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DeJoseph ML, Ellwood-Lowe ME, Miller-Cotto D, Silverman D, Shannon KA, Reyes G, Rakesh D, Frankenhuis WE. The promise and pitfalls of a strength-based approach to child poverty and neurocognitive development: Implications for policy. Dev Cogn Neurosci 2024; 66:101375. [PMID: 38608359 PMCID: PMC11019102 DOI: 10.1016/j.dcn.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
There has been significant progress in understanding the effects of childhood poverty on neurocognitive development. This progress has captured the attention of policymakers and promoted progressive policy reform. However, the prevailing emphasis on the harms associated with childhood poverty may have inadvertently perpetuated a deficit-based narrative, focused on the presumed shortcomings of children and families in poverty. This focus can have unintended consequences for policy (e.g., overlooking strengths) as well as public discourse (e.g., focusing on individual rather than systemic factors). Here, we join scientists across disciplines in arguing for a more well-rounded, "strength-based" approach, which incorporates the positive and/or adaptive developmental responses to experiences of social disadvantage. Specifically, we first show the value of this approach in understanding normative brain development across diverse human environments. We then highlight its application to educational and social policy, explore pitfalls and ethical considerations, and offer practical solutions to conducting strength-based research responsibly. Our paper re-ignites old and recent calls for a strength-based paradigm shift, with a focus on its application to developmental cognitive neuroscience. We also offer a unique perspective from a new generation of early-career researchers engaged in this work, several of whom themselves have grown up in conditions of poverty. Ultimately, we argue that a balanced strength-based scientific approach will be essential to building more effective policies.
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Affiliation(s)
| | | | | | - David Silverman
- Department of Psychology, Northwestern University, United States
| | | | - Gabriel Reyes
- Graduate School of Education, Stanford University, United States
| | - Divyangana Rakesh
- Neuroimaging Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Willem E Frankenhuis
- Evolutionary and Population Biology, Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, the Netherlands; Max Planck Institute for the Study of Crime, Security, and Law, Germany
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2
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Bouchelle Z, Darwiche S, Dalembert G. Financial support policies as a mechanism to reduce child welfare involvement. Curr Probl Pediatr Adolesc Health Care 2024; 54:101554. [PMID: 38184448 DOI: 10.1016/j.cppeds.2023.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Affiliation(s)
- Zoe Bouchelle
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Denver Health, Denver, CO, United States; Guaranteed Income and Health Consortium, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Sabrina Darwiche
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - George Dalembert
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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3
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Bouchelle Z, Nelin TD, Salazar E, Duncan AF, Parker MG. Unconditional cash transfers for preterm neonates: evidence, policy implications, and next steps for research. Matern Health Neonatol Perinatol 2024; 10:2. [PMID: 38183138 PMCID: PMC10768437 DOI: 10.1186/s40748-023-00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
To address socioeconomic disparities in the health outcomes of preterm infants, we must move beyond describing these disparities and focus on the development and implementation of interventions that disrupt the factors contributing to them. Unconditional cash transfers (UCTs), which provide unrestricted payments to individuals or households, can help mitigate income disparities and improve health outcomes. While UCTs have been utilized for other vulnerable populations, their full potential has yet to be realized for low-income families with preterm infants, who face significant financial strain. In this perspective, we review evidence supporting UCTs as an intervention for children in the U.S. (including those born term and preterm), discuss the potential benefits of recurring UCTs to low-income families of preterm infants, and propose a conceptual model through which UCTs may improve outcomes for preterm infants. We conclude with potential policy levers for implementing UCTs and key unanswered questions for researchers.
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Affiliation(s)
- Zoe Bouchelle
- Department of Pediatrics, Denver Health, Denver, CO, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Guaranteed Income and Health Consortium, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy D Nelin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Elizabeth Salazar
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea F Duncan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Margaret G Parker
- Department of Pediatrics, UMass Chan School of Medicine, Worcester, MA, USA
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DiFiore G, Wood S, Jenssen BP, Fiks AG, Mayne SL. Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity. Pediatrics 2023; 152:e2023062657. [PMID: 37974515 PMCID: PMC10774653 DOI: 10.1542/peds.2023-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
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Affiliation(s)
| | - Sarah Wood
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Jenssen
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Ramphal B, Pagliaccio D, Dworkin JD, Herbstman J, Noble KG, Margolis AE. Timing-specific associations between income-to-needs ratio and hippocampal and amygdala volumes in middle childhood: A preliminary study. Dev Psychobiol 2021; 63:e22153. [PMID: 34674248 DOI: 10.1002/dev.22153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 01/23/2023]
Abstract
It is well known that financial disadvantage is associated with alterations in brain development in regions critical to socioemotional well-being such as the hippocampus and the amygdala. Yet little is known about whether family income at different points in development is differentially associated with these structures. Furthermore, little is known about which environmental factors statistically mediate associations between income and subcortical structure. Using a longitudinal birth cohort and linear mixed-effects models, we identified associations between income-to-needs ratio (INR) at 6 timepoints throughout childhood and hippocampal and amygdala volumes at age 7-9 years (n = 41; 236 INR measurements; 41 brain measurements). Mediation analysis identified environmental sequelae of income that statistically accounted for INR-brain associations. Lower INR prior to age 4 was associated with smaller hippocampal volumes, whereas lower INR prior to age 2 was associated with smaller right amygdala volume. These associations were mediated by unmet basic needs (e.g., food, housing). These findings delineate the temporal specificity of associations between income and hippocampal and amygdala structures.
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Affiliation(s)
- Bruce Ramphal
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - David Pagliaccio
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jordan D Dworkin
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kimberly G Noble
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Amy E Margolis
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Noble KG, Magnuson K, Gennetian LA, Duncan GJ, Yoshikawa H, Fox NA, Halpern-Meekin S. Baby's First Years: Design of a Randomized Controlled Trial of Poverty Reduction in the United States. Pediatrics 2021; 148:e2020049702. [PMID: 34475270 PMCID: PMC8487960 DOI: 10.1542/peds.2020-049702] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 02/01/2023] Open
Abstract
Childhood economic disadvantage is associated with lower cognitive and social-emotional skills, reduced educational attainment, and lower earnings in adulthood. Despite these robust correlations, it is unclear whether family income is the cause of differences observed between children growing up in poverty and their more fortunate peers or whether these differences are merely due to the many other aspects of family life that co-occur with poverty. Baby's First Years is the first randomized controlled trial in the United States designed to identify the causal impact of poverty reduction on children's early development. A total of 1000 low-income mothers of newborns were enrolled in the study and began receiving a monthly unconditional cash gift for the first several years of their children's lives. Mothers were randomly assigned to receive either a large monthly cash gift or a nominal monthly cash gift. All monthly gifts are administered via debit card and can be freely spent with no restrictions. Baby's First Years aims to answer whether poverty reduction in early childhood (1) improves children's developmental outcomes and promotes healthier brain functioning, and (2) improves family functioning and better enables parents to support child development. Here we present the rationale and design of the study as well as potential implications for science and policy.
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Affiliation(s)
- Kimberly G Noble
- Departments of Biobehavioral Sciences and Human Development, Teachers College, Columbia University, New York, New York
| | | | - Lisa A Gennetian
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Greg J Duncan
- School of Education, University of California, Irvine, Irvine, California
| | - Hirokazu Yoshikawa
- Department of Applied Psychology, New York University, New York, New York
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Sarah Halpern-Meekin
- Department of Human Development and Family Studies and La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin
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7
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Society to cell: How child poverty gets “Under the Skin” to influence child development and lifelong health. DEVELOPMENTAL REVIEW 2021. [DOI: 10.1016/j.dr.2021.100983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities. Dev Psychopathol 2021; 33:614-624. [PMID: 33955340 DOI: 10.1017/s095457942000173x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.
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Gonzalez MR, Palmer CE, Uban KA, Jernigan TL, Thompson WK, Sowell ER. Positive Economic, Psychosocial, and Physiological Ecologies Predict Brain Structure and Cognitive Performance in 9-10-Year-Old Children. Front Hum Neurosci 2020; 14:578822. [PMID: 33192411 PMCID: PMC7655980 DOI: 10.3389/fnhum.2020.578822] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
While low socioeconomic status (SES) introduces risk for developmental outcomes among children, there are an array of proximal processes that determine the ecologies and thus the lived experiences of children. This study examined interrelations between 22 proximal measures in the economic, psychosocial, physiological, and perinatal ecologies of children, in association with brain structure and cognitive performance in a diverse sample of 8,158 9-10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study. SES was measured by the income-to-needs ratio (INR), a measure used by federal poverty guidelines. Within the ABCD study, in what is one of the largest and most diverse cohorts of children studied in the United States, we replicate associations of low SES with lower total cortical surface area and worse cognitive performance. Associations between low SES (<200% INR) and measures of development showed the steepest increases with INR, with apparent increases still visible beyond the level of economic disadvantage in the range of 200-400% INR. Notably, we found three latent factors encompassing positive ecologies for children across the areas of economic, psychosocial, physiological, and perinatal well-being in association with better cognitive performance and the higher total cortical surface area beyond the effects of SES. Specifically, latent factors encompassing youth perceived social support and perinatal well-being were positive predictors of developmental measures for all children, regardless of SES. Further, we found a general latent factor that explained relationships between 20 of the proximal measures and encompassed a joint ecology of higher social and economic resources relative to low adversity across psychosocial, physiological, and perinatal domains. The association between the resource-to-adversity latent factor and cognitive performance was moderated by SES, such that for children in higher SES households, cognitive performance progressively increased with these latent factor scores, while for lower SES, cognitive performance increased only among children with the highest latent factor scores. Our findings suggest that both positive ecologies of increased access to resources and lower adversity are mutually critical for promoting better cognitive development in children from low SES households. Our findings inform future studies aiming to examine positive factors that influence healthier development in children.
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Affiliation(s)
- Marybel Robledo Gonzalez
- Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Clare E. Palmer
- Center for Human Development, University of California, San Diego, San Diego, CA, United States
| | - Kristina A. Uban
- Public Health, University of California, Irvine, Irvine, CA, United States
| | - Terry L. Jernigan
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Center for Human Development, University of California, San Diego, San Diego, CA, United States
| | - Wesley K. Thompson
- Department of Family Medicine and Public Health, Division of Biostatistics, University of California, San Diego, San Diego, CA, United States
| | - Elizabeth R. Sowell
- Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics of the Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Holmes SC, Ciarleglio MM, Song X, Clayton A, Smith MV. Testing the Family Stress Model among Black Women Receiving Temporary Assistance for Needy Families (TANF). JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:2667-2677. [PMID: 33776388 PMCID: PMC7988309 DOI: 10.1007/s10826-020-01791-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black female primary caregivers who receive Temporary Assistance for Needy Families (TANF) are burdened not only by economic pressure but also by a disproportionate prevalence of psychological disorders. This is particularly pernicious given that poverty and maternal mental health impact child outcomes and may decrease the economic mobility of families. Consequently, it is imperative to understand the mechanisms that explain the association between economic pressure and child outcomes. The current study addressed this gap by testing an application of the Family Stress Model (FSM), which describes how economic pressure results in parental psychological distress, particularly depression, and in turn impacts parenting quality and child outcomes. Additionally, social support was assessed as a potential culturally-salient protective factor within the model. Four hundred sixteen Black female primary caregivers who receive TANF were administered a series of measures assessing mental health and family wellbeing. Structural equation modeling was utilized to test a single model that incorporated all hypotheses. Maternal depression and quality of parenting serially mediated the relationship between economic pressure and school performance. The relationship between economic pressure and adverse child outcomes, however, was mediated only by maternal depression. Social support did not significantly moderate the relationship between economic pressure and maternal depression; however, it did demonstrate a significant direct effect on maternal depression. The current study corroborates the application of FSM to another population. Further, it demonstrates the importance of interventions that target maternal mental health, parenting, social support, and family economic mobility as well as system-level policy interventions to address poverty.
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Affiliation(s)
| | | | - Xuemei Song
- Yale School of Public Health, Yale Center for Analytical Sciences
| | | | - Megan V Smith
- Yale School of Medicine, Department of Psychiatry
- Yale School of Medicine, Child Study Center
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Méndez Leal AS, Silvers JA. Neurobiological Markers of Resilience to Early-Life Adversity During Adolescence. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:238-247. [PMID: 33067165 DOI: 10.1016/j.bpsc.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
Early-life adversity (ELA) exposure (e.g., trauma, abuse, neglect, or institutional care) is a precursor to poor physical and mental health outcomes and is implicated in 30% of adult mental illness. In recent decades, ELA research has increasingly focused on characterizing factors that confer resilience to ELA and on identifying opportunities for intervention. In this review, we describe recent behavioral and neurobiological resilience work that suggests that adolescence (a period marked by heightened plasticity, development of key neurobiological circuitry, and sensitivity to the social environment) may be a particularly opportune moment for ELA intervention. We review intrapersonal factors associated with resilience that become increasingly important during adolescence (specifically, reward processing, affective learning, and self-regulation) and describe the contextual factors (family, peers, and broader social environment) that modulate them. In addition, we describe how the onset of puberty interacts with each of these factors, and we explore recent findings that point to possible "pubertal recalibration" of ELA exposure as an opportunity for intervention. We conclude by describing considerations and future directions for resilience research in adolescents, with a focus on understanding developmental trajectories using dimensional and holistic models of resilience.
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Affiliation(s)
- Adriana S Méndez Leal
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.
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