Howard Dubowitz1, Richard Thompson2, Laura Proctor3, Richard Metzger4, Maureen M Black4, Diana English5, Gina Poole6, Lawrence Magder7. 1. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Md. Electronic address: hdubowitz@peds.umaryland.edu. 2. Richard H. Calica Center for Innovation in Children and Family Services, Juvenile Protective Association, Chicago, Ill. 3. Judge Baker Children's Center, Harvard Medical School, Boston, Mass. 4. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Md. 5. School of Social Work, University of Washington, Seattle, Wash. 6. Human Services Psychology, University of Maryland Baltimore County, Baltimore, Md. 7. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md.
Abstract
BACKGROUND: Much of the research on children in high risk environments, particularly those who have been maltreated, has focused on negative outcomes. Yet, much can be learned from some of these children who fare relatively well. The objective was to examine resilience in high-risk preschoolers, and to probe contributors to their adaptive functioning. METHODS: The sample of 943 families was from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 sites, prospectively examining the antecedents and outcomes of maltreatment. Most of the families were at high risk for maltreatment, and many had been reported to Child Protective Services (CPS) by the time the children were aged 4 years. Standardized measures were used at ages 4 and 6 to assess the children's functioning in behavioral, social and developmental domains, and parental depressive symptoms and demographic characteristics. Maltreatment was determined on the basis of CPS reports. Logistic regressions were conducted to predict resilience, defined as competencies in all 3 domains, over time. RESULTS: Forty-eight percent of the sample appeared resilient. This was associated with no history of maltreatment (odds ratio = 1.50; 95% confidence interval [CI], 1.02-2.20; P = .04), a primary caregiver reporting few depressive symptoms (odds ratio = 2.19; 95% CI, 1.63-2.94; P < .001), (P = .014), and fewer children in the home (P = .03). CONCLUSIONS: Almost half of the sample appeared resilient during this important developmental period of transition to school. This enables clinicians to be cautiously optimistic in their work with high-risk children and their families. However, more than half the sample was not faring well. Child maltreatment and caregiver depressive symptoms were strongly associated with poor outcomes. These children and families deserve careful attention by pediatric practitioners and referral for prevention and early intervention services.
BACKGROUND: Much of the research on children in high risk environments, particularly those who have been maltreated, has focused on negative outcomes. Yet, much can be learned from some of these children who fare relatively well. The objective was to examine resilience in high-risk preschoolers, and to probe contributors to their adaptive functioning. METHODS: The sample of 943 families was from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 sites, prospectively examining the antecedents and outcomes of maltreatment. Most of the families were at high risk for maltreatment, and many had been reported to Child Protective Services (CPS) by the time the children were aged 4 years. Standardized measures were used at ages 4 and 6 to assess the children's functioning in behavioral, social and developmental domains, and parental depressive symptoms and demographic characteristics. Maltreatment was determined on the basis of CPS reports. Logistic regressions were conducted to predict resilience, defined as competencies in all 3 domains, over time. RESULTS: Forty-eight percent of the sample appeared resilient. This was associated with no history of maltreatment (odds ratio = 1.50; 95% confidence interval [CI], 1.02-2.20; P = .04), a primary caregiver reporting few depressive symptoms (odds ratio = 2.19; 95% CI, 1.63-2.94; P < .001), (P = .014), and fewer children in the home (P = .03). CONCLUSIONS: Almost half of the sample appeared resilient during this important developmental period of transition to school. This enables clinicians to be cautiously optimistic in their work with high-risk children and their families. However, more than half the sample was not faring well. Child maltreatment and caregiver depressive symptoms were strongly associated with poor outcomes. These children and families deserve careful attention by pediatric practitioners and referral for prevention and early intervention services.
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