Core Childhood Needs (Part 2)

Whilst Part 1 of this post looked at the protective factors which might help keep a person well, Part 2 considers childhood risk factors, which may increase the likelihood of an individual developing mental health problems; be it in childhood or later in their lives.

Adverse Childhood Experiences

"Adverse childhood experiences" are those which may cause high levels of distress, disruption, or harm to a young person.  These may include:

- Physical, psychological, or sexual abuse.
- Physical or emotional neglect.
- Criminal behaviour in the household.
- Substance abuse.
- Parental domestic violence.
- Parental mental illness.
- Parental incarceration.
- Parental conflict, separation, or divorce.

Whilst many children may experience one of these at some point in their childhood, the effects appear to be cumulative, with worse outcomes for those who experience several of the above.  For example, one study found that the risk of suicide attempts, alcoholism, drug abuse, and depression in adults who had experienced four or more categories of adverse childhood experience were increased 4 to 12-fold. 

Similarly, an accumulation of less 'dramatic' risk factors in a child's life can have a severe impact on their development and well-being.

Let's look at some examples.


Isaiah

Isaiah's early life was happy and fairly uneventful.  He lived with his mum, dad, and older sister, Sasha.  They didn't have a lot of money, but they got by, and his parents spent a lot of time with their children, reading, playing games, and taking them to the park, the cinema, and museums.

But that all changed when Isaiah's mum got arrested and sent to prison.

Since then, his dad has been feeling very depressed and has struggled to motivate himself to even get out of bed.  Though he loves his children, he is caught up in what has happened and can't seem to find the energy to spend time with them.


Isaiah has not had anyone to read with him or help him do his homework.  No-one is doing jigsaws with him or ensuring he knows how to tie his laces.  Each day, Isaiah notices he is a little further behind his peers.  He's starting to feel very bad about himself as he suspects he must be stupid if he can't do what everyone else can.  And with no-one for him to tell about these feelings or anything else that is happening in his life, Isaiah's language and ability to express his needs are also being affected.  This emotional neglect is teaching Isaiah that him and his needs are not very important to anyone else.

With Mum in prison and Dad spending a lot of time in bed, Isaiah's sister Sasha has started to spend more and more time away from home.  She has made friends with a group of older teenagers and is staying out late drinking in the park with them sometimes.  Since no-one is reinforcing the rules at home, Sasha is no longer doing her homework, and her behaviour at school has become increasingly challenging.

In the absence of his parents, Isaiah looks to Sasha to be a role-model, and is learning from her what is acceptable and what is not.  Over time, Isaiah too might seek a sense of belonging and acceptance in a peer group, and is thus at higher risk of joining a gang.   His sense of himself as unimportant, and of others as being unavailable might increase his risk of developing mental health problems, and using unhealthy coping mechanisms such as substances or self-harm to manage these.  In this way, one major event in Isaiah's childhood may have a domino effect with long-term consequences for his future.

David

David is the son of a doctor and a lawyer.  His parents are both very successful, and very busy.  Their jobs are demanding and they work long hours.  The stress they experience often rolls over into their home life, and they frequently argue.  

With so much going on, David's parents need him to behave well.  Their parenting style is authoritarian and demands unquestioning obedience, whilst offering little warmth. As a result of following such regimented rules and regulations, David is timid and unsure of his own mind.  With little freedom to express himself or experiment, he rarely takes initiative, and feels anxious when he is expected to do things independently at school or with friends.

David's anxiety is also triggered by his parents' arguments. He fears being abandoned by one of his parents, or being forced to choose between them.  Sometimes David worries that he is responsible for his parents' arguments.

Although David has a lovely home and all the books he could ever need, his parents' stress and demands may place him at higher risk of developing mental health problems; particularly anxiety or eating disorders.


Jessie

Jessie's home life is very different from David's, though her mum is also very stressed.  Jessie is one of five children, and her mother Kerry is a single parent.  The absence of a second parent in the home means less 1:1 time with a parent for each child, with associated consequences for their adjustment, self-esteem, and conduct.

Overwhelmed by the competing demands of her children, Kerry struggles to set firm rules.  It isn't really clear to Jessie what is expected of her at any one time and since the rules are inconsistently reinforced she often refuses to do as she is told.

Jessie and Kerry frequently butt heads and argue for extended periods of time.  Eventually, Kerry gives in for the sake of some peace and quiet, and Jessie gets what she wanted.  Over time, Jessie has learned that the best way to get what she wants is through opposition and aggression.  If this pattern is not broken, Jessie's conduct problems may extend outside of the home, and she may find herself in trouble at school or even with the law.  Communicating her needs in such a hostile way might also make it difficult for Jessie to form and maintain healthy relationships, leaving her isolated.  


Ahmed

Whilst Jessie has very little 1:1 time with her mother, Ahmed has lots!  Complications at birth left Ahmed very unwell for a short period at the beginning of his life, and his mother has never forgotten her terror at the prospect of losing him.

Aisha is a doting mother who showers Ahmed with love.  Her parenting style is permissive, and whilst it is very warm, it is lacking in discipline.  As a result, Ahmed is used to getting what he wants, when he wants it, and lacks impulse control.  

Aisha is over-involved in Ahmed's life, and he rarely does anything independently.  Though he is a happy child who enjoys spending time with his family, being away from them for even short periods of time can be quite distressing for him, and he experiences acute separation anxiety, complaining of stomach aches and headaches.  His mother's constant fussing may also teach Ahmed he is vulnerable to harm and illness, and cause him to worry excessively about his own safety.

As Ahmed grows older he may be at increased risk of anxiety disorders, including health anxiety.  


Elaheh

Elaheh's family are refugees who only recently arrived in the UK.  Her parents witnessed atrocities in their home country, and her father has post-traumatic stress disorder (PTSD) which can make him respond in scary, unpredictable ways at times.

None of Elaheh's family speak English fluently, and as such, they are quite isolated.  With no social support in the UK they have no-one to ask for help when things are difficult. Elaheh's limited English is also tricky for her at school where she struggles to follow the lessons and is shy with her peers, with whom she would like to make friends.  Sometimes she feels quite lonely.

Whilst both of Elaheh's parents would like to work, neither have a job as yet.  As such, they are living in a very rundown area with high levels of social disadvantage and crime.  The violence in the local area is particularly scary for Elaheh who remembers dangerous things happening before she came to the UK.

The family's financial situation means Elaheh has no internet access at home, and very few books.  Whilst her mother is happy to take her to the library, Elaheh's opportunities to learn at home are limited as compared to her peers.

Sometimes Elaheh witnesses strangers being racist to her parents, and her parents being scared.  If this persists, she might begin to believe they are less acceptable than other people, or that other people are largely hostile and to be feared.  

Elaheh's early experience of atrocity and fear, her father's mental health problems, and a move to a new country where her family are isolated and socially disadvantaged may place her at increased risk of mental health problems.


Paul

As a small child, Paul was the victim of physical and psychological abuse.  He was removed from the family home and placed in residential care.  

Though the people who work at the care home are nice enough, there are a lot of staff members and they all work shifts. Sometimes, Paul starts to form a good relationship with a staff member or another child only for them to leave soon after.  He therefore struggles to form a secure attachment to anyone, and may present as aloof in interpersonal relationships.  

As a child who has been abused, Paul is at higher risk of developing depression, anxiety, eating disorder, or a personality disorder later in life.  His experience of others as dangerous may lead him to respond with either excessive fear or aggression, or to avoid difficult memories using substances.

Paul is likely to need specialist help to process what has happened to him and to help him develop healthy beliefs about the world, and ways of coping with it.


Summary

Whilst we cannot be sure what causes mental illness, there is significant evidence to suggest life experiences and environment play a part, with those who have had multiple adverse experiences at highest risk.  For those who experience difficult times but do not develop mental illness, there are likely a number of protective factors in play.


Next time we will begin to look at mental illness.

The Bear xXx