, 2010) provide behaviors in fi fth, sixth, and seventh graders, and information about development during the sec- as well, predicted placement in the most-optimal ond decade of life that are consistent with the developmental trajectories across the same age views of Geldhof and Little (2011 ). For instance, range (Gestsdóttir et al., 2011 ; Zimmerman, Gestsdóttir, Urban, Bowers, Lerner, and Lerner Phelps, & Lerner, 2007 ) . ( 2011 ) discuss the development of intentional Subsequent research involving the 4-H Study self-regulation in adolescence and the implica- indicated that SOC did exist as a tripartite, dif- tions of such development for thriving. Indexing ferentiated, adult-like construct in adolescents in intentional self-regulation through the Freund Grades 8 through 10 (Gestsdóttir, Lewin-Bizan, and Baltes ( 2002 ) Selection (S), Optimization von Eye, Lerner, & Lerner, 2009 ) . Consistent (O), and Compensation (C; SOC) measure, they with Werner’s orthogenetic principle ( 1957 ) , summarize the results of several studies that have which holds in part that development progresses, examined the development of the SOC processes across life to states of greater differentiation, among youth in Grades 5 through 10. They point older adolescents now presented complex com- to positive links among intentional self-regula- binations of S, O, and C, and, in other research tion, ecological developmental assets, and thriv- with Grade 10 youth, also of loss-based selection ing in adolescence but note, as well, the need for (LBS) behaviors, i.e., behaviors involving the more systematic examination of the longitudinal, selection of a new goal when an initial one is not bidirectional relationships among individual attainable (Gestsdóttir, Bowers, von Eye, strengths and contextual assets in relation to out- Napolitano, & Lerner, 2010) . While overall SOC comes in adolescence and adulthood. To illus- scores of adolescents from Grades 8 to 10 were trate, Urban, Lewin-Bizan, and Lerner ( 2010 ) positively correlated with PYD, there were found that positive development in adolescence differences in relations with PYD when examin- is more likely when these SOC skills are aligned ing the individual components of SOC. That is, with ecological developmental resources associ- high levels of O, C, and LBS—but not S—were ated with community-based, youth development strongly associated with PYD (Gestsdóttir et al., programs. 2009, 2010 ) . Studying the in fl uences and outcomes 17 Resilience and Positive Youth Development: A Relational Developmental Systems Model 301 related to these complex patterns of S, O, C, and of the context on individual adolescents, in LBS development among older adolescents will relation to nonnormative levels of risk or high be an important focus in future research. levels of adversity. We have argued that the In summary, the data from the 4-H Study indi- cognitive, emotional, and behavioral attributes, cate that a key component for the development of or skill sets, that are involved in intentional PYD in adolescence may be developmentally and self-regulation refl ect the fundamental features contextually appropriate manifestations of the of the actions of youth that are pertinent to intentional self-regulation characteristics of selec- resilience. In turn, when the provision of devel- tion, optimization, and compensation. As such, opmental assets by the ecology of youth develop- we agree with Baltes et al. (2006 ) that: ment (i.e., resources provided by people or When orchestrating the optimization of develop- societal institutions or social structures) are ment by processes such as selection and compen- secured by youth using intentional self-regulation sation, the appraisal of resources is of central skills to attain these assets, then adolescents importance. Questions such as how to evolve a thrive. As such, they are apt to act to maintain goal structure and the associated goal-relevant means and motivational investment strategies, how the healthy or positive structure, function, and to deal with selection-related disengagements from integrity of these developmental assets. other possible goals, when to accept a loss and re- Figure 17.2 presents an illustration of this rela- orient one’s life, and when to still strive harder tional developmental systems conception of because current behavior is not yet employed to its fullest capability become crucial in composing life resilience in adolescence. development (p. 643). However, such integration of actions between youth and their ecologies, while ubiquitous Clearly, there is a growing body of scholarship across the adolescent period in signifying resil- that re fl ects the theoretical and empirical use of a ience, may nevertheless undergo developmental ¬® relational individual context approach to transitions and transformations. That is, we may resilience during the adolescent period, espe- ask what facets of the system of relations depicted cially one wherein the contribution of youth to in Fig. 17.2 show quantitative and/or qualitative this relational process involves the enactment of continuity and what facets show quantitative the cognitive, emotional, and behavioral facets of and/or qualitative discontinuity across the ado- intentional self-regulation. However, to more lescent decade. We would expect, for instance, fully instantiate this approach to the study of that both organismic and intentional self-regula- resilience in adolescence, especially as it is mani- tion show developmental variation (intraindivid- fested within and across the transitions that mark ual change) across this period of ontogeny. Thus, this period of ontogeny and in relation to the key the nature of the interrelation between these two contexts of human development, several impor- fundamental facets of self-regulation should tant conceptual and methodological issues will change as well. Moreover, completing this link need to be addressed. between organismic and individual self-regulation is the likelihood that the content of intentional self-regulation needs to change as the Problematics in the Study individual undergoes normative development of Resilience Across the Life Span from the end of childhood through the beginning of adulthood. For instance, such developmental From a relational developmental systems per- change will occur as different facets of develop- spective (Overton, 2010 ) , adaptive individual ment emerge, and as the resources needed from ¬® context relations constitute the fundamental the context to promote PYD vary in relation to refl ection of resilience. As we have emphasized, the different developmental tasks of successive resilience exists when developmental regulations portions of adolescence. Indeed, we noted earlier involve mutually bene fi cial actions of the in this chapter that both the structure of intentional individual youth on the context, and actions self-regulation, as indexed by SOC scores, and 302 R.M. Lerner et al.

A relational developmental systems model of the individual-context relations involved in resilience in adolescence in resilience adolescence relations involved systems model of the individual-context A relational developmental Fig. 17.2 17 Resilience and Positive Youth Development: A Relational Developmental Systems Model 303 of ecological developmental assets may vary As such research is undertaken, we believe across development (e.g., Gestsdóttir & Lerner, that issues of measurement are paramount. 2007; Gestsdóttir et al., 2009, 2010; Zimmerman Several interrelated problems exist here. First, et al., 2007 ) . there is a tripartite measurement issue involved in Given these developmental trends, we may the present formulation of resilience. That is, ask if there are different structures of ecological research must develop psychometrically sound developmental assets that covary along with indices of the person, of the context and, in par- developmental changes in the structure of inten- ticular, of the individual ¬® context relation. tional self-regulation. No research exists in Measuring any one of these three foci of inquiry regard to this question of developmental trans- is dif fi cult enough; measurement of all three of formation. Similarly, would answers to this ques- these targets of assessment in an integrated way tion vary if research were focused on adolescents seems particularly challenging, especially given in different cultural contexts? Would answers the complicated and evolving methodological vary if the focus was on the transitions across issues involved in relational, fi t, or difference this developmental period? Would the funda- scores (e.g., Baltes, Reese, & Nesselroade, 1977 ; mental sequence of the linkages across adoles- Chiou & Spreng, 1996 ; Cronbach & Furby, 1970 ; cence between intentional self-regulation and Singer & Willett, 2003 ; von Eye, 1982 ) . developmental assets vary in relation to interin- In addition, there exist issues of measurement dividual differences in intraindividual changes in equivalence, both across conventional demo- organismic self-regulation? Again, no research graphic categories (age, race, sex, religion, and exists to answer these questions. culture) and, as well, across these diverse eco- In addition, how do nonnormative develop- logical niches to which we have just pointed mental changes or nonnormative historical events (e.g., Little et al., 2009 ) . Moreover, measurement interrelate with normative individual and ecolog- in normative settings may not be the same as ical transformations and transitions? Do such measurement in the face of nonnormative individual and ecological variations alter the con- situations such as wars or natural disasters. tent or structure of intentional self-regulation Nonnormative settings may transform qualita- and/or ecological assets and, in so doing, consti- tively or structurally the requirements that exist tute a different array of adaptive challenges that, for the adaptive individual ¬® context relations in essence, make the nature of resilience qualita- re fl ecting resilience to be identi fi ed. tively or quantitatively different within or across Furthermore, as the sort of research to which portions of adolescence? Moreover, do answers we are pointing is pursued, these issues of mea- to these questions vary in regard to the ecological surement may be expected to be complicated niches within which individual adolescents are further by the fact that, as is the case in all facets interacting? We would expect so. Successful of adolescent behavior and development, some individual ¬® context relations within one’s of the variance in resilience will involve nomo- family of origin may involve different facets of thetic, group differential, or idiographic features intentional self-regulation and of organismic self- of human functioning (Kluckhohn & Murray, regulation (e.g., involving “dif fi cult” tempera- 1948 ) . For instance, nomothetic characteristics ment styles; Chess & Thomas, 1999 ) . In addition, that may play a role in resilience may involve different facets of intentional self-regulation may brain structures (such as the amygdala); the be most salient when individual youth engage sympathetic and the parasympathetic systems, with different types of ecological resources in and the endocrine system. Group differential middle school vs. in high school, preparing to components of human functioning may be leave the family of origin to live independently, marked by the demographic variables we noted or in the playground vs. in the place of part-time above or may be re fl ected by variation in the employment. Once again, research remains to be social capital available to some social groups, conducted to address such nuanced questions. such as religious denominations, but not to 304 R.M. Lerner et al.

others (King & Furrow, 2004 ; Putnam, 1995 ) , or by the institutions of civil society present in Conclusions and Recommendations some nations, but not others (Zaff, Kawashima- for Application Ginsberg, & Lin, 2011 ). Idiographic features may be illustrated by the speci fi c sets of organ- The promotion of PYD is of fundamental con- ismic and intentional self-regulatory processes cern to the developmental science of adolescence possessed by a person, for instance, particular in that it affords insight into how to test theoreti- temperamental attributes (e.g., easy, diffi cult, or cally predicated explanations of fundamental slow-to-warm-up characteristics of tempera- ontogenetic processes by actualizing the optimi- ment; Chess & Thomas, 1999 ) or the attributes zation goals of the fi eld (Baltes, 1997 ; Baltes of intentional self-regulation (e.g., elective et al., 2006 ; Lerner, 2004 ) . As such, a focus on selection, loss-based selection, optimization, resilience in adolescence will elucidate the ways compensation; Freund & Baltes, 2002 ; tena- in which relations between active youth and cious goal pursuit or fl exible goal adjustment; active facets of their ecologies can be constituted Brandtstädter, 1998 ; or primary or secondary to be mutually benefi cial to the young person and control processes; Heckhausen, 1999 ) used by his or her world. an adolescent in a given instance of individual The relational developmental systems ¬® context relations. approach to the study of resilience across ado- The combination of nomothetic, differential, lescence provides a largely nascent program of and idiographic attributes that are present in research to account for the facets of contexts every adolescent not only makes the study of and of individual youth, groups of youth, and resilience diffi cult from a measurement perspec- adolescents in general that must be aligned to tive but, along with the other measurement issues optimize the life chances of our diverse we have noted, also requires that a new genera- humanity. While this research is ongoing, and tion of resilience research be framed by an we still have much to learn about the adaptive expression of the complex, interrelated set of developmental regulations that refl ect resilient questions we noted earlier: For youth with functioning across adolescence, we already have diverse ideographic, group differential, and enough knowledge to suggest to practitioners nomothetic features of functioning, what charac- and policy makers that their actions should focus teristics of intentional self-regulation (with what on both individual youth and context and, in structure and content); within or across what particular, on mutually bene fi cial exchanges portions of adolescence; in what normative or between the two, for any adolescent and for nonnormative proximal (e.g., family, school, or adolescents in general to thrive. OST activity) and distal (e.g., community, soci- In addition, the theoretically framed knowl- ety, culture, or historical epoch) facets of the edge base we have presented affords other rec- ecology, and in interrelation with what array of ommendations for application. For instance, developmental assets, are adaptive individual practitioners may take a strength-based approach ¬® context relations instantiated? to promoting successful interactions between Obviously, addressing this complex question youth and their context. If resilience refl ects suc- involves engaging in a long-term program of cessful functioning when the adolescent’s research. Perhaps equally as obvious, however, is individual ¬® context relations involve high that answers to these questions have important levels of risk and adversity (see Fig. 17.1 ), then implications for applications to youth develop- practitioners may explore the developmental his- ment programs and policies. This observation tory or current circumstances of youth in order to leads to some fi nal comments about the study of identify such successful relations and seek to rep- resilience in adolescence. licate them when the adolescent is not showing 17 Resilience and Positive Youth Development: A Relational Developmental Systems Model 305 resilience. In addition, since resilience is not just Benson, P. L., Scales, P. C., Hamilton, S. F., & Sesma, A. a person-level characteristic, practitioners should (2006). Positive youth development: Theory, research and application. In W. Damon & R. M. Lerner (Eds.), seek to identify the resources in the environment Handbook of child psychology (Theoretical models of that can enhance the probability that past suc- human development 6th ed., Vol. 1, pp. 894–941). cesses will be reenacted or that will create new, New York, NY: Wiley. innovative, and healthier individual ¬® context Benson, P. L., Scales, P. C., & Syvertsen, A. K. (2011). The contribution of the developmental assets frame- interactions in adolescence. work to positive youth development theory and prac- Simply, our message for application is to build tice. In R. M. Lerner, J. V. Lerner, & J. B. Benson on strengths, try to use the resources that keep (Eds.), Advances in child development and behavior: individual ¬® context relations below the tip- Positive youth development (Vol. 41, pp. 198–227). London, England: Academic. ping point requiring resilience, enhance previous Bornstein, M. H., & Lamb, M. E. (Eds.). (2010). successes, and look for new contextual resources Developmental science: An advanced textbook (6th to enhance the probability of resilience among ed.). New York, NY: Taylor and Francis. youth in those situations where it is requisite. The Brandtstädter, J. (1998). Action perspectives on human development. In R. M. Lerner (Ed.), Handbook of evaluation of programs and policies predicated child psychology: Vol. 1. 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David A. Crenshaw

After more than 42 years of direct clinical work with severe trauma in children what amazes the Resilience in the Face of Severe author most is the courage, awesome spirit, and Child Trauma the resilience of these children. These are children who in their brief lives have suffered more The American Psychiatric Association (2000 ) than most human beings experience in a life time. de fi ned a stressor as traumatic when an individual They are children who have seen things that no is exposed to a life-threatening experience or a child’s eyes should ever see; children who have threat to physical integrity that is accompanied heard things that no child should ever hear. These by a subjective response of fear and helplessness. are children who’ve been hurt in ways that no Terr ( 1991) distinguished between Type I trauma child should ever be hurt. But there is something that results from exposure to a single event as else that is quite striking about these children. contrasted with Type II trauma that is a result of From the pile of rubble heaped high by the atroci- repeated or prolonged exposure to trauma. ties that some adults in their worst moments com- Resilience in the face of severe trauma in child- mit towards children emerges a child who often hood, that is, the focus of this chapter, is best in spite of all justifi cation refuses to give up. thought of as Type II trauma as described by Terr. These children reveal a vital spark that is not eas- Type II traumas have also been termed complex ily extinguished—what James Garbarino ( 1999 ) trauma (Herman, 1992 ) and developmental called the “divine spark.” Resilient children are trauma disorder (van der Kolk, 2005, 2007 ) . The determined to surmount even the most formida- terms complex trauma and developmental trauma ble odds—they display courage and strength in disorder call attention to the fact that the PTSD the face of obstacles that would demolish the diagnosis does not capture the disruptive devel- spirit of many less hardy individuals. opmental effects of trauma in childhood when development is still in process. Trauma in childhood can disrupt affect regulation, attachment patterns, and interfere with the achievement of core competencies. Thus the impact of Type II traumas in childhood can have a pervasive disruptive effect on development. These Type II traumas often take the form of sex- D. A. Crenshaw ( ) ual and/or physical abuse or torture and thus are Children’s Home of Poughkeepsie , Poughkeepsie , NY , USA deliberately in fl icted on children by other human e-mail: [email protected] beings, often by adults whom they would

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 309 DOI 10.1007/978-1-4614-3661-4_18, © Springer Science+Business Media New York 2013 310 D.A. Crenshaw

ordinarily turn to for protection and safety, 2010; Seymour, 2010; Solt, 2010: Soracco, 2010 ; namely their parents or caregivers. Wingo et al., 2010 ) . While it is important not to overreach with the Recent research reports of large scale disasters concept of resilience and thereby expect youth to have also expanded our knowledge base of severe rise above their circumstances regardless of the trauma. Among the seminal research recently conditions they face, this needs to be balanced by reported include postwar adjustment in adoles- a healthy appreciation of the amazing capacity of cents in Bosnia (Layne et al., 2010 ) ; Sierra the human spirit to adapt and overcome formida- Leone’s former child soldiers (Betancourt et al., ble odds. Stories of amazing endurance and sur- 2010) ; political violence in Kenya (Kithakye, vival in the face of overwhelming hardship or Morris, Terranova, & Myers, 2010 ) ; survivors of obstacles are recorded in Biblical times, most Katrina (Kilmer & Gil-Rivas, 2010 ; Kronenberg, notably the story of Moses surviving a harsh Hansel, Brennan, Lawrason, & Osofsky, 2010 ; beginning in life and the story of David overcom- Vigil, Geary, Granger, & Flinn, 2010 ) ; tsunamic ing unimaginable odds to triumph in his battle survivors of Sri Lanka (Catani et al., 2010 ; against Goliath. Other Biblical stories of resilient Fernando, Miller, & Berger, 2010 ) ; and the 9/11 children include among many others: Isaac (who World Trade Center terrorist disaster (Gershoff, was bound to an altar and was about to be stabbed Aber, Ware, & Kotler, 2010 ) . by a knife wielded by his father Abraham but saved by the last moment intervention of an angel but according to the story, Isaac lived until the Child Soldiers in Uganda age of 180, the longest-lived of the patriarchs); and Joseph (who was sold into slavery by his A good contemporary example of such awe-inspir- jealous brothers, yet rose to become the most ing resilience in children is described in a study of powerful man in Egypt next to the Pharaoh; sav- posttraumatic resilience in former Ugandan child ing many lives from the 7-year famine). soldiers (Klasen et al., 2010 ) . The children abducted and coerced into becoming child soldiers for the rebels were typically cruelly abused and Resilience of Children in the Wake of often forced to in fl ict atrocities on others. Recent Disasters and Severe Trauma In the study by Klasen and colleagues, 330 former Ugandian child soldiers from war torn In more recent times remarkable stories of sur- districts of Uganda were evaluated for posttrau- vival, courage, resilience, and heroism regarding matic resilience de fi ned as the absence of clini- children of military families affected by the wars cally signi fi cant psychopathology in the aftermath in Iraq and Afghanistan; children impacted by of exposure to severe trauma. The children were 9/11 and Hurricane Katrina also underline the assessed after returning from the armed rebel capacity of children to sometimes overcome group for a minimum of 6 months and at the time unfathomable circumstances (Solt, 2010 ) . In of follow-up were between 11 and 17 years of addition more clinical case reports of healing in age. Of the 330 former child soldiers in the study, contrast to simply documenting the damage in 48.5% were girls. Since the late 1980s, Klasen the aftermath of deliberate as compared to acci- et al. report that an estimated 25,000 children and dental trauma, namely witnessing domestic vio- adolescents were recruited by force into the rebel lence, exposure to neglect, physical, and sexual forces of the Lord’s Resistance Army (LRA). abuse have appeared in the recent literature The study delineated the exposure to severe (Crenshaw & Garbarino, 2008 ; Crenshaw & trauma as follows: Hardy, 2005 ; Crenshaw & Hill, 2008 ; Crenshaw 90.6% of the children were beaten by armed & Lee, 2008 ; Cristantiello, Crenshaw, & Tsoubris, forces 2008 ; Fillette, 2010 ; Green, Crenshaw, & Kolos, 87.9% witnessed murder 2010 ; Hardy & Crenshaw, 2008 ; Noziska-Kenny, 86.4% were threatened with death 18 A Resilience Framework for Treating Severe Child Trauma 311

25.8% were raped by members of the armed and trauma” (Klasen et al., 2010 , p. 1097). group (22.4% for boys; 29.4% for girls) Compared to the voluminous research on psy- 65.2% looted houses chopathology, positive adaptation in the face of 52.6% abducted other children harsh conditions is understudied. 52.6% killed another person 38.6% of the children had been abducted more than once Richard Akena: Transformation and 43.1% of the children had lost both parents Resilience of a Former Child Soldier 36.7% of the children had lost one parent 88.8% reported frequent experiences of A compelling example of a former child soldier domestic and community violence after leaving in Uganda, Richard Akena who was not a part of forced military service the sample in the Klasen et al. ( 2010 ) study, In spite of this picture of severe trauma, it is granted the author permission to share his story. extraordinary that more than one fourth (27.6%) Richard Akena as a child was not abducted just showed a resilient mental health outcome. Given once by the LRA but four times. He was rescued the brutal circumstances forced on these children the fi rst three times but not the fourth. Prior to the who spent an average of 19.81 months in abduc- third abduction his parents were killed by the tion and were abducted at the average age of LRA in a raid on his village. Richard was 10.75 years, it is not surprising that 72.4% showed wounded in this battle but his physical wounds signi fi cant symptoms of psychopathology at out- could not match the devastating pain to his heart come (33% met criteria for major depression, caused by the murder of his parents. 33% met criteria for PTSD, and 18.5% warranted Richard’s experience is not unique. Some of the diagnosis of both disorders). the children in order to survive were required to Klasen’s et al. (2010 ) important study yielded kill their own parents (Eichstaedt, 2009 ) . In his some important clues as to what enables some book First Kill Your Family: Child Soldiers of children to survive psychologically intact after Uganda and the Lord’s Resistance Army , exposure to horrifi c, almost unimaginable circum- Eichstaedt, a journalist, summarized what he stances. These researchers found that perceived encountered when going there to become a senior spiritual support was a signi fi cant contributor to editor for Uganda Radio Network in 2005: resilience in these children and adolescents. “Northern Uganda is a world out of control, Revenge motivation, on the other hand, contrib- where right is wrong, and wrong is right, where uted to a negative outcome for the former child carnage and chaos are the normal state of affairs. soldiers. The preoccupation with revenge and also An army of brutal killers has been committing guilt were risk factors for these youth. Children in atrocities day after day, month after month, year this study had frequently been forced to torture or after year, with no end in sight” (Eichstaedt, kill others, sometimes even their relatives in order 2009 , p. 5). to survive. A major drawback of this study is that it was cross-sectional rather than longitudinal and it is Devastating Trauma of War not clear what changes in psychological functioning of these youth would occur over a longer A shaky peace has come to Northern Uganda. span of time. Even with this caveat, the results Since June of 2006 peace has returned to the are still quite stunning and a compelling testa- areas ravaged by an internal war waged by the ment to the will to survive and the resilience of LRA. But this peace is barely trusted by those children . The authors observed, “One of the most whose lives have been ravaged for more than 20 impressive phenomena of child development is years by rapes, murders, abductions, and pillag- the ability of many children to develop into ing of their homes and villages. Raids by the healthy, well-adapted adults despite adversity LRA are less frequent but still occur and are no 312 D.A. Crenshaw less devastating than ever. Slowly the rebuilding When the LRA was attacked by the Ugandan of the North is taking place, but the infrastructure Army, Richard saw his chance and he began to is being rebuilt at a snail’s pace. run away, 12 km in all. Richard came across some Richard Akena’s mission in life is rebuilding hunters who were out and killed them fearing to the lives of children who have suffered so deeply be captured. Finally he reached safety in during the war years, whose hearts still tremble Acholibur and a government offi cial placed him with fear as night comes, whose faces show the in a Displaced People’s Camp, but there was no emotional scars within; some of the children food for him. The World Food Program would show the visible scars of war such as lips, ears, only hand out food once a month and Richard noses chopped off by machetes which were went without food for 3 days. wielded for the most part by child soldiers. Children who in cold blood killed members of their own family, their own clans, and their own Turning Points tribe—the abducted children turned into killers, like zombies running amok due to the terror tac- A kind lady took Richard in and fed him and gave tics of the LRA. him shelter. He went to Kampala, hoping for a Richard Akena was one of those abducted better life, only to fi nd more despair. It was hard children turned into killers by their captors. to adjust from being a child soldier to living as a Richard was born when the LRA was already on civilian; normality eluded him and that is when a rampage. He grew up in fear of them. The chil- he converted to Christianity, purpose and mean- dren and their families never knew when the LRA ing entered his life. would strike. Richard Akena and thousands like Richard pursued an education, fi nishing High him were robbed of their childhood, of their inno- School and then onward to higher education even cence, of their ability to laugh and dream of a pursuing a Degree in Public Administration from hope fi lled future. Makerere University. As he returned to the North Richard Akena was on his way to school when of Uganda, he began to see the ugly consequences he was captured by the LRA for the fourth time of what the LRA had caused. Children who lived and this time there was no rescue; a 14-year-old in fear, scarred within, orphans whose parents boy’s life changed forever. Beaten, brainwashed, had been killed by the LRA, children who had and coerced, Richard was turned from a 14-year- been physically maimed by lips, ears, noses being old into a killer, a child soldier, where he only cut off, hands amputated by a machete, but most thought of self-preservation and did what he was of all he saw orphans. The LRA war produced told to do. He saw and did things he never thought countless numbers of parentless children in were possible; his mind became numb; his heart Northern Uganda. cold and yet there was a longing within to escape, Richard established Pader Orphans Caring to leave the insanity and cruelty of the LRA Project which is a registered nonpro fi t organiza- behind. tion in Uganda taking in the “throw away” chil- Richard Akena as a teenager saw death, partici- dren of the area giving them a place to call home. pated in killings, saw and participated in lootings, Richard did not and still today has little fund- abductions, beatings, the cutting off of lips, noses, ing—the need is so great—but the generosity of ears, and limbs, all leaving his heart and soul his heart is greater than the need and he prays imprinted with images that would fl ash by him, each day for the daily bread of the children and day and night, for years to come. Richard was he believes that somehow little miracles will made a corporal since he distinguished himself in happen. battles and raids. He was nicknamed Apiiremo Richard Akena, former child soldier with the meaning “Blood” since he was a tough fi ghter LRA explained in a personal communication that who did not show fear, and yet within him was the he is now fi ghting only for food for the 300 hope of going home, or to what was left of it. orphans that he feeds and cares for every day. 18 A Resilience Framework for Treating Severe Child Trauma 313

Richard is a voice for the voiceless—a person The Crucial Role of Mind-Sets who has found his true purpose in life; to care for those who were child soldiers like him, who like Mind-sets in fl uence what we see and hear when himself were made orphans by the LRA, and those meeting with a child as described eloquently by scarred physically and emotionally by the LRA. Brooks ( 2010 ) . Minuchin and Colapinto ( 1994 ) Richard is a man with a dream to help the explained that even the way the clinician gathers helpless of Northern Uganda—each day that information, the questions that are asked, re fl ect dream becomes more of a reality—the ghosts of the mind-set of the therapist and communicate to his past still haunt some nights—but his faith in the child and family what is of greater interest: God has enabled him to foster hope for a brighter pathology or resilience. Mental health profes- future for the orphans and former child soldiers sionals are well trained, if not overtrained to of Northern Uganda. (Adapted with minor editing identify pathology but recognizing and honoring with permission from Richard Akena from resilience in children offers far more leverage for the Pader Orphans Caring Project website: change. Minuchin and Colapinto ( 1994 ) stated http://www.paderorphanscareproject.webs.com/ ). that if you wish to be a diagnostic center then you Richard Akena’s story is one of such severe focus on pathology. But if you wish to become a exposure to trauma that it inspires hope for so change center, then you focus on strengths. many children in all parts of the world who have Goldstein and Brooks ( 2005 ) pointed out, been forcefully confronted with conditions that “Symptom relief has simply not been found to be many people can hardly imagine. It is interesting robustly synonymous with changing long-term in the light of the research by Klasen et al. (2010 ) outcome” (p. xiv). Resilience research widens the that a key turning point for Akena was his con- lens to include a view of the intrapersonal and version to Christianity. In fact in the study by interpersonal dimensions of children adapting to Klasen and colleagues the children’s perceived challenges, and more importantly can provide a spiritual support was not only a protective factor new lens of understanding for therapists from but almost doubled the odds of resilience in their many theoretical backgrounds to incorporate a subjects. The triumph of the spirit of children in strengths-based approach to child and family the face of these horri fi c conditions is a testament therapy (Seymour & Erdman, 1996 ) . to a side of the story that has not received the attention it deserves. The damage done to children by such horror is well documented, the resil- The Remarkable Self-Reparative Forces ience, courage, and determination to prevail over in Children such conditions has unfortunately received much less attention. While Robert White ( 1959) wrote about competence and striving for mastery from infancy onward more than 50 years ago, the integration of A Resilience Framework for Treatment these concepts into child treatment has been of Severe Trauma in Children: Basic neglected relative to the focus on pathology and Tenets trauma. A refreshing exception is the recent book edited by Gil ( 2010a) containing chapters focused In this section, some of the key tenets of the con- on the powerful innate healing forces in children ceptual approach to a resilience framework in exposed to severe trauma (Crenshaw, 2010a ; treating severe trauma are delineated followed by Drewes, 2010 ; Gil, 2010b, 2010c, 2010d; Goldin, a detailed case example of the treatment of a fam- 2010 ; Green, 2010 ; Jalazo, 2010 ; Ludy-Dobson & ily that suffered unusually severe and prolonged Perry, 2010 , Shaw, 2010 ; Sobol, 2010) . In the face trauma. The case example will illustrate how of trauma, the deleterious impact can’t be ignored recent research in severe child trauma and disas- or minimized but reverence and profound respect ters can guide and inform the treatment process. for the innate and powerful drive to adapt, to grow, 314 D.A. Crenshaw and to heal should likewise never be ignored or Psychotherapy Networker Symposium in 2009 minimized. The case studies in Gil’s edited book refl ected on nearly 50 years of doing family ther- provide ample testament to this self-reparative apy. Minuchin (2009 ) shared with the audience drive to be honored and appreciated in children. that his thinking has changed considerably since One of the ways that the self-healing drive he started working with families. Minuchin becomes evident in work with children of severe explained that in the beginning of his career, he trauma is the desire to unburden, to tell their sto- considered that families were simply wrong in the ries, and to have someone they’ve learned gradu- way they viewed their problems. Now, he still ally to trust to witness their pain. The pathology believes that families are wrong, but they are side of this equation is well known. One of the wrong because they “are richer than they think.” cardinal features of posttraumatic stress disorder Minuchin elaborated by saying that families pos- is avoidance of reminders of the trauma. It is true sess rich resources for resolving problems of that children don’t usually want to think about or which they are often unaware. Basically Minuchin talk about trauma events and they do their best to has shifted his mind-set from one that was origi- avoid any reminder of these devastating events nally problem-focused to his current mind-set that but that is only part of the story. The other part of emphasizes strengths and resilience in the family. the story is that these children long to unburden In the case of severe trauma, healing is facili- and when suffi cient trust is developed their innate tated by enlisting the support and resources of the drive to heal will often overtake the natural incli- available family so the child does not undertake nation to avoid and to distract from the pain. the journey isolated and alone. In the cases of deliberate trauma, including domestic violence, physical, or sexual abuse the family may not be The Resilience and Healing Powers available or it may not be feasible to enlist what- of Families ever healthy resources exist in the family to assist in the child’s healing but this clinical decision Waters and Lawrence (1993 ) signi fi cantly con- should not be made without careful evaluation. It tributed to this shift from the “pathology mind- is easy to dismiss such families as not being help- set” in work with families by emphasizing ful resources in the healing process, but the oppo- competence, courage, love, hope, and vision in site may be true. families. Waters and Lawrence didn’t ignore Pipher (2005 ) observed, “Families for all their pathology but rather found the seeds of strength fl aws are one of our remaining ancient and true within the family often embedded in their pathol- shelters. Families, not therapists, will be there for ogy. This refreshing approach to work with fami- our clients if they lose their jobs, go to the hospi- lies brought into the therapy room a focus not just tal, or need someone to show up at their bowling on dysfunction and illness, but health and compe- tournaments” (p. 31). tence, strength, and important qualities rarely In the heartbreaking stories of the Uganda talked about before in family therapy including child soldiers when they were rescued or able to the family’s vision, hope, their love, and compas- escape the LRA many were confronted with the sion. The work of Waters and Lawrence was harsh reality that their parents had been killed. In inspired by White’s (1959 ) work on the concept that case they would seek out an uncle or a brother of competence. White emphasized the innate or sister, or anyone left in their family. Sadly the desire of human beings to master their surround- returning soldiers were often rejected by their ings and environment which he referred to as an surviving family members because of the atroci- underlying competence motivation . If one closely ties the child soldiers were forced to commit observes young children, it is fascinating to watch (Eichstaedt, 2009 ) . In addition to the theft of their their persistent attempts to master their world. childhoods, many also had to face either the dis- Salvador Minuchin, considered one of the pio- appearance of their families or rejection by their neers of family therapy in a presentation at the surviving family upon their return. 18 A Resilience Framework for Treating Severe Child Trauma 315

The Strengths that Reside in combating demoralization. One of the features in Communities of children and families in treatment of Type II traumas is what Garbarino ( 1999 ) has called “ter- The community is an extension of the family and minal thinking” and Hardy refers to as a “survival helps to support, guide, and reinforce the values orientation” (Crenshaw & Hardy, 2005 ) . In other of the dominant culture. Silverstein ( 1995 ) sug- words the repeated assaults on one’s dignities and gested that contemporary culture has deprived threats to one’s very survival lead to an adaption many of what makes life endurable, a sense of that entails keeping hopes at low levels. Survival community, a connection to a larger context that depends on keeping expectations low because gives life meaning and purpose. Beginning with when your dreams are crushed over and over the Industrial Revolution and the migration of again you can’t afford to risk further disappoint- agricultural families to the cities to work in facto- ment. It might be more than the psychic can bear. ries there has been a splintering of family ties. As understandable and as functional as this The more frequent relocations in modern society coping mechanism may be, it makes it hard for often due to work transfers, weakens ties to home such children and families to envision new pos- communities. If it takes a whole village to raise a sibilities and to be receptive to risking themselves child, children exposed to severe trauma need the in new relationships or in the wider world because acceptance, backing, and support of whole com- their assumptions of safety and trust in the world munities in order to heal. In a study of child sol- have long ago been shattered, sometimes in cruel diers in the Sierra Leone war, Betancourt et al. ways. Hope is the fuel people draw on to keep (2010 ) found that community acceptance was a going when the going gets tough, when the road key protective factor for the recovery of the chil- is treacherous or lonely. It was hope that allowed dren after they returned from the con fl ict. Richard Akena to get through the horri fi c experi- Another important feature of the community ences of being brutalized and coerced into brutal- that plays an important role in recovery is the ity towards others. He kept alive in his heart his return to schools. Prompt reestablishment of secret hope that he would someday escape and schooling was one of the best practices endorsed return to his home and community. Yet hope can by a wide range of studies (Ager, Stark, Akesson, also be dangerous for people who are chronically & Boothby, 2010 ; Betancourt et al., 2010 ; exposed to trauma. The loss of hope, the loss of Kronenberg et al., 2010; Masten & Osofsky, vision, and the loss of dreams are harrowing 2010 ) . In the family case study in this chapter, the losses and can decimate the spirit. Children may children were able to return within a week to their be extremely reluctant to be put in that vulnerable same schools following the last in a series of position of embracing hope and risk exposure to horri fi c trauma events. still another crushing blow because it might be the “tipping point” for their psychic survival. From the beginning of the work with the Hope as a Healing Ingredient Taliaferro family (fi ctitious name) that will be described in the next section, the mother of this Hope is a cornerstone of successful therapy but family with the support and encouragement of especially occupies a central role in the treatment the treatment team gave the children the fi rm and of a child or family confronted with severe trauma. clear message: “We will get through this together Hopelessness due to the devastating impact par- as a family!” Sometimes hope is a conscious ticularly of deliberate trauma, and Type II multi- decision. It is a decision even though your world ple traumas that gradually erode the spirit of even has been blown apart, to get up the next morning, the most courageous children, can represent a for- put your best clothes on and go out the door to midable obstacle to the treatment process. meet the world even if it means quite deliber- Jerome Frank ( 1968 ) in a classic paper high- ately simply putting one foot in front of the other, lighted the critical role of hope in psychotherapy just one step at a time. I frequently challenge 316 D.A. Crenshaw

hopelessness in children and families by stating even severe trauma conditions, the research with conviction, “It is only hopeless, if you decide review of larger scale disasters proved especially it is hopeless.” helpful in guiding the work with the eight chil- Facilitating hope in therapy, particularly in dren of this family and their surviving parent. families that have been battered by a series of Among the seminal research recently reported tragedies, requires sensitivity to a delicate bal- and particularly instructive for guiding the work ance that I ( 2010b) described in the title of an with this family are the following studies: post- edited book: Reverence in Healing: Honoring war adjustment in adolescents in Bosnia (Layne Strengths without Trivializing Suffering . If a fam- et al., 2010 ) ; Sierra Leone’s former child soldiers ily is stuck in a survival orientation no matter how (Betancourt et al., 2010 ) ; political violence in warranted, they may feel that the clinician is try- Kenya (Kithakye et al., 2010 ) ; survivors of ing to move them to a more hopeful place to Katrina (Kilmer & Gil-Rivas, 2010 ; Kronenberg meet the validation needs of the therapist rather et al., 2010 ; Vigil et al., 2010 ) ; tsunamic survivors than their own needs. The family may also feel of Sri Lanka (Catani et al., 2010 ; Fernando et al., that the therapist is insensitive to the depth 2010 ) ; and the 9/11 World Trade Center disaster of their suffering and hasn’t taken adequate time (Gershoff et al., 2010 ) . The following key com- to truly hear their story and honor their suffering. ponents of intervention were derived from the Survival for these families may have been above studies and the summary of the fi ndings of partly the result of pride in being able to cope with this research (Masten & Osofsky, 2010 ) . their struggles and bear their suffering. Families may believe in keeping with their spiritual faith that they are being tested as to how much they can Establish a Therapeutic Relationship bear and that their tragedies in life are according that Creates Safety for the Gradual to God’s will. Unless therapists take time to hear Unburdening of the Trauma Stories the stories of suffering and the meaning the families attach to their adversities, the families may More than 2,000 studies (Kazdin, 2005 ) point to feel their suffering is being trivialized and that the the crucial role of the therapeutic alliance in psy- therapist simply doesn’t understand or respect chotherapy outcome research. Kazdin has shown how diffi cult their journey has been or they may that the quality or strength of the therapeutic rela- feel their religious beliefs or faith are disrespected. tionship early in treatment statistically predicts Creating hope requires the healers to be sensitive treatment outcome among adults. In addition to the delicate balance and the necessity of pacing research has shown the better the therapeutic alli- the therapy according to what the family can han- ance the greater the change in treatment (Hovarth dle at any one point in time. & Bedi, 2002 ) . Since the stories of traumatic exposure are particularly dif fi cult to share, the trust developed within the therapeutic relation- A Clinical Case Example of the ship is especially cogent in trauma treatment with Taliaferro Family: A Resilience children as well as adults. Framework The relationship forged with the Taliaferro family whose amazing story of courage and deter- The research literature was carefully reviewed mination unfolded dramatically in the crucible of and informed the treatment of the Taliaferro fam- trauma when I met the mother and her 19-year- ily. The goal of undertaking the literature review old son for the fi rst time just minutes before she was to fi nd current research fi ndings that could told her other eight children the horrible news translate into clear guiding principles for the treat- that their father had killed himself. I provided ment of severe trauma in children. Since the mag- support to the mother and children on an inten- nitude and duration of the trauma experienced by sive basis beginning with that Friday night and this family was beyond the parameters typical of continuing through the weekend as I spent 18 A Resilience Framework for Treating Severe Child Trauma 317

considerable time on the campus of the Children’s and sensitive conversations and to persevere in Home of Poughkeepsie (CHP) where the children spite of many disappointments and setbacks that had been placed on an emergency basis. I talked occurred along the way in the treatment journey. frequently with the children and their mother on In the end the mission to heal the wounds of this the days that followed. I attended at the children’s family and see them reunited successfully again request the funeral service for the father and I was was viewed by all treatment providers and team present when their mother and her extended fam- members as more than worthy of the struggle. ily and the children gathered for dinner on the The healing relationship with this family con- night prior to the funeral service. I met members sisted of many therapeutic relationships not just of the extended family including the maternal the relationship formed with the family by the grandmother, an uncle, an older sister, and her author. A key relationship that was vitally sup- family. I was present when the children made portive and helpful to the mother and the children their fi rst return visit to their own home after throughout the children’s placement at CHP was being in placement for 6 months. I observed the with the child care supervisor in their group, Miss joy of the children as they played with their dogs, Nora. When the sibling group was subsequently and with each other. I watched them sing and moved to a new house established just for them, dance and they showed me their rooms. Miss Nora went with them and became the super- The Taliaferro’s allowed me into the inner visor in the new home. Miss Nora formed a close circle of their family and into their hearts even and trusting relationship with the mother, the though they had been betrayed and mistreated for children truly respected her and she was with years, somehow they found the generosity of them throughout their time at CHP. heart to trust me and I will always consider that a In addition the children benefi tted from impor- great honor and privilege. tant therapeutic relationships with their individ- The extensive degree of trust needed to tell the ual therapists and workers from other community trauma stories of children who’ve experienced agencies who came regularly to CHP to work the cruel blows of deliberately infl icted trauma is with them on various skills and to take them into often the result of two complicating factors. The the community for recreation and excursions. fi rst complication is the shame and stigma associ- The family was virtually surrounded by opportu- ated with the trauma exposure. Children who’ve nities for healing relationships. The children experienced sexual abuse frequently feel tainted formed positive relationships with a number of and damaged as a result of the exploitation by the treatment team staff, administrators in the adults, often adults that they had once trusted and program, other child care staff and with their loved. The shame tends to silence them. Revealing teachers in school. The story is a familiar one: it shame in therapy is a shaming experience itself is relationships not techniques that heal the psy- and requires an uncommon degree of trust in the chic wounds of children. therapist for the child to risk exposure to possible Not all relationships went smoothly and some further humiliation and rejection. did not go well at all as would be expected with a The second complicating factor is that many family that had suffered such extensive betrayal. of these children who have been abused or terror- But it is a compelling testament to the strengths ized by adults were threatened by the perpetrator and courage of these eight children and their that they or someone they love will suffer great mother that such con fl ictual relationships were harm if they ever tell (Crenshaw, Rudy, Triemer, the exception rather than the norm. & Zingaro, 1986 ) . To break the “silent bond” requires not only enormous courage on the part of the child, but a degree of trust not easily Honor and Strengthen Family Bonds achieved in therapy when the child has suffered repeated abuse, and betrayals. The strength of the One of the most consistent of all protective or bond that was formed between the Taliaferro ameliorative factors in the resilience research is family and me enabled us to have many diffi cult the presence of a stable and supportive caregiver 318 D.A. Crenshaw

(Houshyar & Kaufman, 2005 ) . Even with witnessing numerous beatings of their mother, children with a history of deliberate trauma the times when the father held a loaded gun to the availability of a supportive and stable caregiver head of their mother and threatened to pull the or an alternative mentor or guardian is one of the trigger, extensive sexual abuse of two of the ado- critical factors that distinguish between a good lescent girls, and beatings of the kids gradually vs. a poor outcome (Beeghly & Cicchetti, 1994 ; emerged in the months following their placement. Cicchetti & Toth, 1995 ; Houshyar & Kaufman, A prisoner in their own home; accounts of the 2005 ; Kaufman & Henrich, 2000 ; Pynoos, mother and at times the children being locked in Steinberg, & Wraith, 1995 ) . their rooms for long periods of time added to the In view of the robust in fl uence of a stable and horri fi c nature of the abuse and terror that the consistent caretaker and the support of the sur- family experienced. In addition, the father favored viving family, one of the overriding principles in some of the children and gave them power and the treatment of the Taliaferro family after the authority over the others while telling them not to children were removed from their home and sep- listen to their mother because “she did not love arated from their surviving parent, their mother, them.” was to keep the siblings together while in place- As the story of their nightmare that lasted at ment and involve their mother extensively in the least 10 years for the older kids and their mother treatment process; supporting her vital role with unfolded, tales of his actively pitting the children the children by frequent visits. In summarizing against each other and all the children against the implications of research following disasters, their mother emerged. On some occasions the Masten and Osofsky ( 2010 ) emphasized the other children would be ordered by the father to importance of reuniting children and adults with physically attack a child at whom the father was attachment bonds if they have to be separated. angry. Because of concern that the mother of the Watching the Taliaferro family on a snowy children may have been complicit with the abuse Sunday in December, 2010 playing with great by the father, CPS didn’t let the children return zest and joy, making a snowman, sledding, and home even after the tragic death of their father. throwing snowballs you would never guess that The mother LaNora (fi ctitious name), however, the eight children in this family has been removed visited everyday and the children attended the from their home just 9 months before by Dutchess memorial service for their father. Since I was pres- County Child Protective Services (CPS). Nor ent when LaNora told her children of the father’s would it be apparent to any casual observer that death and witnessed the way she comforted, con- the day after their placement in the CHP’s Group soled, and hugged them, I viewed the mother as a Emergency Foster Care (GEFC) program that huge asset in the healing process and someone their father committed suicide. Hearing the gales who had been severely traumatized as well due to of laughter accompanying the playfulness of the the terrorizing conditions including threats to her children and their mother in the snow, it would life, reinforced by beatings and forced confi nement never be assumed that the children and their on multiple occasions. Nine months later, two of mother were terrorized by the violence of the the eight children returned home as a result of father and controlled to such a degree that it took turning 18 and signing themselves out of care. on many of the earmarks of a family cult. The other six remained at CHP. Family members ranging in age from 8 to 19 While this case was complex due to the size of were subjected to long hours of listening to coun- the family and the severity of the abuse and terror try western music of the father’s choosing some- suffered and the prolonged out-of-home place- times late into the night while the father drank ment after the father’s suicide, evidence-based heavily and no one dared move, not even to go to principles were applied to the treatment of this the bathroom. The children knew better than to family. Since maintaining connections with their cross their father when he was in a rage, always surviving parent was deemed essential, even if vis- exacerbated when he was drinking. Stories of its and phone calls were required to be supervised 18 A Resilience Framework for Treating Severe Child Trauma 319 during the fi rst 8 months of placement, the mother Dutchess County Department of Social Services visited the children nearly every day. The children (DSS) and CPS in securing these services. gained meaningful comfort and consolation from Behavioral Crisis services were provided by the the mother’s visits and the treatment team con- Dutchess County Department of Mental Hygiene sulted LaNora frequently on issues related to the on the night of the father’s suicide. Each child children and how best to handle situations that received individual therapy and psychiatric evalu- arose. The sibling group was kept together in one ation and treatment from a community mental cottage. The unwavering dedication of LaNora health clinic operated by a nonprofi t agency Astor and her whole-hearted commitment to reuniting Services for Children & Families (ASCF). In addi- her family was a major contribution to the positive tion, various community intervention programs outcome with this family. were enlisted including Family Preservation and Bridges to Health (both programs offered by ASCF) that provided a wide array of services to Forge Alliances and Collaborations individual family members including psychoedu- to Facilitate the Healing Power of cational, crisis, and vocational services, and will Community also provide follow-up services to the children once they return to their family home. The CHP Research regarding healing and restoration fol- itself has enjoyed the wide support of the surround- lowing severe trauma emphasizes the importance ing community since it was founded in 1847. of a supportive community and the function of A wide range of services were also offered to cultural and community practices that include LaNora including individual therapy (with the support for families and their children (Masten & author), crime victims’ assistance services Osofsky, 2010 ) . Included are restoration of par- through Family Services, Inc., another nonprofi t ticipation in schools, support of family spiritual agency within the community, battered women’s practices (Garbarino, 2010 ) and involvement of counseling and parenting classes from Family community agencies that serve children and their Services as well. Family therapy during the chil- families (Betancourt et al., 2010 ; Klasen et al., dren’s placement was provided by the author and 2010 ; Masten & Osofsky, 2010 ) . The children during the later stages of the work I was joined by were transported to the same schools they had a co-therapist, Amanda Dixon, a clinical staff previously attended, and their spiritual practices member at CHP. The insidious pitting by the were honored and supported. On the night the father of the children against each other and the children were told that their father committed children as a group against their mother was a suicide, LaNora, her children, and the staff ended primary focus of the family therapy sessions with that unforgettable gathering of the family in the the goal of repairing and restoring the relational living room at CHP by joining hands with all the bonds between siblings and between the children family members and the staff present including and their mother. Thus the collaborative effort of the author in a circle and saying together the numerous community agencies with the support “Lord’s Prayer.” On the night of the wake for and encouragement of DSS provided a positive, the father when the family and members of the supportive environment to promote healing of a extended family gathered at the Children’s Home severely battered and traumatized mother and for a dinner; following the dinner they once again eight children who had been terrorized for years. joined hands in a circle in the living room and Five months into the placement, CHP leased a asked me to join them in the circle for prayer. house off-campus for the family to be together, Due to pervasive trauma of long duration and separate from the other children on the main severity impacting every family member from campus. The collaborative decision with DSS to youngest to oldest, CHP enlisted a wide variety of establish a separate house for this family is treatment services within the community. The believed to be the fi rst of its kind in New York agency enjoyed the support and backing of the State—an innovative partnership between a 320 D.A. Crenshaw

public agency (DSS) with the approval of the The children had not been permitted by the father New York Offi ce of Children and Family Services to engage in school sports or school-related activ- (OCFS—a state agency), and a private nonprofi t ities. Nor could they have friends over or even go agency (CHP). into the community without being accompanied LaNora was invited to participate to the fullest by the father except to go to school. The children degree possible including getting the children up eagerly participated at CHP in a wide range of in the morning and off to school and greeting sports, recreational, creative, and artistic activi- them upon their return from school in the after- ties including participation by two of the girls in noon. This dedicated mother would set her alarm an annual talent show that showcases the perfor 5:30 in the morning in order to travel to the forming arts’ talents of CHP’s residents. The group boarding home where she helped wake the enthusiasm and delight that the children took in children, serve breakfast, and get them out to these activities was quite moving to observe and the buses for school on time. She would also was an important step to reintegration within a accompany the children to their numerous ther- more normalized sense of community. apy appointments at Astor’s Community Clinic and to medical appointments. She attended school open house, teachers’ conferences, and any Provide a Sanctuary for Healing Committee for Special Education (CSE) meetings for her children. The Hyde Park Central The Sanctuary Model , a trauma-informed treat- School District (HPCSD) and its teachers were ment program developed by Sandra Bloom also part of the community network of support ( 2005) for the residential treatment of children and vital services for this family. Close coordina- was adapted from a program she developed for tion and communication with the school district the inpatient treatment of adults (Bloom, 1997 ) . was maintained by LaNora as well as the educa- Bloom developed a model for creating or chang- tional coordinator at CHP. Several of the children ing an organizational culture in order to more had learning problems and individual educational effectively provide a cohesive context within plans (IEPs) that required close monitoring. which healing from psychological and social LaNora was also deemed a full- fl edged mem- traumagenic experiences can be facilitated. CHP ber of the treatment team and participated with adopted this model in 2008 and since then has the staff in weekly treatment team meetings conducted extensive Sanctuary training for all where the progress of each child was reviewed. staff. Key features of the model include empow- The input and recommendations of the mother erment of children in placement through com- was highly valued by all team members. Since munity meetings and red fl ag meetings that can she knew her children far better than we, the team be called by any child or any staff member to often deferred to her judgment when deciding on address issues that are not going well in treat- changes to be made in the house or in the treatment. The latter meeting is a collaborative prob- ment plan. lem solving and strategizing meeting with the child and staff together generating creative solutions. The community meetings are designed to Support Normalizing Routines ensure that children and adolescents have a voice and Activities in small as well as large matters that arise within their living group. In their review of the research on disasters and The children also submit letters to the treat- their impact on child development, Masten and ment team to request certain privileges or consid- Osofsky (2010 ) stated the importance of support- erations and they are reviewed and responded to ing normalizing routines and activities after disas- by the treatment team at a weekly meeting. When ters. This was especially important for a family appropriate, children are included in the team that had not been allowed normalized activities. meetings to discuss certain requests or issues. 18 A Resilience Framework for Treating Severe Child Trauma 321

A unique feature of Bloom’s model is the empha- the foundation of their healing. Each of these chil- sis on the parallel process nature of chronic stress dren as well as their mother touched the hearts of as seen in the behavior of children and of staff, as our staff in unforgettable ways by their courage, well as the organization as a whole. The Sanctuary love, loyalty, and determination to heal. model creates a sense of community within the treatment environment that enriches the experience of community outside of the program. The Titrate Treatment According Sanctuary Model creates an environment of to a Dose–Response Gradient dignity and respect that should be the foundation of any trauma-informed treatment program. A key fi nding of research studies in severe child The Taliaferro children actively participated in trauma is that the response to disaster is often Sanctuary through community meetings, team let- determined by the severity of exposure sometimes ters, and participation in red fl ag meetings, and referred to as a “dose– response gradient” but is LaNora became the fi rst parent to go through the also in fl uenced by previous exposures to trauma complete Sanctuary training that we offer our and to the conditions either facilitating or hinder- staff. CHP introduced a new variation to the ing recovery (Masten & Osofsky, 2010 ) . Research Sanctuary model consistent with a strengths-based has also shown a differential effect of severe trauma model called a “green fl ag” meeting to recognize and disaster based on gender and age. Studies signi fi cant progress and success by a child in the reveal that females report more symptoms in program. response to trauma and disaster than males (Masten & Osofsky, 2010; Tolin & Foa, 2006 ) . Younger children are typically more vulnerable to trauma if Honor Strengths of Children it disrupts the quality of caregiving on which they and Families are so dependent (Osofsky, 2004 ) . Older children and adolescents, however, are at higher risk for CHP is so committed to the strengths-based severe trauma because they are typically less pro- approach that honors competence both in children tected from higher dose exposures to trauma (such and adults and the power of mind-sets (Brooks, as rape or military duty) and they also are more 2010 ) that it printed on the forms to be fi lled out aware than younger children of what is happening at every quarterly treatment plan review for each and its consequences (Masten & Osofsky, 2010 ) . child a section entitled: “Islands of Competence” Thus the treatment of severe trauma in children (Brooks, 1994 ) . As Brooks emphasized every can’t be a “one size fi ts all” approach. child has strengths, talents, assets, interests, as It should be noted that only three of the chil- well as their de fi cits or pathology but the change dren in the Taliaferro family were the biological process is greatly facilitated by punctuating the offspring of these two parents. The rest were strengths and highlighting the “islands of compe- adopted and without exception there were differ- tence.” By requiring all treatment plan reviews to ential trauma issues suffered by the children prior re fl ect on the child’s strengths and competencies to the adoptions. One of the children was the program ensures that the vital resources for identifi ed as experiencing a pervasive develop- growth and healing are not overlooked. Resilience mental disorder. Each of the adopted children theory and research fi nding are highly congruent came into the family already suffering a combi- with strengths-based treatment (Masten, Herbers, nation of biological vulnerabilities and exposure Cutuli, & Lafavor, 2008 ) . to psychosocial trauma. In spite of these chal- In the Taliaferro family it would have been lenges and the subsequent severe and prolonged easy to just focus on the pathology, to document exposure to trauma within the family, LaNora the damage. But each family member, the children and each of the children in individual ways as well as their mother, possessed unique strengths, manifested clear and unmistakable posttraumatic talents, and positive personal qualities that became growth and healing. 322 D.A. Crenshaw

NYC, eating out, and then taking a boat trip to Izabella: Transformation and Healing visit the Statue of Liberty and Ellis Island. Six months into the placement Izabella had enrolled Beginning Stage and was taking classes at Dutchess Community College. Izabella made a serious heartfelt invest- Space does not allow me to detail the posttrau- ment in her individual therapy and actively par- matic growth and healing of each member of the ticipated in family therapy. She also made good family but I will give an example. I should note use of the community services provided by that I did not pick Izabella ( fi ctitious name) Astor’s Bridges to Health program. because she has grown the most, and it would be In her individual therapy, Izabella worked hard to pick one on that basis because they each hard to confront the trauma issues that for a long made signifi cant developmental strides in their time the children were forced to remain silent own ways. Izabella, the second oldest, age 17 at about for fear of devastating retaliation. She had the time of placement, and a biological child of witnessed her father hold a gun to her mother’s the two parents had dropped out of school prior head on more than one occasion and had endured to removal from the family. Izabella said that the many a severe beating herself. The children, even reason she dropped out at the beginning of her the older ones, were seldom allowed outside of senior year was that she was taunted by other stu- the home except in the company of the father. If dents at the new school she entered because of they bore bruises or marks from beatings they the clothes she wore. Although this was likely a were kept home from school. It took several factor, a bigger reason, in my judgment, was that weeks after the children were placed before any Izabella was the protector of her mother and her of them could acknowledge what they had been siblings and she didn’t want to be away from through. home and then worry about her mother. The courage that Izabella showed in standing up to her father, when he was threatening or beat- The Healing Process Begins ing her mother or siblings, was amazing and a remarkable sign of resilience in itself. In spite of Once again, the mother took a leading role in the numerous beatings she received as a result of tak- healing process. We gathered the children ing these stands, she remains to this day protec- together in the living room at CHP after we had tive of both her mom and siblings. Another planned this intervention with the mother’s full feature stood out about Izabella when I fi rst met approval and support. LaNora said to the chil- her on the night that LaNora told the children that dren in a fi rm and courageous voice, “We are no their father had killed himself and in the days and longer going to keep secrets.” She explained to months following, was the clothes she wore. the children that she herself had suffered repeated Although a tall and strikingly pretty girl, she abuse by their father, had been locked in her wore no makeup even on special occasions; she room numerous times as punishment and she always wore baggy clothes, and her trademark will not remain silent any longer. Furthermore, heavily worn fl annel shirts. she told the kids that she wanted them to be truthful and to be able to talk about what they had experienced and they too no longer had to Return to School live in fear and remain silent. During that meeting and later that day in a separate meeting I had While in placement, Izabella returned to school with the three older girls including Izabella, the and completed high school. A graduation party disclosures began of the physical and sexual was planned by the program and Izabella’s abuse that two of the older girls experienced and mother that entailed the entire family along with Izabella disclosed the physical abuse that she some of the treatment staff going on a train to had suffered. 18 A Resilience Framework for Treating Severe Child Trauma 323

The Healing Deepens viewed as an overcorrection of the suppressed anger that she had contained for at least the After working hard in individual therapy for 8 past 10 years, her anger was expressed in less months, Izabella with her individual therapist at exaggerated form. The face she showed to the Astor Clinic decided she had reached a point of world and to us dramatically changed. It should maximum bene fi t from processing and working be noted that this same dramatic change in through the trauma experiences. Prior to self-presentation was seen in her mother and fi nishing her course of individual therapy as her siblings as well over the course of their part of an agreed upon therapeutic ritual, placement. Izabella was frequently seen smil- Izabella smashed to pieces in the yard at their ing and laughing and her mother and siblings home the stereo that her father used to play at as well as our entire staff saw a new, much loud volumes his country and western music happier Izabella. and that they had been forced to listen to for Izabella’s posttraumatic growth and healing hours at a time. was dramatically evident when she sent me a At one stage of the work when the children copy of a paper that she wrote for her college were preparing to move to the new home that English class about the day the children were CHP secured for the family to live together, we removed from the home. The paper was a mov- had a meeting with the family including their ing and gripping account of the terror that she mother to go over the ground rules. In this meet- and her siblings experienced on that last day ing, Izabella stormed out and slammed the door they spent with their father, the day they were extremely hard. It was the beginning of her removed from the home by CPS. The story she expressing overtly the anger that she had always wrote included the father leaving the house internalized but was not safe to express thus before the police arrived with a gun hidden in a leading to an anxious and depressed way of cereal box. functioning. We realized as a treatment team not only was this a healthy step in Izabella becoming comfortable with her anger and fi nally feeling Remarkable Courage safe enough to express it but that also we had been insensitive to the experience of these chil- A few weeks later after she shared her paper with dren. This family had been controlled in an me, I told Izabella that I was preparing a training extreme and sadistic way, therefore it was a mis- presentation on “Resilience and Hope” for the take to sit them down and go over a list of rules clinical and child care staff at CHP and asked if and restrictions without considering the impact she would like to read her paper to the group of on them. 60 or more staff. I asked her if she thought this would be helpful to her in her healing process. Izabella immediately agreed to do it and her mom An Amazing Transformation said she would also say a few words to our staff about what had been helpful and anything that Gradually an amazing transformation in we’ve done that was not helpful. Izabella’s self-presentation took place. No I told Izabella that it is a courageous thing to longer dressing in oversized clothes and rag- stand up in front of a large group of people, gedy fl annel shirts, she started to dress and mostly staff members she knew, but some far bet- look like the pretty 17-year-old girl that she ter than others, and that she could change her had never been allowed to be including wear- mind even up to the very last moment. But she ing makeup on special occasions. After another was there when that day arrived. When I gave a dramatic display of anger when she stormed brief introduction, Izabella stood up tall and out of one of our family therapy sessions, and proud, and started reading her story. She broke some angry clashes with her siblings, which I down in a few places; her mother was standing 324 D.A. Crenshaw right next to her with her arm around her, and for honoring of this family but also to recognize the a brief period when Izabella was sobbing her unique healing partnership created by the numer- mother took over the reading. But Izabella quickly ous community agencies. took the paper back and fi nished it. When she As the children were preparing for their dis- stopped I gave her a big hug and among the entire charge, they decided to make me the “honorary room full of people, there was hardly a dry eye. grandfather” of the family. Izabella explained that The staff stood up and gave Izabella and her along with their mother that “I had been there for mother a standing ovation. It is not something the family throughout.” This was a very meaning- that anyone who was there will ever forget. ful and generous act because the family had previ- I was so inspired by the courage, resilience, ously identifi ed that a pivotal point in the life of the irrepressible spirit of this family, the love of the family was the death of the maternal grandfather. children for their mother and her love for them The maternal grandfather was much loved in the that I wrote a tribute to the family in a poetry family and was very protective of the children, and book written to honor the healing mission of the father’s abuse and reign of terror did not begin the CHP called A Place of Healing and Hope until after his death. The family could not recall a (Crenshaw, 2010c ) . The tribute was called single happy Christmas after the grandfather died “A Place of Beauty.” 12 years ago until this past Christmas after the I want to write about a place of beauty. father’s death. I’ve never been so honored and I Although there is much beauty in the world around couldn’t be more proud of “my grandchildren.” us, This place of beauty in not in nature, But exists deeply in the hearts of a family I’ve been privileged to know. Summary

I want to write about courage. Stories of children triumphing over seemly impos- Courage abounds among heroic soldiers and fi re fi ghters. sible odds date back to Biblical times. It is not But I am talking about courage in a mother. reasonable to expect that any child regardless of Courage and heroism in her sons and daughters, circumstances will simply be able to arise above In a family I’ve been privileged to know. their circumstances because there are conditions I want to write about strength. that can overwhelm the best of resilience and Superheroes symbolize strength and power. some children by virtue of their biological, genetic But the strengths important to me are not about biceps or jumping off tall buildings. endowment and exposure to cumulative severe Rather these strengths show in a determination to trauma will simply be more vulnerable than oth- move past the pain ers. Repeated severe trauma can undermine the In a family I’ve been privileged to know. resilience that is part of the normal adaptation I want to write about goodness. processes of children. But neither should we There is plenty of evil but also much goodness in underestimate the resilient, innate healing forces the world. in children nor their awe-inspiring spirit. Recent Goodness abounds in people, in families as well. I’ve seen it as clear as a shiny star on a crystal clear research has shown that some children can emerge night from even the most severe trauma exposure and In the family I’ve been privileged to know (p. 28). resume their developmental stride when interven- In February of 2011, a heartwarming and joyous tion is comprehensive and multidimensional, rec- party celebrating the remarkable courage and ognizes and enlists the strengths and resources of resilience of this family was held at the Children’s the child, family, and community, and the treat- Home on the occasion of the discharge of the six ment program addresses in depth the wounds to children and the reuniting of the family after 11 the soul of the child and family in fl icted by the months in placement. The community of provid- blunt instrument of deliberate trauma. There is no ers were not only invited to come and join in this more challenging, nor rewarding work that a 18 A Resilience Framework for Treating Severe Child Trauma 325

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Nicole O ﬁ esh and Nancy Mather

In this chapter we address how the factors of risk and resilience affect children with learning dis- Learning Disabilities and Risk Factors abilities. Because learning disabilities encompass varied disorders associated primarily with For the child with learning disabilities, the school diffi culty learning, and due to the fact that time environment is riddled with conditions that place spent in school is a substantial part of the day, our the child at risk for negative experiences. Risk central focus is upon children attending school. can be de fi ned as the negative or potentially neg- Both positive and negative school experiences ative conditions that impede or threaten normal shape children’s self-perceptions and contribute development (Keogh & Weisner, 1993 ) . These to their academic self-concepts. Unfortunately, conditions can stem from both internal character- for many children with learning disabilities, their istics associated with the child’s disability and lowered academic self-perceptions are infl uenced external characteristics associated with people by diffi culties in both the academic and social and events in the child’s world. Risk factors then aspects of school (Vaughn & Elbaum, 1999 ) . In are the hazards or adverse events that increase the the fi rst part of this chapter, we discuss how self- likelihood of negative outcomes (Spekman, perception and, subsequently, resilience are Herman, & Vogel, 1993 ) . Because of dif fi culties shaped by school experiences. In the second part, at school, children with learning disabilities are we review various ways to help children with particularly vulnerable and experience ongoing learning disabilities increase their resiliency and challenges in their emotional, behavioral, and preserve their self-esteem and feelings of self- social development (Maag & Reid, 2006 ; worth. Montague, Enders, Dietz, Dixon, & Cavendish, 2008) . These students feel less competent than their peers in these areas as well as academically (Smith & Nagle, 1995 ) . Essentially, they become members of what Steele ( 1995 ) has described as an ability-stigmatized group. Fortunately since the writing of the fi rst edition of this chapter, a number of researchers have continued to identify N. O fi esh () both the factors that place children with learning Stanford University , disabilities at risk as a result of their disabilities Stanford , CA , USA e-mail: no fi [email protected] and several “success attributes” and factors that contribute to resilience (Goldberg, Higgins, N. Mather University of Arizona , Tucson , AZ , USA Raskind, & Herman, 2003 ; Lackaye & Margalit, e-mail: [email protected] 2006 ; McNamara & Willoughby, 2010 ) .

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 329 DOI 10.1007/978-1-4614-3661-4_19, © Springer Science+Business Media New York 2013 330 N. O ﬁ esh and N. Mather

Resilience is viewed less and less as a fi xed trait that is innate or as one that grows in response to a de fi cit. Instead, it is more often conceptualized as a dynamic quality that can be nurtured internally Fig. 19.1 Sorry I ripped it and externally, by the multiple places and ways individuals interact with children (Margalit, 2004 ) . As a child’s resilience increases, so do his could not think of how to spell the word, he or her abilities to cope with or overcome risk and decided to write about his pet rat. He thought for adversity (Doll & Lyon, 1998 ) . several minutes and then attempted to write the fi rst sentence. Feeling unhappy with both the content and the appearance of his writing, he ripped Dif fi culty Learning and School Failure the paper into several pieces. After recess, Edward asked Ms. Jaffe for some tape. Ready to try again, Although a learning disability in and of itself does he taped the pieces back together, and wrote the not predict positive or negative outcomes (Morrison following note, presented in Fig. 19.1 , on the top & Cosden, 1997 ) , many students with learning of his paper: “Sorry I ripped it.” Ms. Jaffe sat disabilities have a multitude of school experiences down with Edward and began to teach him a strat- that erode their feelings of confi dence and damage egy for writing. She taught him to brainstorm his their academic self-concepts (Gans, Kenny, & thoughts without paying attention to spelling at Ghany, 2003 ; Nalavany, Carawan, & Rennick, that moment. She explained they would edit the 2011 ) . The fi nding that many students with learn- paper together for spelling later. Edward was then ing disabilities maintain a positive global self-con- able to complete his description. cept despite poor feelings about how well they Edward’s attempt to try again is an example of perform in school is encouraging (Meltzer, 1995 ; resilient behavior; he is able to keep his academic Meltzer, Roditi, Houser, & Perlman, 1998 ) . This self-concept intact and persist on the task with suggests that fundamentally children with learning effort. Indeed a child who can maintain a positive disabilities seem to know that their dif fi culties are academic self-concept is more likely to persist in primarily academically related and do not re fl ect a areas that are diffi cult, as well as be perceived by summation of their self-worth. their teachers as working hard (Meltzer et al. Nevertheless, unlike an adult who has the 2004 ) . When Ms. Jaffe taught Edward a new option of choosing a career path that capitalizes strategy, she contributed to his future success. As on personal strengths, children with learning dis- Meltzer et al. write, abilities are often required to read, write, and per- When students with LD are successful academi- form math 5 days a week. Failed attempts at cally as a result of hard work and strategy use, they completing or mastering tasks result in feelings value these strategies and feel empowered to work of frustration rather than accomplishment (Lerner, hard and to recognize that their persistence will lead to academic success. (p. 42) 2000 ) . Moreover, elementary age children are oriented to the present moment; they encounter Ms. Jaffe is a powerful role model for teach- the struggles of each school day with the percep- ers. She was able to recognize Edward’s frustration that these school experiences will take place tion as well as intervene which is not always for the rest of their lives, with struggles that will commonplace. Lerner (2000 ) observed, “School last an eternity! is often a place that makes no allowances for the In describing a student with writing dif fi culties, shortcomings of these students, a place where Mather and Gregg ( 2003 ) provided the following teachers are unable to comprehend their illustration: On one afternoon, Ms. Jaffe, a third- dif fi culties” (p. 538). grade teacher, asked her students to write a Shawn is an example of a young woman who description of their favorite animal. Edward was not well understood during her school wanted to write about the giraffe, but because he years. During an evaluation to document her 19 Resilience and the Child with Learning Disabilities 331 learning disabilities and provide justi fi cations hopelessness becomes a barrier to future suc- for accommodations, Shawn, a college fresh- cesses (Brooks, 2001 ) . Moreover, students with man, shared her school experiences (B. J. learning disabilities who have negative self-per- Wendling, pers. comm., Feb 1, 2003). Shawn ceptions are likely to work less hard (but may described school as being fun until fi rst grade perceive themselves as working hard), be strat- when it all changed. She was placed in the bot- egy de fi cient, and be judged by their teachers as tom reading group but that was not low enough exerting less effort (Lackaye & Margalit, 2006 ; so the teacher made a new, lower group just for Meltzer et al., 2004 ) . Some may have dif fi culty her. She then repeated fi rst grade and remained forming an accurate perception of how hard they the sole member of the lowest reading group. try (Klassen & Lynch, 2007 ) . Shawn was fi rst tested for learning disabilities Shawn did not receive help until third grade. in second grade in the public school. Although By that time depression and anxiety had set in. she had signifi cant discrepancies between her Recent research underscores what Shawn and intelligence and basic reading and writing skills, many other children like her have experienced. the school determined that because her full- Students with learning disabilities demonstrate scale intelligence score was in the superior increased levels of anxiety and depression during range, she did not require services at that time. the public school period compared to students In third grade, the teacher wrote on her report without disabilities (Montague et al. 2008 ; card that Shawn was painfully aware of her read- Mugnaini, Lassi, La Malfa, & Albertini, 2009 ; ing diffi culties. She was evaluated again that year Sideridis, 2007 ) . Most recently, results from a at a hospital clinic and the diagnoses were (a) meta-analysis have indicated that students with developmental dyslexia, (b) fi ne motor weak- learning disabilities had statistically signifi cant nesses, (c) attentional dif fi culties, and (d) anxiety increased scores on measures of anxiety (Nelson and depression. The public school agreed to pro- & Harwood, 2011a ) . While research continues in vide services and Shawn received resource help this area, these students seem to be at higher risk through eighth grade. In high school, the coun- for developing, experiencing, and displaying selor encouraged her parents to discontinue spe- characteristics of both depression and anxiety, but cial education, stating that she would have a for many not to clinically signi fi cant levels (Maag better chance of being admitted to the college of & Reid, 2006 ; Nelson & Harwood, 2011a, 2011b ) . her choice if she were not enrolled in special edu- Thus many children do not receive the help they cation. She started college, but dropped out after need to reduce their anxiety which in turn can a couple of weeks because of anxiety over the cause additional processing problems especially academic load. Throughout school Shawn felt with attention, working memory, and executive she was struggling just to keep up and working functioning (Eysenck, Derakshan, Santos, & incredibly hard, but having few successes. Even Calvo, 2007 ) . Nelson and Harwood (2011b ) now she does not understand how she can be so found that parents and teachers rate students with smart about some things (e.g., oral language and learning disabilities as experiencing signifi cantly math), but then struggle so much with reading greater depression than students rate themselves. and spelling. She described that recently, while They speculate that one reason for this may be the reading a book to a child, she forgot how to sound dif fi culties some students with learning disabili- out a simple word. When spelling, she will some- ties have with the metacognitive skills necessary times forget how to spell even the most common to sense and understand their emotions. As we words. As with the case of Shawn, 50% of chil- discuss later in the chapter, teachers can play a dren later identi fi ed as having learning disabili- critical role in providing children with social ties are retained in the fi rst grade (McKinney, emotional support. Osborne, & Schulte, 1993 ) . Thus, a negative In a PBS video on learning disabilities, Last cycle is set in motion where the child believes One Picked, First One Picked On, Richard Lavoie that things will not improve, and this sense of provides an explanation using poker chips to 332 N. O fi esh and N. Mather illustrate how students with learning disabilities third grade. Maria admits that school is stressful gradually lose their resilience and are no longer and her self-esteem is very low. Even as adults, willing to take risks. The high-achieving student stress, anxiety, and a negative self-concept con- has many daily gratifying experiences that help tinue to be ever-present issues (Crawford, 2002 ; develop feelings of confi dence and self-worth. Shessel & Reiff, 1999 ) . Maria’s last comment, This student has thousands of poker chips from however, indicates that she is proud because she accomplishments, as well as peer, teacher, and was able to accomplish something independently. parental praise of acknowledgment and approval. In discussing how poor reading skill affects an When it is time to play, this student can afford to individual’s development, Fernald ( 1943 ) indi- make numerous bets and take risks with little to cated that the greatest liability is not poor reading lose and plenty of chips to spare. In contrast, a per se, but rather the emotional complex that student with learning disabilities often has daily accompanies the reading failure. Stanovich negative experiences and rejections that under- ( 1986) aptly described the broad impact of read- mine the development of self-worth and strip ing failure: away poker chips. This student clutches the small Slow reading acquisition has cognitive, behavioral, pile of poker chips fi rmly in one hand. Participation and motivational consequences that slow the devel- in a game only creates a fear of failure and the risk opment of other cognitive skills and inhibit perfor- of losing the few remaining chips. mance on many academic tasks. In short, as reading develops, other cognitive processes linked to it Even when they receive additional support and track the level of reading skill. Knowledge bases assistance, students with learning disabilities may that are in reciprocal relationships with reading are not feel more competent scholastically over time also inhibited from further development. The lon- (Smith & Nagle, 1995 ) . Figure 19.2 displays sev- ger this developmental sequence is allowed to continue, the more generalized the de fi cits will become, eral journal comments written by Maria, an eighth- seeping into more and more areas of cognition and grade student with reading and spelling dif fi culties. behavior. Or to put it more simply and sadly—in She has been receiving resource services since the words of a tearful 9-year-old, already failing frustratingly behind his peers in reading progress, “Reading affects everything you do.” (p. 390) In exploring the relationship between behavior problems and early reading performance, the results of one study indicated that fi rst graders with reading problems were more likely to display poor task engagement, poor self-control, and behavior problems in third grade. Unfortunately, they were also likely to still exhibit poor reading (Morgan, Farkas, Tufi s, & Sperling, 2008) . Morgan et al. reiterate the need to provide systematic early reading and behavioral interventions to children in need. To put it simply, as skills increase, so do resilient behaviors (Sorensen et al., 2003 ) .

Negative Teacher and Peer Feedback

Clearly, negative teacher and peer feedback contribute to feelings of low self-worth. At times, students’ completed products are greeted Fig. 19.2 Maria’s journal comments with comments that suggest that the assignment 19 Resilience and the Child with Learning Disabilities 333 is not their best work and refl ects limited effort. of failure are often readily apparent. Instead of Jason, a second grader with severe fi ne motor being supportive, the school environment often weaknesses, was assigned a worksheet for exposes what children do not know (Brooks & handwriting practice. After evaluating the Goldstein, 2001 ) . worksheet, the teacher placed a comment on the We are reminded of the Peanuts character top of the paper that stated: “Work carefully, Peppermint Patty who has trouble staying awake please.” This feedback suggests that Jason is in class. When she is not sleeping, she spends not putting forth his best effort and lacks moti- time analyzing the probability patterns of true/ vation. Similarly, a comment on Jason’s paper false tests, rather than attempting to read and from third grade, “Can’t read” conveys the actually answer the questions. In one cartoon, the teacher’s frustration over his poor handwriting, teacher asks Peppermint Patty to come to the rather than providing instructive, positive feed- front of the room to work out an arithmetic prob- back. One is tempted to respond to the comment lem on the blackboard. Patty ponders this request with a succinct reply: “Can’t write.” Although and inquires “in front of the whole class…at the the teacher’s feedback is most likely well inten- blackboard?” As she walks up to the board, she tioned, children frequently perceive these types comments: “Black, isn’t it?” For children with of comments in a negative and accusatory way learning dif fi culties, the fear of making mistakes (Brooks, 2001 ) ; they can cause disappointment, is a hidden presence that casts a dark shadow over increase vulnerability, and contribute to feel- what happens in the classroom (Brooks & ings of incompetence and inadequacy. Students Goldstein, 2001 ) . with learning disabilities want teachers who Even when teachers are supportive and under- acknowledge and praise them for their efforts standing, students with learning disabilities are and provide verbal encouragement. Many teach- often humiliated by their classmates’ performance ers are reluctant to praise children if they do not in comparison to their low levels of academic see “successful performance” (Klassen & skills, as well as their dif fi culties mastering Lynch, 2007 ) . While academic achievement is specifi c tasks. The child feels like an impostor one of the best ways to increase social emo- worried about exposure, and the wounds caused tional well-being, simple encouragement and by early experiences never heal (Salza, 2003 ; praise can help students increase their academic Shessel & Reiff, 1999 ) . Spence, a fi fth grader, competence. Without positive teacher feedback, recalls the parting words of a classmate retreating the child may attempt to hide his or her lower from a playground argument: “Well, guess who levels of academic competence. In her autobi- goes to the resource room. Guess who has a learn- ography, Crawford (2002 ) described how she ing disability. You’re a retard, man.” Although would try to avoid humiliation in third grade by Spence shared the experience with his teacher and sitting in a beanbag chair pretending to be read- the young man was rebuked, the damage to ing. She noted: Spence’s self-esteem had already been done. I couldn’t even understand what I was reading; Similarly during an evaluation, Ben, an adolescent I couldn’t remember any of what the teachers had in seventh grade, stated, “I want you to help me taught us. I wanted it to end. I would run away in get out of RSP (resource specialist program) my mind to a place that was safe, my own world in ‘cause everyone at school knows it stands for which I was the winner, in which I was recognized for what I could do. NO MORE BOOKS! With the Really Stupid People.” Ben’s comments are not tears streaming down my face, I would still pretend surprising given that children with learning dis- to read, but I knew the truth; I knew it was useless. abilities tend to want the same activities, books, (p. 71) homework, grading criteria, and grouping prac- Some individuals will even refuse to do a task or tices as their classmates (Klassen & Lynch, 2007 ; participate in an activity, rather than risk humili- Klingner & Vaughn, 1999) . Especially during ation by revealing incompetence. When called adolescence and secondary school, students are at upon in class, the child’s apprehension and fear risk for a depression in relation to self-concept 334 N. O fi esh and N. Mather

(Montague et al., 2008 ) and have a strong desire speci fi c nature and characteristics of the condition. to simply fi t in and not be seen as different (Bender, In reality, the term “learning disabilities” is 2008 ) . Yet for many children with learning dis- vague, nondescript, and only causes confusion. abilities, the social and emotional problems they Instead, it is more accurate to refer to domain- experience are not predicted by where they receive speci fi c disabilities, such as reading disabilities, special education support (e.g., resource room, writing disabilities, math disabilities, or nonver- self-contained class, or general education setting) bal learning disabilities (Stanovich, 1999 ) , and (Wiener & Tardif, 2004) . Spekman, Goldberg, to label and treat them separately. In addition to and Herman (1993 ) observed, “They may enter making the descriptor more accurate, speci fi c school eager to learn and with expectations for labels also help to convey that the problem is success, but then run head-on into academic circumscribed and not global in nature. Moreover, diffi culties, extreme frustration, feelings of being some types of learning disabilities exacerbate different or retarded, peer rejection, and resultant speci fi c risk factors. For example, despite good low self-esteem and confi dence” (p. 12). verbal skills, students with nonverbal learning It is not uncommon to hear adults with learn- disabilities demonstrate markedly de fi cient ing disabilities share painful experiences of being social skills (Galway & Metsala, 2011) , placing teased, bullied, and ridiculed during their school them substantially at risk for alienating teachers years (Higgins, Raskind, Goldberg, & Herman, and peers who could provide needed support. In 2002 ) . Their perceptions of being different addition, some evidence suggests that students resulted in feelings of fear, confusion, and anger. who are less academically adept and those who These adults described these school-age misun- have nonverbal learning disabilities are less derstandings as being traumatic and as resulting resilient and manifest higher rates of both depres- in humiliation, emotional insecurity, and self- sion and suicide (Bender, Rosenkrans, & Crane, doubt (McNulty, 2003 ) . During interviews, 14 1999 ) . postsecondary students with learning disabilities described their repeated struggles and adversity, as well as the lasting emotional scarring of learn- Social Support and Competence ing differently (Orr & Goodman, 2010 ) . The combination of the disability and people’s Social support is considered an index of resil- responses to it can create personal disruption and iency in that it serves as a stress-buffering condi- devastation (Crawford, 2002 ) . Crawford recalls tion (Robertson, Harding, & Morrison, 1998 ) . her feelings about failure: “There’s nothing worse Subsequently, students who lack the ability to than failing every day: My body would shake, my create and maintain relationships tend to lose the stomach would ache, my head would pound with support network needed to resolve life’s chal- pain, and I would cast my eyes down in an attempt lenges and crises. In addition to academic to hide the tears” (p. 71). In addition to repeated diffi culties, many students with learning disabili- failure experiences, several other factors also ties experience problems with peer acceptance affect the development of resiliency. and are more neglected and rejected than peers (Kuhne & Wiener, 2000 ) . This lack of peer acceptance may be partially because children with Type and Severity of Learning learning disabilities appear to have limited inter- Disability personal understanding, resulting in social dif fi culties in the classroom (Kravetz, Faust, The type and severity of the learning disability Lipshitz, & Shalhav, 1999 ) , on the playground, appear to in fl uence the level of resilience and and with problem-solving (Elliot & McKinnie, long-term outcomes ( Spekman, Goldberg, et al., 1994 ; Vaughn & Haager, 1994 ) . Regardless, the 1993 ; Spekman, Herman, et al., 1993 ; Wong, individual’s social life also impacts academic 2003 ) , and thus, it is necessary to determine the learning (Bryan, 2003 ) . 19 Resilience and the Child with Learning Disabilities 335

Lindsey, a fourth-grade student with a nonver- worked for himself. He recently said his biggest bal learning disability, described the experience challenge was making sure he understood what of being unaccepted by and then losing her his customers wanted, but he had developed strat- friends: “When I see other friends teasing each egies for double checking his understanding. other about food on their clothes or toilet paper Sorensen et al. ( 2003) observed: “From a mental on their shoes, everyone laughs and they’re still health perspective, special education services all friends…but whenever I try to make a joke may need to focus not only on helping children about one of my friends, they’re not my friend acquire skills, but also on helping them develop anymore and nobody laughs…they just don’t like strategies for coping with their learning impair- me anymore.” For some students, dif fi culty with ment in the very setting where this impairment social competence can stem from their diffi culty can be expected to be most stressful for them” in understanding and using language, as well as (pp. 20Ð21). reading social cues (Robertson et al., 1998 ) . As In one study some individuals who spoke with students with nonverbal learning disabili- about growing up with a learning disability shared ties, students with language-based learning dis- social diffi culties across several contexts beyond abilities are atypically at risk for school and peer school such as work, recreation, or family set- alienation and school dropout (Morrison & tings. These individuals did not know where or D’Incau, 1997 ; Voeller, 1991 ) . In the earliest how to meet new people, how to make or sustain grades teachers often suspect the child has a hear- friendships, and they developed romantic rela- ing problem because they present with such pecu- tionships later than their peers (Goldberg et al., liar responses to directions. 2003) . Interestingly, several studies have indi- For example, Ms. Martin commented that dur- cated that despite their lower level of social func- ing the fi rst few weeks of school, one of her fi rst- tioning, students with learning disabilities tend to grade students, Ralph, who had yet to be feel positive about how their teachers and peers diagnosed as having a language-based learning view them (Morrison, 1985 ; Robertson et al., disability, wrote his name anywhere on the front 1998 ) though the quality of relating and friend- of a sheet of paper when told to “write your name ships may differ (Wiener & Tardif, 2004 ) . This at the “top” of the paper.” Puzzled by his behav- discrepancy between the real and perceived ior and the observation that he did not model the events can in fact be a result of the disability itself behavior of his peers, Ms. Martin asked Ralph to (Palombo, 2001 ) or simply a coping mechanism show her where the bottom of the paper was. He (Robertson et al., 1998 ) . It may also be evidence turned it over and pointed to the backside. Ralph of the resilience that parents, teachers, and pro- was an avid swimmer who conceptualized the fessionals seek to foster when they help students terms top and bottom as he would in the swim- with learning disabilities understand the nature of ming pool. It made perfect sense to him—and to their disability (Kloomok & Cosden, 1994 ; Ms. Martin once she fi gured it out. Fortunately, Palombo, 2001 ; Sorensen et al., 2003 ) . as an extremely supportive teacher, she quickly demonstrated to Ralph where to place his name on the paper and how top and bottom could mean Gender slightly different places on a paper and within a pool. Over the years, Ralph’s problems with lan- Although both boys and girls with learning dis- guage comprehension caused him to get in trou- abilities can encounter social diffi culties, some ble with teachers and peers on the playground believe that gender may also play a role in the although he rarely understood why. Through response of children to social failure (Settle & much role playing with the school’s speech and Milich, 1999 ; Wong, 2003 ) , as well as the protec- language specialist, he was able to successfully tive factors that they develop. Recent research navigate the social dynamics of school. As an shows no differences between boys and girls, adult he became a cabinet maker and happily across grade levels with the risk factors of anxiety, 336 N. O fi esh and N. Mather depression, and academic self-concept (Montague positive adult outcomes once they leave school et al., 2008; Nelson & Harwood, 2011a ) . While (Goldberg et al., 2003 ) . more research has been conducted on the risk and How then can we increase children’s successes protective factors that affect males (Morrison & in school? A variety of protective factors appear Cosden, 1997 ) , several studies have described to help children with learning disabilities over- differences between factors affecting risk and come risk and cultivate resiliency, the ability to resiliency in boys and girls. For example, in one spring back from the negative outcomes associ- study, in order to make a successful transition ated with stress factors and risks (Bender et al., into adulthood, intrinsic characteristics such as 1999 ) . Protective factors are those life situations temperament and self-concept were more impor- or events that enhance the chances of positive tant for females, whereas outside sources of sup- outcomes (Keogh & Weisner, 1993 ) . Several pro- port from the family and community made a tective factors that appear to mitigate positive greater difference in the lives of males (Werner, outcomes for children with learning disabilities 1993, 1999 ) . are discussed.

Strategies for Building Resilience Promote Self-Understanding and Acceptance Fortunately, many individuals with learning disabilities do succeed and regain confi dence in later One critical factor for overcoming risk appears to years once they enter adulthood and the work- be self-understanding, acceptance, and a feeling force. In a longitudinal study, Werner (1999 ) of control over one’s life. In studying successful found that between the ages of 10Ð18, only one adults with learning disabilities, Gerber, Ginsberg, out of four children with learning disabilities had and Reiff ( 1992 ) found that having a sense of improved their academic and social status, but by control over their lives was the most critical fac- the age of 32, three out of the four individuals had tor. One way that individuals are able to take con- improved and had adapted successfully to the trol of their lives is by setting realistic goals that demands of work, marriage, and family life. are possible to achieve. The capacity to accom- Another longitudinal study found clear predictors plish goals is in fl uenced by the accuracy of one’s of success for individuals with learning disabili- self-knowledge and self-perceptions (Nalavany, ties and underscored the importance of working Carawan, & Rennick, 2011 ) . In fact, the central on social emotional factors as much as academic problem is not the disability, but the capacity to skills (Goldberg et al., 2003 ; Raskind, Goldberg, confront the various challenges that one faces in Higgins, & Herman, 1999 ) . These fi ndings sug- living with and overcoming it (Gerber & Ginsberg, gest that many individuals with learning disabili- 1990 ) . Individuals who have a greater under- ties are able to succeed in life. The fact that so standing of their disability are more likely to many of these individuals have positive adult out- adjust successfully to adult life because they seek comes points to the powerful role of environmen- help when needed and fi nd educational and voca- tal factors (Dyson, 2003 ; Wong, 2003 ) . Many tional opportunities that incorporate their adults with learning disabilities fi nd innovative strengths (Cosden, 2001 ; Nalavany et al., 2011 ) . ways to teach themselves and thus prove that the Goldberg et al. ( 2003 ) found that successful indi- ability to learn was always present, but perhaps, viduals with learning disabilities set goals that the knowledge of how to teach these individuals were specifi c but fl exible; included a strategy; was absent (Reiff, Gerber, & Ginsberg, 1993 ) . and appeared to be concrete, realistic, and attain- The successful experiences of many adults with able. Moreover, many of the successful adults in learning disabilities indicate that children raised their longitudinal study indicated that their goals with multiple risk factors can still achieve had been with them since their youth, and had 19 Resilience and the Child with Learning Disabilities 337 provided both meaning and direction to their that the most successful participants accepted lives. their learning disability and could talk about Without an understanding of their disability, their strengths, as well as their weaknesses. students with learning disabilities have been Understanding of the disability and self-awareness described as having an external locus of control, then form protective factors that facilitate or attributing their academic performance to rea- lowered levels of anxiety and provide the foun- sons outside of their own thoughts and behaviors dation for acceptance (Morrison & Cosden, (Borkowski, Carr, Rellinger, & Pressley, 1990 ) . 1997; Vogel, Hruby, & Adelman, 1993 ) . Moreover, They often attribute their academic successes to Dyson (2003 ) found that as time passed after a external factors such as luck or that the task was clinical evaluation, parents felt they understood too easy. After several trials of reteaching, Andy, their child better and reported a decline in their a fourth-grade boy with a mathematics disability, child’s depression and adjustment problems and correctly solved a double-digit multiplication improvement in conduct. Seth’s disability service problem. In an effort to reinforce the correct pro- provider helped him to learn about his disability cedure, his teacher enthusiastically asked Andy in college. He wrote, how he fi gured it out. His response was, “Well “She looked at my fi les and we sat and talked about Ms. Hill, I guess it’s just my lucky day.” Andy my disability. She wanted all the students with simply could not see how his effort could disabilities to really know what their disability was in fl uence the events in his life. so that when they asked for help, they could explain their own strengths and weaknesses. She always Since research has shown that an internal locus was a person that would encourage you.” (Orr & of control contributes to resilience (Blocker & Goodman, 2010 , p. 221) Copeland, 1994 ; Wyman, Cowen, Work, & Keriey, 1993 ) , teachers and parents need to Counselors and therapists can also help chil- explicitly convey and support the relationships dren with learning disabilities increase their self- between a child’s efforts and the positive out- understanding. Palombo ( 2001 ) advised that to comes of those efforts. Instead of just saying, treat children with learning disorders successfully, “Wow, you did a great job,” students need to hear the therapist must both understand the effects of comments like: “Do you see how that strategy the learning disorder on the child, as well as be worked for you?” “You are listening carefully able to distinguish between thoughts and behav- and looking at me.” “You remembered to bring iors caused by the disorder from those resulting your homework back,” “Do you see that you can from a reaction to the disorder. For example, a understand these problems when you ask for therapist must be able to distinguish if a child did help?” With specifi c praise, children can know not comply with a parent’s or teacher’s request due exactly which behaviors have worked and what is to diffi culty understanding or following directions, expected (Smith, 2003a ) . or if the noncompliance was a result of depression In one study, college students with and with- resulting from an external event. Parents and out learning disabilities differed signi fi cantly on teachers often misunderstand these children resilience, stress, and need for achievement, but because they do not recognize that the child’s not on locus of control (Hall, Spruill, & Webster, thoughts are neurologically driven, rather than 2002 ) . We can learn from these students with motivated by psychological factors. To illustrate learning disabilities who have successfully this point, Palombo provided the following example: entered postsecondary education about the “Simply put there is a failure to distinguish between importance of teaching students how to under- ‘she won’t’ and ‘she can’t.’ A child with dyslexia stand the nature of their diffi culties and how does not fail to learn to read because she does not their efforts can pay off. In a 20-year longitudi- want to learn but because she cannot learn” (p. 7). nal project tracing the lives of individuals with In discussing and explaining the learning dis- learning disabilities, Higgins et al. ( 2002 ) found ability to the student, parents and teachers need to 338 N. O fi esh and N. Mather be open, honest, and supportive (Miller & Fritz, Successful individuals with learning disabilities 1998 ) . As with the college students in the Hall have at least one person in their lives who accepts et al. ( 2002 ) study, Gerber et al. ( 1992 ) found that them unconditionally and serves as a mentor who successful adults understood and accepted their acts as the “gatekeeper for the future” (Werner, learning disabilities. They wanted to succeed, set 1993 ; Wong, 2003 ) . Hallowell ( 2003 ) recalled achievable goals, and confronted their learning how he struggled to learn to read in fi rst grade. As disabilities (Gerber & Ginsberg, 1990 ) . In addi- he tried to pronounce the words, his teacher, tion to understanding one’s strengths and weak- Mrs. Eldredge, put her arm around him protec- nesses, the person must also be able to see himself tively and took away his fear of learning to read. or herself as being more than “learning disabled” Now as a psychiatrist, he still recalls the power of (Bender et al., 1999 ) . Some successful adults are her arm and the effect it had on his able to reframe their learning disabilities in a pos- development: itive light so that the disability itself functions as “None of this would have happened had it not been a protective factor, making them stronger, more for Mrs. Eldredge’s arm. That arm has stayed around resilient, and more self-actualized (Gerber, Reiff, me ever since fi rst grade. Even though Mrs. Eldredge & Ginsberg, 1996 ; Shessel & Reiff, 1999 ) . resides now in heaven, perhaps reclining on an actual cloud as I write these words, she continues to Smith (1989 ) described the different types of help me, her arm to protect me, and I continue to masks that students with learning disabilities thank her for it, almost every day.” (p. 7) wear to hide their poor skills. Often they fi rst put on these masks in fi rst or second grade when they Teachers play a signi fi cant role in fostering realize that they cannot read like the other stu- resilience because through daily encounters, dents. She encouraged teachers to recognize the they are able to address the child’s emotional, as common masks that students wear to hide their well as academic, needs (Segal, 1988 ; Werner, inabilities: helplessness, invisibility, the clown, 1993 ) . Children with LD who have the mentor- and the victim. When students realize why they ing relationship of an adult during adolescence are having dif fi culties learning and that they are have a greater likelihood of high school comple- not stupid, the masks can be removed and the tion and improved self-esteem. Moreover, this problems treated. same research indicates that teachers and guidance counselors who have cultivated meaningful relationships with their students have a greater The Role of Supportive Adults impact on high school completion than other types of adult mentors (Ahrens, DuBois, Lozano, Supportive adults or mentors are able to foster & Richardson, 2010 ) . Thus, educators have the trust and bolster the self-esteem of children with power to offset certain risk factors as they touch learning disabilities (Bender et al., 1999 ; Brooks, the mind, heart, and spirit of children by creating 2001 ; Werner, 1993, 1999; Wong, 2003 ) . school climates where all students will succeed Oftentimes teachers in the school environment (Brooks, 2001 ) . They provide children with pos- can serve as protective factors for children. In itive experiences that enhance their self-esteem describing the characteristics of resilient chil- and competence, thereby reinforcing their resil- dren, Segal (1988 ) wrote: ience (Brooks, 1991 ; Rutter, 1985 ) . They teach From studies conducted around the world, children not to be afraid of making mistakes and researchers have distilled a number of factors that help students appreciate that mistakes are part of enable such children of misfortune to beat the the learning process (Brooks & Goldstein, 2001 ) . heavy odds against them. One factor turns out to The long-term educational benefi ts from posi- be the presence in their lives of a charismatic adult, a person with whom they can identify and tive school experiences stem more from chil- from whom they gather strength. And in a surpris- dren’s attitudes toward learning and their ing number of cases that person turns out to be a self-esteem than from what they are speci fi cally teacher. (p. 2) taught (Rutter, 1985 ) . Orr and Goodman ( 2010 ) 19 Resilience and the Child with Learning Disabilities 339 collected statements from postsecondary stu- tors that will reduce the negative impact of a dents with learning disabilities regarding those learning disability (Werner, 1999 ) . Caring par- individuals who had supported them along ents and teachers can help preserve the through school. One student commented on a self-esteem of children. person who inspired her in high school. She explained that this teacher consultant was, “… the one person that told me I need to go to col- Provide School-Based Intensive lege, and that I was smart” (p. 221). Another par- Interventions ticipant commented about a counselor who had particularly inspired her. She wrote, “He pulled Within the school setting, teachers and adminis- me to the side and asked if I needed help. He trators have to recognize that a child’s psycho- helped me put things into perspective, think logical, academic, and social well-being should about what I was doing with my life” (p. 221). be addressed. In a meta-analytic review of 64 Parental support is another key factor that intervention studies, Elbaum and Vaughn ( 2001 ) helps children develop a healthy perspective of found that the types of interventions that were self (Cosden, Brown, & Elliott, 2002 ) . Parents or effective varied based upon grade level. The guardians can advocate for their children in interventions that were most effective in elemen- school and provide emotional support (Wiener, tary schools were those that directly focused on 2003 ) . Individuals with learning disabilities who improving academic performance, requiring con- have positive adult outcomes grow up in home siderable time and intensity. In middle school environments that foster emotional stability and high school, counseling interventions were (Hechtman, 1991 ) . In addition, parental accep- more effective. In general, interventions were more tance of academic limitations, as well as acknowl- effective with middle school students than they edgment of strengths, may reduce the stress were with elementary or high school students. caused by the learning disability (Morrison & The extent of positive impact depends upon the Cosden, 1997 ) . Individuals with learning disabil- type and quality of service, as well as the depth ities who became successful adults re fl ected on and breadth of intervention (Spekman, Goldberg, their relationships with their families and how et al., 1993 ; Spekman, Herman, et al., 1993 ) . A their families had shaped their lives. In their large and growing body of literature emphasizes descriptions they stressed that their families had two important points. First, academic achieve- been extraordinarily supportive, had provided ment is a protective factor; when we fi nd ways to them with fi nancial support and a healthy depen- teach children with learning disabilities strategies dence, and an understanding that the learning dis- to succeed, they are more likely to thrive. Second, abilities had caused at times stresses on particular providing instruction in social emotional skills, family members (Goldberg et al., 2003 ) . After including self-awareness, is just as important as reading a long email from a teacher, describing teaching academic skills. her daughter’s most recent failure to meet the Vogel et al. (1993 ) found that the availability requirements of a middle school assignment, of long-term tutoring and one-to-one instruction Annie’s mother wrote, “I hate to see her so characterized the education of successful adults defeated. I will be her cheerleader today. It is with learning disabilities. Unfortunately, many hard because I get down too and I know I have to students with learning disabilities do not receive stay up…recognize her struggle but keep her differentiated instruction and, with continued going.” Parents and teachers, sometimes together, failures, their perceptions of their academic com- sometimes alone, often end up not only being a petence are diminished. Schumm, Moody, and cheerleader, but the entire cheerleading squad. Vaughn ( 2000 ) interviewed third-grade teachers Thus, an interdisciplinary effort among parents, and students with learning disabilities. Overall, teachers, pediatricians, therapists, and psycholo- the teachers reported using whole-class instruc- gists is needed to forge a chain of protective faction that included the same materials for all stu- 340 N. O fi esh and N. Mather dents in the class regardless of levels of learning disabilities require intensive and explicit performance. All students were expected to read instruction that focuses on their specifi c needs grade-level materials even if they could not read (Schumm et al., 2000 ) . Additionally, participants the words in the material. Furthermore, students in one study were seen to lack metacognitive with learning disabilities did not receive instruc- skills, but be very aware of what they wanted tion directed at improving their word analysis from teachers. These adolescents wished for help skills. One teacher voiced strong opposition to that was discreetly provided by teachers sensitive providing instruction in word analysis: “By the to the fact they are self-conscious adolescents, time they come to third grade they really should and that these teachers offered help to the whole have those skills” (p. 483). With undifferentiated class rather than only to the students with learn- instruction and minimal direct instruction in reading disabilities (Klassen & Lynch, 2007 ) . ing, the students with learning disabilities made little academic improvement and their attitudes about reading declined. In contrast to general Select the Most Appropriate education placements, the identi fi cation process Placement resulting in placement in special education programs does not appear to negatively affect the Students with learning disabilities need a social self-concept of students with learning disabili- environment that supports their academic efforts ties, at least within the early grades (Vaughn, and sustains their achievement (Elbaum & Haager, Hogan, & Kouzekanani, 1992 ) . Vaughn, 2001 ) . Although the fi eld continues to To address students’ learning disparities, debate the most appropriate service delivery sys- teachers must help students make as much aca- tem for children with learning disabilities, demic progress as possible. This cannot be fi ndings from studies addressing self-concept and accomplished by having the student use the same educational placements (general education, educational materials as their classmates. The resource room, or self-contained) are equivocal, academic diffi culties of children with learning and no one placement is clearly preferable to problems are chronic, even when they have indi- another (Wiener & Tardif, 2004 ) . The continuum vidualized educational plans (Sorensen et al., of placements must be preserved in order to 2003 ) . A student with learning disabilities increase the likelihood that children will be able requires differentiated, carefully engineered edu- to get the individualized instruction they need. cational programming. Although the student Elbaum found that some studies showed must be treated as equitably as others, the type of higher self-concepts for students in more restric- instruction that is provided will differ substantive settings; others showed higher self-concept tially from that provided to students without for students in less restrictive settings; and still learning disabilities. In the short run, students others showed no difference. The age of the stu- who are behind in reading may feel better about dent can also affect his or her response to the type their reading abilities if they have the same books of classroom placement. Howard and Tryon as their peers; but in the long run, if their skills do ( 2002) investigated the relationship of depressive not improve, they will have little basis for posi- symptomology in a sample of adolescents with tive self-perceptions of their academic compe- learning disabilities placed in general education tence (Vaughn & Elbaum, 1999 ) . Even the same or self-contained classrooms. Although their self- students who reported wanting to have the same ratings did not differ based upon the type of materials as their peers explained that they “… placement, the guidance counselors rated the stu- value teachers who slow down instruction when dents with learning disabilities in general educa- needed, explain concepts and assignments clearly, tion classes as being more depressed than those teach learning strategies, and teach the same in self-contained classes. This fi nding suggests material differently so that everyone can learn” that negative teacher and peer feedback can be (Klingner & Vaughn, 1999 , p. 23). Students with more prevalent in inclusive settings and that sen- 19 Resilience and the Child with Learning Disabilities 341 sitivity to disability may be less than that experi- disabilities. However, even though their grades enced in self-contained settings. were lower, they performed closer to grade In another study, children with learning level in both reading and mathematics than disabilities in four types of special education peers who did not take as many general educa- settings were compared in terms of social accep- tion classes (Blackorby, Chorost, Garza, & tance, number of friends, quality of friendships, Guzman, 2003 ) . As Wagner et al. (2003 ) quality of relationship with best friends, self- wrote, “Poor grades can send a message of concept, loneliness, depression, social skills, and failure to youth that could militate against the problem behaviors. The results suggested a pref- bene fi ts of inclusion and erode the commit- erence toward the inclusive classroom for social ment to school over time” (p. 12). and emotional adjustment; however, the research- One fact is clear: students with learning dis- ers suggested that given the size of the differences abilities need a strong support system throughout it would be inappropriate to conclude that the their school careers. This system can help pre- major variable infl uencing social and emotional serve self-concept and self-worth by: (a) keeping adjustment is the special education placement failure at a minimum, (b) increasing acknowledg- (Wiener & Tardif, 2004 ) . The National ment of nonacademic talents and other compe- Longitudinal Transition Study 2 (NLTS2) is a tencies, and (c) emphasizing learning goals over comprehensive report that provides an analysis of performance goals (Lerner, 2000 ) . A learning a large number of factors that in fl uence the edu- goal rewards effort, even though the fi nal product cation of children with disabilities (Wagner et al., (the performance goal) can be partially complete 2003 ) . The authors underscore that school pro- or incorrect. Because social life and status impact grams, support services, and other experiences school learning (Bryan, 2003 ) , to ensure that have a signifi cant infl uence on children with dis- children with learning disabilities succeed, their abilities, particularly in the domains of academic feelings of low self-worth and self-esteem must engagement and performance (Wagner et al., also be addressed. Whether a child receives ser- 2003 ) . The NLTS2 research team identi fi ed many vices in a resource room or in a general education factors that relate to better school outcomes for class, the child needs to be in an academic envi- students with disabilities. Based on these fi ndings ronment that is safe and secure so that learning parents are encouraged to: will fl ourish (Brooks, 2001 ) . When school teams ¥ Maintain high expectations for future educa- are making decisions about educational place- tion and independence ment, they should consider the student’s own ¥ Stay actively involved in the child’s school preferences, as well as his or her academic, social, experiences and emotional needs (Elbaum, 2002 ) . Some evi- ¥ Support extracurricular activities dence suggests students with learning disabilities prefer resource services or pull-out programs to Teachers and parents are encouraged to: in-class service delivery (Jenkins & Heinen, ¥ Teach persistence at home and at school. The 1989 ; Le Mare & de la Ronde, 2000 ) . Regardless importance of persistence is tremendous of the placement, school environments must be (Wagner et al., 2003 ) benevolent, supportive, and developmentally ¥ Teach social skills appropriate for all children (Bryan, 2003 ) . ¥ Carefully consider placement in general education classrooms. ¥ Results are mixed in terms of advantages and Acknowledge Accomplishments disadvantages of placement: while the general in Nonacademic Domains education setting fostered both learning and social skills, grades earned by students with Another way to foster resilience is to support disabilities in the general education classroom positive development in other areas of perfor- tended to be lower than their peers without mance besides traditional school subjects 342 N. O fi esh and N. Mather

(Werner, 1999 ) . Unfortunately, many parents and across the sand and struggles mightily for every teachers often feel that if they take away the inch of ground she covers. She looks awkward, vulnerable, disabled, and poorly adapted. Consider activity the child enjoys the most and use it as a the same green sea turtle swimming in the ocean. reward, it can motivate the child to perform She swims with power and grace, dives deep, academically. These adults need to be reminded stays down for long periods of time, and comes up that all children need to experience success, and practically dry! Schools can and must give children, at the least, a glimpse and perhaps a taste of the sea caution should be used when taking away the one to which they are headed as they struggle across thing that makes a child smile, relax, or feel that this patch of ground we call school.” (p. 27) he or she is indeed good at something. Harter’s (1985 ) multidimensional model of self-concept Thus, it is important to recognize and acknowl- includes the following six domains of self-per- edge the unique talents of individuals with learn- ception: academic, social, athletic, physical, ing disabilities and to remind them that successful behavioral, and global self-worth. Although stu- school performance does not guarantee or negate dents with learning disabilities often have lower successful life outcomes. Young children do not academic self-concepts than their peers, success- have the ability to shift their perspective on their ful accomplishments in other domains can help own. Parents and teachers need to help them real- offset low academic self-perceptions and help ize that a report card does not refl ect how suc- students maintain self-esteem (Smith & Nagle, cessful they will be as an adult; furthermore they 1995; Vaughn & Elbaum, 1999 ) . Success in any need to be reminded that school is not a life sen- arena of life leads to enhanced self-esteem and a tence! At some point, they will be able to choose feeling of self-ef fi cacy (Rutter, 1985 ) . Students where and how they learn, as well as what they with learning disabilities often fi nd success in a do. This is big news to an elementary school child nonacademic arena, such as sports, the arts, or who has already started to compare her grades technology. with that of her classmates and wonder if life will In a posting to a listserv, Mary Per fi tt-Nelson always be like it is on report card day. (2002 ) noted how different schools would be if The late Sally Smith, founder of the Lab the curriculum, rules, materials, and tests were School in Washington, DC, wrote, “The most developed by artists, musicians, athletes, or math- important help that parents and teachers can give ematicians. She wrote: is to dig deep into the secret, unseen pockets of “We meet and discuss kids and how they are doing their children and students and search for the in our environment. If they are not excelling, few treasures. All of us have talent in something” of us even consider that the environment is not sup- (Smith, 2003b , p. 44). Many individuals have porting the student’s strengths. Changing the envi- successful lives despite having a learning disabil- ronment is rarely considered, nor is it even thought necessary. Districts have done away with technical ity. They develop positive attitudes toward them- courses. We are left with some variation of the col- selves and life. Werner (1993 ) found that a lege track, where the failure rate is astounding. positive temperament did not reduce negative And yet each child could be an expert in some area. outcomes in late adolescence, but did predict It is important that we help the mathematicians and musicians fi nd their way during the 12 years they positive adjustment by the age of 32. must spend in a place designed for someone else.”

Salza (2003 ) expressed similar sentiments and Acknowledge Accomplishments provided the following analogy to illustrate how in Academic Domains the success of adults with dyslexia is often unexpected because we incorrectly assume that the For many students with learning disabilities, the skills needed for school success are the same as problems are circumscribed or domain-specifi c. those needed for life success: For example, the student can struggle with read- “Consider the giant green sea turtle lumbering ing, but excel in math or science. Or the student across the sand to lay her eggs. She heaves herself can be an avid reader, but experience great 19 Resilience and the Child with Learning Disabilities 343 diffi culty with spelling. Because specifi c cogni- you” or “That’s great that you read the directions tive and linguistic mechanisms affect functioning so clearly; what part do you need help with?” or differentially, a student with learning disabilities “Wow! You capitalized the beginning of every will struggle with certain academic tasks, but not sentence” can go a long way in helping children others. For example, a student with a circum- to persevere. Why does this work? Children scribed weakness in phonological awareness will crave attention even for those behaviors that they exhibit dif fi culties in word analysis and spelling value as challenging to them, rather than easy tasks, but not typically in math activities (unless tasks. Every time an adult recognizes the genuine reading is involved). One important consideration efforts that a child has made with sincere praise, is to identify speci fi c academic areas in which it makes the child feel anchored. Moreover, this students with learning disabilities can be edu- works because struggling learners do not intui- cated with peers using the same materials and tively know what they do right in the academic procedures (Klingner & Vaughn, 1999 ; Miller & realm because in their minds they have already Fritz, 1998 ) . Simply having the same book is not tried hard and very often “were wrong.” These the same as using and pro fi ting from the same children who are keenly aware that they are book. Students must be able to read and learn struggling need to know what has been done cor- from the books they are provided. Thus, for stu- rectly so that they can do more of it. Table 19.1 dents with learning disabilities, it is important to reviews important ideas for both parents and identify domain-speci fi c academic strengths and teachers for enhancing a child’s resilience. match curricular materials accordingly. Children and adults who view their disabilities as circumscribed and not as affecting global functioning Conclusion are more likely to have positive self-esteem (Cosden, 2001; Rothman & Cosden, 1995 ) . For Both general and special education teachers need to example, Miguel a high school sophomore work together to provide effective instruction to stu- received intensive reading support, but then dents who are often confused and searching for per- served as a math tutor for classmates struggling sonal survival and accomplishments (Masters, Mori, in algebra class. Acknowledgment of his math & Mori, 1993) . When teachers give students power- competence helped Miguel maintain a positive ful reasons to attend their classes and minimize their self-image, despite his dif fi culties with reading failure experiences, many students with learning dis- and spelling. abilities will not only survive, but they will thrive Regardless of the level of performance, stu- (Sabornie & deBettencourt, 2008 ) . Miller and Fritz dents with learning disabilities must experience ( 1998) encourage teachers to be the one a student realistic accomplishments (Brooks, 2001 ) . Vail will recall favorably when asked, “Tell me about a (2003 ) noted that self-esteem grows from the teacher you remember.” Well-functioning schools inside out, not from the outside in, and that com- can serve as a protective factor for children’s devel- petence leads to con fi dence, which then increases opment and accomplishments (Keogh & Weisner, motivation and results in genuine self-regard. 1993 ; Rutter, 1978 ) . Schools must be effective, Teachers and parents are to be reminded of benevolent, supportive, and developmentally appro- the power of positive praise on behavior. In a priate for all children (Bryan, 2003) . This requires all recent workshop on resilience, a parent com- educators to share a vision and create a plan. We are mented, “When I look at my son’s writing, I just reminded of the advice that the Cheshire cat gave to can’t think of anything to praise.” At the end of Alice while she visited Wonderland, when she asked the workshop she had a list of ten items! Often which way to go upon reaching an intersection. The we understandably take for granted many of the cat inquired: “Where are you going?” Alice little steps it takes to get our children to even the responded: “I have no idea.” The cat then replied: place where they are struggling. Comments like, “When you don’t know where you are going, any “I’m glad you have your school supplies with road will do.” We need to be clear and rigorous in our 344 N. O fi esh and N. Mather

Table 19.1 Twenty ways to foster resiliency in children with learning disabilities 1. Support and promote interest in nonacademic and academic areas. Do not use these activities as rewards or punishment. Every child needs to feel good at something. As Smith said, “Dig deep to fi nd the treasures in your child” (Smith, 2003b ) 2. Provide opportunities to cultivate relationships with other adults who can offer inspiration and hope 3. Offer a shift of perspective on school achievement. Help children to understand that report cards re fl ect only one aspect of life. They are not an indication of how successful a person will be as an adult. This conversation should take place repeatedly over time because children hear this message differently across the age span 4. Help the child develop an understanding of the nature of his or her learning disability. This may take the assistance of a teacher, school psychologist, or other professional. A child needs to k now how a disability impacts school, home, social life, and how to reduce the impact of the disability 5. Nurture strengths. Children need to know what strengths they possess and how those strengths can offset factors related to the disability 6. When learning takes place, provide speci fi c praise so that the child is aware that it was his or her actions that made the learning successful, rather than it just being “a lucky day” or chance event 7. When learning strategies are taught, be speci fi c about how the strategy worked. Children need to understand what behaviors make them a successful learner. This encourages future efforts 8. Provide basic reading instruction in secondary school for children who need it. Do not give up even though reading is no longer a “subject” in school 9. Teach social awareness and social skills for children who need them 10. Pay attention to the personal learning strategies students may develop on their own; if they are successful, praise them for coming up with a strategy that works for them and reinforce it 11. Help children set and achieve attainable goals. Promote ongoing hope by planning for the future 12. Foster collaboration between general and special education teachers. All teachers and tutors need to be working together. The IEP meeting is a good time to foster this collaboration 13. Before placement in or removal from the general education classroom, weigh carefully the academic vs. social implications 14. Reward effort when it is apparent. Help students gauge and re fl ect upon their level of effort, persistence, and perseverance. Rework tasks to build success and encourage persistence 15. Address anxiety and/or depression when indicated through clinical therapy, and/or consultation with a medical provider. These emotional factors can be as detrimental to learning as the disability itself 16. Watch your child perform schoolwork and every month identify fi ve new behaviors that were done well and praise him or her. Praise should be sincere and the behaviors should be meaningful to the child 17. Respect a student’s sensitivity when providing feedback in class. Be discreet 18. Praise a child’s efforts during homework time. Provide breaks, humor, and try to be a good cheerleader even when it hurts to see your child struggle. Be a model of resilience 19. Not all learning disabilities are the same. Make an effort to understand the nature of a particular disability 20. Pay attention to all struggling learners in your class. Teacher support is critical thinking (Donahue & Pearl, 2003) . We must know This is the road we must follow, a road paved where our roads are going and be ever vigilant as we with effective instruction, support, and empathy. plan curriculum and select activities for children with learning disabilities. Brooks ( 2001 ) so aptly described the common mind-set of effective educa- References tors: “We can accomplish this by being empathetic; Ahrens, K., DuBois, D. L., Lozano, P., & Richardson, L. P. by treating students in the same ways that we would (2010). Naturally acquired mentoring relationships like to be treated, by fi nding a few moments to smile and young adult outcomes among adolescents with and make them feel comfortable, by teaching them learning disabilities. Learning Disabilities Research & in ways they can learn successfully, by taking care to Practice, 25 , 207Ð216. Bender, W. N. (2008). Learning disabilities: avoid any words or actions that might be accusatory, Characteristics, identi fi cation, and teaching strate- by minimizing their fears of failure and humiliation, gies . Toronto, ON: Pearson. by encouraging them, and by recognizing their Bender, W. N., Rosenkrans, C. B., & Crane, M. K. (1999). strengths” (p. 20). Stress, depression, and suicide among students with 19 Resilience and the Child with Learning Disabilities 345

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Jan, 2011 from website: www.nlts2.org/reports/ Wiener, J., & Tardif, C. Y. (2004). Social and emotional 2003_11/nlts2_report_2003_11_complete.pdf . functioning of children with learning disabilities: Werner, E. E. (1993). Risk and resilience in individuals Does special education placement make a differ- with learning disabilities: Lessons learned from the ence? Learning Disabilities Research & Practice, Kauai longitudinal study. Learning Disabilities 19 , 20Ð32. Research & Practice, 8 , 28Ð34. Wong, B. Y. L. (2003). General and speciﬁ c issues for Werner, E. E. (1999). Risk and protective factors in the researchers’ consideration in applying the risk and lives of children with high-incidence disabilities. In R. resilience framework to the social domain of learning Gallimore, L. P. Beerheimer, D. L. MacMillan, D. L. disabilities. Learning Disabilities Research & Practice, Speece, & S. Vaughn (Eds.), Developmental perspec- 18 , 68Ð76. tives on children with high-incidence disabilities Wyman, R. A., Cowen, E. L., Work, W. C., & Keriey, J. H. (pp. 15Ð31). Mahwah, NJ: Erlbaum. (1993). The role of children’s future expectations in Wiener, J. (2003). Resilience and multiple risks: self-esteem functioning and adjustment to life stress: A response to Bernice Wong. Learning Disabilities A prospective study of urban at-risk children. Research & Practice, 18 , 77Ð81. Development and Psychopathology, 5 , 649Ð661. Promoting Educational Equity in Disadvantaged Youth: The Role 2 0 of Resilience and Social-Emotional Learning

Jazmin A. Reyes , Maurice J. Elias , Sarah J. Parker , and Jennifer L. Rosenblatt

We are all concerned about the future of American education. But as I tell my students, you do not enter the future—you create the future. The future is created through hard work. Jaime Escalante, Latino Educator

As we enter the second decade of the twenty-fi rst educational environments: educator stress, low century, education in America is at a critical turn- academic expectations, and impaired relations ing point. Call for reform is widespread and with students; ecological instability; and a culture exempli fi ed by the documentary fi lm Waiting for that discourages academic achievement and Superman , which highlights the fact that for many healthy behavior—as well as a host of other circum- American children, access to a quality education stances that demand the attention of students and is often literally a lottery. Equal access to educa- educators at the expense of learning. While years tional opportunity is the philosophical cornerstone of policy initiatives have worked to eliminate of the American public education system. these problems, the future of American public Although signifi cant advances towards realizing education and its ability to produce a skilled this goal have been made over recent decades, workforce capable of competing in an increas- educational quality still varies widely, with Latino ingly challenging and technical global market and African-American children being more likely remains uncertain (Education in America, 2010 ) . to attend disadvantaged schools (Cauce, Cruz, One certainty regarding the future American Corona, & Conger, 2011 ) . The agents of this workforce, however, will be its multiracial and inequity are familiar to most in disadvantaged multiethnic composition. By the year 2050, roughly 47% of working Americans will be mem- J. A. Reyes () ¥ M. J. Elias bers of a racial/ethnic minority group. Of these, Department of Psychology , Rutgers, The State University approximately 24% will be Latino (Toosi, 2006 ) . of New Jersey , Tillett Hall, Room 101, 53 Avenue E , Latinos (or Hispanics) are individuals of “Cuban, Piscataway , NJ 08904 , USA Mexican, Puerto Rican, South or Central e-mail: [email protected] American, or other Spanish culture or origin, S. J. Parker regardless of race” (Offi ce of Management and Department of Psychiatry , Columbia University , New York , NY , USA Budget (OMB), 1997 ) . Currently, Latinos are the largest ethnic minority group in the U.S., account- J.L. Rosenblatt New York University Child Study Center , ing for 15% of the U.S. population. In addition to New York , NY , USA being the largest minority group, Latinos are the

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 349 DOI 10.1007/978-1-4614-3661-4_20, © Springer Science+Business Media New York 2013 350 J.A. Reyes et al. youngest group, with one-in-fi ve U.S. school A recent poll revealed that 89% of Latino youth children being of Latino descent and one-in-four reported that career success is important in their newborns being born to Latina mothers (Pew lives (Pew Hispanic Center, 2009 ) . However, Hispanic Center, 2009 ) . Latinos face a disproportionate number of barri- The Latino youth of today will undoubtedly ers to their academic achievement including shape American society in the twenty- fi rst cen- poverty, lack of participation in preschool, atten- tury. Yet, research indicates that Latino youth face dance at poor quality elementary and secondary signifi cant challenges and engage in many risky schools, and limited neighborhood resources. behaviors that can hinder positive development Poor academic achievement, in turn, results in and well-being. For example, national statistics low labor force participation, higher unemployment reveals that Latino youth engage in higher rates rates, and greater poverty (Zambrana & Zoppi, of attempted suicide, lifetime cocaine use, 2002 ) . What can be done to help Latino youth and unprotected sex than African-American and create better futures that match their career and Caucasian youth (Centers for Disease Control and life aspirations while recognizing that social Prevention, 2007 ) , with Latinas having the high- conditions are not likely to change quickly? est teen pregnancy rate among major ethnic groups A promising means to foster attainments among in the U.S. (Umaña-Taylor, 2009 ) . Latino youth Latino youth is the application of school-based also have the highest school dropout rate. interventions consistent with resilience theoreti- Approximately 21.4% of Latino youth drop out of cal models and research. high school, which is four times the rate among Caucasian youth (5.3%) and nearly triple the rate among African-American youth (8.4%) (U.S. Conceptualizing Resilience Department of Education, 2009 ) . Latino children and adolescents are also more likely to live in It is impossible to enter into any discussion of poverty. The poverty rate among Latino children resilience without fi rst addressing the complex, is three times that of Caucasian children (28% and largely unresolved, conceptual issues sur- Latino vs. 9% Caucasian) (Prelow & Loukas, rounding the construct. Since Norman Garmezy’s 2003 ) . introduction of the concept of resilience over 50 It should be noted that considerable variability years ago (Rolf, 1999) , many empiricists have exists among Latinos in terms of national origin, adopted the term and applied it towards their immigration and migration histories, as well as own work. The term, “resilience,” though, is different levels of education, socioeconomic sta- often subjected to a variety of disparate usages tus, acculturation, and immigration status. (Glantz & Johnson, 1999; Greene & Conrad, Differences among Latinos likely impact the 2002 ) . A now substantial body of theoretical lit- extent and nature of risk exposure and the avail- erature has developed in response to this probability of resources and protective factors Latino lem, propelling an ongoing debate over the children and adolescents experience in their daily ultimate utility of the concept (see Glantz & lives, as well as differences in rates of engage- Johnson, 1999 ) . While challenges to the con- ment in delinquent behaviors and opportunities struct’s parsimony and integrity are numerous for positive developmental outcomes (Kuperminc, and valid (e.g., Kaplan, 1999 ) , many researchers Wilkins, Roche, & Alvarez-Jimenez, 2009 ) . are reluctant to abandon a concept that has such Considering the diversity that exists among and powerful heuristic value (Luthar, Cicchetti, & within the various Latino groups is essential for Becker, 2000 ) . understanding the experiences of Latino youth in It is beyond the scope of this chapter to enter the U.S. (Umaña-Taylor, 2009 ) . fully into this highly nuanced debate. The present Despite the risk statistics highlighted above, focus is on formulating a practical, working Latinos have high aspirations for themselves. defi nition of resilience that maximizes its utility 20 Promoting Educational Equity in Disadvantaged Youth… 351 in the development of educational interventions changing environmental characteristics; the for economically disadvantaged ethnic minority latter mediate harm by changing the child’s ability youth, particularly Latinos. For the resilience to handle challenges. construct to have potential in fl uence on improv- The basic premise underlying these ideas—that ing the life trajectory of Latino youth, two key avenues for intervention exist even when the criteria must be met: (1) the resiliency construct removal of negative forces seems unfeasible—is must add value to existing (and perhaps more key for educational interventions in areas where parsimonious) constructs and (2) the concept of many of the negative forces a child faces (e.g., resilience must be able to inform the design of racism, poverty) exist on a macro level beyond interventions. the direct infl uence of most community-based efforts. In this way, the “protective processes” defi nition of resilience satisfi es the criterion of Resilience as Protective Processes being able to inform interventions. Where this defi nition falters, however, is in the fi rst criterion: At a preliminary level, several competing offering value-added to other existing constructs. de fi nitions of “resilience” seem good candidates Though the importance of risk and protective for meeting these criteria. The simplest of these models is well established, there seems to be little holds the term to be conceptually equivalent to advantage accrued by attaching the label “resil- “protective processes” in models of risk and pro- ience” to these models. tection. The latter concept is of undoubted importance in the formulation of educational interventions in under-resourced communities. Resilience as the Interaction The identifi cation of these processes resulted in of Protection and Risk an important shift in how researchers viewed the life courses of individuals within challenging Some theorists have argued that equating the term environments (Garmezy, 1985 ) . Rather than “resilience” with protective processes, reduces solely focusing on preventing negative outcomes, the potentially unique and powerfully predictive researchers expanded their focus and interven- concept of resilience to a description of compet- tion efforts to bolstering processes that were ing probabilities among risk and protective pro- associated with adaptive outcomes—outcomes cesses (Kaplan, 1999 ) . Such a description does frequently termed “resilient.” Different types of not identify the mechanisms that intervention protective forces were identi fi ed and studied; strategies can use to target speci fi c risks. Although Luthar (1991 ), for example, identifi ed two differ- researchers and educators may have good descrip- ent types: The fi rst, “protective processes,” coun- tions of processes that may be helpful to most teract the harmful effect of stressors (such as individuals, they still do not have a clear under- educators providing normative coping strategies standing of how to best help those individuals for students during school transitions, or provid- who have the highest likelihood of poor ing parents with explicit approaches they can use outcomes. to manage the dramatic infl ux of homework their This gap in models of risk and protection children receive as they move through primary offers a window in which some have argued resil- and secondary school); the second, called “pro- ience may offer the greatest value. One compel- tective-enhancing processes,” strengthen chil- ling view de fi nes resilience as a transactional and dren’s competence so that they are better able to three-dimensional (person, environment, and manage stressors (these include social-emotional time) theoretical framework that outlines how a skills, which are described later in the chapter, or subset of protective processes specifi c to “at-risk” training children in how to handle sexual harass- populations interacts with agents of environmen- ment by a caretaking adult). The former mediate tal risk and with individual characteristics and the effect of stressors on the child through developmental processes to infl uence outcome. 352 J.A. Reyes et al.

In this way “resilience” refers to a process in Resilience as a Conceptual Placeholder which specifi c protective infl uences moderate the effect of risk processes within both individual In the 1999 chapter that detailed the preceding and environment in order to foster adaptive argument, Kaplan concludes convincingly that outcomes. This framing of resilience would nei- resilience is a once-useful construct whose time ther include protective processes that affect out- has since passed. Indeed, conceptualizations of come by lessening the magnitude of risk processes resilience as a character trait or a consistent pro- by acting on them directly, nor those protective cess cannot stand close scrutiny; there is no tan- processes that impact on outcomes uniformly, gible, observable, de fi ning feature common regardless of the presence of risk. Instead, “resil- across all individual instances of “resilience.” ience” would comprise interactions between risk Resilience is an aberration—a failure in the pre- and protective processes, and in this way might dictive model—and the potential causes for this offer the substantial informative value of being aberration are infi nite (Kaplan, 1999 ) . They range able to prescribe particular protective processes from a child’s broad social context to minute fea- as ameliorative to speci fi c areas of risk. tures of a child’s environment at the precise Such transactional models of resilience, how- moment outcome was measured, or any combi- ever, have been plagued by two signi fi cant chal- nation of the factors in between. We may be able lenges. The fi rst, outlined by Luthar and Cushing to identify variables that account for this aberra- (1999 ) , is of a statistical nature: in relying on an tion in a signi fi cant number of people, but it is of interaction term to identify “resilient” individuals, greater theoretical and practical utility to include researchers not only are unable to specify the these variables in a re fi ned predictive model that actual number of individuals represented by the applies to all “at-risk” individuals than to parti- interaction but also are frequently unable to repli- tion them off into a separate category of “resil- cate their fi ndings because of the typically small ience.” In this way, “resilience” is not seen as a effect sizes associated with interaction terms. specifi c phenomenon per se, but rather as a con- Models of resilience based on interactions ceptual tool in the development of increasingly between risk and protective processes face an re fi ned predictive models. This conceptual tool additional challenge: No matter how detailed the would function as a “placeholder”—highlighting model may be, it can nevertheless be re fi ned fur- a group for whom the predictive model has failed, ther. Kaplan ( 1999 ) argues convincingly how and reserving a space in the model for an as-yet individuals identifi ed as “resilient” were likely undiscovered set of variables that may explain never at risk in the same manner as their “vulner- this failure. able” peers; instead, they were included in mod- In essence, Kaplan and those who hold “the els of resilience only because the fi eld had an placeholder” view do not differ in their conceptu- inadequate predictive model of how risk operates alizations of the bounds of utility for the resilience in combination with other factors. construct. The difference lies in their beliefs about An example can illustrate this situation. the expiration of that utility. While Kaplan sees “Resilient” outcomes have been found within resilience as a concept that has historically served troubled schools (risk factor) by those with strong to highlight some predictive failures and models internal locus of control and social problem-solv- in need of refi nement, he argues that this function ing skills (protective factors). However, one could has acted on a broad conceptual level, and, having argue that those individuals are not in fact “resil- done so, resilience has served out its utility. In ient” because they were never at risk. The model contrast, we see resilience as having continued fails to distinguish the presence of protective pro- applicability in the process of re fi ning each indi- cesses from the lack of risk. Therefore, in this vidual predictive model—prescribing an exami- example, the phenomenon is not so much “resil- nation of unexpected outcomes and holding a ience” as it is possession of appropriate locus of place in the model for variables that will explain control and problem-solving skills. them. The concept of resilience, then, takes on a 20 Promoting Educational Equity in Disadvantaged Youth… 353 sustained utility—not only in the development of possible ways that cultural practices enhance or new models, but also the continued re fi nement of interfere with resilience ( Masten & Motti- old ones. This process cannot be expected to end Stefanidi, 2009 ) . Forces within a child’s ethnic in a model yielding perfect predictions, but mod- culture may serve as a buffer against adverse els can (and should) be re fi ned in a series of suc- social circumstances. For example, the Latino cessive approximations towards that goal. Each cultural value of familism , which emphasizes the stage of this process can be aided by examining importance of the family unit and stresses the instances of “resilient” outcome and analyzing obligations and support that family members owe these instances for systematic differences that to both nuclear and extended kin is believed to may inform the identi fi cation of new predictors. protect Latino youth against externalizing prob- The “placeholder” conceptualization of resilience, lems (German, Gonzales, & Dumka, 2008 ) . as depicted in Fig. 20.1 , offers practical utility in At the same time, sociocultural factors may hinder formulating educational interventions for youth resilience. Research indicates that certain cultural considered to be at risk, thereby satisfying the fi rst beliefs and practices, such as focusing more on criterion for defi ning the term. The refi nement of spiritual than medical cures, can greatly in fl uence predictive models is clearly central to this task, the utilization of medical and mental health ser- both in helping to identify intervention targets vices and treatment adherence. This, in turn, will accurately, and to discover the specifi c risk and affect a child’s recovery from an illness or disease protective processes the intervention should be (Antshel, 2002 ) . formulated to address. The speci fi c directives the Researchers have begun to pay increasing resilience construct adds to the refi nement process attention to the role of culture in models of meet the second, value-added criterion. risk and resilience. Kuperminc et al. ( 2009 ) have proposed a cultural-ecological-transactional model for studying resilience among Culture and Resilience Latinos and other ethnic minority groups in the U.S. In this model, the interaction between a While culture plays an important role in children’s child’s culture of origin and the mainstream development, it is typically afforded a distal or culture plays a central role in development. indirect role in models of resilience. Culture refers Thus, cultural factors, including values, behav- to the common language, history, symbols, beliefs, iors, and norms interact and transact with every unquestioned assumptions, and institutions that level of a child’s ecology and help shape out- are part of the heritage of members of an ethnic comes. The placeholder conceptualization of group (Roosa, Morgan-Lopez, Cree, & Specter, resilience calls for special attention to cultural 2002) . Culture and cultural practices exert risk and protective factors, as these variables are signifi cant infl uence on children’s development often not taken into account and may help and there is much to be learned about the many explain unexpected outcomes.

Fig. 20.1 The placeholder conceptualization of resilience 354 J.A. Reyes et al.

Remaining Conceptual Challenges do not reach optimal functioning within this context can still do so in other aspects of their lives. One remaining challenge is determining what Overall, working within the educational constitutes a positive outcome, even within an resilience framework retains many of the educational environment. Such decisions neces- bene fi ts of “resilience” while excising some of sarily rely on the culturally and temporally biased its hazards. Within the bounds of this restricted perspective of the researcher, a perspective that focus, we will use academic achievement (including may overlook key factors at work in the popula- grade point average, standardized test scores, tion of interest. However, in the speci fi c context educator ratings of academic performance, and of urban, low-SES educational institutions serv- level of schooling completed) during the typical ing predominantly minority groups, outcomes urban, low-SES KÐ12 educational experience as are easier to grasp. Although school achievement the measure of positive adaptation in the process and completion are indeed “positive” outcomes of educational resilience. only because they are valued by the dominant culture, they are nonetheless agreed-upon by the educational system and its participants. Arguably, Formulating Interventions to Improve families who participate in the public education Academic Achievement Outcomes system enter into an unwritten social contract with their schools that is fulfi lled when schools The “placeholder” conceptualization of resilience engender an exchange of adequate levels of skill is rooted largely in this construction’s ability to accumulation and degree attainment for a certain dictate a clear structure within which predictive amount of schooling. Using this “contract” helps models may be re fi ned and interventions may be to delineate more objectively what comprise pos- designed. Our interpretation of resilience leads us itive outcomes in a model of educational resil- to a four-step approach: ience, as well as making clear that generating 1 . Identify distal agents of risk. Given our over- suffi cient skill accumulation to overcome contex- arching goal of working towards equalizing tual disadvantage for poor Latino students will educational opportunity, our starting point is require an above-average educational effort by the identi fi cation of a single-risk process— schools if the contract is to be honored. attending a low-SES school—and a single- Focusing on resilience within educational associated outcome—high school dropout. settings also allows researchers to avoid another 2 . Identify instances of resilience. The next step common critique that the resilience fi eld has requires us to identify those students who have faced: in order to accommodate the statistical de fi ed our initial predictive relationship. For and logistical demands of research, those who instance, Latino students who graduate despite study resilience often de fi ne positive outcomes their disadvantaged school setting. narrowly, failing to acknowledge the numerous 3 . Look for systematic differences that differenti- aspects of life in which a person can succeed. ate instances of resilience. These differences This has resulted in models of resilience that are perhaps best conceptualized as the absence seemingly ignore important areas in which those of risk processes, the presence of protective who did not achieve “resilient” outcomes have processes, or a set of such processes interact- succeeded. An educational resilience model ing. While the operational distinction between avoids this by restricting its focus to the KÐ12 the absence of risk and the presence of protec- educational experience; by doing so, it can tion is often diffi cult to delineate, such distinc- employ a widely accepted, context-specifi c tions are rarely of practical import. As outlined defi nition of “positive adaptation” (i.e., gradua- in the following section, we propose that social tion, grades, and achievement on standardized and emotional skills constitute a set of protec- tests) while acknowledging that individuals who tive processes that systematically differentiate 20 Promoting Educational Equity in Disadvantaged Youth… 355

academically successful students in high-risk for variables in a predictive model that can settings. accommodate these instances of academic suc- 4 . Identify best options for intervention. Once a cess; social and emotional learning (SEL) may be theoretical understanding of those processes one such variable (Fig. 20.2 ). associated with instances of resilience is established, interventionists must adopt a practical stance in assessing the implications of these Social and Emotional Learning Defi ned fi ndings. Decisions must be made as to the relative feasibility of lessening speci fi c risk Just as students arrive at school with unique bod- processes or bolstering specifi c protective pro- ies of knowledge and cognitive strategies, they cesses. Particularly in under-resourced com- come equipped with their own social and emo- munities, it is essential to design interventions tional skills. They have often developed these such that they provide the optimal balance of techniques through interactions in their homes ef fi cacy and ef fi ciency, with sustainability and communities; as such, they can learn new over time. strategies in the school environment through SEL programs. These initiatives broadly aim to develop “social competence,” de fi ned as “the Social and Emotional Learning capacity to integrate cognition, affect, and behaviors, to achieve specifi ed social tasks and positive The remainder of this chapter applies the preced- developmental outcomes… [It is] a set of core ing framework to our specifi c concern: equaliz- skills, attitudes, abilities, and feelings given func- ing educational opportunity. Given this point of tional meaning by the contexts of culture, neigh- entry, the identi fi ed distal agent of risk is low- borhood, and situation” (Elias, Kress, & Neft, SES educational settings. Students in such envi- 2003 , p. 1023). In short, SEL interventions help ronments are clearly at heightened risk for poor students accumulate knowledge and skills that academic outcome (Elias et al., 1997 ) . However, facilitate the optimal emotional processing of while these associations between risk and out- their social contexts. Targeted competencies come offer a prediction, they do not offer a prog- include self-awareness, self-management, social nosis. Some students are exceptions to the rule; awareness, relationship skills, and decision mak- they fi nd pathways to academic success despite ing (Collaborative for Academic, Social, and challenging school environments. The educa- Emotional Learning (CASEL), 2003a ) . tional resilience paradigm directs us to look to these exceptions to fi nd ways to change the rule. The next step, then, involves examining ways in SEL as a Predictor of “Resilience” which these students differ from their peers. An increasing body of research points to social and The claim that SEL skills constitute important emotional skills as a key factor distinguishing variables explaining instances of resilience students who attain academic success in chal- requires empirical support on two levels. The lenging environments. Resilience holds a place fi rst level is the demonstration that SEL skills

Fig. 20.2 Theoretical model of social and emotional learning (SEL) as a variable in explaining resilience 356 J.A. Reyes et al. can reliably differentiate instances of resilience Ubriaco, 1985 ; Gottfredson, 2001 ). Recently, from more typical academic outcome. Such Durlak, Weissberg, Dymnicki, Taylor, and research is necessarily correlational in nature Schellinger (2011 ) conducted a meta-analysis of and, as such, is restricted in its ability to infer 213 universal, school-based SEL intervention causation. Causation may be better examined at outcome studies to examine the impact of SEL the second level of research: intervention evalu- programming on social and emotional skills, atti- ation. Intervention evaluations allow approxi- tudes towards self and others, positive social mate experimental control of targeted skills, behavior, conduct problems, emotional distress, thereby affording stronger support for model and academic performance. The analyses included formulation. 270,034 kindergarten through high school stu- At the fi rst level, a number of studies have found dents. Results revealed that compared to con- SEL skills (or closely related constructs) to be trols, students’ SEL skills, attitudes, positive associated with instances of academic resilience. social behaviors, and academic performance For example, studies have identi fi ed associations improved following intervention. Students also between school achievement and positive social demonstrated fewer conduct problems and had and emotional skills (Caprara, Barbaranelli, lower levels of emotional distress (Durlak et al., Pastorelli, Bandura, & Zimbardo, 2000 ; Haynes, 2011 ). While these fi ndings offer empirical Ben-Avie, & Ensign, 2003 ). Research has also justifi cation for the implementation of SEL pro- linked social and emotional skills with higher grams, they offer little theoretical explanation for achievement on standardized tests (Welsh, Parke, their demonstrated ef fi cacy. The remainder of the Widaman, & O’Neil, 2001 ; Wentzel, 1993 ) . chapter will focus on propositions as to why SEL Conversely, antisocial conduct often co-occurs interventions are effective—their mechanisms of with poor academic performance (Hawkins, action and their key implementational advan- Farrington, & Catalano, 1998 ). tages. It should be emphasized that this discussion is theoretical and heuristic, rather than SEL intervention research . These associations empirical, in nature. One of the goals of future are encouraging, but far from conclusive as to the research in this area will be to design studies such specifi c role SEL skills play in instances of resil- that the specifi c processes underlying the success ience. Research at the second, intervention evalu- of SEL interventions may be delineated. ation level helps to elucidate the patterns of A guiding assumption in the current discus- causality in these relationships. While a true sion is that any variable that might explain edu- experimental manipulation of SEL is logistically cational resilience will ultimately be dependent impossible, intervention research approximates on a dynamic interaction of three dimensions: such manipulations by providing experimental person, environment, and time. By nature, these groups with opportunities for the development of three dimensions are mutually determined, so SEL. Well-designed studies also provide SEL there is little meaning in the examination of one measures to check for the success of skill acquisi- in the absence of the other two. Thus, this dis- tion. While the exact mechanisms responsible for cussion of the probable agents of educational any differences in the experimental group cannot resilience presumes them to be of a three-dimen- be concluded with certainty, this method argu- sional nature. School-based SEL programs coun- ably offers the most scienti fi c method available teract common mechanisms of risk and foster for maximizing this certainty. the protective resources in all of three dimen- To that end, a number of analyses of school- sions of educational resilience: the students based prevention programs conducted in recent themselves, their educational and social environ- years provide general agreement that some of ments, and the interaction of these dimensions these programs are effective in reducing mal- over time. adaptive behaviors, including those related to In order to come to a clearer understanding of school success (e.g., Durlak, 1995 ; Elias, Gara, & the mechanisms through which ethnic minority 20 Promoting Educational Equity in Disadvantaged Youth… 357 students demonstrating educational resilience Student–Educator Interactions may be buffered from negative in fl uences on academic outcomes, it is necessary to parse the The manner in which students and their educa- broad-risk processes associated with “poverty” tors and/or school administrators interact has into their more proximal agents of risk in an enormous infl uence on student learning (Wang, educational context. The following sections Hertel, & Walberg, 1997 ). Often, the emotional identify such mechanisms that are hypothe- climate in low-SES, underperforming schools sized to mediate the relationship between pov- can affect educators in ways that ultimately harm erty and suboptimal academic achievement. the academic outcomes of their students. The discussion covers categories of risk that Speci fi cally, the emotional climate can function were culled from a review of literature from proximally to students through high levels of the education-reform, resilience, and educa- educator stress and low academic expectations, tional-resilience fi elds. Processes selected were both of which have been identifi ed as more com- those that theoretically and/or empirically were mon within low-SES educational environments found to a greater degree among low-SES (Peng & Lee, 1994 ) . These factors hamper stu- schools with high proportions of minority student achievement by discouraging educators dents than among their wealthier counterparts. from spending time and energy supporting and The processes were also linked with poor aca- motivating their students in positive ways. As demic outcomes in such communities and were depicted in Fig. 20.3 , the result of this interaction theoretically and/or empirically demonstrated is poor educatorÐstudent relationships and low- as mediators of the relationship between SES ered academic performance, both of which con- and academic outcomes. Risk categories tinue cycles of educator stress and low academic described in the following sections were then expectations. created by grouping together those mecha- This is an especially worrying cycle within nisms that theoretically and/or empirically low-SES schools because positive educatorÐstu- were elements of the same larger process. This dent relationships have been found to protect at- method yielded the following broad mecha- risk students from negative academic outcome nisms for intervention: factors that in fl uence (Esposito, 1999 ; Haberman, 2004 ) . Some research the studentÐeducator dynamic (i.e., educator has suggested that these relationships may hold stress/frustration, low academic expectations, particular protective value for minority students and impaired educatorÐstudent relationships) (Meehan, Hughes, & Cavell, 2003 ; Wang et al., and factors that in fl uence the studentÐcommu- 1997). Unfortunately, data also suggest that nity dynamic (i.e., ecological instability and minority students are less likely to enjoy strong disconnect between school and community relationships with their educators in comparison cultures). The processes through which SEL to their more advantaged peers. Contributing fac- interventions interact and ameliorate each of tors within disadvantaged school districts have these risk factors will be outlined theoretically been identi fi ed above and in Fig. 20.3 , and they and supported with relevant research in the fol- include widespread disengagement of faculty and lowing discussion.

Poor educator– Educator stress / student relationships frustration Less energy spent positively supporting / motivating students Low academic Low academic expectations performance

Fig. 20.3 Reciprocal in fl uences in high-risk school settings 358 J.A. Reyes et al. staff; a lack of interpersonal and self-regulatory programs provide professional development skills among students to form strong relationships before program implementation, tools for internal with adults; and everyday challenges that absorb and external personnel to observe program imple- student and teacher energy at the expense of edu- mentation, and feedback and coaching for educa- catorÐstudent relationships (Haberman, 2004 ; tors (CASEL, 2003b ) . In this way, educators are Kozol, 2005 ) . empowered to use new and frequently more effec- SEL interventions can ameliorate the cycle of tive ways to maintain a positive and productive educator stress, low expectations, poor studentÐ atmosphere in their classrooms. teacher relationships, and low academic perfor- Many SEL programs offer support for mance in two ways: (1) through professional educators; one such program offering extensive development that helps educators to manage their professional development is The Responsive stress and to understand the role that low expecta- Classroom ( http://www.responsiveclassroom. tions might play in student behavior and (2) by org ). The program places less emphasis on social encouraging students to change their behavior in and emotional skill instruction and more empha- such a way that they are able to persist on diffi cult sis on changing teaching strategies, employing academic tasks and elicit more support from edu- six practices that help accomplish the program’s cators. These mechanisms of action are discussed goal: classroom organization, morning meetings, in further detail below. rules and consequences, academic choice, guided discovery, and family communication. These strategies help educators manage their classrooms SEL and Poor Educator–Student in positive ways, which helps reduce their frus- Interactions tration and anxiety. The strategies also foster more open and effective educatorÐstudent rela- Educator effects. When school environments are tionships, which also can reduce educator stress. chaotic, the effort that educators might otherwise Responsive Classroom’s professional develop- apply to educating and motivating students in a ment includes workshops, summer intensive pro- positive way must be diverted to managing prob- grams, individual, on-site consultation, and lematic student behavior and their own worries comprehensive guidelines that help the educator about personal safety. The stress and frustration implement and integrate the program into exist- brought about by this and other aspects of the ing curricula ( CASEL, 2003b ) . This approach school environment decrease educators’ levels of has demonstrated a positive impact on student commitment to their students and their careers, behavior and academic performance (Rimm- and may ultimately lead to “burnout.” Positive Kaufman, Fan, Chiu, & You, 2007 ) . correlations between number of years of educator experience and student achievement (Glass, Student effects . In addition to improving relations 2002 ) suggest that the cycle of educator stress/ between educators and their students by reducing burnout and low student academic achievement educators’ levels of stress and frustration, SEL may be self-propagating. interventions explicitly teach social problem- SEL programs address educator stress through solving skills that can generalize from students’ professional development. The orientation and peer relationships to their interactions with adults. training received through most empirically sup- These skills increase the likelihood that students ported SEL programs help educators gain the same will elicit positive, supportive behavior from their emotion-regulation and social problem-solving teachers. Primary social and emotional skills skills as they are expected to foster in their stu- that help students become aware of their own and dents. These skills help them better manage the others’ emotions, regulate their behavior, and stress and demands that often arise in their role, make good behavioral decisions all help students and can increase educators’ career effi cacy and communicate more effectively and openly with satisfaction (CASEL, 2003b ). The best SEL their teachers. The Caring School Community 20 Promoting Educational Equity in Disadvantaged Youth… 359 program, for example, employs a number of achieve higher math and reading grades than Latino strategies specifi cally aimed at strengthening and African-American children regardless of prior educatorÐstudent relationships. The vehicle for student achievement. There are several potential these strategies is a schedule of regular class explanations for this inequity. First, lowered expec- meetings in which communication and relation- tations may be an artifact of educators’ stereotypical ship-management skills are taught and practiced beliefs about members of minority and low-SES by both students and educators. Meetings are groups. A number of theorists have offered a second used to discuss problems, plan classroom activi- explanation, positing that educators’ perceptions ties, make class decisions, and refl ect on class- may be infl uenced by observing students within an room events. Emphasis is placed on creating an educational structure based on the value system of a environment in which students are comfortable dominant culture (e.g., Kozol, 2005 ) . Finally, given expressing their opinions and feel valued as con- that race and economic status are signi fi cant risk tributing members of the classroom community. factors for academic dif fi culty, educators may sim- SEL programs can dramatically improve ply be forming expectations based on their own classroom climate by providing educators with experience. positive and effective classroom-management techniques; these techniques reduce educator Educator effects. SEL programs target negative stress and remove many distractions that detract teacher expectations directly and indirectly. The from learning and teaching (Elias & Schwab, more immediate approach consists of professional 2006 ) . SEL programs also help educators and development that explicates the goals of SEL, the students learn open and effective ways of com- processes through which those goals are achieved, municating about confl ict and emotional distress; and the research supporting their effectiveness. when these skills are applied in the classroom, This process makes explicit the potential of all educatorÐstudent relations improve, and educa- students to learn, a phenomenon that contradicts tors are better able to motivate students and con- low academic expectations. Such training also vey course information. offers speci fi c strategies to help educators become aware of and alter how they convey expectations to students. The Skills, Opportunities, and Low Academic Expectations Recognition (SOAR) program, for example, helps educators develop and communicate clear stan- A large body of research has demonstrated that edu- dards for their students. In addition, educators are cator expectations can have a powerful impact on encouraged to actively seek out individual areas students’ academic outcomes, regardless of the of strength for each student and provide recogni- degree of congruity between these expectations and tion for students based on these strengths. SOAR students’ actual prior achievement (Rosenthal & techniques are directly contrary to having low Jacobson, 1968 ; Rosenthal & Rubin, 1978 ; Wang & academic expectations, thereby reducing the like- Haertel, 1987 ) . These fi ndings also have been repli- lihood that low expectations will be conveyed to cated in urban samples (Gill & Reynolds, 1999 ; students ( http://www.preventionscience.com). Haberman, 2004 ; Kuklinski & Weinstein, 2001 ) . A second, less direct SEL program approach Some data suggest that educators tend to have lower to modifying low academic expectations consists expectations for Latino and African-American of bolstering student performance, the mecha- youth. Recently, McKown and Weinstein ( 2008 ) nisms of which are discussed in the following conducted a study examining teacher expectations section. Many empirically supported SEL proof year-end math and reading achievement in a grams have been linked to improved academic diverse sample of 640 fi rst-, third-, and fi fth-grade performance (Elias & Arnold, 2006 ; Zins, children from 30 urban elementary school class- Weissberg, Wang, & Walberg, 2004 ) . Educators rooms. Results revealed that teachers were more who witness this change are provided with evi- likely to expect Asian and Caucasian children to dence that does not support their low expectations; 360 J.A. Reyes et al. as depicted in Fig. 20.3 , if educators respond to the academic achievement of their students. These this by conveying higher academic expectations roles, and how SEL programs can change them, to their students, they often elicit better academic are detailed in the sections that follow. performance. The cycle of raised expectations and performance then can be maintained by students meeting increasingly higher academic Ecological Instability expectations from their educators. A number of factors related to ecological insta- Student effects . SEL programs bolster students’ bility and transition have been found to increase meta-cognition and self-ef fi cacy with regard to students’ risk for academic diffi culty. Familial academic and other tasks. These skills help instability and divorce (Masten, Best, & Garmezy, students—especially those from historically dis- 1990; Wang & Gordon, 1994), frequent reloca- advantaged groups—recognize and persevere in tion (Lash & Kirkpatrick, 1994; Scanlon & the face of low academic expectations. The High/ Devine, 2001 ; Temple & Reynolds, 1999 ) , and Scope educational program, for example, aims to middle school transition (Elias et al., 1985 ) have foster self-con fi dence, social competence, and a all been linked with lower academic performance “can-do” attitude in each of its program partici- and increased rates of school behavior problems. pants (High/Scope Educational Research Not surprisingly, children in low-SES com- Foundation, 2003 ) . Kindergarten through third- munities tend to experience a greater degree of grade students who participated in High/Scope ecological instability than do their peers from had signifi cant improvement in 18 of 25 academic more advantaged environments. Disadvantaged indicators, as compared to two control groups; families are more likely to be headed by a single strongest results were found for low-SES students mother, and disadvantaged single mothers are (High/Scope Educational Research Foundation). more likely to experience instability in relationship partners, creating frequent changes in household composition and location. Poor fami- Community–Student Interactions lies are also subject to more frequent residence changes in general (Kerbow, 1996 ) , often result- Characteristics of the environment outside of the ing in multiple school changes. Relative to other school can play signi fi cant roles in student achieve- ethnic groups in the U.S., Latinos are more ment within the school (Leventhal & Brooks- likely to raise their children in two parent fami- Gunn, 2000 ) . This is true of both advantaged and lies (Grau, Azmitia, & Quattlebaum, 2009 ) . disadvantaged communities; in the former, exter- However, there is considerable diversity within nal characteristics tend to exert positive in fl uences Latinos concerning marriage, single parenthood on student achievement. Wealth, for example, rates, and other demographic variables. For plays a stabilizing role in the life of a family, which example, some of the highest rates of nonmari- facilitates student focus on academic material tal fertility and cohabitation can be found among when in the classroom. Communities that share those of Puerto Rican origin. Those of Cuban their schools’ values—such as the importance of decent, on the other hand, have a higher average succeeding in and completing high school and age at marriage and lower nonmarital fertility higher education while young—reinforce aca- rates (Glick & Van Hook, 2008 ) . Nevertheless, demic achievement. Access to health information single parenthood among Latinos is on the rise. and resources, which often characterize wealthier Roughly 33% of the children born to Latinos communities, results in better student health were born to unmarried mothers in 2002 (Grau choices and reduced consequences when they et al., 2009 ) . make poor choices. These outcomes reduce the The risk posed by ecological instability seems negative impact of health behavior on student to be additive; that is, the more simultaneous achievement. However, many characteristics of changes experienced by a student, the greater that disadvantaged communities play different roles in student’s academic decline (Simmons, Burgeson, 20 Promoting Educational Equity in Disadvantaged Youth… 361

Carlton-Ford, & Blyth, 1987) . The logical infer- program (Community of Caring: See Appendix). ence from these data is that schools in low-SES, The Lions-Quest program, which targets social highly unstable environments may help increase and emotional skills, positive health behaviors, academic performance by fostering a stable school and service learning, for example, helps schools environment (Cohen & Elias, 2011 ) . Research create committees of faculty members, students, supports this inference: In a study examining the and parents to monitor the educational environ- long-term impacts of family transitions on chil- ment (CASEL, 2003b ) . The program also is dren, researchers found that structured, safe, and designed to be continuous across grades, facili- predictable school environments helped buffer tated by school-wide programs and disciplinary children of divorced families from adverse envi- strategies and professional development for staff ronments (Hetherington, 1989 ) . to increase program consistency (Lions Clubs Intervention strategies should therefore aim to International Foundation, 2003 ) . Unpublished increase the stability and predictability of the studies of Lions-Quest programs that have been school environment. SEL programs achieve this implemented with Caucasian, Asian, and African- end by offering a consistent and coherent frame- American students showed not only that students work that can encompass many of the disparate in the program had better social skills and fewer disciplinary policies and psychoeducational educator-reported behavior problems, but also activities that often coexist in the school environ- had higher overall GPAs and math and English ment. Professional development in SEL strate- grades than did a control group (CASEL, 2003b ) . gies help educators foster a collaborative and The Community of Caring Program addresses mutually reinforcing learning environment in health behaviors and academic achievement which students experience a consistent set of through a whole-community approach that behavior expectations, classroom-management “works to implement and encourage fi ve values— strategies, and extracurricular support (such as caring, responsibility, respect, trust, and family” mentoring and emotional health groups) across (Community of Caring: See Appendix). The cur- schools, grades, and classrooms (Elias & Arnold, riculum provides extra materials to aid imple- 2006 ; Elias et al., 1997 ) . Such consistency eases mentation throughout the school (CASEL, 2003b ) transitions between grades and schools. and involves on-site professional development Not only do SEL programs target ecological for faculty and staff. Unpublished data from instability directly by creating consistent educa- 1,000 Caucasian, Asian, and African-American tional environments, but they also ameliorate the ninth-grade students indicated improved aca- risks students face by helping them develop skills demic and behavioral outcomes for those who that buffer against the negative impact of an unsta- participated in the program. ble environment. A direct evaluation of a school- The consistent school environment created by based intervention designed to bolster social SEL programs seem able to counteract some of the problem-solving skills found that program par- negative effects of ecological instability that are ticipation mitigated the normative decline in aca- experienced by many disadvantaged youth. The demic performance associated with middle school structured setting and consistent management and transitions (Elias et al., 1985 ) . This research disciplinary techniques encouraged by SEL curri- implies that social and emotional competence can cula can smooth transitions between grades and protect children against the deleterious academic schools and can help students maintain a sense of effects of an unstable environment. security and predictability when other parts of Two SEL programs include speci fi c materials their lives may be in fl ux. They also learn skills to to help districts promote high academic achieve- better allow them to manage strong emotions and ment while supporting environmental consistency new situations. This helps students devote the through school-wide implementation: the Lions- energy they would have spent on managing stress Quest “Skills” curricula (Lions Clubs International and learning new rules towards learning. That Foundation, 2003 ) and the Community of Caring programs implemented throughout entire schools 362 J.A. Reyes et al. and districts have been linked with improved aca- resilience, including “having religious faith, demic outcomes supports these claims. emphasizing a collective orientation, valuing children and engaging in multiple affective gestures from early on, teaching children values which Disconnect Between School include responsibility to others, collective respon- and Community sibility, respecting elders and authority fi gures, and sibling responsibility, and valuing civility such as One risk process identi fi ed in poor academic per- the expression of politeness and helpful behaviors” formance is incongruity between cultures inside (Zambrana & Zoppi, 2002 , p. 45). Latino students and outside the school ( Roosa, Dumka, Gonzales, often attend schools where few personnel are of & Knight, 2002 ; Roosa, Morgan-Lopez, et al., Latino background. Despite the fact that Latino 2002 ; Tharp, 1989 ; Wang et al., 1997 ). When the youth account for about 20% of the U.S. student values espoused inside of school are not in accord population, only 4% of public school teachers and with those lauded outside of school by students’ 4.1% of school principals are Latino (Zambrana communities, families, and peers, they have & Zoppi). This demographic imbalance makes diffi culty identifying with and accomplishing Latino issues less likely to be addressed within academic goals (Roosa, Dumka, et al., 2002 ; school systems. Additionally, the confl ict between Roosa, Morgan-Lopez, et al., 2002 ; Tharp, 1989 ) . family values and mainstream American cultural School personnel should pay particular attention values, such as independence, assertiveness, and to differences between the mainstream cultural competitiveness can decrease Latino students values of schools and the values of Latino fami- learning and achievement (Zambrana & Zoppi). lies. For example, in a study of immigrant SEL programs strive to align school cultures Mexican families, Valdes (1996 as cited by with those outside of the educational environment Woolley, Kol, & Bowen, 2009 ) found there were in a way that fosters positive development among major differences in parent and teacher defi nitions youth. In support of this claim, two of the three key of education. Latino parents were deeply con- strategies identifi ed by Greenberg et al. ( 2003 ) in a cerned with their children’s educación (focusing review of research on SEL programs involved more on behavior, respect for adults, and inter- aligning the school environment with the commu- personal skills). Teachers, on the other hand, nity and family environments. In addition, studies were concerned with the children’s education have found that interventions that connect families (focusing on academics). These cultural differ- with their children’s schools and the larger com- ences lead each to incorrectly conclude that the munity with its schools promote educational other was neglecting the children’s learning. Such resilience (Wang & Haertel, 1987 ) and have misinterpretations can often lead to parents avoid larger- and longer-term effects (Epstein, Coates, contact with teachers and teachers feeling frus- Salinas, Sanders, & Simon 1997 , Haynes & trated and giving up on making connections with Comer, 1996 ; Walberg, 1984 ). parents (Woolley et al.). Lack of communication between parents and school personnel puts Latino School–Community Partnerships . SEL programs students at a disadvantage, as parents do not bridge the gap between schools and their families receive informational resources regarding their and communities in a variety of ways. One strat- children’s education (i.e., enrollment in Advanced egy is to improve the alliance directly through Placement courses, taking the SAT, the process of schoolÐcommunity or schoolÐfamily partner- entering college and mechanisms for fi nancial ships (Greenberg, Domitrovich, & Bumbarger, assistance) (Zambrana & Zoppi, 2002 ) . 2001) . Service learning and family outreach ini- Like parents, Latino students may become dis- tiatives are especially effective at bridging the connected from school if their cultural and family gaps between communities and families and their values and assets are not valued in school. Latino schools. For example, Lions-Quest programs culture is rich with protective factors related to (Lions Clubs International Foundation, 2003 ) 20 Promoting Educational Equity in Disadvantaged Youth… 363 provide evidence-based, developmentally appro- drug abuse (McCluskey, Krohn, Lizotte, & priate interventions for grades KÐ12 through Rodriquez, 2002 ) , alcohol use (McCluskey et al.), schoolÐcommunity partnerships. In an effort to smoking (Newcomb et al., 2002 ) , and unpro- align the values of families with those of their tected sexual activity (resulting in STDs or children’s schools, the program includes home- unwanted or early pregnancy) (McGee & work assignments that students complete with Newcomb, 1992 ) . As noted above, Latino youth their guardians and skills-building workshops for suffer from higher than average rates of substance parents. The Lions-Quest program targets com- abuse, have an earlier age of onset of sexual activ- munity culture through its high school curricu- ity than Caucasian youth, and are less likely to lum, Skills for Action; this segment involves use condoms, which results in higher rates of teen service learning in the surrounding community pregnancy and risk of contracting STDs (Lescano, and has resulted in “gains in positive community Brown, Raffaelli, & Lima, 2009 ) . Currently, 20% values” and increased empathy and ability to of all people living with and newly diagnosed work with and relate to diverse groups (Lions with AIDS between the ages of 13 and 24 are Clubs International Foundation). More impor- Latino (Lescano et al.). tantly in a discussion of educational resilience, These circumstances are widely associated the program also reduced dropout risk (Lions with lower academic achievement in terms of Clubs International Foundation). grades, test scores, and school completion and Caring School Community (The Child tend to occur at signifi cantly higher rates in low- Development Project: See Appendix) also has SES communities. Poor health choices also have speci fi c strategies for fostering a sense of cohe- strong connections to greater likelihoods of vio- sive culture within all ecological levels in which lence. It is estimated that 9% of Latino males the child functions: in the classroom through between the ages of 12 and 17 are victims of vio- class meetings, within the school through buddy lence (National Center for Mental Health programs, within the family through conversa- Promotion and Youth Violence Prevention, 2004 ) . tion prompts, and throughout the community Moreover, after unintentional injury, homicide is through schoolÐcommunity programs. Grade- the leading cause of death for Latino youth school students who went through the program (Shetgiri et al., 2009 ) and Latino gangs make up had a stronger sense of the school as a commu- 46% of all gangs in the U.S. (Kuperminc et al., nity and more liking for their school (The Child 2009 ) . Furthermore, the culture that values vio- Development Project). Even after the students lence poses risks not only for the aggressors but transitioned to middle school, they maintained a also for those around them, such that small groups stronger feeling of community and still reported of physically or emotionally destructive individu- more liking for their schools and greater trust in als can have disproportionately large negative their educators than if they had not received the effects on entire schools. program (The Child Development Project). Research indicates that urban school children experience growth in aggression over the course Confronting a Culture of Violence, Sex, and of each school year; empirically supported SEL Substance Use. Many urban, disadvantaged com- programs, such as the Resolving Con fl ict munities struggle with a subculture that promotes Creatively Program (RCCP), slow and virtually violent solutions to interpersonal problems and halt this process. SEL programs directly target glamorizes sex and substance use. This subcul- violent and poor health behaviors through com- ture frequently carries over into the community’s prehensive, multimodal violence-prevention and educational institutions, undermining academic health-promotion modules that have been shown achievement, healthy development, and prosocial to foster healthy decision making and reduce behavior (U.S. Department of Health and Human high-profi le aggressive acts (such as bullying and Services, 2001 ) . Various health behaviors have gang involvement) and lower pro fi le and more been identifi ed as risk factors for low academic commonplace antisocial behavior (such as inter- achievement and/or school dropout, including personal aggression and theft). They accomplish 364 J.A. Reyes et al. this through promoting fi ve commonly identifi ed to increase frequency of neutral and positive stu- social and emotional competencies, which con- dent behavior and their understanding of social stitute the focus for many SEL programs (CASEL, skills; educators reported that the program helped 2003a ; Zins et al., 2004 ) . Bolstering students’ with classroom management, and that it decreased skills in self-awareness (recognizing one’s own disruptive and aggressive behavior in the class- emotions), social awareness (recognizing emo- room (Grossman et al., 1997 ). tions in other people), self-management (acting The same social, emotional, and decision- on one’s emotions in a controlled, productive, making skills that decrease violent behaviors also prosocial manner), relationship management support better health choices among youth. Know (responding calmly and constructively to others’ Your Body (American Health Foundation) targets behavior), and decision making (focusing on general health behaviors through frequent lessons long-term rather than short-term goals) all work that target fi ve areas: self-esteem, decision mak- to de-escalate stressful interpersonal situations ing, communication, goal setting, and stress man- that frequently lead to poor health choices and agement. Several evaluation studies have shown violence at school and in the community. that Know Your Body results in improved health Decreased drug and alcohol use, pregnancy rates, behaviors, including reduced rates of smoking. health problems, and violent interactions result in Teenage Health Teaching Modules (Education less energy and time being devoted to managing Development Center) is notable in its compre- these problems and their emotional effects (such hensive programming that goes beyond drug pre- as anxiety, anger, and grief) in students and edu- vention, healthy sexual development, and general cators. The time that administrators, educators, health promotion and targets academic skills, and students would have diverted toward those citizenship, and violence prevention (CASEL, ends can then be applied to the task of teaching 2003b ) . A study of this program in high school and learning, thereby fostering positive educa- found that it reduced tobacco, illicit drug, and tional outcomes among students. alcohol use, along with consumption of fried Many SEL programs identify violence preven- foods (CASEL). However, another, unpublished tion as a primary aim, and they use different tech- study’s fi ndings of the program’s effects in mid- niques to achieve that aim. The I Can Problem dle school were less conclusive (CASEL). Solve (ICPS; formerly, Interpersonal Cognitive In general, SEL programs reduce or mediate Problem Solving) curriculum (Shure, 1992a , the effects of negative forces in the community 1992b , 1992c ), for example, focuses on fi ve main outside of the school, thereby supporting positive problem-solving skills to reduce violence: means- academic outcomes among youth. By providing end thinking, weighing pros and cons, alternative students with safe, predictable educational envi- solution thinking, consequential thinking, and ronments that are responsive to the values of the empathy. These skills have been shown to increase context in which they function, schools can help problem-solving skills and foster positive rela- students devote more energy to academic topics, tionships and prosocial behavior both inside and and do so in a more effi cient manner. SEL pro- outside the classroom, with effects lasting up to 4 grams provide holistic frameworks that help edu- years. ICPS has been shown to both intervene and cators achieve these aims through systematic prevent problem behavior such as bullying and change (Elias & Arnold, 2006 ) . violence. Another program, Peace Works, was based on resiliency theory and research, and prevents violence through multimodal intervention Implementation of the Educational in three dimensions: the learning environment, the Resilience Model student’s social competence, and problem behavior reduction. Studies of the program have found Research to date indicates that effectively imple- reduction in fi ghts (Peace Works: See Appendix). mented SEL programs are particularly far-reach- The Second Step curriculum (Committee for ing interventions that are associated with Children: See Appendix) has similarly been found overcoming the clustering risks endemic to urban, 20 Promoting Educational Equity in Disadvantaged Youth… 365 low-SES school environments. To the extent that 1997). Still, the challenges involved in establish- SEL programs are implemented across grade and ing a comprehensive SEL program need not deter schools within a district—as they are designed to educators from the task. Their status confers them be—they can be particularly effective at amelio- a unique capability to build opportunity for their rating the chronic nature of risk factors that inter- students. As institutions that are mandated to fere with the achievement of developmental educate all children within a certain geographical milestones (Gore & Eckenrode, 1994 ) . However, area, schools are able to have unparalleled, the ability of the programs described in this far-reaching in fl uence on their constituents. As chapter to build educational opportunity and con- institutions that are often respected and promi- tribute to resilient outcomes varies with, and in nent in their communities, schools are able to set most cases, depends upon their level of imple- standards for and exert positive infl uence on mentation (Elias, 2007 ; Greenberg et al., 2003 ) . numerous ecological levels: students, parents and This fact presents the most pressing issue for SEL families, neighborhoods, and the wider public. In researchers and supporters to resolve: barriers to addition, their ability to infl uence students over implementation. Enacting the scope and degree the course of time, across developmental stages of system change that are necessary to realize the and milestones, grants schools vast promise as a positive effects of these programs is challenging source of systematic, comprehensive change for nearly all school districts, and can be espe- (Elias & Arnold, 2006) . The potential for such cially so for ones whose fi nancial, personnel, and effi cient and powerful enactment of social trans- physical assets are limited. Gathering the organi- formation provides the impetus for school admin- zational and motivational resources to implement istrators to choose an empirically validated SEL and subsequently evaluate an SEL program across program and allocate the resources necessary for a district’s educators, grades, schools, and aca- its full implementation. demic subjects can be overwhelming; fortunately there are numerous resources that outline best practices for accomplishing such an initiative. Limitations and Directions for Future Recommended resources are listed in “SEL Research Implementation Resources.” One foundation of successful implementation All research on the risk and protective forces in is selecting an SEL program with strong empiri- academic success carries with it the limitations of cal validation. A number of programs exist with the educational fi eld’s current correlational meth- well-documented effi cacy. The Collaborative for odologies. Although all of the risk factors dis- Academic, Social, and Emotional Learning cussed in this chapter have been focused on (CASEL) has created a guide (CASEL, 2003a ; low-SES, Latino status, and academic dif fi culty, Safe and Sound, available for download from educational resilience research has yet to build a http://www.casel.org) evaluating the effi cacy of robust, empirically based understanding of mech- and evidence supporting widely available SEL anisms that link poverty, culture, and poor aca- programs. All of the curricula mentioned in this demic outcomes. However, SEL programs have chapter are among the 22 programs given been shown repeatedly to increase academic CASEL’s “select” designation, based on program achievement, and such programs ameliorate quality and evidence of effectiveness. A list of many of the risk factors that have been proposed these programs is provided in Appendix. to hinder youth’s academic achievement. However, selecting such programs may be Furthermore, research designs and statistical viewed as necessary but still insuffi cient condi- analyses are often not focused on examining tions for effective implementation. Research those who do not follow the paths of central ten- shows clearly that even empirically validated dency de fi ned by the data. Optimal application of programs are neither “implementation proof,” a transactional approach to resilience would nor can they be rendered such (Gager & Elias, include greater use of idiographic, person-based 366 J.A. Reyes et al. methodologies, to supplement the more usual High/Scope Educational Approach for nomothetic, variable-based methods. The resil- Preschool and Primary Grades, http://www.high- iency paradigm offers a framework for continu- scope.org ing research in which exceptions to the predictive I Can Problem Solve (ICPS), http://www. model inform us as to the ongoing re fi nement of researchpress.com our models, in a series of successive approxima- Know Your Body, http://www.kendallhunt. tions towards greater explanatory power. com Despite years of research, progress toward Learning for Life, http://www.learningforlife. social and educational equity has been disappoint- org/ ingly slow. This is particularly the case for Latino Lions-Quest (“Skills series”), http://www. youth whose presence in the American population lions-quest.org is growing but who are not receiving proportionate Michigan Model for Comprehensive Health attention with regard to their academic and social- Education, http://www.emc.cmich.edu emotional needs. Youth growing up now in low- PATHS (Promoting Alternative Thinking SES communities face challenges too numerous Strategies), http://www.preventionscience.com and pervasive to be effectively eradicated during Peace Works (Peace Education Foundation), their formative years. Without a particular focus http://www.peaceeducation.com on Latino youth, schools will fi nd themselves Productive Con fl ict Resolution Program: unable to move ahead to their potential because A Whole School Approach, http://www.school- they will have left behind a sizable subgroup, one, mediationcenter.org paradoxically, that is deeply supportive of educa- Reach Out to Schools: Social Competency tional values and characterized by many protec- Program (Open Circle Curriculum), http://www. tive processes that are supportive of educational open-circle.org success. The educational resiliency paradigm Resolving Con fl ict Creatively Program posits that this reality need not be deterministic of (RCCP), http://www.esrnational.org negative outcomes. Efforts to reduce these struc- Responsive Classroom, http://www.respon- tural agents of risk should be pursued broadly and siveclassroom.org continuously at the level of policy; meanwhile, Second Step, http://www.cfchildren.org SEL offers an additional, and perhaps more imme- Skills, Opportunities, and Recognition diately feasible, approach by ameliorating the (SOAR), http://www.preventionscience.com negative effects of many of these structural agents Social Decision Making and Problem-Solving of risk within disadvantaged educational environ- Program, http://www.umdnj.edu/spsweb ments. In essence, the application of the resiliency paradigm as articulated herein offers a means of reducing educational inequity, or at least its most References negative effects, on those most at risk by targeting both the educational environment itself and by Antshel, K. M. (2002). Integrating culture as a means of fostering students’ internal resources. improving treatment adherence in the Latino population. Psychology, Health & Medicine, 7 , 435Ð449. Caprara, G. V., Barbaranelli, C., Pastorelli, C., Bandura, A., & Zimbardo, P. G. (2000). Prosocial foundations of children’s academic achievement. Psychological Appendix: CASEL’s Select SEL Science, 11 , 302Ð306. Programs (Adapted from CASEL, Cauce, A. M., Cruz, R., Corona, M., & Conger, R. (2011). The face of the future: Risk and resilience in minority 2003a) youth. In G. Carlo, L. J. Crockett, & M. Carranza (Eds.), Health disparities in youth and families: Caring School Community (Child Development Research and applications (pp. 13Ð32). 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Jennifer Taub and Melissa Pearrow

When asked to write a chapter focusing on school Department of Education (2007 ) estimates that for this book, we thought of the many fi ne books, 0.67% of students between 6 and 21 years of age chapters, and articles written about the multitude of are identi fi ed as having an emotional disturbance school-based programs targeted at the prevention of and qualifying them for services under IDEA. social and emotional problems in children and ado- We strongly support such programs and believe lescents. The majority of these programs target they have a vital role in our nation’s schools. We speci fi c issues, such as drug and alcohol prevention, also believe that such programs contribute, directly weapons-reduction, school-community partner- or indirectly, to the reduction of factors related to ships, school-based mental health clinics, and violence in schools, as well as the promotion of school-based family support services (to name, but factors related to resilience in our nation’s student a few). All of them target the social and emotional population. well-being of our nation’s students, and could be In our focus on “school-wide” interventions, said to broadly foster resilience. In this chapter, we are taking a primary prevention perspective, however, we will not be discussing programs that defi ned by Durlak and Wells ( 1997) as “an inter- target youth who have been identifi ed as having vention intentionally designed to reduce the problems, programs with a clinical or mental health future incidence of adjustment problems in cur- focus, or other programs that have a secondary or rently normal populations as well as efforts tertiary prevention focus. Programs that target directed at the promotion of mental health func- students with identi fi ed problems are more likely tioning” (p. 117), where interventions target stu- to have a clinically focused symptom-reduction dents with or without problem behaviors and are emphasis rather than a wellness-promotion resil- delivered to all students. We believe that schools iency model (Cowen, 1994 ; Cowen, Hightower, play a critical and unique role in the develop- Pedro-Carroll, Work, Wyman, & Haffey, 1996 ) . ment of resilience in young people as “current They typically target a small proportion of the models of resilience assume that a systemic per- overall student population; for example, the U.S. spective is important for building protective factors that support children in an integrative manner” (Esquivel, Doll, & Oades-Sese, 2011 ; p. 650). This chapter will broadly focus on J. Taub () school- and classroom-based programs that are Boston Chinatown Neighborhood Center, Inc. , implemented within the school environment, Boston , MA , USA e-mail: [email protected] are specifi cally designed to promote social and emotional competence and prevent the develop- M. Pearrow University of Massachusetts Boston , ment of bullying and/or violent behaviors. As Boston , MA , USA such, treatments and strategies that target only

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 371 DOI 10.1007/978-1-4614-3661-4_21, © Springer Science+Business Media New York 2013 372 J. Taub and M. Pearrow individuals already identi fi ed as displaying In order for schools to foster resiliency, it is problem behaviors (secondary prevention) will necessary to characterize the resilient child. As not be addressed, and our focus will be on uni- reviewed extensively in earlier chapters, there are versal (school-wide) and primary prevention two general groupings of protective factors asso- programs that target the entire school popula- ciated with resiliency in children - internal and tion. There are many such programs which have external. Internal protective factors are those that found to be effective in increasing prosocial are located within the individual, such as impulse behaviors and reducing negative, bullying, control, good decision-making, social problem aggressive, and violent behaviors by addressing solving, and the ability to form positive relation- individuals and the whole school climate (Hahn ships with others (Henderson & Milstein, 1996 ) . et al., 2007) . We believe a resilience focus neces- External factors include having families, schools, sitates enhancing social and emotional learning and communities with characteristics such as set- (SEL) and competence, and promoting stress ting and enforcing clear boundaries, limits, hardiness in all children to reduce the overall norms, and rules, encouraging supportive and incidence of violence and bullying. The impor- caring relationships with others, and possessing tance of such universal programs in school set- values of altruism and cooperation (Henderson & tings will be explored, as well as how they can Milstein ) . A school-wide program designed to enhance resilience through their implementation foster resiliency can use as its mechanism the in the day-to-day activities of children and ado- bolstering of internal factors by working at the lescents. Prevention programs that have been student (individual) level. Such a program can empirically validated will be reviewed, as well teach skills such as con fl ict resolution or social as strategies for implementation and examina- problem solving to students. External (school) tion and the needs and future directions of vio- factors can be enhanced through implementing lence prevention programming and research. environmental changes such as introducing a peer mediation program or making changes in a school’s disciplinary policies. Resilience and Primary Prevention The focus on primary prevention is grounded in a public health orientation (Doll & Cummings, Resilience has been de fi ned as an individual’s 2008 ) . Primary prevention has been de fi ned as capacity for adapting to change and stressful “actions taken prior to the onset of disease to events in healthy and fl exible ways. Or, as intercept its causation or to modify its course Henderson and Milstein ( 1996 ) state simply, it is before pathology is involved” (Goldston, 1985 , how adults and children bounce back from stress, p. 454). As such, these programs are educational trauma, and risk in their lives. In research studies, rather than clinical in nature, since they do not resilience has been identi fi ed as a characteristic of necessarily target disease or the amelioration of youth who, when exposed to multiple risk factors, symptoms. For prevention programs to be effec- show successful responses to challenge and use tive, interventions must begin early in life, target this learning to achieve successful outcomes (e.g., developmental levels, and include aspects of the Hawkins, Catalano, & Miller, 1992 ; Masten, Best, individual and the environment, since many of & Garmezy, 1990 ; Rutter, 1985 ; Werner, 1989 ) . the undesirable behaviors related to later aggres- The National Academy of Sciences (Reiss & Roth, sion and the attitudes that accompany such behav- 1993 ) defi ned resilience as patterns that protect iors are evident long before adolescence (Reiss & children from adopting problem behaviors in the Price, 1996 ) . Some programs target identi fi ed face of risk. Resilience involves adaptive responses students; for example, aggressive children dem- to such environmental stressors as changes in fam- onstrate de fi cits in social skills knowledge and ily or community circumstances, or exposure to are more likely to respond impulsively when trauma (Huizinga, Loeber, & Thornberry, 1995 ; confronted with social problems (Dodge, Pettit, Overstreet & Mathews, 2011 ) . McClaskey, & Brown, 1986) . Thus, intervention 21 Resilience Through Violence and Bullying Prevention in Schools 373 programs are effective in increasing social skills 20% of bystanders report or intervene in some knowledge, improving social behavior, and in way (Nickerson, Mele, & Princiotta, 2008 ) . Given preventing declines in social behavior (e.g., the prevalence of such incidents, most students Catalano, Berglund, Ryan, Lonczak, & Hawkins, will at some point be in the role of bystander. 2002 ; Durlak & Wells, 1997; Leff, Power, Manz, Being a bystander can have negative consequences Costigan, & Nabors, 2001 ; Olweus & Limber, including feelings of guilt and distress (Twemlow, 2010 ) . As such, interventions should start early Fonagy, & Sacco, 2004 ) . Some researchers have as they are more cost-effective, and since the categorized types of bystanders, including those resources spent on an adolescent are enormous who egg on and encourage the bullies (“active compared to the cost of interventions spent early accomplice”), those who laugh (“encouraging in a child’s life (Doll, Jones, Osborn, Dooley, & accomplice”), those who do nothing (“passive Turner, 2011 ; Flannery & Williams, 1999 ) . By the accomplice”) and those who intervene on behalf time children get to middle school, large numbers of the victim (“defender”) (Olweus & Limber, have engaged in aggressive, risky, or bullying 2010) . Defenders are more likely to be agreeable, behaviors (Bosworth, Espelage, DuBay, Dahlberg, prosocial, cooperative, and trustworthy (Tani, & Daytner, 1996 ; Englander, 2011 ; Johnson & Greenman, & Schneider, 2003 ) . It is therefore Johnson, 1995 ; Petersen, Pietrzak, & Speaker, highly benefi cial for programs to engage, together, 1998 ) . For instance, one large-scale survey found the range of bystanders so that the skills of the that children in grades three through fi ve reported defenders can be modeled for the passive bystand- that during the past week, 15% had been sent to ers and accomplices. the offi ce for disciplinary problems, 13% tried to The profound need to address issues of bully- start a fi ght, 27% hit someone, and 12% reported ing and violence prevention has resulted in legis- being threatened with a gun or knife (Embry, lative mandates with resources to support Flannery, Vazsonyi, Powell, & Atha, 1996 ) . implementation of prevention programs (Naglieri, Universal, primary prevention programs tar- LeBuffe and Shapiro, 2011 ) . At present, 48 states get all students in a school, not just particular stu- have legislation on the books aimed at the pre- dents. There is a strong need to target the majority vention of bullying in schools; two-thirds of those of school-aged children, even if they do not meet laws also address cyberbullying. Laws such as criteria for mental health diagnoses, as over 50% the one in our state (Massachusetts) have of elementary school children, over 60% of mid- signifi cantly expanded the domains in which dle school children, and two-thirds of high school schools are able and compelled to respond to sit- students report having been bullied in the past uations that occur between students whether they year. Most common is name calling, reported by occur at school or in the community. This creates about 50% of elementary students, and over 60% a new and challenging level of responsibility for of older students. Elementary school boys report schools, as they are impelled to address situations experiencing more physical bullying (41%), while which may occur outside of school, and which about 25% of elementary school girls and the may be unseen (e.g., texting or cyberbullying). same number of older students report being victims of physical bullying. Social exclusion and rumors as a form of bullying starts in elementary Importance of Prevention school (14% of boys, 27% of girls), and increases Programming in Schools in middle (36%) and high school (45%) (Englander, 2011 ) . Social exclusion and rumors Schools are the largest system capable of impact- as a form of bullying starts in elementary school ing the majority of children and their families. (14% of boys, 27% of girls), and increases in mid- The President’s New Freedom Commission dle (36%) and high school (45%) (Englander, ( 2003) called for a transformation in the delivery 2011 ) . While approximately 80% of bullying of mental health services, and the role of school incidents are witnessed by a bystander, less than mental health services was highlighted since 374 J. Taub and M. Pearrow schools are uniquely positioned to play a central ported agency that provides services primarily to role in enhancing the mental health promotion children and youth receives comparable fi nancial and prevention programming. Schools provide support to address these issues. the opportunity to observe and intervene directly There are several factors which impact the in the setting where the child spends a signi fi cant ways in which violence and aggressive behavior amount of time while also reducing issues of is managed within a school including the overall stigma related to mental health treatment. It is climate, policies and procedures, and implicit and estimated that approximately 70% of children explicit rules. There is increasing recognition of and adolescents in need of treatment do not the range of behaviors which can and should be receive mental health services, and for children addressed to make schools safe places, which pro- who do receive mental health services, schools mote resiliency for all students (Bostic & Brunt, are the primary providers (Hoagwood & Erwin, 2011 ; Greenberg et al., 2003 ) . However, individ- 1997) . Schools are particularly well suited to pro- ual factors, such as whether or not a teacher was mote children’s development in the area of social bullied as a child, also impact how such incidents adjustment and can be a refuge where children are dealt with in school settings (Ransford, who have many environmental risks can fi nd Greenberg, Domitrovich, Small, & Jackson, 2009 ; structure and effective methods of success Yoon, 2004 ) . Teachers are more likely to see (Comer, 1980 ; Doll & Lyon, 1998 ) . Moreover, physical and verbal aggression as more damaging over 180 studies have demonstrated that when than social exclusion, which is not necessarily schools implement universal programs that target true (Yoon & Kerber, 2003 ) . In some schools, social-emotional learning (SEL), the students teachers and school staff can be perceived as demonstrate signifi cant increases in self-control, bullying towards students (Twemlow, Fonagy, & decision-making, attitudes towards self and oth- Sacco, 2006 ) . Teachers who feel self-effi cacy in ers, social behaviors, and decreases in conduct dealing with bullying and aggression are more problems and aggression and emotional distress able to manage the situations effectively. Involving (Payton et al., 2008 ) . the entire school community, including parents, Schools afford the opportunity to promote teachers, bus drivers, cafeteria staff, etc. is associ- social competence within this naturalistic ated with less violence and aggression. Other fac- setting - in classrooms, on the playground - where tors associated with decreases in bullying and the skills can be developed, generalized, and school violence include: Staff discussions about moreover, are more effective than efforts utilized bullying, clear rules for the school that are posted in traditional person-centered interventions or and enforced, student involvement, community through other community organizations partnerships with local organizations, strong (Weissberg, Caplan, & Sivo, 1989 ) . School effec- school leadership, professional development for tiveness research demonstrates that schools do teachers and staff, increased adult supervision, have major effects on children’s development and non-punitive consequences for aggressors/bullies, offer “the most ef fi cient and systematic means and access to mental health services for all stu- available to promote the psychological, social, dents in need (Pepler, 2006 ) . and physical health of school-age children” Recently, there has been attention focused on (Weissberg, Caplan, & Harwood, 1991 , p. 833). the behaviors that broadly fall under the category Factors like strong leadership, high and consis- of “bullying,” including most acts thought of as tent academic and behavioral expectations, and “violent” and directed at another individual. In creating a sense of belonging have been identi fi ed addition to physical acts such as pushing or hit- as strongly contributing to effective schools ting, there are other behaviors, often more fre- (Johnson, Schwartz, Livingston, & Slate, 2000 ) . quent and just as negative to both school climate Moreover, the largest expenditure of state bud- and individual student welfare, that fall under the gets is on education, totaling $567 billion in 2009 bullying category. Such behaviors include acts (U.S. Census Bureau, 2011 ) . No other state sup- that cause emotional harm such as cyberbullying, 21 Resilience Through Violence and Bullying Prevention in Schools 375 damage to one’s property, threats or intimidation, proactive and reduce the risk of stigma while also social exclusion, and relational aggression (e.g., maximizing resources by providing services to spreading rumors). Victims of such acts have out- large groups of children (Macklem, 2011 ; Power comes just as negative as those who are victims of et al., 2010 ) . Positive behavior intervention and physical aggression, including being more likely supports (PBIS) is an overarching term in the to develop anxiety, somatic complaints, eating fi eld of education to describe strategies that sup- disorders, depression, and suicidality (Fekkes, port the development of social emotional compe- Pijpers, & Verloove-Vanhorick, 2004 ) . Recent tencies, prevent disruptive behaviors, enhance research has shown that as many as half of middle the school’s organizational health, and foster the school students surveyed said they have been vic- resilience of students and teachers (Bradshaw, tims of cyberbullying, and a third said they had Zmuda, Kellam, & Ialongo, 2009; Stoiber & been perpetrators of cyberbullying (Smith, Gettinger, 2011 ) . School-wide PBIS is a non- Mahdavi, & Carvalho, 2008 ) . While boys cyber- curricular universal prevention strategy that aims bully both those they know and those they don’t, to alter the school environment by creating girls are more likely to cyberbully their friends, improved systems (e.g., reinforcement, data man- and research suggests girls are more likely to be agement), and procedures (e.g., offi ce referral, both victims and perpetrators of cyberbullying training) that promote positive change in staff than boys (Snell & Englander, 2010 ) . and student behaviors (Bradshaw, Koth, Bevans, These surveys document the high incidence Ialongo, & Leaf, 2008 ) . PBIS is organized by the of problem behaviors in school-age children, three-tiered prevention model where universal with a high level of unmet need for these prob- school-wide components of the model are com- lems. Violence prevention research has demon- plemented by the secondary (classroom), and ter- strated that engaging in violence prevention tiary (individual) systems of support (for a review, activities increases standardized academic see Carr et al., 2002 ; Sugai & Horner, 2006 ) . The achievement scores (Payton et al., 2008 ; focus on organizational structures is critical and Twemlow et al., 2001 ) and reduces various prob- there is strong research support for the aforemen- lems that impact academic development, ranging tioned strategies; readers are referred to these from suspensions to time out of class visiting the sources for additional information. school nurse (e.g., Farrington, 2002 ; Hausman, There are two primary mechanisms for the Pierce, & Briggs, 1996 ; Krug, Dahlberg, Brener, prevention of violence in schools. The fi rst is to Ryan, & Powell, 1997 ) . And critically, tragic promote resiliency through the enhancement of events such as mass school shootings perpetrated protective factors, such as the promotion of by youth, or children who have attempted or prosocial behaviors, social competency, and other completed suicide where bullying was a primary resilience-related factors. The second mechanism factor, have underscored the profound need for is through risk reduction, decreasing violence- violence-prevention programs in schools. related behaviors, and antecedents of those behaviors. Within each mechanism, there are both internal and external levels. At the internal Mechanisms for Prevention Programs level are student-centered programs, which include individually based interventions such as School-wide prevention and intervention pro- teaching the expression of feelings, assertiveness grams, which fi t within a public health orienta- training, con fl ict resolution, perspective taking, tion, that involve teachers, family, community and anger management. At the external level is members, and peers have shown to produce posi- environment or school-centered programs, which tive outcomes even for the most vulnerable youth include interventions such as changes in school (Power, Mautone, & Ginsburg-Block, 2010 ) . policies for students’ disruptive behavior, imple- Universal programs are delivered to all children, mentation of peer mediation programs, programs whether or not they have identifi ed needs, are that address teachers’ classroom organization, 376 J. Taub and M. Pearrow changes in scheduling and staf fi ng to provide A great number of secondary prevention pro- more adult supervision, or parent components. grams, targeting those children who have dis- A comprehensive meta-analysis of primary played problem behaviors, have been prevention programs conducted by Durlak and implemented in schools targeting the reduction Wells (1997 ) indicated that, overall, school-cen- of aggressive student behaviors, and related tered programs show small yet meaningful effect problems. Many of these programs are effective sizes (mean ES = 0.35), while student-centered in their goals, and would likely work well as programs show small to large effect sizes (mean companions to a universal prevention program ES = 0.25Ð0.93), depending on the age of student such as the ones described below. Reviewing and the mode of intervention. These authors found these programs is, however, outside the scope of that programs targeting younger children (ages this chapter. 2Ð7) tend to show the greatest effect sizes, whether Here we list some of the programs with the the approach is primarily affective education strongest current research base, utilizing the (mean ES = 0.70) or interpersonal problem solv- Standards of Evidence Criteria for Effi cacy, ing (mean ES = 0.93). Student-centered programs Effectiveness, and Dissemination outlined by the targeting children over the age of 7 tend to show Society for Prevention Research ( 2004 ) . In order small effect sizes (mean ES = 0.24Ð0.36), similar to assist those working in school settings, we also to those seen in school-centered programs. provide the most current information available Programs that focus on self-control or social com- regarding the materials, costs, and training needed petency, utilizing cognitive-behavioral or behav- to implement these programs. As such informa- ioral instructional methods, also show small yet tion can change, we recommend that you use the signifi cant positive results in a meta-analytic study information provided about costs as a guideline, (Wilson, Gottfredson, & Najaka, 2001 ) . and consult the programs’ websites for the most Many school-wide violence prevention pro- up-to-date information. Programs are presented grams strive to enhance protective factors, as well in alphabetical order. as reduce risk, although some programs focus on Good Behavior Game http://www.jhsph.edu/ just one or the other. Most programs are geared bin/i/h/gbg.pdf . toward the internal level, using as their primary Classroom Prevention Program (Good mechanism the direct teaching of both cognitive Behavior Game + Academic Enhancement): and affective skills to students. It is easier to http://toptierevidence.org/wordpress/wp-content/ enhance social competencies than decrease vio- uploads/Classroom-Prevention-Program- lence-related behaviors (e.g., Hudley & Graham, Manual-Werthamer-1993.pdf . 1993 ; Taub, 2002) , and research on single- The Good Behavior Game (GBG) is an approach programs reducing violence are more approach to the management of classroom behav- likely to demonstrate results than those involving ior that rewards positive group behavior for dis- family, peers, and community given the issues of playing appropriate on-task behaviors during complexity (Park-Higgerson, Perumean-Chaney, instructional times. It has been designed for use Bartolucci, Grimley, & Singh, 2008 ) . This makes in fi rst grade classrooms. The class is divided into sense, as a new prosocial skill will need to be two or three teams and a point is given to a team learned before it can be used in place of an anti- for any inappropriate behavior displayed by one social, violent, or aggressive behavior. of its members. Any team with four or fewer check marks at the end of a specifi ed time - ranging from 10 min at the start of the year to a full day Review of Universal Prevention later on - is rewarded. If both teams keep their Programs points below a preset level, then both teams share in the reward (Barrish, Saunders, & Wold, 1969 ) . Given our focus on prevention and resilience, in Tangible rewards (e.g., stickers) are used early in this section we describe primary prevention pro- the school year and less tangible rewards (e.g., grams, designed for school-wide implementation. working on a project) are added. 21 Resilience Through Violence and Bullying Prevention in Schools 377

The GBG is supplemented by weekly teacher- on the GBG developed by the Baltimore led class meetings designed to build children’s Prevention Program is available at http://www. skills in social problem solving. The most effec- jhsph.edu/bin/i/h/gbg.pdf . tive components of the game are division of the class into teams, consequences for a team win- CPP : Teachers receive approximately 60 h of ning of the game, and criteria set for winning the training in the program prior to implementation, game (Harris & Sherman, 1973 ) . Approximately as well as supervision and feedback from pro- 20 independent replications of the GBG across gram experts on a monthly basis during the year. different grade levels (e.g., elementary school, The program’s training and content is standard- high school), different types of students (e.g., ized; its cost is approximately $500 per student regular education, special education), different per year in 2010 dollars. settings (e.g., classroom, lunchroom, urban, sub- The manual for the combined program is avail- urban), and some with long-term follow-up show able here: http://toptierevidence.org/wordpress/ strong, consistent impact on impulsive, disrup- wp-content/uploads/Classroom-Prevention- tive behaviors of children and teens as well as Program-Manual-Werthamer-1993.pdf. reductions in substance use or serious antisocial behaviors (Embry, 2002 ; Kleinman & Saigh, 2011 ; Lannie & McCurdy, 2007 ; McCurdy, Olweus Bullying Prevention: http:// Lannie, & Barnabas, 2009 ) . www.olweus.org/public/bullying_ The GBG has also been combined with an prevention_program.page enhanced academic curriculum to create the Classroom Prevention Program (CPP) (Werthamer, Recommended in the Blueprints for Violence Cooper, & Lombardi, 1993 ) . This combined pro- Prevention series (Olweus, Limber, & Mihalic, gram has been extensively researched and has 1999 ) as a model program, the Olweus Bullying shown positive outcomes in across a number of Prevention program has been shown to lead to a domains. A 17-year longitudinal follow-up study substantial reduction in reports of bullying and of 18 randomized inner city school fi rst grade victimization in Norway, and has had mixed classrooms found those in the CPP intervention fi ndings in the US. Evaluation in Norway in 42 had: lower likelihood of smoking at age 13 (Storr, schools over a 2-year period found that the fre- Ialongo, Kellam, & Anthony, 2002 ) ; by grade 12 quency of bully/victim problems decreased by had higher educational attainment (21% more 50Ð70% (Olweus, 1997 ) , and have shown a likely to receive a GED or HS diploma; 62% more signifi cant reduction in students’ reports of likely to attend college); were 36% less likely to general antisocial behavior such as vandalism, have received special education services; and fi ghting, theft, and truancy, and signifi cant scored approximately one grade level higher in improvements in the “social climate” of the class, reading and math (Bradshaw et al., 2009 ) . as re fl ected in students’ reports of improved order The Coalition for Evidence Based Policy’s and discipline, more positive social relation- Top Tier Initiative’s Expert Panel (2011 ) consid- ships, and a more positive attitude toward schoolers the stand alone GBG to be “promising but not work and school (Olweus et al., 1999 ) . yet Top Tier or Near Top Tier” and the combined In the US, there have been no randomized CPP to be “Near Top Tier.” controlled trials. One recent longitudinal evaluation study in an urban school district over 4 years found the number of bullying incidents per 100 Materials student hours decreased by 65% following implementation of the program. Components associ- GBG : There is no cost, and no speci fi c materials ated with decreased incidents were: posting of are needed to implement the GBG. Teachers can rules, consistent enforcement of positive and neg- implement this program in their classroom with ative consequences, and training adult monitors little to no outside support or assistance. A manual to engage students in activities (Black & Jackson, 378 J. Taub and M. Pearrow

2007 ) . A nonrandomized controlled trial with ten behavior problems through a classroom-based public middle schools indicated no reductions in intervention. The approach is a combination of bullying in the intervention schools overall, but cognitive-behavioral and affective education found positive effects (reductions in bullying) for (Greenberg, Kusché, & Mihalic, 1998 ) . This pro- white students (Bauer, Lozano, & Rivara, 2007 ) . gram has been held up as a model program by A research report (non-peer reviewed) in SAMHSA, a “best practices” program by the Pennsylvania reported that Olweus school have Centers for Disease Control and Prevention, and “seen large reductions in bullying, increased staff is listed as a “promising program” by the US response to bullying, and promoted a better Department of Education and the surgeon gener- understanding of the impact of bullying through- al’s report on youth violence, and included in the out the community” (Chilenski, Bumbarger, Blueprints for Violence Prevention services Kyler, & Greenberg, 2007 , p. 4). (Greenberg et al., 1998 ) . Evaluations of the This program utilizes both student-level and PATHS curriculum found the program positively school-level approaches, which include environ- impacted students’ emotional understanding and mental changes in school climate and in the oppor- interpersonal problem-solving skills (Curtis & tunity and reward structures for bullying behavior Norgate, 2007 ; Greenberg & Kusché, 1996 ) . and sanctions for rule violations in school. A review by Leff, Power, Manz, Costigan, and Nabors ( 2001) found the PATHS program to be a “possibly efﬁ cacious” program, based in part Materials upon ﬁ ndings of evaluations of the PATHS program used in conjunction with another pro-

Costs for this program include a coordinator for gram (Families and Schools Together - FAST). the program, plus approximately $200 per school A recent controlled trial found signi fi cant to purchase the questionnaires, materials, and improvement in all dimensions for the interven- DVD needed, and approximately $55 per teacher tion group but not the control. Teacher interviews to cover costs of classroom materials. The estab- also indicated that they perceived the program to lishment of a Bullying Prevention Coordinating help children acquire better understanding of Committee is a prerequisite for implementation, emotions, and to improve empathy and self- as is completion of 2 day training for one or two control skills (Curtis & Norgate, 2007 ) . A self- committee representatives, at a cost of $3000. published report of the evaluation of the PATHS These individuals are then responsible for train- program in Pennsylvania reported that the pro- ing school staff. Additional phone consultation gram has increased elementary students’ ability (at $125/hour) is recommended throughout the to prevent and resolve confl icts and resulted in fi rst year of program implementation. signifi cant decreases in classroom behavior problems (Chilenski et al., 2007 ) .

Promoting Alternative Thinking Strategies Materials

Information: http://www.prevention.psu.edu/ A kit for kindergarten through sixth grade costs projects/PATHS.html . between $400Ð800, depending on the age level. Materials (for purchase): http://www.chan- Each grade requires a separate kit, so the total for ning-bete.com/prevention-programs/paths/paths. PreK-4th grade would be $1,950; a counselor kit html . is $1900 (grades 1-4) or $2,700 (Preschool - 4th The Promoting Alternative Thinking Strategies grade). Materials are estimated at between $15- (PATHS) curriculum is a student-level program 45 per student per year. The lower ﬁ gure would focusing on promoting emotional and social apply to a school that chooses to deliver the pro- competencies and reducing aggression and gram through current staff who are trained in 21 Resilience Through Violence and Bullying Prevention in Schools 379

PATHS, and the higher cost would apply to a Peacemakers Project school that hires a PATHS coordinator to deliver the program. This program, geared toward students in grades four through eight, has both primary prevention and secondary prevention components. The pri- PeaceBuilders: http://www. mary prevention component is delivered by peacebuilders.com/ teachers in classrooms and consists of a psychoeducational curriculum and procedures for This is a universal, elementary-school-based infusing program content into the school envi- violence prevention program that attempts to ronment. The secondary prevention component alter the climate of a school by teaching students targets students who have preexisting disciplin- and staff simple rules and activities aimed at ary problems and is delivered by school coun- improving a child’s social competence and selors. A large-scale study with a comparison reducing aggressive behavior. PeaceBuilders group in an urban public school system was activities are built into the school environment conducted on this curriculum and was found to and the daily interactions among students, teach- have signifi cant, positive program effects on six ers, and administrative staff, all of whom are of the seven variables assessed (Shapiro, taught a common language and provided models Burgoon, Welker, & Clough, 2002 ) . These posi- of positive behavior, environmental cues to sig- tive effects included increased knowledge of nal such behavior, opportunities to rehearse posi- psychosocial skills, decreased self-reported tive behavior, and rewards for practicing it aggression, and teacher-reported aggression. In (Embry et al., 1996 ) . A study in eight schools comparison to controls, a 41% decrease in with comparison sites found signi fi cant gains in aggression-related disciplinary incidents and a teacher-reported social competence for students 67% reduction in suspensions for violent behav- in kindergarten through second grades, in child ior were found in the intervention schools self-reported “peace building” behavior in (Shapiro et al., 2002 ) . kindergarten through fi fth grades, and reductions in aggressive behavior in grades three through fi ve (Flannery et al., 2003 ) . Another study found Materials the program to be more effective with the highest risk children, who experienced the greatest gains A variety of program materials are available in social skills and the greatest reductions in through their PeaceBuilders website. Training for aggressive behavior following program imple- each site is required; PeaceBuilders send a trainer mentation (Vazsonyi, Belliston, & Flannery, directly to the site and will train up to 40 staff at 2004 ) . once. The 4 h “Essentials” training is required ($2,500) and a variety of other training modules are available, such as PeaceBuilders for parents Materials ($1,250).

Costs of materials are $8 per elementary student, and include student and teacher materials. Resolving Confl ict Creatively Program: There are also training expenses of $1,500 and http://esrnational.org/professional- up, depending on the type of training. This fee services/elementary-school/prevention/ includes “train the trainer” training for up to resolving-confl ict-creatively-program- four staff people. Training and materials pack- rccp/ ages can be tailored to the needs of a school or district. Materials are available through www. The Resolving Confl ict Creatively Program PeaceBuilders.com . (RCCP) includes a K-12 classroom curriculum 380 J. Taub and M. Pearrow and a student-led mediation program. As such, The program is grounded in social/cognitive the program has both student-level and environ- learning theory and targets the in fl uence of intrap- ment-level components. The RCCP focuses on ersonal attributes, behaviors, and environmental teaching confl ict resolution and intergroup factors, following Perry and Jessor’s (1985 ) relations through constructive problem solving, health promotion model to reduce risk factors perspective taking, costÐbene fi t analysis, deci- associated with violence by promoting nonvio- sion-making, and negotiation (DeJong, 1994 ) . lent alternatives. An evaluation of the curriculum There are also training components for teach- in randomized classrooms found that RIPP par- ers, administrators, and parents (Lantieri, ticipants had fewer disciplinary violations for DeJong, & Dutrey, 1996 ) . An evaluation of the violent offenses and in-school suspensions, more RCCP in 11 elementary schools found preser- frequent use of peer mediation, and reductions in vation of competence-related processes and fi ght-related injuries than students in the control slower growth in aggression-related processes group. The reduction in suspensions was main- when compared with students taught few or no tained at 12-month follow-up for boys but not for RCCP lessons (Aber, Jones, Brown, Chaudry, girls. The program’s impact on violent behavior & Samples, 1998) . A more recent study of over was more evident among those with high pretest 11,000 students found RCCP has a positive levels of problem behavior (Farrell, Meyer, & impact on aggressive behaviors and related White, 2001 ) . An extension of the RIPP curricu- beliefs, and children with more RCCP lessons lum into seventh-grade classrooms found stu- also did better in math (Aber, Brown, & Jones, dents who participated in RIPP-7 had fewer 2003 ) . disciplinary code violations for violent offenses during the following school year (Farrell, Meyer, Sullivan, & Kung, 2003 ) . RIPP is recommended Materials on the SAMHSA National Registry of Evidence Based Programs. Trainings for implementation of RCCP are individualized and personalized, and costs are not listed online currently. With the training come all Materials relevant materials and on-site classroom visits and coaching. Training includes a planning meet- The 3-day, on-site training (includes instructor ing, data collection, school needs assessment, 3-4 manual) is $850 per person plus travel expenses. day introductory workshop, peer mediation train- Instructor manuals are $350 per grade level, and ing, administrator and school staff training, and student workbooks are $5 each. parent training.

Second Step: http://www.cfchildren. Responding in Peaceful and Positive org/programs/ssp/overview/ Ways: http://www. preventionopportunities.com/ The Second Step program, based on the work of Shure and Spivack (1978 ) , attempts to improve The Responding in Peaceful and Positive Ways children’s social competence by developing (RIPP) program is a middle school (6thÐ86th student skills in the areas of perspective taking, grades) universal violence prevention program social problem solving, impulse control, and that combines the use of a student-level, social- anger management (Beland, 1992 ; Committee cognitive, problem-solving model where speci ﬁ c for Children, 1992) . This is a school-wide pro- skills for violence prevention are taught through- gram for kindergarten through eighth grade out the school year in the classroom. RIPP also with several controlled research studies to show employs a school-wide peer mediation program. effectiveness in the elementary grades. The Second 21 Resilience Through Violence and Bullying Prevention in Schools 381

Step curriculum was selected as a Model Materials Program by the US Substance Abuse and Mental Health Services Administration Program kits, which can be obtained from the (SAMHSA) for inclusion in their National Committee for Children, cost roughly $1,500 for Registry of Effective Prevention Programs. a kit for all of the elementary grades. Individual Preliminary research in urban and suburban grade level kits can also be purchased. Training areas indicated that after participation in Second is needed to implement the program, which is Step, children’s perspective taking and social available online. Currently the training is being problem-solving abilities improved signifi cantly offered for free, although there have been fees in when compared with controls (Sylvester & the past. Frey, 1997 ) . This research, however, did not assess changes in children’s behavior after the intervention. In another study, a large-scale, randomized controlled trial of the Second Step Conclusions was conducted in six urban schools. The researchers found modest reductions in levels There are many good programs available for uni- of observed aggressive behavior and increases versal implementation in schools to help children in neutral and prosocial behavior, especially in develop social and emotional competences, the playground and cafeteria settings, among thereby increasing resiliency and reducing violent second and third graders (Grossman et al., and socially inappropriate behavior in children. 1997) . Another evaluation of this program with We suspect that one of the factors associated with rural third through sixth graders found the positive fi ndings of the reviewed programs is signi fi cant improvements in independent behav- the teaching of a shared language and skills for ioral observations of engaging appropriately positive and healthy interpersonal interactions with peers, and on teacher ratings of social within entire school communities. A shared lan- competencies and antisocial behaviors at the guage allows all parties - students, teachers, and intervention school when compared with stu- staff - to communicate positively and effectively, dents at a comparison site (Taub, 2002 ) . Second enhance social interactions, reduce interpersonal Step was discussed as a promising “universal” con fl ict, and foster resilience, and implementation school-based violence prevention program in a effectiveness will also be determined by the sup- 2001 review of programs (Leff et al., 2001 ) . port of school leadership. Since that time, a variety of peer reviewed stud- As the review of programs exempli fi es, schools ies have shown Second Step to have positive also have a number of choices of programs that effects in a variety of areas, such as decreasing are affordable once the commitment to imple- aggressive behavior and improving impulse mentation and training is made. Many of these control (Edwards, Hunt, Meyers, Grogg, & programs can very well be time-effi cient and Jarrett, 2005 ) , increasing prosocial skills and cost-effective in the long run as well, especially if empathy (Cooke, Ford, Levine, Bourke, Newell, they result in a reduction of teacher and staff time & Lapidus, 2007 ; Edwards, et al., 2005 ; Frey, for responding to students’ behavior and more Nolen, Edstrom, & Hirschstein, 2005 ) and with time for classroom instruction, and if they lead to a range of populations, including with low SES increased student time spent in the classroom Middle school students (Holsen, Iversen, & instead of in the principal’s of fi ce, in detention, Smith, 2009 ) , or on suspension. Second Step has good teacher buy in (Cooke, It is important to note that primary prevention et al., 2007 ; Edwards et al., 2005 ) , and is shown programs are more effective when targeting to be most effective when implemented school- younger children (Doll et al., 2011 ; Durlak & wide, with administrative support and endorse- Wells, 1997; Hahn et al., 2007 ) . Children in pre- ment (Larsen & Samdal, 2008 ) . school through the early elementary grades are 382 J. Taub and M. Pearrow likely to benefi t most from interventions that implementation of these programs? We trust that increase students’ awareness and expression of our colleagues are and will investigate these and feelings, as well as interventions that enhance other questions related to the effects of school- cognitively based social problem-solving skills. wide violence prevention programs. Such interventions will most likely enhance resilience and decrease aggression and violence. Although there is not a great deal of longitudinal data available, we would also hope that compre- References hensive interventions in the early school years Aber, J. L., Brown, J. L., & Jones, S. M. (2003). would help to establish a repertoire of healthy Developmental trajectories toward violence in middle interpersonal interactions that will serve as a childhood: Course, demographic differences, and strong base for years to come. response to school-based intervention. Developmental Although there is a general need for more Psychology, 39 , 324Ð348. Aber, L. J., Jones, S. M., Brown, J. L., Chaudry, N., & research in this area, there is also an incumbent Samples, F. (1998). Resolving con fl ict creatively: need for further research of these prevention pro- Evaluating the developmental effects of a school- grams with children of various ethnically and lin- based violence prevention program in neighborhood guistically diverse backgrounds. One of the and classroom context. Development and Psychopathology, 10 , 187Ð213. authors has had the anecdotal experience of using Barrish, H. H., Saunders, M., & Wold, M. M. (1969). the Second Step program (Committee for Good behavior game: Effects of individual contingen- Children, 1992) in an elementary classroom cies for group consequences on disruptive behavior in where nearly half of the children were of Asian a classroom. Journal of Applied Behavior Analysis, 2 , 119Ð124. descent. The cultural norm of restricting the Bauer, N. S., Lozano, P., & Rivara, F. P. (2007). The effec- expression of affect (Sue & Sue, 1999 ) impacted tiveness of the Olweus Bullying Prevention Program the role play and modeling activities that are cen- in public middle schools: A controlled trial. Journal of tral to the program. These sorts of experiences Adolescent Health, 40 , 266Ð274. Bostic, J. Q., & Brunt, C. (2011). Cornered: An approach highlight the need to identify the context and eco- to school bullying and cyberbullying and forensic logical variables in which prevention and inter- implications. Child and Adolescent Psychiatric Clinics vention strategies are effective. of N. America., 20 (3), 447Ð465. We also look forward to long-term longitudi- Beland, K. (1992). Second Step: A violence prevention curriculum for grades 1–5, Revised. Seattle, WA: nal studies to help elucidate some of the lasting Committee for Children. effects of universal, primary violence prevention Black, S. A., & Jackson, E. (2007). Using bullying inci- programs delivered to school-age children. In dent density to evaluate the Olweus Bullying order for these studies to be adequately con- Prevention Programme. School Psychology International, 28 , 623Ð638. ducted, federal and state agencies will need to Bosworth, K., Espelage, D., DuBay, T., Dahlberg, L. L., & support research and program evaluations with a Daytner, G. (1996). Using multimedia to teach confl ict- commitment to examining long-term, rather than resolution skills to young adolescents. American short-term, outcomes. This support will also Journal of Preventive Medicine, 12 (5), 65Ð74. Bradshaw, C. P., Koth, C. W., Bevans, K. B., Ialongo, N. require effective collaboration between the edu- S., & Leaf, P. J. (2008). The impact of school-wide cation, mental health, and public health domains positive behavior interventions and supports (PBIS) to address the multiple aspects of development. It on the organizational health of elementary schools. is hoped that these studies will include, but not be School Psychology Quarterly, 23 , 462Ð473. Bradshaw, C. P., Zmuda, J. H., Kellam, S. G., & Ialongo, limited to, some of the following issues: Does N. S. (2009). Longitudinal impact of two universal participation in earlier grades impact disciplinary preventive interventions in fi rst grade on educational infractions in later grades? Does participation in outcomes in high school. Journal of Educational such programs reduce later involvement in juve- Psychology, 101 , 926Ð937. Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., nile justice or mental health? Does delivery to Turnbull, A. P., Sailor, W., et al. (2002). Positive younger children (preschool) have differential behavior support: Evolution of an applied science. effects? Do teacher variables contribute to the Journal of Positive Behavior Interventions, 4 , 4Ð16. 21 Resilience Through Violence and Bullying Prevention in Schools 383

Catalano, R. F., Berglund, M. L., Ryan, J. A. M., Lonczak, Doll, B., & Lyon, M. (1998). Risk and resilience: H. S., & Hawkins, J. D. (2002). Positive youth devel- Implications for the practice of school psychology. opment in the United States: Research ﬁ ndings on School Psychology Review, 27 , 348Ð363. evaluations of positive youth development programs. Durlak, J. A., & Wells, A. M. (1997). Primary prevention Prevention and Treatment, 5, Retrieved from Nov, mental health programs for children and adolescents: 2011, http://journals.apa.org/prevention/volume5/pre A meta-analytic review. American Journal of 0050015a.html . Community Psychology, 25 , 115Ð152. Chilenski, S. M., Bumbarger, B. K., Kyler, S. & Greenberg, Edwards, D., Hunt, M. H., Meyers, J., Grogg, K. R., & M. T. (2007). Reducing youth violence and delinquency Jarrett, O. (2005). Acceptability and student outcomes in Pennsylvania: PCCDs Research-based Programs of a violence prevention curriculum. The Journal of Initiative. 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Jennifer L. Fleming , Mary Mackrain, and Paul A. LeBuffe

Social and emotional competence is a critical and they have areas of competence and perceived factor in children’s development and school ef fi cacy valued by self or society (Masten, Best, readiness. According to the New Freedom & Garmezy, 1990) . For example, LeBuffe et al. Commission on Mental Health ( 2003 ) , one in ( 2009 ) reported that children with higher social every fi ve children has social and emotional or and emotional competence as measured by the mental health concerns. An estimated two-thirds Devereux Student Strengths Assessment of all young people with concerns are not getting (DESSA) had fewer and less severe behavioral the help they need (Mental Health America, problems than children with lower social and 2011 ) . These concerns, if left unaddressed, pre- emotional competence. This result was found for dict school failure and more serious mental health both high-risk and low-risk children suggesting problems such as depression, anxiety, and con- that social and emotional competence had a main duct disorders which are expensive and diffi cult effect in decreasing the negative impact of risk to treat (Raver & Knitzer, 2002 ) . Social and emo- and thereby promoting resilience. The impor- tional competence has been defi ned as “the abil- tance of promoting social and emotional compe- ity of children to successfully interact with other tence in children is being increasingly recognized children and adults in a way that demonstrates an in research, practice, and policy (Durlak, awareness of, and ability to manage, emotions Weissberg, Dymnicki, Taylor, & Shellinger, in an age- and context-appropriate manner” 2011; Payton et al., 2008 ) . Durlak et al. (2011 ) (LeBuffe, Shapiro, & Naglieri, 2009 , p. 5). conducted a meta-analysis of 213 school-based These social and emotional competencies are studies involving more than 270,000 students that critical skills that often serve as protective fac- investigated the outcomes of universal social and tors, buffering children from the negative effects emotional learning (SEL) programs. They found of risk and adversity and thereby supporting their that students in well-implemented SEL programs resilience (Masten & Garmezy, 1985 ) . Children showed positive outcomes compared to students who experience chronic adversity fare better or in control groups in a wide range of domains. The recover more successfully when they have a SEL programs resulted in increased social and positive relationship with competent adults or emotional skills; improved attitudes toward self, prosocial peers, they are good learners and prob- school, and others; decreased behavioral con- lem-solvers, they are engaging to other people, cerns; and, importantly, an average 11 percentile point gain in tests of academic achievement. In regards to practice, the promotion of social J. L. Fleming ( ) • M. Mackrain • P. A. LeBuffe and emotional well-being and resilience is Devereux Center for Resilient Children , Villanova , PA , USA becoming a required area of competence for some e-mail: j fl [email protected] child-serving professions. For example, the

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 387 DOI 10.1007/978-1-4614-3661-4_22, © Springer Science+Business Media New York 2013 388 J.L. Fleming et al.

Model for Comprehensive and Integrated School Elementary and Secondary Education Act (ESEA) Psychological Services of the National to support training in SEL programs for principals Association of School Psychologists (NASP, and teachers. 2010 ) de fi nes the core competencies of contem- As the evidence for the critical importance of porary school psychologists to include the provi- social and emotional competence in promoting sion of “effective services to help children and resilience and success in school and life contin- youth succeed academically, socially, behavior- ues to accrue, and as more state and local educa- ally and emotionally” (p. 1). School psycholo- tional agencies adopt SEL standards, teachers gists are expected to “have knowledge of … are increasingly expected to teach and promote evidence-based strategies to promote social- these skills in the classroom. For many teachers, emotional functioning and mental health” (p. 2) this is yet one more mandate to add to their as well as “promote the development and mainte- growing list of responsibilities. Paradoxically nance of learning environments that support then, the expectation that teachers promote the resilience…” (p. 6). Similarly, in the early care resilience of their students may be a source of and education fi eld, the National Association for stress for the teachers themselves and jeopar- the Education of Young Children (NAEYC) rec- dize their own resilience. It is our contention ommends the use of developmentally appropriate that the effectiveness of the teacher in promot- practice , which includes a strong emphasis on a ing the social and emotional competence and teacher nurturing a child’s social and emotional resilience of students is directly in fl uenced by development by basing all practices and deci- the social and emotional well-being and resil- sions on (1) theories of child development, (2) ience of the teacher him or herself. Therefore, if individually identifi ed strengths and needs of we desire to promote the resilience of the stu- each child uncovered through authentic assess- dents, we should also commit to supporting the ment, and (3) the child’s cultural background as resilience of the teachers. This chapter will de fi ned by his community, family history, and explore three facets of this issue. First, we will family structure (Bredekamp & Copple, 1997 ) . present some of the common stressors affecting These practice standards refl ect the recognition teachers. Second, we will discuss how these of the importance of SEL by leading professional stressors, mediated through the teachers, nega- organizations concerned with the well-being of tively infl uence children. Last, we will present children. some promising approaches for promoting the With respect to policy, as of the summer of resilience of all adults, with an emphasis on 2011, eight states had adopted or were drafting teachers. explicit K-12 educational standards in the social and emotional domain. The remaining 42 states as well as 6 United States Territories had included Common and Unique Stressors some SEL goals or benchmarks in their educa- Experienced by Teachers tional standards (Collaborative for Academic, Social, and Emotional Learning (CASEL), 2011 ) . According to the American Psychological Similarly, all states had preschool educational Association, the United States is an “overstressed standards related to SEL, with 48 of these states nation” (American Psychological Association having comprehensive, free standing standards (APA), 2010 , p. 5). In this survey of over 1,000 for SEL. In addition, the Academic, Social and adults, one-third (32%) of parents report that Emotional Learning Act of 2011 was introduced their stress levels are extreme and parents overall to the 112th Congress. This proposed legislation say that they are living with stress levels that is still under consideration as this chapter is being exceed their de fi nition of healthy. Adults experi- written, but if passed, will support the implemen- ence multiple sources of stress including money tation of SEL programs in the schools, particu- (76%), work (70%), family responsibilities larly through providing funds through the (58%), and relationships (55%). Some sources 22 Caring for the Caregiver: Promoting the Resilience of Teachers 389 of stress, especially the economy and work been linked with experiencing job stressors such stability have been exacerbated by the current as high work demands and low personal control recession. (Betoret, 2009 ; Santavirta, Solovieva, & Theorell, Teachers experience these and many other 2007 ) . In fact, Lambert et al. ( 2009 ) asserted that sources of stress as well. Since the passage of the there are more studies of burnout in teachers than No Child Left Behind (NCLB) Act in 2002, any other professional group. teachers have been under considerable pressure Burnout is de fi ned as a psychological response to ensure that all children demonstrate pro fi ciency comprised of emotional exhaustion, depersonal- in reading and mathematics by 2014. In addition ization, and reduced personal accomplishment to the demands of NCLB, many teachers are also (Maslach & Jackson, 1981 ) . The most central adversely affected by administrative demands aspect of burnout, emotional exhaustion, is char- such as excessive paperwork and severe time acterized by a feeling of being emotionally over- constraints (Kyriacou, 2001 ; Lambert, McCarthy, extended and drained of mental resources. It O’Donnell, & Wang, 2009 ) . As noted by includes feelings of fatigue, loss of energy, and McCarthy and Lambert (2006 ) , working condi- being worn out. Depersonalization is de fi ned as tions have also deteriorated for many teachers a negative or cynical attitude towards aspects of with more children displaying problem behav- the job, including the people one works with, iors, lacking motivation, or coming to school such as students, parents, or colleagues. The sleep-deprived. Furthermore, teachers are coping third component of burnout involves reduced with an increasing number of demanding or personal accomplishment at work, such as feel- unsupportive parents. The pressure due to school ings of incompetence, low morale, or reduced reform efforts, inadequate administrative sup- meaning or fulfi llment with the job. Within the port, poor working conditions, lack of participa- education fi eld, teachers report considerable tion in school decision making, the burden of burnout (Bauer et al., 2006; Kyriacou, 2001 ; paperwork, and lack of resources have all been Schonfeld, 1990 ) , which has been characterized identifi ed as common factors that can cause stress by indicators such as job dissatisfaction, changes among school staff (Hammond & Onikama, in attitudes about teaching, and impaired job per- 1997 ) . formance (Guglielmi & Tatrow, 1998 ; Montgomery & Rupp, 2005 ; Santavirta et al., 2007; Tennant, 2001 ) . Effects of Stressors on Teachers Furthermore, research suggests that chronic stress and burnout are linked to poor physical Given the multiple stressors present for teachers health in teachers, such as an increased risk of it is no surprise that their health and well-being is headaches, gastrointestinal problems, cold and often compromised. Although stress that is infre- fl u episodes, sleep disturbances, muscle tension, quent can impact the physical and emotional and hypertension (Melamed, Shirom, Toker, health of teachers, it is the in fl uence of chronic Berliner, & Shapira, 2006 ; for a review; see Leiter stress that is more alarming. Across occupations, & Maslach, 2000 ) in addition to mental health chronic exposure to a variety of stressors such as problems such as depressed mood, reductions in high job demands and workload, lack of personal self-esteem and self-effi cacy, decreased motiva- control, insuffi cient rewards, quality of interaction, and job dissatisfaction (Burke, Greenglass, tions in the workplace, perceived fairness in work & Schwarzer, 1996 ; Jurado, Gurpegui, Moreno, decisions, and values related to the job can lead & de Dios, 1998 ; Montgomery & Rupp, 2005 ; to the development of burnout over time when Santavirta et al., 2007 ; Schonfeld, 2001 ; Tennant, coping resources are inadequate (Maslach & 2001 ) . These physical and mental health prob- Leiter, 2005, 2008 ; Maslach, Schaufeli, & Leiter, lems can impact teachers’ personal and profes- 2011 ) . The phenomenon of burnout has been sional lives and result in increased teacher well-documented in the education fi eld and has absences and turnover. 390 J.L. Fleming et al.

The problem of teacher turnover has received teachers experiencing high levels of stress are not increasing attention in recent years. Although physically present in the classroom as much as reports have varied on the incidence of turnover in teachers with lower levels of stress. High rates of public schools, it appears that teachers are leaving teacher turnover and absenteeism can disrupt the the profession at an increasing rate (Provasnik & formation of relationships between teacher and Dorfman, 2005 ) . Current estimates by the National students and can negatively impact on the quality Center for Education Statistics (Keigher, 2010 ) of care provided to children (Helburn, 1995 ; suggest that about 15.6% of public school teach- Howes & Hamilton, 1993 ) . ers were in transition during the school years of Even when physically present in the classroom, 2007–2008 to 2008–2009. Of these teachers, highly stressed teachers who are experiencing approximately 8.0% left teaching employment burnout may be less emotionally available to their (attrition) and 7.6% moved to a different school students; believe they no longer contribute to stu- (migration). Even more troubling are the rates for dent learning and growth; and show lower quality early childhood teachers. Estimates suggest that interactions with students (Belsky et al., 2007 ; the annual job turnover rate for child care provid- Hamre & Pianta, 2004 ; Helburn, 1995 ) . In their ers is estimated to be between 25% and 40% study of over 500 teachers, Lambert et al. (2009 ) (Center for the Child Care Workforce, 2004 ) . This reported that high-stress teachers had a tendency combined turnover is associated with substantial to both depersonalize and distance themselves fi nancial costs. One estimate by the Alliance for from their students, seeing “the children as objects Excellent Education (2005 ) used public teacher rather than developing individuals” (p. 986). The turnover cost estimates from the U.S. Department impact of these outcomes in fl uences both the of Labor to compute an annual cost of about $4.9 teacher’s ability to form healthy relationships with billion to schools. children and the ability to effectively manage the classroom, both of which contribute to the overall classroom climate and may negatively in fl uence How Stress Impacts Adult Ability children’s social, emotional, behavioral, and aca- to Care for and Teach Children demic outcomes (Jennings & Greenberg, 2009 ) . In addition, distressed teachers are less able to Of equal concern to the effects of stressors on the handle misbehavior or provide guidance to their teachers’ well-being are the effects of teacher students (Biglan, 2008 ) . stress on students. The negative impacts of teacher For young children especially, the ability to form stress on students are many; in this chapter we close relationships and attachment to teachers or will focus on only three: (1) reduced teacher avail- caregivers is critical for healthy development. Early ability and the impact on attachment and relation- developing attachment may be distorted by parental ships with children, (2) impairments in ability of or caregiver unresolved losses, traumatic events, or teachers to model social and emotional compe- chronic stressors (Shirilla & Weatherston, 2002 ) . tence, and (3) direct negative effects on children. When adults are stressed and unsupported it can negatively impact their ability to provide the level of Reduced Teacher Availability. Teachers experi- quality caregiving that infants and children need to encing high levels of stress are less available to prepare them for school and life success. Research students both physically and emotionally. In addi- is clear that an adult’s neglect of a child’s physical tion to the higher rates of transition described or emotional needs, use of harsh or inconsistent above, highly stressed teachers also have impaired punishment, little expressive speech, and frequent job performance, lower productivity, and increased changes in routines, which are all behaviors related absenteeism (Leithwood, Menzies, Jantzi, & to experiencing high levels of stress, lead to devel- Leithwood, 1999 ; Tennant, 2001 ) . As a result of opmental risk. When adults provide clear, consis- the physical sequelae of stress noted above and tent expectations, positive emotional expression, the decreased morale associated with burnout, stability, and responsive caregiving it promotes a 22 Caring for the Caregiver: Promoting the Resilience of Teachers 391 child’s potential (Rintoul et al., 1998) and lays the typically emphasize both direct instruction and emotional foundation that enables readiness for continual modeling of the skills by teachers in the learning (Norman-Murch, 1996 ) . Children grow classroom. This modeling provides children with and thrive in the context of close and dependable the opportunities to apply concepts to their daily relationships that provide love and nurturance, secu- lives, for example by observing a teacher rity, responsive interaction, and encouragement for appropriately manage a frustrating event or prob- exploration. According to Werner and Smith ( 1992 ) , lem-solving through a peer confl ict. Numerous common factors among resilient children include studies have demonstrated the effectiveness of having a close bond with at least one person that social-emotional learning programs for students provided stable care, mothers’ modeling of compe- (Durlak et al., 2011; Greenberg et al., 2003 ) and tence, and positive relationships with extended fam- suggest that teacher willingness and ability to ily members and caregivers when parental ties were generalize social-emotional skills by modeling not available. When the teacher or caregiver is during interactions with students throughout the unavailable to the young child as a result of chronic day impacts student behavior (Conduct Problems stress, these relationships can be disrupted and the Prevention Research Group, 1999 ) . consequences can be severe and long-lasting However, teachers who are already over- (Shonkoff & Phillips, 2000 ) . whelmed by the demands of teaching may fi nd it dif fi cult to model appropriate social-emotional Impairments in the Ability of Teachers to Model behaviors for children. Teachers are constantly Social and Emotional Competence. According to exposed to emotionally challenging situations, Bandura ( 1977 ) , individuals, including children, and if they are already experiencing high levels are able to learn through the observation and imi- of stress, they may not have the capacity to effec- tation of others, a phenomenon described as social tively manage those emotions in the presence of learning. Within this theory, children perceive children. Similarly, it may be dif fi cult to model adults’ behavior and may later imitate that behav- an appropriate confl ict-resolution approach for ior. This theory has been applied to help explain students if teacher emotions, such as frustration, the development of prosocial behavior in children. are already at a high level. When this occurs, stu- For example, parental modeling of empathy and dents miss out on critical opportunities to apply concern for others infl uences children’s prosocial learned skills to their everyday lives, and may behaviors (Eisenberg, Fabes, Schaller, Carlo, & instead imitate inappropriate or ineffective behav- Miller, 1991 ; Fabes, Eisenberg, & Miller, 1990 ) iors. This may ultimately impact their ability to and parents’ ability to manage emotions in fl uences internalize these skills and may contribute to later the way children experience and express their own emotional or behavioral concerns. emotions (Eisenberg, Fabes, Carlo, & Karbon, 1992 ; Roberts & Strayer, 1987 ) . Direct Negative Effects on Children. In addition Teachers too, in fl uence the social and emo- to social learning outcomes, stress-related nega- tional development of children. A multitude of tive behaviors evidenced by teachers most likely social-emotional learning curricula exist to pro- engenders negative emotions and behaviors in mote these skills in children.1 These programs students. For example, research has suggested that teachers low on self-effi cacy (which is associated with high stress and burnout) demonstrate 1 For a list of evidence-based K-12 social and emotional less effective teaching practices, impacting stu- learning programs, see the Collaborative for Academic, Social, and Emotional Learning (CASEL; http://casel.org/ dent achievement, motivation, and self-effi cacy publications/safe-and-sound-an-educational-leaders- (Skaalvik & Skaalvik, 2007 ; Tschannen-Moran guide-to-evidence-based-sel-programs/ ). For a list of evi- & Woolfolk Hoy, 2001 ) . Additionally, teacher dence-based early childhood social and emotional reports of stress have been linked to student apa- programs, see the Technical Assistance Center on Social Emotional Intervention ( http://www.challengingbehavior. thy (Jenkins & Calhoun, 1991 ) and student mis- org/do/resources/documents/roadmap_2.pdf ). behavior in the classroom (Yoon, 2002 ) . 392 J.L. Fleming et al.

The negative effects of parental stress on areas. The protective factors which emerged children are well documented. According to the include a strong personal satisfaction from their 2010 Stress in America Study (APA, 2010 ) 69% work (Brunetti, 2006 ; Castro, Kelly, & Shih, of parents believe that their stress has little or no 2010 ; Howard & Johnson, 2004 ; Stanford, 2001 ; impact on their children, although this apparently Williams, 2003 ) ; strong social support from fam- is not the case. The overwhelming majority of ily, friends, colleagues, and school leadership children (91%) reported that they were aware of (Brunetti, 2006 ; Howard & Johnson, 2004 ; their parents’ stress. Perceived parental stress Stanford, 2001 ) ; and a strong belief in the ability resulted in youth ages 8–17 reporting feeling sad to control what happens to them, such as the (39%), worried (39%), frustrated (31%), and ability to depersonalize unpleasant events, learn- helpless (21%). Children who reported that their ing from the events and then moving on, and parents experienced high levels of stress were seeking to understand others’ motivation and cir- eight times more likely to report being stressed cumstances (Howard & Johnson, 2004 ) . themselves as compared to children of low stress In addition, recent studies have highlighted parents (17% vs. 2%). Although these data per- some of the skills resilient teachers working in tain to parents and children, it is reasonable to high-need areas possess. These include asking suggest that a similar effect would be found with for help, advice, or resources when needed; uti- students reacting to perceived teacher stress. lizing effective problem-solving approaches; the ability to manage relationships with colleagues and parents effectively; and seeking ways to Programs Promoting Adult Resilience rejuvenate and fi nding ways to balance life and work (Castro et al., 2010 ; Patterson, Collins, & A multitude of adult resilience programs speci fi c Abbott, 2004 ) . to workplace employees exist throughout the US A number of programs exist that target and and internationally, many of which are designed promote many of these attributes in teachers. One and offered at the company level and provide lim- such program is the Inner Resilience Program ited evidence of effectiveness. There are, however, (IRP; Simon, Harnett, Nagler, & Thomas, 2009 ) , programs applicable to a variety of workplace designed following September 11, 2001 to sites that offer promising results, including, but enhance the well-being and resilience of teachers not limited to, the Promoting Adult Resilience living in lower Manhattan. Following a pilot (PAR) Program (Liossis, Shochet, Millear, & study, the program was expanded to include edu- Biggs, 2009; Millear, Liossis, Shochet, & Biggs, cators from public schools across New York City. 2008 ) ; the READY program (Resilience and Teachers participated in a variety of activities Activity for Every Day; Burton, Pakenham, & designed to reduce stress and burnout; increase Brown, 2010 ) ; and the Personal Resilience and attention, concentration, and job satisfaction; and Resilient Relationships (PRRR) worksite training improve relationships with colleagues. Activities program (Waite & Richardson, 2004 ) . included yoga classes, a series of monthly group Given the negative impact of stress on teach- classes, a weekend retreat, and curriculum trainers’ health, job satisfaction, and career longevity, ing for a classroom component. Following the as well as on student attachment and relation- program, teachers reported reduced stress levels, ships, social and emotional competence, and increased mindfulness and attention levels, and self-perceived stress, it is understandable that improved relationships with colleagues. attention is being given to fostering the well- The Emotional Intelligent Teacher (EIT; being and resilience of teachers. Several recent Brackett & Caruso, 2006 ) program, one compo- studies have examined characteristics of teach- nent of a larger school-based SEL initiative, pro- ers who have managed to thrive in the education vides explicit training to teachers on fundamental profession despite facing a variety of stressors, skills drawn from emotional intelligence theory such as working in disadvantaged or high-need (Mayer & Salovey, 1997 ) , a theory complementary 22 Caring for the Caregiver: Promoting the Resilience of Teachers 393 to resilience. In this one-day workshop, teachers and instruction to young children. The DARS learn information about emotion-related skills was developed to accompany the Devereux Early (i.e., identifying, understanding, and managing of Childhood Assessment Program for Infants and emotions) and how these emotion-related skills can Toddlers (Mackrain, LeBuffe, & Powell, 2007 ) , be applied to classroom situations experienced by therefore the focus groups and literature reviews teachers (Brackett & Katulak, 2006 ) . focused on parents, teachers, and other caregivers The programs described in this section address of young children. However, the protective fac- a critical need and have demonstrated positive tors identifi ed and the items on the DARS are outcomes, but have some limitations as well. applicable to all adults. These are organized group interventions that The result of this process was the creation of a require an organizational sponsor such as an set of 23 items that relate to four adult protective employer. If one does not work at an organization factor domains. The Relationships grouping that is committed to supporting the resilience of (5 items) addresses behaviors that re fl ect the staff through programs such as these, access is mutual, long-lasting, back-and-forth bond we very limited. Furthermore, many schools are fac- have with another person in our lives . Sample ing dif fi cult funding situations that may make Relationship items include “I have good friends these programs diffi cult to implement at this time. who support me,” and “I have a mentor or some- Additionally, employees in a group session with one who shows me the way.” The Initiative group- their coworkers may feel some reluctance to self- ing (8 items) inquires about the ability to make disclose the sources of stress in their lives or the positive choices and decisions and act upon them. success of prior attempts at coping. Sample Initiative items include “I try many ways to solve a problem,” and “I can ask for help.” Internal Beliefs (6 items) asks the adult to refl ect The Devereux Approach to Fostering on the feelings and thoughts we have about our- Adult Resilience selves and our lives, and how effective we think we are at taking action in life. Sample Internal The Devereux Center for Resilient Children, rec- Beliefs items include, “My role as a caregiver is ognizing the critical need for supporting the resil- important,” and “I am hopeful about the future.” ience of the adult as a requisite for enhancing the The Self-Control grouping (4 items) probes social and emotional competence and resilience behaviors related to the ability to experience a of children, developed The Devereux Adult range of feelings, and express them using the Resilience Survey (DARS; Mackrain, 2007 ) . This words and actions that society considers appro- self-re fl ective instrument is designed to help priate. Sample Self-Control items include, “I set adults, including teachers, refl ect on the presence limits for myself,” and “I can calm myself down.” of important protective factors in their lives. The Adults completing the DARS are asked to re fl ect DARS items are based on information gleaned on the presence of these protective factors in their from a thorough literature review of adult resil- lives and then check 1 of 3 boxes for each of the ience, national focus groups with adults who care 23 items indicating that, “Yes” that protective for and work on behalf of young children (e.g., factor is present in their lives, “Sometimes” it is parents, home visitors, infant mental health spe- present, or it is “Not Yet” present. cialists, and early care and education providers) Staff at the Devereux Center for Resilient and conversations with national experts. The Children investigated the reliability and validity focus groups and conversations with national of the DARS by correlating participants’ scores experts focused on gathering information related on the DARS with their respective scores on the to (1) what behaviors adults felt were important Connor–Davidson Resilience Scale (CD-RISC; to help them “bounce back” or cope successfully Connor & Davidson, 2003) , a 25-item scale com- with risk and adversity as well as, (2) what behav- prising four factors related to resilience: personal ior adults need to provide nurturing, quality care competence, intuition/coping with stress, secure 394 J.L. Fleming et al. relationships, and spiritual in fl uences. A total of settings, it can also be utilized by a single adult. 721 teachers completed both measures in coun- Furthermore as a self-refl ective approach, the terbalanced order. This sample population had a results do not have to be shared or discussed with distribution similar to the U.S. Census Bureau others enabling participants to be more honest (2007) population data in regards to race, ethnic- and forthright. In addition, as Kyriacou ( 2001 ) ity, and age, however in regards to gender, more noted, it is important for teachers to discover females participated in the study than males. which strategies work best for them. Although Findings revealed that the DARS had high inter- training is available from the Devereux Center nal consistency ( a = 0.76), and correlated highly for Resilient Children in the use of the DARS and with CD-RISC scores (Spearman rho = 0.58, Building Your Bounce, it is not required. As such, p = 0.01), supporting the psychometric properties these resources are easily used by a variety of of the DARS. adults and complement the group interventions A guiding principle of the Devereux Center described above. for Resilient Children is that assessments should provide information that guides the development and implementation of strategies to enhance the Conclusions resilience of the person who is the subject of the assessment. That is, the purpose of assessments Nearly all adults in the United States experience developed by the Center is to promote, not just stressors of too many demands and too little time. measure, resilience. In keeping with this princi- Apparently, most adults feel that their level of ple, the DARS is accompanied by a self-re fl ective stress has increased over the past 5 years (APA, journal, Building Your Bounce: Simple Strategies 2010 ) . The current “Great Recession” is exacer- for a Resilient You (Mackrain & Bruce, 2009 ) . bating concerns over employment and fi nancial In addition to including the DARS, this resource stability for many adults and their families. For provides strategies, derived from both research teachers the stressors are many and multiplying. and practice, which are linked to the 23 items and Demands to meet annual yearly progress on high designed to promote adult resilience. For exam- stakes testing, children who come to school not ple, in relation to the Internal Beliefs item, “My ready to learn, increasing behavior problems in role as a caregiver is important” one of the strate- the classroom, to name but a few common stres- gies is to fi rst list all of the routine, sometimes sors are in some cases overwhelming the coping tedious, things that one does as a teacher. Next resources of teachers. It is critical that schools the adult is asked to refl ect and write down the promote the well-being of teachers so they can in positive effects of these routines on him or her- turn support students in acquiring the social and self. A teacher might list as a routine task writing emotional skills that are essential for school and weekly progress notes on each child, but then life success. Supporting teachers’ resilience is a re fl ects and realizes that those notes enable her to promising practice that is critical to educational see progress in her students’ abilities and com- planning efforts at the national, state, and local municate that news to parents and the student. levels. After completing the DARS, the adult selects one or more of the items that receive a rating of “Sometimes” or “Not Yet” and then selects a References related strategy from Building Your Bounce to promote the development of that protective Academic, Social, and Emotional Learning Act of 2011, factor. H.R. 2437, 112th Cong. (2011). Retrieved September As a self-directed and self-re fl ective approach, 6, 2011, from http://www.govtrack.us/congress/billtext. the DARS and Building Your Bounce can be uti- xpd?bill=h112-2437 . Alliance for Excellent Education. (2005, August). Teacher lized by any adult interested in enhancing his or attrition: A costly loss to the nation and to the states her resilience. Although it can be used in group (Issue brief). Washington, DC: Author. Retrieved 22 Caring for the Caregiver: Promoting the Resilience of Teachers 395

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Schools have historically been the great equalizer horses could drink. At 18, he worked with his in the American landscape—the “ticket out” for father for a mountain lumber company and, 65 youth struggling to overcome conditions of years later, he was still grateful to the owner for adversity and poverty (Pianta & Walsh, 1998 ) . telling him that he would be ﬁ red each fall and For immigrants to the eastern seaboard, schools rehired each summer because he ought to be in were safe havens where children learned English, college. My father would shake his head gently received public health services, and became liter- and remember, “He said I was too smart to be ate and employable (Pulliam & Van Patten, 2007 ) . lumbering for the rest of my life.” As each wave of homesteaders moved west across Then, and now, schools are vested with the the country, schools popped up alongside the responsibility of ensuring the success of each newly broken sod. Universal access to public generation’s youth (Pianta & Walsh, 1998 ) . education has been a de ﬁ ning feature of the North Indeed, a central tenet of the No Child Left American culture, and schools are fertile settings Behind Act (NCLB, Public Law No. 107-110, for promoting the intellectual, psychological, and 115 Stat. 1425, 2002) was that schools are respon- personal competence of youth (Masten & sible for successfully teaching all children, Coatsworth, 1998 ) . regardless of their socioeconomic status, ethnic- Poignant tales of schooling and learning have ity, language, or parents’ education. Threaded passed down through my own family. My grand- through contentious and passionate debates about mother told vivid stories of being 12 years old the adequacy of schools and correctness of their and traveling alone by train from her parents’ practices, political will in the United States reit- land in Montana to central Kansas. In 1912, erates and reinforces the central importance of schools had not yet been built near their new public education. To quote the prominent jour- homestead but, in Kansas, she could live with nalist, Dan Rather, children’s dream for success relatives and attend school. My father remem- “begins with a teacher who believes in you, who bered riding a pony to a one-room Montana tugs and pushes and leads you to the next plateau, schoolhouse, and then going out at lunchtime to sometimes poking you with a sharp stick called break the ice on the water bucket so that the truth.” In response, schools do “deliberately intervene in children’s lives” (Werner, 2006 , p. 102), and they are entrusted by the public to do so. The purpose of this chapter is to reframe this B. Doll () American dream around current research and con- Educational Psychology, College of Education ceptual frameworks of resilience, and to show how and Human Sciences, University of Nebraska , Lincoln , 238 Mabel, Lee Hall Lincoln, NE , USA these frameworks can become a foundation for e-mail: [email protected] local micro-studies to identify classroom strategies

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 399 DOI 10.1007/978-1-4614-3661-4_23, © Springer Science+Business Media New York 2013 400 B. Doll that contribute to students’ psychological wellness [NRC/IOM], 2004 ; Slavin & Madden, 2001 ) . and strengthen their competence. This chapter These are worthy endeavors. However, at its core, uses Masten and Coatsworth’s (1998 ) very simple resilience often emerges out of very personal defi nition of resilience: “Resilience is how chil- interactions that occur between children and dren overcome adversity to achieve good develop- adults, and between children and other children mental outcomes” (p. 205). This narrows the (Masten & Coatsworth, 1998 ; Pianta & Walsh, defi nition of resilience beyond its usage in the 1998) . This gives special relevance to the daily popular press. Within this de fi nition, my own son classroom interactions that occur between and and daughter would not be considered “resilient” among adults and children. although they are highly successful, because they The remainder of this chapter will fi rst describe have not struggled with any signi fi cant adversity in the characteristics of classrooms that make it pos- their fi rst 3 decades of life. Alternatively, in many sible for children to overcome adversity and schools where I have worked, substantial numbers experience success and competence. Next, we of children came to school hungry, frightened, will describe the data-based decision-making with inadequate clothing, or with shocking memo- strategy that we use to translate this de fi nition ries of family or community violence or abuse. into classroom practices, including how we con- Resilience describes the conditions that allow duct needs assessments of classrooms, the ways these children to triumph nevertheless. in which plans are crafted and put into place to This chapter’s translation from resilience strengthen classroom resilience, and the ways in research into classroom practices relies heavily which evaluations of the classroom changes are on an essential assumption articulated by Egeland, embedded into the strategy. Sprinkled throughout Carlson, and Sroufe ( 1993 ) and reiterated by this description will be the lessons that we have Pianta and Walsh ( 1998 ) : Resilience emerges out learned in carrying out these classroom change of a constellation of child, family, and commu- strategies with teachers and students. We will nity factors. Consequently, practices to strengthen close with a candid discussion of the research children’s resilience are best integrated into the that we have not yet done—the next steps. natural contexts where children live their daily Throughout the chapter, the singular focus of our lives (Masten, 2001 ) . Moreover, it makes no work is to develop and re fi ne a practical strategy sense to speak about resilience as a characteristic that teachers can use (alone or in partnership with of children because children do not achieve resil- colleagues) to create classroom environments ience by “pulling themselves up by their own that predispose their students to success. bootstraps” (Doll, Zucker, & Brehm, 2004 ) . Instead, resilience is a characteristic that emerges out of the systemic interdependence of children Classroom Conditions with their families, communities, and schools. That Foster Resilience This chapter examines resilience as a characteristic of school settings because schools domi- A useful description of the classroom conditions nate children’s lives for at least 15,000 hours that make it possible for children to succeed (Rutter, Maughan, Mortimore, Ouston, & Smith, despite the odds can be culled from the past 50 1979 ) , and represent a secondary and highly years’ developmental research on risk and resil- important source of childhood caretaking. Even ience (Coie et al., 1993 ; Doll & Lyon, 1998 ; more narrowly, this chapter focuses very deliber- Werner, 2006 ) . This tradition began with a large ately on resilience of classrooms. Other scholars number of longitudinal studies, many initiated in have described the resilience of schools, school the 1950s and 1960s that followed participants climates that promote wellness, and school–com- from their birth through adolescence or even munity partnerships that promote student success adulthood. Werner ( 2006 ) describes ten of these (Comer, Haynes, Joyner, & Ben-Avie, 1996 ; large-scale studies that continue to follow their National Research Council/Institute of Medicine participants into the present. The essential 23 Enhancing Resilience in Classrooms 401

question examined in the studies was: what are ience research (Werner, 2006 ) . Several of these the characteristics of children, their families, or same factors were also identifi ed in rigorous their communities that predicted which children educational research as predictors of the aca- would be identi fi ed with disabilities or distur- demic success of students who experienced bances in adolescence or adulthood? Researchers signifi cant psychosocial disadvantages outside gathered comprehensive data on the children, of school (NRC/IOM, 2004) . Prominent among their family, their community at the time of birth, these are rewarding and caring relationships and then meticulously followed the children between and among the adults and children who through decades. Results of these studies have populate a classroom. Within our operational been very competently summarized in Werner de fi nition of resilient classrooms, my colleagues (2006 ) . A brief and over-simpli fi ed synopsis is and I have emphasized three of these relational this: there was a remarkable concordance across characteristics as essential to resilient class- the various studies conducted on different conti- rooms: (1) the quality of the relationships that nents and with different predicted outcomes. exist between the teacher and students in the Across the studies, the same 8–10 factors were classroom; (2) the nature of the peer relation- potent predictors of childhood risk. Many of these ships that exist among classmates; and (3) the factors were characteristics of families and com- degree of collaboration and connectedness that munities rather than characteristics of individual exists between the classroom and students’ fami- children. Moreover, the number of factors rather lies (Doll et al., 2004 ) . Another important set of than the precise combination of factors was a protective classroom practices are those that pro- powerful indicator that the children were likely to mote students’ autonomy and self-regulation. succumb to risk. Thus, the results suggest that Again, we have emphasized two of these auton- children could weather some adversity but were omy characteristics as essential to resilient class- far more vulnerable when struggling with multi- rooms, (4) the degree to which the students are ple adversities piled one on top of the other. empowered to set goals and make decisions on While the examination of risk was worthwhile their own behalf (academic self-determination); in its own right, our operational framework for and (5) the degree to which the students’ are sup- understanding classroom conditions that promote ported in managing their own behavior (aca- resilience grew out of a subsequent question began demic self-control). Finally, but equally to be raised in the 1980s (Doll & Lyon, 1998 ; importantly, resilient classrooms foster chil- Werner, 2006 ) . Each study had participants who dren’s optimism and hope. Within our opera- were quite successful even though, by all rights tional de fi nition, we emphasize (6) the degree to and because they were growing up with multiple which classrooms support students’ con fi dent risk factors, they would have been predicted to fail. expectations that they will succeed in class (aca- These were the resilient children. An important demic effi cacy). More extensive descriptions of question was: What were the characteristics of these six characteristics of classroom resilience, children, their families, and their communities that and the research that underlies their selection, predicted which children would overcome adver- can be found in Doll, LeClair, and Kurien ( 2009 ) sity and succeed? These characteristics have come and Doll, Kurien, et al. ( 2009 ) . to be called “protective factors” because, when present in suffi cient numbers, they appear to insulate children from the deleterious effects of risk Translating Resilience Research and make it more likely that they will grow into into Classroom Practices successful adults with ample education, rewarding vocations, satisfying family lives, and making The central thesis of our work is that it is possible important contributions to their communities. to deliberately embed these protective factors into Between eight and ten essential protective the fabric of everyday practices in classrooms; and factors were identifi ed in developmental resil- that doing so increases the likelihood that children 402 B. Doll will learn and be successful in these classrooms that are already amply represented within a even when they are struggling with many and very classroom. As an example, the majority of needs signifi cant social and economic disadvantages assessments that we have conducted in elemen- (Doll et al., 2004 ) . To implement these contextual tary schools have often shown that teachers’ changes within classrooms, we have adapted a relationships with their students were exception- familiar data-based problem-solving strategy that ally strong and caring (Doll, Spies, Champion, begins with a needs assessment to identify essen- et al., 2010; Doll, Spies, LeClair, Kurien, & tial protective factors that are present or missing Foley, 2010) . Similarly, in most classrooms, stu- within a classroom, the data which are thought- dents had satisfying peer friendships within fully examined and interpreted by teachers in col- which they felt supported and appreciated. laboration with their students and colleagues to Simultaneously, students frequently reported become the basis for planned modifi cations in that their classmates argued a lot with each other, classroom practices that address the needs, the picked on each other, and were often disruptive effects of which are carefully monitored by rein the classroom. In these modal classrooms, the collecting some of the needs assessment data. We logical focus of classroom changes will be on think of this as a classroom micro-study in which these aspects of peer con fl ict and student disrup- members of the class conduct local research to tion. This planful decision about where to inter- verify that they are fostering a classroom environ- vene and what to strengthen is not necessarily ment that maximizes the competence and success the norm in classroom change programs. In too of all students who are its members. All that is many cases, manualized preventive interventions needed to put this micro-study framework into are implemented in a standard format without place are clear operational defi nitions of the class- regard to the strengths that already exist within a room characteristics that act as protective factors; classroom. With the wisdom of a child, a fourth- measures of these characteristics that are techni- grader told me why this is a problem, explaining cally sound, meaningful, and practical to collect in “We really like you and we don’t mind doing this classrooms; and a “toolbox” of classroom strate- stuff. But we think you ought to know—we gies and modi fi cations that can strengthen those already know this.” characteristics that are found to be wanting. Within a data-based problem-solving cycle, When described in these terms, our classroom the measures underlying the needs assessment change strategy is deceptive in its simplicity. The must be simultaneously sound technically and challenge is that all of these occur within the practical to use. As a result, we have spent an existing system of schools, in which classrooms inordinate amount of energy developing class- exist within grade level teams which, in turn, wide measures of the six characteristics that are exist within schools, then school districts, and reliable, valid, brief, simple to collect, easily col- then communities. Moreover, even though class- lated, and analyzed, with results that can be read- rooms operate under the legitimate authority of ily organized into a diagram or graph. A needs teachers and administrators, classroom changes assessment that was highly time consuming would emerge transactionally out of the interactions of intrude into the instructional mission of class- adults and children within and among each other. rooms, and that would prevent its use. If results of Thus, it is a very complex endeavor to implement needs assessments were highly complicated, they classroom change strategies while simultane- would not “speak” to the teachers and children ously respecting the existing classroom system. who populated the classroom, and so would not catalyze the suggestions for change. Given these Classroom needs assessment : There is an essen- constraints, we were impressed with the useful- tial, common sense reason for beginning class- ness of anonymous student surveys that were room resilience interventions with a needs aggregated across all students in a classroom. assessment: precious resources should never be The resulting ClassMaps Survey (Doll, Spies, squandered on strengthening protective factors Champion, et al., 2010 ; Doll, Spies, LeClair, et al., 23 Enhancing Resilience in Classrooms 403

2010 ) is a 55-item anonymous student survey Ideally, using simple classroom data to with eight subscales: three peer relationships sub- reframe daily routines and practices can contrib- scales examining peer friendships in the class- ute to a classroom’s effi ciency as well as its room (My Classmates), peer confl ict (Kids In effectiveness. Nevertheless, carving out time to This Class), and worries about being victimized collect data is very challenging in today’s rushed (I Worry That); two other relationships subscales classrooms and can become a signifi cant barrier that examine teacher–student relationships (My to a micro-study. Consequently, we are experi- Teacher) and parents’ participation in students’ menting with a computer administration of an learning (Talking With Parents); and three self- online ClassMaps Survey. We administer our regulation subscales describing students’ disci- beta version in one of a school’s computer labs. pline (Following Class Rules), expectations for Each student’s computer station is logged onto success (Believing in Me), and self-determination the online ClassMaps Survey using a password (Taking Charge). Students complete the survey by and fi le name that is unique to the classroom selecting “never,” “sometimes,” “often,” or teacher. Students wear headphones so that the “almost always” for each item, and the results are survey is individually read to each of them as aggregated across all students in a class. To ensure they proceed through the items. They click on higher scores uniformly represent more support- their grade and gender, and then each item is dis- ive classroom environments, negative items are played and read aloud, one at a time. As soon as reverse coded. Early research has established that students click on their answer, the program takes the resulting survey factors consistently into the them to the next item. Once they answer the last six classroom characteristics have strong internal item, a colorful “thank you” picture fl ashes up consistency (a ranges from 0.79 to 0.93 in ele- on the screen, signaling to the teacher that they mentary classrooms and from 0.82 to 0.91 in mid- have fi nished. The students then pull up one of dle school classrooms), and correlates in predicted the other instructional programs that the class is ways with other indices of the six characteristics. working on, while waiting for the classmates to The advantages of these aggregated classroom fi nish the survey. When all the students are surveys are that they provide information that fi nished with the survey, the teacher can log onto teachers are not always privy to—students’ pri- the teacher screen, and immediately access and vate perceptions of the support they experience print graphs describing the class’s responses to from classmates and teachers, their personal the surveys. Use of the online ClassMaps Survey sense of belonging and expectations of success, cuts administration times to approximately and their felt responsibility for charting their own 15 min for an elementary or middle school class- course into academic success. Any single stu- room, and the teachers can use their con fi dential dent’s sense of their classroom emerges out of the password to access the summary data moments interactions between their personal characteris- after the last student fi nishes. tics and temperament, and the social and behav- Other measures could be used instead of the ioral contexts provided by the classroom. ClassMaps Survey within this micro-studies However, the collective experience of all students framework. Examples include school records of in a class is an invaluable barometer of the “felt discipline reports, students possessive “votes” on experience” of the class as a whole and a stable the occurrence of teasing or arguments during refl ection of classroom-level characteristics. recess, homework completion records, or play- Combined with teachers’ own experience of the ground maps on which the students have marked classroom, and focused very specifi cally on the places where students do or do not get along. aspects of classrooms that have been linked to the Where these measures of one or more of the six success of students-at-risk, these intersecting classroom resilience characteristics were already perspectives begin to articulate the ecological available to the class, they were useful in addition system of the classroom in a way that is highly to or instead of the ClassMaps Survey results. In relevant to student resilience. other cases, teachers or students became 404 B. Doll

emboldened by their experiences with micro-stud- and they were afraid of failing the weekly test. ies, and began to write their own survey questions, Classroom changes that took student perceptions speci fi c to the unique needs of their class. into account alongside teacher perceptions were often simple and quickly effective. Planning for classroom modi fi cations : The essen- Some teachers have been immediately comfort- tial purpose of any micro-study is to enhance the able with collecting and thinking about classroom protective factors in classrooms that contribute to data and quickly took leadership over their class- students’ academic, behavioral, and social suc- room micro-studies; other teachers have thought cess. There are three immediately obvious ways of “collecting data” as a very complex and time- in which this might occur (Masten & Coatsworth, consuming task, and were slow to look at and be 1998 ) : (a) by providing scaffolded assistance that responsive to their classrooms’ results. Over time, allows students to act in more competent ways we have learned to overtly market classroom data than they could achieve alone; (b) by removing to be highly attractive and acceptable to reluctant the barriers to students’ competence that might classroom teachers. Classroom data are most be embedded within the context; and (c) by attractive and more readily interpreted when dis- re fi ning the classroom de fi nition of competence played in graphs or fi gures than in long lists of so that it matches developmentally appropriate tables. Data that are collapsed onto a single sheet expectations. Our original plans had been to sim- of paper (one or two-sided) are most usable. ply show ClassMaps Survey results from the Teachers’ interest has been heightened when we classroom to teachers, and to support them in have packaged their data into regularly scheduled crafting plans that might accomplish one or all of newsletters printed in full color, annotated with these three purposes in response to weaknesses graphics, with embedded comments describing identi fi ed in the data. other resources or material that we can make avail- The simple act of showing teachers data about able upon request, and timed to coincide with their classroom can be highly reactive. In our teachers’ existing school-improvement meetings. very early investigations of school playgrounds Several master teachers showed us the critical (Doll, Murphy, & Song, 2003 ) , we had to care- importance of classroom meetings to classroom fully guard data describing recess problems from micro-studies. By including students in inter- teachers’ eyes or they would step in and “ fi x” the preting and planning from classroom data, the problems before the study’s conclusion. meetings broadened teachers’ ecological per- Eventually, realizing that this was actually what spectives on classroom practices and diversi fi ed we wanted, we began to deliberately share class- the solutions that they used to strengthen classroom data with teachers. In turn, they were quick room routines. We plan these classroom meet- to share the data with the students in simple class- ings around four simple questions to the students: room meetings. When this occurred, students’ is the classroom data accurate? What do students interpretations of the data’s veracity and mean- believe causes the strengths and weaknesses in ing, and their suggestions for effective solutions, the classroom? What could teachers do to make were often quite different from those of the teach- the classroom a better place for kids to learn? ers. For example, teachers thought that a class And, what could students do that would needed more playground supervisors and stricter strengthen the classroom? Brief chart notes playground rule enforcement, and students focused the students’ attention on the questions, thought that there needed to be more games so and the listed answers became permanent records that students kept busy playing instead of fi ghting that teachers could consult when planning class- at recess. Teachers thought that there needed to room modi fi cations. Students appreciated being be more serious consequences when students included in the planning, and had a clearer sense were inattentive and disruptive during mathemat- of the purpose and potential of the classroom ics period, but students thought that they were micro-study. As one seventh grader noted, “I get wiggly because the work was much too dif fi cult it now. This is all about trying to fi x our school.” 23 Enhancing Resilience in Classrooms 405

In this frame of mind, students were more recess soccer into two separate games so that receptive to the classroom changes that they each fi eld is less crowded. owned and had helped to plan. Still while some In other classrooms, the needed changes were student perspectives were refreshingly frank, neither simple nor readily apparent to the teach- others were more guarded, particularly as stu- ers and they were quickly overwhelmed when dents became older and more self-conscious confronted with classroom data describing weak- about their reputations with their classmates. In nesses that they did not know how to address. response, one inventive teacher supplemented One natural, systemic way to extend the number the open class discussion with computer-aided and quality of teachers’ solutions was to pair “chats” in which students could type in addi- them with two or three other teachers at similar tional private observations simultaneous with the grades, or to pair inexperienced teachers with an open discussion. These private notes were par- experienced master teacher. Within these peer- ticularly revealing in describing the cross-gender support groupings, teachers shared strategies tensions that were heightened by a co-ed soccer that had previously proven successful in chang- game that dominated their recess. ing classroom relationships or autonomy. In Sometimes, simple but very necessary changes other cases, a master teacher or a school mental in classroom routines and practices were quickly health professional (school psychologist, school apparent to teachers as soon as they leafed counselor, or school social worker) acted as a through their classroom data and discussed it consultant to teacher teams who were conduct- with their students. Many of these could be imple- ing micro-studies in their classrooms. When we mented immediately—providing students with served this consultant role, we learned to bring direct instruction in test-taking strategies; incor- one-page strategy sheets for classroom problems porating stress-reducing strategies into the prepa- that were evident in a classroom’s data. The top rations for an exam; arranging students in small halves of the strategy sheets list 8–10 classroom groups or tables and vesting them with the respon- modi fi cations that teachers have used with good sibility for reminding each other of pending success to address similar problems; the bottom assignments or appointments; or adding more halves list routines and practices that have been games to the recess playground. For example, in described in the published literature. Rather than many schools where we have worked, playground “teach” the solution lists, we simply laid them soccer games were a common source of frequent out on the table when teachers were planning and disturbing peer confl ict. Students disagreed and allowed teachers to scan them for strategies about what the “right” rules were for soccer; they that seemed most relevant and about which they struggled to fi nd fair ways to choose balanced wanted more information. Then we described teams, they played soccer on fi elds that were too these strategies in more detail. In still other cases, small (and the ball fl ew off into the middle of teachers have asked us to go back into the litera- nearby ball courts or games) or that were too ture and search for additional information or large (and students could not easily tell where the sources that meet a particular need in their sidelines and goals were located). Students often classroom. spent so much time fi guring out how to play soc- By far, the most common barrier to classroom cer that they never had very much time left to change has been time—time for teachers to stop play it. Often, these disagreements followed the and refl ect on their classroom environments, time students back into classroom instructional time. to search out new information or gather together Teachers’ solutions have included such common simple data, and time to implement changed rou- sense strategies as: researching the rules for soc- tines. When classrooms lack the resources to cer during the classroom social studies lesson; implement a routine or practice that is too choosing teams every Monday and keeping the time consuming, we drew upon the untapped same teams for the full week; relocating the soc- resource that is plentiful in almost every class- cer fi eld or marking it more clearly; dividing room—the time and energy of the students. 406 B. Doll

Indeed, our use of students has sometimes pushed a problem-solving conversation when they had the limits of reason and, to our surprise, they become involved in a hurtful teasing incident. rarely disappointed us. As examples, students in Half of the worksheet would be completed by both elementary and middle school grades have the student who was teased and the other half collected and collated simple data such as weekly would be completed by the student who did the “teasing thermometers” in which students rate teasing. However, none of the teasing worksheets the level of teasing in the classroom, or goal- was ever used. The students found a written achievement data in which students record their worksheet to be a bit aversive, and so they sim- mastery of classroom academic standards. ply talked through the recess problems to avoid Students have created the graphs for the data, completing the worksheet. Certain elements of been “coaches” who remind classmates to carry plans were overlooked or deliberately omitted if out a new routine, served on advisory boards that these were over-ambitious, did not fi t seamlessly conduct mini-studies of their own, searched out into a classroom day, or competed with other rule manuals for playground games, and written demands on the classroom. The fact that this had newsletters home for parents. occurred became obvious once the plan checklists were reviewed, and teachers could then Implementing modifi ed routines and practices focus their attention on what could be done to fi x and monitoring their impact: The best-made the plan or fi x the implementation. plans for classroom modifi cations have little Once planned changes had been in place for impact unless they are actually acted upon. between 4 and 6 weeks, simple evaluations were Planned classroom changes were more likely to conducted to describe changes in the classrooms’ be carried out if they were carefully written targeted protective factors. At a minimum, the down, described as discrete steps, and clearly micro-studies collected pre–post data to verify assigned to one or more person in the classroom. whether classroom environments had improved This written plan could also be used as a check- during the time when the changed routine or prac- list that the teacher or a student used to check off tice was put into place. Thus, we deliberately steps as each was completed. Ultimately, the designed the ClassMaps Survey so that any one of checklist recorded the degree to which the plan the subscales could be administered separate from was followed with fi delity, and this record made the full survey, and most micro-studies re-col- it possible to interpret data describing the lected only those subscales that were relevant to changes’ impact within the context of what actu- their planned changes. Comparisons of pre–post ally happened in the classroom. Still, fi delity is a data were not suffi cient to determine whether bi-directional phenomenon. When planned classroom modi fi cations caused any improve- changes were not carefully implemented, the ments that were seen. However, on a very prag- fault sometimes lay with the plan itself. Plans matic level, the degree to which the changes are to were abandoned if they overreached the resources blame for the improvements may not be an urgent of a classroom. In one case, a school leadership question for teachers to answer. If the classroom team had planned to hold bi-weekly coordinat- modifi cations were convenient and fi t seamlessly ing meetings with all of the paraprofessionals into the classroom’s day, and the classroom rela- who supervised the recess playground at lunch- tionships and autonomy were stronger, teachers’ time. In fact, the supervisors’ time was already decisions to simply continue the modi fi cations scheduled into other student support activities were reasonable ones. Alternatively, when the and the school did not have the funds to pay for classroom modifi cations required signifi cant additional paraprofessional time to attend a resources, needed administrative consent, or rep- meeting. Sometimes plans con fl icted with the resented a change in policy, teachers required a needs or interests of the teachers or students. For more ambitious evaluation. For example, by col- example, a fourth-grade classroom had created a lecting classroom data repeatedly across brief teasing worksheet that walked students through intervals (e.g., daily or two or three times a week), 23 Enhancing Resilience in Classrooms 407 it was possible for teachers to examine trends in “resilient classroom.” To date, our work has been the data and determine whether improvements in dedicated to establishing that these characteris- the data co-occurred with the changed routine. tics of classrooms matter for children’s learning, Thus, classrooms sometimes created small mini- that they can be reliably and validly assessed, surveys of 1–3 questions and students were and that the results of these assessments can sup- assigned to collect these daily. Alternatively, more port practical plans to strengthen the classroom sophisticated small-n research designs might be learning environment. In brief, we have worked important to verify the need for an intervention, to create a micro-study template that allows show size of the intervention’s effect, examine the teachers and their students to empirically exam- effect’s persistence over time, show that the results ine the resilience-promoting features of their could be replicated in other classrooms, or estab- own classroom. lish that the intervention is worth the cost for Now, we are directing much of our attention stakeholders like administrators, school-board towards carefully specifying the intervention members, or community representatives. Such strategies that teachers can use to strengthen the results could justify the continuation of a less six classroom characteristics. Originally, we had convenient but highly effective classroom assumed that this would require that we carefully modi fi cation. “manualize” the micro-study consultation proce- In some cases, the micro-study results showed dures; create sourcebooks of classroom routines, that nothing had changed or that the classroom’s practices, and manualized interventions; and then protective factors had deteriorated. In this event, a implement these in large sample, random assign- logical next step was to implement evidence- ment, treatment-control studies. We anticipated based intervention that rigorous, peer-reviewed that our most ambitious challenge would be spec- studies have demonstrated to hold promise for ifying the consultative process in meticulous strengthening classrooms’ relationships, student ways so that it could be replicated with good autonomy, or expectations of success (Kratochwill fi delity, all the while refi ning the procedures to be & Stoiber, 2002 ) . Several resources are available highly acceptable to classroom teachers. Instead, for identifying evidence-based educational inter- it has become increasingly apparent that our most ventions, including interventions listed on the dif fi cult task has been to frame the micro-study website of the What Works Clearinghouse procedures so that these accommodate the many ( www. whatworks.ed.gov ), several Response-to- diverse systems that exist within the classrooms. Intervention resources (e.g., www.intervention- Clearly, one size does not fi ll all classrooms, and central.org); the Collaborative for Academic, our micro-study procedures need to be innovative Social and Emotional Learning ( http://www.casel. and fl exible enough to fi t the pragmatic realities org); and the UCLA Center for Mental Health in of daily classroom practices. Ultimately, the suc- the Schools ( http://smhp.psych.ucla.edu). cess of the micro-studies will be sustained over time if teachers fi nd the micro-study strategy to be viable, interesting, authentically relevant to Next Steps their teaching, a strategy that saves them time and maximizes their impact with students—in short, The rich tradition of research in developmental a strategy that is worth their time. resilience holds special relevance to schooling Eighteen years ago, Coie et al. (1993 ) argued because it establishes the characteristics of social that practice ought to inform developmental and psychological environments that are optimal research in the same way that developmental for children’s capacity to overcome adversity. research ought to inform practice. Our most Our efforts to translate resilience research into compelling lesson has been to listen carefully classroom practices began by operationalizing to teachers and their students, and thoughtfully its most robust and universal fi ndings into a set attend to the wisdom in their observations of class-wide characteristics that could de fi ne a about their classrooms, the change strategies 408 B. Doll that they use, and the accommodations they Finally, an important feature of the micro- have made to the micro-study procedures. study strategy is that it is not a remedial strategy Then, we have infused the best of these teacher- for struggling teachers. Instead, micro-studies generated ideas into our framework so that its provide committed teachers with one more tools potential is enhanced. The micro-study strat- that they can use to stretch their capacities as egy has become more effective when we have teachers, maximize the match between their stu- crafted balanced partnerships with teachers dents’ needs and their classroom practices, and and, in some cases, with students, and they nudge their students towards rewarding and suc- work alongside us as we translate developmen- cessful adulthood. Deliberately intervening to tal resilience research into classroom practices. strengthen children’s lives is an essential goal of In essence, it has been important that class- most dedicated teachers. room practices inform our promotion of resilience as much as our research is informing classroom practices. References One particularly compelling question that we are addressing with teacher partners is this: Coie, J. D., Watt, N. F., West, S. G., Hawkins, J. D., Which of the six resilience-promoting character- Asarnow, J. R., Markan, H. J., et al. (1993). The sci- istics ought be emphasized in plans to strengthen ence of prevention: A conceptual framework and some directions for a national research program. American classroom resilience? Are each of these equally Psychologist, 48 , 1013–1022. important for the classrooms’ support for student Comer, J. P., Haynes, N. M., Joyner, E. T., & Ben-Avie, success and competence? In addition, it is not yet M. (Eds.). (1996). Rallying the whole village: The clear whether or how the relative importance of Comer process for reforming education . New York: Teachers College Press. these factors might shift from one school to Doll, B., Kurien, S., LeClair, C., Spies, R., Champion, A., another, one cultural community to another, & Osborn, A. (2009). The ClassMaps survey: across generations, for high vs. low risk youth, or A framework for promoting positive classroom envi- given different outcomes indicators of success. ronments. In R. Gilman, S. Huebner, & M. Furlong (Eds.), Handbook of positive psychology in the schools Most of the current research on classroom effec- (pp. 213–227). New York: Routledge. tiveness has only examined one of these charac- Doll, B., LeClair, C., & Kurien, S. (2009). Effective class- teristics, independent of the others. In real rooms: Classroom learning environments that foster classrooms, though, these merge into a psychoso- school success. In T. Gutkin & C. Reynolds (Eds.), The handbook of school psychology (pp. 791–807). cial climate and interventions to strengthen this Hoboken, NJ: Wiley. climate must work with the complexity of the Doll, B., & Lyon, M. (1998). Risk and resilience: system. Implications for the practice of school psychology. The central purpose of our classroom change School Psychology Review, 27 , 348–363. Doll, B., Murphy, P., & Song, S. (2003). The relationship efforts is not merely to change school proce- between children’s self-reported recess problems, and dures, but to enhance youth success. We remain peer acceptance and friendships. Journal of School convinced that it is absolutely essential to draw Psychology, 41 , 113–130. broadly from developmental resilience research, Doll, B., Spies, R. A., Champion, A., Guerrero, C., Dooley, K., & Turner, A. (2010). The ClassMaps sur- and work carefully to apply educational and vey: A measure of students’ perceptions of classroom developmental research on classroom relation- resilience. Journal of Psychoeducational Assessment, ships and student autonomy. Much of the research 28 , 338–348. on these domains has been academic and theo- Doll, B., Spies, R. A., LeClair, C., Kurien, S., & Foley, B. P. (2010). Student perceptions of classroom learning retical rather than practice oriented. Still, the act environments: Development of the ClassMaps survey. of translating this research into practice is shift- School Psychology Review, 39 , 203–218. ing our frame of reference and inherently Doll, B., Zucker, S., & Brehm, K. (2004). Resilient class- reshapes our understanding of resilience. In the rooms: Creating healthy environments for learning . New York: Guilford Publications. fi nal analysis, we expect that this will make our Egeland, B., Carlson, E., & Sroufe, L. A. (1993). Resilience as understanding of classroom resilience stronger. process. Development and Psychopathology, 5 , 517–528. 23 Enhancing Resilience in Classrooms 409

Kratochwill, T. R., & Stoiber, K. C. (2002). Special issue: Pianta, R. C., & Walsh, D. J. (1998). Applying the Evidence-based interventions in school psychology: construct of resilience in schools: Cautions from a The state of the art and future directions. School developmental systems perspective. School Psychology Psychology Quarterly, 17 , 341–389. Review, 27 , 407–417. Masten, A. S. (2001). Ordinary magic: Resilience pro- Pulliam, J. D., & Van Patten, J. J. (2007). History of edu- cesses in development. American Psychologist, 56 , cation in America (9th ed.). Upper Saddle River, NJ: 227–238. Merrill Prentice Hall. Masten, A. S., & Coatsworth, J. D. (1998). The develop- Rutter, M., Maughan, B., Mortimore, P., Ouston, J., & ment of competence in favorable and unfavorable Smith, A. (1979). Fifteen thousand hours: Secondary environments: Lessons from research on successful schools and their effects on children. Cambridge, MA: children. American Psychologist, 53 , 205–220. Harvard University Press. National Research Council and the Institute of Medicine. Slavin, R. E., & Madden, N. A. (2001). Success for all: (2004). Engaging schools: Fostering high school stu- Research and reform in elementary education . dents’ motivation to learn. Committee on Increasing Mahwah, NJ: Lawrence Erlbaum Associates. High School Students’ Engagement and Motivation to Werner, E. E. (2006). What can we learn about resilience Learn; Board on Children, Youth, and Families; Division from large-scale longitudinal studies. In S. Goldstein of Behavioral and Social Sciences and Education. & R. B. Brooks (Eds.), Handbook of resilience in chil- Washington, DC: The National Academies Press. dren . New York: Springer. Creating a Positive School Climate: A Foundation for Resilience 2 4

Jonathan Cohen

Life is full of ups and downs. What allows some Social, Emotional and Civic people to be able to “bounce back” and some Competence, School Climate not? Virtually all scholars appreciate that this Reform and Resiliency capacity to “bounce back” or be resilient is a biopsychosocially informed interactive process This chapter honors and builds on other chapters that refers to the fi ndings that some individuals in this volume that have underscored how healthy, have relatively good psychosocial outcomes consistent, engaged, and “connected” student– despite suffering risk experience that would be adult relationships (Jordon, Chap. 7; Werner, expected to bring about complicating effects Chap. 8), instructional and school-wide efforts (Rutter, 2006a, b) . There has been an important designed to promote children’s (and adults) debate about the nature of resiliency that is social, emotional, and civic competencies (Elisa, re fl ected in many of the chapters in this book and Parker & Rosenblatt, Chap. 22; Scales, Chap. 26; elsewhere (e.g., Greenberg, 2006 ) . This chapter Winslow, Sandler & Wolchik, Chap. 28; Shure & will not address the history and controversies that Aberson, Chap. 29), empathic socially and emo- have shaped our unfolding understanding of this tionally “smart” parenting and healthy families fundamentally important capacity. Here we will (Sheridan, Dowd & Eagle, Chap. 12; Brooks, use the term resiliency to refer to the person’s Chap. 27) promotes social and emotional compe- capacity to overcome stress or adversity. tencies and healthy relationships that provide a Resilience is not a trait that people either have or foundation for resiliency. do not have. It involves behaviors, thoughts, and The ideas presented in this chapter rest on the actions that can—at least to some extent—be assumption that developing social, emotional, learned and developed in anyone. and civic competencies as well as growing up in This chapter will describe how measuring safe, supportive, engaged schools and homes will K-12 school climate and using this data to engage promote what Brooks and Goldstein ( 2001 ) have students, parents, and school personnel is a prac- described as a resilient mindset that are associ- tical, helpful, and data-driven school improve- ated with specifi c skills (Goldstein & Brooks, ment strategy that provides the foundation for 2005 ) . 1 These include feeling appreciated and resilience, student learning, and positive youth development. 1 There is correlational support for this assumption. There is not experimental or quasi-experimental data yet to con fi rm or discon fi rm that notion that enhanced social, J. Cohen () emotional and civic abilities as well as safe, supportive, National School Climate Center , New York , NY , USA engaging and helpfully challenging learning environments e-mail: [email protected] promote resiliency.

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 411 DOI 10.1007/978-1-4614-3661-4_24, © Springer Science+Business Media New York 2013 412 J. Cohen competent; learning to become more (intrinsi- shaped by how re fl ective we are (Cohen & cally) motivated; having learned realistic goals Pickeral, 2009 ) . and expectations for self; they have developed • Accept that change is a part of living. Certain social and emotional skills (e.g., refl ective and goals may no longer be attainable as a result of empathic capacities); fl exible problem solving/ adverse situations. Accepting circumstances decision making; perspective taking, clear com- that cannot be changed can help you focus on munication and dispositions (e.g., viewing mis- circumstances that you can alter. Again, this takes and obstacles as challenges rather than “bad capacity is fundamentally related to how things” to avoid) that provide the foundation for refl ective the person is or how able they are to learning and healthy social relations. be in the moment and be a fl exible and cre- Social, emotional, and civic skills, knowledge ative problem solver/decision maker. and dispositions can be learned (Cohen, 2006 ; • Move toward your goals. Develop some real- Zins et al., 2004). This overlaps with fi ndings istic goals. Do something regularly—even if it from Positive Psychology suggesting that many seems like a small accomplishment—that aspects of resilience are teachable (Reivich & enables you to move toward your goals. Shatte, 2002 ; Seligman, 1990 ) . And, Seligman, Instead of focusing on tasks that seem unach- Ernst, Gillham, Reivich, and Linkins (2009 ) sug- ievable, ask yourself, “What’s one thing gests that when children develop the skills of I know I can accomplish today that helps me “emotional fi tness” it promotes resiliency. Again move in the direction I want to go?” in an overlapping manner, there seem to be a • Take decisive actions. Act on adverse situa- number of evidence-based protective factors that tions as much as you can. Take decisive contribute to resilience, some of which overlap actions, rather than detaching completely from with social, emotional and civic abilities, and dis- problems and stresses and wishing they would positions (e.g., optimism, effective problem solv- just go away. ing, impulse control, empathy) that contribute to • Look for opportunities for self-discovery. resilience (Masten & Reed, 2002 ) . People often learn something about them- Brooks, Brooks, and Goldstein ( 2012 ) have selves and may fi nd that they have grown in recently summarized an important and growing some respect as a result of their struggle with body of empirical research that supports the notion loss. Many people who have experienced trag- that when we teach children to become more edies and hardship have reported better rela- (intrinsically) motivated and promote engagement, tionships, greater sense of strength even while we are also promoting resilience . feeling vulnerable, increased sense of self- These ideas overlap with and compliment the worth, a more developed spirituality, and American Psychological Associations’ ( 2010 ) heightened appreciation for life. recent summary of factors that support the devel- • Nurture a positive view of yourself. Developing opment of resiliency: con fi dence in your ability to solve problems and • Making connections . Good relationships with trusting your instincts helps build resilience. close family members, friends, or others • Keep things in perspective. Even when facing strengthen resilience. Some people fi nd that very painful events, try to consider the stress- being active in civic groups, faith-based orga- ful situation in a broader context and keep a nizations, or other local groups provides social long-term perspective. Avoid blowing the support and can help with reclaiming hope. event out of proportion. Assisting others in their time of need also can • Maintain a hopeful outlook. An optimistic bene fi t the helper. outlook enables you to expect that good things • Avoid seeing crises as insurmountable prob- will happen in your life. Try visualizing what lems. You can’t change the fact that highly you want, rather than worrying about what stressful events happen, but you can change you fear. how you interpret and respond to these events. • Take care of yourself. Pay attention to your How we interpret “the moment” is profoundly own needs and feelings. Engage in activities 24 Creating a Positive School Climate: A Foundation for Resilience 413

that you enjoy and fi nd relaxing. Exercise reg- Educators model and nurture an attitude that ularly. Taking care of yourself helps to keep emphasizes the benefi ts and satisfaction from learning. Each person contributes to the operations your mind and body primed to deal with situ- of the school and the care of the physical ations that require resilience. environment. We will now turn to school climate reform as a data-driven strategy that mobilizes the “whole Some scholars and researchers have argued school community” to support the development that it is useful to distinguish “climate” and “cul- of social, emotional and civic competencies, and ture” and “supportive learning environments” or a resilient mindset. “conditions for learning” (e.g., Deal & Peterson, 2009 ; Schoen & Teddlie, 2008 ). The National School Climate Council ( 2007 ) considers these School Climate: Research, Policy, as overlapping terms. We suggest that what is and Practice Trends most important is that we are clear about what we are operationally referring to when we use any or Educators have studied school climate for over all of these terms. 100 years (Cohen, McCabe, Michelli, & Pickeral, Over the last 3 decades, educators and 2009 ) . Over the last 3 decades there has been a researchers have worked to identify specifi c ele- growing body of empirical research that has stud- ments that make up school climate. Although ied which factors color and shape the learning there is not “one list” that summarizes these ele- environment at school (for reviews, see: Cohen ments, virtually all researchers suggest that there et al., 2009 ; Freiberg, 1999; National School are four major areas that are essential to pay Climate Council, 2007 ) . In 2007 the Education attention to: Safety (e.g., rules and norms; physi- Commission of the States and the National School cal safety; social–emotional safety); Relationships Climate Center (formerly the Center for Social (e.g., respect for diversity; social support: adults; and Emotional Education) formed the National social support: students; leadership); Teaching School Climate Council ( www.schoolclimate. and learning (e.g., social, emotional, ethical, and org/about/council.php ): a group of practice and civic learning; support for learning; professional policy leaders committed to narrowing the gap relationships); and, the Institutional Environment between school climate research on the one hand, (e.g., school connectedness/engagement; physi- 2 and school climate policy, practice and teacher cal surrounding). Over time, empirical research education on the other hand (National School will help to refi ne, redefi ne and further develop Climate Council, 2007 ) . The National School our understanding of what aspects of school cli- Climate Council (2009 ) worked to synthesize mate can and need to be assessed. research on the subject and developed the follow- As summarized below, there is a compelling ing consensually created de fi nition of school cli- and robust body of empirical research that under- mate and a sustainable, positive school climate: scores how various aspects of safety, relationships, teaching and learning, and the environment School climate refers to the quality and character affect and/or predict learning and positive youth of school life. School climate is based on patterns of people’s experience of school life and refl ects norms, goals, values, interpersonal relationships, 2 The US Departments of Education’s Division of Safe and teaching, learning, leadership practices, and orga- Drug Free Schools has recently suggested that States con- nizational structures. sider including an assessment of “wellness” as well as A sustainable, positive school climate fosters youth rates of substance use/abuse. This stems from mandates to development and learning necessary for a produc- “track” these public health-related concerns. Although tive, contributing, and satisfying life in a demo- school climate surveys do assess aspects of health cratic society. This climate includes norms, values, (e.g., supportiveness; connectedness to school) “wellness” and expectations that support people feeling is a somewhat neglected element that most school climate socially, emotionally, intellectually, and physically scholars have not explicitly focused on. Another limita- safe. People are engaged and respected. Students, tion of all current school climate measures is that they do families, and educators work together to develop, not yet recognize the “voice” of community leaders and/ live, and contribute to a shared school vision. or members. 414 J. Cohen development. As summarized below there are Middle School Association, 2003 ; National predictive as well as a larger body of correlational School Board Association, 2009 ). fi ndings that support the notion that when school At the invitation of a State Department of community members learn and work together to Education, The National School Climate Council create positive and sustained school climate, aca- has developed National School Climate demic achievement, and school connectedness Standards : Benchmarks to promote effective and graduate rates all increase. This contributes teaching, learning and comprehensive school to the development of what Brooks and Goldstein improvement ( www.schoolclimate.org/climate/ have referred to as a resilient mind set. standards.php). The following fi ve standards (that are linked to a set of indicators and subindicators) Research : Over the last 40-some years, there has are designed to support local school communities been a growing body of empirical research addressing three essential questions: (1) what is con fi rming that school climate matters. Positive our vision for the kind of school we want for our and sustained school climate predicts and/or is children and/or students? (2) Given this vision, associated with increased academic achieve- what kinds of policies and rules do we need? ment, positive youth development, effective risk And, (3) Given this vision and set of policies and/ prevention, health promotion efforts, and teacher or rules, what kinds of instructional and systemic satisfaction and retention (for detailed summa- practices do we need to actualize this vision? The ries of this research, see Cohen, McCabe, fi ve standards are: Michelli, & Pickeral, 2009 ; Cohen & Geier, 1. The school community has a shared vision 2010 ). As a result of this research several and plan for promoting, enhancing, and sus- government institutions, including the US taining a positive school climate. Department of Justice (2004 ), the Centers for 2. The school community sets policies Disease Control and Prevention (2009 ) the US speci fi cally promoting (a) the development Department of Education’s, as well as a growing and sustainability of social, emotional, ethi- number of state departments of education empha- cal, civic, and intellectual skills, knowledge, size the importance of safe, civil and caring dispositions and engagement and (b) a com- schools, school connectedness (or the belief by prehensive system to address barriers to learn- students that adults in the school care about their ing and teaching and reengage students who learning and about them as individuals) and/or have become disengaged. positive school climates. 3. The school community’s practices are identifi ed, prioritized and supported to (a) pro- Policy: In theory, research shapes policy, which in mote the learning and positive social, emo- turn dictates and encourages quality practice. But, tional, ethical, and civic development of there are a variety of factors that commonly under- students; (b) enhance engagement in teaching, mine this logical framework (Hess, 2008 ). For learning, and school-wide activities; (c) whatever sets of reasons, the federal government address barriers to learning and teaching and and state departments of education have not yet reengage those who have become disengaged; responded adequately to school climate research and (d) develop and sustain an appropriate fi ndings. Recent State Department of Education operational infrastructure and capacity build- school policy scans revealed signi fi cant shortcom- ing mechanisms for meeting this standard. ings in how climate is defi ned, measured, and 4. The school community creates an environ- incorporated into policies (see Cohen et al., 2009 ment where all members are welcomed, sup- for details about the fi ve major problems that cur- ported, and feel safe in school: socially, rently defi ne these policy shortcomings). emotionally, intellectually, and physically. This troubling gap is curious given that most 5. The school community develops meaningful classroom, building, district, state and federal and engaging practices, activities, and norms educational leaders appreciate the importance of that promote social and civic responsibilities school climate (e.g., Jennings, 2009 ; National and a commitment to social justice. 24 Creating a Positive School Climate: A Foundation for Resilience 415

A number of States are now in the process as of a resilient mindset. Today, there are hundreds well as considering adopting or adapting these of school climate measures. However, very few standards. are reliable, valid, and comprehensive in two ways: (1) recognizing student, parent/guardian, Practice trends: School leaders have been and school personal “voice” as well as (2) mea- invested in measuring and working to improve suring all of the dimensions that the National school climate for some time. However, until School Climate Council suggests need to be recently most building leaders used “home evaluated in a comprehensive school climate grown” school climate assessments tools that assessment. were neither reliable nor valid (Cohen et al. A recent study of 102 school climate measures 2009) . And, the federal No Child Left Behind revealed that only three met American educational act has powerfully focused funding Psychological Association criteria for being reli- and school improvement efforts on the four cur- able and valid: the Comprehensive School rent measures that driven American public edu- Climate Inventory (CSCI); the School Climate cation: reading, math, and science scores as well Inventory-Revised (SCI-R), and the Western as rates of physical violence. Alliance for the Study of School Climate’s School This is changing. In late 2009, the Safe and Climate Assessment Inventory (Gangi, 2009 ) . Drug Free Schools Division of the US Department And, a recent independent evaluation by Social of Education began to examine ways to use school Development Research Group (University of climate as an organizing data-driven concept and Washington) of 72 (1) social emotional learning process, one that recognizes the range of proso- (SEL) measures and (2) school climate surveys cial, risk prevention and health-mental health for middle schools reported that ten met their cri- promotion efforts that protect children and teria for being reliable and valid and aligned with encourages social, emotional, ethical, and civic SEL related criteria. The CSCI was one of these learning (Jennings, 2009 ) . The Safe and Drug ten measures and the only school climate mea- Free Schools Division has recently allocated over sure that was recommended (Haggerty, Elgin, & 155 million dollars to support 11 states to develop Woolley, 2011 ) . statewide school climate assessment and improve- Table 24.1 presents examples of major indica- ment systems to support low achieving schools tors and sample questions linked to each of the and create and sustain quality school climate. major school climate factors. And, in the last few years, several large districts The US Departments of Education funding in (e.g., Anchorage, Chicago, New York, Denver) this area (noted above) will support at least 11 have begun to measure school climate or many states developing reliable and valid measurement important aspects of climate. tools and systems over the next 4 years. Pending congressional approval, the US Department of Education plans to signifi cantly increase funding Current School Climate Measurement in this area so that a growing number of States Tools and Improvement Systems: will develop school climate assessment and Supporting the Development of a improvement systems. Resilent Mindset In public education today, measurement systems or data is too often used as a “hammer” or a An underlying premise for this chapter is that way of simplistically giving schools, districts, or what is measured is what counts. And, that mea- States a literal or fi gurative “grade” which can suring and hence recognizing the social, emo- have immediate funding implications. This is why tional, and civic as well as intellectual dimensions it is not uncommon that educators lie about test of learning and using this data to mobilize school scores. Measurement systems and educational community members to create even safer, more data should be a “ fl ashlight” rather than a supportive, engaging, and helpfully challenging “hammer”—information that guides learning and learning environments supports the development improvement efforts. And, it to this topic that we 416 J. Cohen

Table 24.1 Four essential dimensions of school climate (and some of the elements included within each) Dimension Major indicators and sample questions Safety Rules and norms Clearly communicated rules about physical violence and verbal abuse and clear and consistent enforcement In my school, there are clearly stated rules against insults, teasing, harassment, and other verbal abuse Adults in the school will stop students if they see them physically hurting each other (e.g., pushing, slapping, or punching) Physical safety Sense that students and adults feel safe from physical harm in the school I feel physically safe in all areas of the school building I have seen other students being physically hurt at school more than once (e.g., pushed, slapped, punched, or beaten up) Social and emotional Sense that students feel safe from verbal abuse, teasing, and exclusion security I have been insulted, teased, harassed, or otherwise verbally abused more than once in this school There are groups of students in the school who exclude others and make them feel bad for not being a part of the group Teaching and learning Support for learning Supportive teaching practices, such as constructive feedback and encouragement for positive risk taking, academic challenge, individual attention, and opportunities to demonstrate knowledge and skills in a variety of ways My teachers show me how to learn from my mistakes My teachers encourage me to try out new ideas (think independently) My teachers help me fi gure out how I learn best Social and civic Support for the development of social and civic knowledge and skills, including effective learning listening, con fl ict resolution, re fl ection and responsibility, and ethical decision making In my school, we have learned ways to resolve disagreements so that everyone can be satis fi ed with the outcome In my school, we talk about the way our actions will affect others Interpersonal relationships Respect for diversity Mutual respect for individual differences at all levels of the school–student–student; adult–student; adult–adult Students in this school respect each other’s differences (e.g., gender, race, culture, etc.) Adults in this school respect each other’s differences (e.g., gender, race, culture, etc.) Social support: adults Collaborative and trusting relationships among adults and adult support for students in terms of high expectations for success, willingness to listen, and personal concern Adults in my school seem to work well with one another If students need to talk to an adult in school about a problem, there is someone they trust who they could talk to Social support: students Network of peer relationships for academic and personal support Students have friends at school they can turn to if they have questions about homework Students have friends at school they can trust and talk to if they have problems Institutional environment School connectedness/ Positive identi fi cation with school, sense of belonging, and norms for broad participation in engagement school life for students and families I feel good about what I accomplish in school I think my parents/guardians feel welcome at my school My school encourages students to get involved in other things than schoolwork (e.g., sports, music/drama clubs, etc.) (continued) 24 Creating a Positive School Climate: A Foundation for Resilience 417

Table 24.1 (continued) Dimension Major indicators and sample questions Physical surroundings Cleanliness, order, and appeal of facilities and adequate resources and materials My school is physically attractive (pleasing architecture, nicely decorated, etc.) My school building is kept in good condition My school has up-to-date computers and other electronic equipment available to students Source : National School Climate Center Comprehensive School Climate Inventory ( www.schoolclimate.org/programs/ csci.php ). Used with permission now turn: how can we use school climate data to tion of risk prevention, health promotion, and “lead the way” in supporting positive youth educational efforts. development, learning (student and adult!) and the promotion of a resilient mindset. School climate recognizes essential social, emotional, ethical, civic and intellectual aspects of learning and our school improvement efforts : The School Climate Improvement Einstein wisely suggested “not everything that Road Map can be counted counts, and not everything that counts can be counted.” But, in K-12 education, Growing out of the work of the National School as in business and medicine, it is commonly Climate Council (2007 ) as well as our Center’s accepted that “what is measured is what counts.” work with thousands of schools and districts In fact, we are always—to a greater or lesser across America, we have developed a fi ve-stage extent—measuring or taking stock: consciously, school climate model that integrates the “prob- systemically, in valid and reliable ways or not!3 lem solving” process that shapes all school When we measure school climate in valid and reform efforts, with research and best practices reliable ways, we are, by defi nition, recognizing that grow out of character education, social the essential social, emotional, ethical, and civic emotional learning, community schools and risk as well as intellectual aspects of the learning pro- prevention/health promotion research and best cess (Cohen, 2006 ; Durlak, Weissberg, Dymnicki, practices (Cohen, 2006 ; Cohen & Pickeral, Taylor, & Schellinger, 2011; Hawkins, Kosterman, 2009 ; Devine & Cohen, 2007 ) . Each of these Catalano, Hill, & Abbott, 2008 ) . We are also fi ve stages is characterized by a series of tasks assessing important ethical and civic dispositions and challenges that we have listed below in such as the fairness of school norms or the role of Table 24.2 below. people as bystander (who collude with bullies What follows is a brief discussion of some of actively or passively) or upstanders (who says the tasks and challenges that de fi ne each of the fi rst three stages of the school climate improve- 3 It is interesting and often surprising to refl ect on how ment process and how they support the develop- powerfully measurement shapes all of our day-to-day ment of safe, supportive, engaging and helpfully lives. Consider how you identify people (e.g., health care challenging schools for students and adults to providers or accountants) organizations (the school we learn, teach and “grow up” in. But, before I send our children to; clubs; work places) to work with and/or join. Consider how we make judgments about describe some of these tasks/challenges and how “how did today go?” and/or how healthy or “rich” (in they related to the development of resilient mind however we de fi ne “rich”) we are. And, when it is discov- sets, I want summarize three, overlapping and ered that 1% of a community is spending 30% of its health organizing ideas related to (i) recognizing the care costs, these (shocking) measurements can actually set in motion meaningful health care reform (Gawande, essential social, emotional, and civic aspects of 2011) . We are continually making judgments based on learning; (ii) engagement; and the (iii) coordina- formal and/or informal data and assessment systems. 418 J. Cohen

Table 24.2 The school climate improvement process: stages, tasks, and challenges

Stage one: preparation and planning Forming a representative SC improvement leadership team and establishing ground rules collaboratively Building support and fostering “Buy In” for the school climate improvement process Establishing a “no fault” framework and promoting a culture of trust Ensuring your team has adequate resources to support the process Celebrating successes and building on past efforts Re fl ecting on Stage One work Stage Two: Evaluation Systematically evaluating the school’s strengths, needs, and weaknesses with any number of school climate as well as other potential measurement tools Developing plans to share evaluation fi ndings with the school community Re fl ecting on our Stage Two work Stage Three: Understanding the fi ndings, engagement, and developing an action plan Understanding the evaluation fi ndings Digging into the fi ndings to understand areas of consensus and discrepancy in order to promote learning and engagement Prioritizing goals Researching best practices and evidence-based instructional and systemic programs and efforts Developing an action plan Re fl ecting on Stage Three work Stage Four: Implementing the action plan Coordinating evidence-based pedagogic and systemic efforts designed to (a) promote students’ social, emotional, and civic as well as intellectual competencies; and (b) improve the school climate by working toward a safe, caring, participatory, and responsive school community The instructional and/or school-wide efforts are instituted with fi delity, monitored and there is an ongoing attempt to learn from successes and challenges The adults who teach and learn with students work to further their own social, emotional, and civic learning Re fl ecting on Stage Four work Stage Five: Reevaluation and development of the next phase Reevaluating the school’s strengths and challenges Discovering what has changed and how Discovering what has most helped and hindered further the school climate improvement process Revising plans to improve the school climate Re fl ecting on Stage Five work 24 Creating a Positive School Climate: A Foundation for Resilience 419

“no” directly or indirectly) to bully-victim behav- meaningful opportunities to engage students and ior (Devine & Cohen, 2007 ) . parents/guardians as well as school personnel in An assumption that underlies this chapter is ways that support student learning and their that we can and need to recognize the social, healthy development. emotional, ethical, and civic as well as intellec- During the fi rst stage of the school climate tual aspects of learning and development to sup- improvement process, Planning and Preparation , port the development of a resilient mindset. school leaders have an opportunity to introduce the school climate assessment as an engagement Supporting meaningful engagement: students, strategy. When a principal is able to say to stu- parent/guardian and school personnel learning dents, parents/guardians and school personnel, and working together: Comprehensive school cli- “We need to understand what you think are our mate improvement practices include, by de fi nition, strengths and needs. We need to learn together “the whole village.”4 There is a long-standing and about how to prioritize our goals. And we need to growing body of research that supports the notion work together to actualize the instructional and/ that when students are meaningfully engaged in or systemic goals that have grown out of our the process of learning, positive youth develop- school climate evaluation.” Naturally, this will ment and academic achievement increases and contribute to people feeling recognized and hon- student drop out rates decreases (Akey, 2006 ; ored. It powerfully supports collaborative learn- Hardre & Reeve, 2003 ; Newman, 1992 ). Today, ing and working together: the foundation for only one in two students feel engaged in schools authentic learning communities. (Quaglia Institute for Student Aspirations, 2010 )! One of the fi rst tasks in the Planning and In an overlapping manner, research underscores Preparation phase is to create a truly representative the importance of parents and guardians being leadership team. This is challenging. There is no engaged in the life of the school and as active simple way to insure true and complete representa- partners with teachers and how these essential tion of the whole school community. But we can take educator–parent/guardian partnerships promote meaningful steps in this direction. Rather than select- positive youth development and student learning ing students from honors classes and/or the range of (Epstein et al., 2009 ; Henderson, Mapp, Johnson, existing student leadership positions, school leaders & Davies, 2007 ; Patrikakou, Weissberg, Redding, can go to the cafeteria and pick a student from each & Walberg, 2005 ) . There is signifi cant support for table. Students who are part of various cliques tend to the notion that family strengthening approaches sit together. In this way, the team of student’s chosen have the greatest impact on increasing resilience speaks for the whole school. Students are initially (Kumpfer & Summerhays, 2006 ) . But the chal- incredulous. But, as they come to know that the adults lenge is how to do so? The school climate improve- really want to understand their perceptions and goals, ment process provides a series of practical and a truly representative student leadership team grows (Preble & Taylor, 2009 ). Students can and need to become co-leaders in 4 As noted above the major limitation of all current school climate surveys is that they do not recognize the ‘voice” of any school climate improvement process. They community leaders. The Public Education Network has can, for example, become involved with the pro- developed a Civic Index ( http://civicindex4education.org/ cess of understanding comprehensive school cli- main/home.cfm?Category=What_is&Section=Main ) and mate fi ndings and can be active in developing the federally funded Communities that Care program ( http://ncadi.samhsa.gov/features/ctc/resources.aspx ) are “change projects” that grow out of this data. Then two important examples of data driven efforts that seek to we are not only promoting school connectedness recognize the essential voice of community leaders. In (Centers for Disease Control and Prevention, partnership with the Public Education Network, our Center 2009 ); we are promoting the skills and dispositions is now developing a new forth scale for the Comprehensive School Climate Inventory (CSCI) ( www.schoolclimate. that support student participation, student engage- org/climate/practice.php ) that will recognize the voice of ment and an engaged citizenry (Cohen, Pickeral & community leaders and members. Levine, 2010 ; Northwest Regional Educational 420 J. Cohen

Regional Educational Laboratory, 2008 ). Middle education” are often dismissed by middle and and high school students are sometime cynical high school educators as the latest “fl avor of the about whether the adults at school really care about month” or “not my area or focus.” Unless the what they think and need (Quaglia, 2008, 2010). child’s symptoms signifi cantly disrupt function- But in scores of schools we’ve seen, the ability of ing, many parents and too many educators are, students to identify problems and goals are mean- understandably, unsure when to confer with a ingful to them in important and far reaching ways mental health professional. (e.g., Devine & Cohen, 2007; Preble & Taylor, It is critical that schools recognize children’s 2009 ; Wessler & Preble, 2003 )! needs and support effective risk prevention and health/mental health as well as their prosocial edu- School climate improvement provides a model cational needs. School climate improvement, like that recognizes and supports the coordination of all school improvement efforts, need to be a con- effective risk prevention, health/mental health tinuous process that is grounded in a fl exible and promotion and prosocial efforts: One of the most creative problem solving cycle. Research on school serious challenges that educators face is the num- climate and best practice from prosocial education, ber of children who enter school and come each risk prevention, and health/mental health promo- day with a host of factors that interfere with school tion has resulted in a fi ve-stage school climate readiness. These range from neighborhood, fam- improvement model (Cohen & Pickeral, 2009 ; ily, school, peer, and individual factors. These fac- Devine & Cohen, 2007 ) . In this model, schools tors become major barriers to learning. There are begin by preparing for the next phase of the school a number of reasons why K-12 education fails to climate/improvement efforts, and then assessing apply recent research fi ndings about effective school climate; understanding the fi ndings and child and adolescent health and mental health, developing an action plan. After they have devel- interventions and treatments to school improve- oped an action plan, the next phase focuses on ment efforts (Adelman & Taylor, 2006 , 2007). implementation the instructional and/or systemic This failure is one of the most important factors efforts; and the next phase begins the cycle anew. contributing to inequities in American public edu- As outlined in Table 24.1 , each of these stages cation (Rothstein, Jacobsen & Wilder, 2005 ). involves a series of tasks and challenges that can be Poverty, for example, powerfully undermines and embedded into any and all comprehensive models complicates the ability of a parent or guardian to for systemic change and school transformation. adequately address children’s basic needs. Too often, school improvement efforts are Neither are educators educated to understand fragmented and uncoordinated. For example, and appreciate the nutritional and social, emo- schools often focus on improving reading instructional, and civic dimensions of development and tion or promoting safety or engaging parents/ learning.5 This may contribute to a common guardians. These goals in fact, overlap. How safe phenomenon: many K-12 educators are disin- students feel, for example, will color and shape clined or even frightened by “mental health and language (and other aspects of) learning. And, illness” related matters that provide an essential how engaged parents/guardians are in the life of foundation for the development of a resilient the school powerfully colors our ability to protect mindset. Even terms of educational movements students and promote their learning. School cli- like “social emotional learning” and “character mate evaluations provide a snapshot of safety, relationships, teaching, and learning within the 5 Over the last 2 decades there certainly has been extraor- school, as well as other environmentally related dinary educational efforts to support pre-K educators strengths and needs. Depending on how the about these issues. Organizations like Zero to Three fi ndings are used (see below), the school com- ( www.zerotothree.org ) have had a profound and just munity then has the opportunity to learn, plan, impact on federal and state pre-K policy and practice. However, this has not become a facet of K-12 policy and and implement improvement efforts that built on practice. current strengths and needs. 24 Creating a Positive School Climate: A Foundation for Resilience 421

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Rothstein, R., Jacobsen, R., & Wilder, T. (2005). Grading Seligman, M. E. P., Ernst, R. M., Gillham, J., Reivich, K., & education: Getting accountability right . New York: Linkins, M. (2009). Positive education and classroom Teachers College Press. interventions. Oxford Review of Education, 35 , 293–311. Rutter, M. (2006a). The promotion of resilience in the face of U.S. Department of Justice. (2004). Toward safe and adversity. In A. Clarke-Stewart & J. Dunn (Eds.), Families orderly schools—The national study of delinquency count: Effects on child and adolescent development (pp. prevention in schools. Ofﬁ ce of Justice Programs, 26–52). New York, NY: Cambridge University Press. National Institute of Justice, Report # 205005. Retrieved Rutter, M. (2006b). Implications of resilience concepts July 20, 2006, from http://www.ojp.usdoj.gov/nij for scienti ﬁ c understanding. Annuals of the New York Wessler, S. L., & Preble, W. (2003). The Respectful Academy of Science, 1094 , 1–12. school: How educators and students can conquer hate Schoen, L. T., & Teddlie, C. (2008). A new model of and harassment . Alexandria, VA: Association for school culture: A response to a call for conceptual Supervision and Curriculum Development (ASCD). clarity. School Effectiveness and School Improvement, Zins, J., Weissberg, R. W., Wang, M. C., & Walberg, H. 19 (2), 129–153. (Eds.). (2004). Building school success on social emo- Seligman, M. E. P. (1990). Learned optimism . New York, tional learning: What does the research say? New NY: Knopf. York: Teachers College Press. Part VI Shaping the Future of Children and Adults Positive Adaptation, Resilience and the Developmental Assets 2 5 Framework

Arturo Sesma Jr. , Marc Mannes , and Peter C. Scales

Advances in our understanding of adaptation are intervention and prevention practices (Rolf & rooted in the seminal work of Garmezy, Rutter, Johnson, 1999 ) . Werner, and others who “discovered” a not This attention to the broad array of factors that inconsiderable proportion of children who, facilitate healthy youth development has fueled a thought to be at risk for current and future mal- relatively new set of models focusing on the adaptation, showed few or no signs of pathology strengths, resources, and positive experiences of and often exhibited high levels of competence youths and of their communities (Benson & (Garmezy, 1974; Rutter, 1979; Werner & Smith, Pittman, 2001 ) . Under the broader rubric of posi- 1982 ) . Investigating what made a difference in tive youth development, and with the knowledge this group of children’s lives led at ﬁ rst to gained from decades of research on resilience descriptions of correlates of positive develop- and risk and protective factors, these models seek ment among children living in high-risk contexts new ways of conceptualizing, measuring, and and has progressed to complex process models promoting optimal outcomes for youth (Benson, allowing for multiple causal effects across mul- Scales, Hamilton, & Sesma, 2006 ; Connell, tiple ecologies (Masten, 1999a ) . Two of the great Gambone, & Smith, 2001 ; Eccles & Gootman, contributions from this line of work have focused 2002 ; Pittman, Irby, & Ferber, 2001 ) . on elucidating the mechanisms thought to under- One of these models is Search Institute’s lie both adaptive and maladaptive developmental developmental assets framework. Over the past trajectories under conditions of adversity, as well 20 years, Search Institute has been a leading force as advancing the position that studies of positive in theoretical and empirical work examining the adaptation and competence should be studied relations among developmental resources, opti- alongside the more dominant models of risk, mal development, and community mobilization pathology, and treatment (Garmezy, 1974 ; (Benson, 2003 ; Brown, 2008 ; Eccles & Gootman, Rutter, 1979 ; Masten, 2001 ) . These advance- 2002 ; Lerner, 2003 ) , with the primary goal of ments in turn have been instrumental in current establishing an interdisciplinary and applied line of inquiry exploring the viability and developmental signiﬁ cance of the “informal, natural, and nonprogrammatic capacity of community” A. Sesma Jr. () St. Catherine University , St. Paul , MN , USA (Benson & Saito, 2001 , p. 146). e-mail: [email protected] In this chapter we describe the developmental M. Mannes assets framework and its relation to resilience Booz Allen Hamilton , Minneapolis , MN , USA models by addressing three dimensions salient to P. C. Scales both approaches: (1) the taxonomy of factors Search Institute , Minneapolis , MN , USA thought to promote positive development and

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 427 DOI 10.1007/978-1-4614-3661-4_25, © Springer Science+Business Media New York 2013 428 A. Sesma Jr. et al. adaptation; (2) the criteria used to determine or community has a role and a responsibility in defi ne positive developmental outcomes; and (3) the lives of youth. strategies and mechanisms for enhancing the Search Institute’s attempt at capturing these development of youth. In the process, we high- four elements lies in our work on how young light points of convergence and distinction from people experience various “developmental resilience models along these three dimensions. assets.” Developmental assets are defi ned as a set Given that resilience is not a homogeneous arena of interrelated experiences, relationships, skills, of research, with differences in models, terminol- and values that are known to enhance a broad ogy, and assumptions, we will draw on broad range of youth outcomes and are assumed to themes to provide the context for the description operate similarly for all youth (Benson, Leffert, of the developmental assets model. Scales, & Blyth, 1998; Scales & Leffert, 2004 ) . We have identi fi ed 40 of these assets, which refl ect broad conceptualizations about strength- Facilitators of Positive Development: based, positive child and youth development that The Developmental Assets Framework are rooted in explications of key developmental socialization processes of connection, support, The developmental assets framework is part of regulation, autonomy, and competencies (Barber the rapidly developing fi eld of positive youth & Olsen, 1997 ; Benson, Scales, & Mannes, 2003 ; development (PYD). PYD is the umbrella term Scales & Leffert, 2004 ) . for a number of approaches that, by and large, These developmental processes, however, need share the following characteristics (see also to be understood in light of the multiple and inter- Benson et al., 2006 ; Hamilton, Hamilton, & active infl uences on child well-being. The asset Pittman, 2003 ) : framework borrows heavily from Bronfenbrenner’s • A strength-based approach to development . (1979 ) notion that successful development is a An emphasis on elements that facilitates opti- function of the individual in constant transaction mal (thriving) development rather than factors with multiple supportive ecologies. Additionally, associated with problematic behavior. The the work of Jessor (1993 ) and Sameroff, Seifer, converse of strength-based models is the risk and Bartko (1997 ) on the “shared causation” and or de fi cit-model, where the emphasis is on cumulative nature of risk and protective factors problem behaviors and how to reduce or pre- have informed the development and interpretation vent them. of developmental assets. Thus, one of the main • Multiple agents across multiple sectors . purposes of the asset framework is to identify cor- Children develop in families, schools, neigh- relates and predictors of short- and long-term borhoods, and in the context of multiple rela- positive outcomes in order to guide theory and tionships. Any model that purports to describe research on developmental strengths. Central to development must re fl ect the various settings these efforts is an examination of interactive and in which development proceeds. richly layered community effects on youth devel- • Focus on relationships . Positive development opment. Like various lists of protective factors as a function of intentional and meaningful (Eccles & Gootman, 2002 ; Hawkins, Catalano, & relationships with youth—getting to know Miller, 1992 ; Masten, 2001 ; Masten & Reed, them, asking their opinions, acknowledging 2002 ; Werner & Smith, 1993 ) , the assets frame- that youth have a voice and something to work identifi es both external and internal qualities contribute. (see Table 25.1 ). The external assets (i.e., health- • Facilitating positive development is an every- promoting features of the environment) are day, commonplace occurrence . Promoting grouped into four categories: (1) support; (2) youth development is not solely the province empowerment; (3) boundaries and expectations; of professionals or practitioners; everyone in a and (4) constructive use of time. The internal 25 Positive Adaptation, Resilience and the Developmental Assets Framework 429 munity o seek (continued) advice and counsel from parents 2. Positive family communication—Young person and her or his parent(s) communicate positively, and young person is willing t person and her or his parent(s) communicate positively, communication—Young family Positive 2. support from three or more nonparent adults person receives Other adult relationships—Young 3. caring neighbors person experiences Caring neighborhood—Young 4. a caring, encouraging environment Caring school climate—School provides 5. in helping young person succeed school involved are actively in schooling—Parent(s) involvement Parent 6. useful roles in the community people are given as resources—Young Youth 8. in the community 1 h or more per week person serves Service to others—Young 9. person feels safe at home, school, and in the neighborhood Safety—Young 10. whereabouts has clear rules and consequences monitors the young person’s boundaries—Family Family 11. clear rules and consequences School boundaries—School provides 12. behavior responsibility for monitoring young people’s Neighborhood boundaries—Neighbors take 13. responsible behavior and other adults model positive, Adult role models—Parent(s) 14. best friends model responsible behavior person’s uence—Young fl peer in Positive 15. parent(s) and teachers encourage the young person to do well High expectations—Both 16. or other arts person spends 3 or more hours per week in lessons practice music, theater, activities—Young Creative 17. at school and/or in the com person spends 3 or more hours per week in sports, clubs, organizations programs—Young Youth 18. 19. Religious community—Young person spends 1 or more hours per week in activities in a religious institution person spends 1 or more hours per week in activities Religious community—Young 19. nights per week or fewer person is out with friends “with nothing special to do” two at home—Young Time 20. to do well in school person is motivated motivation—Young Achievement 21. engaged in learning person is actively School engagement—Young 22. school day every person reports doing at least one hour of homework Homework—Young 23. person cares about her or his school Bonding to school—Young 24. person reads for pleasure 3 or more hours per week Reading for pleasure—Young 25. on promoting equality and reducing hunger poverty person places high value Equality and social justice—Young 27. and stands up for her or his beliefs person acts on convictions Integrity—Young 28. when it is not easy” person “tells the truth even Honesty—Young 29. personal responsibility person accepts and takes Responsibility—Young 30. or to use alcohol other drugs active it is important not to be sexually person believes Restraint—Young 31. Support and support of love high levels life provides support—Family Family 1. Empowerment Empowerment youth that adults in the community value person perceives youth—Young Community values 7. Boundaries and expectations Constructive use of time Positive values values Positive on helping other people person places high value Caring—Young 26. Commitment to learning Search Institute’s developmental assets framework assets framework developmental Search Institute’s Table 25.1 External assets Internal assets 430 A. Sesma Jr. et al. 33. Interpersonal competence—Young person has empathy, sensitivity, and friendship skills sensitivity, person has empathy, Interpersonal competence—Young 33. cultural/racial/ethnic backgrounds of and comfort with people different person has knowledge Cultural competence—Young 34. peer pressure and dangerous situations person can resist negative Resistance skills—Young 35. ict nonviolently fl con person seeks to resolve ict resolution—Young fl Peaceful con 36. a high self-esteem person reports having Self-esteem—Young 38. person reports that “my life has a purpose” Sense of purpose—Young 39. person is optimistic about her or his personal future of personal future—Young view Positive 40. Positive identity Positive “things that happen to me” person feels he or she has control over Personal power—Young 37. Social competencies choices to plan ahead and make how person knows Planning and decision-making—Young 32. (continued) Table 25.1 Used with permission © Search Institute 1997. All rights reserved. Internal assets 25 Positive Adaptation, Resilience and the Developmental Assets Framework 431 assets (i.e., competencies and skills that young The Relation of Developmental Assets people use to guide their behavior) are placed in to Outcomes four categories as well: (1) commitment to learning; (2) positive values; (3) social competen- The fundamental assumption of the asset model cies; and (4) positive identity. Search Institute’s is that the more positive experiences youth pos- studies collectively involving more than three sess, the greater the likelihood they will succeed million 6th–12th graders (Benson, 2006 ; Benson, developmentally. Studies from Search Institute Scales, Leffert, & Roehlkepartain, 1999 ; Leffert and others consistently show that youth who et al., 1998; Scales, Benson, Leffert, & Blyth, report relatively more assets are less likely to 2000 ) , as well as our extensive synthesis of empir- engage in problematic risk behavior patterns and ical studies on development in adolescence (Scales more likely to endorse engaging in positive, & Leffert, 2004 ) , middle childhood (Scales, socially constructive behaviors (Benson & Scales, Sesma, & Bolstrom, 2004 ) , and early childhood 2009b ; Scales et al., 2000 ; Taylor et al., 2002 ) . (VanderVen, 2008 ) have yielded numerous posi- For example, 50% of youth with 0–10 assets tive conclusions about the contribution of devel- report engaging in a pattern of problematic alco- opmental assets to students’ avoidance of high-risk hol use, compared to only 3% of youth with behaviors and measures of thriving, including 31–40 assets, a 17-fold risk ratio. Conversely, helping others, overcoming adversity, and school 89% of youth with 31^4-0 assets report that they success, as well as hopeful purpose and positive value and affi rm cultural diversity, while only emotionality ( Benson & Scales 2009a, 2009b ) . 34% of youth with 0–10 assets report this. Though important to our conceptual and Similarly, 32% of asset-depleted youth report empirical work on positive development, this engaging in early sexual intercourse, vs. only 3% framework was also designed with highly for asset-rich youth, and only 8% of asset- applied objectives as well. Thus, a second pur- depleted youth report getting mostly. As in pose of the asset model is to create an easily school, compared with 49% of asset-rich youth accessible language around positive develop- (Search Institute, 2001 ) . Multivariate analyses ment that can act as a catalyst for community investigating the cumulative effect of assets indi- mobilization and action on behalf of its youth. cate that the total number of assets explains 57% The signifi cance of this facet cannot be over- of the variance in a composite index of risk stated. Developmental assets were speci fi cally behaviors (Leffert et al., 1998 ) , and between 47 chosen to re fl ect the kinds of relationships, envi- and 54% of the variance in a composite index of ronments, norms, and competencies over which positive behaviors (Scales et al., 2000 ) , all over people in a community have some degree of and above demographic variables such as mater- control (Benson, Scales, & Mannes, 2003 ) . As nal education, grade, and gender. Similar cumu- Scales and Leffert ( 1999 ) put it: although not lative effects are found when the sample is broken everyone can offer youth a well-designed expe- down by race/ethnicity and SES levels (Sesma & rience that builds their planning and decision- Roehlkepartain, 2003 ) . making skills, everyone can talk with Another way of showing this effect is to create adolescents, keep an eye on them when their a cumulative asset gradient. Figure 25.1 depicts parents are not around, protect them, and give the mean number of high-risk behavior patterns them help when they need it. Everyone can help (e.g., problematic alcohol use, antisocial behav- make youth feel valued and supported (p. 13). ior) and thriving outcomes (e.g., values diversity, Much of the research and applied fi eldwork succeeds in school, exhibits leadership; see next conducted at Search Institute addresses the section below) plotted as a function of the num- signifi cance of these kinds of experiences for ber of assets experienced by youth. These linear youth, including how to mobilize individuals functions mirror the more oft-cited cumulative within communities to begin engaging in these risk graph, wherein risk factors are plotted along kinds of intentional relationships with youth. the jc-axis. The concept of cumulative risk grew 432 A. Sesma Jr. et al.

Fig 25.1 Cumulative asset a 10 gradient—number of risk behaviors ( a ) and 8 thriving behaviors (b ) reported by youth as a function of cumulative assets 6 (each asset point is in increments of 5 assets; 4 1 = 0–5 assets, 2 = 6–10 assets, etc.). Unpublished Number of Risk Search Institute data Behaviors (Out of 10) 2

0 12345678 Asset Level b 8

Behviors (out of 8) 2 Number of Thriving

0 12345678 Asset Level out of two consistent fi ndings: risk factors often assets at one point in time and outcomes one or co-occur, and that it is the accumulation of many more years later. Both the amount of an asset risk factors, not just one, that thwarts develop- (or the number of assets if multiple assets are mental progress (Belsky & Fearon, 2002 ; studied) and specifi c clusters of assets are related Sameroff & Fiese, 2000 ) . Few factors moderate to outcomes over time. For example, Scales and this linear function, as it has been documented Roehlkepartain (2003 ; Scales, Benson, across age, gender, race/ethnicity, socioeconomic Roehlkepartain, Sesma, & van Dulmen, 2006 ) status (SES) level, and cross-culturally (Keating found that each increase in the level of assets young & Hertzman, 1999 ) . What these fi ndings from people reported (from 0–10, to 11–20, 21–30, and cumulative risk effects suggest is that the power 31–40 assets) in 1998, when the sample was in of assets lies in the cumulative pile-up of effects seventh through ninth grades, was associated with across multiple contexts. A corollary to this a signi fi cantly higher grade point average (GPA) echoes the admonition from resilience research- 3 years later, when the sample was in the 10th–12th ers when discussing risk factors: there is unlikely grades; this fi nding also held when Time 1 GPA to be one asset or set of assets that is the “most was controlled. This is signifi cant because GPA important” for enhancing development. Attempts tends to be very stable over time, such that one’s at identifying the “magic bullet” of assets violates previous grades are by far, in all studies, the single the assumption of the multifi nality of positive best predictor of one’s future grades. Moreover, development and are unlikely to yield fruitful assets in one year are strongly related to grades results (Masten, 1999b ; Scales & Leffert, 2004 ) . that same year. These results support the hypoth- Although the majority of studies show point-in- esis that early asset levels provide signifi cant time connections between assets and positive youth independent contribution to later academic per- outcomes, some also demonstrate the link between formance. Benson & Scales ( 2009b ) also found 25 Positive Adaptation, Resilience and the Developmental Assets Framework 433 that higher asset levels in middle school predicted Second, our work with communities indicates lower levels of violent and antisocial behavior 3 that individual adults are more likely to be years later in high school. In a study of whether engaged and active in intentional activities if the changes in assets are related to changes in outcome, focus is shifted from vulnerable youth and ado- Taylor and his colleagues (2002 ) measured assets lescents to all children and adolescents. Focusing and positive functioning a year apart for youth on at-risk and vulnerable youth seems to have the involved in gang activity and a control group of unfortunate effect of strengthening the belief that youth involved in a community-based organization youth development is the responsibility of the (CBO). Among the results reported was that for professional sector (clinicians, program imple- both gang- and CBO-involved youth, changes in menters, social workers), which has the concomi- positive functioning covaried positively with tant effect of fostering civic disengagement increases in assets over the year interval. (Benson et al., 1998 ) . Of course, this does not preclude examinations of how assets interact with risk-only factors, such as ADHD or poverty Developmental Assets and Resilience (Stouthamer-Loeber et al., 1993 ) . Studies investi- Constructs gating the moderating effects of developmental assets, both with other assets as well as with risk Even though the fundamental distinction between factors, are currently under way. Furthermore, it developmental assets and protective factors would seems that most of the developmental assets fall seem to be that protective factors are, by defi nition, into what Sameroff ( 1999 ) and Rutter ( 2000 ) call operative only under the context of risk (Rutter, dimensional factors, and what Stouthamer- 2000) , while assets are presumed to be operative Loeber and her colleagues ( 1993 ) call protective regardless of any presumed moderator (e.g., risk/ plus risk effects. These are factors that, depend- adversity, gender, SES, etc.), attempts at greater ing on the spectrum one chooses to emphasize, terminological clarity of resilience constructs can either be a risk or a protective factor. For have blurred this distinction (Luthar, Cicchetti, & example, one of our assets is family support , Becker, 2000 ) . Thus, terms like “protective-stabi- which is defi ned in a way that emphasizes the lizing” and “vulnerability” are added to the resil- positive end of the construct. However, other ience lexicon in order to lend greater precision to researchers can use the same global construct the putative interactions among risk, moderating (a facet of family functioning) and focus on the attributes, and competence outcomes (Luthar negative pole (lack of family support; high degree et al., 2000 ) . Using these more differentiated con- of family con fl ict) and call this a risk factor. This structs, developmental assets seem to be most does not appear to be all that problematic, given closely related to protective factors (Luthar et al., that one’s theoretical model should dictate how 2000) , promotive factors (Sameroff, 1999) , or one chooses to de fi ne relevant constructs (so long assets (Masten & Reed, 2002 ) . The core element as the dimensionality of the construct is not for- of all of these constructs is a direct positive gotten), but also since the effect seems to be the in fl uence on development regardless of risk sta- same whether one is increasing protective factors tus. Though it is likely that some of the develop- or reducing risk factors (Sameroff, Bartko, mental assets interact with or moderate risk effects Baldwin, Baldwin, & Seifer, 1999 ) . (i.e., should really be characterized as protective- enhancement or protective-stabilizing factors), we do not posit the kinds of complex interactions Beyond Competence to Thriving across assets and risk as outlined by some resilience researchers, for at least two reasons. The second dimension relevant to both assets and First, the preponderance of research on each resilience models refers to how each model oper- of these assets shows, in general, similar predic- ationalizes competence or positive development. tive utility across different groups of youth Masten and Curtis (2000 ) , using the concept of (Benson et al., 2003; Scales & Leffert, 2004 ) . stage-salient tasks, de fi ne competence as a track 434 A. Sesma Jr. et al. record of “adapta-tional success in the develop- emphasis to this construct not only as an element mental tasks expected of individuals of a given of personal actualization, but also as inextricably age in a particular cultural and historical context” bound with the moral ethos of the larger commu- (p. 533). Other resilience researchers defi ne com- nity in which persons live and to which, even as petence as the absence of psychopathology or young people, they are essential contributors. In problems, while still others incorporate both other words, when young people thrive, they are stage-salient tasks and absence of symptoms to not simply doing well as individuals; they also determine their outcome criteria (Masten, 2001 ) . are connected and contributing in meaningful Luthar et al. ( 2000 ) attempt to refi ne the criteria ways to the common good that is realized through and standards used to determine competence by the groups, neighborhoods, communities, and positing that the selection of outcomes should be societies to which they belong (Lerner, Brentano, dictated by the type and severity of stress, and by Dowling, & Anderson, 2002 ) . 1 a conceptual link between the presenting risk factors and the outcome. They suggest that perhaps the outcome criterion be excellent or superior Differences Between Developmental functioning in a theoretically related domain Assets and Thriving Indicators when risk levels are low or moderate. This criterion for determining an outcome—excellent or The concept of thriving encompasses not only the optimal functioning—comes closer to Search relative absence of pathology, but also more Institute’s work on de fi ning what it means to explicit indicators of healthy and even optimal thrive developmentally (Benson & Scales 2009a, development. There is some conceptual similar- 2009b; Scales & Benson, 2005 ) , but Benson and ity between the notion of developmental assets Scales and other scholars (see Lerner, Brentano, and that of thriving indicators, in that both con- Dowling, & Anderson, 2002 ) go farther, suggest- cepts focus on the presence of strengths in young ing that thriving must re fl ect not just on optimal people’s lives. However, there are some impor- development of the person but mutually enhanc- tant differences between these concepts. ing growth of the person and their contexts . Most important, thriving signi fi es an optimal Scholars and practitioners are beginning to developmental process (and outcomes), not just focus more on what de fi nes not just normal or adequate, competent functioning. As such, thriv- adequate development, but optimally successful ing indicators are unipolar constructs. That is, the development, or thriving. A new science of “pos- absence of thriving in the sense defi ned here is itive psychology” is emerging that focuses on not necessarily negative. The individual may still human happiness, optimism, and fulfi llment be experiencing adequate development and rather than on the pathology and de fi cits that have achieving basic competency across various out- driven psychology for the past 50 years (Seligman comes. In contrast, the relative absence or lower & Csikszentmihalyi, 2000 ) . The integration of levels of developmental assets, as refl ected in the the positive aspects of Erikson’s life cycle frame- research fi ndings to date, seems associated with work and the core principles of positive psychol- poorer developmental outcomes among the ado- ogy, resilience, positive youth development, and lescents (Benson et al., 1999 ) . the developmental assets framework together may provide an even more comprehensive canvas 1 Speci fi cally, thriving may be understood as a develop- on which the strength-based child and adolescent mental process of recursive cause and effect engagement research and practice of the coming decades with one’s ecology over time that repeatedly results in optimal outcomes as viewed at any one point in time. unfolds. Thriving in this sense refl ects processes that are unique to A developmental systems focus on such con- or more pronounced in particular stages of development, structs of human thriving echoes the notions of such as the successful navigation of rapidly expanding maximum personal ful fi llment re fl ected in peer relationships in middle childhood, or the signi fi cant cognitive maturation in early adolescence that can radi- Maslow’s theory of self-actualization. However, cally affect, for better or worse, young people’s construc- conceptualizations of thriving must give greater tion of supportive social environments. 25 Positive Adaptation, Resilience and the Developmental Assets Framework 435

Second, assets are conceptualized as building around what constitutes thriving in adolescence. blocks of success, whereas thriving indicators are The orientation of both the public and research- seen as signs or markers of success. In explana- ers toward young people is predominantly toward tory terms, developmental assets experienced naming and reducing negative behavior, or, at cumulatively over time are considered predictors best, how to promote adequate or competent of or contributors to developmentally optimal functioning among young people (Benson, 2006 ; outcomes that are represented by thriving indica- Scales, 2001 ; Scales et al., 2003 ) . The territory of tors. If the assets are conceptualized as the “build- thriving is beginning to be discussed, but until ing blocks” of success, the question can then be recently, has been largely uncharted. Thus, public raised, building toward what? The thriving indi- and scientifi c consensus has been more diffi cult cators represent the “what” that the assets are to achieve on what constitutes adolescent “thriv- helping young people build toward. Experiencing ing” than it has been to agree about the constella- the assets defi nes conditions under which the tion of risk behaviors that is desirable to reduce in attainment of those thriving outcomes is made adolescence.2 more likely. To some extent, “thriving” can only Undoubtedly, that relative dif fi culty also is be judged subjectively, by the individual him- or partly due to notions of “thriving” being more herself. For example, who can say that people are rooted in moral worldviews and more culturally not thriving who are happy, emotionally open, contextualized than are ideas about risk (Scales and socially generous, but not as rich or powerful & Benson, 2005 ) . For example, youth involve- as they could have been, because they exercised ment in violence or cigarette smoking is plainly their autonomy to make a choice not to pursue harmful to them and can kill them. These effects such paths? Perhaps they did so precisely because are appreciable regardless of one’s cultural back- the pursuit of riches and power would have ground or moral orientation. But showing leader- con fl icted with other “well-being outcomes” they ship ability or being individually successful in valued even more, such as a wonderful marriage, other ways may not be so highly valued within a lots of time with their own kids, and other peo- culture or moral orientation that values self- ple’s kids, or the in-depth pursuits of hobbies or effacement and group harmony more highly. volunteering. Thus, any taxonomy of thriving indicators neces- Nevertheless, thriving suggests not only inter- sarily refl ects a particular moral and cultural nal satisfaction, but also demonstrable excellence framework that is likely to have less universality or substantive positive growth in a dimension of than competing taxonomies of risk or basic life. This may be measured either by comparison competence. to others or by comparison to where one was before on that “outcome.” Without this criterion as a form of one’s “personal best,” the concept of 2 Two early exceptions were two special issues of the thriving becomes elitist. Instead, with the dual Journal of Adolescent Research, one that was devoted to notion of thriving signifying demonstrable excel- “positive aspects of adolescence” (Adams, 2001 ) and the lence or substantive positive growth, everyone is other that called for youth social policy to focus on positive outcomes as much as it does on negative ones capable of thriving. In addition, some people are (Pittman, Diversi, & Ferber, 2002 ) . Toward that end, for more capable of thriving by being “better” than example, Child Trends, Inc., and the Chapin Hall Center others in given areas. for Children at the University of Chicago, in collaboration with the US Department of Health and Human Services, also played an early leadership role by hosting a conference of state leaders in 2002 to suggest positive indicators Thriving Indicators for Adolescents of youth development (later released as a book (Moore & Lippman, 2005 ) ). If added to state-level data collection, Compared to the voluminous literature on ado- such indicators would better inform policymakers’ decisions about child, youth, and family policies and pro- lescent risk-taking and negative behaviors, or the grams. But there are relatively few examples of studies or substantial literature on adequate development or policy initiatives that go beyond measuring only negative competence, there is a relative paucity of research or just adequate behavior among youth. 436 A. Sesma Jr. et al.

In addition, defi nitions of thriving clearly need (detailed in Scales et al., 2000 ) . Such thriving to vary by age. Although the main focus of our indicators seem to satisfy what Takanishi, work has been on adolescence, a useful frame- Mortimer, and McGourthy ( 1997 ) de fi ned as their work of thriving also must include constructs that “primary” criterion for indicators of positive ado- are continuous from earlier stages, as well as lescent development: the attainment of social com- constructs that are unique to particular develop- petency for adult roles and responsibilities. That mental stages. For example, there likely are some broad criterion includes being an educated and potential thriving indicators that are developmen- productive worker, a person who can maintain a tally relevant to adolescence but not to middle healthy lifestyle, a caring family member, and an childhood, such as having a signifi cant girlfriend involved citizen in a diverse society. or boyfriend relationship. At the same time, valid Our more recent de fi nition of ‘thriving’ thriving indicators for adolescence likely include encompasses similar “status” descriptions of some that are essentially the same as develop- optimal functioning, but goes beyond them to mentally valid indicators for middle childhood. refl ect a more dynamic, process-oriented Young people’s active helping of others might be approach, characterized by three key, intercon- an example. The items used to measure the “help- nected parts3 . As we describe in Benson and ing others” indicator might differ between those Scales (2009a, 2009b , p. 90), thriving: two developmental stages, but the essence of the 1. Represents a dynamic and bi-directional inter- prosocial behavior as an indicator of thriving play over time of a young person intrinsically would not. For example, perhaps we would expect animated and energized by discovering his/her adolescents to formally volunteer more as an specialness, and the developmental contexts indicator of thriving, whereas we would expect (people, places) that know, affi rm, celebrate, younger children’s helping to be demonstrated encourage, and guide its expression. more by informal helping of their friends and 2. Involves ‘stability of movement’ or the ‘bal- neighbors. ance’ of movement toward something (Bill Originally, Search Institute studied seven indi- Damon, personal conversation, May 11, cators of thriving among adolescents: school suc- 2006), that is, thriving is a process of experi- cess, helping others, valuing diversity, exhibiting encing a balance between continuity and dis- leadership, overcoming adversity, maintaining continuity of development over time that is physical health, and delaying grati fi cation (Scales optimal for a given individual’s fused rela- et al., 2000 ) . These original seven indicators of tions with her or his contexts (per discussion well-being status were selected for study for two of developmental continuity and discontinu- main reasons. First, a wealth of research suggests ity in Lerner, 2003 ) . that these indicators are related to numerous posi- 3. Re fl ects both where a young person is cur- tive physical, socioemotional, psychological, and rently in their journey to idealized person- cognitive outcomes, both proximally and distally, hood, and whether they are on the kind of and that these positive associations occur among path to get there that could rightly be called diverse young people by gender, race/ethnicity, one of exemplary adaptive development and socioeconomic background (see review in regulations. Scales & Leffert, 2004 ) . Second, these thriving Given the complex balance and plasticity that indicators collectively refl ect that adolescents have these parts of the thriving de fi nition re fl ect accomplished at least adequately and perhaps between person and context, continuity and dis- excellently a number of developmental tasks con- continuity, and status and process, we also prefer ceived as important for all young people, regard- to describe a young person at any point in time as less of cultural background. These would include more or less thriving oriented, rather than as developing their intellectual capacities and a sense thriving or not. of belonging, being able to explore and enlarge their worlds while minimizing risks, and being 3 A thorough description of the evolution of the theory of able to persist and succeed despite challenge thriving is found in Benson and Scales (2010 ) . 25 Positive Adaptation, Resilience and the Developmental Assets Framework 437

initiatives that are using the framework, we have Fostering Positive Development: identifi ed fi ve components (as depicted in Developmentally Attentive Table 25.2) that can transform communities into Communities more developmentally attentive places; that is, places that are more intentional in their efforts to The fi nal dimension relates to the way in which foster the healthy development of their children positive development or adaptation is achieved. and adolescents. Central to this multifaceted From a resilience perspective, the dominant approach is to mobilize young people, such that delivery system for fostering resilience is via youth themselves are engaged in a community’s science-based intervention and prevention pro- activities. This echoes others’ assertions that from grams that, ideally, reduce risk factors and a positive youth perspective, young people are enhance protective factors (Rolf & Johnson, seen as resources and contributors to their envi- 1999 ) . Masten and Reed’s (2002 ) tripartite typol- ronments (Eccles & Gootman, 2002 ; Lerner et al., ogy for promoting resilience highlights this goal 2002 ; Whitlock & Hamilton, 2003 ) . Importantly, by suggesting strategies that prevent or reduce our studies also have shown that when young peo- risks and stressors, strategies that improve the ple experience higher levels of such “voice” and number and/or quality of resources or assets, and empowerment, they enjoy far better outcomes, strategies that bolster and strengthen basic human across academic, psychological, social, and adaptive systems (e.g., cognitive functioning, behavioral domains (Scales, Roehlkepartain, & attachment relationships). Prevention and inter- Benson, 2009 ) . Another strategy is to activate the vention programs are increasingly targeting mul- various sectors of a community; that is, the orga- tiple risk and protective factors across multiple nizations, institutions, and settings that are able to contexts in fostering resilience and positive promote youth development, including schools, development, at times with impressive results families, faith-based organizations, neighbor- (Catalano, Berglund, Ryan, Lonczak, & Hawkins, hoods, and youth organizations. Rallying the mul- 2002 ; Eccles & Gootman, 2002 ; Weissberg & tiple settings of a community around positive Greenberg, 1998 ) . youth development provides an important redun- From a developmental asset perspective, pro- dancy of messages and experiences to youth grams are important, but cannot be the sole strat- regarding their value in the community. A third egy in facilitating healthy outcomes for youth. strategy, engaging adults, refers to adults both in Programs alone cannot offer the kinds of sup- their formal roles as citizens, leaders, members, ports, opportunities, and relationships young and decision makers who can infl uence the sec- people need. This work requires a broader strat- tors, but also to adults as individuals who by their egy in which multiple contexts in young people’s actions and statements in their ongoing daily rela- lives are strengthened to promote the kinds of tionships with young people can build youths’ factors that sustain and support positive develop- assets (Scales et al., 2003 ) . ment for all youth (Benson & Saito, 2001 ; Becoming a mentor is a formal illustration of Connell et al., 2001 ; Scales, Roehlkepartain, & such engagement, but informal interactions can Benson, 2009 ; Villaruel, Perkins, Borden, & also be important (Lopez & McKnight, 2002 ) . Keith, 2003 ) . When many adults demonstrate their respect and One way to conceive of this broader approach appreciation of youth and when they actively is through the notion of a “developmentally atten- seek to get to know them, the community becomes tive community.” This conception of community more welcoming and more growth-enhancing. is rooted in strategies that identify mutually rein- Fourth, infl uencing civic decisions is necessary forcing lines of action, all intended to make com- to both promote and sustain a community’s munities places that promote youth development. activities. Through our study of community change models Finally, the last component of a developmen- and observations of hundreds of community tally attentive community is the presence of 438 A. Sesma Jr. et al.

Table 25.2 Search Institute’s fi ve action strategies for a developmentally attentive community Engage adults . Engage adults from all walks of life to develop sustained, strength-building relationships with children and adolescents, both within families and in neighborhoods Young people need the adults in their lives to acknowledge them, af fi rm them, and connect with them. They need these things from the adults who are not paid to work with them, as well as the professionals who are Engaging parents as asset builders—and af fi rming the many ways they already build assets—is particularly important, given their central role in children’s lives Mobilize young people . Mobilize young people to use their power as asset builders and change agents Many youth feel devalued by adults. And most report their community does not provide useful roles for young people. It should become normative in all settings where children and youth are involved to seek their input and advice, to make decisions with them, and to treat them as responsible, competent allies in all asset-building efforts It is also important to help young people tap their own power to build assets for themselves, their peers, and younger children Activate sectors . Activate all sectors of the community—such as schools, congregations, children and youth, businesses, human services, and health care organizations—to create an asset-building culture and contribute fully to young people’s healthy development Young people are customers, employees, patients, participants—members of their community in many of the same ways adults are. All sectors have opportunities to examine the ways they come in contact with young people and identify ways they can support their healthy development Invigorate programs . Invigorate, expand, and enhance programs to become more asset rich and to be available to and accessed by all children and youth Though much asset-building occurs in daily, informal interactions, programs young people take part in throughout their community must also become more intentional about asset building. Opportunities for training, technical assistance, and networking should be made available in these settings In fl uence civic decisions . In fl uence decision makers and opinion leaders to leverage fi nancial, media, and policy resources in support of this positive transformation of communities and society Community-wide policies, messages, and priorities not only shape people’s perceptions of youth, but they also can motivate and support individuals, organizations, and sectors to make asset building an ongoing priority effective programs. As noted above, programs be the only target of change—adults are impli- have the potential to signi fi cantly alter maladap- cated as much if not more so in this work. Unless tive developmental trajectories, indeed, evidence adults believe that they have the potential to play suggests that, however, without signi fi cantly a signifi cant role in the lives of youth, much of changing the environments in which youth live the work described in this chapter cannot take may lead to the kinds of modest short- and long- place. Thus, the strategies and assumptions that term effects often reported in reviews of preven- stem from our work do not focus on fi xing or tion programs (Eccles & Gootman, 2002 ) . Indeed, changing young people’s behavior as much as this raises an interesting moderating hypothesis: they focus on infl uencing the attitudes, percep- Are the effects of a proven program enhanced tions, and behaviors of adults toward youths when implemented in a community characterized (Benson, 2006 ) . by these other four components? Questions such There is no single model for how a commu- as this one are possible when we begin to think nity-wide, asset-building initiative is launched beyond program models as the only planned or and sustained. We believe that each community intentional efforts at infl uencing development brings a unique mix of strengths, history, and and start to acknowledge the powerful role that a existing efforts into the planning and implemen- community can play when united around its tation of its initiative. However, certain dynamics youth. appear essential. What should be clear from this model is our • Cultivate a shared vision. Invite community assumption that not only are programs not members to articulate and keep alive a shared suf fi cient to promote positive development across vision for an asset-rich community. Develop a many groups of youth, but also that youth cannot shared community-wide vision centered on 25 Positive Adaptation, Resilience and the Developmental Assets Framework 439

increasing the asset base for all children and in the community, to promote the positive adolescents. Know that reaching this target development of children and youth. cannot be rushed or done with a single new idea or program. Conclusion

Positive Adaptation, Resilience, and the As this review suggests, there is a great deal of Developmental Assets Framework consonance between the developmental assets framework and models of resilience. Both Rather, it will take long-term commitment, mul- approaches identify multiple sources of develop- tiple and coordinated changes, and a passion for mental nutrients across numerous ecologies likely the vision that will sustain your efforts. to foster adaptive functioning and optimal devel- • Recruit and network champions . Nurture rela- opment. Likewise, both approaches provide com- tionships with people who have the passion to plementary notions regarding the confi gurations spread the word and help make the vision a of positive developmental outcomes for youth. reality. Create opportunities for these champi- And both af fi rm the signi fi cance of programs as a ons to learn from, support, and inspire each mechanism for promoting healthy behaviors and other. attitudes. • Communicate. Distribute information, make Because the developmental assets framework presentations, and tap the media to raise is different from a programmatic approach, the awareness about asset building and local scope and implications of our work are broader. efforts. Share with your community what This work represents a shift away from relying young people experience. Emphasize the abil- solely on prevention and intervention efforts to ity of all community members—including the intentional mobilization and engagement of young people—to build assets. individuals and systems within communities in • Strengthen capacity . Provide or facilitate the service of healthy youth development. This is training, technical assistance, coaching, tools, no simple task, not the least of which because or other resources that help individuals and “community” as the unit of analysis is far less organizations in their asset-building efforts. wieldy than a controlled program design, but also • Re fl ect, learn, and celebrate . Re fl ect on and because of the paucity of research examining the learn from current progress and challenges. role of deliberate community-wide effects on the Many people, places, and programs already health and well-being of youth. Note though that build assets. Highlight and honor existing and this discussion of community mobilization in no new asset-building efforts in the community. way is meant to replace or supplant targeted pro- • Manage and coordinate. Manage and coordi- grammatic efforts; one of the implications of the nate schedules, budgets, and other administra- asset model is that strong and effective programs tive tasks, as needed. are a necessary component of a developmentally Asset-building communities mobilize people, attentive community and that programs are emi- organizations, institutions, and systems to take nently complementary to positive youth develop- action around a shared understanding of positive ment approaches (Catalano, Hawkins, Berglund, development. Ultimately, rebuilding and strength- Pollard, & Arthur, 2002 ; Resnick, 2000 ; Whitlock ening the developmental infrastructure in a com- & Hamilton, 2003 ) . munity is not a program run by professionals. It is Nevertheless, if, as Bronfenbrenner and Morris a movement that creates a community-wide sense (1998 ) note, the “growing chaos in … everyday of common purpose. It places residents and their environments in which human beings live their leaders on the same team moving in the same lives…interrupts and undermines the formation direction, and creates a culture in which all resi- and stability of relationships and activities that are dents are expected, by virtue of their membership necessary for psychological growth” (p. 1022), 440 A. Sesma Jr. et al. then working toward bringing structure and inten- Benson, P. L., Scales, P. C., Leffert, N., & Roehlkepartain, tionality to these environments under the banner of E. R. (1999). A fragile foundation: The state of developmental assets among American youth . Minneapolis, positive youth development provides a promising MN: Search Institute. approach to increasing the developmental out- Benson, P. L., Scales, P. C., & Mannes, M. (2003). comes for young people. Developmental strengths and their sources: Implications for the study and practice of community building. In R. M. Lerner, F. Jacobs, & D. 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I have focused for almost 30 years on examining In scientifi c circles, research related to resilience the impact that parents have in nurturing hope, has primarily studied youngsters who have self-esteem, and an optimistic outlook in their overcome trauma and hardship (Beardslee & children ( Brooks, 1998; Brooks & Goldstein, Podorefsky, 1988 ; Brooks, 1994 ; Crenshaw, 2001, 2003, 2011) . My intention in this chapter is 2010; Hechtman, 1991 ; Herrenkohl, Herrenkohl, to examine specifi c steps that parents can take on & Egolf, 1994 ; Masten, Best, & Garmezy, 1990 ; a daily basis to reinforce a resilient mindset and Rutter, 1985 ; Werner & Smith, 1992 ) . However, lifestyle in their children. Before describing both several researchers and clinicians have raised the characteristics of this mindset and strategies important issues, such as: “Does a child have to to strengthen it in youngsters, I believe it is nec- face adversity in order to be considered resil- essary to address the following two questions: ient?” or “Is resilience refl ected in the ability to 1. What is meant by the concept of resilience? bounce back from adversity or is it caused by 2. Do parents really have a major in fl uence on the adversity?” (Kaplan, 2005 ) . development of resilience in their children? My colleague Sam Goldstein and I believe that the concept of resilience should be broadened to apply to every child and not restricted to What Is Resilience? those who have experienced adversity (Brooks & Goldstein, 2001, 2003) . All children face chal- Resilience may be understood as the capacity of lenge and stress in the course of their develop- a child to deal effectively with stress and pres- ment and even those who at one point would not sure, to cope with everyday challenges, to rebound be classi fi ed as “at-risk” may suddenly fi nd from disappointments, mistakes, trauma, and themselves placed in such a category. This abrupt adversity, to develop clear and realistic goals, to shift to an at-risk classifi cation was evident on a solve problems, to interact comfortably with oth- dramatic scale for the hundreds of children who ers, and to treat oneself and others with respect lost a parent or loved one as a consequence of the and dignity (Brooks & Goldstein, 2001 ) . terrorist attacks on 9/11. Nurturing resilience should be understood as a vital ingredient in the process of parenting every child whether that R. B. Brooks () child has been burdened by adversity or not. Department of Psychology , Other mental health specialists have also McLean Hospital and Harvard Medical School , 60 Oak Knoll Terrace , Needham , MA 02478 , USA expanded the defi nition or scope of resilience to e-mail: [email protected] go beyond bouncing back from adversity. Reivich

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 443 DOI 10.1007/978-1-4614-3661-4_26, © Springer Science+Business Media New York 2013 444 R.B. Brooks and Shatte ( 2002 ) contend that “everyone needs the non-genetic differences in human behavioral resilience” and they write: traits. Though some have lauded Harris for her … resilience is the capacity to respond in healthy contribution to the fi eld of child development, and productive ways when faced with adversity she has also been widely criticized by profession- and trauma; it is essential for managing the daily als who have interpreted her conclusions as sug- stress of life. But we have come to realize that the gesting that parents are inconsequential players same skills of resilience are important to broaden- ing and enriching one’s life as they are to recover- in their children’s lives (Pinker, 2002 ) . ing from setbacks (p. 20). However, Harris’ position may be interpreted not as a dismissal of the infl uence of parents, but A more inclusive de fi nition of resilience that rather as a call to be more precise in understand- embraces all youngsters encourages us to con- ing the impact of parents on the present and ulti- sider and adopt parenting practices that are essen- mately, future lives of their children. Pinker tial for preparing children for success and ( 2002) , citing a number of studies of fraternal satisfaction in their future lives. A guiding prin- and identical twins reared together or apart, con- ciple in each interaction parents have with chil- tends that it is not that parents don’t matter; they dren should be to strengthen their ability to meet in fact matter a great deal. It’s that over the long life’s challenges with thoughtfulness, con fi dence, term, parent behavior does not appear to purpose, responsibility, empathy, and hope. These signi fi cantly in fl uence a child’s intelligence or qualities may be subsumed under the concept of personality. In contrast, Siegel ( 1999 ) has posited resilience. The development of a resilient mind- that a child’s attachment and relationship with set, which will be described in detail later in this caregivers is a major determinant of mental health chapter, is not rooted in the number of adversities and adaptation. experienced by a child, but rather in particular The position taken in this chapter is that even skills and a positive attitude that caregivers rein- if those personality qualities in a child attributed force in a child. to parental infl uence are in a statistical equation much smaller than previously assumed, they may in the daily lives of children be the difference in Do Parents Have a Major In fl uence determining whether or not a child succeeds in on the Development of Resilience school, develops satisfying peer relationships, or in Their Children? overcomes a developmental or behavioral impairment. Parents possess enormous in fl uence in the Many people convinced of the profound infl uence lives of their children. Data suggesting that a par- that parents exert on a child’s development and ticular parenting style may play a minimal role in resilience, might wonder why it is necessary to intelligence or personality development does not pose this question. However, the answer is not as absolve parents of their responsibility to raise clearcut as many may believe (Goldstein & their children in moral, ethical, and humane ways. Brooks, 2003 ) . Recently developed, sophisticated The quality of daily parent-child relationships scienti fi c instruments have highlighted the makes a vital difference in the behavior and signifi cant impact of genetics on adult personal- adjustment of children. As Sheridan, Eagle, and ity, adaptation, and cognitive and behavioral pat- Dowd (2005 ) note, “The development of resil- terns. As a consequence, the degree to which iency and healthy adjustment among children is parents infl uence their child’s development has enhanced through empathetic family involvement been questioned by several researchers (Harris, practices” (p. 168). 1998 ; Pinker, 2002 ) . Not surprisingly, the impact of parental behav- In her book The Nurture Assumption , Harris ior on children is less debatable when the behavior (1998 ) presented evidence to suggest that the in question is inappropriate, humiliating, or abu- extended environment outside of the home, par- sive compared with that which is positive or ticularly the impact of peers, explained much of benign. For example, Jaffee (2005 ) has highlighted 26 The Power of Parenting 445 the devastating effects on a child’s emotional well- They conclude: being and resilience when confronted with parents … resilience is a developmental process that who have a history of mental disorder and also involves individual differences in children’s attri- engage in violent and abusive behavior. Kumpfer butes (e.g., temperament, cognitive abilities) and and Alavarado ( 2003 ) , emphasizing the signi fi cance environments (e.g., supportive parenting, learning enriched classrooms). The genetic and environ- of parental behavior write: mental in fl uences underlying these individual dif- The probability of a youth acquiring developmen- ferences are correlated, and they interact with each tal problems increases rapidly as risk factors such other to produce the variation that we see between as family confl ict, lack of parent-child bonding, children, and over time within children… . It is disorganization, ineffective parenting, stressors, imperative that scientists and practitioners recog- parental depression, and others increase in com- nize that these gene-environment transactions are parison with protective or resilience factors. Hence, probabilistic in their effects, and the transactions family protective mechanisms and individual resil- and their effects can change with shifts in genes or iency processes should be addressed in addition to environments (p. 60). reducing risk factors… . Resiliency research suggests that parental support in helping children develop dreams, goals, and purpose in life is a Although researchers and clinicians debate major protective factor (p. 458). the extent to which particular parenting practices impact on children in speci fi ed areas, it seems Pinker ( 2002) notes, “Childrearing is above that all agree that parents make a signifi cant dif- all an ethical responsibility. It is not okay for ference either in the day-to-day and/or future parents to beat, humiliate, deprive, or neglect lives of their children. We concur with this posi- their children because those are awful things for tion and believe that it is essential that we iden- a big strong person to do to a small helpless one” tify both those parental practices that nurture the (p. 398). Similarly, Harris writes, “If you don’t skills, positive outlook, and stress hardiness nec- think the moral imperative is a good enough rea- essary for children to manage an increasingly son to be nice to your kid, try this one: Be nice to complex and demanding world as well as those your kid when he’s young so that he will be nice that do harm to children. We must search for con- to your when you’re old” (p. 342). sistent ways of raising children that will increase Pinker (2002 ) poignantly captures the moral the likelihood of their experiencing happiness, dimension of parenting practices in the following success in school, contentment in their lives, and statement: satisfying relationships. If children are to realize these goals they must develop the inner strength There are well-functioning adults who still shake to deal competently and successfully, day after with rage when recounting the cruelties their par- day, with the challenges and pressures they ents infl icted on them as children. There are others who moisten up in private moments when recalling encounter (Brooks & Goldstein, 2001 ) . a kindness or sacri fi ce made for their happiness, perhaps one that the mother or father has long forgotten. If for no other reason, parents should treat The Characteristics of a Resilient their children well to allow them to grow up with such memories (p. 399). Mindset

Given the complexity of a child’s develop- Resilient children possess certain qualities and/or ment, it is unlikely that a specifi c number will ways of viewing themselves and the world that ever be assigned as a “parent’s share” or percent- are not apparent in youngsters who have not been age of that development. As Deater-Deckard, Ivy, successful in meeting challenges. The assump- and Smith (2005 ) wisely observe, “The question tions that children have about themselves is no longer whether and to what degree genes or infl uence the behaviors and skills they develop. environments matter, but how genes and environ- In turn, these behaviors and skills in fl uence this ments work together to produce resilient children set of assumptions so that a dynamic process is and adults” (p. 49). constantly operating. This set of assumptions 446 R.B. Brooks may be classi fi ed as a mindset (Brooks & examine their own mindset, beliefs, and actions. Goldstein, 2001 ) . We will now examine guideposts that can facili- An understanding of the features of a resilient tate this process together with case examples. mindset can provide parents with guideposts for nurturing inner strength and optimism in their children. Parents adhering to these guideposts Parenting Practices That Nurture can use each interaction with their children to Resilience in Children reinforce a resilient mindset. While the outcome of a specifi c situation may be important, even Following is a list of ten guideposts proposed by more essential are the lessons learned from the Brooks and Goldstein ( 2001, 2003 ) that form the process of dealing with each issue or problem. scaffolding for reinforcing a resilient mindset and The knowledge gained therefore supplies the lifestyle in children. These guideposts are rele- nutrients from which the seeds of resiliency will vant for all the interactions parents and other fl ourish. caregivers have with children whether coaching The mindset of resilient children contains a them in a sport, helping them with homework, number of noteworthy characteristics that are engaging them in an art project, asking them to associated with speci fi c skills. These include: assume certain responsibilities, assisting them They feel special and appreciated. when they make mistakes, teaching them to share, They have learned to set realistic goals and expec- or disciplining them. While the speci fi c avenues tations for themselves. through which these guideposts can be applied They believe that they have the ability to solve will differ from one child and one situation to the problems and make sound decisions and thus next, the guideposts themselves remain constant. are more likely to view mistakes, setbacks, 1. Being empathic and obstacles as challenges to confront rather A basic foundation of any relationship is empa- than as stressors to avoid. thy. Simply defi ned, in the parenting relationship They rely on effective coping strategies that pro- empathy is the capacity of parents to place them- mote growth and are not self-defeating. selves inside the shoes of their children and to see They are aware of and do not deny their weak- the world through their eyes. Empathy does not nesses and vulnerabilities but view them as imply that you agree with what your children do, areas for improvement rather than as but rather you attempt to appreciate and validate unchangeable fl aws. their point of view. Also, it is easier for children to They recognize and enjoy their strong points and develop empathy when they interact with adults talents. who model empathy on a daily basis. Their self-concept is fi lled with images of strength It is not unusual for parents to believe they are and competence. empathic, but the reality is that empathy is more They feel comfortable with others and have fragile or elusive than many realize. Experience developed effective interpersonal skills with shows that it is easier to be empathic when our peers and adults alike. This enables them to children do what we ask them to do, meet our seek out assistance and nurturance in a com- expectations, and are warm and loving. Being fortable, appropriate manner from adults empathic is tested when we are upset, angry, or who can provide the support they need. disappointed with our children. When parents They are able to de fi ne the aspects of their lives feel this way, many will say or do things that over which they have control and to focus actually work against a child developing their energy and attention on those rather resilience. than on factors over which they have little, or To strengthen empathy, parents must keep in any, in fl uence. mind several key questions, questions that I fre- The process of nurturing this mindset and quently pose in my clinical practice and work- associated skills in children requires parents to shops. They include: 26 The Power of Parenting 447

“How would I feel if someone said or did to me that they knew he possessed much strength, but what I just said or did to my child?” there were areas that were more challenging for “When I say or do things with my children, am I him such as reading. By being empathic they behaving in a way that will make them most transformed an accusatory attitude into a prob- responsive to listening to me?” lem-solving framework by asking John what he “How would I hope my child described me?” thought would help. This more positive approach “Do I behave in ways that would prompt my child made it easier for John to acknowledge his to describe me in the way I hope?” diffi culties in school and prompted his willing- “How would my child actually describe me and ness to receive tutoring. how close is that to how I hope my child Sally, a shy 8-year-old, was frequently would describe me?” reminded by her parents, Mr. and Mrs. Carter, to While thinking about these questions as the say hello when encountering family or friends. essential features of effective parenting, they are Yet, from a young age Sally’s temperament left often neglected when parents are confronted with her feeling anxious, fearful, and easily over- frustration and anger. This is evident in the fol- whelmed in new situations. It was not unusual for lowing two case examples. Sally to seek refuge behind her mother when peo- Mr. and Mrs. Kahn were perplexed why their ple she did not know visited the Carter home. son John, a seventh grader, experienced so much Both of the Carters were outgoing and were per- dif fi culty in completing his homework. John was plexed by Sally’s cautiousness and fearfulness, an excellent athlete but had a long history of especially since they viewed themselves as sup- struggling to learn to read. His parents, noticing portive and loving parents. They felt that Sally John’s lack of interest in school activities, could be less shy “if she just put her mind to it.” believed he was “lazy” and he could do the work The Carters became increasingly frustrated if he “put his mind to it.” They often exhorted and embarrassed by Sally’s behavior, prompting him to “try harder” and they angrily reminded them to warn her that if she failed to say hello to him on a regular basis how awful he would feel as others she would be lonely and have no friends. a senior in high school when he was not accepted They frequently asked her after school if she had into the college of his choice. taken the initiative to speak with any of the chil- Although perhaps well-intentioned, when Mr. dren in her class. These kinds of comments and Mrs. Kahn told John to “try harder” they backfi red, prompting Sally to become more failed to consider how these words were experi- anxious. enced by their son. Many youngsters who are Mr. and Mrs. Carter, desiring their daughter to repeatedly told to “try harder” interpret this state- be more outgoing, failed to appreciate that Sally’s ment not as helpful or encouraging but rather as cautious demeanor was an inborn temperamental judgmental and accusatory, intensifying their trait and could not be overcome by simply telling frustration rather than their motivation to improve. her to “say hello” to others. They were to dis- Thus, the words the Kahns used worked against cover that each reminder on their part not only their goal to motivate John. If they had re fl ected intensifi ed Sally’s discomfort and worry but also upon how they would feel if they were having compromised a warm, supportive relationship dif fi culty at work and their boss yelled, “Try with their daughter. harder,” they may have refrained from using these In parent counseling sessions the Carters words. learned that they could assist Sally to be less shy, Mr. and Mrs. Kahn learned that by placing but they fi rst had to re fl ect upon how their current themselves inside John’s shoes, they could com- actions and words impacted on their daughter. municate with him in ways that would lessen They had to ask, “If I were shy would I want any- defensiveness and increase cooperation. They one to say to me what I say to Sally?” or “Am I told him that they realized they came across as saying things to Sally that are helping or hindering “nagging” but did not wish to do so. They said the process of her becoming more comfortable 448 R.B. Brooks with others?” In essence, these kinds of questions against the development of a resilient mindset in helped them to assume a more empathic stance. his son since it contained an accusatory tone, a Both parents learned that telling a shy person to try tone focusing on Michael’s shortcomings rather to become less shy is often experienced as accusa- than on his strengths. It did not offer assistance or tory and not as a source of encouragement. hope. Mr. and Mrs. Carter informed Sally that they Covey ( 1989 ) , describing the characteristics knew that it was not easy for her to say hello to of effective people, advocates that we fi rst attempt people she did not know and added that it was not to understand before being understood. What he easy for many other children as well. They said is suggesting is that prior to expressing our views, that maybe working together with Sally they we would be well-advised to practice empathy by could fi gure out steps she could take to make it listening actively and considering what messages less dif fi cult to greet others. These comments the other person is delivering. Effective commu- served to empathize and validate what Sally was nication is implicated in many behaviors associ- experiencing and also to convey a feeling of ated with resilience, including interpersonal “we’re here to help, not criticize.” Finally, they skills, empathy, and problem-solving and deci- communicated to Sally, “Many kids, who have sion-making abilities. trouble saying hello when they’re young, fi nd it Given the signi fi cance of effective communi- easier as they get older.” This last statement con- cation skills in our lives, during my therapeutic veyed realistic hope. And hope is a basic charac- activities and my workshops I frequently pose the teristic of a resilient mindset. following questions for parents to consider when Being empathic permitted the Carters to com- they interact with their children: municate with Sally in a nonjudgmental way and “Do my messages convey and teach respect?” in the process they nurtured their daughter’s “Am I fostering realistic expectations in my resilience. children?” 2. Communicating effectively and listening “Am I helping my children learn how to solve actively problems?” Empathy is closely associated with the ways “Am I nurturing empathy and compassion?” in which parents communicate with their chil- “Am I promoting self-discipline and self- dren. Communication is not simply how we speak control?” with another person. Effective communication “Am I setting limits and consequences in ways involves actively listening to our children, under- that permit my children to learn from me standing, and validating what they are attempting rather than resent me?” to say, and responding in ways that avoid power “Am I truly listening to and validating what my struggles by not interrupting them, by not telling children are saying?” them how they should be feeling, by not derogat- “Do my children know that I value their opinion ing them, and by not using absolute words such and input?” as always and never in an overly critical, demean- “Do my children know how special they are to ing fashion (e.g., “You never help out”; “You me?” always act disrespectful”). “Am I assisting my children to appreciate that Resilient children demonstrate a capacity to mistakes and obstacles are part of the process communicate their feelings and thoughts effec- of learning and growing?” tively and their parents serve as important models “Am I comfortable in acknowledging my own in the process. When 10-year-old Michael insisted mistakes and apologizing to my children on completing a radio kit by himself and then when indicated?” was not able to do so, his father, Mr. Burton, If parents keep these questions in mind, they angrily retorted, “I told you it wouldn’t work. can communicate in ways that reinforce a resilient You don’t have enough patience to read the direc- mindset. However, this task is not always easy to tions carefully.” Mr. Burton’s message worked accomplish as was evident at a family session 26 The Power of Parenting 449 with Mr. and Mrs. Berlin and their 13-year-old they change their approach, it is like “giving in to daughter Jennifer. The Berlins sought a consulta- a child” and they are concerned that their chil- tion given for Jennifer’s sadness and what they dren will take advantage of them. One mother called “her pessimistic attitude towards said, “My son forgets to do his chores and I keep everything.” reminding him and we keep getting into battles. At the fi rst session, Jennifer said, “I feel very But I can’t back off. If I do my son will never sad and unhappy.” learn to be responsible. He will become a spoiled Mrs. Berlin instantly countered, “But there’s brat like too many other kids are these days.” no reason for you to feel this way. We are a loving Without realizing it, the mother’s constant family and have always given you what you reminders backfi red. They not only contributed need.” to tension in the household, but in addition, they Jennifer’s expression suggested both sadness reinforced a lack of responsibility in her son by and anger at her mother’s remark. While Mrs. always being there to remind him of what he was Berlin may have intended to reassure her daugh- expected to do rather than having him learn to ter, her comment served to rupture communica- remember his responsibilities on his own. tion. People do not want to be told how they Parents with a resilient mindset of their own should or should not feel. If someone says she recognize that if something they have said or feels depressed, she does not want to hear that done for a reasonable amount of time does not there is no reason to feel this way. work, then they must change their “script” if their What might Mrs. Berlin have said? A good children are to change theirs. This position does place to start is validation. Parents must fi rst vali- not mean giving in to the child or failing to hold date what their child is saying. Validation does the child accountable. It suggests that we must not mean you agree with the other person’s state- have the insight and courage to consider what we ment, but that you convey to that person you can do differently, lest we become entangled in “hear” what is being said. Consider the following useless, counterproductive power struggles. It response that Mrs. Berlin might have offered: also serves to teach children that there are alter- I know you’ve been feeling depressed. I’m not cer- natives ways of solving problems. If anything, it tain why, but I’m glad you could tell us. That’s why helps children learn to be more fl exible and we’re seeing Dr. Brooks to try and fi gure out what accountable in handling dif fi cult situations. will help you to feel better and also, how dad and Mr. Lowell was imprisoned by a negative I can help. script, especially towards his 12-year-old son If the messages of parents are fi lled with Jimmy. The moment Mr. Lowell arrived home, empathy, validation, and support, a climate is the fi rst question he asked Jimmy each and every established for nurturing resilience. day was, “Did you do your homework? Did you 3. Changing negative scripts do your chores?” Even if Jimmy had not done his Well-meaning parents have been known to homework or chores, he quickly responded “yes” apply the same approach with their children for just to “get my father off my back.” Over several weeks, months, or years even when the approach years their relationship deteriorated. Jimmy felt has proven ineffective. For instance, a set of par- all his father cared about were grades and chores. ents reminded (nagged) their children for years to Mr. Lowell felt his son was “lazy” and needed clean their rooms, but the children failed to com- daily “prodding” to become more responsible. ply. When I asked why they used the same unsuc- In counseling sessions, Mr. Lowell became cessful message for years, they responded, “We aware of how his words echoed those of his father thought they would fi nally learn if we told them when Mr. Lowell was Jimmy’s age. With impres- often enough.” sive insight he said, “Jimmy must see me just like Similar to the reasoning offered by these par- I saw my father, an overbearing man who rarely ents, many parents believe that children should complimented me but was quick to tell me what be the ones to change, not them. Others believe if I did wrong.” 450 R.B. Brooks

Mr. Lowell ruefully asked, “Why do we do the fronted with their parents’ statements and same things toward our kids that we didn’t like questions. our parents doing to us?” Unconditional love, which we will discuss in It is a question frequently raised. While the greater detail in the next guidepost, is an essential answer may differ to some extent from one per- feature that charismatic adults bestow on chil- son to the next, the basic issue is how easily we dren. If children are to develop a sense of secu- become creatures of habit, incorporating the rity, self-worth, and self-dignity, they must have script of our own parents even if we were not people in their lives who demonstrate love not happy with that script. We practice what we have because of something they accomplish but learned. because of their very existence. When such love Yet, parents are not destined to follow these is absent, it is difﬁ cult to develop and fortify a ineffective, counterproductive scripts. Once they resilient mindset. are aware of their existence they can consider When I have asked adults to recall a favorite other scripts to follow. Mr. Lowell, equipped with occasion from their childhood when their parents new insight, no longer greeted Jimmy with ques- served as a charismatic adult for them, one of the tions about his homework or chores, but instead most common memories involved doing some- showed interest in his son’s various activities, thing pleasant and alone with the parent. One including drawing and basketball. He and Jimmy man described having his father’s “undivided signed up for an art class together offered by a attention.” He said, “My father really listened to local museum and they “practiced hoops” on a me when no one else was around and we could regular basis. Similar to the Kahn’s approach talk about anything. It was tougher to do when with John and the Carter’s with Sally, Mr. Lowell my older sister and younger brother were also recognized that if Jimmy were to change, he, as there.” the adult, would have to make the initial Similarly, a woman said, “I loved bedtime changes. when my mother or father read me a story. If my 4. Loving our children in ways that help them to mother was reading to me, my father was reading feel special and appreciated to my brother. If my father was reading to me, my It is well established that a basic foundation of mother was reading to my brother.” With a smile, resilience is the presence of at least one adult this woman added, “Don’t get me wrong, I loved (hopefully several) who believes in the worth and my brother and I enjoyed when we did things as goodness of the child. The late psychologist a family, but I think I felt closest to my parents Julius Segal referred to that person as a “charis- when I did something alone with each. My hus- matic adult,” an adult from whom a child “gath- band and I do the same things with our kids ers strength” (Segal, 1988 ) . One must never today.” underestimate the power of one person to redirect The power of “special times,” poignantly cap- a child toward a more productive, successful, sat- tured in the words of this man and woman, are isfying life. recalled by many adults. It is recommended that Parents, keeping in mind the notion of a char- parents create these times in the lives of their ismatic adult, might ask each evening, “Are my children. Parents of young children might say, children stronger people because of the things I “When I read to you or play with you, it is so said or did today or are they less strong?” special that even if the phone rings I won’t answer Certainly, Mr. Burton yelling at his son Michael it.” One young child said, “I know my parents when the latter had difﬁ culty in completing a love me. They let the answering machine answer radio kit or Mr. and Mrs. Carter questioning Sally calls when they are playing with me.” each day if she had initiated conversations with When children know that they will have a time classmates were actions that diminished their alone with each parent, it helps to lessen sibling children’s emotional well-being. Neither Michael rivalry and vying for the parent’s undivided atten- nor Sally was likely to gather strength when con- tion. A parent of six children asked at a workshop, 26 The Power of Parenting 451

“Is it possible to create special moments with each temperaments, others with cautious or shy child when you have six.” The answer is that it is temperaments, while still others with “diffi cult” more dif fi cult with six than with two children in temperaments. the household, but it is still possible. It requires When parents lack knowledge about these more juggling, but if these times result in children inborn temperaments, a powerful determinant of feeling special in the eyes of their parents, the personality and behavior according to Harris struggle to juggle one’s schedule is worth the ( 1998) , they may say or do things that compro- effort. As Pinker (2002 ) advised, “If for no other mise satisfying relationships and interfere with reason, parents should treat their children well to the emergence of a resilient mindset. This allow them to grow up with such memories” dynamic certainly occurred in Mr. and Mrs. (p. 399). Carter’s initial approach to their daughter Sally’s Children are very sensitive if a parent is not shy demeanor. Basically, they exhorted her to present at their birthday, at a holiday, at their fi rst make friends, feeling that her cautious, reserved Little League game, or at a talent show. In today’s nature could easily be overcome. They did not fast-paced world many parents work long hours appreciate how desperately Sally wished to be and travel and thus, it is likely they may miss more outgoing and have more friends, but it was some of their children’s special moments, but diffi cult to do so, given her temperament. It was these absences should be kept to a minimum. One only when her parents demonstrated empathy adult patient recalled that his father missed all but and communicated their wish to help, that Sally a couple of his birthdays between the ages of 5 felt accepted. and 12. “I know he had to travel for his business, Another example concerned 10-year-old Carl. but he knew when my birthday was. I think he He dawdled in the morning, often missing the could have scheduled his business trips to be school bus. His parents, Mr. and Mrs. Thomas, there for my birthday.” Tears came to his eyes as found themselves obligated to drive him to he added, “You certainly don’t feel loved when school. A neighbor suggested them not to drive your father misses your birthday. And to make Carl to school, that by doing so they were just matters worse, most of the time he forgot to “reinforcing his lateness.” They took this neigh- call.” bor’s advice and told Carl if he was not ready Time alone with each child does not preclude when the school bus arrived, they would not drive family activities that also create a sense of belong- him and he would miss school. Carl missed ing and love. Sharing evening meals and holi- school, which upset him. However, much to the days, playing games, attending a community dismay of his parents, his upset did not prepare event as a family, or taking a walk together are all him to be ready for school the next day. They opportunities to convey love and help children were confused about what to do next and became feel special in the eyes and hearts of their increasingly angry with their son for his irrespon- parents. sibility. As a further motivation to be ready on 5. Accepting our children for who they are and time, they decided to restrict many of his pleasur- helping them to establish realistic expecta- able activities if he were late. Unfortunately, that tions and goals failed to bring about the desired results. One of the most dif fi cult but challenging par- Carl’s parents were unaware that his dif fi culty enting tasks is to accept our children for who they with lateness was not because he was irresponsi- are and not what we want them to be. Before chil- ble, but rather because he moved at a slow pace dren are born, parents have expectations for them and was distractible, frequently becoming drawn that may be unrealistic given the unique tempera- into other activities. Instead of yelling and pun- ment of each child. Chess and Thomas ( 1987 ) , ishing, it would have been more effective to two of the pioneers in measuring temperamental accept that this is their son’s style and to engage differences in newborns, observed that some him in a discussion of what he thinks would help youngsters enter the world with so-called easy to get ready on time. As we shall see under the 452 R.B. Brooks guidepost for developing responsibility discussed receptive to accepting positive feedback. Parents below, when given the opportunity even young should continue to offer this feedback, but must children are capable of offering sound solutions recognize that genuine self-esteem, hope, and to problems they encounter. resilience are based on children experiencing In addition, collaborating with Carl’s school success in areas of their lives that they and to have a motivating “job” or responsibility wait- signi fi cant others deem to be important. This ing for him might have provided a positive incen- requires parents to identify and reinforce a tive to assist him to consider ways to be ready on child’s “islands of competence.” Every child time even with his slower temperament. I fre- possesses these islands of competence or areas quently use such a strategy. A child with whom I of strength and we must nurture these rather than worked who was tardy on a regular basis was overemphasize the child’s weakness. given the job of “tardy monitor” at his school, a During an evaluation of a child, I regularly ask position that entailed arriving early and keeping the parents to describe their child’s islands of track of which students were late. The child loved competence. I ask the child to do the same, often the responsibility and arrived on time with via the question, “What do you think you do renewed purpose. well?” or “What do you see as your strengths?” Accepting children for who they are and For children who respond, “I don’t know,” appreciating their different temperaments does I answer, “That’s okay, it can take time to fi gure not imply that we excuse inappropriate, unac- out what we’re good at, but it’s important to fi gure ceptable behavior but rather that we understand out.” If we are to reinforce a more optimistic atti- this behavior and help to modify it in a manner tude in children, it is imperative that we place the that does not assault a child’s self-esteem and spotlight on strengths and assist children to artic- sense of dignity. It means developing realistic ulate the strengths that they possess. goals and expectations for our children. One problem related to the issue of acceptance Fortunately, in the past 10Ð15 years there have discussed in the previous guidepost, is when par- been an increasing number of publications to ents minimize the importance of their child’s help parents and teachers appreciate, accept, island of competence. For example, 13-year-old and respond effectively to a child’s tempera- George struggled with learning problems. Unlike ment and learning style (Carey, 1997 ; Keogh, his parents, Mr. and Mrs. White, or his 16-year- 2003 ; Kurcinka, 1991 ; Levine, 2002, 2003 ; old sister, Linda, he was not gifted academically Sachs, 2001 ) . or athletically. When his parents were asked dur- 6. Helping our children experience success by ing an evaluation to identify George’s islands of identifying and nurturing their “islands of competence, they responded with an intriguing, competence” “We’re somewhat embarrassed to tell you. We Resilient children do not deny problems that just don’t think it’s the kind of activity that a they may face. Such denial runs counter to mas- 13-year-old boy should be spending much of his tering challenges. However, in addition to time doing.” acknowledging and confronting problems, Eventually, Mr. White revealed, “George likes youngsters who are resilient are able to identify to garden and take care of plants. That would be and utilize their strengths. Unfortunately, many okay if he did well in school and was involved in children who feel poorly about themselves and other activities. How can a 13-year-old boy be so their abilities experience a diminished sense of interested in plants?” hope. Parents sometimes report that the positive Rather than my fi nding fault with the Whites’ comments they offer their children fall on “deaf reactions to George’s interests, it was vital to help ears,” resulting in parents’ becoming frustrated them understand the importance of identifying and reducing positive feedback. and building on his strengths even if those It is important for parents to be aware that strengths were not initially valued by them. To be when children lack self-worth they are less resilient, children need to feel that they are skilled 26 The Power of Parenting 453 in at least one or two areas that are esteemed by For example, in a Little League game two others. children struck out every time they came to bat. Clinicians and educators should insure that One child approached the coach after the game treatment and educational plans begin with a list and said, “Coach, I keep striking out. Can you of the child’s strengths and include strategies that help me fi gure out what I’m doing wrong?” This can be used to reinforce and display these response suggests a child with a resilient mind- strengths for others to see and praise. Of what use set, a child who entertains the belief that there are a child’s strengths if they are not observed are adults who can help him to lessen mistakes and supported by others? (strikeouts). Laurie, a teenager, had dif fi culty in getting The second child, who unfortunately was not along with her peers, but young children gravi- resilient, reacted to striking out by fl inging his tated towards her. Her parents described her as bat to the ground and screaming at the umpire, the “pied piper” of the neighborhood. Given this “You are blind, blind, blind! I wouldn’t strike out strength, she began to baby-sit. As the responsi- if you weren’t blind!” Much to the embarrass- bilities involved with baby-sitting helped her to ment of his parents he then ran off the fi eld in develop confi dence, she was more willing to tears, continuing to blame the umpire for striking examine and change her approach with her peers, out. Since this child did not believe he could which led to greater acceptance. Similarly, improve, he coped with his sense of hopelessness 10-year-old Brian, a boy with reading dif fi culties, by casting fault on others. had a knack for artwork, especially drawing car- Parents can assist their children to develop a toons. His parents and teachers displayed his car- more constructive attitude about mistakes and toons at home and school, an action that boosted setbacks. Two questions that can facilitate this his self-esteem and in a concrete way communi- task are to ask parents to consider what their cated that his reading problems did not defi ne children’s answers would be to the following him as a person, that he also possessed strengths. questions: When children discover their islands of com- “When your parents make a mistake, when some- petence, they are more willing to confront those thing doesn’t go right, what do they do?” areas that have been problematic for them. Adults “When you make a mistake, what do your parents must be sensitive to recognizing and bolstering say or do to you?” these islands. In terms of the fi rst question, parents serve as 7. Helping children realize that mistakes are signifi cant models for handling mistakes. It is experiences from which to learn easier for children to learn to deal more effec- There is a signi fi cant difference in the way in tively with mistakes if they see their parents doing which resilient children view mistakes compared so. However, if they observe their parents blam- with nonresilient children. Resilient children tend ing others or becoming very angry and frustrated to perceive mistakes as opportunities for learn- when mistakes occur or offering excuses in order ing. In contrast, children who are not very hope- to avoid a task, they are more likely to develop a ful often experience mistakes as an indication self-defeating attitude towards mistakes. In con- that they are failures. In response to this pessi- trast, if they witness their parents use mistakes as mistic view, they are likely to fl ee from chal- opportunities for learning, they are more likely to lenges, feeling inadequate, and often blaming do the same. others for their problems. If parents are to raise The second question also deserves serious resilient children, they must help them develop a consideration by parents. Many well-meaning healthy attitude about mistakes from an early parents become anxious and frustrated with their age. children’s mistakes. Given these feelings they The manner in which children respond to may say or do things that contribute to their chil- mistakes provides a signifi cant window through dren fearing rather than learning from setbacks. which to assess their self-esteem and resilience. For instance, parental frustration may lead to 454 R.B. Brooks such comments as: “Were you using your brains?” are displayed, and the use of problem-solving or “You never think before you act!” or “I told skills. you it wouldn’t work!” These and similar remarks Too often parents label the fi rst responsibili- serve to corrode a child’s sense of dignity and ties they give children “chores.” Most children self-esteem. and adults are not thrilled about doing chores, No one likes to make mistakes or fail, but whereas almost every child from an early age parents can use their children’s mistakes as appears motivated to help others. The presence of teachable moments. They can engage their chil- this “helping drive” is supported by research in dren in a discussion of what they can do differ- which adults were asked to re fl ect on their school ently next time to maximize chances for success. experiences and to write about one of their most Using empathy, they can refrain from saying positive moments in school that boosted their things that they would not want said to them self-esteem and motivation (Brooks, 1991 ) . The (e.g., how many parents would fi nd it helpful if most frequently cited memory was being asked to their spouse said to them, “Were you using your assist others (e.g., tutoring a younger child, paint- brains?”). ing murals in the school, running the fi lm projec- Parents must also have realistic expectations tor, passing out the milk, and straws). for their children and not set the bar too high or To highlight the importance of teaching too low. If the bar is set too high, children will responsibility and compassion, I typically ask continually experience failure and are likely to parents how their children would answer the fol- feel they are a disappointment to their parents. lowing questions: Setting the bar too low may rob children of expe- “What are the ways in which your parents show riences that test their abilities and their capacity responsibility?” to learn to manage setbacks. Very low expecta- “What behaviors have you observed in your par- tions also convey the message, “We don’t think ents that were not responsible?” you are capable.” “What charitable activities have your parents If parents are to reinforce a resilient mindset been involved with in the past few months?” in their children, their words and actions must “What charitable activities have they and you convey a belief that we can learn from mistakes. have been involved with together in the past The fear of making mistakes and being humili- few months?” ated is one of the most potent obstacles to learn- Parents would be well-advised to say as often ing, one that is incompatible with a resilient as possible to their children, “We need your help” lifestyle. rather than “Remember to do your chores.” In 8. Developing responsibility, compassion, and a addition, parents who involve their children in social conscience by providing children with charitable endeavors, such as walks for hunger or opportunities to contribute AIDS or food drives, appreciate the value of such Parents often ask what they can do to foster an activities in fostering self-esteem and resilience. attitude of responsibility, caring, and compassion Responsibility and compassion are not promoted in their children. One of the most effective ways by parental “lectures” but rather by opportunities of nurturing responsibility is offering children for children to assume a helping role and to opportunities to help others. When children are become part of a “charitable family,” a family enlisted in helping others and engaging in respon- that is engaged in acts of compassion and sible behaviors, parents communicate trust in giving. them and faith in their ability to handle a variety 9. Teaching our children to solve problems and of tasks. In turn, involvement in these tasks rein- make decisions forces several key characteristics of a resilient Children with high self-esteem and resilience mindset including empathy, a sense of satisfac- believe that they are masters of their own fate and tion in the positive impact of one’s behaviors, a that they can defi ne what they have control over more con fi dent outlook as islands of competence and what is beyond their control. A vital ingredient 26 The Power of Parenting 455 of this feeling of control is the belief that when Much to the surprise of Mr. and Mrs. Stern, problems arise, they have the ability to solve their sons came forth with solutions that were problems and make decisions. Resilient children noteworthy for being grounded in simple rules. are able to articulate problems, consider different The boys decided that they would take turns sitting solutions, attempt what they judge to be the most in the front seat as well as alternating every half appropriate solution, and learn from the outcome hour in the use of the computer. (Shure, 1996 ; Shure & Aberson, 2005 ) . As Shure ( 1996 ) has found in her research, If parents are to reinforce this problem-solving even preschool children can be assisted to develop attitude in their children, they must refrain from effective and realistic ways of making choices constantly telling their children what to do. and solving problems. When children initiate Instead it is more bene fi cial to encourage chil- their own plans of action with the guidance of dren to consider different possible solutions. To parents, their sense of ownership and control is facilitate this process, parents might wish to estab- reinforced, as is their resilience. lish a “family meeting time” every week or every 10. Disciplining in ways that promote self-disci- other week during which the problems facing pline and self-worth family members can be discussed and solutions To be a disciplinarian is one of their most considered. important roles that parents assume in nurturing Jane, a 9-year-old girl, came home from school resilience in their children (Brooks & Goldstein, in tears and sobbed to her mother, Mrs. Jones, 2007 ) . In this role parents must remember that that some of her friends refused to sit with her at the word discipline relates to the word disciple lunch, telling her they did not want her around. and thus is a teaching process. The ways in which Jane felt confused and distressed and asked her children are disciplined can either reinforce or mother what to do. Mrs. Jones immediately erode self-esteem, self-control, and resilience. replied that Jane should tell the other girls that if Two of the major goals of effective discipline they did not want to play with her, she did not are: (a) to ensure a safe and secure environment want to play with them. While this motherly in which children understand and can de fi ne advice may have been appropriate, quickly tell- rules, limits, and consequences, and (b) to rein- ing Jane what to do and not involving her in a force self-discipline and self-control so that chil- discussion of possible solutions took away an dren incorporate these rules and apply them even opportunity to strengthen her own problem-solv- when parents are not present. A lack of consis- ing skills. tent, clear rules and consequences often contrib- As another example, Barry and his older utes to chaos and to children feeling that their brother, Len, constantly bickered. According to parents do not care about them. On the other their parents, Mr. and Mrs. Stern, they fought hand, if parents are harsh and arbitrary, if they about everything, including who would sit in the resort to yelling and spanking, children are likely front seat of the car and who would use the com- to learn resentment rather than self-discipline. puter. Len was frequently reminded by his par- There are several key principles that parents ents to be more tolerant since he was the older of can follow to employ discipline techniques that the two. They warned him that his failure to com- are positive and effective. Given the signifi cant ply with their request would result in punishment. role that discipline plays in parenting practices Len’s response was to become angry and distant, and in nurturing resilience, they are described in feeling he was being treated unfairly. Eventually, detail. the parents sat down with Barry and Len, shared with them the negative impact that their arguing Practice prevention: It is vital for parents to was having on the family, and asked them to become proactive rather than reactive in their come up with possible solutions to particular interactions with their children, especially in problems and to select what they considered to be regard to discipline. For example, discipline prob- the best solution. lems were minimized in one household when a 456 R.B. Brooks young, hyperactive boy was permitted to get up responsibility and resilience. Obviously, behaviors from the dinner table when he could no longer concerning safety deserve immediate attention. remain seated. This approach proved far more Other behaviors will be based on the particular effective than the previous one used by the parents, values and expectations in the house. If children namely, to yell and punish him; when a punitive are punished for countless behaviors, if parents atmosphere was removed, this boy also learned are constantly telling them what to do in an arbi- greater self-control. In another home, a boy’s tan- trary manner, then the positive effects of discipline trums at bedtime ended when he was allowed to will be lost. have a nightlight in his room and keep a photo of his parents by his bedside (both were his ideas to Rely when possible on natural and logical conse- deal with nightmares he was experiencing). quences: Children must learn that there are consequences for their behavior. It is best if these Work as a parental team: In homes with two par- consequences are not harsh or arbitrary and are ents, it is important that parents set aside time for based on discussions that parents have had with themselves to examine the expectations they have their children. Discipline rooted in natural and for their children as well as the discipline they logical consequences can be very effective. use. This dialog can also occur between divorced Natural consequences are those that result from a parents. While parents cannot and should not be child’s actions without parents having to enforce clones of each other, they should strive to arrive at them such as a child having a bicycle stolen common goals and disciplinary practices, which because it was not placed in the garage. While most likely will involve negotiation and compro- logical consequences sometimes overlap with mise. This negotiation should take place in private natural consequences, logical consequences and not in front of their children. involve some action taken on the part of parents in response to their child’s behavior. Thus, if the Be consistent, not rigid: The behavior of children child whose bicycle was stolen asked parents for sometimes renders consistency a Herculean task. money to purchase a new bicycle, a logical con- Some children, based on past experience, believe sequence would be for the parents to help the that they can outlast their parents and that eventu- child fi gure out how to earn the money needed to ally their parents will succumb to their whining, pay for the new bicycle. crying, or tantrums. If guidelines and consequences have been established for acceptable Positive feedback and encouragement are often behavior, it is important that parents adhere to the most powerful forms of discipline : Although them. However, parents must remember that con- most of the questions I am asked about discipline sistency is not synonymous with rigidity or focus on negative consequences or punishment, it in fl exibility. A consistent approach to discipline is important to appreciate the impact of positive invites thoughtful modifi cation of rules and con- feedback and encouragement as disciplinary sequences such as when a child reaches adoles- approaches. Parents should “catch their children cence and is permitted to stay out later on the doing things right” and let them know when they weekend. When modifi cations are necessary, they do. Children crave the attention of their parents. should be discussed with children so that they It makes more sense to provide this attention for understand the reasons for the changes and can positive rather than negative behaviors. Well- offer input. timed positive feedback and expressions of encouragement and love are more valuable to Select one’s battlegrounds carefully : Parents can children’s self-esteem and resilience than stars or fi nd themselves reminding and disciplining their stickers. When children feel loved and appreci- children all day long. It is important for parents to ated, when they receive encouragement and sup- ask what behaviors merit discipline and which port, they are less likely to engage in negative are not really relevant in terms of nurturing behaviors. 26 The Power of Parenting 457

Carey, W. B. (1997). Understanding your child’s tempera- Concluding Remark ment . New York: Macmillan. Chess, S., & Thomas, A. (1987). Know your child . New York: Basic Books. Research may never be able to assign a precise Covey, S. (1989). The seven habits of highly effective percentage to capture the impact of a parent on a people . New York: Simon & Schuster. child’s development. However, as noted earlier, Crenshaw, D. A. (Ed.). (2010). Reverence in healing: Honoring strengths without trivializing suffering . New whatever the percentage, we know that the York: Jason Aronson. day-to-day interactions parents have with their Deater-Deckard, K., Ivy, L., & Smith, J. (2005). Resilience children are in fl uential in determining the quality in gene-environment transactions. In S. Goldstein & of lives that their children will lead. Parents can R. Brooks (Eds.), Handbook of resilience in children (pp. 49Ð63). New York: Kluwer. serve as charismatic adults to their children. They Goldstein, S., & Brooks, R. (2003). Does it matter how we can assume this role by understanding and forti- raise our children? June article on websites www. fying in their children the different characteristics samgoldstein.com and www.drrobertbrooks.com of a resilient mindset, by believing in them, by Harris, J. R. (1998). The nurture assumption: Why children turn out the way that they do. New York: Free Press. conveying unconditional love, and by providing Hechtman, L. (1991). Resilience and vulnerability in long them with opportunities that reinforce their term outcome of attention defi cit disorder. Canadian islands of competence and feelings of self-worth Journal of Psychiatry, 36 , 415Ð421. and dignity. Nurturing resilience is an immeasur- Herrenkohl, E. C., Herrenkohl, R. C., & Egolf, B. (1994). Resilient early school-age children from maltreating able, lifelong gift parents can offer their children. homes: Outcomes in late adolescence. The American It is part of a parent’s legacy to the next Journal of Orthopsychiatry, 64 , 301Ð309. generation. Jaffee, S. (2005). Family violence and parental psychopathology: Implications for children’s socioemotional development and resilience. In S. Goldstein & R. Brooks (Eds.), Handbook of resilience in children (pp. References 149Ð163). New York: Kluwer. Kaplan, H. (2005). Understanding the concept of resil- Beardslee, W. R., & Podorefsky, D. (1988). Resilient ado- ience. In S. Goldstein & R. Brooks (Eds.), Handbook of lescents whose parents have serious affective and other resilience in children (pp. 39Ð47). New York: Kluwer. psychiatric disorders: Importance of self-understand- Keogh, B. K. (2003). Temperament in the classroom: ing and relationships. The American Journal of Understanding individual differences . Baltimore, MD: Psychiatry, 145 , 63Ð69. Brookes Publishing. Brooks, R. (1991). The self-esteem teacher . Loveland, Kumpfer, K. L., & Alavarado, R. (2003). Family- OH: Treehaus Communications. strengthening approaches for the prevention of youth Brooks, R. (1994). Children at risk: Fostering hope and problem behaviors. American Psychologist, 58 , resilience. The American Journal of Orthopsychiatry, 457Ð465. 64 , 545Ð553. Kurcinka, M. S. (1991). Raising your spirited child . New Brooks, R. (1998). Parenting a child with learning dis- York: HarperCollins. abilities: Strategies for fostering self-esteem, motiva- Levine, M. D. (2002). A mind at a time . New York: Simon tion, and resilience. In T. Citro (Ed.), The experts & Schuster. speak: Parenting a child with learning disabilities (pp. Levine, M. D. (2003). The myth of laziness . New York: 25Ð45). Waltham, MA: Learning Disabilities Simon & Schuster. Association of Massachusetts. Masten, A. S., Best, K. M., & Garmezy, N. (1990). Brooks, R., & Goldstein, S. (2001). Raising resilient chil- Resilience and development: Contributions from the dren: Fostering strength, hope, and optimism in your study of children who overcome adversity. child . New York: McGraw-Hill. Development and Psychopathology, 2 , 425Ð444. Brooks, R., & Goldstein, S. (2003). Nurturing resilience Pinker, S. (2002). The blank slate: The modern denial of in our children. Answers to the most important parent- human nature . New York: Viking. ing questions . New York: McGraw-Hill. Reivich, K., & Shatte, A. (2002). The resilience factor . Brooks, R., & Goldstein, S. (2007). Raising a self-disci- New York: Broadway Books. plined child: Help your child become more responsi- Rutter, M. (1985). Resilience in the face of adversity: ble, con fi dent, and resilient . New York: McGraw-Hill. Protective factors and resistance to psychiatric disor- Brooks, R., & Goldstein, S. (2011). Raising resilient children. ders. The British Journal of Psychiatry, 147 , In G. P. Koocher & A. M. La Greca (Eds.), The parents 598Ð611. guide to psychological fi rst aid: Helping children and Sachs, B. E. (2001). The good enough child: How to have adolescents cope with predictable life crises (pp. 142Ð an imperfect family and be perfectly satisfi ed . New 150). New York, NY: Oxford University Press. York: HarperCollins. 458 R.B. Brooks

Segal, J. (1988). Teachers have enormous power in Shure, M. B., & Aberson, B. (2005). Enhancing the pro- affecting a child’s self-esteem. The Brown University cess of resilience through effective thinking. In Child Behavior and Development Newsletter, 4 , S. Goldstein & R. Brooks (Eds.), Handbook of resil- 1Ð3. ience in children (pp. 373Ð394). New York: Kluwer. Sheridan, S. M., Eagle, J. W., & Dowd, S. E. (2005). Siegel, D. S. (1999). The developing mind: How relation- Families as contexts for children’s adaptation. In S. ships and the brain interact to share who we are . New Goldstein & R. Brooks (Eds.), Handbook of resilience York: Guilford Press. in children (pp. 165Ð179). New York: Kluwer. Werner, E. E., & Smith, R. S. (1992). Overcoming the Shure, M. B. (1996). Raising a thinking child. New York: odds: High risk children from birth to adulthood . New Pocket Books. York: Cornell University Press. Building Resilience in All Children: A Public Health Approach 2 7

Emily B. Winslow , Irwin N. Sandler , Sharlene A. Wolchik, and Colleen Carr

In this chapter, we present a conceptual framework for the promotion of resilience in children that Resilience Concepts integrates concepts from the study of resilience with a public health approach to improving mental We de fi ne resilience as “a child’s achievement of health at the population level. The chapter begins positive developmental outcomes and avoidance with a review of resilience and public health con- of maladaptive outcomes under signifi cantly cepts and describes how these perspectives can be adverse conditions” (Wyman, Sandler, Wolchik, integrated within a broad framework for the pro- & Nelson, 2000 ) . Three concepts are central to motion of health and prevention of dysfunction. this de fi nition: adversity, positive outcomes, and We then present examples of evidence-based pre- the resources that are responsible for achieving ventive interventions and policies that have suc- positive outcomes under conditions of adversity. cessfully implemented components of this framework. Given our focus on promoting resilience, we limit discussion and examples of inter- Adversity ventions to those designed to create resources for children not diagnosed with mental health disor- Adversity is conceptualized as a relationship der, although the framework could readily be between children and their environment in which extended to interventions for children with clinical satisfaction of basic needs and goals is threatened or levels of dysfunction. Finally, we provide an over- in which accomplishment of age-appropriate devel- view of how the framework might be used by plan- opmental tasks is impeded (Sandler, 2001 ) . ners to create resources in their communities that Adversities can be conceptualized as occurring in will promote resilience, as well as examples of individual, family, or community-organizational tools currently available to assist planners in this domains. Adversities in the individual domain process. include experiences such as illnesses, injuries, or abuse, which compromise children’s relations with their environments. Adversities in the family domain E. B. Winslow () ¥ I. N. Sandler ¥ S. A. Wolchik include changes in family structure (e.g., divorce, ¥ C. Carr death) or functioning (e.g., confl ict) that threaten Department of Psychology, Arizona State University , children’s well-being. Adversities in the community- Tempe , AZ , USA e-mail: [email protected] ; [email protected] ; organizational domain include characteristics [email protected] ; [email protected] of communities (e.g., poverty, disorganization)

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 459 DOI 10.1007/978-1-4614-3661-4_27, © Springer Science+Business Media New York 2013 460 E.B. Winslow et al. or social institutions (e.g., school violence) that adaptation processes or by reducing the child’s diminish children’s satisfaction of basic needs and exposure to adversities (Sandler, 2001 ) . Individual accomplishment of developmental tasks. resources include cognitive, emotional, and Relations between exposure to adversities in behavioral skills, such as high cognitive ability, childhood and the development of a wide range effective emotion regulation, and adaptive coping of mental health and social adaptation dif fi culties efforts. An important protective resource in the in childhood and adulthood are well established family domain involves positive parenting, which (Grant et al., 2003 ; Sandler, Ayers, Suter, Schultz, is characterized by warmth, responsivity, effective & Twohey, 2003 ) . Illustratively, based on a study discipline, and support for effective coping. of 9,508 members of a large HMO, Felitti et al. Community-organizational resources include (1998 ) observed that exposure to four or more access to high-quality schools, prosocial neigh- adversities in childhood was associated with a borhoods, and opportunities for involvement in 4Ð12-fold increase in risk for alcoholism, drug other formal or informal systems that provide abuse, depression, and suicide attempts in adult- support or protect against the occurrence of adver- hood. Similarly, Furstenberg and colleagues sities, such as religious or secular youth groups, found that the odds of negative mental health out- organized sports, community volunteer groups, comes for children exposed to eight or more groups that develop speci fi c talents (e.g., music, adversities was 5.7 times greater than for children art, drama), and relationships with extended fam- exposed to three or fewer adversities (Furstenberg, ily members. Cook, Eccles, Elder, & Sameroff, 1999 ) . Studies have also demonstrated consistent relations between mental health and social adaptation Public Health Approach problems and exposure to speci fi c adversities in childhood such as parental divorce (Lansford, In contrast to the resilience perspective, which 2009 ) , family and neighborhood poverty (Edin & focuses on delineating resources and protective Kissane, 2010 ; Winslow & Shaw, 2007 ) , parental processes that promote healthy outcomes among mental illness (Goodman & Brand, 2008 ) , child individuals or families facing adversity, the pub- maltreatment (Cicchetti & Toth, 2005 ) , exposure lic health approach to prevention focuses on how to domestic or community violence (Evans, to change population-level behaviors, environ- Davies, & DiLillo, 2008; Fowler, Tompsett, mental factors, or processes to reduce incidence Braciszewski, Jacques-Tiura, & Baltes, 2009 ) , rates of disorders (i.e., number of new cases) and and bereavement (Melham, Walker, Moritz, & to increase healthy outcomes in a population Brent, 2008 ) . (Rose, 1992 ) . To effectively impact population- level outcomes while addressing individual differences (i.e., varying levels of adversities, Resources resources, and problems), the public health model incorporates multiple intervention levels: mental Studies of resilience focus on identifying resources health promotion interventions to enhance well- that facilitate the occurrence of positive outcomes being of the general public or a whole popula- and the avoidance of negative outcomes for chil- tion, universal prevention programs to prevent dren in the face of adversity (Luthar, 2006 ) . disorders in the general population or in a whole Positive and negative outcomes are conceptual- population that has not been identifi ed based on ized as interrelated and include successful accom- individual risk, selective interventions for those plishment of developmental tasks and avoidance at-risk due to exposure to speci fi c adversities, of emotional and behavioral problems and mental and indicated programs for individuals experi- disorders. Resources in the individual, family, and encing sub-diagnostic symptomatology (National community-organizational domains facilitate Research Council and Institute of Medicine positive outcomes by either promoting effective [NRC/IOM], 2009 ) . 27 Building Resilience in All Children: A Public Health Approach 461

Promotion Programs such as increasing population awareness, providing support and recruitment for more Mental health promotion programs are typically intensive prevention efforts, reducing stigmati- offered to the general public or a whole popula- zation for those participating in targeted pro- tion to enhance individuals’ life skills (e.g., social grams, and reinforcing common messages competence) and promote well-being, as well as provided via different outlets (Offord, 2000 ; to strengthen individuals’ ability to cope with Stormshak, Kaminski, & Goodman, 2002 ) . For adversity (NRC/IOM, 2009) . Although such example, parents who participate in an intensive programs typically help prevent disorders as well, parenting skills intervention may feel supported their primary purpose is to promote healthy out- by their community, rather than stigmatized, if comes (e.g., self-esteem, morality, friendships). universal efforts have been successful at pro- Promotion programs may be less stigmatizing moting the importance of positive parenting than prevention programs, particularly compared and value of actively improving one’s parenting to prevention programs that target specifi c sub- skills (Sanders, Turner, & Markie-Dadds, groups; because the emphasis is placed on 2002 ) . Universal programs may also be inte- maximizing individuals’ potential rather than grated into community structures or organiza- avoiding the development of disorder (NRC/ tions that serve the full population (e.g., schools, IOM, 2009 ) . health systems), and thus may promote policies or cultural practices (e.g., parental involvement in schools) that can benefi t the entire popula- Universal Prevention Programs tion. Further, because a great number of people are involved, universal programs have the Universal prevention programs are given to the potential for producing large effects at the pop- general public or a whole population group not ulation level, although the benefi ts received by identifi ed on the basis of individual risk and aim each individual may be relatively small (Rose, to reduce the incidence of mental health disor- 1992; Shamblen & Derzon, 2009 ) . ders (NRC/IOM, 2009 ) . Although conceptually distinct, universal prevention and promotion interventions typically overlap considerably in Selective Programs practice, because effective mental health promotion programs also prevent maladjustment, and Selective preventive interventions target specifi c universal preventive interventions often promote individuals or subgroups of the population well-being in addition to preventing disorders whose risk for mental disorder signifi cantly (Catalano, Berglund, Ryan, Lonczak, & Hawkins, exceeds that of the general population due to 2002 ; Payton et al., 2008 ) . Given the substantial exposure to one or more adversities (e.g., paren- overlap, we discuss universal prevention and pro- tal mental illness), and who can be identifi ed motion programs interchangeably in the rest of based on some marker variable rather than indi- the chapter. vidual assessment of problematic functioning To justify inclusion of all individuals in a (NRC/IOM, 2009 ) . Although selective programs population and to maximize the benefi t-cost are not delivered to all members of the general ratio, universal programs must be able to be population, these interventions could involve a delivered to everyone, should be low in costs large number of individuals, particularly if per individual, should be effective for and selected adversities are highly prevalent (e.g., acceptable to the population, and have little parental divorce). Therefore, selective programs potential for harm (NRC/IOM, 2009 ) . Universal should not exceed moderate costs per individual promotion and prevention programs can pro- and should be characterized by low risk for vide several benefi ts, particularly when incor- potential iatrogenic intervention effects (NRC/ porated within a multilevel system of strategies, IOM, 2009 ) . 462 E.B. Winslow et al.

Selective prevention programs can provide important services that supplement universal Framework for Building Resilience efforts. Selective programming provides a in All Children potentially ef fi cient way to direct additional resources to individuals with higher than aver- As illustrated in the previous sections, the public age need for services (Offord, 2000 ) . In addi- health approach incorporates multiple intervention, targeting specifi c subgroups allows tion levels that ful fi ll distinct and mutually rein- provision of services tailored to the unique forcing roles when implemented simultaneously needs of these subgroups (i.e., needs not shared in a community. In such cases, all children or by other subgroups of the population). For families in a population would have access to example, children who experience traumatic universal promotion and prevention programs. events, such as parental divorce, death, or abuse, Subgroups identi fi ed on the basis of exposure to may benefi t from specialized preventive services adversity would receive these services as well as provided to caregivers and/or children that are more specialized selective program(s). Those designed to facilitate positive adjustment to the experiencing sub-diagnostic levels of symptoma- speci fi c adversity. tology would have access to universal promotion and prevention programs as well as indicated programs, which may include multiple interven- Indicated Programs tion components designed to reduce symptoms and reverse the progression of severity. A minor- In addition to programs for subgroups identifi ed ity of families would qualify for both selective on the basis of exposure to adversities, indi- and indicated services and would have access to cated preventive interventions target children all levels of intervention. manifesting sub-diagnostic levels of mental From a resilience perspective, this multilevel health symptoms or families experiencing prob- framework takes into account the varying levels lems adapting to adversity (e.g., high confl ict of exposure to adversity and availability of pro- divorces) based on individual assessment of tective resources among members of a popula- child or family functioning (NRC/IOM, 2009 ) . tion. Table 27.1 shows how multiple domains of For example, children may be selected to par- interventions to promote resilience processes can ticipate in a behavioral management program be subsumed within the classifi cation of univer- on the basis of parent or teacher report of high sal promotion/prevention, selective, and indicated levels of disruptive behavior. The primary goal interventions. Interventions at each level build of indicated programs is to reduce the occur- individual, family, and/or community-organiza- rence of new cases of mental disorder or other tional resources associated with resilient out- serious outcomes (i.e., incidence) by decreas- comes among children facing adversity. We refer ing symptomatology and reversing the progres- to these as “constructed resilience resources” sion of severity. Indicated prevention programs given they are promoted by interventions designed are often moderately to highly intensive inter- for that purpose. By looking across columns ventions that may include multiple components within each row of the matrix, one can see the (e.g., parent education plus school-based behav- range of interventions that might be used to con- ior management) and/or may involve individu- struct resources in a given domain. For example, alized approaches, such as one-on-one sessions mutually reinforcing programs to improve par- with a mental health counselor. Similar to selec- enting might be developed for the general popu- tive prevention programs, indicated interven- lation, as well as for those experiencing speci fi c tions provide additional resources (i.e., beyond adversities or early levels of problems. By look- universal level) to prevent the development of ing across the rows within each column, one can serious problems in families and children who see how resources could be constructed in multi- are most at risk. ple domains to promote resilience in a defi ned 27 Building Resilience in All Children: A Public Health Approach 463 Develop community structures to deal more Develop sub-diagnos- with youth experiencing effectively of problems to strengthen their ability tic levels to future exposure or prevent to cope effectively adversities Teach parenting skills to counteract ongoing Teach behavior) problems (e.g., child externalizing Teach skills (e.g., cognitive appraisals of stress) skills (e.g., cognitive Teach problems or skill to children with elevated de fi cits Change ecologies of existing organizations organizations Change ecologies of existing (e.g., courts) to promote healthy adjustment for at-risk subgroups (e.g., divorced to organizations new Develop families). to a services for children exposed provide (e.g., parental death) c adversity fi speci Promote effective parenting for children Promote effective (e.g., poverty) c adversity fi to a speci exposed Teach coping skills and provide information coping skills and provide Teach c stressor fi a speci to children experiencing (e.g., parental divorce) Intervention Intervention level Selective Indicated Promote community or organizational changes Promote community or organizational or that reduce the occurrence of adversities support for all children to adapt provide (e.g., transition to events to normative effectively junior high school) adaptive outcomes and help avoid future outcomes and help avoid adaptive ability to or strengthen the child’s adversities cope effectively problem solve, regulate affect, and deal with affect, regulate problem solve, ict) fl potential problem situations (e.g., peer con Strategies to construct resilience resources across multiple domains and levels to construct resilience resources across multiple domains and levels Strategies Community- organizational Family Family Promote parenting practices that enhance child Table 27.1 Resource domain Child Universal Promotion/Prevention Promote child strengths to cope with stressors, 464 E.B. Winslow et al. population. For example, complementary child, more areas, such as building skill competencies, family, and organizational programs might be fostering self-effi cacy, and promoting prosocial developed for the entire community to build relationships (Catalano et al., 2002; Payton et al., resources that promote well-being and develop- 2008 ) . Similarly, universal preventive interven- mental competencies and prevent disorder. tions are designed to build child resources based Universal promotion and prevention programs on the theory that promoting skills and strengths construct resources that promote resilience by will help children effectively adapt to conditions reducing the occurrence of adversities for the full of adversity (current and future) and decrease the population or facilitating skills that promote likelihood of future adversities, thereby prevent- healthy adaptation when adversities occur. These ing the development of disorders and facilitating interventions may be designed to enhance child successful attainment of developmental tasks capacities (e.g., coping skills, academic compe- (Sandler, 2001) . A variety of universal promotion tence), family competencies (e.g., parental warmth, and prevention programs designed for general effective discipline, communication), or organiza- populations have impacted child well-being out- tional resources (e.g., learning structures, curri- comes by constructing resources in the child cula, peer structures, school policies, neighborhood domain, including programs that teach skills such empowerment). Selective programs build resources as problem-solving, social skills, confl ict resolu- to promote effective adaptation to speci fi c adversi- tion, affect regulation, cognitive restructuring, ties, such as child coping skills for parental divorce, empathy, impulse control, and leadership quali- parenting skills for families living in poverty, or ties (see Durlak, Weissberg, & Pachan, 2010 ; community-school partnerships to facilitate suc- Hahn et al., 2007 ; Neil & Christensen, 2009 ; cessful transitions to high school for inner-city Payton et al., 2008 ; Soole, Mazerolle, & youths. Indicated interventions construct resources Rombouts, 2008 for reviews). to improve adaptation processes for those exhibit- For example, the Promoting Alternative ing mental health problems, such as positive Thinking Strategies (PATHS) elementary school, thinking skills for adolescents experiencing sub- multiyear curriculum is designed to build chil- diagnostic depressive symptoms, parent behavior dren’s social and emotional competence through management skills for families with oppositional more than 50 lessons on knowledge about emo- children, or court organizational procedures for tional states, skills for regulating affect, problem- diverting delinquents to interventions rather than solving, and social skills (Conduct Problems detention. In the following sections, we provide Prevention Research Group [CPPRG], 1999 ; examples of programs with demonstrated ef fi cacy Greenberg, Kusche, Cook, & Quamma, 1995 ) . in promoting child well-being through universal Several randomized controlled trials have indi- promotion/prevention, selective, or indicated inter- cated that when PATHS is supported by schools vention strategies that construct resources in child, and well implemented by teachers, the curricu- family, or community-organizational domains. lum is successful in promoting academic engagement and social, emotional, and behavioral competence in a variety of populations (CPPRG, Resources Constructed 1999, 2010a ; Curtis & Norgate, 2007 ; in the Child Domain Domitrovich, Cortes, & Greenberg, 2007 ; Kam, Greenberg, & Walls, 2003 ) . Researchers have Universal Promotion also found that PATHS helps prevent problem and Prevention Programs outcomes, including socially withdrawn behavior, conduct problems, and peer dif fi culties Promotion programs in the child domain focus (CPPRG, 2010a ; Curtis & Norgate, 2007 ; on enhancing children’s development in one or Domitrovich et al., 2007 ) . 27 Building Resilience in All Children: A Public Health Approach 465

Selective Programs symptoms (Bienvenu & Ginsburg, 2007 ; Payton et al., 2008 ; Stice, Shaw, Bohon, Marti, & Rohde, In contrast to universal interventions, which are 2009 ; Wilson & Lipsey, 2007 ) . designed for all individuals in a population, selec- For example, the Coping with Depression tive prevention programs build resources for sub- (CWD) course is a cognitive-behavioral interven- groups confronting speciﬁ c adversities. Selective tion that has been adapted for many different target interventions in the child domain typically focus populations, including as an indicated prevention on bolstering coping skills needed to effectively program for adolescents with sub-diagnostic handle the challenges posed by adversities such levels of depressive symptomatology (Cuijpers, as parental divorce (Pedro-Carroll, 1997 ; Stolberg Muñoz, Clarke, & Lewinsohn, 2009 ) . This inter- & Mahler, 1994 ) , parental death (Sandler, Ayers, vention teaches adolescents how to identify and et al., 2010 ) or trauma (Enright & Carr, 2002 ) ; or challenge negative thoughts using cartoons, role- enhancing cognitive skills to counteract the del- plays, and group discussions. A meta-analysis of eterious effects of adversities such as social dis- 25 randomized controlled trials of CWD found advantage (Lange & Carr, 2002 ) . that for the 6 trials that used CWD as an indicated For example, the Children of Divorce prevention program, adolescents who participated Intervention Project (CODIP) is a 12-session, in the intervention had a 38% lower chance of group intervention for school-age children whose developing a depressive disorder than adolescents parents have divorced and is designed to help chil- in the control group (Cuijpers et al.). Garber et al. dren identify and appropriately express emotions, (2009 ) conducted a multicenter, randomized cope effectively, restructure divorce-related mis- control trial of this preventive intervention with conceptions, and create positive perceptions of adolescents who had current or past depressive themselves and their families (Pedro-Carroll, 1997 ; symptomatology and at least one parent with a Pedro-Carroll & Cowen, 1985 ) . Pedro-Carroll and current or past depressive disorder. They found colleagues found that participation in CODIP signiﬁ cant preventive effects on both diagnosis of improved children’s coping, problem-solving depression and self-reported depressive symptoms skills, and classroom competence (e.g., social through a 9-month follow-up period but only for skills, task orientation) and resulted in decreases adolescents whose parents were not currently in anxiety and classroom adjustment problems depressed. (e.g., acting out, learning problems) compared to a no-intervention control group at posttest and 2 years following the intervention (Pedro-Carroll, Resources Constructed Sutton, & Wyman, 1999 ) . in the Family Domain

Universal Promotion Indicated Programs and Prevention Programs

Indicated prevention programs are designed to Promotion programs in the family domain target meet the needs of individuals within a population aspects of the home environment that could be who are experiencing mental health problems but optimized to enhance child development. For do not meet criteria for a mental health diagnosis. example, Whitehurst et al. (1988 ) developed and Indicated prevention programs in the child evaluated a shared reading program, called dia- domain typically teach youths skills such as how logic reading , to promote language development to identify feelings, manage anger, or challenge in toddlers and preschoolers. The 6-week program, distorted cognitions. This approach has been which has been tested in both group- and video- benefi cial in reducing dysfunction among youths based formats (Arnold, Lonigan, Whitehurst, & experiencing internalizing and/or externalizing Epstein, 1994 ) , encourages parents to make book 466 E.B. Winslow et al. reading interactive by asking the child open-ended discipline at posttest, compared to a minimal- questions about the story, praising and elaborating contact control group (Spoth et al., 1998 ) . Long- on children’s verbalizations, and prompting the term follow-up 10-years post-intervention child to relate aspects of the story to his/her own demonstrated that youths whose families partici- life. A meta-analysis of 16 experimental studies pated in the programs had lower rates of alcohol found signifi cant positive effects of the dialogic and polydrug use in young adulthood compared reading program on language development com- to the comparison group. The program indirectly pared to reading-as-usual control groups, with impacted substance use in young adulthood by stronger effects on expressive than receptive reducing substance use initiation in adolescence language skills, for younger (i.e., toddler and (Spoth et al., 2009 ) . Although both programs preschool age) than older (i.e., kindergarten age) have empirical support, fi ndings have been more children, and for higher SES than lower SES robust for the ISFP (Spoth et al.), and initial families (Mol, Bus, de Jong, & Smeets, 2008 ) , benefi t-cost analyses suggest that ISFP may be although several studies have demonstrated pos- more cost-effective than PDFY: the benefi t-cost itive effects of dialogic reading for children ratio for ISFP was $9.60 per $1 invested vs. $5.85 experiencing socioeconomic adversity (see per $1 for PDFY (Spoth, Guyll, & Day, 2002 ) . Zevenbergen & Whitehurst, 2003 for a review). Universal prevention programs in the family domain typically focus on improving parenting Selective Programs practices and communication patterns to help children learn skills such as effective coping and Family-based selective interventions build self-regulation skills to foster competence and resources to counteract conditions of adversity, prevent dysfunction. Several universal family- such as premature birth, parental divorce, death, based programs have been shown to build family abuse, or poverty, by providing parent or family resources, increase child competence, and reduce skills training. Several family-based selective the likelihood of substance abuse and other men- prevention programs have been shown to posi- tal health problems (Lochman & van den tively impact child and adolescent well-being Steenhoven, 2002 ; NRC/IOM, 2009 ; Sandler, (Lochman & van den Steenhoven, 2002 ; NRC/ Schoenfelder, Wolchik, & MacKinnon, 2011 ) . IOM, 2009 ; Sandler et al., 2011 ; Webster-Stratton For example, Spoth and colleagues have eval- & Taylor, 2001 ) . uated the effects of two universal family-based For example, the Family Bereavement prevention programs: the 5-session Preparing for Program was found to reduce mental health prob- the Drug Free Years (PDFY) (now called Guiding lems of both bereaved children and their spous- Good Choices) and the 7-session Iowa ally bereaved parents 6 years following their Strengthening Families Program (ISFP) (now participation in the program, thus showing a called the Strengthening Family Program for “double prevention effect” (Sandler, Ayers, et al., Parents and Youth: 10Ð14) (Spoth, Redmond, & 2010) . This program was designed to change Shin, 1998, 2001; Spoth, Trudeau, Guyll, Shin, & multiple risk and protective factors that had pre- Redmond, 2009 ) . Both programs were designed viously been found to be related to problem out- to construct family resources, such as positive comes among bereaved children. The intervention parentÐchild involvement and communication focuses on changing the family environment and effective parent management; however, (e.g., positive parenting, surviving parent’s men- PDFY intervenes primarily with parents, whereas tal health, stressful events following the death) as ISFP includes parents and youths together in well as promoting youth’s adaptive coping most sessions. Results of randomized controlled (Sandler et al., 2008 ) . At the 6-year follow-up, evaluations with rural families of sixth grade the program was found to strengthen family pro- children have shown that both ISFP and PDFY tective factors (e.g., positive parenting), to reduce improved parentÐchild warmth and effective externalizing problems and grief in youths 27 Building Resilience in All Children: A Public Health Approach 467

(Sandler, Ayers, et al., 2010 ; Sandler, Ma, et al., 2007 ) . These fi ndings are consistent with research 2010 ) , and to reduce depression in spousally demonstrating that children exposed to multiple bereaved parents (Sandler, Ayers, et al., 2010 ) . adversities, rather than single stressors, are most Wolchik and colleagues found that families at risk for mental health problems and therefore facing multiple adversities benefi ted most from a most in need of selective prevention programs parenting program for divorced mothers, the New that build resources to reduce the negative effects Beginnings Program (NBP) (Dawson-McClure, of these adversities (Sandler et al., 2003 ) . Sandler, Wolchik, & Millsap, 2004 ; Wolchik et al., 2002; Wolchik, Sandler, Weiss, & Winslow, 2007) . NBP was designed for divorced families Indicated Programs of school-age children to improve motherÐchild relationships, increase effective discipline, pro- Indicated programs for externalizing problems mote father–child contact, and decrease children’s often include an individual- or group-based parent exposure to interparental con fl ict and negative behavior management training approach (see divorce events (Wolchik et al., 2000 ; Wolchik, Lochman & van den Steenhoven, 2002 ; NRC/ West, Westover, & Sandler, 1993 ) . Two random- IOM, 2009 ; Sandler et al., 2011 ; Webster-Stratton ized controlled trials conducted on NBP have & Taylor, 2001 for reviews). For example, the shown that the program successfully decreased Incredible Years BASIC program (Webster- exposure to negative events and bolstered several Stratton, 2001) is a 14-session, group, parent family resources, including motherÐchild rela- training intervention that employs videotaped tionship quality, effective discipline, and will- parentÐchild interactions and group discussion to ingness to change visitation (Wolchik et al., teach effective parenting practices, such as child- 1993, 2000 ) . directed play time, effective commands, praise for Long-term follow-up of the second experi- prosocial behavior, and nonviolent consequences mental trial demonstrated a wide array of pro- for misbehavior (i.e., time out; natural and logical gram bene fi ts lasting 6 years post-intervention, consequences). The program’s ability to reduce when youths were ages 15Ð18, including main externalizing problems has been demonstrated in effects of the program to reduce rates of diag- several randomized controlled trials as an indi- nosed mental disorder and number of sexual part- cated prevention program for children exhibiting ners, as well as to increase grade point averages, sub-diagnostic conduct problems (e.g., Jones, for the NBP group compared to the control group Daley, Hutchings, Bywater, & Eames, 2007 ; Reid, (Wolchik et al., 2007 ) . Results from structural Webster-Stratton, & Hammond, 2007 ) . equation modeling showed that the NBP initiated a positive cascade of outcomes across development (Bonds et al., 2010 ) . For example, the pro- Resources Constructed in the gram increased mothers’ effective discipline at Community-Organizational Domain posttest, which led to decreases in externalizing behavior several months later, which subse- Universal Promotion and Prevention quently led to higher academic achievement in Programs adolescence (Bonds et al.). For several outcomes (i.e., externalizing, inter- Promotion programs in the community-organiza- nalizing, and mental health symptomatology; tional domain focus on creating system-level alcohol and drug use; and self-esteem), youths changes to enhance children’s social, emotional, who showed the greatest long-term benefi t from and cognitive competencies. In a meta-analysis of the NBP were those who entered the program positive youth development programs that targeted with higher risk for subsequent mental health system-level changes, Durlak et al. (2007 ) found problems (based on a risk index of externalizing promotion programs in the school domain success- behaviors and family adversities) (Wolchik et al., fully changed school-wide and classroom-level 468 E.B. Winslow et al. processes, with overall effect sizes in the moderate disruptive behaviors by students in the classroom to large range. occur because peers reinforce misbehavior For example, the School Development through reactions such as smiles, giggles, laughs, Program (SDP; Comer & Emmons, 2006 ) is a and pointing; therefore, reinforcement for nega- whole-school intervention that focuses on chang- tive behaviors can be diminished by providing ing school culture to support positive youth group-based rewards for inhibiting them (Embry, development. The SDP is a process model of 2002) . The GBG intervention is presented as a school reform that involves three teams—the game in which teachers positively reinforce stu- School Planning and Management Team, the dent teams who do not exceed negative behavior Student and Staff Support Team, and the Parent standards set by the teacher. GBG is played peri- Team. The teams develop, implement, and moni- odically over the school year, beginning with tor a comprehensive school reform plan to highly predictable procedures and immediate improve school climate and student achievement. rewards and evolving into less predictable times Periodic assessments are conducted and and locations with deferred rewards (Kellam, modifi cations are made as needed. The SDP Ling, Merisca, Brown, & Ialongo, 1998 ) . In a specifi es three guidelines for facilitating positive large, randomized controlled trial of fi rst grade working relationships among team members: (1) students from 19 Baltimore public schools, Dolan a focus on problem-solving, not blaming; (2) the et al. (1993 ) found signi fi cant reductions in use of consensus decision-making rather than aggression at posttest for both boys and girls in majority rule; and (3) members working collab- the intervention group as compared to the control oratively rather than alone. Multiple studies, group. At 5-year follow-up, intervention effects including randomized controlled trials (e.g., Cook, on teacher-rated aggression remained for boys Murphy, & Hunt, 2000 ) , have shown that the who were elevated in aggression at baseline SDP has short-term effects on improving school (Kellam, Rebok, Ialongo, & Mayer, 1994 ) . Long- climate and long-term effects on student achieve- term follow-up with young adults aged 19Ð21 ment. In a meta-analysis of 29 school reform pro- who had participated in GBG in their fi rst and grams, the SDP emerged as one of three programs second grade classrooms found intervention with the strongest evidence of program effects effects on reduced drug and alcohol disorders, based on the quantity and quality of research con- regular smoking, and antisocial personality dis- ducted to date (Borman, Hewes, Overman, & order for participants who had been more aggres- Brown, 2003 ) . sive and disruptive at baseline (Kellam et al., Universal prevention programs that focus on 2008) . The GBG intervention appears to improve building resources in the community or organiza- behaviors of the more aggressive males by chang- tional domain are based on the theory that changing the ecology of the classroom to be less aggres- ing aspects of children’s macro-level environments sive overall (Kellam et al., 1998 ) and to be more will reduce the likelihood of future adversities conducive to developing prosocial affi liations and provide support to help all children effec- with nondeviant peers (van Lier, Vuijk, & Crijnen, tively manage stressors that occur in these set- 2005 ) . tings (Sandler, 2001 ) . Organizationally based School restructuring is another example of universal programs have been developed to universal prevention in the organizational domain. change school ecologies to prevent behavioral Restructuring programs have been developed to and academic problems (Felner et al., 2001 ; reduce the adjustment problems of youths mak- Flannery et al., 2003 ) and improve classroom ing the transition to junior high or high school. management strategies to decrease undesirable These school transitions are associated with student behaviors (Embry, 2002 ) . increased risk for multiple negative outcomes For example, the Good Behavior Game (GBG) including decreased grades, lower self-esteem, is a classroom-based, behavior management and higher distress, which place youths at intervention, which is based on the theory that increased risk for later problems such as 27 Building Resilience in All Children: A Public Health Approach 469

depression and further academic diffi culties mandatory parenting programs) (Braver, Hipke, (Seidman, Aber, & French, 2003 ) . Developmental Ellman, & Sandler, 2003 ) . theorists have proposed that these negative effects Postdivorce child custody is an example of are due to a mismatch between the school envi- policy in the organizational domain that has been ronment and adolescent needs for autonomy, shown through empirical research to be related to identity formation, and close af fi liation with children’s adjustment. Speci fi cally, Bauserman peers and adults (Eccles et al., 1993 ) . The School ( 2002 ) conducted a meta-analysis of 33 studies Transitional Environment Project (STEP) was comparing children’s adjustment in joint- vs. designed to restructure the school context to bet- sole-custody arrangements. Although the magni- ter meet the needs of students during these high- tude of effects tended to be small, Bauserman risk transitions by creating a small group of ( 2002 ) found that when families were awarded students who move through all primary classes joint custody rather than sole custody, family together and by assigning a single adult to serve relationships were better and children showed as counselor, advisor, and liaison for their fami- better adjustment across a variety of outcomes, lies (Felner et al., 1993 ) . Thus, the program including higher self-esteem and better emo- restructures the high school experience to increase tional, behavioral, and divorce-specifi c adjust- social support from peers and adults. ment. Although parents awarded joint custody Evaluations have demonstrated that students were less con fl ictual before and after divorce than who experienced the STEP program had better those awarded sole custody, interparental con fl ict emotional adjustment, grades, and attendance did not account for differences in adjustment of levels, and were less likely to drop out of school children in sole- vs. joint-custody families. by 12th grade, as compared to a random sample In one prospective, longitudinal study, custody of students who experienced the usual high school arrangement predicted children’s later adjust- transition (Felner et al., 1993, 2001 ) . ment, even after controlling for a large number of pre-divorce selection factors, including interparental relationships, maternal and paternal par- Selective Programs enting, parental adjustment, child adjustment, and demographic variables (Gunnoe & Braver, Society develops institutions, policies, and prac- 2001) . Causality cannot be inferred from these tices to deal with children and families experi- static-group investigations because families are encing stressful life situations such as poverty, not randomly assigned to different custody parental divorce, bereavement, or physical ill- arrangements. However, the fi ndings suggest that ness. For example, the domestic relations court a judicial presumption in favor of joint custody provides an institutional structure within which for most families (i.e., those without parental families obtain a divorce and resolve legal issues fi tness concerns) may help promote resilience (e.g., parental rights and responsibilities), as well among children who have experienced parental as decide how fi nancial assets will be divided. divorce (Gunnoe & Braver). Alternative policies and practices may have signi fi cant impact on children’s exposure to postdivorce stressors, such as interparental con fl ict, Indicated Programs loss of contact with a parent or economic hardship, as well as on the quality of children’s adjust- Organizational interventions to improve adapta- ment following divorce. Consequently, the courts tion for youths already manifesting problem have been proactive in developing alternative behaviors target policies or social structures practices to reduce confl ict (e.g., mediation of designed to deal with these problems. The theory disputes), increase children’s involvement with underlying these interventions is that policies or both parents (e.g., joint custody), and strengthen organizational structures can decrease or prevent parental functioning following divorce (e.g., the worsening of problems either by reducing 470 E.B. Winslow et al. future occurrence of adversities or by marshaling showed decreased recidivism rates compared to resources to promote resilience. Examples of the diversion without services and control condi- such interventions include school policies for tions at 1-year follow-up (Smith, Wolf, Cantillon, dealing with pregnant adolescents (Schellenbach, Thomas, & Davidson, 2004 ) . Leadbeater, & Moore, 2003 ) , court approaches to dealing with juvenile delinquents (Sturza & Davidson, 2006 ) , and a service system for chil- Constructing Resources Across dren in foster care (Leve, Fisher, & Chamberlain, Domains and Levels 2009 ) . Although policies and organizational struc- As the previous sections illustrate, a variety of tures to deal with problem behaviors are ubiqui- interventions have been empirically shown to tous, their effects on adversities, resilience promote resilience and prevent dysfunction by resources, and problem outcomes have rarely constructing resources in child, family, or organi- been examined empirically. One well-evaluated zational domains using universal promotion/pre- program in the organizational domain to promote vention programs, selective prevention approaches, resilience in children experiencing behavior and indicated interventions. Effi cacious interven- problems is the Adolescent Diversion Project tions have been identifi ed for all nine cells in the (Sturza & Davidson, 2006 ) . This program is matrix presented in Table 27.1 . While single based on theoretical propositions concerning the efforts to build resilience can be described within harmful effects of social labeling on the future each of the matrix cells, building resilience in all course of delinquency and on the value of mobi- children requires coordinated efforts that com- lizing community resources to support the com- bine interventions across domains (rows) and petencies of juvenile offenders in adapting to levels (columns) to address individual differences prosocial roles in the community. The program in adversities, resources, and needs among chil- targeted youths identi fi ed by law enforcement as dren in a community. Several evidence-based involved in delinquent behaviors but not yet prevention programs have combined interven- offi cially adjudicated in the juvenile justice sys- tions across domains and/or levels to promote tem. As an alternative to involvement in the jus- resilience and prevent dysfunction (CPPRG, tice system, delinquents participated in advocacy, 2002, 2007, 2010b; Hawkins, Guo, Hill, Battin- family, or behavioral interventions to improve Pearson, & Abbott, 2001; Metropolitan Area their community adaptation. Child Study Research Group, 2002 ; Reid et al., Multiple randomized controlled trials have 2007; Sanders et al., 2002 ; Vitaro, Brendgen, & demonstrated the effi cacy of the diversion pro- Tremblay, 2001 ) . gram model. Illustratively, in one study, youths For example, the Seattle Social Development were randomly assigned to one of three condi- Project (SSDP) is an evaluation of a universal tions: diversion with services (the Adolescent intervention provided to students exposed to Diversion Project), diversion without services, community-school adversity (i.e., children and treatment-as-usual (e.g., court-processed). attending public elementary schools in high- Each individual in the diversion with services crime areas of Seattle) (Hawkins, Catalano, condition was assigned a family worker from a Kosterman, Abbott, & Hill, 1999 ) . In this non- local service agency who assisted the youth and randomized controlled trial, three conditions family in developing behavioral goals and a were compared: full intervention, late interven- reward system for the youth and in assessing tion, and no intervention. In the full intervention community resources available to support the condition, services were provided in grades 1 youth’s educational advancement and civic through 6 and included interventions in child, involvement. Results indicated that participants family, and organizational domains: social com- assigned to the diversion with services condition petence training for children, parenting classes, 27 Building Resilience in All Children: A Public Health Approach 471 and annual teacher training. The late intervention included the same services provided only in Putting Science into Practice grades 5 and 6. Long-term follow-up studies of the SSDP into A growing number of ef fi cacious prevention pro- adolescence and young adulthood have indicated grams have been identifi ed that promote resil- that those who received the full intervention (but ience for children who experience adversities. not the late intervention) had higher levels of These programs share two key characteristics. educational and occupational attainment; engaged First, they build individual, family, and/or com- in signi fi cantly less violent behavior, criminal munity-organizational resources associated with activity, and risky sexual behavior; had fewer resilient outcomes for children facing adversities. anxiety symptoms; and females were less likely Second, these programs have been shown to be to become pregnant, as compared to those in the ef fi cacious in bolstering resources, preventing control group (Hawkins, Smith, Hill, Kosterman, problem outcomes, and promoting resilience & Catalano, 2007 ) . through well-controlled evaluation studies. In contrast to interventions such as SSDP that Without evidence from well-controlled evalua- build resources across multiple domains, the Triple tions, programs can offer only promissory notes, P—Positive Parenting Program (Sanders et al., not proven benefi ts. Unfortunately, many com- 2002 ) is an example of a program that promotes a munities have not adopted evidence-based pro- specifi c resource (i.e., effective parenting) across gramming, relying instead on interventions that multiple intervention levels. The Triple P model is have been well packaged but not adequately eval- based on the principle that individual families uated (Backer, 2000 ; Ennett et al., 2003 ; Redmond within a community differ with respect to the et al., 2009 ) . In the following sections, we exam- amount of support and assistance needed to pro- ine some of the main issues and challenges com- mote positive parenting. Rather than being a single munities must tackle to make effective use of program, Triple P is a system of fi ve intervention evidence-based, resource-building interventions, levels that vary in intensity from a media-based, as well as tools and systems that have been devel- universal parenting program to a brief, video-based oped to help communities successfully navigate selective program to more intensive, group-based the process of putting science into practice. indicated interventions. Multiple randomized controlled trials have been conducted on most of Triple P’s intervention levels and have provided Needs Assessment evidence for their effi cacy in promoting effective parenting and children’s prosocial behavior (de An important challenge a community initially Graaf, Speetjens, Smit, de Wolff, & Tavecchio, faces involves conducting a needs and resources 2008a, 2008b ; Nowak & Heinrichs, 2008 ) . assessment of the population (Hawkins, Recently, Prinz, Sanders, Shapiro, Whitaker, and Catalano, & Arthur, 2002 ; Wandersman, Imm, Lutzker (2009 ) conducted a population-level dis- Chinman, & Kaftarian, 2000 ) . This process is semination trial on the full Triple P system. In this critical for de fi ning the problems and generating experimental trial, 18 counties were randomly speci fi c goals the community hopes to achieve. assigned to either a services-as-usual control con- The process involves collecting epidemiologic dition or a county-wide Triple P dissemination data on adversities, resources, and problems condition, in which the existing child service pro- prevalent in the community, which are used to vider workforce was trained to implement the guide goal setting and the selection of interven- Triple P system. The researchers found that dis- tion strategies. Identifi cation of adversities, semination of the multilevel, Triple P system led to resources, and problems is facilitated by the use a signi fi cant reduction in child maltreatment cases of multiple sources of data, including commu- at the population level (Prinz et al., 2009 ). nity member perceptions (i.e., youth and adult 472 E.B. Winslow et al. reports) and archival data (e.g., census, court, among youths (Hawkins et al., 2002 ) . CTC is a school records) (Wandersman et al.). comprehensive, manualized system for guiding Given that community leaders are likely to be community leaders through the entire process of unfamiliar with needs assessment methodology, planning and implementing science-based pre- a variety of tools and systems have been devised vention strategies including: (a) assessing com- to guide leaders through this process (Chinman, munity readiness to use CTC; (b) introducing Tremain, Imm, & Wandersman, 2009 ; Glaser, prevention science and CTC principles to key Van Horn, Arthur, Hawkins, & Catalano, 2005 ) . stakeholders and community members; (c) estab- For example, the Search Institute1 has developed lishing a community prevention board to carry surveys to assist community leaders in identify- out CTC activities; (d) collecting community- ing whether “developmental assets” (i.e., speci fi c data on risk and protective factors, ado- research-based protective resources) are present lescent substance use, and other mental health or absent in their communities (Scales & Leffert, and behavior problems; (e) using assessment data 2004 ) . The “Pro fi les of Student Life: Attitudes to develop an action plan; (f) selecting science- and Behaviors” survey is a 158-item question- based prevention strategies shown to be effective naire administered in one 50-min classroom in reducing community-specifi c risk factors and period to students in grades 6 through 12. This enhancing protective processes; (g) implement- survey assesses the availability of 20 external ing the selected prevention strategies; and (h) assets in students’ families and communities monitoring and evaluating implementation. (e.g., nurturing relationships with adults, sup- During the needs assessment phase, the CTC portive institutions, enrichment opportunities, community board develops a profi le of commu- collective youth monitoring) and 20 internal nity strengths and challenges based on results of assets (e.g., student commitment to learning, student surveys and archival data (e.g., census) prosocial values, social skills, positive self-iden- that measure risk behaviors (i.e., substance use, tity). This survey also obtains information on stu- delinquency), adversities, and resources across dent demographics, high-risk behaviors (e.g., four domains: community, school, family, and substance use), resilience indicators (e.g., school peer-individual (Glaser et al., 2005 ; Hawkins success), and developmental defi cits (e.g., abuse et al., 2002, 2009 ) . A community map is created history). Research supports the reliability and detailing the distribution of adversities and validity of this assessment tool (Leffert et al., resources across different neighborhoods in the 1998; Reininger et al., 2003 ; Zullig, Ward, King, community, allowing the board to focus efforts Patton, & Murray, 2009 ) . The institute’s fee- on high-risk neighborhoods. based service includes telephone consultation on Whitlock and Hamilton (2003 ) conducted an administration issues, an administration manual, informal study based on interviews with repre- student survey forms, computerized scanning of sentatives of New York communities that used forms and analysis by the institute, a summary one or more youth survey approaches including report of survey results, and resources to aid com- those described here. They concluded that suc- munity mobilization efforts to develop asset- cessful implementation of these approaches building strategies for promoting positive youth depended on widespread community buy-in and outcomes. participation, combined with fl exibility regarding Communities That Care (CTC)2 is a similar the roles and actions of community coalition service developed to help communities formulate boards. strategies for promoting healthy behaviors and preventing negative mental health outcomes Intervention Strategy Selection 1 Search Institute surveys: http://www.search-institute.org/ survey-services After the needs assessment and goal-setting phase, 2 CTC website: http://www.sdrg.org/ctcresource communities face the challenge of selecting 27 Building Resilience in All Children: A Public Health Approach 473

intervention strategies to meet the community’s Collaborative for Academic, Social, and Emotional goals (Chinman et al., 2009 ; Hawkins et al., 2002 ) . Learning (CASEL)’s Safe and Sound Program A multilevel approach that includes a mix of evi- Guide6 ; and Child Trends Lifecourse Interventions dence-based universal promotion/prevention, to Nurture Kids Successfully (LINKS) database.7 selective, and indicated programs that counteract For example, SAMHSA’s NREPP website offers a adversities and construct resources across multi- searchable database of more than 170 mental health ple domains has the potential to provide an promotion, prevention, and treatment interventions, ef fi cient way of meeting the diverse needs of indi- as well as substance abuse prevention and treat- viduals within the community, while building ment programs, that have been shown to be effec- resilience at the population level (Hawkins et al., tive through methodologically rigorous evaluations. 2002 ; Sanders et al., 2002 ; Sheeber, Biglan, Users can search for programs based on type Metzler, & Taylor, 2002 ) . The conceptual frame- (e.g., prevention, treatment); outcomes impacted work presented in this chapter could help guide (e.g., alcohol use, delinquency); age, gender, and the process of selecting appropriate intervention ethnicity of children with whom the program has strategies. Community leaders could use data col- been implemented; as well as intervention settings lected on adversities, problems, and resources (e.g., school, home) and locations (e.g., urban, sub- prevalent in their area to choose selective inter- urban). Programs are described with respect to ventions to counteract specifi c adversities that are intervention level (i.e., universal, selective, indi- highly prevalent in their community, universal cated), intervention strategies employed, target promotion and prevention strategies within a populations served, key outcomes impacted, any domain to bolster resources lacking, and indicated iatrogenic effects that have been reported, quality programs to address substance use and mental of the research, readiness for dissemination, cost health problems. estimates, and program developer contacts. However, to effectively choose programs that meet a community’s needs, community leaders need to have access to concise information regard- Implementation and Evaluation ing programs that have been shown to promote speci fi c resources, counteract speci fi c adversities, Selecting evidence-based programs does not and reduce specifi c adjustment problems. guarantee that programs will be successfully Recognizing the necessity of providing this type of implemented in a community. Even when evi- information to communities and practitioners, a dence-based programs are selected, often they variety of federal and nonprofi t organizations have are not well implemented in natural service deliv- developed principles of effectiveness to guide the ery systems (Gottfredson et al., 2006 ; Greenberg identi fi cation of promotion and prevention pro- et al., 2003 ) . Fidelity of implementation has been grams that work, as well as registries listing effec- identi fi ed as an important factor determining tive programs and details regarding the conditions whether or not evidence-based programs deliv- under which these programs have been shown to be ered in community settings produce the same effective: Substance Abuse and Mental Health effects as the original intervention models Service (SAMHSA)’s National Registry of (Berkel, Mauricio, Schoenfelder, & Sandler, Evidence-Based Programs and Practices (NREPP)3 ; 2011; Durlak & DuPre, 2008 ) . Therefore, pro- Offi ce of Juvenile Justice and Delinquency gram packages need to include training programs, Prevention (OJJDP)4 ; U.S. Department of ongoing technical assistance, and procedures for Education’s What Works Clearinghouse5 ; the monitoring implementation as ways to promote

3 SAMSHA NREPP: http://nrepp.samhsa.gov 4 OJJDP website: http://www.strengtheningfamilies.org 6 CASEL Safe & Sound Program Guide: http://www.casel. 5 Department of Education What Works Clearinghouse: org/programs/selecting.php http://ies.ed.gov/ncee/wwc 7 Child Trends LINKS database: http://childtrends.org/links 474 E.B. Winslow et al. adherence to interventions (Durlak & DuPre; use outcomes) and demographic variables Redmond et al., 2009 ) . (Hawkins et al., 2009 ) . For the most part, fi ndings In addition to intervention packaging features, held equally for both boys and girls and by risk client characteristics, provider preferences, and status, although stronger effects were found for organizational issues have been identifi ed as fac- reducing substance use among boys in eighth tors that infl uence the quality of implementation grade and for reducing delinquency among stu- and the sustainability of interventions (Backer, dents who were nondelinquent at baseline 2000 ; Durlak & DuPre, 2008 ; Mayer & Davidson, (Oesterle, Hawkins, Fagan, Abbott, & Catalano, 2000 ) . It is important to ensure that organizations 2010 ) . implementing prevention programming possess Although these results are encouraging, the or develop characteristics associated with suc- potential public health impact of CTC and sys- cessful implementation, such as a shared vision tems like it could be improved by integrating more about the value and purpose of the program, staff effective methods of engaging parents into fam- with appropriate skills and cultural competence, ily-based prevention programs. For example, in adequate resources to support the program, strong the CTC trial, communities rarely met their goal organizational leadership, and a shared decision- of providing parenting services to at least 20% of making process (Durlak & DuPre, 2008 ; families (Fagan et al., 2009 ) . In fact, initiation Wandersman, 2009 ; Wandersman et al., 2000 ) . rates ranged from 4 to 7% across 4 years. In a Further, to improve the effectiveness of evidence- large-scale trial of the multilevel Triple P Positive based prevention programming delivered in com- Parenting Program, family engagement rates were munity settings, implementation steps must be also low (1% engaged in the 8-session parenting clearly de fi ned and planned out (e.g., timeline, program; <10% engaged in any Triple P level) responsibility assignments), and continuous qual- (Prinz et al., 2009 ) . Even in a study that obtained ity improvement strategies need to be used to sys- a relatively higher participation rate, Redmond tematically assess and feed back information and colleagues’ (2009 ) trial of PROSPER about intervention planning, implementation, (PROmoting School-university-community Part- and program outcomes (Wandersman, 2009 ; nerships to Enhance Resilience), only a small Wandersman et al., 2000 ) . minority of families participated in the family- Experimental trials evaluating the effective- focused intervention (17%). ness of systems that guide community leaders Given the well-established effectiveness of through the process of putting science into prac- evidence-based, preventive parenting interven- tice have produced promising results (Chinman tions (Lochman & van den Steenhoven, 2002 ; et al., 2009 ; Hawkins et al., 2009 ; Redmond et al., Sandler et al., 2011 ; Webster-Stratton & Taylor, 2009 ) . For example, Hawkins et al. (2009 ) con- 2001 ) , it is critical to develop more effective strat- ducted a population-level evaluation of the CTC egies for engaging parents into these programs to system in which 24 towns were randomly maximize their public health impact (Spoth, Clair, assigned to CTC or a control condition. Risk and Greenberg, Redmond, & Shin, 2007 ) . Several fac- protective factors and youth outcomes were tors have been shown to predict participation, assessed using annual student surveys conducted such as high parent education and income, per- longitudinally for 4 years with 4,407 middle- ceived need for and benefi ts of participating in the school students. The investigators found that the intervention, and lower perceived barriers to par- CTC system was implemented with fi delity ticipation (e.g., Dumas, Nissley-Tsiopinis, & (Fagan, Hanson, Hawkins, & Arthur, 2009 ) . Moreland, 2007 ; Spoth, Redmond, & Shin, 2000 ; Signi fi cant effects of the CTC system were found Winslow, Bonds, Wolchik, Sandler, & Braver, for reducing the incidence and prevalence of sub- 2009) . Targeting potentially modifi able predictors stance use (i.e., tobacco and alcohol) and delin- of participation, such as perceived benefi ts and quency compared to control communities, barriers, and adapting strategies that have worked controlling for baseline prevalence (for substance in other fi elds such as child treatment (McKay, 27 Building Resilience in All Children: A Public Health Approach 475

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Myrna B. Shure and Bonnie Aberson

In the fi rst edition of this book, a problem-solving of the subtleties of this process. We know that approach to resiliency was illustrated to show some families, for instance, can adjust in reason- how early high-risk behaviors as physical and ably adaptive ways to what appear to be circum- verbal aggression could be reduced and pre- stances very similar to those in families who vented, and how clinical applications of the cannot. Even among the very poor, many of problem-solving approach could enhance the whom experience insurmountable pressures of resiliency of children exhibiting emotional dis- daily living, some can cope better than others and turbance and ADHD. We have now learned that a can have children who emerge as stellar examples different form of aggression, called relational of healthy human functioning. aggression, popularized by the “mean girls syn- This chapter will describe an interpersonal drome” (e.g., Simmons, 2002 ; Wiseman, 2002 ) cognitive problem-solving (ICPS) approach that can sti fl e resilience, and how the problem-solving George Spivack developed with the fi rst author approach can help both the perpetrator and the (Shure), an approach that can provide a protec- victim of such behaviors. We have also learned tion against stress—protection that can provide a how a feeling of bonding to school can increase signi fi cant mediator of resilience that helps peo- resilience, and how the problem-solving approach ple cope with insurmountable pressures, frustra- can promote that feeling. Finally, we have dis- tion, and even failures in life. First, socially covered that in addition to emotional disturbance adjusted and interpersonally competent children and ADHD, children with other diagnoses can be and those in regular classrooms displaying vary- helped with the problem-solving approach, and ing degrees of high-risk behaviors such as impul- how this can transpire with Asperger’s syndrome sivity and inhibition will be discussed. Examples will be illustrated. of how the problem-solving approach has helped No one doubts that clinicians, parents, teach- both adjusted and high-risk children develop ers, and other caregivers are in a unique position resilience in typical, everyday confl ict situations to affect social adjustment and interpersonal will be illustrated. How school bonding can pro- competence in children. There is, however, a rea- mote resilience, and how interpersonal problem- son to wonder whether we have a thorough grasp solving can help children bond to their school environment will also be discussed. Examples of how clinicians can put into practice the efforts of M. B. Shure ( ) controlled, empirical research of the fi rst author Drexel University , Philadelphia , PA , USA e-mail: [email protected] and others will then be described through vignettes reported by the second author (Aberson) B. Aberson Joe Dimaggio Children’s Hospital , Hollywood , in her work with children diagnosed with clinical FL , USA and neurological disorders.

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 481 DOI 10.1007/978-1-4614-3661-4_28, © Springer Science+Business Media New York 2013 482 M.B. Shure and B. Aberson

Traditionally, educators and clinicians believed Let’s look at Sara, who asked her sister to let that if emotional tension could be relieved, it her play with her doll, and like Zachary, was told would be easier for children to think “straight.” It she couldn’t have it. Could she think of other seemed to George Spivack and Shure just as ways to get her sister to let her play with her doll? reasonable to believe that if one could think If not, she might become frustrated with her sis- “straight,” it would be easier to relieve emotional ter and react aggressively, or perhaps avoid the tension. Let’s look at Zachary (all names are problem entirely by withdrawing. Sara might pseudonyms), a 4-year-old who wanted a wagon have hit her sister, not as an impulsive reaction to that Richard was playing with. When Richard frustration, but after deciding that hitting is one refused his request, Zachary did not create a new way to get it. If this were the case, the new ques- problem by becoming disorganized in the face of tion is whether she also thought about the poten- stress. His ability to think of other options cre- tial consequences of her hitting and whether that ated the opportunity for him to demonstrate might have infl uenced her decision to hit. She fl exibility, and this led him to another tactic “If might have foreseen that her sister could hit her you let me have the wagon, I’ll give it right back.” back and not let it concern her. She might go Richard did not answer. Zachary then asked him, ahead and hit her anyway. Perhaps she could not “Why can’t I have it?” Richard replied, “Because think of anything else to do. When Sara’s sister I need it. I’m pulling the rocks.” Zachary paused, told her she could play with her doll after she was then quietly offered, “I’ll pull them with you.” fi nished with it, Sara thought of something differ- “Okay,” said Richard. And the two children ent to do while she waited, an important coping played with the wagon together. strategy in itself. Sara was able to wait without Zachary’s teacher may not have agreed with getting impatient, fl ying off the handle, hitting the way this problem was solved. her sister, or giving up. She might have thought Richard should have What do Zachary and Sara have that children let Zachary have the wagon when he fi rst asked who are not so successful in negotiating for what for it because Richard already had his turn. But they want but do not have? These two children Zachary was satisfi ed with pulling together. have the ability to think of more than one way to Instead of ending up in dissatisfaction and frus- solve a typical interpersonal problem, to mesh tration, both children responded warmly toward their needs with the needs of the other child, and each other and felt good about their own deci- to consider what might happen next if they were sion. Zachary was able to think about his original able to carry out a particular solution. desire, the wagon, and when faced with resistance could then think of alternative ways to solve the problem (ask for it; promise a quick return; Problem-Solving and Resilience suggest playing together). He was able to understand the other child’s feelings and incorporate Arend, Gove, and Sroufe (1979 ) found that 5-year- them into a solution that ended up successful. olds who can think of more options to interpersonal Like other good problem solvers, Zachary may problems are more likely to display ego resiliency, have thought about hitting or pushing Richard or de fi ned as “the ability to respond fl exibly, persis- just pulling the wagon away, and he may also tently, and resourcefully, especially in problem sit- have been able to anticipate the consequences of uations” (p. 951). The authors continue: “Individuals such acts. But most importantly, his ability to presumably have a typical or preferred level or think of other options prevented Zachary from threshold of control. Being ego-resilient implies experiencing frustration and failure. He could the ability to modulate this preferred level of con- bounce back. He didn’t have to give up too soon. trol in situational appropriate ways.” The ego- Perhaps this was possible because Zachary had brittle individual, on the other hand, “implies available to him more than one way to solve his infl exibility—an inability to respond to changing problem. requirements of the situation—and a tendency to 28 Enhancing the Process of Resilience Through Effective Thinking 483 become disorganized in the face of novelty or teacher.” Good problem solvers could think of stress.” This individual will be “impulsive (or con- those solutions too, but added solutions as, “Take strained) even in situations when such behavior is turns,” “Say, ‘I’ll give it right back,’” “Tell him clearly inappropriate.” Perhaps having more than he’ll be his friend,” and more creative ones as, one way to solve problems that involve other peo- “Put her name on it and she’ll think it’s hers,” and ple available in one’s repertoire of thought provides “Say, ‘you’ll have more fun if you play with me the very fl exibility and resourcefulness that creates than if just play by yourself.’” Although good an ego-resilient individual. In addition to being problem solvers could, like poor ones, think of fl exible and able to bounce back in the face of fail- “Take it,” they were also more likely to offer, ure, Brooks and Goldstein (2001 ) observe that “Wait ‘till he’s fi nished,” and surprisingly, “Wait resilient children “have learned to set realistic goals ‘til he’s not looking and then take it.” Poor prob- and expectations for themselves. They have devel- lem solvers might have thought of “Say ‘I’m oped the ability to solve problems and make deci- sorry’” for breaking the fl ower pot, “I won’t do it sions and thus are more likely to view mistakes, again,” and perhaps some form of “fi x it,” while hardships, and obstacles as challenges to confront good problem solvers could add, “Paint it her rather than as stressors to avoid. They have devel- favorite color,” “Put her favorite fl ower in it,” oped effective interpersonal skills with peers and “Pretend he’s asleep and mommy can’t spank adults alike” (p. 5). him,” and “Bring her mommy a drink and she’ll Children who are empathic and good problem feel better.” solvers have developed effective interpersonal Shure, Spivack, and Jaeger ( 1971 ) found that skills, as they have more friends and are less frus- good problem solvers were, compared to poor trated when things don’t go their way. And, as ones, less physically and emotionally aggressive, Brooks and Goldstein note, parents can help by less likely to fl y off the handle when things don’t being empathic, communicating effectively, go their way, better able to wait their turn and teaching our children to solve problems and make share things, more aware of, if not genuinely con- decisions, and disciplining in a way that promotes cerned for, peers in distress, and more sought self-discipline and self-worth. Children who can after by their classmates. They were also less plan their own actions that have positive, not neg- likely to display inhibited behaviors in the class- ative, consequences are better able to take control room, such as timidity, fear of jumping into play of their lives, instead of letting life take control of with others, and ability to stand up for their rights. them. The ef fi cacy of ICPS for adjustment in youngsters from preschool through adolescence has been con fi rmed by others who have found poor Problem-Solving Skills ICPS skills to be associated naturally with high- that Foster Resiliency risk impulsive and inhibited behaviors as well as display of fewer positive prosocial behaviors in In youngsters as young as 4 and 5 years of age, both lower- and middle-income groups (for a Spivack and Shure measured the ability to think thorough review of these studies, see Spivack and of alternative solutions to two types of problems: Shure 1982) . Importantly, the very behaviors (a) wanting a toy another child has and (b) how to with which poor ICPS skills are associated are keep mother from being angry after having bro- also, as longitudinal research has found, early ken something of value to her. Using the Preschool predictors of later, more serious outcomes as vio- Interpersonal Problem Solving (PIPS) test (Shure lence, substance abuse, unsafe sex, and some & Spivack, 1972 ) , it was possible to distinguish forms of psychopathology, including depression, good from poor problem solvers as early as pre- perhaps even suicide (Bender & Lösel, 2011 ; school. To obtain a chance to play with a toy Loeber & Hay, 1997; Moffi tt & Caspi, 2001 , another child has, poor problem solvers thought Nagin & Tremblay, 1999 , Parker & Asher, 1987 ; of “Ask,” “Grab it,” “Hit him,” or “Tell the Roff, 1984; Rubin, 1985, Rubin, Burgess, & 484 M.B. Shure and B. Aberson

Coplin, 2002, Valois, MacDonald, Bretous, & on that solution for nearly every stimulus pre- Fischer, 2002 ) . sented (broke a fl ower pot, scratched a table, tore Shure and Spivack learned something inter- a hole in a book, etc.). esting from the solutions given by socially Given that perhaps the process of solving a adjusted and behaviorally competent children problem, rather than the content per se, can guide as well as those who were not. It might, at fi rst, behavior, Shure, Spivack, and Jaeger ( 1971 ) appear that the solution “Wait ‘til he’s not looking tested children for other skills that could both dis- and then take it,” is an aggressive one, based on tinguish good from poor problem solvers and the content, “take it.” Or, it might appear to be a skills that would relate to measures of social solution that an inhibited child would give adjustment and interpersonal competence. As because, as one might conjecture, “The child measured by the What Happens Next Game doesn’t have to confront anyone, and there’s no (WHNG) (Shure & Spivack, 1990 ) , the ability to con fl ict.” It turned out that neither was the case; anticipate what might happen next if an act were that it was the socially adjusted children (those carried out or consequential thinking emerged as displaying neither aggressive nor inhibited behav- a signifi cant mediator of behavior as well. For iors) who were most likely to give that solution. example, when asked, “What might happen next” After having thought about why this was the case, if a child grabbed a toy from another (Shure, Shure and Spivack came upon two possibilities. 2003 ) , poor problem solvers more likely gave First, socially adjusted youngsters were likely to responses such as, “He’ll grab it back,” “He’ll hit give more, different, relevant solutions to the him,” or, “He’ll tell the teacher.” Good problem presented interpersonal problems, and “Wait ‘til solvers could also think of these, but added he’s not looking and then take it” was only one of responses such as, “It might break,” “He’ll lose a several solutions offered. Therefore, a child who friend,” or, as one very creative boy said, “He’ll gave this solution was not stuck on one or two ways eat marshmallows in front of him and then when to solve a problem. Second, the cognitive compo- he wants one, he’ll say no ‘cause you took my nents of this solution include a non-impulsive truck.’” When asked what might happen next if, thought, “Wait…” and thinking of the best time for example, a child takes something from an to do something—“when he’s not looking.” adult without fi rst asking, poor problem solvers However rudimentary, this could be the precursor were not only more likely to think of fewer con- to a more sophisticated problem-solving skill sequences, but much less empathic ones. Over found related to behavioral adjustment in the pre- and over, impulsive and inhibited youngsters teen years, a skill called means–ends thinking— were more likely to give consequences directed planning sequenced steps toward a goal (e.g., toward themselves, such as “He’ll get whooped,” making friends), anticipating potential obstacles “He’ll have to go to his room,” or “Mom will take that could interfere with carrying out that plan away his toys.” Adjusted youngsters who could (the kids don’t like him), and recognizing that also think of those possibilities were also more time and timing, that is, recognizing a good time likely to think of empathic possibilities. to act and/or appreciating that goals are not Responding to a fi ctitious child having taken an always reached immediately (Spivack & Shure, umbrella without her mom knowing it, one 1982 ) . Another solution that made Spivack and adjusted child said, “When it rains, she won’t Shure recognize that it may be how , not what have an umbrella, and she’ll get wet, and she’ll children think that guides behavior is “Say ‘I’m catch a cold.” sorry’” for having broken mommy’s fl ower pot or Having identifi ed alternative solution and con- other act of property damage. While one may sequential thinking skills as associated with social think that it would have been the adjusted chil- adjustment and interpersonal competence in 4- to dren who gave that solution, a socially appropri- 6-year-olds, and sequenced planning, or meansÐ ate one, it turned out that while those youngsters ends thinking as an additional, more complex skill could offer that one, inhibited children got stuck beginning about age 8, Spivack and Shure then 28 Enhancing the Process of Resilience Through Effective Thinking 485 asked why better problem solvers are more socially impact of ICPS upon behavior was put to the test adjusted and interpersonally competent than their via intervention created to investigate a linkage peers and with adults as rated by teachers as well between ICPS ability and behavioral adjustment as peers and independent observers (Shure, 1993 ) . by experimentally altering ICPS skills, and then Do ICPS skills precede healthy adjustment or observing changes in the child’s display of behav- vice versa? Are children who are socially adjusted iors naturally associated with ICPS skills. If ICPS and interpersonally competent because they have ability were found to mediate such behaviors, good problem-solving skills, or do children have Spivack and Shure would be able to identify those good problem-solving skills because they are ICPS skills that play the most signifi cant role in socially adjusted and interpersonally competent? adjustment, which would form the basis for a It seems reasonable to assume that children who new approach to prevention of high-risk behav- get along with others, are not aggressive, and not iors in children. socially inhibited have more opportunity to relate to others and more opportunity to practice social cognitive skills. It seems equally logical that an From Theory to Training Program individual who becomes preoccupied with the end goal of a motivated act rather than how to obtain it, In the early 1970s, Shure and Spivack began sys- who is not adept at thinking through ways to tematic intervention to enhance ICPS skills with solve a typical interpersonal problem, or does not inner-city 4-year-olds. Based on Spivack’s theo- consider consequences and the possibility of alter- retical position and the content of solutions given nate routes to the goal is an individual who might by children when we tested them, the approach make impulsive mistakes, become frustrated and was to teach children how , not what to think, in aggressive, or evade the problem entirely by with- ways that would help them successfully resolve drawing. In any case, his initial needs remain everyday interpersonal problems. Originally unsatis fi ed, and, if such behaviors occur repeat- called Interpersonal Cognitive Problem Solving edly, intense unpleasant affect will be aroused, (ICPS), now called I Can Problem Solve (also interpersonal relationships can suffer, and varying ICPS), the training manuals for preschool and for degrees of maladaptive behavior and symptoms kindergarten and the primary grades (Shure, can ensue. On the other hand, an individual with 1992a, 1992b ) consist of sequenced games and means-ends thinking, a habit of thinking in terms dialogues, including prerequisite language skills, of alternate possible solutions and an appreciation feeling word concepts, and the fi nal alternative of consequences, should more effectively evaluate solution and consequential thinking skills to be and choose from a variety of options when faced learned. with a problem, turn to a different (more effective) solution in the case of actual failure, experience less frustration, be successful in interpersonal affairs, ICPS Word Pairs and be less likely to exhibit psychological dysfunction. Although there is no doubt an interaction Word pairs such as is/is not, same/different, before/ of both premises, it seems reasonable to assume after, might/maybe, and some/all are fi rst used in that youngsters like Zachary and Sara are likely, game form because when children learn to associ- with their ICPS competence, to experience less ate particular words with play, they are more likely frustration and failure than youngsters who cannot to use them when it’s time to settle disputes. In bounce back if their fi rst ideas should elude them. nonstressful situations , children fi rst have fun An implicit assumption of Spivack’s theoreti- thinking about what an object in the room is and is cal position (Spivack & Shure, 1982 ) is that the not (e.g., “This is a table, it is not a chair, a balloon, availability of ICPS thinking is an antecedent a ceiling”), then to name something in the room condition for interpersonal adjustment and that is the same , and something different , whether psychological health. This notion of mediating they pointed to the table before or after they 486 M.B. Shure and B. Aberson pointed to the fl oor, and what thing Mom might solution and consequential thinking skills, in point to next. Children can have fun talking about light of their own and other’s feelings—and that how Mom is the same as Dad, and how Mom is if one solution doesn’t work, or is thought to not not the same, is different from Dad, what games be a good idea—it is possible to try a different way. they like to play that are different from games their Beginning about age 8, children in the inter- sister likes to play, and whether it rained before or mediate elementary grades (Shure, 1992c ) are after they played outside. Children also like to exposed to age-appropriate problem situations to play with the words now and later, and make up think of feelings, solutions, and consequences, as situations such as, “I am eating breakfast now. well as more sophisticated skills of thinking: I will eat dinner later.” The words some and all How a person can have more than one feeling have been used in a phrase, to think, for example, about the same thing at the same time (mixed that “I like to play with my new truck some of the emotions), understanding that there is more than time, but not all of the time. I can let my brother one explanation why people do what they do play with my truck some of the time too.” It’s fun (“Maybe he didn’t wave because he’s mad at me,” for children to make up their own ways of using or, “Maybe he just didn’t see me”), and ability to these words, ways that later help them think about engage in the sequenced planning, or the means- how to solve con fl icts that come up at home and at ends thinking skill described above. school. Applying these word pairs to real life, for In addition to the ICPS programs for use in example, a child can respond to the question, “Is schools from preschool through grade six, ICPS your idea a good one or not a good one,” in light has been developed for use by parents. With the of what might happen next, and is the child able to Raising a Thinking Child Workbook (Shure, 2000 ) , think about what happened before a fi ght began and its Spanish edition Enseñando a Nuestros with questions such as, “Did he hit you before or Niños a Pensar (Shure, 2005 ) based on Raising a after you hit him?” The words is and is not are also Thinking Child (Shure, 1996 ) and Raising a incorporated into phrases that help the child think Thinking Preteen (Shure, 2001 ) , the same ICPS about good times and not good times to do things, approach was adapted for use at home. such as when a child is interrupting someone. The Shure and Spivack learned that in addition child can be asked, “Is this a good time or not a to teaching prerequisite and problem-solving good time to talk to me?” Children enjoy thinking skills to children, application of newly acquired about the question, “Can you think of a different ICPS skills to real life can be key to actual way to tell your brother what you want,” and behavior change. Using the concepts described, they’re more willing to wait until later when they the trainer, whomever that may be, learns to recognize the word later from their play games. help children associate how they think with what The second phase of the ICPS training pro- they do through a process Shure calls “ICPS gram helps children identify feelings, not only of dialoguing.” Replacing negative punishment, others, but their own. Children learn that it is pos- demands, or threats, such as often humiliating sible to learn that different people can feel differ- time-out or yelling, or even the more positive ent ways about the same thing—that feelings approaches of suggesting what to do (e.g., “Ask change, and there are ways to determine this by your brother for what you want”; “share your watching, listening, and asking. After learning toys”), and explaining and reasoning (e.g., “If games to put words to people’s feelings, children you hit your brother, you might hurt him”), learn to think about what makes other people feel ICPS trainers ask questions that guide children the way they do. Children who do not care if, for to think about what they do in light of how they example, a child hits them while grabbing a truck and others might feel, what might happen next, may have become immune to their own, albeit and if needed, to think of a different way to temporary pain to get what they want. Once solve the problem. Here is how one mother used feeling words are identi fi ed and children think the ICPS dialoguing approach with her pre- about what makes people feel the way they do, school child, Sean, who complained, “Mommy, they are ready for games and dialogues that teach Tommy hit me.” 28 Enhancing the Process of Resilience Through Effective Thinking 487

Mom: What’s the problem? What’s the of youngsters trained as early as preschool and matter? kindergarten improve more than comparable Sean: Tommy hit me. controls, but as measured 1 and 2 (Shure & Mom: What happened before he hit you? Spivack 1982) , and up to 4 years later (Shure, Sean: I hit him fi rst. 1993 ) , the impact was maintained. In only 3 Mom: What for? months time, and regardless of IQ, impulsive Sean: He won’t let me have any clay. children became less impatient and less likely Mom: How do you think Tommy feels when to explode when faced with frustration. Socially you hit him? withdrawn youngsters became more outgoing, Sean: Mad. more able to express their feelings, and less Mom: And then what happened after you hit fearful. Tanya, for example, who played him? onlooker day after day before training and Sean: He hit me. shied away when her teacher tried to help her Mom: And how did that make you feel? into a group, made a dramatic move during the Sean: Mad. 11th week of the program. She told a group in Mom: Can you think of a different way to get the doll corner, “If you need a fi reman, I’m Sean to let you have some clay so you right here.” One of the children who previ- both won’t be mad and he won’t hit ously ignored her then happened to notice a you? pretend fi re. Sean: I could tell him I’ll help him make a dog. Not only did the behaviors of the trained group Sean felt less threatened when asked “What as a whole improve (also replicated by others, e, happened before he hit you?” than he would have g., Allen, 1978 ; Boyle & Hassett-Walker, 2008 ; from the more threatening question, “Why did you Feis & Simons, 1985 ; Kumpfer, Alvarado, Tait, hit him!?” Associating the word before with his & Turner, 2002; Santos Elias, Marturano, Ameida ICPS word games, Sean felt safe to tell his mom Motta., & Giurlani, 2003 ; Weddle & Williams, what really happened. When this mother discovered 1993 ; Wowkenech, personal communication, that her child hit fi rst, she didn’t offer advice or August 26, l978), but those who most improved lecture the pros and cons of hitting. Instead, she in the trained problem-solving skills were the continued the ICPS dialogue by encouraging her same children whose behavior most improved child to think about his own and Tommy’s feelings, (Shure & Spivack, 1980 ) , suggesting a direct link and the original problem (wanting the clay). Then and support for Spivack’s theory that the trained she helped him look for alternative ways to solve ICPS skills played a signifi cant role in mediating the problem and consider what might happen as a behavior. Importantly, youngsters showing result of those solutions. Now active participants, behavioral adjustment and social competence in not passive recipients, children who are engaged to preschool were less likely than controls to begin think about what they do are much more likely to showing behavioral aberrance in kindergarten, carry out their own ideas than those demanded, suggesting that ICPS serves as a primary preven- suggested, or even explained by an adult. By send- tion program as well as one that reduces already ing a covert message, “I care how you feel, I care existing high-risk behaviors. In the Feis and what you think, and I want you to care too,” children Simons ( 1985) study, trained preschoolers in are also more likely to care about other people too. rural Michigan, compared to comparable controls, decreased negative behaviors, especially anxious/fearful and hyperactive/distractable Evidence of Impact with Adjusted behaviors as measured by the Behar and and High-Risk Children String fi eld (1974 ) teacher rating scale, outcomes also found by Aberson, Albury, Gutting, Mann, What did ICPS training do for the thinking and and Trushin (1986 ) . Behavioral changes were behavior of the children? When trained by associated with an improved ability to problem teachers, not only did ICPS skills and behavior solve. Importantly, trained children also received 488 M.B. Shure and B. Aberson fewer referrals to mental health services than aggression are likely to engage in later physical controls. In the Wowkenech (1978) study, behav- aggression. Victims of aggression may suffer in ioral impact was not only greater for ICPS-trained misery beyond their years in school. In fact, 5-year-olds than for age-mates trained in model- Smith, Singer, Hoel, and Cooper ( 2003 ) found ing-reinforcement groups, but as soon as the that youngsters who were threatened, humiliated, training was over, ICPS-trained youngsters con- belittled, or otherwise picked on in school— tinued to try other ways to resolve a con fl ict, especially those who did not, and still don’t have while modeling-reinforcement-trained young- coping strategies—may continue to be victim- sters were more likely to revert to their old (often ized years later in the workplace. ineffective) ways of handling con fl ict. It seems reasonable to assume that both the A form of aggression that provokes confl icts perpetrator and the victim of relational aggres- among peers that has recently been noticed by sion would benefi t by ability to solve interper- researchers is what Crick (1996 ) has coined rela- sonal problems, by fi nding other ways to treat tional aggression , aggression that “involves peers they don’t like or who they feel betrayed harming others through purposeful manipulation them, and by fi nding ways to cope with being or damage to their peer relationships” (e.g., using treated with such behaviors. Boyle and Hassett- social exclusion as a form of retaliation) p. 2317. Walker (2008 ) , who implemented ICPS with kin- This form of aggression includes spreading dergarten and fi rst-grade children, found rumors and telling lies about someone so others signifi cant gains in positive prosocial behaviors, won’t play with that child, talking about a party but also signi fi cant reductions in both physical in front of a child who is not invited, being told and relational aggression, suggesting that trained there is no room at the cafeteria table when there children did fi nd alternative ways to react to peers are several empty seats, etc. Relational aggres- who upset them or made them feel angry. While sion is more common in girls than in boys (Ostrov no known research to date has studied the victims & Crick, 2007 ) , who are more relationship- of relational aggression exposed to ICPS, Shelly, oriented than boys. Being the victim of relational age 4, was told there was no room in the art cor- aggression can be more hurtful than being kicked ner for her when there was plenty of space. Before in the shins because it lasts longer, the victim ICPS, Shelly would have walked away and begins to wonder why no one likes her, and soon sulked. This time she said, “I’ll make you a ticket doesn’t want to come to school. Victims of rela- to the zoo,” and the girl laughed and let her sit tional aggression often experience psychological next to her. Shelly cut a “ticket” out of construc- distress including depression and anxiety, peer tion paper, gave it to her and the two girls played rejection, and loneliness (Crick & Bigbee, 1998 ; together the rest of the free play period. Shelly Crick & Grotpeter, 1995 ) . While this type of was no longer rejected, or lonely. aggression begins in about the third grade, there For fi fth and sixth graders, fi rst trained in the are precursors as early as preschool Ostrov, ICPS approach, the content of particular prob- Woods, Jansen, Casas, and Crick ( 2004 ) . Crick, lems and what adults say and do can differ, but Casas, and Mosher ( 1997 ) found that among 3- to the extent to which an adult encourages the child 5-year-olds, children who say they won’t invite a to think does not change as a child gets older or peer to a birthday party if they can’t have their because he or she is a member of a particular way, won’t let a classmate into their play group, socioeconomic level. Although it did take some- won’t listen to someone or may cover their ears what longer to achieve the same behavioral are more likely to experience social-psychological impact as with younger children, the positive maladjustment than peers not engaged in these prosocial behaviors increased in the same kinds of behaviors. And, as Ostrov ( 2010 ) has 3-month time period in grade fi ve, while the neg- found, even as early as preschool, victims of rela- ative behaviors decreased after a second expo- tional aggression are likely to engage in later sure, in grade six (Shure & Healey, 1993 ) . relational aggression just as victims of physical Although it is possible that the delayed impact on 28 Enhancing the Process of Resilience Through Effective Thinking 489 negative behaviors can be a result of less intense and students, which had been started earlier in the training due to academic demands (3 times year, and, very importantly, to newly emphasized weekly vs. daily for the younger children), it is dialoguing to help children apply newly acquired also reasonable to assume that perhaps aberrant cognitive problem-solving skills to everyday behaviors are simply more habitual in older than interpersonal problems. In fact, Weissberg and in younger children and therefore more resistant Gesten (1982 ) report that the incorporation of dia- to change. Given that ICPS and behaviors in older loguing into the curriculum may “be a key teach- children are still correlated phenomena, more ing approach to facilitating children’s independent intense or extensive ICPS intervention appears problem solving efforts” (p. 59). logical to pursue. The evidence suggests, how- In addition to relational aggression, another ever, that even though it may take somewhat lon- area of research receiving recent attention is that ger to affect negative behaviors in older children, of school bonding. Blum (2002 ) found that ado- for those not trained earlier in life, grades fi ve lescents who feel connected to school, that teach- and six are not too late. Importantly, standardized ers care about them and treat them fairly, feel a achievement test scores improved among ICPS- part of the school, and importantly, feel safe are trained children, especially social studies, read- less likely to engage in violence, substance abuse, ing, and math, suggesting that children whose and other serious outcomes. It turned out that the behavior improved could better focus on the task- most important factor contributing to a feeling of oriented demands of the classroom, and subse- connectedness was school climate, including quently, do better in school. Returning to Brooks teachers who encouraged students to be actively and Goldstein’s ( 2001 ) analysis that resilience involved in classroom management, where stu- involves “hardships and obstacles as challenges dents treat each other with respect, get along well to confront rather than as stressors to avoid,” it is with the teacher, are engaged in academic les- important to note that Elias et al. ( 1986 ) have sons, etc. These are all features that ICPS fosters, shown that fi fth graders who learn problem- and recognition of bonding as a contributor to solving skills experience less stress during their resiliency can add important insight into why transition from elementary to middle school. In behaviors of ICPS-trained youngsters improve. addition to the logistics of transferring to a new In 6- to 8-year-olds, Kumpfer, Alvarado, Tait, school and coping with peer pressure, these and Turner (2002 ) found that a similar feeling of stresses included adjusting to more stringent aca- belongingness to school increased signifi cantly demic requirements. The youngsters in the Elias in ICPS-trained youngsters compared to controls, et al. study stayed on-task and performed better youngsters whose self-regulation also improved, academically in school. suggesting the link between a feeling of school It may be important here to underscore the bonding and behaviors at a very early age. importance of the ICPS dialoguing in effecting Are parents able to be effective ICPS media- behavior change. Weissberg and his colleagues tors? Shure and Spivack (l979) found that inner- developed social problem-solving programs for city, African-American preschoolers trained by elementary school-age children and found that their mothers, like those trained by their teachers, compared to their fi rst attempts, Weissberg et al. signi fi cantly improved more than controls in solu- (1981 ) attribute improved behavioral gains in both tion and consequential thinking and in impulsive urban and suburban second to fourth graders to and inhibited behaviors as observed in school, methodological research improvements (e.g., bet- suggesting that ICPS skills learned at home gen- ter-matched controls, less teacher rating bias), eralized to a different setting—the school. Mothers more motivated, responsible teachers, and more who improved their own problem-solving skills closely monitored training, supervision, and con- and applied ICPS dialogues when handling real sultation efforts. They also attribute behavioral problems at home had children who most gains to a curriculum that might better have met improved in the trained ICPS skills and behaviors. the needs of urban as well as suburban teachers Importantly, it was the mothers who best learned 490 M.B. Shure and B. Aberson to solve problems between a hypothetical mother a group of institutionalized emotionally disturbed and her child (e.g., her child has been saying “no” boys, the more socially isolated were more a lot lately) who were also most likely to apply the de fi cient in measured ICPS skills than those who ICPS dialogues when real problems would arise, were less isolated. partly, we believe, because they learned to solve a Although training of depressed children problem one step at a time, to recognize and cir- speci fi cally with ICPS has not, to date, been con- cumvent potential obstacles, to appreciate that ducted, severely antisocial, often isolated children problems cannot always be solved immediately can benefi t from ICPS training alone or when (means-ends thinking), as well as to understand, combined with other forms of cognitive-behavior or, at least accept their child’s point of view. When therapy. Small and Schinke (1983 ) applied a prob- fi rst trained in kindergarten by their teachers, and lem-solving approach at a residential treatment in fi rst grade by their mothers (Shure, 1993 ) , center for 7- to 13-year-old emotionally troubled children whose mothers best applied the ICPS boys of normal intelligence, referred because of dialogues were still maintaining their gains 3 hyperactivity, impulsivity, extreme acting-out, years later, at the end of grade four. delinquency, learning diffi culties, and minimal neurological dysfunction. Conducted in six 60-min training sessions over 2 weeks, the impact From Training Adjusted and High-Risk of an adapted ICPS curriculum was compared to a Children to Clinical Applications combined ICPS/social skills training, where leaders modeled use of effective gestures, expressions, So far we have addressed ways that ICPS can be and verbal statements, and group members acted used to help children solve the more typical, as protagonists, antagonists, coaches, and feed- everyday problems, such as hitting siblings or back sources during practice role play. When classmates and sharing. Although fewer studies combined, the boys tried new styles of problem- have been conducted with children with clinical solving and interpersonal communication, gave diagnoses, Shure and Spivack (1972 ) found social one another social praise for displaying adaptive problem-solving defi ciencies in 8- to 12-year-old behavior, and planned how to exercise their learn- youngsters attending a school for the emotionally ing when faced with problems. Compared to a disturbed compared to age-mates in public time-comparable discussion-only group, in which schools, and Lochman and Dodge (1994 ) con fi rm the boys merely discussed problems but did not that severely violent preadolescents and adoles- learn ICPS or social skills, and a test-only condi- cents tend to be more defi cient in a wide range of tion, the ICPS-adapted group combined with social cognitive processes, including social prob- social skills training had the most impact on lem-solving skills, than their moderately aggres- decreasing classroom teacher-rated behaviors as sive or nonaggressive peers. Similarly, Dodge measured by the Devereax Elementary School ( 1993 ) cites research within his cognitive model Behavior (DESB) rating scale (Spivack & Swift, of information processing that suggests that both 1967) , including classroom disturbance, impa- aggressive and depressed youngsters who view tience, disrespect-defi ance, and external blame. their interpersonal worlds with anger or hopeless- With teachers blind to experimental conditions, it ness are defi cient in social problem-solving skills, is notable that ICPS alone and social skills train- and “demonstrate deviant response accessing pating alone still had signifi cantly more impact than terns that indicate a dearth of competent behav- groups with no problem-solving or social skills ioral responses” (p. 569). Consistent with Dodge, training, offering hope that “troubled young peo- depressed 9- to 11-year-olds were, compared to ple can learn to think and act responsibly in social nondepressed peers, signifi cantly more defi cient situations” (p. 12). in the measured ICPS skill of means-ends think- In a study with 7- to 13-year-old male out- ing (Sacco & Graves, 1984 ) . Interestingly, patients in a psychiatric clinic, (Yu, Harris, Higgens and Thies (1981 ) found that even within Solovitz, & Franklin, 1985 ) children, mostly 28 Enhancing the Process of Resilience Through Effective Thinking 491 from the working class, single-parent (divorced) skills and behavioral adjustment in this families, received the Rochester Social population. Problem Solving curriculum (Weissberg, In a sample of psychiatric inpatient 7- to Gesten, Liebenstein, Doherty-Schmid, & Hutton, 13-year-olds hospitalized for treatment of antiso- 1979 ) —a program that, like ICPS, teaches social cial child behavior, Kazdin, Esveldt-Dawson, problem-solving (called SPS) and thinking skills. French, and Unis (1987 ) found that 20, 45-min Over a 20-week period, twice a week, children sessions, 3Ð4 times a week of treatment modeled were trained in groups by clinic staff members, after ICPS had greater impact than nondirective and, in addition, concurrent group parent sessions relational therapy or no treatment at all. The cog- were held. Parents were informed about the nitive problem-solving-trained youngsters concepts their children were learning and encour- showed “signi fi cantly greater decreases in exter- aged to implement the principles at home, nalizing and aggressive behaviors in overall and group discussions included a variety of behavior problems at home and at school, and to parent issues. Compared to control groups, who increases in prosocial behaviors and in overall received generally eclectic clinical services adjustment” (p. 76), and the impact was seen at ranging from individual to family therapy, trained the 1-year follow-up. As measured by the children improved in both SPS skills and parent- Achenbach and Edelbrock (1983 ) rating scale, rated behaviors, including greater social compe- prosocial behaviors of problem-solving-trained tence and less externalizing symptomatology children improved to the point of falling within (e.g., delinquent or aggressive behaviors). Parents the normative range; the majority did, however, who attended the most sessions also had children remain outside the normative range for deviant who exhibited less internalizing (e.g., depressed behaviors. The fi nding, with respect to prosocial or uncommunicative behaviors). Although not behaviors, is interesting in that with normal but compared to training by the clinical staff alone, it high-risk children within the same general age is important to note that among diagnostically range, studied by Shure and Healey ( 1993 ) and disturbed children, SPS group training with added described above, it was the prosocial behaviors parent training can have more impact than non- that improved fi rst as well. A later combination ICPS treatment, which consisted of a variety of of problem-solving with a behavioral parent- therapeutic treatment variables assumed to be management component (in which the parent ameliorative of the manifest psychopathology. reinforced the child’s behavior with privileges, Over a 6-month period, DeFranco-Nierenberg activities, and prizes) did increase the number of and Givner ( 1998 ) found that severely emotion- deviant behaviors to fall within the normal range ally disturbed low-income kindergarten to second (Kazdin, Siegel, & Bass, 1992 ) . graders trained by their counselors signifi cantly Although ICPS-like training for severely anti- improved compared to comparable non-trained social children did not transform most of the youngsters on PIPS solution scores ( Shure youngsters studied by Kazdin et al. into normally and Spivack, 1974a, 1974b ) . They also showed behaving youngsters, the decreases in externaliz- increased prosocial behaviors and decreased ing and aggressive behaviors were signi fi cantly inhibited, internalizing behaviors as measured by greater than those exposed to a therapy in which the Hahnemann Preschool Behavior Rating Scale children were guided to express feelings, shown (Spivack & Shure, undated ) and the Achenbach empathy and unconditional positive warmth, but and Edelbrock teacher report form ( 1983 ) . When not trained to solve problems directly. This fi nding the teacher worked together with the counselor, is important because ICPS intervention is based on externalizing, impulsive behaviors also decreased. the premise that empathy, recognition, and open While training was longer than for normal chil- discussion about feelings are prerequisite to dren (6 months) and in smaller groups (6 children behavior change. They generate a greater reper- per group), it is important to note that ICPS can toire of solutions, but the solution and consequen- have signifi cant impact on the problem-solving tial thinking most directly mediate behavior. 492 M.B. Shure and B. Aberson

If, for example, a withdrawn child is aware that ratings on the Parenting Stress Inventory (Abidin, something she did made someone angry—a step 1990 ) indicated signi fi cantly high levels of stress ahead of not being sensitive to that outcome—her related to parenting Patricia, was usually con- anxiety about that person’s anger won’t be relieved frontational and punitive with speci fi c dif fi culties unless she knows what to do to allay that anger. related to getting ready for school in the morn- Whether the population is within the normative or ings and doing homework. These factors resulted the clinical behavior range, knowing what to do is in destruction of the parentÐchild relationship, a result of the fi nal problem-solving solution, con- despite the fact that Patricia was regressed in her sequential and sequenced planning skills of ICPS. behavior and very dependent on her mother. We now turn our attention to how the second Aberson, who was at that time a school psy- author (Aberson) helped three children with mul- chologist assigned to Patricia’s school, explained tiple neurological and clinical disorders develop to Patricia that her mother would be learning characteristics associated with resilience as a some games to play with her and would be asking result of training in ICPS. All three demonstrated her questions to help her learn how to solve prob- characteristics of attention defi cit hyperactivity lems. Patricia agreed that this would be a good disorder (ADHD). Patricia also had comorbid idea. conditions of anxiety and depression, and Jimmy, To help Patricia think about her dawdling in of impulsivity and oppositional de fi ance. The the morning, her mother learned to ask ICPS dia- third child, Jorge, developed posttraumatic stress logue questions as, “How do you feel when you disorder (PTSD) following a serious accident come to school on time?” (recognizing child’s 1 year after the initial treatment, and returned to feelings), “How do you think your teacher feels Aberson for help. These children (whose names when you’re late?” (recognizing the other per- have been changed to protect con fi dentiality) son’s feelings), “How do you feel when every- received training from their parents who partici- body’s yelling at each other in the morning?” pated in small-group family training or in family and, in time, “What can you do to solve this prob- therapy. lem?” Her mother aided Patricia in solving the problem by breaking the solution down into smaller steps, with questions as: (1) “What can Patricia’s Story you do the night before to make it easier to get ready in the morning?” (2) “Can you make a list A child of British origin, Patricia demonstrated of the different things that you have to do to get characteristics of (ADHD) inattentive type when ready?” (3) “What would you do fi rst, second, she was in kindergarten (as reported in Aberson, third?” (applying sequenced steps of means-ends 1996; Aberson & Ardila, 2000 ) . Her mother, a thinking) as a way to help her get her tasks in single parent, attended 6 weekly small-group par- order, and (4) “Can you think of a way to mark enting classes when Patricia was in second grade. each task after doing it so you’ll know it’s com- By that time ratings on the Behavior Assessment plete?” After 6 weeks of ICPS training, these System for Children (BASC) (Reynolds & steps were no longer necessary. Patricia’s mother Kamphaus, 1992 ) by her teacher, her mother, and reported that although at fi rst ICPS dialoguing herself suggested that she was also experiencing with her daughter involved lengthy conversations symptoms of depression and anxiety in addition due to Patricia’s oppositional responses, eventu- to attention problems. Patricia was not doing her ally it did take hold and their relationship work at home or at school, despite average intel- improved. Patricia was able to plan what she was ligence and achievement levels. Her grades were going to wear to school the night before and also below average. She had only one friend at school, independently plan how she could get ready on who was able to bully her by telling her she would time in the morning. not be her friend if she did not do what she To help Patricia complete her work in school, wanted. Her relationship with her mother, whose as well as her homework, which she often refused 28 Enhancing the Process of Resilience Through Effective Thinking 493 to do, her mother shifted from arguing about it to be unmedicated and remained in a regular school asking questions such as, “What do you want to program. do when you fi nish your homework?” (a way of empowering, instead of overpowering her child). Her teacher reported that her effort and work Jimmy’s Story completion in school improved, and battles over homework gradually ended, with Patricia’s Jimmy, of Southeast Asian descent, was adopted becoming able to do her homework independently as an infant. His parents learned ICPS in a parent- with only occasional help from her mother. training group, followed by family therapy, when Although Patricia continued to have dif fi culty Jimmy was in the second grade. At that time, making friends, her peer relationships did Jimmy was impulsive, oppositional, and defi ant improve when playing with children at home. in school and at home. Before ICPS, his physical Instead of going to her mother and crying when education (PE) teacher told his parents that he she was having diffi culty getting along with a was just a “mean kid.” When asked how he felt playmate, she began to think of alternative ideas about being left out of PE, Jimmy answered, of what to do when her friend wanted to play with “Sad.” Using an ICPS vocabulary word, he was different things. asked, “What happened before your teacher told Because Patricia was struggling due to a mild you that you couldn’t play?” He responded that learning problem in math and was less mature he was fooling around and would kick the ball than her peers, she, together with her mother, into another kid. When asked what he could do so decided that she should repeat the fi fth grade, that wouldn’t happen, Jimmy answered that he despite the fact that retention was not recom- could say to himself, “Don’t fool around, and mended by the school. Patricia was happy with make sure my hands and feet are quiet.” On the this decision, which she played a part in making, next report card Jimmy earned an A in conduct in and told her peers that she felt she needed more PE. Before ICPS, Jimmy often did not bring time before going to middle school. Several years home report cards because they resulted in pun- later, in the tenth grade, Patricia was earning As ishment and lectures. Now Jimmy and his parents and Bs, even in math. She had friends and contin- agreed to use a report card in a new way. The ued to enjoy a close relationship with her mother. teachers rated Jimmy in four different areas, on a Her resilience was demonstrated by the fact that scale of 1Ð5, including doing his work in class, she bene fi ted from retention in the fi fth grade. homework, getting along with peers, and follow- Although this outcome is not consistent with ing rules. His parents agreed to respond to the research on the effect of retention ( Dawson, report by asking three questions, written on the Raforth, & Carey, l990 ) , her success might be bottom of the report card: fi rst, “What makes you attributed to the relationship of mutual respect feel happy about this report?” second, “Does between Patricia and her mother and use of the anything make you feel sad or frustrated?” problem-solving approach in making this “What?” and third, “What can you do tomorrow decision. to make it better?” After only 2 weeks, Jimmy In Patricia’s case, the immediate benefi t of the was earning the highest ratings in all four areas. ICPS dialoguing was the improvement in her He felt proud because he now knew that he had relationship with her mother, followed by the power to make things better. After ten ses- improvement in school and eventually improved sions, Jimmy became a better student and had peer relationships. Four years after the parent- more friends. training sessions, Patricia was, as again measured Jimmy’s relationship with his parents became by ratings from teachers, her mother, and by her- closer, and having been helped to think about his self, free of symptoms of depression and anxiety, own and other’s feelings, including how someone although mild attention problems remained. feels when he shouts at them, he was able to dem- Never medicated from the start, she continued to onstrate empathy toward his younger, handicapped 494 M.B. Shure and B. Aberson brother. On one occasion when his mother became During the problem-solving sessions, Jorge frustrated with his brother shouted at him, Jimmy thought of ways he could solve this problem. He asked, “How do you think Steven feels when you asked his teacher if he could sit alone in a quiet speak to him like that?” Mom was surprised at place when doing seat work and then return to how Jimmy had used an ICPS question she had his seat next to his friends. He also planned a previously learned to ask of him. When Jimmy homework schedule with his mother and took was asked, “What did you learn from ICPS?” he over the responsibility for doing his homework. answered, “I learned that the same solution will He and his younger brother worked out a plan so not work in every situation.” Because of the that his younger brother, who acted out for increased academic demands 3 years later, in the Jorge’s attention, would be able to wait for Jorge fi fth grade Jimmy and his mother decided that his to fi nish his homework before playing with him. test grades might improve with stimulant medica- Jorge used the ICPS phrase, “This is not a good tion. And in middle school, Jimmy was on the time. I will play with you when I fi nish my home- honor roll. work.” Feeling that the family’s stress level was signifi cantly reduced, therapy was terminated after 10 weeks. Jorge’s Story A year later, an unfortunate setback occurred. On a family trip, the SUV rolled over several times Jorge, a child diagnosed with the ADHD- and Jorge, able to exit the car, witnessed his fathers’ combined type, was in second grade in a self- close call with death. This accident resulted in the contained gifted program when his parents entire family experiencing posttraumatic stress entered into family therapy. He was, at that time, disorder as well as physical injuries to both par- taking stimulant medication. This family is ents. At fi rst, the parents did not apply the tech- middle-class Cuban American with a second niques of ICPS, and Jorge’s behavior and school male child, who at that time was in preschool. performance deteriorated. With the combination Jorge, although gifted, was experiencing confl ict of PTSD and ADHD, Jorge was very anxious and with his parents primarily with regard to doing angry and afraid to be alone in his room. At times, homework and fi ghting with his younger brother. he became belligerent toward his mother. His parents used both punitive techniques and Because of the traumatic accident and its rewards in dealing with family problems. With resultant stress, Jorge and his parents returned to neither of these having the desired effect, both therapy for support. Learning to adapt the vocab- parents and their children were becoming increas- ulary and principles of ICPS to the new situation, ingly frustrated. Jorge was guided to think of different things he Jorge and his family became acquainted with could visualize or say to himself when he experi- ICPS when they attended a brief presentation at enced panic. He was also taught slow, deep Jorge’s school. It was Jorge’s idea for a family to breathing as an additional tool for coping with attend sessions to learn how to problem solve. panic. These new visualization and slow, deep- After the family learned the objectives of the breathing skills, skills specifi c to anxiety disor- program and speci fi c goals for the family were der, could now provide additional options from outlined, feeling games were introduced, and which to choose when Jorge was faced with this each member listened to the other nonjudgmen- new type of problem. tally. During that time, Jorge’s parents learned Jorge’s parents agreed to apply ICPS dialogues that he felt sad when they shouted at him. As a rather than shouting when they became frustrated result, his parents held family meetings each with their son. His father, who struggled with a week to play ICPS games and problem solve low frustration tolerance due to his injuries, instead of shouting. Jorge also had a problem in thought of things different from shouting that he school. He was unable to concentrate on his could do when he became frustrated or angry. In work because he kept talking with his friends. addition, Jorge’s teacher was advised about these 28 Enhancing the Process of Resilience Through Effective Thinking 495 family changes and thought of ways she could one component of a 7-week summer program help Jorge when he began to panic, such as allow- with unmedicated ADHD youngsters involved ing him to see the counselor. After a few months, parents, and it was those parents who participated the family had returned close to their functioning in the program who rated their children as most before the accident. After 6 months Jorge’s father improved in self-control. returned to his former responsibilities at work as Abikoff and Gittelman ( 1985 ) also concluded well. In grade 6, Jorge earned good grades at that social problem-solving training yielded no school, continued to mature, and took on more signi fi cant impact on academic, behavioral, or responsibility. Occasionally he, like many chil- cognitive measures in children with ADHD, nor dren with ADHD, didn’t study for a test or began did it facilitate withdrawal of medication. In this a project late, resulting in a low grade. However, study, parents attended two training sessions he learned from his mistakes, studied and planned and were instructed to encourage and praise a earlier the next time. He was no longer afraid to systematic and refl ective approach to schoolwork. be alone. Jorge and his parents learned how to In addition, children were rewarded points in share and solve problems together, paving the exchange for toys and games for “working hard way for a close, positive relationship that had and trying your best” to encourage the child’s strengthened the family bonding in ways that participation in the program. This would not be hadn’t existed before. Jorge observed with pride effective unless the child had the skills to do that. that other families didn’t listen to each other and Jorge’s way of “working hard” and “trying his problem solve the way his family does. best” was in his deciding to ask his teacher if he could sit away from the other children to avoid distractions while doing class work. The outcome Comments on the Effi cacy of Jorge’s making this decision was very different of Clinical Cases from what it would have been had the teacher made the decision for him. Unlike dispensing Each of the children described above displayed points in exchange for toys and games to try hard symptoms of ADHD, and two of them also expe- (external rewards), Jorge’s newly acquired prob- rienced at least one initial comorbid disorder, not lem-solving skills nourished a genuine desire to uncommon for children with ADHD (Hinshaw, succeed (internal rewards). Unlike Abikoff and 2000) . Research suggests that there is signifi cant Gittlemans’ subjects, for whom cognitive train- comorbidity between attention de fi cit disorder ing did not help discontinue medication, inten- with disorders of mood, anxiety, and conduct sive ICPS dialoguing by his parents may have (Biederman, Newcorn, and Sprich, 1991 ) . Despite contributed to Jorge’s becoming medication free. existing literature that suggests that training is More than the fact that parents were intimately based on the ICPS model has little or no impact involved in the therapeutic process may be how on guiding interpersonal behaviors in real-life they were involved. Referring to clinicians who situations with children with ADHD (Abikoff, employ cognitive-behavioral (CB) strategies, 1991 ) , including parents may provide some clues Braswell and Kendall (2001 ) point out, “the CB for its success. In discussing interventions with clinician must strive to be sensitive to the par- children with ADHD, Hinshaw ( 2000 ) reports ents’ beliefs about the causes of the child’s several studies that demonstrate that cognitive- dif fi culties; otherwise, it may be dif fi cult for the behavioral therapies, including problem-solving, parents to fully endorse or enthusiastically par- are typically conducted with the child, either ticipate in a treatment plan that is not consistent individually or in small group formats. The prem- with the parents’ understanding of the problem” ise of potentially greater impact by including par- (p. 257). In this regard, the effect of the children’s ents can be supported by the one study reported neurological condition on their behavior was by Abikoff that did have a positive impact. Kirby explained. Consistent with Braswell and Kendall’s (1984 ) incorporated social problem-solving as ( 1988 ) recommendation, dif fi culties at school 496 M.B. Shure and B. Aberson and at home were viewed as “problems to be competence and worth, recruits the child as a solved rather than the inevitable outcome of a partner in the therapeutic process, and provides speci fi c disease process or family circumstance” the child opportunities to learn how to make, (p. 176). The parents were asked what solutions evaluate, and modify personally relevant deci- they had attempted in the past and then were sions.” In each of the case studies described asked if they were ready to try a new approach. above, the children were consulted regarding The difference between the problem-solving their family’s participation in the program to approach and other methods of handling prob- which they agreed. In fact, it was Jorge himself lems was explained, such as commands, demands, who requested the family therapy using ICPS. punishing, and also, how it differed from commonly used positive approaches such as suggesting what and what not to do and why. Beginning The Issue of Generalization with a very simple problem, such as the child interrupts the parent, the parent practiced the dif- It may have been the therapist’s approach to the ferent ways of talking with their child about this. parents with whom she worked that helped their They came to see that what they were doing was children generalize their social cognitive skills one way, not a bad way, but that ICPS is a differ- from the setting in which they were learned, to ent way. These parents were excited to try some- another setting—an effect that Whalen and thing new. The transfer of the relationship of Henker ( 1991 ) report rarely occurs with children mutual respect that developed between the thera- with ADHD. These authors propose two types of pist and the parents during the sessions to their generalization one might look for when evaluat- relationship with their children may have played ing a program: (l) transfer of treatment-related a key role in the success of the intervention. gains in nontarget domains and nontreatment set- To help parents understand their children’s tings including academic and social skills and (2) behavior, some cognitive-behavior therapists positive ripples as improved likeability, perceived help parents reframe what their children are self-ef fi cacy, willingness to take risks or accept doing. For example, a parent who views his or challenges, improved frustration tolerance, and her child’s shoving of others as innately destruc- attitudes toward studying and learning. Jimmy tive can be helped to reinterpret that behavior and Jorge were helped to transfer their attitudes with statements as, “I notice he is most likely to toward studying and learning through a home- shove other children when the classroom is very school report card developed by the therapist crowded and the children are expected to share a which was responded to with ICPS dialoguing small number of supplies” (Braswell & Kendall, techniques rather than external (often negative) 2001 , p. 258). Although reframing can set the consequences. Patricia’s teacher at the time of stage for the parent to understand their child’s parent training was aware of the intervention and, behavior in a new light and “encourage construc- although not trained in ICPS, was more sensitive tive efforts to cope with the problem at hand,” to her feelings than before. ICPS training gives the parent tools to teach their Braswell and Kendall ( 1988 ) note that “over- children speci fi c skills to do that. lap between training tasks and generalization tar- In addition to the parents’ understanding of gets is necessary for obtaining optimal gains. their children’s behavior and their beliefs being Training in applying the new skills to a variety of in accord with the intervention they are receiving, tasks provides the child with opportunities to Whalen and Henker (1991 ) report that “consider- learn how the strategies can be adapted to an as ation of children’s preferences may be a practical yet unexperienced situation” (p. 203). Not only means of enhancing clinical outcomes” (p. 135). did these children learn how to think in ways they They continue, “Soliciting and considering the could successfully resolve problems in a variety child’s view when selecting and evaluating thera- of settings and for a variety of problems, but the pies conveys a positive message about the child’s generalization across settings and time may have 28 Enhancing the Process of Resilience Through Effective Thinking 497 occurred because of the continued parentÐchild in England during the summer. She still had dialoguing and enhanced feelings of empower- attention problems but was functioning well due ment of the parents as well as the children. to her compensating for the problem because of It might be proposed that the ripple effects of her high level of motivation and increased self- the treatment, namely, increased feelings of self- con fi dence. Jimmy had replaced impulsivity and ef fi cacy, resulted in an increased motivation in oppositional/de fi ant behavior with the use of school and increased frustration tolerance in effective problem-solving strategies and contin- these children. Additionally, the process of prob- ued to have positive peer relationships when lem-solving, that is, thinking of different solu- observed 4 years later. Stimulant medication was tions, evaluating their potential consequences, introduced (in grade fi ve), not for interpersonal including how they and others feel or might feel, behaviors, but for attention to schoolwork. And may have been internalized by the children rather Jorge, who did not have a comorbid condition than believing that one particular solution is best diagnosis until the automobile accident, which at for any one particular problem that may arise in that time was so severe that PTSD became pri- their lives. As noted by D’Zurilla and Nezu mary, no longer experienced these symptoms and (2001 ) , “ ‘Problem solving’ refers to the process again was compensating for symptoms of ADHD of fi nding solutions to specifi c problems, whereas and functioning well. ‘solution implementation’ refers to the process of Although ICPS intervention does not cure carrying out those solutions to actual problem- ADHD’s core symptoms of hyperactivity and the atic situations” (p. 213). Not teaching specifi c ability to stay focused, Braswell and Kendall solutions to solve speci fi c problems plus the ( 2001) conclude from the research they cite that encouragement to implement solutions offered cognitive problem-solving approaches can be by the child that are predicted to have positive suitable “for treatment of adjunctive issues (such consequences (through ICPS dialoguing) may as parentÐchild confl ict), and for treatment of contribute to these children’s ability to carry out coexisting concerns (including aggressive behav- their newly acquired ICPS skills in settings other ior, anxiety, and depression)” (pp. 276–277), the than where they were fi rst learned. In the arena of very comorbid behaviors exhibited by Patricia social behaviors and interpersonal competence, and Jimmy. Although improvement can, at least we saw earlier with nonclinical but high-risk in part, be due to improved executive functioning children that parent-trained children were able to problems common to ADHD, such as planning generalize their learned ICPS skills from the set- and use of verbal mediation to self-regulate ting in which they were trained (the home) to a behavior, these three children learned the very different setting (the school). Although socializa- skills that Whalen and Henker ( 1991 ) argue must tion skills were never a problem for Jorge, be acquired before cognitive-behavior therapy improvement in the ability to solve interpersonal can be effective—“suf fi cient foresight and verbal problems and empathize with others appears to dexterity to plan, guide, and evaluate their behav- have contributed to the improved socialization iors” (p. 131). ICPS may also provide the struc- skills in Patricia and Jimmy. ture and mode of interaction in the family that increases the necessary structured environment that ADHD children need. The Comorbid Conditions

In all three cases, follow-up suggested the comor- Amount of Training bid diagnoses no longer existed and the children were compensating adequately with the symp- Despite the above advantages to advance impact of toms of ADHD. Patricia no longer experienced ICPS, one might question how behavioral changes depression or anxiety. In fact, she tried out for the can occur and remain after only 6Ð10 family ther- school soccer team and enjoyed attending school apy or parent-training sessions. With regard to 498 M.B. Shure and B. Aberson cognitive-behavior therapy (CBT), Goldstein and poor self-regulation and are often rigid and Goldstein (1998 ) concluded that “When cognitive stubborn, lacking ﬂ exibility in their thinking. As behavior therapy is dealing with conditions that a result, they are often rejected by their peers. are ‘hard wired’ or neurologically based as appears They are offended without cause and are not to be the case with ADHD, it may be the case that offended when there is a cause. Continuous peer CBT applications have not been implemented with rejection may lead to unexpected aggressive the intensity that matches the true treatment needs responses on their part. When their parents and/ of the clients” (as cited by Braswell & Kendall, or teachers teach them interpersonal problem- 2001 , p. 276). Despite the relatively few treatment solving skills, they learn to think more ﬂ exibly sessions, the parents of children described in these and to better regulate their behavior. As a result, case studies provided intensive treatment to their they function better at home and at school. children on a daily basis through playing the ICPS Billy, a very bright 4-year-old with Asperger’s games and dialoguing with their children about syndrome, was rejected by his peers at preschool problems that came up at home and at school. In due to his rigid behaviors and poor self-regula- addition, the lasting effect of the treatment was tion, behavior which was also displayed at home. also fostered through supportive telephone com- Because his parents didn’t understand why he munication every 3 or 4 months over several years was behaving this way, they put him in time-out, with the therapist—a form of informal booster which made the situation worse. ICPS was able shots. to help Billy modify his behavior.

Asperger’s Syndrome Billy’s Story

In addition to ADHD, exempli fi ed by Patricia, Billy has twin brothers who were, at the time of Jimmy, and Jorge, ICPS can have a signifi cant treatment, under 1 year of age. Both of his par- impact on children diagnosed with Asperger’s ents were becoming increasingly more frustrated syndrome. Children with Asperger’s syndrome because of his aggressive and inappropriate are often hyper verbose about what interests them, behaviors at home and at school. The situation and their conversations are often one-sided and came to a head when he was asked to leave his egocentric. They do not pay attention to the needs preschool for aggressively behaving like the class and interests of others, or how they react to what police of fi cer with the other children. Additionally, the child is saying. They also have dif fi culty notic- he frequently hit his baby brothers. When told to ing behavioral cues in others, and once they start go to time-out he hit or kicked his parents or talking about what interests them, they have brothers on the way there or afterwards. diffi culty shifting to a new topic (Klin, Volkmar, Billy’s parents sought help with the above & Sparrow, 2000 ) . Klin et al. note that executive problems and received parent training with the functioning de fi cits are evident across the entire ICPS approach. Additionally, Billy’s mother autistic spectrum, including those with Asperger’s participated in ICPS games with her son in syndrome. The American Psychiatric Association’s the psychologist’s of fi ce. Treatment lasted for Diagnostic and Statistical Manual of Mental approximately 10 weeks. After 1 month changes Disorders (DSM IV TR, 2009 ) notes that children were noticed at home. For example, 1 day after with Asperger’s have dif fi culty maintaining peer Billy was playing video games and was forced to relations, display repetitive movements, and have stop for dinner, he demanded that he be given the a narrow range of interests. ketchup. His mother asked him, “What is a differ- Aberson, who has worked with children with ent way you might ask for the ketchup?” He Asperger’s syndrome, has found that they not responded, “May I please have the ketchup?” only have diffi culty shifting to a new topic, but Using ICPS words, he asked, “Can I fi nish my also in shifting behaviors. She adds that they have video game after dinner?” He also learned to 28 Enhancing the Process of Resilience Through Effective Thinking 499 understand that his mother could play with him outcomes as discussed in this chapter, and also, some of the time but not all of the time. He also on academic achievement in normal and high-risk, learned to recognize good times and not good but not clinically diagnosed youngsters from times for him to play with his mother. kindergarten through high school (Durlak, After 10 weeks Billy became more coopera- Weissberg, Dymnicki, & Taylor, Schellinger, 2011 ) . tive at home and his aggressive behavior ceased. Regarding impact of ICPS with children diag- In fi rst grade he was placed in a full day gifted nosed with ADHD and Asperger’s syndrome program with accommodations where he such as those described here is clearly encourag- remained with the same friends throughout the ing, it should also be noted that these children fi fth grade. He is currently in a magnet program were not referred. In fact, their parents initiated as well as gifted classes in middle school. He is the therapy, and, as noted, one of them at her an empathic high functioning student and enjoys child’s request, and were at least of average intel- positive relationships with teachers, parents, ligence. Although Jorge and his parents did suffer peers, and siblings. Most importantly, his bond- a trauma, it was temporary. ing with his parents is so close that he openly For parents who have their own chronic psy- problem solves with them whenever needed. chological disturbances to deal with, ICPS may In addition to the intensity of training and the not, indeed, be enough. In this regard, however, increased bonding between parent and child, the Baydar, Jamila Reid, and Webster-Stratton (2003 ) questions of ICPS dialoguing, the goal of which found that mothers of nonclinical Head Start is to stimulate and enrich the ICPS skills of the children with mental health risk factors of depres- child, help children take over tasks independently. sion, anger, history of abuse as a child, and sub- Additionally, children become aware of the natu- stance abuse were engaged in, and bene fi ted ral consequences of their behavior and how they from, a program based on the problem-solving and others feel when they don’t live up to their model at levels comparable to mothers not end of the responsibility or hurt others physically experiencing these risk factors. With their or emotionally. The repeated association of ICPS training adapted to meet the needs of the parents dialogue questions redirecting behaviors and in (e.g., transportation, child care), trained parents planning tasks with the fun games of ICPS may, with mental health risk factors, compared to as it did for Patricia, Jimmy, Jorge, and Billy, controls, signi fi cantly reduced harsh/negative and result in children’s being more attentive to their inconsistent/ineffective parenting and increased parents—and in more positive interactions with supportive positive parenting. This fi nding is them. encouraging because the need to train parents with these kinds of maladaptive behaviors becomes evident with Cataldo (1997 ) fi nding that Qualifying Considerations for ICPS maltreating (child abusing) mothers, compared to Impact on Behavior non-maltreating mothers, were not only defi cient in the ability to think of solutions to problems There are many variations of CBT (summarized that come up with their children, but were in Braswell & Kendall, 1988, 2001 ) that may de fi cient in solving-problems in general (e.g., have a signifi cant impact on how a child’s think- wanting her friend to go with her to a movie). Not ing affects his or her behavior. No claim is made only were the maltreating mothers poor problem that ICPS is the most ef fi cacious way to go about solvers, but the children of abused parents are doing that, but rather, it is presented as a different similarly de fi cient in problem-solving skills way. However, a comprehensive meta-analysis of (Haskett, 1990 ) . The positive impact of training school-based social and emotional learning proof parents with maladaptive behaviors as shown grams, of which ICPS is one, has shown that by Baydar et al. research notwithstanding, with these kinds of programs have signifi cant impact respect to the speci fi c behaviors of the children on behaviors that predict later, more serious described here, more systematic empirical 500 M.B. Shure and B. Aberson research comparing ICPS with other CBT tech- and problems can be solved. It is the open and niques, such as cognitive restructuring and/or accepting communication fostered by ICPS that attribution training, and in combination with increases the bonding and feelings of empower- behavioral ones (e.g., rewards) is needed, as well ment that problems can, indeed, be solved. As one as comparing the impact of these when imple- parent stated, “I learned that I as a parent can be mented by diagnostically disturbed and nonclini- part of the solution for my child rather than adding cal samples of parents. It would also be useful to to the problem. Before using this approach I was compare training of peers and teachers as well as trying to take power and felt powerless. Now we parents, a combination that Braswell and Kendall solve the problem together.” When the parents (1988 ) suggest might maximize generalization. described in Aberson and Ardila were asked 2 or Before concluding, however, that even ICPS and more years after training how often they dialogue ICPS-like interventions alone cannot succeed with their children, they often believed, as one par- with children with ADHD and Asperger’s, we ent explicitly said, “I can’t tell you that. That’s just believe the clinical evidence presented by the our way of life. But honestly, we don’t have to dia- four case studies described, the impact of ICPS logue very much because our children solve prob- on severely emotionally disturbed teacher- and lems for themselves.” Children who have lived in counselor-trained youngsters, and the decreased environments using the ICPS program develop the behavioral dysfunction in non-clinical ICPS abilities associated with resilience as they learn to teacher-trained youngsters in the studies men- think for themselves and cope with the challenges tioned earlier provides suffi cient justifi cation for of an unpredictable world. more systematic empirical research that actively engages parents together with their children, research that may provide further understanding References of what it takes to have an impact with these particular populations at home and at school. Aberson, B. (1996). 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Conclusions The Future of Children Today 2 9 Sam Goldstein and Robert B. Brooks

How do we go about predicting the future of only part of the story. It is widely suggested that children today? What statistics should be exam- on average families needed income about twice ined? What outcomes should be measured? What the federal poverty level to make ends meet. formulas computed? There are no defi nitive or Children living in families with incomes below precise answers. In the second edition volume, this level in 2006, for example, represented 39% we have attempted to expand upon and address of the nation’s children, more than 28 million these issues through the study and clinical appli- (Douglas-Hall & Chu, 2007 ) . These statistics are cation of resilience and resilience processes. We higher in third world countries. Poverty is asso- have sought to address which variables and ciated with multiple risk factors and long-term through which processes within the child, imme- stressors that threaten development, ranging diate family, and extended community interact to from exposure to violence, lack of appropriate offset the negative effects of adversity, thereby medical, educational, psychological care and increasing the probability of our survival. Some poor nutrition (Garbarino, 1995) . As multiple of these processes may serve to protect the nega- authors in this volume have demonstrated, stress tive effects of speci fi c stressors while others sim- during all stages of children’s development ply act to enhance development. In the truest increases risk for a wide range of adverse out- sense, the study of resilience as an outcome phe- comes, including those related to education, nomenon gathers knowledge that hopefully can vocation, psychological, and emotional adjust- be used to shape and change the future for the ment. These have a long-term effect well into the better. adult years (Shore, 1997 ) . Further, the younger What is the future of children today? In 2002, the child the greater is the risk and vulnerability The National Center for Children in Poverty sug- (Fantuzzo, McWayne, & Bulotsky, 2003) . For gested that approximately one in six children in example, 20% of children under age 6 live at or the United States lives in poverty (NCCP, 2002 ) . below the poverty level ( Fantuzzo et al. ) . Multiple However, the of fi cial poverty measure provides barriers for change exist, including a continued lack of understanding of those forces or phe- S. Goldstein () nomena that protect vulnerable youth as well as Neurology, Learning and Behavior Center , access to those services that have been deemed Salt Lake City , UT 84102 , USA effective for those at risk (National Advisory e-mail: [email protected] Mental Health Councils Workgroup on Child R. B. Brooks and Adolescent Mental Health Intervention, Department of Psychology, McLean Hospital and Development and Deployment, 2001; National Harvard Medical School, 60 Oak Knoll Terrace, Needham , MA 02498 , USA Institute of Health and Mental Health, 1998 ) . e-mail: [email protected] A report by the Surgeon General (U.S. Department

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 507 DOI 10.1007/978-1-4614-3661-4_29, © Springer Science+Business Media New York 2013 508 S. Goldstein and R.B. Brooks of Health and Human Services, 1999 ) set forth specifi c culture and context in which resil- priorities to reduce stigma and increase access to ience is operating. assessment and treatment services, take advan- 3. Aspects of children’s lives that contribute to tage of resources available in the community, resilience are related to one another in patterns and foster partnerships among professionals. that re fl ect a child’s culture and context. These reports and the data they summarize 4. Tensions between individuals and their cul- raise grave concerns about the future of children tures and contexts are resolved in ways that based upon assessment of their functioning today. refl ect highly specifi c relationships between Yet our knowledge of those factors that protect aspects of resilience. As Ungar points out, and insulate continues to grow. We know more resilience as a phenomenon may be far more about how to help vulnerable children or for that complex than originally theorized. Interventions matter all children transition successfully into to seek to bolster aspects of resilience among adult life than ever before. As the authors in this culturally diverse populations of at-risk chil- second edition have attested, we have begun the dren and youth only succeed if these phenom- work to further our understanding and create an ena are better understood. applied science; a model that embraces the To gaze into the future of our species is but to “whole-child perspective” focusing upon compe- gaze into the eyes of children. Our future is tence, context, and contributors to children’s determined by the success or failure of our physical and mental health. As Fantuzzo et al. efforts to prepare children to become happy, (2003 ) note, “competencies of the whole child healthy, functional, and contributing members not disorders or de fi ciencies are core to this of society in their adult lives. But the task of developmental perspective” (p. 17). As such, a raising children and preparing a generation to model of resilience must focus on children by take our place has become increasingly more examining the tasks they must perform and master diffi cult. Perhaps it is the complexity of our at each age as they prepare to transition into culture that brings with it the increased risks adulthood. As we better understand these tasks and vulnerabilities that have fueled the statis- and the forces that nurture mastery we become tics of adversity for youth—delinquency, men- better prepared to foster resilience in all children. tal health problems, academic diffi culty. These Such a model at its core focuses upon assets and refl ect our increasing diffi culty instilling in abilities rather than diagnoses and disabilities. children the qualities necessary for health, hap- In this model, the interaction of the child and the piness, and success. It is within this framework environment form the context in which develop- that the fi elds of medicine, mental health, and ment takes place. Such a model also focuses on education jointly arrive at the crossroads. This adults in the child’s world capable of contributing path refl ects a conscious effort to help all chil- to healthy development and resilience. Finally, dren develop and become profi cient in ways of such a model focuses on competencies of the thinking, feeling, and behaving, which can and child rather than de fi ciencies measured based will insulate them from the many adversities upon an a priori list of abnormal behaviors. they are likely to face in our world. The many A recently published study (Ungar, 2008 ) accomplished and gifted authors contributing reports on a 14 site evaluation of over 1,500 youth to this volume represent as Wright and Masten globally. These fi ndings support four proposi- ( 2004) point out, the third wave of resilience tions underlying a culturally and contextually research, representing an effort to bring embedded understanding of resilience: scientifi c theory and hypothesis into clinical 1. There are global as well as culturally contex- practice. The breadth, depth, scope, and qual- tually specifi c aspects to young people’s lives ity of the work in this volume offer great prom- that contribute to their resilience. ise that, as Bell ( 2001) points out, resilience 2. Aspects of resilience exert differing amounts can be cultivated and strengthened in all of in fl uence on a child’s life depending on a youth. 29 The Future of Children Today 509

As this second edition attests, there is an increas- who were then followed through their children’s ing body of research focusing on understanding the 15th birthday. Many of these were mothers means and manner by which some youth overcome 18-years-old or younger at the start of the study. adversities that are overwhelming to many others. This program reduced three domains of risk for For example, although estimates of the incidence the development of problem behaviors in chil- of a range of psychiatric disorders in children of dren. The effects of the program included a reduc- depressed mothers are high, a sizable proportion of tion in maternal substance abuse during children of depressed mothers eventually achieve pregnancy, a reduction in child maltreatment, and acceptable levels of psychosocial functioning a reduction in family size, closely spaced preg- (Downey & Coyne, 1990 ) . How do these children, nancies, and chronic-welfare dependents. Thus, a despite exposure to a signi fi cant adversity, manage comprehensive prenatal and early childhood visi- to achieve positive adaptation? One approach to tation program was able to affect risks that likely examining resilient outcomes in the face of adver- contribute to adversity, increasing resilience sity has been to measure protective factors that may among children and youth born into at-risk fami- interact with risks as well as “resource factors” that lies. Even since the publication of the fi rst edition may have positive effects on both high- and low- of this volume, there has been a signifi cant risk groups (Conrad & Hammen, 1993 ) . In their increase in scienti fi c research as well as trade and study, Brennan, Le Brocque, and Hammen (2003 ) educational programs under the umbrella of resil- examined parentÐchild relationships in detail as ience (Olds et al., 1998 ) . predictors of resilient outcomes in children of As Fraser and Galinsky (1997 ) hypothesize, depressed mothers. Depressed mothers have been we will eventually collect and integrate suffi cient found to display less optimal parenting qualities research to create a resilience-based model of than nondepressed mothers (Goodman & Gotlib, practice. Such a practice, these authors suggest, 1999 ) . Brennan et al. (2003 ) followed over 800 provides a framework for conceptualizing psy- 15-year-old teenagers and their parents drawn from chological, emotional, and behavioral conditions a large longitudinal study. They demonstrated that in childhood well beyond symptom and impair- positive parentÐchild relationship qualities acted as ment descriptions. Such a model provides mark- protective factors for adolescent children of mothers, correlates, and possible causes classifi ed ers with a history of depression. High levels of per- ecologically as broad environmental conditions, ceived maternal warmth and acceptance and low family, school, and neighborhood conditions and levels of perceived maternal psychological control individual psychosocial and biological condi- and emotional over involvement were associated tions. Such a model appreciates that some risk with higher levels of resilient outcomes in these factors contribute uniquely to particular problems youth. These results are consistent with fi ndings of and some protective factors may insulate certain others (Belsky, 2001 ; DePan fi lis, 2006 ) . It is likely problems but may also act in an af fi rmative way that these qualities too act as resource factors even for even unaffected youth. With such a model, for children of mothers who are not depressed. clinicians would choose the best course of “treat- In fact, the parenting qualities these authors ment” for each affected individual by taking assessed had the same direction of effect for chil- advantage of protective factors, seeking to reduce dren of depressed and nondepressed mothers. risks, and as needed, providing direct interven- Can these fi ndings be applied to create an tion to the affected child. As these authors point applied science of resilience? In 1998, Olds, out, this perspective is “based on the idea that Pettit, Robinson, and Henderson demonstrated childhood problems are multidetermined. That is, they could. This group identi fi ed risk factors for they develop as the result of many causes whether disruptive and aggressive behavior in children. at the level of the individual, the family or com- They provided a program of prenatal and early munity or the broader environment” (p. 267). For childhood home visitation for groups of mothers such a model to be utilized effectively, certain 510 S. Goldstein and R.B. Brooks thresholds of knowledge must be crossed by U.S. Department of Health and Human Services clinicians. These include: Administration for Children and Families. Douglas-Hall, A., & Chu, N. M. (2007). Basic facts about Basic knowledge of risk and protection, low income children, birth to age 18 . New York: ¥ Speci fi c knowledge of risk and protective National Center for Children in Poverty, Mailman factors for speci fi c problems or disorders. School of Public Health, Columbia University. ¥ Speci fi c knowledge of risk and protective fac- Downey, G., & Coyne, J. C. (1990). Children of depressed parents: An integrative review. Psychology Bulletin, tors in a local community. 108 , 50Ð76. ¥ Knowledge of interventive research so that Fantuzzo, J., McWayne, C., & Bulotsky, R. (2003). effective change strategies can be used to Forging strategic partnerships to advance mental reduce the in fl uence of risk. health science and practice for vulnerable children. School Psychology Quarterly, 32 (1), 17Ð37. ¥ Knowledge of interventive research so that Fraser, M. W., & Galinsky, M. J. (1997). Toward a resil- effective change strategies can be used to ience-based model of practice. In M. W. Fraser (Ed.), strengthen protective mechanisms (Fraser & Risk and resilience in childhood: An ecological per- Galinsky, 1997 ) . spective. Washington, DC: National Association of Social Workers Press. An article “Prevention that Works for Children Garbarino, J. (1995). Raising children in a socially toxic and Youth” by Weissberg, Kumpfer, and Seligman environment . San Francisco, CA: Josey-Bass. (2003 ) in an issue of the American Psychologist Goodman, S., & Gotlib, I. (1999). Risk for psychopathol- refl ects the growing interest in applying resilience ogy in the children of depressed mothers: A developmental model for understanding mechanisms of processes through a preventive model. Yet, there is transmission. Psychology Bulletin, 106 , 458Ð490. much work to be done to systematically evaluate National Advisory Mental Health Council’s Workgroup the myriad of variables within children, their fami- on Child and Adolescent Mental Health Intervention, lies, and in the environment that may contribute to, Development and Deployment. (2001). Blueprint for change: Research on child and adolescent mental mediate, and moderate adult outcome. Much addi- health. Rockville, MD: National Institute of Mental tional research remains to be completed to under- Health. stand how to best disseminate and promote this National Center for Children in Poverty (2002, March). knowledge so that it becomes an integral part of Child poverty fact sheet: Low-income children in the United States: A brief demographic pro fi le. New York: raising and educating children and fostering their National Center for Children in Poverty, Mailman mental health. It is hoped that the clinical applica- School of Public Health, Columbia University. tion of resilience processes will lead to a primary National Institute of Health and National Institute Mental prevention model which, as Weissberg, Kumpfer, Health. (1998). Bridging science and service. A report by the National Advisory Mental Health and Seligman ( 2003 ) note, “is a sound investment Council’s Clinical Treatment and Services Research in society’s future” (p. 425). Workgroup . Washington, DC: National Institute of Mental Health. Olds, D., Pettit, L., Robinson, J., & Henderson, C. (1998). References Reducing risks for antisocial behavior with a program of prenatal and early childhood home visitation. Journal of Community Psychology, 26 , 65Ð83. Bell, C. C. (2001). Cultivating resiliency in youth. Journal Shore, R. (1997). Re-thinking the brain: New insights into of Adolescent Health, 29 , 375Ð381. early development . New York, NY: Families and Work Belsky, J. (2001). Emanuel Miller lecture developmental Institute. risks (still) associated with early child care. Journal of U.S Department of Health and Human Services. (1999). Child Psychology and Psychiatry, 42 (7), 845Ð859. Mental health: A report by the surgeon general . Brennan, P. A., Le Brocque, R., & Hammen, C. (2003). Rockville, MD: USDHHS. Maternal depression, parent-child relationships, and Ungar, M. (2008). Resilience across cultures. British resilient outcomes in adolescence. Journal of the Journal of Social Work, 38 , 218Ð235. American Academy of Child and Adolescent Weissberg, R. P., Kumpfer, K. L., & Seligman, M. E. P. Psychiatry, 42 , 1469Ð1477. (2003). Prevention that works for children and youth. Conrad, M., & Hammen, C. (1993). Protective and resource American Psychologist, 58 , 425Ð432. factors in high- and low-risk children: A comparison of Wright, M. D., & Masten, A. S. (2004). Resilience pro- children with unipolar, bipolar, medically ill, and normal cesses in development: Fostering positive adaptation mothers. Developmental Psychopathology, 5 , 593Ð607. in the context of adversity. In S. Goldstein & R. Brooks DePan fi lis, D. (2006). Child neglect: A guide for preven- (Eds.), Handbook of resilience in children . New York, tion assessment and intervention . Washington, DC: NY: Kluwer. Erratum Resiliency in Maltreated Children Shadi Houshyar, Andrea Gold, and Melissa DeVries

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, DOI 10.1007/978-1-4614-3661-4_10, © Springer Science+Business Media New York 2013

DOI 10.1007/978-1-4614-3661-4_30

Andrea Gold was erroneously listed as a chapter author in this 2nd edition.

The online version of the original chapter can be found at E1 http://dx.doi.org/10.1007/978-1-4614-3661-4_10 Index

A depression , 83, 193 ACTH. See Adrenocorticotropin (ACTH) hyperactivity , 225 Adaptation indicated prevention programs , 465 adult , 94, 95 lives , 96 adversity , 19 Mexican descent , 47 children , 22, 83, 99, 143 modern , 82 context-specifi c , 24 neuroticism , 59 dysfunctional/deviant , 46 poverty , 110 and human development , 39 PTSD (see Posttraumatic stress disorder (PTSD)) human system , 8 PYD (see Positive youth development (PYD)) individuals , 119 recruitment, Lord’s Resistance Army (LRA) , 310 life crisis , 41 resilient , 41 measurement , 4 sickle cell disease , 45 mutual , 5 suicides , 7 outcomes , 106, 107 thriving indicators personal adjustment and ecological , 298 defi nition , 436 positive ( see Positive adaptation) developmental stages , 436 protective factors , 4 Search Institute , 436 public health violence , 435 adversities , 460, 464 young girls , 82 community , 470 Adrenocorticotropin (ACTH) mental health and social diffi culties , 460 PTSD , 169 process , 464 release, pituitary , 164Ð165 quality , 94, 95 stress reactivity, adult rats , 166Ð167 resilient , 24Ð26 Adversity. See also Positive adaptation service of , 298 ABC model , 205Ð206 socioemotional , 109 childhood , 90, 99 stress, life , 39 classrooms , 407 ADHD. See Attention defi cit hyperactivity disorder competent youth , 9 (ADHD) development, children , 6 Adolescents distribution, individual adolescents and context adaptation , 108 relations , 294, 301, 304 ADHD , 189 emotional reactivity , 276 African Americans , 7 family , 63 and children , 15, 65 major life events approach , 242 children, depression (see Depression, youth) nurturing resilience , 443 children of mothers, depression , 509 Personal Resiliency Profi les , 282Ð283 children, resiliency scales (see Resiliency Scales for poverty/neighborhood , 11 Children and Adolescents (RSCA)) prediction, resilience , 3 coping problems , 25 prenatal and early childhood visitation program , 509

S. Goldstein and R.B. Brooks (eds.), Handbook of Resilience in Children, 511 DOI 10.1007/978-1-4614-3661-4, © Springer Science+Business Media New York 2013 512 Index

Adversity See also Positive adaptation (continued) symptoms and severity , 4 protective factors , 273Ð274 validity , 248 public health approach Attention defi cit hyperactivity disorder (ADHD) indicated programs , 462 abilities, development , 219 individual, family and community domain , adverse outcome, predictors 459Ð460 adulthood , 226 promotion programs , 461 biological factors , 227Ð228 relationship, mental health and environment , 460 child and family characteristics , 224 selective interventions programs , 461Ð462 diagnosis , 225, 227 Universal prevention programs , 461 disruptive behaviors , 226 “putting it in perspective”, PRP , 207 drug use , 225 RLH model , 203 EI symptoms , 226Ð227 statistics , 508 family stress , 225Ð226 successful coping , 87 Montreal cohort , 226 surgency levels , 65 negative expressed emotions , 226 and trauma , 311 protective factors and adaptive behaviors, girls , 227 types , 6 variables, symptoms , 225 youth , 3 community samples , 219Ð220 Afterschool programs , 122 DBD Ages and Stages Questionnaire: Social Emotional assessment, impairment , 185Ð186 (ASQ-SE) , 249 childhood diagnosis , 194 Antisocial personality disorder (ASPD) , 222 comorbidity , CD, 192 Applied resiliency model , 10 depression , 193 ASPD. See Antisocial personality disorder (ASPD) developmental course , 188Ð189 Asperger’s syndrome , 498Ð499 hyperactive-impulsive symptoms , 186 ASQ-SE. See Ages and Stages Questionnaire: Social inattentive symptoms , 186 Emotional (ASQ-SE) prevalence , 190 Assessment genetic factors , 63 ASQ-SE , 249 good adjustments, predictors , 218Ð219 BERS , 249Ð250 and HA (see Hyperactivity (HA)) classroom needs inattentiveness, overactivity and impulsivity , 216 academic success , 403 neuropsychological correlates ClassMaps Survey , 402Ð403 brain structures , 217Ð218 classroom modifi cations , 404Ð406 discrimination , 218 collective experience, students , 403 familial factors , 218 measures , 402 inattentiveness and distractibility , 216 monitoring, modifi ed routines and practices response inhibition theory , 217 implementation , 406Ð407 state regulation and delay aversion theory , 217 preventive interventions , 402 volitional control , 217 reframe daily routines and practices , 403 research evidence , 219 resilience interventions , 402 subtypes , 216 school records , 403Ð404 weakness and strength-based model , 219 teachers’ and student relationship , 402 DECA-C , 252Ð253 DECA-I/T , 251Ð252 B DESSA, DESSA-SSE and DESSA-mini , 253Ð254 Behavioral and Emotional Rating Scale (BERS) , family and environmental infl uences , 23 249Ð250 future of children, functioning , 508 Behavioral disorders PIPPS , 255 BERS , 250 preBERS , 255Ð256 DESSA-mini , 254 program impact , 113 prevention , 5 public health Belsky’s developmentalÐecological model , 128 community , 471Ð472 BERS. See Behavioral and Emotional Rating Scale (BERS) individual , 461, 462 Bullying periodic , 468 diagnosis , CD, 186 RSCA , 281 self-imposed isolation , 7 social emotional competencies (see Devereux Center victimization, RSCA , 281 for Resilient Children (DCRC) assessments) Bullying prevention, schools socioeconomic status levels , 108 drug and alcohol , 371 SPECT , 169 importance, programs Index 513

behaviors , 374Ð375 Child maltreatment management, violence and aggressive behavior , 374 clinical samples mental health services , 373Ð374 families , 133 social competence , 374 parent mental disorder , 132 victims , 375 substance abuse , 131Ð132 materials (see School prevention programs, materials) description , 131 mechanisms population samples , 133 external and internal student-centered programs , socioemotional development (see Socioemotional 375Ð376 development) meta-analysis, primary programs , 376 ChildÐParent Center programs (CPC) PBIS , 375 Chicago longitudinal study , 89, 99 risk reduction , 375 children, attended , 99 universal programs , 375 Children violence prevention programs , 376 adaptation , 22 primary prevention ADHD (see Attention defi cit hyperactivity disorder defi nition , 372 (ADHD)) effects , 372 adjusted and high-risk , 487Ð490 environmental stressors , 372 adolescents, depression (see Depression, youth) internal and external factors , 372 adolescents, resiliency scales (see Resiliency Scales interventions , 372Ð373 for Children and Adolescents (RSCA)) negative consequences , 373 and African American families , 108 social exclusion and rumors , 373 aversive behaviors , 65 violence , 373 cognitive performance , 65 review, universal programs DBD , 187Ð188 Good Behavior Game (GBG) , 376Ð377 development , 6 secondary prevention , 376 developmentally attentive community , 437, 438 school and classroom-based programs , 371 differential treatment , 67 “school-wide” interventions , 371 dyslexia , 47 SEL , 372 effortful control , 59 experience , 83 future C families incomes, statistics , 507 CBC. See Conjoint behavioral consultation (CBC) knowledge, risk and protection , 510 CBT. See Cognitive-behavior therapy (CBT) parentÐchild relationship , 509 CD. See Conduct disorder (CD) prenatal and early childhood home visitation , 509 Childhood reports, evaluation of youth , 508 abuse , 46 resilience-based model, practice , 509 and adolescence (see Poverty) success/failure efforts , 508 adversities , 90, 99, 460 “whole-child perspective” , 508 antisocial genetic risks, maladaptive outcomes , 62 adversities , 135 high quantities , 297 and adulthood , 135 immigrant and refugee , 98 maltreatment , 133 individual attributes and sources, support , 90Ð92 mental health/substance , 129 LDs (see Learning disabilities) ASPD , 222 maltreatment, resiliency (see Maltreated children) DBD ( see Disruptive behavior disorders (DBD)) measurement (see Resilience) defi ned , 57 nurturing resilience early education , 7 accepting , 451Ð452 girls , 83 discipline techniques , 455Ð456 health problems , 94, 95 effective communication and active listening , hyperactivity , 220, 222, 228 448Ð449 interventions , 28 empathy , 446Ð448 MAOA , 230 “islands of competence” , 452Ð453 organismic and individual self-regulation , 301 love , 450Ð451 outcome measures, predictors , 226 mistakes , 453Ð454 problems , 509Ð510 negative scripts, change , 449Ð450 requirements , 8 problem-solving and decision making , 454Ð455 severe child trauma , 311, 312 responsibility and compassion , 454 sexual abuse , 23 older , 20Ð21 stimulant treatment , 233Ð234 parents , 29 514 Index

Children (continued) therapeutic relationship, safety , 316Ð317 populations , 3, 57 titrate treatment, doseÐresponse gradient , 321 positive anticipation/approach , 29, 59 Type I and II trauma , 309 positive social support , 63 wake of disasters and severe trauma , 310 preschool , 96 Classrooms proximal experiences , 107 average , 7 public health ( see Public health approach, children) characteristics , 400 resilient mindset , 6, 8 children, behavioral problems , 111 self-reparative forces , 313Ð314 conditions sharing, adversities/risk factors , 19 childhood risk , 401 sociable and gregarious, behaviors , 64 description , 400 social information , 66 protective factors, children , 401 soldiers, Uganda (see Child soldiers, Uganda) risk, 399 stress and mental health problems , 4Ð5 data-based decision-making , 400 and teens , 7 defi nition, resilience , 400 wake of disasters and severe trauma , 310 development, relationship , 408 wellness , 4 management , 489 and youth, poverty , 110Ð111, 115Ð117 practices, translating resilience Child soldiers, Uganda changes , 402 changes, psychological function , 311 implementing modifi cations , 406Ð407 posttraumatic resilience , 310 modifi cation plan , 404Ð406 Richard Akena needs assessment , 402Ð404 care and feeds, orphans , 312Ð313 social and economic disadvantages , 401Ð402 devastating trauma, war , 311Ð312 “toolbox” , 402 feature, Northern Uganda , 313 public education , 399 orphans creation, LRA , 312 regular , 481 spiritual support , 313 resilience frameworks , 399Ð400 Uganda Radio Network , 2005, 311 responsibility, schools , 399 severe trauma , 310Ð311 schooling and learning , 399 spiritual support and revenge motivation , 311 school setting , 400 torture , 311 second grade , 468 Child trauma, resilience framework social and psychological environment capacity, human spirit , 310 adversity , 407 description , 309 intervention , 407 impact, Type II traumas , 309Ð310 micro-study procedures , 407Ð408 Izabella teacher-rated behaviors , 490 courageous , 323Ð324 youth struggles , 399 deepens , 323 Cognitive-behavior therapy (CBT) early stage and strides development , 322 applications , 498 healing process , 322 ICPS , 499Ð500 “Resilience and Hope” , 323 Collaborative for Academic, Social and Emotional school return , 322 Learning (CASEL) , 365 training presentation , 323 Conduct disorder (CD) transformation, self-presentation , 323 ADHD , 223, 227 severe trauma treatment, tenets DBD community , 315 comparison, ODD , 185 guide and process , 313 delinquency , 187Ð188 healing powers, family , 314 depression , 193 hope as healing ingredient , 315Ð316 developmental pathways , 189Ð190 mind-sets , 313 diagnosis , 186Ð187 self-reparative forces , 313Ð314 sexual/physical abuse , 194 soldiers, Uganda (see Child soldiers, Uganda) symptoms, ODD , 192Ð193 stressor , 309 Conjoint behavioral consultation (CBC) Taliaferro family address the needs , 154, 156 forge alliances and collaborations, community , description , 152Ð153 319Ð320 family strengths , 156 guiding principles, severe trauma , 316 partnerships and support networks , 156Ð157 honor strengths, children and family , plan implementation , 153Ð155 317Ð319, 321 process , 153, 155 sanctuary model , 320Ð321 services , 153, 154 support, normalizing routines and activities , 320 skills and competencies , 157 Index 515

Connections symptoms , 202 assets and positive youth outcomes , 432 unipolar depression , 202 attentional control and negative emotions regulation, 59 universal vs. targeted interventions , 211 corpus callosum , 170Ð171 DESSA. See Devereux Student Strengths Assessment courage (DESSA) children experience , 83 DESSA-mini. See Devereux Student Strengths Assess- development , 81 ment—Mini (DESSA-mini) “Girls Circle” model , 82 DESSA-SSE. See Devereux Student Strengths Assess- “Go Grrrls” program , 82 ment—Second Step Edition (DESSA-SSE) Penn program , 83 Development prohibition, anger , 82 and child rearing study , 88 young adolescent , 82 children, resilience hippocampus , 165 complexity , 445 intentional self-regulation , 299 devastating effects , 444Ð445 making , 412 fraternal and identical twins , 444 people, interests and life , 10 personality qualities , 444 PFC , 163, 164 and Christchurch health study , 89 Rothbart’s theory, temperament , 58 clinical psychology , 11 Corticotropin releasing hormone (CRH) cognitiveÐbehavioral models, depression mRNA expression , 166, 167 hostile attributional bias , 203 neurotransmitter systems, stress response , 164Ð165 Learned Helplessness model , 202Ð203 PTSD , 169, 171 pessimistic explanatory styles, childhood, 203Ð204 CRH. See Corticotropin releasing hormone (CRH) RLH model , 203 transitions , 204 competence and support , 92Ð93 D CRH , 171 DBD. See Disruptive behavior disorders (DBD) disorder , 461, 464 DBT programs. See Dialectical behavior therapy (DBT) and Dunedin multidisciplinary health study , 89 programs ecology, child and adolescent , 106 DECA. See Devereux Early Childhood Assessment experiences, focal population , 116 (DECA) gender, role , 76 DECA-C. See Devereux Early Childhood Assessment— genetic and environmental factors , 57 Clinical Form (DECA-C) healthy personal environmental systems , 4 DECA-I/T. See Devereux Early Childhood Assessment human , 6, 10 for Infant Toddler (DECA-I/T) intellectual , 78 Depression neural systems , 168 ADHD , 192, 193 positive youth programs , 467 adult , 97 poverty , 507 adversities, childhood , 460 principles, “healthy/normal” , 110 child soldier, Uganda , 311 problem behaviors, children , 509 coping , 465 psychological , 75 diagnosis , 465 PTSD , 162, 171 Emotional Reactivity Scale scores , 281 PYD (see Positive youth development (PYD)) genetic inﬂ uences , 62 resilent mindset , 415Ð416 and 5-HTTLPR genotype , 97 resilience measurement, children LDs , 333Ð334 clarity and pilot testing , 244 parentÐchild relationship qualities , 509 experimental evidence , 244 pathophysiology , 136 responsibility , 245Ð246 posttraumatic stress symptoms , 130 standardization and data collection , 244Ð245 prediction , 62 resilience processes (see Positive adaptation) reduction , 467 RSCA , 274, 279 school transitions , 469 SDP , 468 substance use and disruptive behavior , 192 Seattle Social Development Project (SSDP) , 470 symptoms, 129, 492 “separate self” model , 73 teenagers, struggle , 7 shyness , 59 youth stages, children’s , 507 anxiety disorders , 201 trajectories and resilience cognitive and behavioral factors , 204 gene and environment interaction , 229Ð230 effects, interventions , 210Ð211 MTA , 230Ð233 PRP ( see Penn Resiliency Program (PRP)) predictors and persisters , 228Ð229 516 Index

Developmental assets framework and resilience relationship , 393 characteristics, PYD , 428 self-directed and reﬂ ective approach , 394 communication and strengthen capacity , 439 Devereux Student Strengths Assessment—Mini cumulative asset gradient , 431Ð432 (DESSA-mini) , 254 description , 427Ð428 Devereux Student Strengths Assessment—Second Step developmentally attentive communities , 437Ð439 Edition (DESSA-SSE) , 253Ð254 manage and coordinate , 439 Dialectical behavior therapy (DBT) programs , 172 positive youth outcomes and assets , 432Ð433 Diffusion tensor imaging (DTI) , 170 protective factors , 433 Disadvantages recruit and network champions , 439 disruptive behaviors , 194 Search Institute (see Search Institute) educational equity, youth ( see Education equity and youth) thriving indicators Disruptive behavior disorders (DBD) adolescents , 435Ð436 behavior, children , 183 competence , 433Ð434 clinical practice, guidelines , 195 differences , 434Ð435 comorbidity Developmental systems theory (DST) , 22Ð23 ADHD and CD , 192 Development risk CD and ODD , 192Ð193 children, shy , 111Ð112 depression , 193 “diathesis-stress” perspective , 111 developmental and psychiatric disorders , 191 environmental circumstances , 112 diagnosis , 191Ð192 environmental conditions , 112 covert, oppositional and aggressive behaviors , 185 Felner risk/protective factors , 113, 115 and delinquency , 187Ð188 human , 106 developmental course resilience enhancement efforts , 113 ADHD , 188Ð189 strengths and personal competencies , 112 ODD and CD , 189Ð190 Devereux Adult Resilience Survey (DARS) , 393, 394 diagnostic symptoms Devereux Center for Resilient Children (DCRC) assess- ADHD , 185Ð186 ments delinquency , 187Ð188 description , 261 ODD and CD , 186Ð187 DESSA comprehensive system (see Devereux Stu- “externalizing disorders” , 183 dent Strengths Assessment (DESSA)) inattentive, hyperactive and impulsive behaviors , 185 infants and toddlers , 264 prediction, adult outcome , 184 preschoolers , 264Ð265 prevalence PYD , 261Ð262 foster families , 190 risk and protective factors , 262Ð263 oppositional behavior , 190Ð191 school age children , 265Ð266 risk factors , 191 SEL , 263Ð264 risk factors Devereux Early Childhood Assessment (DECA) biological , 193Ð194 psychometric characteristics , 251 parental antisocial behavior , 193 scale description , 250Ð251 psychological and psychosocial , 194 Devereux Early Childhood Assessment—Clinical Form transition , 183Ð184 (DECA-C) , 252Ð253 youth , 194Ð195 Devereux Early Childhood Assessment for Infant Tod- Disruptive disorders. See Disruptive behavior dler (DECA-I/T) disorders (DBD) psychometric characteristics , 251Ð252 DST. See Developmental systems theory (DST) scale description , 251 DTI. See Diffusion tensor imaging (DTI) Devereux Student Strengths Assessment (DESSA) CD-RISC , 393Ð394 childhood program , 393 E comprehensive system, DCRC Education national and local norms, comparison , 268Ð270 early childhood , 7 OPM , 267Ð268 maternal , 98, 431 pretestÐposttest comparison technique , 268 parental , 109 resources , 266Ð267 postsecondary , 25 universal screening , 267 Educational opportunity , 354, 355, 365 DARS and self-control , 393 Education equity and youth deﬁ nition , 387 communityÐstudent interactions, equity description , 393 advantage and disadvantages , 360 psychometric characteristics , 253 culture violence, sex and substance use , 363Ð364 purpose and scale description , 253 ecological instability , 360Ð362 Index 517

environment outside, school , 360 income levels , 106 inside and outside performance, culture , 362 indicated programs , 462 Latino families , 362 individual and ecological changes , 298 schoolÐcommunity partnerships , 362Ð363 industrial revolution and migration , 315 SEL programs , 362 intervention efforts , 151 teacher and parent , 362 low-income , 7 concepts , 350 middle-class , 88 educational environments , 349 military , 310 implementation, resilience model and normal, affective disorders , 88 CASEL , 365 poverty , 121, 122 organizational and motivational resources , 365 process, outcomes , 152 positive effects, programs , 365 resilience and healing powers , 314 program selection , 365 SES , 232 SEL programs , 364Ð365 social networks and supports , 151Ð152 social transformation , 365 spiritual faith , 316 limitations and directions theories , 146 designs and statistical analyses , 365Ð366 treatment, Type II traumas , 315 educational resiliency paradigm , 366 universal promotion and prevention program , 463 risk and protective forces , 365 youth , 109 social and educational equity , 366 Family violence and parent psychopathology resilience Belsky’s developmentalÐecological model , 128 academic achievement outcomes , 354Ð355 children , 127 benefi ts , 354 description , 127 culture , 353 etiology , 127Ð128 educational environment , 354 intimate partner violence , 130Ð131 K-12 educational experience , 354 prevalence placeholder , 352Ð353 perpetrators , 129 positive outcomes, school , 354 victims , 130 protective processes , 351 risk and protection , 351Ð352 school achievement , 354 G scope , 350Ð351 Gamma-aminobutyric acid/benzodiazepine (GABA/BZ) studentÐeducator interactions systems , 166, 169 description , 357 GBG. See Good behavior game (GBG) emotional climate , 357 GeneÐenvironment interactions expectations, low academic , 359Ð360 depression , 97 interventions , 358 genetic factors , 96 minority students , 357 5-HTTLPR genotype , 97 performance, low academic , 357 MAOA , 97 reciprocal infl uences, high-risk school setting , GeneÐenvironment transactions 357Ð358 active and evocative, correlations , 67 SEL and poor educator-student , 358Ð359 brain, perceptual and cognitive mechanisms , 67 theoretical literature , 350 children’s subjective experiences , 66 Emotional impulsiveness (EI) symptoms , 226Ð227 child report , 67Ð68 cognitive factors ability , 60 F self-referent social cognitions , 60Ð61 Families correlation , 64Ð65 African American , 108 developmental process , 65 average , 507 idiosyncratic experience , 67 CBC , 152Ð157 interaction and children , 88 behavioral genetic studies , 62 cultural awareness , 146Ð147 COMT gene , 63 defi nitions , 145 defi ned , 62 dysfunctional , 24 and genetic factors , 63Ð64 emotional problems , 24 humans, serotonin transporter gene , 62 existing strengths and capabilities , 151 MAOA , 63 family-centered services , 151 molecular genetic techniques , 62 fosters research designs , 23 neuroendocrine stress response , 63 helping behaviors , 152 positive social support , 63 518 Index

GeneÐenvironment transactions (continued) I nature and nurture ICPS approach. See Interpersonal cognitive molecular genetic techniques , 57Ð58 problem-solving approach quantitative behavioral genetic techniques , 58 Impairment nongenetic factors , 61 amygdala , 193 objective measures , 66 diagnosis, ADHD , 185 risk, protective factor , 65Ð66 Emotional Reactivity Scale , 284 temperament and personality self-control (see Self-control impairment effortful control , 59Ð60 and resilience) extraversion/surgency , 58Ð59 teachers ability, social and emotional competence negative affectivity , 59 (see Social emotional competencies) personality dimensions , 58 Interpersonal cognitive problem-solving Genetics (ICPS) approach and environmental factors , 57, 63Ð64 and behaviors in older children , 489 infl uence , 5 effi cacy , 483 and nongenetic factors , 61 impact, behavior , 499Ð500 quasi-experimental behavioral studies , 61 intervention , 497 variations , 10 skills , 485, 487 Genotype x environment (GxE) , 135Ð136 word pairs Girls. See also Relational resilience, girls age-appropriate problem situations , 486 ADHD , 227 behavior changes , 486 and boys , 94 children, feelings identifi cation , 486 CD , 186 dialoguing approach, preschool child , 486Ð487 child soldiers, Uganda , 310, 311 nonstressful situations , 485Ð486 emotional reactivity , 281 use, parents , 486 intervention, Good Behavior Game (GBG) , 468 PTSD symptoms , 172 risk status , 474 L syndrome , 481 LDs. See Learning disabilities (LDs) “Girls Circle” model , 82 Learned Helplessness model , 202Ð203 “Go Grrrls” program , 82 Learning disabilities (LDs) Good behavior game (GBG), 376, 468 academic domains GxE. See Genotype x environment (GxE) cognitive and linguistic mechanisms , 343 foster resiliency, children , 344 materials and procedure , 343 H self-esteem and performance level , 343 Helplessness struggles , 342Ð343 feelings , 93 teachers and parents role , 343 and frustration, parent , 78 adults support , 338Ð339 optimism (see Depression, youth) child growing , 10 severe child trauma , 309 description , 329 HPA axis. See Hypothalamic pituitary adrenal (HPA) axis diffi culty and school failure , 330Ð332 5HTTLPR. See Serotonin transporter gene-linked poly- gender , 335Ð336 morphic region (5HTTLPR) negative teacher and peer feedback Hyperactivity (HA) academic achievement , 333 adolescent , 225 adults , 334 community samples , 220Ð221 classmate retreating , 334 diagnosis depression , 333Ð334 description , 223Ð224 description , 332Ð333 East London and Swedish cohorts , 221 education support , 334 Montreal and Wisconsin cohorts , 221Ð222 humiliation risk , 333 New York cohort , 221 lack of motivation and effort , 333 substance abuse , 222Ð223 peanuts character , 334 PACS , 218 nonacademic domain U.K. birth cohort , 228Ð229 curriculum, rules, materials and test , 342 Hyperactivity disorder foster resilience support , 341Ð342 characteristics , 492 parents and teachers support, talents symptoms , 495, 497 individuals , 342 youngsters , 495 self-concepts , 342 Hypothalamic pituitary adrenal (HPA) axis, 166, 168, 169 sports, arts and technology , 342 Index 519

placement description , 163 analysis, NLTS2 , 341 developmental issues , 170Ð171 classroom , 340Ð341 early stress, neurobiological effects description , 340 CA3 region, hippocampus , 166Ð167 needs strong support system , 341 foraging demands , 166 self-concepts , 340 GABA/BZ system , 166 social and emotional adjustment , 341 handled rats , 167 student own performance , 341 HPA axis, CRH and NE drive , 166 risk factors massage treatment , 162Ð163 hazards , 329 modifying effect, factors individual interaction , 330 clinical studies , 171 negative experiences , 329 cross-fostering , 168Ð169 success attributes , 329Ð330 dams and adult offspring , 168 vulnerable and experience , 329 maternal licking and grooming , 167Ð168 school-based intensive interventions , 339Ð340 rat pups , 168 and school failure , 330Ð332 neurobiological correlates, PTSD (see Posttraumatic self-understanding and acceptance stress disorder (PTSD)) college students , 337 neurotransmitter systems, stress response counselors and therapists , 337 CRH, PVN and ACTH , 164Ð165 external and internal locus control , 337 hippocampus , 164Ð165 goals , 336Ð337 PFC , 163Ð164 individuals , 336 protective factor , 162 knowledge and perceptions , 336 rat pups, separation , 162 masks , 338 resiliency framework , 161 parents and teachers , 337Ð338 Virginia longitudinal study , 88Ð89 strength and weaknesses, persons , 338 Maltreatment social support and competence , 334Ð335 children (see Maltreated children) type and severity , 334 development , 15 Learning disorders , 337 MAOA , 230 Longitudinal studies MAOA. See Monoamine oxidase A (MAOA) gene biological aspects Measurement geneÐenvironment interactions , 96Ð97 children (see Resilience) health , 95Ð96 PYD sensitivity , 96 relational developmental systems , 295, 296 coping, adversity , 87 resilience , 294 cross-cultural context , 97Ð98 risk and positive adaptation , 87 developmental continuity, poor adaptation , 25 school climate , 415Ð416 early developmental competence and support , 92Ð93 Mental health system , 4 estimation, structural equation models , 45 Minnesota ParentÐChild Project , 88 evaluation, foster resilience Molecular genetic techniques , 57Ð58, 62 rescue, children , 98 Monoamine oxidase A (MAOA) gene , 135 social competence , 99 Multimodal treatment of attention-deﬁ cit hyperactivity gender differences , 95 disorder high-risk children, US , 87 ADHD symptoms , 231Ð232 individual attributes and support, children , 90Ð92 description , 230 infancy, adulthood , 87 effects, stimulants , 231 protective mechanisms moderators boys and girls , 94 comorbid anxiety , 232 clusters , 94Ð95 comorbidity status , 232Ð233 individual dispositions and sources, support , 94 management , 233 maternal competence, infancy , 94 SES , 232 teenagers and parents , 509 non-ADHD symptoms , 232 vulnerability and resilience , 93

N M NDAPP. See Notre Dame Adolescent Parenting Project Maltreated children , 24 (NDAPP) child abuse , 161 Notre Dame Adolescent Parenting Project clinical implications , 171Ð173 (NDAPP) , 89 520 Index

O empathy , 446Ð448 ODD. See Oppositional defi ant disorder (ODD) “islands of competence” , 452Ð453 Ongoing progress monitoring (OPM) , 267Ð268 love , 450Ð451 OPM. See Ongoing progress monitoring (OPM) mistakes , 453Ð454 Oppositional defi ant disorder (ODD) negative scripts, change , 449Ð450 DBD problem-solving and decision making , 454Ð455 CD symptoms , 192Ð193 responsibility and compassion , 454 developmental pathways , 189Ð190 parenting intervention evaluation , 65 distinction , CD, 185 PIPPS , 255 negativistic, defi ant, disobedient and hostile PMTO model , 28 behavior , 186 preBERS , 256 prevalence , 190 PRP-P , 209Ð210 development , 229Ð230 psychological functioning , 108 symptoms, children , 232 psychotic , 93 Optimism PYD , 297 defi ned , 60, 76 remarriage , 88 helplessness (see Depression, youth) severe child trauma , 310Ð312, 314, 322 PYD , 296 and siblings , 24 resilient mindset , 446 social programs and polices , 122 Sense of Mastery Scale , 277, 285 therapist’s approach , 496 training programs , 119 work , 7 P PBIS. See Positive behavior intervention and supports PACS. See Parent Account of Childhood Symptoms (PACS) (PBIS) Paraventricular nucleus (PVN) , 164Ð165 PE. See Physical education (PE) Parent Account of Childhood Symptoms (PACS) , 218 Penn Interactive Peer Play Scale (PIPPS) , 254Ð255 Parent-Management Training Oregon (PMTO) , 28 Penn program , 83 Parent psychopathology Penn Resiliency Program (PRP) ADHD , 192 ABC model and family violence (see Family violence) beliefs, activating event , 206 Parents cartoons , 205Ð206 abused , 499 explanatory style , 206 alcoholic , 93 idiosyncratic beliefs , 205 ASQ-SE , 249 abilities , 205 attachment , 280 assertiveness and negotiation training , 208 behavior , 29 decision-making and problem-solving models , 208 BERS , 249Ð250 depressive symptoms, intervention group , 209 characteristics, resilient mindset , 445Ð446 description , 204Ð205 children , 29 nonassertive behaviors , 208 child’s development and resilience, infl uence parents and children complexity , 445 cognitive resilience skills , 210 devastating effects , 444Ð445 communication , 210 fraternal and identical twins , 444 description , 209 personality qualities , 444 goals , 209Ð210 concept, resilience , 443Ð444 intervention condition, adolescent , 210 DBT programs , 172 teachable moments , 210 DECA, DECA-I/T and DECA-C , 251Ð252 “putting it in perspective” , 207 DESSA and DESSA-SSE , 253Ð254 self-disputing , 206Ð207 development, ICPS , 486 Penn Resiliency Program for Parents (PRP-P) , 209Ð210 divorce , 465 Personal Resiliency Profi les, RSCA emotionally ill , 41 adolescent clinical and non-clinical samples , 283Ð284 identifi cation, depression adolescents , 465 clinical case study, Ellen’s involved, therapeutic process , 495 Emotional Reactivity Scale , 284Ð285 mental illness , 10 Index scores , 284, 285 “mother nature’s protective factor” , 20 Sense of Mastery Scale , 285 nurturing resilience, children Sense of Relatedness Scale , 285Ð286 accepting , 451Ð452 subscale scores , 286 discipline techniques , 455Ð456 description , 278 effective communication and active listening , normative samples , 282Ð283 448Ð449 preventive screening , 284 Index 521

Person-focused approaches , 21 improvement process PFC. See Prefrontal cortex (PFC) description , 417, 418 Physical education (PE) , 493 engagement , 419Ð420 PIPPS. See Penn Interactive Peer Play Scale (PIPPS) risk prevention, health promotion and educational PMTO. See Parent-Management Training Oregon efforts , 420 (PMTO) social, emotional and civic learning , 417, 419 Positive adaptation measurement systems assets/compensatory factors , 19 American Psychological Association , 415Ð417 characteristics , 10 essential dimensions , 415Ð417 children and adolescents , 15 public education , 415, 417 child trauma , 311 US Departments of Education , 415 competence , 18 practice trends , 415 contextual specifi city, protective processes , 23Ð24 research and policy , 414 cultural infl uences , 26Ð27 school communities, standards , 414Ð415 cumulative risk factors , 18 social, emotional and civic competencies , 411Ð413 defi nition and illustration , 16, 17 Positive youth development (PYD) developmental and ecological systems adaptive functioning , 295 DST , 22Ð23 characteristics, individual youth and features , 293 promotive and protective factors , 22 DCRC , 261Ð262 resilience research , 22 defi nition , 295 social context, child , 23 developmental assets framework , 428 transactional systems approach , 23 fundamental ontogenetic processes , 304 developmental assets framework and resilience life-span ( see Developmental assets framework and changes , 301 resilience) ecological resources , 303 epigenetic and neurobiological processes , 30Ð31 group differential components, human functions , foster resilience 303Ð304 evidence base , 29 human development , 294 experimental intervention designs , 28Ð29 idiographic features , 304 multifaceted intervention studies , 28 individual-context relations , 301, 302 prevention models , 28 integration actions , 301 prevention programs , 29Ð30 issues, measurements , 303 theory-driven intervention designs , 27 nomothetic characteristics , 303 timing, intervention , 28 programs and policies , 304 human brain , 20 relational developmental systems , 301 increase, vulnerability , 31 relationships , 304 individual resilience and factors identifi cation , 16 structures, ecological assets and intentional self infants , 20 regulation , 303 inferential concept, judgments , 16 perspective older children , 20Ð21 adaptive developmental regulations , 297 parents , 20 ecological assets , 297Ð298 pathways , 99 individual strengths , 297 person and variable-focused approaches , 21 plasticity and diversity , 295, 297 poverty , 20 probability distribution, risk and adversity , 293Ð294 prematurity , 18 regulations , 294Ð295 promotive and protective factors , 21 relational developmental systems theories , 295, 296, protective factors , 19 304 psychopathology , 15 relational processes , 294 and risk , 87 relationship , 293 stability and change, resilient self-regulation (see Self-regulation, PYD) female survivors, child sexual abuse , 26 strength-based approach , 304Ð305 healthy vs. maladaptive pathways , 24 universal promotion and prevention programs , 467 individual trait , 26 Posttraumatic stress disorder (PTSD) information, recovery , 25 and ADHD , 494 maladjustment and deviant behavior , 25 children and adolescents Positive anticipation/approach , 58, 59 cerebellar volume , 170 Positive behavior intervention and supports (PBIS) , 365 clinical implications , 171Ð172 Positive school climate corpus callosum , 170Ð171 defi nition , 413 hippocampal volume and DTI , 170 empirical research , 413Ð414 neurobiological correlates , 169Ð170 522 Index

Poverty PSUD. See Psychoactive substance use disorder (PSUD) adversity , 459, 460, 466 Psychoactive substance use disorder (PSUD) , 223 calculation, US census , 105 Psychopathology childhood , 98 developmental , 22, 110 children , 144 genetic and environmental factors , 63Ð64 chronic , 88 prediction , 15 creating resilience PTSD , 170 parents , 122 resilience research , 15 population-level programs , 121 risk , 9 and disadvantage severe and persistent , 87 “developmental” approach , 110Ð111 PTSD. See Posttraumatic stress disorder (PTSD) identifi cation, tasks , 110 Public health approach, children transactional-ecological perspective , 110 adversity (see Adversity) disorder, outcome specifi city , 115Ð117 community assessment disorder/positive developmental trajectories , 111Ð113 Communities That Care (CTC) , 472 experience, childhood and adolescence community leaders , 472 African-American families and children , 108 multiple sources data , 471Ð472 creation, “compensatory effects” , 107 prevalence , 471 economic and educational forms, disadvantage , survey , 472 109 defi nition, resilience , 459 income level, family , 106 description , 459 neighborhoods, unemployment , 106Ð107 framework parental education , 109 construction, resilience resources , 462 quantitative vs. qualitative assessments , 108 reinforcing programs , 462, 464 “Savage inequalities” , 106 sub-diagnostic levels, symptomatology , 462 social and economic disadvantage , 107 universal promotion and prevention programs , socioemotional adaptation , 109 464 and family confl ict , 11 implementation and evaluation mediating conditions , 113Ð114 benefi ts , 474Ð475 nature and resilience enhancement , 114Ð115 determination, evidence-based programs , 473 prevention , 117Ð121 encouraging, CTC and systems , 474 PYD , 261 experimental trials , 474 risk factor, negative outcome , 20 monitoring , 473Ð474 school climate , 220 quality and effectiveness , 474 socio economic disadvantages , 145 risk and protective factors , 474 stricken home , 10 improving metal health, population level , 459 PreBERS. See Preschool Behavioral and Emotional intervention strategy selection, community Rating Scale (PreBERS) counteraction, adversities , 473 Prefrontal cortex (PFC) , 163Ð164 data collection , 473 Preschool Behavioral and Emotional Rating Scale goal , 472Ð473 (PreBERS) , 255Ð256 identifi cation and effects, programs , 473 PretestÐposttest comparison technique , 268 prevention and promotion programs , 473 Prevention. See also Bullying prevention, schools SAMHSA’s NREPP website , 473 cognitiveÐbehavioral techniques, Depression , 204 multiple intervention levels , 460 comprehensive approaches , 30 positive outcomes , 460 delinquency , 195 promotion, healthy outcomes , 460 effective , 11 resources construction (see Resources construction, and intervention , 31 public health) practice, discipline , 455Ð456 scientifi c practice , 471 programs , 10, 29Ð30 PVN. See Paraventricular nucleus (PVN) PTSD, adults , 171 PYD. See Positive youth development (PYD) public health ( see Public health approach, children) randomized trial , 29 “science of prevention” , 5 Q TÐE model ( see TransactionalÐecological approach, Quantitative behavioral genetic techniques , 58 prevention) “Prevention that Works for Children and Youth” , 510 Problem-solving approach , 481Ð483 R PRP. See Penn Resiliency Program (PRP) RCT. See Relational-cultural theory (RCT) PRP-P. See Penn Resiliency Program for Parents (PRP-P) Reconceptualizations of resilience Index 523

adversity , 42 social support , 78Ð79 benign/malignant outcomes, life stress , 41 and women characteristics and outcomes, individuals , 39Ð40 African-American girls , 81 classes , 52 Caucasian girls , 80Ð81 criterion/context-specifi c favorable outcomes , 43 feel, mutually growth-fostering and distressful life experience , 42 relationships , 80 functional equivalence , 40 “psychiatric diagnosis” , 81 human development and adaptations , 39 women’s voices and lives , 77 individual/system, risk , 43Ð44 Resilience. See also Relational resilience, girls integrative explanatory framework adjusted and high-risk children , 487Ð495 affective/emotional responses , 50 advantages, ICPS , 497Ð498 human behavior, social infl uence , 49 American psychologist , 510 life stress , 48 Asperger’s syndrome , 498 self-evaluative responses , 50 characteristics , 147Ð149 self-feelings , 51 and child, LD (see Learning disabilities (LDs)) self-referent cognitive responses , 51 “choice machines” , 5 situational context , 49Ð50 classrooms (see Classrooms) theory of behavior , 48 clinical psychology , 8Ð10 nonresilience/vulnerability , 40Ð41 comorbid conditions , 497 outcomes, risk/adversity , 41 defi ned , 6 protective factors , 43 democratic/authoritative model , 6 and self-referent processes depression, youth (see Depression, youth) adverse outcomes , 44 description , 143 measurements , 45 development (see Positive adaptation) medical conditions , 47 disruptive disorders, childhood (see Disruptive “mental distress” , 45 behavior disorders (DBD)) outcomes, antecedent , 46 education equity and youth (see Education equity and “protective self-cognitions” , 46 youth) “reactive approach motivation processes” , 46 effi cacy, clinical cases , 495Ð496 relevance , 44, 45 emotional tension , 482 risk/protective factors and adverse/benign out- evolving family structure , 144Ð145 comes , 47 “exceptional characteristics” , 6 “self-esteem” , 44, 46Ð48 family , 144Ð147 self-threatening experiences , 46 foster resiliency, problem-solving skills , 482Ð483 three wave longitudinal study , 45 frustration and failure , 482 Reformulated Learned Helplessness (RLH) model , 203 gene-environment transactions Relational confi dence , 78 (see GeneÐenvironment transactions) Relational-cultural theory (RCT) , 73 generalization , 496Ð497 Relational resilience, girls ICPS impact, behavior , 499Ð500 “allostatic load” , 74 interaction, protective and risk factors , 4 amygdala alert system , 74 longitudinal studies (see Longitudinal studies) contribution, temperament , 78 maltreated children (see Maltreated children) courage, connection , 81Ð83 measurement, children gender ASQ-SE , 249 adolescents , 75 BERS , 249Ð250 child development modes , 76 daily hassles , 242 “fi ght/fl ight” , 77 DECA-C , 252Ð253 impact of culture , 75 DECA-I/T , 251Ð252 “learned helplessness” , 76 description , 241 self-denigration , 76 DESSA-mini , 254 social esteem , 76 DESSA-SSE , 253Ð254 “tend-and-befriend” response , 77 development (see Development) women’s and men’s coping styles , 77 major life events approach , 242 mutuality , 79Ð80 PIPPS , 254Ð255 RCT , 73, 77Ð78 PreBERS , 255Ð256 research, neuroscience , 73 psychometric characteristics , 246Ð248 self-esteem , 78 risk and protective factors , 242Ð243 shame , 80 RSCA , 256 “smart vagus” , 74Ð75 science and practice , 241Ð242 social pain , 74 transformation , 258 524 Index

Resilience. See also Relational resilience, girls (continued) internal mechanisms, relatedness , 276 mental health , 4Ð5 parent attachment , 280 nurturing, children (see Children) Personal Resiliency Profi les (see Personal Resiliency parentÐchild bonding , 500 Profi les, RSCA) positive adaptation and developmental assets preventive screening , 284 framework ( see Developmental assets protective factors , 273Ð274 framework and resilience) psychometric characteristics , 256 positive school climate (see Positive school climate) purpose and scale description , 256 preventive intervention effectiveness , 5 relationships , 275Ð276 and problem-solving reliability evidence , 279 ego-resilient , 482 resource and vulnerability indexes , 278Ð279 interpersonal skills , 483 risk behavior , 281Ð282 protective factors , 5 self-concept , 279Ð280 public health ( see Public health approach, children) sense of mastery , 275, 277 PVD ( see Positive youth development (PYD)) sense of relatedness , 275, 277Ð278 reconceptualization (see Reconceptualizations testÐretest reliability , 279 of resilience) Resources construction, public health research , 3, 6 beyond domains and levels “resilient mindset” , 3 efforts , 470 risk , 6Ð7 individual differences, adversities , 470 RSCA ( see Resiliency Scales for Children multiple randomized controlled trials , 470, 471 and Adolescents (RSCA)) Seattle Social Development Project (SSDP) , and self-control impairment 470Ð471 ( see Self-control impairment and resilience) Triple P—Positive Parenting Program , 471 and socioemotional development (see Socioemotional indicated programs development) child domain , 465 synthesis, model , 10Ð11 community-organizational domain , 469Ð470 teachers and promoting resilience family , 467 adult resilience programs , 392Ð393 selective programs children , 390Ð392 child domain , 465 classroom skills , 388 community-organizational domain , 469 common and unique stressors , 388Ð389 family , 466Ð467 effects, stressors , 389Ð390 universal promotion and prevention programs expectation , 388 child domain , 464 K-12 educational standards , 388 community-organizational domain , 467Ð469 practice standards , 388 family , 465Ð466 social and emotional competence , 387 RLH model. See Reformulated Learned Helplessness TÐE approach (see Poverty) (RLH) model training program , 485Ð487 Rothbart’s theory , 58 wellness , 4 RSCA. See Resiliency Scales for Children youth , 3 and Adolescents (RSCA) Resilience framework child trauma ( see Child trauma, resilience framework) classrooms (see Classrooms) S DCRC , 263 School prevention programs maltreatment , 161 cost , 378 practice and policy , 28 CPP , 377 research and practice , 15 evolution , 381 Resiliency Scales GBG , 377 ConnorÐDavidson (CD-RISC) , 393Ð394 Olweus Bullying Prevention RSCA ( see Resiliency Scales for Children blueprints, violence prevention series , 377 and Adolescents (RSCA)) improvements, “social climate” , 377 Resiliency Scales for Children and Adolescents (RSCA) US , 377Ð378 bullying and victimization , 281 PATHS , 378Ð379 description , 273, 277 PeaceBuilders , 379 development , 274, 279 peacemakers project , 379 emotional reactivity requirements, training , 379 description , 276Ð277 Resolving Confl ict Creatively Program (RCCP) , subscales , 278 379Ð380 vulnerability, negative affect and behavior, 280Ð281 Responding in Peaceful and Positive Ways (RIPP) , 380 Index 525

second step, children’s social competence , 380Ð381 Self-control impairment and resilience training , 379 ADHD (see Attention defi cit hyperactivity disorder travel expenses , 380 (ADHD)) Schools behavioral control , 215 behavior management , 462 classroom , 215Ð216 bonding , 29 description , 216 classrooms (see Classrooms) gene and environment interaction , 229Ð230 and community , 464, 470 MTA , 230Ð233 development, child’s experiences , 109 neurofeedback , 234 elementary , 93, 464, 470 outcome studies and methodological issues failure abilities, development , 219 depression and anxiety , 331 community samples , 219Ð220 feelings, confi dence , 330 good adjustments, predictors , 218Ð219 intelligence score , 331 HA , 218 LDs ( see Learning disabilities) research evidence , 219 PBS video , 331Ð332 weakness-and strength-based model , 219 personal strengths and career , 330 predictors and persisters, developmental reading , 331 trajectories resilient behavior , 330 Caucasian boys , 228 self-worth and poker chips , 332 functioning, normalization , 229 spelling diffi culties , 332 HA symptoms , 228Ð229 teachers , 330Ð331 stimulant treatment and subsequent substance use , writing , 330 233Ð234 feeling of bonding , 481 undesirable behavior , 215 group intervention , 465, 468 Self-regulation, PYD high-quality , 460 cognitive and behavioral skill , 298 and home , 41, 107Ð108 healthy functions , 298 ICPS programs , 486 organismic and intentional intensive interventions changes, behaviors , 299 academic achievement and social emotional characteristics, SOC , 301 skills , 339 contribution, individuals quality , 298 analyses, child physiology and academic , 339 defi nition , 299 effects, elementary, middle and high schools , 339 development, action-control beliefs , 299Ð300 placement and academic progress , 340 interindividual differences , 299 teachers and grade-level materials , 339Ð340 loss-based selection (LBS) behaviors , 300Ð301 milieu and neighborhood , 20 physiological and intentional processes , 299 organizational resources , 464 physiological functions , 298Ð299 performance and achievement levels , 109 selection, optimization, and compensation policies , 470 skills , 300 PRP-P , 209Ð210 personal adjustment , 298 public , 490 SEM. See Standard error of measurement (SEM) PYD “Separate self” model , 73, 81 ecological resources , 303 Serotonin transporter gene-linked polymorphic region out-of-school-time , 293 (5HTTLPR) , 135 self-regulation , 298 SES. See Socioeconomic status (SES) structure , 293 Single photon emission computed tomography restructuring , 468Ð469 (SPECT), 169 SEL programs , 263 Social and emotional learning (SEL), education equity success and nurturing parentÐchild relationships , 29 and youth Universal prevention programs , 461 causation, intervention evaluations , 356 Search Institute defi ned , 355 ‘developmental assets’ framework description , 355 adolescence and childhood, empirical studies , 431 implementation , 356 cumulative effect , 431Ð432 interaction, person, environment and time , 356 description , 428Ð430 intervention evaluations , 356Ð357 developmentally attentive community , 437Ð439 poverty and risk categories , 357 external and internal assets , 428, 431 risk categories , 357 thriving indicators, adolescents , 436 school-based prevention programs , 356 surveys , 472 standardized test , 356 SEL. See Social-emotional learning (SEL) theoretical model , 355 526 Index

Social emotional competencies encourage , 489 assessment (see Devereux Center for Resilient foreign American college , 45 Children (DCRC) assessments) functioning , 499 DESSA and DESSA-SSE , 253Ð254 high-risk transitions , 469 impairments, teachers ability homes , 109 children development , 391 intervention and control group, PRP , 208Ð209 imitation , 391 national and local norms, comparison , 268Ð270 learning programs , 391 neighborhoods and communities , 106 Social pain overlap theory , 74 original survey , 98 Social problem-solving (SPS) , 490Ð491 poverty , 119 Socioeconomic status (SES) , 232 PYD Socioemotional development curricular behavior and development , 297 description , 134Ð135 studentÐteacher ratios , 293 GxE , 135Ð136 self-disputing , 207 5HTTLPR , 135 SEL programs , 263Ð264 hypotheses , 134 STEP program , 469 MAOA , 135 suicide , 7 resilience , 136 vulnerability , 284 SPECT. See Single photon emission computed tomography (SPECT) Spivack’s theory , 487 T SPS. See Social problem-solving (SPS) Terror management theory (TNT) , 48 Standard error of measurement (SEM) , 246, 247 The National Longitudinal Transition Study 2 (NLTS2) , 341 Stress TNT. See Terror management theory (TNT) common and unique stressors TransactionalÐecological approach, prevention NCLB , 389 comprehensive model , 117, 120 school reform efforts , 389 conditions and adaptive patterns , 121 survey , 388Ð389 disorders , 120 effects of stressors, teachers exosystems , 120 chronic stress and burnout , 389 mesosystemic relationships , 119 depersonalization , 389 micro and macrosystems , 118Ð119 emotional exhaustion , 389 outcomes, children and youth , 117 impact, physical and emotional , 389 parent training programs , 119Ð120 job turnover , 390 person-setting interactions , 120 physical and mental health , 389 “socio” pathology , 121 impacts, adult ability Trauma direct negative effects, children , 391Ð392 adversities , 465 effects, teacher stress , 390 catastrophic , 18 impairments, teachers ability , 391 children , 3, 7 reduce teacher availability , 390Ð391 experience , 23 Stress inoculation model , 8 older children , 20Ð21 Structural equation models , 45 PTSD , 170 StudentÐeducator interactions Treatment emotional climate , 357 ADHD (see Attention deﬁ cit hyperactivity disorder low academic expectations (ADHD)) educator effects , 359Ð360 child trauma, tenets (see Child trauma, resilience impact, student’s academic outcomes , 359 framework) inequity , 359 chronic antidepressant , 171 student effects , 360 DBT programs , 172 poor educatorÐstudent interactions depression, youth , 202, 204, 211 educator effects , 358 effects , 497 student effects , 358Ð359 massage , 162 Students psychopathology , 15 ABC model , 205Ð206 PTSD , 172 ADHD , 227 residential , 490 adolescents, Iceland , 46 RSCA , 284, 287 classroom , 468 siblings , 64 decision-making and problem-solving , 208 symptom-driven interventions , 4Ð5 developmental assets , 431 youth, injured , 7 Index 527

V “continuum of vulnerability” , 26 Variable-focused approaches , 21 deﬁ ned , 10Ð11, 43 Violence “exceptional characteristics”, child , 6 community , 26, 460 Felner risk/protective factors acquired , 113 neighborhood , 194 genetic , 185 physical , 415, 416 girls , 83 school ( see School) MAOA gene , 97 youth involvement , 435 and resilience , 40, 93 Vulnerability RSCA acquisition , 120, 121 bullying and victimization , 281 ADHD , 189 Ellen’s Personal Resiliency Proﬁ le , children , 20 284, 286, 287 and competencies , 112, 113 emotional reactivity , 278, 280Ð281