Resilience and vulnerability in children who have experienced abuse

Dr. Andrea Danese and Dr. Helen L. Fisher explain how greater knowledge about resilience could help us to support children who have been maltreated

The NSPCC estimates that more than half a million children suffer abuse or neglect in the UK a year.

Children drawing and coloring pictures

Our research at King’s College London has highlighted that experiencing abuse or neglect increases the risk of a child having poor mental and physical health and a worse quality of life.

But we’ve also found that, within groups of children who have been maltreated, there are significant individual differences in these outcomes.

Exploring why some children cope better than others - and finding out how to identify and perhaps even build up this capacity - could help more children recover from abuse.


The impact of child maltreatment

We’ve contributed to research highlighting the vulnerabilities and health problems that can be experienced by children who have been maltreated. These include:

    • cognitive functioning: children who have been maltreated have, on average, mild/moderate but pervasive cognitive impairments. This includes lower scores in general intelligence, executive function, processing speed, memory, perceptual reasoning and verbal comprehension (Danese et al, 2017).
    • poor mental health: children who have experienced abuse and neglect are at greater risk of developing a wide range of mental health problems when compared to those who have not been abused, including depression, anxiety, substance abuse, antisocial behavior and psychosis (Fisher et al, 2013Arseneault et al, 2011)
    • problems with treatment for mental health disorders: individuals who report a history of childhood maltreatment tend to develop more chronic and complex forms of mental illness. They also tend to respond less well to treatment (Nanni, Uher and Danese; Agnew-Blais and Danese, 2016).
    • higher rates of obesity: children who have been maltreated are more likely to become overweight in later life (Danese and Tan, 2014).
    • adult health problems: compared to children who have not experienced abuse, children who have been maltreated tend to have higher levels of inflammatory molecules in their blood. This could put them at greater risk of developing cardiovascular disease and diabetes in adulthood (Danese et al, 2007).

Other studies have shown that children who have been abused are more likely to have: a poorer quality of life (Abajobir et al, 2017); worse socioeconomic outcomes (Pinto Pereira and Power, 2017); and a greater likelihood of attempting suicide and using drugs (Norman et al, 2012). 

Individual differences in the health risk associated with child maltreatment 

Although the research shows that children who have been abused or neglected are more likely to experience negative health outcomes than other groups of children, there are significant individual differences between children who have been maltreated. Not all children who have been abused or neglected will develop physical or mental health problems.

Therefore, we need to understand more about the factors that make some children more resilient, and others more vulnerable, in the face of maltreatment.

What is resilience?

Despite having experienced serious stresses or adversities, some individuals still manage to have a relatively good outcome – they don’t experience the same mental and physical health problems as other individuals who suffered the same experiences (Rutter, 2013).

Research to date has identified several factors that might affect resilience after childhood adversity. These include individual factors (for example a child’s cognitive abilities and temperament); family factors (such as family history of psychopathology or mental disorders, poor sibling relationships); and community factors (including neighborhood deprivation and crime) (Collishaw et al, 2007; Jaffee et al, 2007).

This suggests that children who are bright, able to cope with intense emotions, have supportive family relationships and live in safe and tightly knit communities are less likely to develop mental health problems after experiencing maltreatment.

Understanding resilience

There are several questions that we still need to address in order to better understand resilience.

These include:

    • how can we best identify which children are at greatest risk of developing physical and mental health problems after maltreatment?
    • do the same characteristics of the child, the family and the community increase resilience against different health problems?
    • can we “build” resilience by intervening early with children who have been maltreated?

Resilience and practice 

Greater knowledge about resilience can be helpful for practitioners working with children who have experienced abuse or neglect.

It could help them identify those children who are more vulnerable or more resilient, in order to tailor support services to each child’s needs.

It could also help to identify factors that could increase protection against the health risks associated with maltreatment. This would help practitioners build a child’s resilience and ultimately help prevent them from experiencing health problems later on.

To develop the knowledge in this area, we are analysing the Environmental Risk (E-Risk) Longitudinal Twin Study to find out which factors, measured over two decades, could buffer the detrimental effects of childhood maltreatment on mental and physical health and quality of life.

We hope that the results from this work will help practitioners to deliver targeted, efficient and cost-effective support to children who have experienced abuse and neglect.

Research to help children

Dr Andrea Danese and Dr Helen L. Fisher are leading one of 4 new research projects we are funding in partnership with the Economic and Social Research Council (ESRC) to find out what works to help children get back on track after abuse. Find out more about the £1.7 million to fund new research into what works for children after abuse.

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References

  1. Arseneault, L. et al (2011) Childhood trauma and children's emerging psychotic symptoms: A genetically sensitive longitudinal cohort study. The American Journal of Psychiatry, 68(1):65-72.

  2. Collishaw, S. et al (2007) Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample. Child Abuse and Neglect: 31 (3): 211-229.

  3. Danese, A. and Tan, M. (2014) Childhood maltreatment and obesity: systematic review and meta-analysis. Molecular Psychiatry 19, 544-554.

  4. Danese, A. et al (2017). The origins of cognitive deficits in victimized children: implications for neuroscientists and clinicians. The American Journal of Psychiatry, 174(4):349-361.

  5. Danese, A. et al. (2007) Childhood maltreatment predicts adult inflammation in a life course study. Proceedings of the National Academy of American Sciences, 104(4):1319-1324.

  6. Harker, L. et al. (2013) How safe are our children? London: NSPCC.

  7. Nanni, V., Uher, R. and Danese, A. (2012) Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. American Journal of Psychiatry, 2012; 169(2):141–51.

  8. Pinto Pereira, S.M., Li, L. and Power, C. (2017) Child maltreatment and adult living standards at 50 years. Pediatrics, 139(1): e2 0161595.

  9. Rutter, M. (2012) Annual research review: resilience – clinical implications. Journal of Child Psychology and Psychiatry, 54(4): 474–487.