Survival of the strongest
Some problem children come out of care well-adjusted, others still traumatised. Just luck or is there a cure-all?
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Thursday 24 September 1998
All parents have asked themselves a version of this question. Divorce, bereavement, the stress of joining a new school or of taking exams - all these strike different children differently. What are the qualities that make some children more resilient than others, and can their resilience be strengthened?
Frank Dobson, the Secretary of State for Health, would like an answer. This week, Mr Dobson announced a crackdown on failing social service departments who have allowed children to languish in care with the result that although they account for less than one per cent of the child population and their care costs well over pounds 10,000 a year each - more than the fees at Eton - they are also responsible for 40 per cent of juvenile crime and comprise, when they leave care, one third of the homeless on the streets.
Most parents who had paid pounds 10,000 a year for their child's education only to see them end up flogging The Big Issue from a sleeping bag on the Strand would demand their money back and that, in effect, is what Mr Dobson is threatening. But is he right? What can be done to turn social disadvantage into social success?
Few people are better placed to provide an answer than Professor Sir Michael Rutter, doyen of child psychiatrists and an intellectual behemoth in the field of psychosocial research. Professor Rutter, who retires this month from the Institute of Psychiatry, has spent much of his 40- year career examining the factors that make some children thrive while others don't. He has written 30 books and over 400 articles and his contribution to the field is to be celebrated at the Royal College of Psychiatrists annual meeting in Bristol this week. As the father of three grown up children, now with children of their own, he also knows something about surviving the rigours of adolescence - for both parent and child.
In the 1950s, the received wisdom, exemplified by the writings of the psychotherapist John Bowlby, was that all children who suffered bad experiences were permanently damaged. Today, it is taken for granted that however devastating the experience to which children are exposed, some will come through.
A study of children rescued from Romania's orphanages in the early 1990s showed half were mentally retarded and a third were suffering from malnutrition. Professor Rutter said: "They were in pretty bad nick. We have all seen films of the orphanages - they were dreadful. Some of the children had spent two, three, four years in conditions beyond anything seen in this country and you might suppose that would have led to a uniformity of outcome. It did not."
By the age of six, some of those who were rescued were still retarded while others had IQs as high as 130, the mark of superior intelligence. "The interest then was on what were the mechanisms that determined some did well while others did badly. Does resilience lie in the detail of the experiences or in what happens afterwards?"
The answers are still coming in. Some evidence points to biological effects. Experiments in rats, for example, show that animals subjected to stress develop larger adrenal glands which then accentuate their response to subsequent stress. Changes in the hormonal systems of the Romanian children have been detected but their significance remains unclear.
Other evidence suggests children develop a mind set in response to suffering. A high proportion of those raised in institutions lack a "planning tendency" - interest in the future in terms of marriage or career - and act impulsively. In the case of girls, this may lead to early pregnancy and co-habitation as a means of escape. "They developed a mind set that they were at the mercy of fate and couldn't affect what happened to them," says Rutter. But another group who had done well at school or achieved some other success did better. Success in one arena of their lives gave them a feeling of efficacy and helped them to cope with challenges."
Every parent will recognise these features in their experience of their own children. Adolescence, Professor Rutter says, is much more difficult for today's children because they face more difficult choices - about drugs and alcohol, for example - and because, with the extension of full time education beyond the age of puberty, they are mature but economically dependent. The task, both for parents and the care system, is to allow them freedom without abandoning them. "Children need to take responsibility and they have to be allowed to make mistakes. You [the parents/carers] have to weigh things up so that the likelihood of success outweighs the likelihood of failure. But part of growing up involves learning to cope with difficulties. To remove the difficulties is neither practicable nor helpful."
A key point is that the risks associated with psychological damage are cumulative. Even where a family situation is very bad, reducing the overall level of risk can be helpful. What matters is how the risks impinge directly on the child. Thus, poverty is less important as a risk factor than the parental conflict it can give rise to which may in turn lead to parental rejection or scapegoating of the child. By helping parents to avoid embroiling children in their conflict, the damage can be lessened.
Of his own three children - now in their thirties, one a doctor, one a psychologist and one taking a break from her job in personnel to raise a family - Rutter says there were "periods of anxiety" during their adolescence over their friends and other choices they made. "The important thing is to maintain relationships - to be guiding the children without interfering. It doesn't pay to be heavy-handed but it is equally wrong to assume that they don't want guidance. Even when they are being rebellious, children pay a lot of attention to what their parents say. Keeping the lines of communication open can be quite difficult sometimes."
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