Friday Forum Recap: Promoting Resilience in Highly Stressed Children
On May 13, 2016, Dr. Abigail Gewirtz presented a Friday Forum Encore on Promoting Resilience in Highly-Stressed Children: Long-term Program Findings. In her presentation, Dr. Gewirtz addressed three key questions: What is resilience in children? What do we know about parenting and its association with child adjustment among families facing traumatic and/or highly stressful events? And, can prevention programs to strengthen parenting improve children’s resilience? A recap of the presentation is provided below.
What is resilience? Children and youth are considered resilient, if they appear to be ‘doing OK’—that is, functioning in the normative range with regard to social, emotional, behavioral, and academic adjustment, despite experiencing adversity (i.e., stressful and/or traumatic living conditions). Several long term studies on resilience have revealed individual, family, and environmental conditions or characteristics that promote resilience. Across multiple studies, the ‘shortlist’ of factors that are associated with children’s resilience includes effective parenting or caregiving. [1]
What do we know about parenting and its association with child adjustment among families facing traumatic and/or highly stressful events? Most of the research on resilience focuses on adjustment in general conditions of ‘cumulative risk’—that is, stressors such as having a mentally ill parent, living in poverty, living in an overcrowded home, etc. This developmentally-oriented literature has shown that effective parenting is particularly important for children in risky situations—and that it is in these risky contexts that parenting is most likely to be impaired. For example, studies of families affected by the Great Depression, farm families and African American families in the rural South have shown that poverty places children at risk for poor psychosocial outcomes by stressing parents and their parenting.[2,3] That is, parenting appears to mediate the associations between stressful family events and child adjustment. A somewhat separate literature has examined the impact of traumatic events (i.e., those events involving a threat to life or limb) on adults and children.[4] Only recently have those two literatures become more integrated, paving the way for a detailed examination of how stressful and traumatic events might impact the family (i.e., parents, their parenting practices, and their children’s adjustment). This line of research is important because it provides clues about how we might best intervene to prevent and/or treat families facing adverse events.
In order to understand parenting in stressful and traumatic contexts, we need to understand how traumatic events affect parents and their parenting, and how the impact on parenting might affect children’s adjustment. Our research lab has been examining these questions among families affected by parent(s)’ deployment to war in Iraq or Afghanistan, with support from the National Institutes of Health (DA-R01-030114), and the Department of Defense (ADAPT4U grant #W81XWH1410143). Since the start of the wars in Afghanistan and Iraq that began after the terrorist events of 9/11/2001, more than a million service members have been deployed to the Middle East, and over two million children have been affected by the deployment of one or both of their parents.[5] Almost half of the US military force deployed to the conflicts were ‘civilian soldiers’—that is, members of the National Guard and Reserves (NG/R). NG/R service members faced significant and often unexpected disruptions to their civilian lives as a result of deployment. Some research indicates that NG/R personnel are at higher risk for PTSD and substance use disorders than regular active-duty personnel. Moreover, because NG/R service members are, on average, older than Active Over personnel, they are more likely to be partnered and parenting. Yet NG/R service members have less access to the services and supports commonly available on military installations. A study of more than 600 National Guard male soldiers deployed to Iraq in 2008-2009 showed that soldiers’ posttraumatic stress symptoms at the end of their deployment predicted less effective parenting (as reported by soldiers themselves) a year later.[6]
Can prevention programs to strengthen parenting improve children’s resilience? We recently completed a randomized controlled trial of the first evidence-based parenting program specifically designed to support NG/R families with school-aged children in which a parent had returned from deployment. The trial allows us not only to rigorously evaluate the program, known as ADAPT—After Deployment, Adaptive Parenting Tools—but also to learn about parenting and child adjustment in deployed military families. Using multi-informant, multi-method measures (i.e., parent, teacher, and child report of child adjustment; observations of parent-child interactions to measure parenting, and father and mother reports of couple adjustment) we are learning a tremendous amount about this highly stressed population.
Analysis of our baseline data from the 336 families participating in the study demonstrates that rather than length or number of deployments detrimentally affecting the family (i.e., couple parenting, couple adjustment, and children’s adjustment), mothers’ and fathers’ PTSD symptoms were the key stressors significantly associated with children’s adjustment (as reported by teachers, parents, and children themselves). Mothers’ (but not fathers’) PTSD symptoms also negatively affected the couple’s parenting practices; poorer parenting in turn was associated with poorer children’s adjustment.[7] Examining just deployed fathers’ parenting, longer deployments, and lower family income were associated with fathers’ less effective observed parenting practices.[8] We also compared the adjustment of deployed with never-deployed mothers: deployed mothers experienced worse PTSD symptoms, more past year adverse life events, and more difficulties in emotion regulation. However, there were no differences between the two groups of mothers in their appraisal of their parenting or their child’s adjustment. We continue to examine change and stability in associations over time.[9]
After baseline data collection, families were randomly assigned to the 14-week long ADAPT group or a treatment-as-usual condition. The group targeted key positive parenting skills including teaching through encouragement, emotion socialization, discipline, problem-solving, monitoring, and positive involvement with children. Parents practiced skills in group, and were provided home practice exercises, and a website with demonstrations of the skills and related resources. Seventy-five percent of the families who were assigned to the ADAPT condition came to at least one session, and most of those came to more than seven sessions; mothers and fathers attended almost in equal proportions (47% fathers; 53% mothers). Both mothers and fathers reported high satisfaction with the program.[10]
We examined whether the program had an impact on parents’ self-efficacy, their parenting, their children’s adjustment, and their own mental health, at 6 months, 1 year, and 2 years post-baseline. Using intent-to-treat analyses, (i.e., comparing everybody assigned to the control condition with everybody assigned to the ADAPT condition regardless of whether they actually participated in the group) we found that ADAPT significantly improved observed parenting of couples at 1 year, and improved children’s adjustment (both internalizing and externalizing problems, reported by parents, children, and teachers).[11] Improvements to parenting self-efficacy at 6 months, also led to reductions in both mothers’ and fathers’ PTSD symptoms and suicidality at one year.[12] Analysis of 2-year program findings is just starting. Our findings parallel earlier findings of civilian parenting programs, for example with divorced families, which show that parenting programs have cascading changes on multiple outcomes within families, for parents, children, and parenting. Indeed, two classic divorce studies have shown improvements from prevention parenting programs lasting nearly a decade or more.[13,14]
In sum, prevention research has demonstrated that effective, evidence-based prevention programs targeting parenting can have powerful effects on families. By improving parenting practices—and parents’ self-efficacy—these programs appear to initiate a cascade of positive outcomes to improve children’s resilience, as well as their parents’ mental health.
Abigail Gewirtz, Ph.D., L.P., is Lindahl Leadership Professor in the Department of Family Social Science and the Institute of Child Development at the University of Minnesota, and Director of its Institute for Translational Research in Children’s Mental Health.
References
1. Masten AS. Ordinary magic: Resilience processes in development. Am Psychol, 2001;56: 227–238.
5. Department of D. Profile of the Military Community [Internet]. Department of Defense; 2009. Available: http://download.militaryonesource.mil/12038/MOS/Reports/2009-Demographics-Report.pdf
7. Gewirtz, A. H., DeGarmo, D. S., & Zamir, O. Testing a military family stress model.
