ArticlePDF AvailableLiterature Review

Measuring resilience in children: a review of recent literature and recommendations for future research

October 2020
Current Opinion in Psychiatry 34(1)

October 2020
34(1)

DOI:10.1097/YCO.0000000000000663

Authors:

Leonora King

McGill University

Alexia Jolicoeur-Martineau

Lady Davis Institute for Medical Research

David P Laplante

Lady Davis Institute - Jewish General Hospital

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Purpose of review: Understanding variability in developmental outcomes following exposure to early life adversity (ELA) has been an area of increasing interest in psychiatry, as resilient outcomes are just as prevalent as negative ones. However, resilient individuals are understudied in most cohorts and even when studied, resilience is typically defined as an absence of psychopathology. This review examines current approaches to resilience and proposes more comprehensive and objective ways of defining resilience. Recent findings: Of the 36 studies reviewed, the most commonly used measure was the Strengths and Difficulties Questionnaire (n = 6), followed by the Child Behavior Checklist (n = 5), the Resilience Scale for Chinese Adolescents (n = 5), the Rosenberg Self-Esteem Scale (n = 4), and the Child and Youth Resilience Scale (n = 3). Summary: This review reveals that studies tend to rely on self-report methods to capture resilience which poses some challenges. We propose a complementary measure of child resilience that relies on more proactive behavioral and observational indicators; some of our preliminary findings are presented. Additionally, concerns about the way ELA is characterized as well as the influence of genetics on resilient outcomes prompts further considerations about how to proceed with resiliency research.

Images and examples of the Challenging Puzzles Task (CPT). Three questions corresponding to positive self-evaluation, hopefulness and motivation are asked after each puzzle and participants can respond using the child-friendly rating scales.

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Trajectory patterns for the three indicators of resilience on the Challenging Puzzle Task (CPT) identifying children as being in the resilient, rebound or discouraged group.

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URRENT

PINION

Measuring resilience in children: a review of recent

literature and recommendations for future research

Leonora King

, Alexia Jolicoeur-Martineau

, David P. Laplante

Eszter Szekely

, Robert Levitan

, and Ashley Wazana

Purpose of review

Understanding variability in developmental outcomes following exposure to early life adversity (ELA) has

been an area of increasing interest in psychiatry, as resilient outcomes are just as prevalent as negative

ones. However, resilient individuals are understudied in most cohorts and even when studied, resilience is

typically defined as an absence of psychopathology. This review examines current approaches to resilience

and proposes more comprehensive and objective ways of defining resilience.

Recent findings

Of the 36 studies reviewed, the most commonly used measure was the Strengths and Difficulties

Questionnaire (n¼6), followed by the Child Behavior Checklist (n¼5), the Resilience Scale for Chinese

Adolescents (n¼5), the Rosenberg Self-Esteem Scale (n¼4), and the Child and Youth Resilience Scale

(n¼3).

Summary

This review reveals that studies tend to rely on self-report methods to capture resilience which poses some

challenges. We propose a complementary measure of child resilience that relies on more proactive

behavioral and observational indicators; some of our preliminary findings are presented. Additionally,

concerns about the way ELA is characterized as well as the influence of genetics on resilient outcomes

prompts further considerations about how to proceed with resiliency research.

Keywords

challenging puzzle task, children, early life adversity, resilience, gene-by-environment interactions

INTRODUCTION

Development is marked by periods of heightened

neural plasticity in which brain regions involved in

the regulation of emotion and stress are particularly

sensitive to the effects of early life adversity (ELA).

Although ELA can have long-term negative impacts

on the developing child, sometimes resulting in

psychiatric and behavioral problems [1 –4], many

children remain unaffected [5,6]. In fact, as many as

50% of individuals who are exposed to stressful

events do not go on to develop a stress-related

psychiatric illness in later life [6,7]. This suggests

that there are important variations in how people

respond to stress and traumatic events, with some

individuals prone to maladaptive outcomes and

others who function well. As a result, the focus of

recent research has been to better understand the

factors that contribute to positive outcomes in addi-

tion to negative ones.

Positive adaptation or better-than-expected out-

comes in the context of ELA is known as resilience

[8,9]. Although there are varying definitions of resil-

ience, it is best understood as a dynamic process that

integrates many systems within an individual as

well as in the environment of the individual, leading

to positive adaptation in the face of adversity. More

specifically, resilience is not a static state or trait-like

attribute [10], rather it is a biopsychosocial process

that involves several interacting factors including

Jewish General Hospital, Lady Davis Institute for Medical Research

and McGill University,

Mila, Jewish General Hospital, University of

Montreal,

Jewish General Hospital, Lady Davis Institute for Medical

Research, Montreal and

Family Mental Health Research Institute,

Centre for Addiction and Mental Health, University of Toronto, Toronto,

Canada

Correspondence to Ashley Wazana, MD, Child Center for Development

and Mental Health, Jewish General Hospital, 4335 Chemin Cote Sainte-

Catherine West, Montre´al, QC, Canada H3T 1E4.

Tel: +1 514 340 8222x27652; e-mail: ashley.wazana@mcgill.ca

Curr Opin Psychiatry 2021, 34:10– 21

DOI:10.1097/YCO.0000000000000663

www.co-psychiatry.com Volume 34 Number 1 January 2021

REVIEW

neurobiological mechanisms, stress and emotional

regulation systems, prosocial skills, coping strategies

and temperament [11–14].

MEASURING RESILIENCE IN CHILDREN

How resilience is characterized and detected may

vary depending on the developmental period as

responses to challenges are typically content and

context-specific [15]. It has been suggested that

detecting resilient functioning in young children

may be more reliable given that their vulnerability

confers increased sensitivity to the environment

making them more responsive to the task at hand

[16]. Still, the methods by which resilience is cap-

tured and measured (whether in children or adults)

poses some challenges particularly because resil-

ience has often been characterized as an absence

of psychopathology or dysfunction although the

two are not synonymous. Rather, resiliency research

is more robust when it captures some of the more

proactive cognitive, emotional, and behavioral pro-

cesses associated with resilient functioning.

The current review aims to highlight recent

trends in resiliency research by reviewing studies

of child resilience published in the last 18 months.

Using PubMed, a biomedical literature database, the

following search parameters were entered: ((((resil-

ience[Title] OR resilient[Title] OR resiliency[Title]

OR ‘positive outcomes’[Title] AND ((’2019/04/

15’[Date - Publication]: ‘2020’[Date - Publication])))

AND (child[Title] OR children[Title]) AND (english[-

Filter])) NOT (review[Title/Abstract]). A total of 99

articles were returned. After scanning titles and

abstracts for relevance, 34 studies were excluded

for the following reasons: they were measuring resil-

ience in parents, caregivers or mothers who had

children with some disability, disorder or medical

condition (n¼34), whereas the remaining studies

were excluded (n¼29) because they were deemed

irrelevant for other reasons (e.g., were editorials,

consisted of retrospective reports of ELA or the name

of the cohort had the term resilience in it). The final

selection consisted of 36 articles for which the age

range was birth to 19 years old.

The majority of the studies identified in the

review used quantitative approaches, whereas four

studies used qualitative methods [17 –20] and three

studies incorporated a mixed-methods research

design [21–23]. Twenty-four of the 36 studies

reviewed were cross-sectional, seven were longitu-

dinal and the remaining five were intervention-

based. Although measures of psychopathology were

featured in the reviewed studies, unless they were

used to construct a measure of resilience, they are

not reported here as it was not the purpose of the

review. Otherwise, resilience was featured as the

outcome measure in 27 studies, whereas another

seven studies examined resilience as a mediating

factor (n¼4) [24,25

,26,27] or as a predictor variable

(n¼3) [21,28,29] and two studies assessed the psy-

chometric properties of resilient measures [30,31].

In terms of sample size, the range of participants for

the qualitative studies was from nine to 137,

whereas for quantitative studies, the range was from

24 to 51 156 participants. The majority of measures

were based on child or youth self-reports (n¼26),

whereas nine of the 36 studies were based on parent-

reports and one on teacher reports (Table 1).

The most common instrument used to measure

resilience in children was the Strengths and Diffi-

culties Questionnaire (SDQ) which was used in six of

36 studies. The SDQ captures both positive and

negative outcomes in children and can be adminis-

tered to children, parents, or teachers. The 25-item

SDQ (and an optional incapacity section) measures

current attention/hyperactivity problems, conduct

problems, emotional problems, peer relationships,

and prosocial behaviors [32]. In the current review,

three of the six studies administered the parent-

reported version of the SDQ [22,33,34], whereas

the child-reported version was used twice [35,36]

and the teacher-reported version once [37]. Of these,

three studies included SDQ total scores in their

analyses [22,35,37], two studies used both total

scores and the prosocial skills subscale [33,34] and

one study used only the peer relations subscale of

the SDQ [36].

The other two most common measures of child

resilience were the Resilience Scale for Chinese Ado-

lescents (RSCA) and the Child Behavior Checklist

(CBCL), each of which were administered in 5 stud-

ies. The RSCA is a 27-item survey with a 5-point

KEY POINTS

Measures of resilience in children are moving away

from defining resilience as an absence

of psychopathology.

The majority of child resiliency measures tend to be

based on self-reports and to a lesser extent,

parent reports.

A more objective and comprehensive measure of child

resilience that combines self-ratings and interrater

codings of video observations in response to a

challenging task is proposed.

Considerations about the ways in which ELA is

characterized as well as the influence of genetics on

resilient outcomes are discussed.

Measuring resilience in children King et al.

Table 1. Review of studies and measures used

Study

Age range

(in years)

Informant Sample

size

Study

design

Resilience

variable

Rosenberg

self-esteem CYRM CBCL Qualitative Other measure(s)

Asante et al., 2019 Mean age¼14 Child 16 Cross-sectional Outcome x Qualitative semistructured interviews

Beeckman et al., 2019 8– 18 Child 59 Cross-sectional Mediator AFQ-Y þCPAQ-A

Bethell et al., 2019 6– 17 Parent 51,156 Cross-sectional Outcome Child Flourishing Index, Family Resilience &

Connection Index and Social Engagement Index

(constructed using items from the NSCH)

Cheetham-Blake

et al., 2019

7– 11 Child 34 Cross-sectional Predictor x The Kidcope questionnaireþat-home parent –child

dyadic interviews

Cohen et al., 2019 10– 11 Child 167 Cross-sectional Predictor x My Life Today scale þ10-item emotional regulation

scale þThe BSI

Conover et al., 2020 6– 10 Parent 36 Intervention Outcome x x Context of ‘Tell Me a Story’ intervention; Ego-

Resiliency Q-Sort (ER-11); total CBCL as well as

internalizing and externalizing subscales used

Cui et al., 2020 14– 18 Child 1354 Longitudinal Outcome x x Future Events Questionnaire; child maltreatment was

measured every two years from birth onwards

Ellersgaard et al., 2020 7 Child 522 Cross-sectional Outcome KIDSCREEN-27 (Quality of life measures) & Self-

esteem scale ‘I think I am’

Elmore et al., 2020 8– 17 Parent 40 302 Cross-sectional Mediator Using the ‘HOPE: Health Outcomes from Positive

Experiences’ framework, the following factors were

constructed: emotional competency, constructive

social engagement, safe and stable environment,

trusting relationships with adults

Study

Age range

(in years) Informant

Sample

size

Study

design

Resilience

variable SDQ

Rosenberg

self-esteem CYRM CD-RISC Qualitative Other measure(s)

Fogarty

et al., 2019

10 Parent 9 Longitudinal Outcome x x Semistructured interviews about: experiences of abuse

within relationships, making decisions around

staying or leaving relationships, parenting, how

they and their children coped, and help seeking

Folayan

et al., 2020

6– 16 Child 1001 Cross-sectional Psycho-metrics x x Perceived Social Support scale

Hebbani

et al., 2020

Mean age

¼19.7

Child 331 Cross-sectional Outcome x Socio-cultural factors Questionnaire (culturally

mediated factors linked to resilience) þSGSS þthe

Ryff and Keyes Scales of Psychological Well Being

Herbell et al.,

2020

6– 17 Child 1900 Cross-sectional Outcome Child Flourishment Index þFamily Resilience and

Connection Index; parental coping and parental

emotional support were also measured (constructed

using items from the NSCH)

Jefferies et al.,

2019

9– 12 Child 227 Cross-sectional Outcome x x Other measures of physical activity and competence

including PLAYfun, PLAYself, PLAYinventory,

PLAYparent and PLAYpe_teacher; also the peer

relations subscale of the SDQ was used

Kaiser et al., 2020 13– 14 Child 12 Cross-sectional Outcome x Phenomenological qualitative approach using in-depth

interviews

Mood and anxiety disorders

12 www.co-psychiatry.com Volume 34 Number 1 January 2021

Table 1 (Continued )

Study

Age range

(in years) Informant

Sample

size

Study

design

Resilience

variable SDQ

Rosenberg

self-esteem CYRM CD-RISC Qualitative Other measure(s)

Kirby et al., 2020 4 –5 Teacher 636 Longitudinal Outcome x GHQ-28, Kessler-6, Infant Characteristics

Questionnaire, FRS adult deprivation questions,

EYFSP, maternal self-efficacy; these measures were

administered either at 6, 18, 12, or 24 months in

parents

Study Age range

(in years) Informant

Sample

size

Study

design

Resilience

variable

SDQ

RSCA CYRM CBCL Qualitative Other measure(s)

Liu et al., 2020 12–14 Child 646 Cross-sectional Outcome x Also measured parent-child relations

Llistosella et al., 2019 12– 19 Child 270 þ15 þ432 Cross-sectional Psychometrics x Study I ¼CRYM-28; Study II ¼semi-structured

interviews with 6 youth aged 17 to 19, 4

participants from Study I and 5 resilient experts;

Study III ¼validation of the CYRM-32; convergent

and discriminant validity was compared with the

BRCS, ACS, and AF5

Malee et al., 2019 6 –14 Parent 448 Longitudinal Outcome x Completed every 6 months; resilience was defined as

having CBCL T-scores within the normal range (T-

score <60)

Mantovani et al.,

2020

14– 18 Child 9 Intervention Outcome x Semistructured, one-to-one interviews in relation to a 1-

year peer-mentoring relationship

Matsuyama et al.,

2020

6– 10 Parent 2712 Longitudinal Mediator CRCS; resilience as a mediator between parent –child

interactions and dental caries incidence

Mayr et al., 2020 9– 15 Child 24 Intervention Outcome Lifestyle intervention; cardiorespiratory fitness and

Piers-Harris 2 children’s self-concept scale was

assessed at baseline and at 12 weeks

Miller-Graff

et al., 2020

4– 17 Parent 385 Cross-sectional Outcome x SDQ ¼Total and prosocial skills subscale; other

parental measures included: the FACES-IV, the PBS,

and the RRC-ARM

Morgan

et al., 2020

9– 16 Child 252 Cross-sectional Outcome x Also administered the Perceived Parental Rearing

Patterns Scale (EMBU), Chinese version

Study

Age range

(in years) Informant

Sample

size

Study

design

Resilience

variable SDQ RSCA

Rosenberg

self-esteem CBCL Qualitative Other measure(s)

Ndetei et al., 2019 11– 18 Child 1883 Cross-sectional Outcome x Resilience scale (ER-89) þYSR

Rotheram-Borus

et al., 2019

0– 5 Parent 1073 Longitudinal Outcome x x Resilience was defined as being within the normal

range for growth, cognitive functioning, and

behavior; measures include: the Bayley Scale of

Infant Development, the Peabody Picture

Vocabulary Test, the KABC

Shaw et al., 2019 11, 13, 15 Child 5286 Cross-sectional Outcome 5-item World Health Organization Wellbeing

index þ3 promotive factors: frequency of eating

family meals together, classmate support and

teacher support

Tam et al., 2020 9 –10 Child 276 Intervention Outcome x x Resilience-based intervention; also administered:

MSAS and the CSES-A

Measuring resilience in children King et al.

Table 1 (Continued )

Study

Age range

(in years) Informant

Sample

size

Study

design

Resilience

variable SDQ RSCA

Rosenberg

self-esteem CBCL Qualitative Other measure(s)

Tian et al., 2019 10–17 Child 2898 Cross-sectional Predictor x Also assessed self-harm and depressive symptoms

Veronese et al.,

2020

7– 13 Child 29 Cross-sectional Outcome x Participatory approach based on children’s drawings

of maps representing safe and unsafe places

followed by a guided walk (n¼10) through those

places

Vreeman et al.,

2019

10– 14 Child 253 Intervention Outcome x Context of RCT; depression symptoms were measured

using the Patient Health Questionnaire (PHQ-9);

resilience was defined as having low scores on

SDQ Total and PHQ-9

Wang et al., 2019 0.5 –6 Parent 2397 Cross-sectional Mediator DECA þInfant-Junior Middle School Student’s Ability of

Social Life Scale; having a score of 60 or more on

DECA was defined as resilience

Worku et al., 2019 13 Child 137 Cross-sectional Outcome x Conducted interviews and focus groups þthe Ryff and

Keyes Scales of Psychological Well Being

Study Age range (in years) Informant Sample size Study design Resilience variable Other measure(s)

Wu et al., 2020 8–14 Child 816 Longitudinal Outcome Self-rating Scale of Psychological Resilience; the

preliminary questionnaire was validated in a

presample of 269 children

Xiao et al., 2019 10– 17 Child 2898 Cross-sectional Outcome RSCA ¼Resilience Scale for Chinese Adolescents

Young et al., 2020 4 Child 64 Longitudinal Outcome Different types of intelligence were assessed using the

WPPSI-III; language ability was determined using

the CELF-Pre2; visual ability and motor coordination

was assessed using the Beery-Buktenica Test of VMI;

cortical thickness, surface area and brain volume

were assessed using MRI scans; resilient was

defined as having good neurodevelopmental

outcomes and cognitive abilities

ACS, Coping Strategies for Adolescents; AF5, Self-Concept Form 5; AFQ-Y, Avoidance and Fusion Questionnaire for Youth; BRCS, Brief Resilient Coping Scale; BSI, Brief Symptom Inventory; CBCL, Child Behavior

Checklist; CD-RISC, Connor Davidson-Resilience Scale; CELF-Pre2, Clinical Evaluation of Language Fundamentals—Preschool, 2nd Ed; CPAQ-A, Chronic Pain Acceptance Questionnaire –Adolescent version; CRCS,

Children’s Resilient Coping Scale; CSES-A, Cultural Self-Efficacy Scale for Children and Adolescents; CYRM, Child and Youth Resilience Measure; DECA, Devereux Early Childhood Assessment; EMBU, Egna Minnen av

barndoms uppfostran; EYFSP, Early Years Foundation Stage Profile; FACES-IV, Family Adaptability and Cohesion Scale; FRS, Family Resources Survey; GHQ-28, General Health Questionnaire; KABC, Kaufman

Assessment Battery for Children; MSAS, Making Sense of Adversity Scale; NSCH, National Survey of Children’s Health; PBS, Parent Behavior Scale; RRC-ARM, Resilience Research Centre-Adult Resilience Measure;

RSCA, Resilience Scale for Chinese Adolescents; SDQ, Strengths and Difficulties Questionnaire; SGSS, Sherer General self-efficacy scale; VMI, visual motor integration; WPPSI-III, Wechsler Preschool and Primary Scales

of Intelligence 3rd Ed; YSR, Youth Self Report.

Mood and anxiety disorders

14 www.co-psychiatry.com Volume 34 Number 1 January 2021

Likert scale that taps into seven domains: goal focus,

emotion control, positive cognition, family support,

interpersonal assistance, personal strength, and sup-

port [38]. The RSCA was exclusively used in studies

with Chinese participants [29,39,40

,41,42]. The

CBCL addresses a range of emotional and behavioral

problems including internalizing and externalizing

symptoms, attention problems, and aggressive

behaviors; total scores or its subscales can be used

[43]. The preschool version of the CBCL contains

100 items, is intended for children aged 1.5 –5 years

and relies on parent reports. The school-age version

is made up of 118 items, is designed for children

aged 6–18 years and can be teacher or parent-

reported; otherwise if the child is 11 years or older,

then the 112-item Youth Self-Report (YSR) version

of the CBCL can be used [44]. For the current review,

three studies relied on parent reports [34,45,46

whereas two studies administered the YSR version

[47

,48]. Of the studies identified in the current

review, one study examined the CBCL total scores

as well as the internalizing and externalizing sub-

scales [46

], another analyzed the CBCL total scores

along with the aggressive subscale [34], another used

the activities and social subscale [47

], and two used

the CBCL total scores only [45,48]. However, in two

of these studies, the CBCL scores were used as an

indicator of behavioral and emotional problems

rather than resilience [46

,48]. The other studies

used the CBCL ‘activities and social’ subscale as a

measure of social competence [47

], whereas the

remaining two studies defined resilience as having

CBCL scores in the normal range [34,45].

The next most commonly used instruments

were the Rosenberg Self-Esteem Scale and the Child

and Youth Resilience Measure (CYRM). The Rosen-

berg Self-Esteem Scale was administered in four

studies [28,30,40

,47

] and the CYRM in three

[31,36,46

]. The Rosenberg Self-Esteem scale is com-

posed of 10 items and conforms to a 4-point Likert

scale [49]. There are three versions of the CYRM, the

12, 28, and 32-item versions all of which are based

on a 5-point Likert scale [50,51]. The CYRM-12 was

administered in two studies [36,46

] whereas the

CYRM-32 was used and validated in one study [31].

Another two studies [30,52] administered the

25-item Connor Davidson-Resilience Scale [53],

although Folayan et al. [30] utilized the reduced

10-item version [54]. The Ryff and Keyes Scales of

Psychological Well Being is an instrument consist-

ing of six subscales: self-acceptance, positive rela-

tions with others, autonomy, environmental

mastery, purpose in life and personal growth [55]

and was administered in two studies as well [23,52].

The remaining studies used other measures of resil-

ience and are indicated in Table 1.

With the exception of six studies where resilience

was either characterized as an absence of psychologi-

cal inflexibility [24], having low scores on the SDQ

[35,37], or being in the normal range behaviorally

(e.g., CBCL scores) [34,45], developmentally [34], or

cognitively [56], the remaining studies used actual

resilient scales or measures of positive adjustment

rather than relying on an absence of psychopathol-

ogy to characterize resilience. This is reassuring con-

sidering that a similar review which was conducted

recently (from 2004 to 2018) and examined measures

of resilience in children, found that over half of the

identified studies characterized resilience as an

absence of psychopathology, namely low levels of

externalizing and internalizing problems, anxiety,

depressive symptoms, aggression, delinquency, anti-

social behavior, and drug use [57

]. It is possible that

current research in psychiatry is starting to address

concerns about equating an absence of psychopa-

thology with resilience.

A significant limitation of the studies identified

in the current review and of those reviewed by Gart-

land et al. [57

] is that none featured observable

behavioral measures of resiliency in the children;

rather they were all based on self-reports and par-

ent-reports or to a lesser extent, teacher-reports. Some

of the limitations of relying on self-report measures

are that they introduce social-desirability and recall

biases [58] and disagreement among informants has

been a long-standing issue in research [59,60]. Obser-

vational measures of resilience such as how a child

copes with a stressful task may be a more reliable

means of detecting resilience in young children as it

provides insight into the behavioral and cognitive

processes involved. Although there was one study

identified in our review which used the BEST-C (the

children’s version of the Trier Social Stress Test) and

includes verbal reports assessing self-reported stress

and coping in response to the task, these reports were

only examined in the context of a manipulation

check. Furthermore, the main purpose of this study

was to assess the impact of this task on salivary

cortisol and heart rate [21]. An alternative to this

paradigm is the Challenging Puzzles Task (CPT),

which not only captures how children deal with a

stressful task but also taps into three indicators of

resilience: positive self-evaluation, hopefulness, and

motivation [15,61–63]. These constructs are detect-

able in children as young as four years old [64] and are

relatively stable up to five years later [65].

RECOMMENDATIONS FOR FUTURE

RESEARCH

The Maternal Adversity, Vulnerability and Neurode-

velopment (MAVAN) project, a community-based,

Measuring resilience in children King et al.

prospective cohort study of pregnant mothers and

their offspring, is currently using the CPT to identify

the developmental pathways associated with risk and

resilience. Dyads are assessed longitudinally, with

multiple assessments of both mother and child in

home and laboratory from pregnancy to late adoles-

cence. In our study, the CPT was administered to five-

year-old children by a trained experimenter in the

child’s home alongside other measures of child

behavior. The CPT [66] is a modified version of the

task used by Cole et al. [64,65] with children of the

same age: our adapted version consisted of five puzzle

trials instead of the original seven trials. The CPT

consists of a series of possible and impossible puzzles,

whereby reactions to a challenge (in this case, three

impossible puzzles) are captured via a rating scale.

Puzzles one and five are possible to solve and can be

completed with the help of the research assistant as

needed whereas puzzles 2–4 are impossible and have

a time limit of 2minutes. A picture of each puzzle is

shown before the challenge begins and after each

puzzle the children are asked the following questions:

How well do you think you did on the puzzle? (posi-

tive self-evaluation); How do you think you will do on

the next puzzle?(hopefulness); How do you feel about

doing the next puzzle? (motivation). To answer these

questions, a prepuzzle trial is conducted to ensure the

child understands the accompanying rating scales (of

stars and happy/sad faces) which range from 1 (nega-

tive outlook) to 5 (positive outlook; Fig. 1).

Measures of resilience were captured in two

ways. First, self-ratings according to the above ques-

tions were recorded and used to conduct data-driven

trajectory analyses across the five puzzles for each

indicator of resilience. Whether assessing positive

self-evaluation, hopefulness or motivation, prelimi-

nary data corresponding to these trajectory analyses

revealed three distinct and consistent response pat-

terns. One group of children remained relatively

stable and exhibited positive self-appraisal through-

out the puzzle task even when faced with failures

(resilient group), another group showed a decrease

in self-appraisal when faced with impossible puzzles

followed by an improvement in self-appraisal when

presented with a solvable puzzle (rebound group),

whereas a third group of children exhibited steadily

decreasing self-appraisal even when presented with

a solvable puzzle post-impossible trials (discouraged

group; Fig. 2). Similar trajectories have been

detected in other studies on resilience [67 –69], fur-

ther validating our findings.

Second, a video component of the CPT is cur-

rently being coded according to the Disruptive

Behavior Diagnostic Observation Schedule (DB-

DOS), a structured clinic-based assessment designed

to capture emotional dysregulation in young

children [70,71]. For our purposes, the DB-DOS was

adapted to capture salient behaviors relevant to the

CPT: anger modulation, stress reactivity, compe-

tence, prosocial skills, and coping strategies. Exam-

ples of the behaviors in question are noted across all

five puzzles with attention paid to the intensity and

frequency as well as the child’s verbal and physical

cues (e.g., frowning, self-talk, complaints, shrugging

of shoulders, crossing of arms). Codes range from 0

to 3 with 3 indicating that the behavior in question

is present to a high degree and 0 indicating that the

behavior is not present. The scores are then totaled

across each domain. Because of the subjectivity in

coding, internal reliability was set at 80% with the

second coder needing to demonstrate agreeableness

on 4/5 behavior codes before going on to code inde-

pendently. Additionally, 40% of the videos were

double-coded and 25% triple-coded to establish

interrater reliability. Essentially, this video compo-

nent of the CPT will complement the self-ratings with

observed measures, thereby enriching this task as a

robust and valid measure of resilience. Analyses using

this measure are currently underway.

EARLY LIFE ADVERSITY

Models of resilience have historically included con-

sideration of developmental pathways including the

role of ELA and constitutional (e.g., genetic) suscep-

tibility. The operationalization of ELA requires spe-

cific attention as one factor that is often overlooked

and difficult to disentangle is the timing of exposure

to ELA. The early life period is critical as some win-

dows of development may be more influential than

others. For example, the prenatal period has been the

focus of much investigation because the fetus is

forming according to incoming signals from the

maternal environment [72]. The fetus is therefore

susceptible to prenatal stress and maternal mood

states whose effects can be directly transmitted via

neuroendocrine signals and epigenetic programming

[73,74]. On the other hand, postnatal influences have

the potential to modulate or even override prenatal

effects as well as genetic vulnerability effects [75– 77].

Children’s brains are known to be extremely plastic

up until early adulthood [78,79] and compelling

evidence from attachment and maternal care

research demonstrates the profound impact of post-

natal influences on child development [80– 82].

Other research suggests that it is not necessarily a

question of timing, but whether the prenatal envi-

ronment ‘matches’ the postnatal environment, a

concept known as the match-mismatch hypothesis

[83]. If the postnatal environment is congruent with

the prenatal environment, the fetus’ adaptations in

utero will apply outside the womb resulting in more

Mood and anxiety disorders

16 www.co-psychiatry.com Volume 34 Number 1 January 2021

favorable outcomes. However, if the prenatal and

postnatal environments are a mismatch, the fetus

will be maladapted to the postnatal environment,

leading to negative outcomes. Another theory pro-

poses that prenatal stress can promote postnatal

plasticity and positive outcomes (if reared in a sup-

portive environment) because of an increased sensi-

tivity that develops from prenatal stress exposure

[84]. Regardless of timing effects, perhaps the more

important question is: does prenatal ELA extend into

FIGURE 1. Images and examples of the Challenging Puzzles Task (CPT). Three questions corresponding to positive self-evaluation,

hopefulness and motivation are asked after each puzzle and participants can respond using the child-friendly rating scales.

Measuring resilience in children King et al.

the postnatal period and if so, how chronic and/or

severe is the ELA? To answer this question, longitudi-

nal measures of ELA are necessary. However, the

chronicity and severity of ELA is not often captured

when assessing environmental risk; rather the mere

presence or absence of a stressor is captured [13,85,86].

Categorizing environmental risk this way likely leads

to inconsistent results as one incident of child mal-

treatment can have a very different impact compared

with having experienced years of child maltreatment.

THE ROLE OF GENETICS

No article identified for this review assessed the

influence of genetics on resilient outcomes in

children although several gene variants (namely,

those associated with the serotonin transporter,

BDNF, CRHR1, and DRD4 [BDNF ¼brain-derived

neurotrophic factor, CRHR1 ¼corticotropin-releas-

ing hormone receptor 1, DRD4 ¼dopamine receptor

4]) have been associated with resilience because of

their implication in emotional and stress regulation

[12,87–93]. Despite a general consensus that there

are direct genetic influences on resilience, mixed

results from genetic studies [94

,95

,96] have

prompted a reflection about how to capture the

complexity of genetic susceptibility and its interac-

tion with environmental factors. As a result, current

research efforts are not only moving away from

candidate gene studies, but they are also moving

FIGURE 2. Trajectory patterns for the three indicators of resilience on the Challenging Puzzle Task (CPT) identifying children

as being in the resilient, rebound or discouraged group.

Mood and anxiety disorders

18 www.co-psychiatry.com Volume 34 Number 1 January 2021

toward gene-by-environment (G E) interaction

studies to explain behavior. Emerging evidence sug-

gests that a combination of environmental and

genetic factors likely influence the relationship

between stress exposure and resilient outcomes. In

other words, genotype may only be a risk factor

under certain environmental conditions [7], a con-

cept that is supported by the differential suscepti-

bility hypothesis [83]. Specifically, the differential

susceptibility hypothesis posits that an underlying

biological vulnerability may not only render indi-

viduals more sensitive to adverse environments

(resulting in worse outcomes), but equally sensitive

to positive environments as well, flourishing as a

result [96]. On the other hand, individuals without

genetic susceptibility may be more likely to perse-

vere regardless of environmental quality.

GE approaches are consistent with findings in

molecular biology which reveal that gene expres-

sion is contingent upon transcriptional signals that

derive from the internal and the external environ-

ment. That the majority of G E studies demon-

strate moderate replicability [97], leads to reflection

about a number of factors. First, most G E studies

focus on a restricted range of environmental factors

and a limited number of genes. This suggests the

need for approaches that can model complex and

comprehensive lists of environmental and genetic

factors [98]. Second, most G E studies are based on

a diathesis-stress model whereby genetic suscepti-

bility to psychiatric disorders manifests under

stressful conditions with more severe stressors

increasing the chances that a disorder will develop

in a dose-dependent manner [99]. The concern is

that the diathesis-stress model often focuses on

negative environmental influences and negative

outcomes; otherwise an absence of adversity and

dysfunction is measured in place of positive factors

[8,13]. Measuring resilience as the absence of adver-

sity or dysfunction may mask potential differential

susceptibility findings as such approaches favor

vulnerability explanations [100] which may lead

to inconsistent results. The diathesis-stress model

also fails to explain why susceptibility genotypes

have not been selected against over the course of

evolution. The significant frequency of many of

these ‘susceptibility’ genotypes [95

] suggest some

advantage to carrying ‘risk alleles’ or at the very

least, that the expression of such genes depends on

variability in the environment.

CONCLUSION

The results from this review suggest that research on

resilience in children is moving away from opera-

tionalizing resilience merely as the absence of

psychopathology, in favor of an understanding that

resilience is a dynamic process that encompasses

several interacting features including coping strate-

gies, emotional regulation abilities, flexibility, self-

esteem, a positive outlook, and prosocial skills.

Some of the studies identified in this review

attempted to capture some of this complexity by

using mixed-methods approaches or by using mul-

tiple instruments to measure resilient functioning.

Also important to note is that although the majority

of the reviewed studies featured resilience as an

outcome variable, very few reported an effect size

[23,33,36,37,101], a key measure needed to deter-

mine the explanatory value of the models being

tested. Despite the move toward more valid mea-

sures of resilience, the exclusive reliance on self-

report or parent-report measures poses some chal-

lenges as resilience is a multidimensional construct

that relies on behavioural and cognitive processes.

For this reason, we propose a method of operation-

alizing resilience in young children that combines

behavioral tasks, self-ratings, and observational

measures. Preliminary findings derived from this

approach appear promising.

We also highlight other considerations in resil-

ience research and propose recommendations for

going forward pertaining to: how ELA is character-

ized; and the influence of genetics on resilient out-

comes. Having a better understanding of these

factors may help explain variability in outcomes.

Although this review outlines measures of resilience

in children, one of the next steps should be the

construction and validation of resilience measures

applicable across the lifespan. This would enable the

exploration of the stability of resilient functioning,

critical protective factors, including key strategies

and processes that could be used in the promotion of

mental wellness. The application of such interven-

tion strategies would be most optimal in early child-

hood when the plasticity of children’s behavior,

cognitive and emotional development can be

exploited to undo maladaptive patterns not

yet entrenched.

Acknowledgements

We would like to thank all the families who participated

in this study, without which this research would not have

been possible.

Financial support and sponsorship

The primary sources of funding for this study include the

Canadian Institute for Health Research (CIHR), grant

numbers: 359912, 365309, and 231614.

Conflicts of interest

There are no conflicts of interest.

Measuring resilience in children King et al.

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The Childhood Resilience Study: Resilience and emotional and behavioural wellbeing experienced by Australian Aboriginal and Torres Strait Islander boys and girls aged 5-9 years

Article

Full-text available

Apr 2024
PLOS ONE

Background Resilience is a process of drawing on internal or external strengths to regain, sustain or improve adaptive outcomes despite adversity. Using a child resilience measure co-designed with Aboriginal and Torres Strait Islander communities, we investigate: 1) children’s personal, family, school and community strengths; 2) gender differences; and 3) associations between resilience and wellbeing. Methods 1132 parent/caregivers of children aged 5–12 years were recruited to the Childhood Resilience Study, including through the Aboriginal Families Study. The Aboriginal Families Study is a population-based cohort of 344 mothers of an Aboriginal and/or Torres Strait Islander child. This paper focuses on the wave 2 survey data on child resilience at age 5–9 years (n = 231). Resilience was assessed with the Child Resilience Questionnaire-parent/caregiver report (CRQ-P/C), categorised into tertiles of low, moderate and high scores. Child emotional/behavioural wellbeing and mental health competence was assessed with the parent-report Strengths and Difficulties Questionnaire. All Tobit regression models adjusted for child age. Outcomes Aboriginal and Torres Strait Islander girls had higher resilience scores compared to boys (Adj.β = 0·9, 95%CI 0·9–1·4), with higher School Engagement , Friends and Connectedness to language scale scores. Resilience scores were strongly associated with wellbeing and high mental health competence. A higher proportion of girls with low resilience scores had positive wellbeing than did boys (73.3% versus 49.0%). High resilience scores were associated with lower SDQ total difficulties score after adjusting for child age, gender, maternal age and education and family location (major city, regional, remote) (Adj.β = -3.4, 95%CI -5.1, -1.7). Compared to the Childhood Resilience Study sample, Aboriginal Families Study children had higher mean CRQ-P/C scores in the personal and family domains. Interpretation High family strengths can support Aboriginal and Torres Strait Islander children at both an individual and cultural level. Boys may benefit from added scaffolding by schools, family and communities to support their social and academic connectedness.

Resilience and Positive Wellbeing Experienced by 5–12-Year-Old Children with Refugee Backgrounds in Australia: The Childhood Resilience Study

Article

Full-text available

May 2024
Int J Environ Res Publ Health

Refugee research tends to be deficit based and focused on the risks threatening positive adaptation and wellbeing. High rates of mental (and physical) health issues have been reported for refugee adults and children, including intergenerational trauma. This study uses the new Child Resilience Questionnaire (CRQ), co-designed with refugee background communities, to describe resilience and positive wellbeing experienced by children of refugee-background. The Childhood Resilience Study (CRS) recruited 1132 families with children aged 5–12 years in Victoria and South Australia, Australia. This included the recruitment of 109 families from 4 refugee background communities: Assyrian Chaldean (Iraq, Syria), Hazara (Afghanistan), Karen (Burma, Thailand) and Sierra Leonean families. CRQ-parent/caregiver report (CRQ-P/C) scores were categorised into ‘low’, ‘moderate’ and ‘high’. The child’s emotional and behavioural wellbeing was assessed with the Strengths and Difficulties Questionnaire, with positive wellbeing defined as <17 on the total difficulties score. Tobit regression models adjusted for a child’s age. The CRQ-P/C scores were not different for boys and girls of refugee background. Children of refugee-background (n = 109) had higher average CRQ-P/C scores than other CRS children (n = 1023) in the personal, school and community domains, but were lower in the family domain. Most children with ‘high’ resilience scores had positive wellbeing for both children of refugee-background (94.6%) and other CRS children (96.5%). Contrary to common stereotypes, children of refugee-background show specific individual, family, school and cultural strengths that can help them navigate cumulative and complex risks to sustain or develop their positive wellbeing. A better understanding as to how to build strengths at personal, family, peer, school and community levels where children are vulnerable is an important next step. Working in close collaboration with refugee communities, schools, policy makers and key service providers will ensure the optimal translation of these findings into sustainable practice and impactful public policy.

Resilience to Stress During Pregnancy: Biopsychosocial Mechanisms and Implications for Offspring Emotional and Behavioral Outcomes in Toddlerhood

Article

Full-text available

Feb 2024

Exposure to high levels of stress during pregnancy is a known risk factor for a wide range of offspring outcomes, but little is known about the biopsychosocial factors underlying resilience and recovery from stress during pregnancy. The current study investigated associations between emotional and instrumental support during pregnancy and resilience to stress during pregnancy, including perceived resilience (belief in ability to “bounce back” from adversity) and physiological resilience (ability to physiologically recover quickly after an acute stressor). We further tested whether support and resilience during pregnancy predicted offspring internalizing and externalizing behaviors. Participants included 130 pregnant women (ages 26–28 years; 58% Black, 27% White, 15% Multiracial; 28% receiving public assistance) from a population-based longitudinal study. During pregnancy, participants reported on emotional and instrumental support, current life stressors, and perceived resilience to stress. In addition, heart rate variability was recorded continuously before, during, and after a controlled stress test to measure physiological recovery from stressors. When offspring were 2–3 years of age, mothers reported on children’s internalizing and externalizing problems. Results from moderated mediation analyses indicated that emotional, but not instrumental, support was associated with perceived resilience during pregnancy, which predicted lower internalizing and externalizing problems in offspring. Emotional support also predicted greater physiological recovery during pregnancy, but only for individuals reporting multiple life stressors. Findings suggest that emotional support may influence psychological and physiological responses to stress during pregnancy, with implications for offspring emotional and behavioral health. Clinical implications of these results and directions for future research are discussed.

Stress Markers, Executive Functioning, and Resilience Among Early Adolescents With Complex Congenital Heart Disease

Article

Full-text available

Feb 2024

Importance Infants with complex congenital heart disease (cCHD) may experience prolonged and severe stress when undergoing open heart surgery. However, little is known about long-term stress and its role in neurodevelopmental impairments in this population. Objective To investigate potential differences between early adolescents aged 10 to 15 years with cCHD and healthy controls in physiological stress markers by hair analysis, executive function (EF) performance, and resilience. Design, Setting, and Participants This single-center, population-based case-control study was conducted at the University Children’s Hospital Zurich, Switzerland. Patients with different types of cCHD who underwent cardiopulmonary bypass surgery during the first year of life and who did not have a genetic disorder were included in a prospective cohort study between 2004 and 2012. A total of 178 patients were eligible for assessment at ages 10 to 15 years. A control group of healthy term-born individuals was cross-sectionally recruited. Data assessment was between 2019 and 2021. Statistical analysis was performed from January to April 2023. Exposure Patients with cCHD who underwent infant open heart surgery. Main Outcomes and Measures Physiological stress markers were quantified by summing cortisol and cortisone concentrations measured with liquid chromatography with tandem mass spectrometry in a 3-centimeter hair strand. EFs were assessed with a neuropsychological test battery to produce an age-adjusted EF summary score. Resilience was assessed with a standardized self-report questionnaire. Results The study included 100 patients with cCHD and 104 controls between 10 and 15 years of age (mean [SD] age, 13.3 [1.3] years); 110 (53.9%) were male and 94 (46.1%) were female. When adjusting for age, sex, and parental education, patients had significantly higher sums of hair cortisol and cortisone concentrations (β, 0.28 [95% CI, 0.12 to 0.43]; P < .001) and lower EF scores (β, −0.36 [95% CI, −0.49 to −0.23]; P < .001) than controls. There was no group difference in self-reported resilience (β, −0.04 [95% CI, −0.23 to 0.12]; P = .63). A significant interaction effect between stress markers and EFs was found, indicating a stronger negative association in patients than controls (β, −0.65 [95% CI, −1.15 to −0.15]; P = .01). The contrast effects were not significant in patients (β, −0.21 [95% CI, −0.43 to −0.00]; P = .06) and controls (β, 0.09 [95% CI, −0.11 to 0.30]; P = .38). Conclusions and Relevance This case-control study provides evidence for altered physiological stress levels in adolescents with cCHD and an association with poorer EF. These results suggest that future studies are needed to better understand the neurobiological mechanisms and timing of alterations in the stress system and its role in neurodevelopment.

Systematic review and critical appraisal of instruments that measure children and adolescent protectors and family strengths against child maltreatment

Article

Aug 2023
AGGRESS VIOLENT BEH

How do you feel at school? A cross-country comparative analysis of migrant adolescents’ school well-being

Article

Full-text available

Jan 2023

Adolescents present a relevant stakeholder in international migrations since they comprise a large share of all migrants. Previous studies show that migration processes significantly affect the well-being of migrant adolescents. This article investigates how the school environment, with its pedagogical practices and interpersonal relationships established between migrant adolescents, their classmates, and teachers, affect migrant adolescents’ well-being. Our research draws on quantitative data collected as part of the MiCREATE project. The sample of migrant adolescents (N = 700) was surveyed in 46 schools in six countries: Austria, Denmark, Slovenia, Spain, Poland, and the United Kingdom. Results indicate that migrant adolescents like school and feel safe there, however, they tend to be more satisfied with relationships established with teachers than with peers. Furthermore, differences in self-perceived school well-being emerge when comparing countries with a longer tradition of high migration flows (Spain, Denmark, and the United Kingdom) and those less experienced (Poland and Slovenia), although slight exceptions were detected. The results lead to the conclusion that schools that foster intercultural education and fulfilling interpersonal relationships are essential for school well-being of migrant adolescents and present an important step toward successful integration of migrant youth.

Adaptation of the Suicide Attempt Resilience Scale (SRSA-18, Spanish version) for adolescents

Article

Full-text available

Nov 2022

Background The assessment of resilience as an outcome in adolescents remains a challenge, with few instruments available. Some studies have focused on risk factors, but few have focused on protective factors as a formula for measuring resilient outcomes. Aims To adapt a new Suicide Attempt Resilience Scale (SRSA-18) for use with adolescents, analysing its structural validity, the gender and age invariance of the measure, and divergent and convergent validity, together with its reliability. Method The psychometric properties of the scale were assessed in 628 participants aged between 13 and 18 years, of whom 342 (54.5%) were girls. Results After a process of adaptation for adolescents, exploratory and confirmatory factor analysis yielded a three-dimensional structure with adequate goodness-of-fit indices, invariance of the measure according to gender and age, adequate levels of reliability (ω = 0.91), high convergent validity with the 14-Item Resilience Scale and high divergent validity with the suicidal act/planning subdimension of the Adolescent Suicidal Behavior Assessment Scale. Conclusions There is a need to create and adapt instruments to measure resilience in some populations with high psychosocial vulnerability as a key aspect for measuring the impact of prevention and mental health promotion programmes in adolescents.

Children and adolescents weathering the storm: Resilience in the presence of bullying victimization, harassment, and pandemic lockdown in northern Norway

Article

Apr 2024
SCAND J PSYCHOL

Resilience is a concept of growing interest because it can systematically inform prevention measures and psychosocial interventions for children and adolescents. The aim of this study was to explore resilience factors among young people who are victims of bullying and harassment (age 9 to 16 years old). In 2021 the burden of the pandemic lockdown became an additional adversity. The study used a repeated cross‐sectional design. Two datasets with a total of 2,211 participants from 2017 ( N = 972) and 2021 ( N = 1,239) were included. The strengths and difficulties questionnaire (SDQ) was applied to define the resilient and non‐resilient groups, and the quality‐of‐life questionnaire (KINDL) was used to map resilience factors. A total of 227 participants reported that they were being bullied, and 604 participants reported harassments from their peers. We used correlation and regression analyses to identify which factors predicted the highest resistance to the negative effects of bullying and harassment. The results were that 77.2% of the participants stayed resilient when facing these maladjustments, but this dropped to 61.7% during the pandemic. The most important resilience factors before the pandemic were the school environment, emotional well‐being, and good relations with their friends. The impact of these predictors changed during the pandemic. Emotional well‐being increased in strength, school environment was reduced, and friends did not predict resilience anymore. The effect sizes were generally large to medium. As it is common to experience adversity at some stage in life, it is vital for families, schools, social and healthcare workers to be aware of the factors associated with resilience. The results of this study may contribute towards an evidence base for developing plans to increase the capacity of resilience among young people.

Defining and Measuring Resilience in Children with a Chronic Disease: a Scoping Review

Article

Full-text available

Apr 2023

Unlabelled: More than 25% of all children grow up with a chronic disease. They are at higher risk for developmental and psychosocial problems. However, children who function resiliently manage to adapt positively to these challenges. We aim to systematically review how resilience is defined and measured in children with a chronic disease. A search of PubMed, Cochrane, Embase, and PsycINFO was performed on December 9, 2022, using resilience, disease, and child/adolescent as search terms. Two reviewers independently screened articles for inclusion according to predefined criteria. Extraction domains included study characteristics, definition, and instruments assessing resilience outcomes, and resilience factors. Fifty-five out of 8766 articles were identified as relevant. In general, resilience was characterized as positive adaptation to adversity. The included studies assessed resilience by the outcomes of positive adaptation, or by resilience factors, or both. We categorized the assessed resilience outcomes into three groups: personal traits, psychosocial functioning, and disease-related outcomes. Moreover, myriad of resilience factors were measured, which were grouped into internal resilience factors (cognitive, social, and emotional competence factors), disease-related factors, and external factors (caregiver factors, social factors, and contextual factors). Our scoping review provides insight into the definitions and instruments used to measure resilience in children with a chronic disease. More knowledge is needed on which resilience factors are related to positive adaptation in specific illness-related challenges, which underlying mechanisms are responsible for this positive adaptation, and how these underlying mechanisms interact with one another. Supplementary information: The online version contains supplementary material available at 10.1007/s42844-023-00092-2.

Resilience and the Child with Learning Disabilities

Chapter

Mar 2023

The mindset of both teachers and students plays a significant role in how successfully students learn and thrive in schools. Mindsets are defined as the assumptions and expectations we possess about ourselves and others that determine our behaviors. This chapter identifies the components of a resilient mindset and describes the seven instincts that fall under the concept of tenacity. The input of the teacher as a “charismatic adult” for students, as an essential source for their intrinsic motivation, resilience, and social-emotional development, is highlighted. A foundation for an effective classroom environment that enriches the “whole” student is the presence of positive emotions. Such emotions encourage the emergence and maintenance of personal control, self-discipline, intrinsic motivation, responsibility, caring, and resilience. Deci and Ryan’s framework for intrinsic motivation, “self-determination theory,” and its focus on the importance of meeting four basic needs—belonging and connectedness; self-determination and autonomy; competence; and meaning and purpose—are described together with specific strategies to reinforce these needs in all students.

The Impact of Parental Remote Migration and Parent-Child Relation Types on the Psychological Resilience of Rural Left-Behind Children in China

Article

Full-text available

Jul 2020
Int J Environ Res Publ Health

Using survey data of middle school students from Ye county in Henan province and Chenggu and Ningqiang county in Shaanxi province, China, adopting latent class analysis and hierarchical linear regression, this study analyzes the impact of parental remote migration and parent-child relation types on the psychological resilience of rural left-behind children. The results show that: Only mother’s remote migration has a significantly negative impact on the psychological resilience of rural left-behind children, the time of parental first migration, the distance of father’s migration, and children’s migration have no significant impacts; parent-child relation of “alienation connection and weak function” or parent-child relation combination of “parental alienation connection and weak function” is the most unfavorable factor for the psychological resilience of rural left-behind children, while father-child relation of “close connection but lacking function”, mother-child relation of “intimate connection and strong function”, and combination of “paternal close connection but lacking function - maternal intimate connection and strong function” are the most favorable factors. There is gender difference in the impact of father-child relation types and mother-child relation types, the impact of father-child relation types is stronger than that of mother-child relation types; harmonious parental relation, supportive friends, caring teachers, and moderate home-school interaction are favorable for the psychological resilience of rural left-behind children.

Resilience trajectories of cancer survivors: a meaning-making perspective

Chapter

Full-text available

Jan 2020

The transition from active treatment to survivorship is often a highly stressful and potentially critical juncture in determining long-term postactive treatment well-being of individuals with cancer. While decrements in well-being are often observed on average, there is tremendous variation across survivors on many different indices of well-being. During this reentry period, many survivors attempt to make sense of their cancer experience and its ultimate impact on their lives. Based on the broader trauma and coping literature and theory, this chapter considers posttrauma (cancer treatment) adjustment by examining factors that facilitate and/or impede three posttrauma trajectories: continued distress, recovery, and resilience. Influencing these trajectories are aspects of the cancer and treatment (e.g., length and intensity, time since diagnosis), psychosocial resources (e.g., social support) and appraisal and coping processes (e.g., threat vs challenge appraisals, approach vs avoidance coping). With this information, clinicians and researchers can assess and target mutable factors to help those who are distressed and potentially promote resilience during the transition from active treatment to cancer survivorship.

Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age

Article

Full-text available

Jul 2020
FRONT HUM NEUROSCI

Children born very preterm (VPT) are at high-risk for altered brain development and impaired neurodevelopmental outcomes but are not well-studied before school-age. We investigated 64 four-year-olds: 37 VPT children [<32 weeks gestational age [GA]; 22 males; mean GA: 28.8 weeks ± 1.6], 25 full-term (FT) children (12 males), plus two VPT cases with ventriculomegaly and exceptionally resilient outcomes. All children underwent high-resolution structural magnetic resonance imaging and developmental assessments. Measures of brain volume, cortical thickness, and surface area were obtained. Children born VPT demonstrated reduced cerebral and cerebellar white matter volumes yet increased cerebral gray matter, temporal lobe, occipital lobe and ventricle volumes after adjusting for total brain volume. Cortical thickness was greater in the VPT children compared to FT children across all lobes. On developmental assessments, the VPT children scored lower on average than FT children while the two cases had intact cognitive abilities. In addition to larger ventricle volumes, the two cases had white matter and gray matter volumes within the ranges of the FT children. The VPT children displayed distinct differences in structural brain volumes at 4 years of age, consistent with delayed maturation. The cases with persistent ventriculomegaly and good cognitive outcomes displayed typical gray matter and increased white matter volumes, indicating a potential protective developmental phenomenon contributing to their intact cognitive abilities.

Internal consistency and correlation of the adverse childhood experiences, bully victimization, self-esteem, resilience, and social support scales in Nigerian children

Article

Full-text available

Jul 2020
BMC Res Notes

Objectives: We evaluated the internal consistencies and the correlation between measures of adverse childhood experiences (ACE), bully victimization, self-esteem, resilience, and social support in children/adolescents in Nigeria. Results: The Cronbach's alphas were 0.67 for the ACE Questionnaire; 0.79 for the victimization subscale of the Illinois Bully Scale; 0.60 for Rosenberg's self-esteem scale; 0.81 for Connor-Davidson resilience scale; and 0.93 for multidimensional perceived social support scale. Social support was negatively correlated with ACE (r = - 0.21) and bully victimization (r = - 0.16) and was associated with higher self-esteem (r = - 0.29) and higher resilience (r = 0.15). Likewise, higher resilience was associated with fewer ACE (r = - 0.07), higher self-esteem (r = - 0.21), and higher bully victimization (r = 0.13). Higher self-esteem was associated with fewer ACE (r = 0.25) and lower bully victimization (r = 0.16), whereas bully victimization was positively correlated with ACE (r = 0.20). The correlations were all statistically significant.

The Interaction of Adverse Childhood Experiences and Resiliency on the Outcome of Depression Among Children and Youth, 8-17 year olds

Article

Full-text available

Jul 2020
CHILD ABUSE NEGLECT

Background Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression. Objective Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression. Participants and setting Data were drawn from the nationally representative 2016-2017 National Survey of Children’s Health (NSCH) and included a total sample of 40,302 children and adolescents. Methods Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used. Results Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience. Conclusions These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.

Longitudinal Analysis of Child Resilience Link to Dental Caries

Article

Jul 2020

Purpose: To investigate the association between parent-child interactions in the first grade, child resilience in the second grade, and dental caries incidence in the fourth grade of elementary school. Methods: The longitudinal data of 3,168 children from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study were analyzed. In 2015, caregivers of all first-grade public elementary school children in Adachi City, Tokyo, Japan, provided answers about their parenting behaviors. In the second grade, child resilience and oral health behaviors were measured. The incidence of dental caries in the fourth grade was assessed during mandatory dental checkups at school. Structural equation modeling was applied. Results: Parent-child interactions at the first-grade was associated with higher resilience of children in second grade (standardized coefficient [β] equals 0.402; 95 percent confidence interval [95% CI] equals 0.357 to 0.446), which was associated with favorable oral health behavior in the same year (β equals 0.236, 95% CI equals 0.159 to 0.313). Favorable oral health behavior was inversely associated with dental caries incidence in the fourth grade (β equals -0.108, 95% CI equals -0.170 to -0.045). Conclusion: Parent-child interactions were associated with improved resilience and fewer incidents of dental caries in children.

A comparison of psychological resilience and related factors in Chinese firstborn and only children

Article

Aug 2020

The objective of this research is to compare psychological resilience in Chinese firstborn and only children and its relation to perceived parenting styles and child abuse. The results found that total psychological resilience score, and resilience subscales such as emotion control and goal focus mean scores of the firstborn child was significantly lower compared to the only child (Ps<0.05). The total psychological resilience scores of both male and female in firstborn children was significantly lower, when compared respectively to only children (Ps<0.01). Emotional warmth and understanding in both parents was positively correlated to total psychological resilience (Ps<0.01) in the only child. Severe punishment by the father and rejection/denial by the mother were factors negatively correlated to total psychological resilience score in the only child (Ps<0.01). Severe punishment and rejection/denial by the father and severe punishment by the mother was negatively correlated to total psychological resilience score in the firstborn child (Ps<0.05). Child abuse was negatively correlated to total psychological resilience (r= -0.246, P < 0.05) scores in the only child, and was negatively correlated to goal focus (r= -0.191, P < 0.05) and emotion control (r= -0.222, P < 0.05) scores in the first born child. In conclusion, the firstborn child had a lower psychological resilience score when compared to the only child, especially the female firstborn child. Negative perceived parenting style and child abuse were detrimental to psychological resilience.

Family resilience and flourishment: Well-being among children with mental, emotional, and behavioral disorders

Article

Aug 2020

Approximately 20% of children and adolescents in the United States are affected by mental, emotional, and behavioral (MEB) disorders. Child flourishment and family resilience contribute to healthy family development, including the promotion of child MEB wellbeing. Identifying factors that promote child flourishment and family resilience are critical. This study aimed to determine the prevalence and parenting factors associated with family resilience and child flourishment among children aged 6–17 years with MEB disorders. This was a secondary analysis of the 2016–2017 National Survey of Children's Health. The sample consisted of parents and their children (n = 1,900, weighted n = 5,375,670). Data were weighted to be representative of the US population and analyzed using descriptive statistics and linear regression. We found that only 6.3% of children aged 6–17 with an MEB were optimally flourishing. Parental aggravation was negatively associated with child flourishment, and parental coping was positively associated with child flourishment. In total, 66.5% of families with children exhibited resilience. Parental coping and availability of parental emotional support were positively associated with family resilience. Potential interventions that leverage study findings include parent training to increase parental emotional regulation (e.g., increase frustration tolerance, coping skills) and family navigation services to increase parental support (e.g., emotional support, coping skills) through the child's treatment trajectory. Overall, this study provides evidence of a disparity in flourishment in America's youth with MEB disorders, and despite this adversity, families are resilient.

Caregiver and family factors promoting child resilience in at-risk families living in Lima, Peru

Article

Oct 2020
CHILD ABUSE NEGLECT

Background Child victimization is one of the most serious, preventable threats to child health and wellbeing around the world. Contemporary research has demonstrated that polyvictimization, or children’s experience of multiple types of victimization, is particularly detrimental. Objective The current study aims to evaluate relationships between child victimization and child resilience with a particular focus on caregiver and family promotive factors. Participants and setting Participants included N = 385 caregiver-child dyads from a high-risk neighborhood in San Juan de Lurigancho district in Lima, Peru. Methods Data were collected in the context of a representative survey of houses in the neighborhood; an index child (ages 4-17) was randomly selected for each household and caregivers provided reports on core study constructs. Results Child victimization (β = .35, p < .001) and harsh punishment (β = .17, p < .001) were associated with higher levels of child adjustment problems. Caregiver depression was associated with both higher adjustment problems (β = .22, p < .001) and higher prosocial skills (β = .14, p = .003). Caregiver resilience was associated with lower adjustment problems (β = -.15, p = .01) and higher prosocial skills (β = .14, p = .04). Positive parenting was associated with lower adjustment problems (β = -.15, p < .001) and higher prosocial skills (β = .20, p < .001). Family cohesion (β = .23, p = .001) was positively associated only with children’s prosocial skills. Conclusions Findings suggest that caregiver resilience and positive parenting are consistent promotive factors for child resilience across indicators, including both adjustment problems and prosocial skills. These promotive factors may therefore be promising potential targets address in the context of interventions aimed at promoting child resilience.

A study of resilience among young adult children of alcoholics in Southern India

Article

Jun 2020

Young Adult Children of Alcoholics (YACOA) are vulnerable to emotional psychopathology. However, some of them remain healthy and lead a productive life despite growing up in adverse circumstances. The present study aims at understanding the relationship between resilience and positive psychological factors among those healthy YACOA. Participants who were identified as YACOA were enrolled from both urban and rural colleges in Karnataka (India). Among them, those who did not report emotional psychopathology were assessed on measures of Resilience, socio-cultural factors (family support, community support, and participation in religious rituals), Self-efficacy and psychological well-being. They were divided into high and low resilience groups based on the median scores. YACOA with high resilience had a significant positive association with cultural factors of resilience whereas YACOA with low resilience had significant positive association with self-efficacy and sub-categories of psychological wellbeing. Binary Logistic Regression analysis found that socio-cultural factors were found to be associated with high resilience among YACOA. This study has recognized the significance of socio-cultural factors and self-acceptance in enhancing resilience among healthy YACOA. These findings offer insights into the interventions for the wellbeing of the YACOA.

Measuring resilience in children: a review of recent literature and recommendations for future research

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