dr. david pearson -- failure to thrive
TRANSCRIPT
•Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty
• Institutional care
•Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty
• Institutional care
• Living in war zones
•Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty
• Institutional care
• Living in war zones
• Ineffective/poor parenting
CHILDREN WHO ARE ABUSED ARE 9X MORE LIKELY TO
EXPERIENCE PSYCHOSIS IN LATER LIFE
From: Read & Bentall, (2013), see Dissociation. Kennedy, Kennerley & Pearson. Routledge (2013)
Using 27,390 self selected participants
earlier traumatic or abusive life experiences predicted later high levels of anxiety
and depression
From: Kinderman, Schwann & Pontin (2013)
From: Dissociation. Kennedy, Kennerley & Pearson - Routledge 2013
Examples of studies linking child adversity with later mental health problems
Clinical area examples Country of origin examples
Personality Hetzel and McCanne
Disorder (2005)
Berger et al. Japan
(1994)
Pseudo-seizures Ozcetin et al.
(2009)
Dalenberg and Russia
Palish (2004)
Post Traumatic Stovall-McClough
Stress Disorder and Cloitre (2006)
Hartt and Waller UK
(2002)
Dysfunctional Johnston et al.
schema modes (2009)
Putman USA
(1997)
Being a psychiatric Waldinger, Swett,
patient Arlene and Kristen
(1994)
Ozcetin et al. Turkey
(2009)
Borderline Korzekwa, Dell and
Personality Pain (2009)
Disorder
Hirakata Canada
(2009)
Murderers with Lewis, Yeager, Swica,
Dissociative Pincus and Lewis (1997)
Identity Disorder
Kessler et al. 21 countries
(2010)
Kessler et al. All major mental
(2010) disorders, using
WHO WMHS data
The links between child adversity and later mental
health problems are irrefutable.
Studies show that this is across disorders and cultures
Failure to thrive
Organic
(e.g., malnutrition)
Non-organic
(e.g., experiences of adversity, like institutional care)
• UNICEF (2009) - 160 million children live below the poverty line
• HUNGaMa Survey (2009) - estimated up to 59% stunted, 42% underweight (<5yrs) *
• MOSPI (2012) - 48% stunted, 20% wasted, 42% underweight (<5yrs)**
• NFHS-3 (2007-) - 45% stunted, 23% wasted, 40% underweight (<3yrs)***
(stunted – height for age, wasted – weight for height, underweight – weight for age)
* Naandi Foundation
** Ministry of Statistics and Program Implementation – Govt of India
***National Ministry of Health and Family Welfare – Govt of India
from - Kennedy, Pearson, Brett-Taylor & Talreja, (2014)
When growths slows
1. development slows
2. together with failure to thrive or stunting there is an associated package of problems that are known as attachment disorder
3. there are also associated cognitive problems
If we look at these three areas
(in real life these three areas interact with each other and cannot be clearly separated)
1. Development slows • Development happens in the same sequence for all children
• There is a need for one skill to be built on top of another
• At certain times children develop much more quickly – this is known as sensitive periods – they only happen at a certain time
• This means that development has to happen at the right time, otherwise this can cause long term damage
• For example if 7 year old development has not happened for a year, then at 8 years old it cannot happen because:
a) the foundations are not in place
b) the child is geared up neurologically, psychologically and socially to develop 8 year old skills (not 7 year old skills)
This can cause developmental collapse
• Development can be seen as similar to a building with weak walls –
When the wind blows the building may fall down
• A child’s development may fall down when challenged by demands, panic emotion etc
• This means that a child’s behaviour may appear much younger than its age
• This may be known as confused maturity or confused development
2. Attachment Disorder• All children need human contact to develop – often referred to as
attachment and / or bonding
• Children who fail to thrive often have attachment and relationship problems, e.g., holding hands in a shelter, inappropriate relationships, weak relationships
• Confused emotions, e.g., attaching wrong emotions, not controlling emotions, emotions based on exploitation or abuse
3. Cognitive Problems• It has been established that children who fail to thrive:
• Have poorer cognitive abilities (e.g., Mackner et al. 1997)
• Poor information processing (e.g., Kennedy, Kennerley & Pearson, 2013)
• Higher brain pathology (e.g., Korzekwa et al. 2009)
• Poor brain development (e.g., DeBellis et al. 2011)
• High anxiety levels (e.g., Essex et al. 2002; Van der Vegt et al. 2010)
see Kennedy, Kennerley & Pearson, Dissociaton, Routledge 2013
To summarise:• Adversity and failure to thrive damages development and mental health
• This situation affects at least half of children in India
• It is a daily problem for disadvantaged children
• The damage can be long term or even life long
• The position can be reversible
• There is a need for an adult to be alongside the child
• There is a need for the adult to understand the effects of adversity
Evidence for recovery:
• Cognitive deficits are recoverable (e.g., Corbett, 2004)
• Cognitive deficits decreased over time with improved nutrition and care (e.g., Boddy, 2003)
• Using international adoption studies the Rutter et al. research indicated long term improvements
• Growth can increase and return to expected levels
The most effective way to recover from these deficits are
1. better nutrition
2. good contact
3. life skills improvement
Nearly always children need a person to help them out of this
situation – often known as a mentor
This person may be:
A teacher
A program leader
An adult who stands by the child
A relative
A volunteer
If you see a group of disadvantaged children on a scrap of
land and as you go by, you throw them a football and continue to drive past
They will kick the ball around – this does not repair the damage of adversity and failure to thrive
Actually they were probably kicking something around before you drove past
These children need a team leader, a role model, belonging to a team, learning rules, etc. the football itself does not change lives