Connections

Connections

Sam Goldstein, Ph.D.
This is a SamGoldstein.com Monthly Article - April, 2004
Copyright © 2004 Dr. Sam Goldstein - All Rights Reserved

A number of years ago, the late psychologist, Dr. Julius Segal, defined the role of a charismatic adult in the life of children as ?a person with whom they identify and from whom they gather strength.? Among populations of adults with childhood histories of risk, including abuse, neglect and school failure, researchers find that a number of individuals rise above adversity. These individuals had met significant challenges and were, as adults, leading successful and satisfying personal and professional lives. They were resilient. One of the most important factors resilient individuals cite was having at least one adult in their lives who cared about and loved them unconditionally. This was an adult who was an advocate for them, especially in times of need. This finding has been reported in populations of individuals across multiple continents facing multiple and varied risks. Thus, the concept of ?connection? has been a central theme in the work Dr. Robert Brooks and I have done through our writing, presentations and clinical practice.

The publication of a recent commission report highlighted the importance of connections for children, making this a central theme and building a case for creating communities capable of developing, maintaining and nurturing important connections. In this month?s article, I am going to summarize this report from the Commission on Children at Risk.

The Commission on Children at Risk is comprised of a group of thirty-three physicians, research scientists, mental health and youth service professionals. Their mission is to empirically investigate the social, moral and spiritual foundations of child well-being, to evaluate the degree to which current practice and policy in the U.S. recognizes these foundations and to make recommendations for the future. This Commission includes such illustrious individuals as T. Berry Brazelton, Michael Resnick, Stephen Suomi, Peter Benson and James P. Comer. In particular, Dr. Comer?s ground breaking work at Harvard University has developed educational settings that foster the emotional, behavioral and interpersonal development of children. The Commission recently published their report, Hardwired to Connect. The report published by the Institute for American Values is available to the public. I urge all of you to consider obtaining a copy (www.americanvalues.org).

In our writing and in previous columns, we have described what we believe to be a crisis in America and world wide relative to the rising rates of mental health problems, emotional distress and health impairments among U.S. children and adolescents. It is becoming increasingly more difficult to successfully prepare children with the stress hardy qualities necessary to transition successfully into the complex world we have created. In our writing we have noted that our response to this alarming trend has been two fold, neither of which has been particularly effective. Either we have attempted to build stronger walls and locks to keep the world away from our children, a futile process; or we have focused on developing treatments, both medical and psychotherapeutic in an effort to reduce symptoms and help those struggling to recover. Though we are designing more and more special programs for children at risk, it has been difficult to stem the tide. At times it almost appears that the more special programs we develop the more children seem to struggle. Though we recognize that it is important to help children at risk, perhaps a better approach would be to develop an understanding of why so many more children are at risk and do something about the risks rather than wait until children struggle to treat them. As the Commission notes, a broad variety of environmental conditions appear to be contributing to the growing numbers of suffering children. The Commission concludes that this is the result, in part, of a ?lack of connectedness.? Connections are defined by the Commission as links to other people as well as to moral and spiritual values.

Let?s first examine some of the risk factors. In 2002, scholars at the National Research Council estimated that at least one of every four teens in the United States was currently at serious risk of not achieving productive adulthood. A report in Mental Health Weekly Digest in 2003 noted that approximately 20% of U.S. children, ages nine to seventeen, had a diagnosable mental or addictive disorder associated with at least minimum impairment. These numbers appear to reflect actual increases in these problems, not simply changes in methods of assessment or rates of treatment. In fact, despite increased treatment for depression, the current generation is more likely to be depressed and anxious than it?s parents? generation. U.S. children as a group report more anxiety than children who were psychiatric patients in the 1950's. High levels of anxiety were not only problems in and of themselves but also associated with risk for major depression, suicide, substance abuse, health and relationship problems into adulthood. Several studies report that an estimated 8% of U.S. high school students suffer from clinical depression. The World Health Organization suggests that the total number of U.S. children suffering from serious depression may even be higher. About 20% of youth in the general population have seriously considered suicide. A recent study of mental health problems among college students at a large mid-western university found that over the past thirteen years the number of students being seen for depression doubled. The number of suicidal students tripled. The number of students seen after a sexual assault quadrupled. A growing body of research summarized two years ago in the Journal of Education and Treatment of Children reported that children entering out of home care for mental and developmental problems are more disturbed than in the past.

Interestingly, the Annie E. Casey Foundation recently issued a report examining eleven material and demographic indicators of child well-being reported that eight of the eleven improved, at least slightly, in the last decade of the previous century. These included reductions in poverty and living in single parent families. An Index of Child and Youth Well Being consisting of twenty-eight, mostly material and demographic indicators, found that overall childhood well-being rose through the late 1990's but was still lower at that point than in 1975. Here is more positive data. There is a downward trend in the U.S. in births to teenagers. The number of high school students who say they have never had sexual intercourse rose by almost 10% over the last ten years of the previous century. Still as many as one in three teenagers report having engaged in binge drinking and despite aggressive media campaigns, tobacco use rose slightly at the end of the last century. Death rates over the last fifty years among youth due to unintentional injuries or health problems has fallen by about 50%. During the same period, homicide deaths rose among U.S. youth by more than 130%, while suicide rates rose by nearly 140%.

With so many indicators suggesting that youth could be doing better mentally, educationally, emotionally and physically, or at least holding ground, why the downward trend? The Commission suggests that our communities are simply unprepared to provide children with the stress hardy skills necessary to deal with our complex culture. Over fifty years ago, Emile Durkheim, suggested that perhaps at the core, the problem for many youth was a lack of connectedness. The Commission has taken this position, suggesting that our models and capacity to understand the needs of children are inadequate. More and more children are taking psychiatric medications with an increasingly strong ph armacological model underlying mental health treatment. Yet, there is also an increasing recognition that not only may some antidepressants be harmful to children but that the benefits of antidepressants have been marketed as far exceeding their true worth when compared to placebo, non-treatment or, for that matter, psychosocial intervention. The Commission suggests that while there is great promise and progress in ph armacologic and psychotherapeutic treatments, there has been little progress in prevention. As Dr. Comer points out, rather than attempt to save more and more struggling children, as a culture and society we must begin to examine why more are struggling and do something about these causes. The Commission suggests that the solution lies in creating ?authoritative communities.? They define these communities as ?groups that live out the types of connectedness that our children increasingly lack. They are groups of people who are committed to one another over time and who model and pass on at least part of what it means to be a good person and live a good life.? The Commission suggests that ?science is increasingly demonstrating that the human person is hardwired to connect.? In 1999, Dr. Edward Hallowell, titled his trade book, Connect: Twelve Vital Ties that Open Your Heart, Lengthen Your Life and Deepen Your Soul. Human moments, those that create connections are those that create strength and resilience for each of us, Dr. Hallowell writes. This model of creating authoritative communities is very much based upon a resilience framework. The focus is to create an environment in which despite stress, children buffered by the adversities they face each day are, as Ann Frank wrote eloquently years ago, capable of ?having courage, feeling strong, and bearing a great deal.? Dr. Brooks and I have just completed an edited volume on resilience (Handbook of Resilience in Children) to be published by Kluwer Publishers this coming fall. Our effort was to review the research and question whether resilience can be measured and, in fact, used in clinical practice not just to facilitate recovery but to provide all youth with resilient mindsets. In our volume, Arturo Sesma and colleagues write about positive adaptation, resilience and their developmental ASSET model. Maurice Elias and colleagues write about using educational settings to build opportunity. Emily Winslow and colleagues write about public health approach to building and facilitating resilience.

Here are the ten ?planks? or reasons the Commission offers to create authoritative communities:

1. Mechanisms by which we become and stay attached to others are biologically primed and increasingly discernable in the basic structure of the brain.
2. Nurturing environments or the lack of them effect gene transcription and the development of brain circuitry. I suggest each of you read Daniel Siegel?s recent book, The Developing Mind (Guilford).
3. The nature versus nurture debate is not relevant to a serious discussion of child well being and youth programming.
4. Adolescent risk taking and novelty seeking are connected to changes in brain structure and function.
5. Assigning meaning to gender in childhood and adolescence as a human universal deeply influences well being. In our upcoming textbook, William Pollock writes about creating resilience in males, while Judy Jordan writes about relationship resilience in females.
6. The beginning of morality is the biologically primed moralization of attachment.
7. The ongoing development of morality in later childhood and adolescence involves the human capacity to idealize individuals and ideas.
8. Primary nurturing relationships influence early spiritual development which influences each of us biologically in ways that are similar to those created by primary nurturing relationships.
9. Religiosity and spirituality significantly influence well being.
10. The human brain appears to be organized to ask ultimate questions and seek ultimate answers.

The Commission provides a description of the characteristics of an authoritative community as follows:

1. It is a social institution that includes children and youth.
2. It treats children as ends in themselves.
3. It is warm and nurturing.
4. It establishes clear limits and expectations.
5. The core of its work is performed largely by non-specialists.
6. It is multi-generational.
7. It has a long term focus.
8. It reflects and transmits a shared understanding of what it means to be a good person.
9. It encourages spiritual and religious development.
10. It is philosophically oriented to the equal dignity of all persons and to the principle of love of neighbor.

Are you connected? Do you live and work in an authoritative community? Take a moment and consider the past week. Whom have you spoken to, not just in passing, but indepth? Whom have you gathered strength from? For whom have you been a charismatic individual? The good news is it is never too late. If you are connected, work each day at maintaining connections with people, ideals, causes and faith. It not, set about to do so. Relish your accomplishments. Experience the joy of success in nurturing connections. Participate in activities that benefit the lives of others. Be a vital, contributing member of your community and society. Engaging in daily resilience exercises and reflecting throughout one?s life time on the assumptions and characteristics that are the underpinnings of a resilient mindset, particularly one that fosters connections, reinforces an attitude of perseverance, caring and hope. Such an attitude is essential for your emotional and physical health and for the future of our children.