Imagine two intersecting lines. The horizontal line is the level of risk a child experiences from low levels of risk on the left to high levels on the right. Crisscrossing this line is another vertical one, representing low resilience at the bottom, and high levels of resilience at the top. Divided this way, we create four quadrants. Think of these quadrants as representing the difference between a well-loved child who is bullied only at school versus a child with a parent with a severe mental illness living in a violent community who experiences the same level of bullying but has far fewer resources to change it.
New research by an international team I lead suggests that depending on where a child scores on risk and resilience (which quadrant he or she is in) changes what the child needs to be resilient. At lower levels of risk, a boost in self-esteem, meditation and help with self-regulation can have a huge impact on a child's life. At higher levels of danger, however, interventions need to focus much more on shaping a child’s environment if a child is to succeed. Children at higher risk need services, better schools, or maybe a mentor to take them away from a toxic situation now and again. In contrast, when risk is low, the focus of intervention can be much more on helping a child develop the best possible cognitions (e.g., thinking positive thoughts) or changing regimes of personal behaviour (e.g., who the child chooses as her friends).
Below are some specific suggestions for children in each quadrant.
Interventions for 5-19 Year Olds
Quadrant 1: Low Risk, High Resilience. These are children with lots of advantages. Even if they are struggling with a mental health challenge, they are likely to respond well to individualized psychotherapy, have the resources to reinforce lessons learned during treatment, and usually enjoy sufficient supports to quickly transition from formal therapy back to the informal supports that are there to help them. Time limited intervention is likely best as there is a real danger that professioinal treatment can cause a child to think of him- or herself as mentally ill (adopt a label). Think about the worried well in endless cycles of psychotherapy and one can see how too much treatment can convince people they are mentally ill even when they have very little wrong and all the advantages they need in life to get what they need outside the therapy room. For children, excessive treatment with well-resourced kids can unintentionally undermine the role played by a child’s natural support systems in his or her extended family, at school, and in a child’s community. Low risk, highly resilient children should be largely left alone to overcome challenges with the help of those already in their lives.
Quadrant 2: High Risk, High Resilience. These children have either created for themselves adaptive coping strategies or have had these strategies provided to them. These children benefit from interventions, especially those that help them deal with the inevitable crises that occur in their usually very chaotic lives at home and at school. These young people tend to favor supports that are personable and accessible, but they also appreciate structure and natural consequences. Helping these children maintain their strengths is critical to them sustaining their resilience. As much as possible, if a child in this quadrants has found a place where he or she is coping well, the most efficacious intervention can be to advocate for that environment to remain consistent. If the child has found a great teacher, best to keep the child in the same classroom for as long as possible. If the child plays a sport or likes to sing, best to keep the child engaged with that activity no matter how stressful other parts of his or her life becomes. While individual cognitive therapies may benefit these children, these young people are more likely to appreciate attachments to caring adults that are activity based (e.g., a school tutor, a coach, a counselor who checks in on the child over lunch hour). Short-term intensive interventions are less likely to undermine these children’s natural support networks.
Quadrant 3: High Risk, Low Resilience. These children are the most vulnerable and frequently require long periods of treatment from multiple service providers. They want and need workers who will bend the rules and understand the child’s life in context. These children may have “hidden” strengths that are not easily recognized by systems that see instead children who resist treatment and misbehave as the only coping strategy they know. Interventions should be long-term whenever possible and emphasize continuity of attachment with both the child’s professional helpers and informal family and peer supports. These children respond best to interventions that change the child’s environment first before efforts are made to change the child. This builds the child’s trust and conveys to the child that his or her maladaptive coping strategies (e.g., social withdrawal, anger, anxiety) may be functioning good enough in a dysfunctional environment. When possible, help coordinate interventions across multiple systems (e.g., if the child has a mentor in the community, be sure that mentor participates in activities with the child at school and at home if possible). It is also a good idea to advocate for resources that can increase a child’s resilience resources (e.g., relationships, self-esteem, sense of culture and belonging, etc.) and buffer the impact of risk factors.
Once stabilized, individualized treatment may be highly effective for these kids but only if the lessons learned are reinforced by at least one, and possibly more of the child’s support networks. For example, enhancing a sense of self-efficacy or positive self-regard needs an appreciative audience at home and/or school if personal change is to be sustained. In other words, these children need to know someone will notice if they perform in the school play or answer most of the questions correctly on a snap quiz. For these children, multiple systems share responsibility for the child’s positive development.
Quadrant 4: Low Risk, Low Resilience. This is the trickiest of the four groups to deal with clinically or as a parent. On the one hand, these kids have fewer stressors but they also show a lack of ability to cope with any change at all. The vulnerability of these youth tends to be more individual than contextual. They will require help to build both internal and external resources required for healthy psychological and social development. These children may, however, be reluctant to engage in treatment because the lack of immediate stressors means these kids aren’t motivated to change until their environment makes more demands of them. Children who are over-protected may actually function reasonably well for a time despite very few internal or external resources to cope if bad things were to happen.
Intervention with these young people takes time, though is best provided during a crisis when the child is uncomfortable and motivated to develop new skills. Because the child will likely need both internal and external strengths, these children tend to respond best to systemic interventions that are carried out by a consistent helper who provides a trusting relationship. These children tend to benefit from manageable, age appropriate exposure to stress that enables them to develop new capacities to cope with future crises.
A Note About Age
The younger the child, the more changes in the child’s behavior will depend on the changes made by the systems that surround the child. For example, a younger child needs a primary caregiver or teacher to shape the child’s environment and improve the child’s access to the resources necessary to make the child more resilient. That means its really up to adults to provide bed time routines, good food, safety, and reasonable expectations. Older children tend to rely more on themselves, their peers or others in their social networks. How and where a child accesses resources will change as the child grows older.
Four different child profiles, four different approaches to making children resilient. The danger is that when we provide the same kind of help to every child, we may overlook what a child really needs. We may even do children harm, making children dependent on professional helpers when they could do just as well leaning on their own natural supports.