'At-risk' concept (child development)

 

Introduction

The at-risk concept lies at the heart of developmental and clinical psychology and is a fundamental concept in understanding developmental pathology. Children are called developmentally ‘at-risk’ when biopsychological characteristics, or social factors, or both, suggest that they will, with high probability, develop into maladapted unsuccessful adolescents or adults. Examples of such outcomes include school failure, persistent unemployment, delinquency, aggression, risky behaviors, alcoholism, drug abuse, eating disorders, psychosomatic disorders, and psychopathology.

Early research endeavors aimed at detecting signs of deviant development, or of deviant conditions for development, as early as possible in order to be able to suggest preventive, or compensatory interventions. More recent research and theorizing has elaborated the at-risk concept and extended risk models to include related concepts, such as ‘vulnerability’, and complementary concepts, such as ‘protective factors’ and ‘resilience.’

Empirical approaches

Risk evidence is based on retrospective analyses and, ideally, on prospective follow-up or longitudinal research. Retrospectively, most children with school problems, and most maladapted adolescents or adults, have indeed disproportionately unfortunate childhoods, often correlated with early health problems. Longitudinal and follow-up studies have also confirmed that early health risks (preterm birth, prenatal teratogenic influences, perinatal problems), as well as early social or family problems (e.g., poverty, low educational level of the parents, family discord), significantly and substantially predicted later personality and behavioral problems. However, under equivalently adverse circumstances, some children developed into well-adapted, healthy, and successful adults. They appeared to be ‘resilient,’ or ‘invulnerable,’ or ‘resourceful.’

Results from most empirical studies apply only at a group level. In other words, they are useful for identifying variables in early childhood that are significantly associated with later poor outcomes, but not every individual with them has such outcomes. The term ‘at-risk’ simply implies an increased probability of poor outcome, not a certain outcome for each individual. More recent research endeavors, therefore, include the analyses of individual pathways, and the search for those factors that enable a person to withstand the odds, or to recover from deviation.

The at-risk concept, vulnerability, and resources

In psychological research, the term ‘at-risk’ has mainly been used to characterize persons with limited personal, health, social, or cultural resources. Under optimal and supportive conditions, they would have a fair chance of developing inconspicuously, but they would fail to cope with additional stress associated, for instance, with developmental transitions (e.g., puberty), or with highly probable critical events (e.g., school change, change of peer network), or with hazards of life (e.g., parental divorce, loss of family member, major school failure, major sociopolitical changes). In this regard, children who are born preterm, or those with chronic illnesses, are considered as developmentally at-risk, or at least as ‘vulnerable.’ Similarly, physically healthy children who come from poor and from unfavorable homes may lack the necessary social and emotional support to cope with additional stressful situations. Some early personality characteristics (e.g., difficult temperament, shyness) and sub-optimal emotional relationships (e.g., insecure attachments) may also function as limited resources in challenging situations.

Finally, periods of developmental transition, such as that from sensorimotor intelligence to representational thought, or puberty, may disclose latent vulnerabilities and emotional instabilities. Children at developmental risk may lack the necessary variability and flexibility of responses (or resiliency), or they have insufficient access to social resources, to cope successfully with these new challenges (O’Connor & Rutter, 1996).

Table 1. Delineation of what is involved in the ‘at-risk’ concept.


Level

Risk

Protection

Factors

Biological risks, social risks Established risks versus at-risk

Biological, social, and cultural resources

Personal level Mechanisms

Vulnerability

Inadequate coping

Inadequate parenting


Lack of curiosity and exploration

Risky behavior Negative transactions

Resilience Coping

Positive parenting Stress training Curiosity and exploration Consideration Positive transactions

Outcome

Maladaptation Psychopathology

Psychologically healthy person

Developmental risk and sensitive periods

The notion of’critical’ or ‘sensitive’ periods implies a very specific susceptibility to external influences. With regard to noxious (i.e., teratogenic) influences on the developing organism, the early embryonic period is considered to be particularly perilous for organ malformations, whereas during the fetal period and early infancy, in times of rapid brain growth, the formation of neural connections can be disrupted or distorted by teratogenic influences (e.g., maternal drug exposure).

The notion of sensitive periods has also been used with regard to experiences during developmentally specific ‘time-windows’. In the case of ‘experience-expectant processes,’ specific kinds of experiences are necessary in order to fine-tune and complete a particular function (e.g., stereoscopic vision), or to orient the child’s attention to certain aspects of the world (e.g., the visual or the acoustical world, specific aspects of the mother tongue). In a broader sense, infancy and toddler-hood constitute a sensitive period for the development of language, communication, and socioemotional attachment. If developmentally appropriate experiences are missed, or distorted, or extremely delayed, as might occur with blind or deaf infants or in cases of massive neglect, later acquisition of these competencies will at best be more arduous, but the result may also be deviant. Also, the kinds of experiences that the infant encounters lay the grounds for usually long-lasting individual differences, as shown, for instance, in the cases of language development and attachment formation.

The term ‘sensitive period’ has also been used for a child’s cognitive and motivational ‘readiness’ to learn cultural standards and techniques with age-appropriate ease. There has been a never-ending debate over whether there are general or specific optimal time-windows for specific cultural learning experiences (e.g., toilet training, learning to read and to write, mathematics, school entry generally), and whether ‘precocious’ or ‘delayed’ learning constitute ‘special opportunities’ or ‘risks.’ Initially, researchers and politicians had hoped that compensatory preschool intervention would inoculate socially disadvantaged children against early school failure. Although generally a relative success story, these very ambitious aims of early interventionists were not met.

At-risk versus established risk

Occasionally, special populations of children with well-diagnosed physical or mental disorders (e.g., Down’s syndrome) have been called ‘at-risk.’ Strictly speaking, the at-risk concept can be only meaningfully applied to these sub-groups with established risks when referring to secondary handicaps (see Table 1). Secondary handicaps are, for instance, particularly poor learning strategies, poor social strategies, or an inadequate self-esteem, or other kinds of problem behaviors that are likely to result from inappropriate parenting. Intuitive parenting seems to be developed fairly well in parents with ‘normal’ children. With physically or behaviorally deviant children, it is often more difficult to establish the optimal fit between the child’s developmental needs and parental behavior. Parents often tend to be either overprotective, or insensitive to the weak behavioral signs of their infant. An attitude of learned helplessness may ensue in the child that inhibits active learning and exploration, both of which are important prerequisites for healthy psychological development.

Risk factors and protective factors

Risk factors are influences on the young child and the developing person that are likely to alter that individual’s personal resources. Specific kinds of risks and outcomes have proven to be only loosely related (Rutter, 2002). It is more likely that the accumulation of different kinds of risks increases the probability of some kind of negative outcome, generally speaking. Two classes of risk factors are roughly distinguished in developmental research: biological risk factors (e.g., preterm birth, perinatal complications) and social risk factors (e.g., low parental education, poverty, parental discord, parental mental illness, maternal depression). Scores constructed from cumulated biological risks are supposed to indicate an increased probability of psychobiological vulnerability, and scores from cumulated, chronic or acute, social risks a heightened probability of psychosocial stress.

Risk models differ as to whether they combine both risk sources additively or multiplicatively. An additive model implies that maladaptation or psychopathology increase linearly with the number of biological and social risk factors, and a multiplicative model that the effect of social risk factors is relatively higher for children with biological risks, and the effect of biological risks is greater for children living in adverse social circumstances. It appears that the additive models hold well for children born slightly preterm. For children of epileptic mothers, the multiplicative model seems to be more adequate. In the case of control children from similar social backgrounds, however, only the quality of the family environment (e.g., as measured by the HOME inventory) during early childhood seems to affect their cognitive abilities during adolescence. For children of epileptic mothers, especially those exposed in utero to antiepileptic drugs taken by their mothers, the quality of the family environment during the school years and in early adolescence adds to variations in outcome measures. It seems that children of epileptic mothers are both more sensitive, and sensitive over a longer period of development, to adverse social influences, but also to positive social influences (Titze et al.,2001).

As a complement to the study of risk factors, research into potential protective factors has come into focus. In many instances, they are simply the positive counterparts of risk factors, as applies to poor or good parenting. Also, cultural factors can act as protective factors (and probably also as risk factors). Infants with a ‘difficult temperament’ seem to develop inconspicuously in a cultural environment that is accepting for those variations, as was observed in Latin-American families in New York. Variable-centered approaches concerned with what kinds of risk predict which outcomes tend now to yield to more person-centered approaches, with a focus on what kinds of risk affect which sub-group of children.

From risk factors to risk mechanisms

Recent research has focused on patterns of development, or trajectories, of children at high or low risk, and on potential mechanisms that, along the trajectories, translate biological and social risk factors into psychological dysfunctioning (Rutter, 2002). Early biological risks (e.g., preterm birth) can change the infant’s appearance or temperament in such a way that the caregivers respond less adequately (e.g., less sensitively, or with overprotection), thus creating a sub-optimal rearing climate. Biological risks can generally reduce a child’s physical and psychological resources, constrain his or her information-processing capacities, or de-stabilize the child’s self-regulation abilities (Lengua, 2002).

Supportive environments may partially compensate for the child’s reduced resources, but quite often a less supportive, or a disadvantaged, environment provokes situational coping strategies (e.g., aggressive or shy behavior) that, in the long run, may lead to problem behavior. Children at biological risk or in threatening environments tend to show fewer developmentally beneficial cognitive and social behaviors, such as curiosity and exploration. Instead, they tend either to avoid challenging situations or to overreact with disruptive emotions, both kinds of coping that will restrain their developmental potential even further (Rauh, 1989).

Resilience

Children are considered at-risk when they encounter hazardous life circumstances or events that clearly exceed normal resources (e.g., warfare, natural or social disasters). Those who, against all predictions, do not succumb to these adversities are considered to have special resiliencies (i.e., a pre- or acquired disposition enabling them to withstand major hazards and to return to a normal life course). It is a kind of self-righting potential, and also refers to a child’s ability to draw effectively on all available personal and social resources.

Successful coping with everyday challenges appears to be a kind of ‘stress training’ or ‘steeling,’ and may help to build up a repertoire of personal resources (Rutter, 2002). Coping with risky situations can, to some degree, be learned and can serve as preparations for future difficult situations. The term ‘at-risk’ could consequently also be applied to those children who, in spite of a sufficient health status, and in spite of general abilities and social conditions within the normal range, do not develop an adequate repertoire of personal or social resources to cope with stressful or risk-carrying situations. These would be the children who as adolescents, without any obvious risk factors, succumb to drug abuse or are seduced to partake in risky behaviors.

Risk-provoking behaviors

Particularly during adolescence, but also in childhood, some individuals engage in risky behaviors in that they actively provoke risky situations. Most of these youths seem to lack a proper sensitivity to dangers and threats. Their self-concept is disproportionately positive, their social perception appears to be inadequate, and their role-taking underdeveloped. While some of these characteristics are reminiscent of adolescent egocen-trism, others refer to inadequate emotion regulation (e.g., a reduced ability to attend, an inability to learn systematically, difficulties in controlling impulses), or to a need for sensation. These young people seem to literally select, and attract, or even produce, adverse events and hazardous experiences.

Debatable issues

There has been a debate about whether the same mechanisms account for behavioral variations within the normal range, as well as for psychopathology (Rutter, 2002). In a similar vein, there has also been debate about whether the same kinds of processes account for the development of competence or dysfunction, or whether different ones should be considered for children with either heightened or reduced susceptibility to specific risk influences. Moreover, the concepts of resiliency and vulnerability as general personality traits seem to yield to ideas of domain-specific, or even age-specific characteristics.

Conclusions

The at-risk concept combines research on biological and psychological development with that on socialization, as well as models of developmental psychology and differential psychology, with those of developmental psychopathology. Research based on this concept provides ideas for the prevention of adverse developmental outcomes and for early intervention, with its focus not only on the individual, but also on the social and cultural context in which the child develops.

The different aspects of ‘at-risk’ that have been detailed here have given rise to quite diverse and sometimes divergent research traditions that, in the future, will need to communicate with each other. To date, most developmental risk research has been limited too narrowly to the nuclear family, and to the periods of early childhood and of adolescence. Future research needs to take a broader perspective in developmental time and in social space, and, at the same time, needs to study in more detail the transformations of risk experiences into concrete transactions and coping behaviors at the personal level. This implies a more dynamical view of the developing person in his or her immediate environment.

Furthermore, very little is known about the impact of cultural differences, and of social and cultural changes on kinds of risk and protective factors, and on related changes in risk outcomes. Epidemiological studies with longitudinal and time-sequential designs that would take these cultural factors into account are still extremely rare. Even if we might know what have been risk influences in the past with effects in the present time, we are still broadly ignorant of the future impact that contemporary risk factors may have on children when they become adolescents and adults.

Finally, there are studies suggesting that some risk effects (e.g., maltreatment, holocaust) may extend even into the next generation. This appears to be plausible for extreme personal experiences. Life circumstances have changed markedly in the past decades. Children survive who would never have done so before, such as extremely preterm children and those with chronic illnesses. Many children are protected today from adverse circumstances that were regular events in previous generations (e.g., certain types of illnesses, family member losses). New life patterns and new challenges in children’s lives have appeared. We do not know, for example, whether growing up in single-parent households, although usually coped with well by most children, may affect these children’s behavior as parents, or whether experiences with street violence will extend into the next generation.

Next post:

Previous post: