Apr 18, 2024

How parents can shape a child’s future with small moments of joy

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In the pediatric world, we’ve worried a great deal about what we call ACEs, or adverse childhood experiences, which can disrupt children’s lives and get in the way of the safe and stable nurturing relationships they need. Research has shown us the long shadows that early adversity can cast over health and mental health.

But more recently, the relatively newer science of PCEs, or positive childhood experiences, has reframed the discussion, and helped balance out our understanding of how children grow, and the power of parents and caregivers to help them, even in tough times.

A study published in the journal JAMA Pediatrics in 2019 examined the effect of these PCEs. In addition to asking about ACEs, the researchers asked 6,188 adults seven additional questions about their childhoods.

Had they been able to talk to their families about their feelings? Had they felt their families stood by them during difficult times? Had they enjoyed participating in community traditions? Did they feel a sense of belonging in high school? Were they supported by friends? Were there at least two non-parent adults who took an interest in them? Had they felt safe and protected by an adult in their home?

The risk of depression or mental health struggles dropped by 72 percent among adults who reported six or seven of the positive experiences listed above, and by 50 percent for those reporting three to five.

Christina Bethell, the lead author, is a professor of child health at the Johns Hopkins Bloomberg School of Public Health where she directs the Child and Adolescent Health Measurement Initiative. And those positive experiences, Bethell said in an email, affect the nervous system of the developing child and help bolster a sense of worth and identity all through life.

“High adversity does not mean you’re doomed,” Bethell told me, pointing out that every person in a child’s life has the opportunity to help that child feel connected, safe and well. And those nurturing relationships are what help children overcome what life throws at them. “The absence of the positive is the problem,” she said.

As a pediatrician, my cause has been encouraging a very particular positive, reading aloud with young children, using checkups to encourage and support families so they start as early as possible. This program, Reach Out and Read, now reaches 4.2 million children a year, offering guidance, encouragement, modeling and books.

When I see an infant or a toddler, happy in a parent’s lap, going back and forth over a book with babble or gestures or words - well, something in me feels that child is going to be okay. It’s language and early literacy, but most of all it’s being held and attended to, because for young children, learning and development happen through relationships and interactions.

I was excited to see a study, published in June, that looked at more than 10,000 young adolescents in the United States and found those whose parents reported that they had started reading for pleasure at an early age had better cognitive performance, increased brain cortical areas and better mental health in adolescence than children who had started reading for pleasure later - or never started. The study, conducted by researchers from the universities of Cambridge and Warwick in Britain and Fudan University in China, involved brain scans, cognitive test scores and measures of academic performance, as well as mental health symptoms and behavioral problems.

One of the authors, Barbara Sahakian, a clinical psychologist who is a professor of clinical neuropsychology at the University of Cambridge department of psychiatry, said in an email that the size and design of the study allowed them to control for confounding factors, and the types of analysis involved made it possible to suggest a probably causal relationship.

“We found that the effects of reading for pleasure in early childhood were beneficial for adolescents regardless of family socio-economic status, family income and parental education.”

The science of ACEs rocked medicine when the original studies began coming out.

Physicians at Kaiser Permanente in California, working with the Centers for Disease Control and Prevention, surveyed patients about 10 kinds of childhood exposures that could interfere with children’s emotional development and the relationships they formed: Had they suffered emotional or physical neglect, emotional, physical or sexual abuse; had they had a household member who was incarcerated, addicted or mentally ill; had they been exposed to divorce or to domestic violence?

The original study was conducted from 1995 to 1997, with results published in 1998, showing that higher numbers of adverse experiences in childhood were associated with not only higher rates of mental health problems and substance use disorder in adulthood but also higher rates of heart disease, cancer and chronic lung disease.

The science of teasing out different kinds of early adversity became more sophisticated, taking into account community and social factors such as poverty, racism and deprivation. Research in neurobiology helped draw the causal connections, always emphasizing the importance of early relationships, explaining the ways these early adversities, by disrupting those relationships, affected the body and mind.

The CDC offers an ACE Pyramid, showing the progression from adverse experiences to disrupted neurodevelopment and cognitive impairment, through health risk behaviors and on to disease and early death.

In 2014, a study showed that children with two or more ACEs were more than twice as likely to have a chronic medical condition or mental health problem - and more likely to have school problems and many other difficulties. But the researchers who were looking at adverse events in children were also looking at resilience, because it was clear that there was a lot of variation in children’s trajectories, Bethell said.

“It was true that children who faced ACEs and adversity were more likely to have mental health and behavioral health problems, but most did not,” she said.

In that study, resilience was protective - the capacity to stay calm and in control, the ability to communicate and to ask for help.

Researchers needed measures that assessed more than the presence or absence of problems - questions that actually looked at whether children were flourishing.

Flourishing children are interested in learning new things, can manage their emotions and behaviors in challenging situations, and can persist to achieve their goals.

Bethell said the research showed - for children facing high levels of adversity - “the tremendous protective power of family resilience and parent-child connection.” But notably, it also showed “how important these are even for children without adversity.”

In a paper published in 2019 in the American Journal of Preventive Medicine, researchers looked at data from almost 30,000 children from infancy to age 5, collected in the National Survey of Children’s Health. They examined what they called Positive Parenting Practices (PPPs), including reading stories, storytelling, singing, eating meals together and going on family outings.

Their results showed that while adverse experiences had a negative effect on development, the positive effects of PPPs could mitigate and even overcome those negative effects.

One of the authors, David E. Bard, a psychologist who is a professor of pediatrics at the University of Oklahoma College of Medicine in Oklahoma City, said the most fascinating finding in the project was that there was almost no correlation between the adversity score and the PPP score.

In other words, looking at whether bad things had happened in a family didn’t tell you whether good things were also happening.

“I had expected maybe these were two sides of the same coin,” Bard said. If adverse experiences were happening, wouldn’t that also mean that families were generally dysfunctional, that parents might be too devastated to be nurturing? Instead, they were almost unrelated - lots of parents who were facing problems were also managing to nurture their children. And parents who didn’t necessarily face those negatives were not necessarily engaging in those positive practices.

“The parenting influences were actually stronger than the adverse influences,” Bard said. “It’s a very promising message, we ought to be doing everything we can to help parents create those positive experiences.”

There are many different ways for parents to do that.

“The very first study we did in 2015 really showed me there was no magic bullet,” Bethell said. “It’s more about how you are than what you do.”

That is, she said, parents don’t need to set impossibly high standards for themselves, or create special big moments of connection; instead, they need to invite connection, reflection and interaction in all the small moments.

“What I’m really saying is it’s the quality of their presence and connection with the child that is the magic juice that makes those behaviors really matter even if you’re not doing it perfectly, that is what is lodged in the nervous system of the child,” Bethell said.

It’s about using the moments of your day to be present and caring with your child, she said, and about children being able to talk about their feelings and problems.

Do it when you’re cooking or cleaning or driving or shopping, ask about what they’re experiencing and feeling, and model self-reflection by narrating your own experience, including acknowledging difficult feelings and mistakes.

Children feeling safe and supported and able to discuss even difficult subjects leads to flourishing. And every person in a child’s life has that power to connect and support, she said.

“For a child to feel safe and well and heard, the power is all with us,” Bethell said. “We don’t lift that up enough.”

“We need to make it easier for parents to do what I would call the right thing,” Bard said.

That means policies that support families and reduce stress, and support the mental health and well-being of parents (and child-care workers, and teachers, and maybe even pediatricians). It means policies and programs that reduce the disparities and deprivations that increase risk for many children and many communities.

It also means honoring the everyday interactions and connections and rituals within homes, within extended families and within communities. The moments really matter, and the positives do add up, sometimes in ways we cannot see clearly as we go. Yes, the reading is good for the developing brain - but so is the pleasure.

Perri Klass is a professor of journalism and pediatrics and director of the Arthur L. Carter Journalism Institute at New York University.