Risk and Protective Factors
Risk and Protective Factors: The Child, Family, and Community Contexts
Development is influenced by individual, family, and community contexts. Understanding a child's development requires considering the interactions between the child and their surrounding environment.
Qualitative differences in attachment and neurodevelopmental processes shape varied developmental pathways.
Risk and protective factors at the child, parental, and community levels interact to influence development. Risk factors increase the likelihood of compromised outcomes, while protective factors enhance development.
Research on Risk and Resilience
Research in the 1960s showed that children exposed to the same risk factors (e.g., chronic poverty) were affected differently, leading to the concept of resilience.
Resilience Definitions:
Ability to function competently under threat or recover quickly from extreme stress/trauma.
A process of adaptation.
Good developmental outcomes and adaptive abilities despite high-risk situations (Masten, 2014).
An adaptive process developing over time in the context of risk and resilience factors.
Resilience is a transactional process dependent on supportive environmental factors, especially responsive and protective parenting.
Resilience is considered a normative process that every child must achieve, not just a special attribute in high-risk conditions (Baldwin et al., 1993, p. 743).
Effective support at critical times is essential for resilience. Research focuses on intervening processes to protect children's development under risk (Werner, 2000).
Identifying risk and protective factors is crucial for mental health assessment and intervention. A developmental perspective emphasizes early processes like attachment quality and social determinants of health.
Child, parental, and community factors are presented separately for clarity, but they interact in reality.
Risk and protective processes have a transactional relationship. Outcomes range on a continuum based on the balance of risk and protective factors across development, as well as the timing of stressors or opportunities (Evans & Cassells, 2014; Sameroff, 2006).
Assessment must examine the balance, duration, and timing of risk and protective factors. Protective factors can offset risk. Continuous protective processes promote resilient traits and coping mechanisms.
Risk Factors
Conditions creating developmental risk:
Child vulnerabilities (e.g., mental impairment, chronic illness).
Impaired parenting.
Socioeconomic and institutional factors (e.g., lack of medical care, chronic poverty).
Chronic risks (e.g., parent with schizophrenia) have more impact than acute risks (e.g., brief psychotic episode).
Risk factors become more dangerous as their number increases due to interactive and potentiating effects (Sameroff, 2006; Wille et al., 2008).
One or two risk factors are manageable, but three or more can overwhelm the child and parents, potentially causing developmental or psychiatric disorders.
Sameroff et al.'s (1987) study showed that four-year-olds from low-income families with two or fewer risk factors had IQs averaging 115. Children with four risk factors averaged 94, and those with seven to eight risk factors had IQs in the mid-80s. Accumulation of risk accounted for a 30-point difference in IQ.
Total number of risk factors may be more important than specific types of risk (Evans, Li, & Whipple, 2013).
The most destructive scenario involves accumulated risk over time and in number of factors, combined with few protective mechanisms (Sroufe et al., 1999).
Child-Based Vulnerabilities
Biological Factors
Biological conditions that put children’s development at risk:
Genetic syndromes
In utero exposure to teratogens (e.g., infectious diseases, alcohol, cocaine)
Prematurity and low birth weight
Birth injury or anoxia
Exposure to environmental poisons (e.g., lead)
Chronic illnesses
Genetic risks range from specific medical syndromes (e.g., fragile X, Prader-Willi) to general risks for mental disorders (e.g., autism, ADHD, mood disorders, Tourette syndrome, learning disorders, schizophrenia) (Muter & Snowling, 2009; Rutter, Moffitt, & Caspi, 2006).
Genetic risk does not always result in psychiatric diagnoses due to individual differences and supportive environments.
Instead of a correspondence between a particular gene and a specific disorder, a limited set of genetic risks impair general processes (e.g., cognitive or emotion functions) across many disorders (Kiser, Rivero, & Lesch, 2015).
Certain environments may expose vulnerability in some children and resilience in others (Ellis & Boyce, 2008).
Genes can take alternate forms, called alleles.
Variations in gene structure have been associated with temperamental characteristics and certain mental disorders (Rutter et al., 2006).
For instance, infants with the short allele of the DRD4 gene are rated by their mothers as higher in negative emotionality at 2 and 12 months (Rosenblum, Dayton, & Muzik, 2009, p. 86).
Genetically shaped emotional tendencies' development into enduring negativity or emotion regulation deficits is influenced by the caregiving environment (Rosenblum et al., 2009).
The nature-nurture dichotomy has been recast as "gene-environment interdependence" (Rutter, 2007b).
Multiple genes have small effects and lead to “genetic burdens” that influence the development of both mild and severe forms of disorders (Kiser et al., 2015).
Schizophrenia research shows the influence of both gene and environmental contexts. Adopted children whose birth mothers had schizophrenia were studied longitudinally to see whether they would develop schizophrenia.
Children of a parent with schizophrenia are 10 times more likely to develop the disorder than members of the general population (American Psychiatric Association, 2013).
Quality of family environment influenced whether the child's potential for schizophrenia was realized.
“Virtually no cases of schizophrenia in the offspring were detected when the adoptive family was rated as healthy (i.e., well organized and with little conflict among members). However, the genetic risk for schizophrenia was fully expressed in adoptive families rated high on conflict and disorganization” (Reiss & Neiderhiser, 2000, p. 364).
Biological Conditions and Attachment
Biological vulnerabilities at birth have the potential to affect attachment.
Challenges involved in caring for infants with significant medical problems may have the effect of interfering with the developing attachment relationship.
Specifically, such infants may be less responsive or more irritable than typically developing infants.
Parents may not know how to respond to an ill, premature infant and may at first resist investing emotionally in an infant who may die or be seriously compromised.
Parenting risk factors, such as depression or a history of insecure attachment, may compound parents' difficulties in relating to the infant.
Finally, the environmental risk of being in a NICU for an extended period interacts with these child and parent factors (Aylward, 2009).
Transactional Effects of Biological Conditions Over Time
Biological conditions compromise future development due to sequelae such as developmental delay, neurological disorders, congenital disorders, and disorders of self-regulation (Shannon, 2009).
These physiological factors may also contribute to difficulties in attachment as well as other parent-child relationship issues.
Parents who have babies who are very ill in infancy or are diagnosed with chronic illnesses in early childhood have had to constantly monitor the child's physical states. Hyperattentiveness and protectiveness may persist as a generalized style of relating to the child, whom the parents continue to perceive as fragile.
Parents may constantly run interference for the child and reduce her choices, thereby limiting the acquisition of autonomous skills that are within her developmental abilities (Thomasgard & Metz, 1996).
The child may internalize the parents' view of her and begin to restrict herself inappropriately.
From the perspective of intervention, it is important to discuss with parents the need to develop appropriate expectations for what their child can accomplish and to encourage them to set limits on the child's use of her disability to avoid doing things of which she is capable.
The intensive and invasive medical treatment of chronic or serious illnesses such as cancer can also pose developmental risk, especially during early childhood, when the child's coping mechanisms are not well developed.
Multiple hospitalizations in infancy and early childhood, especially those involving surgery, may interfere with the child's developmental tasks and compromise the parent-child relationship because of ongoing stress experienced by the parents (Minde, 2000).
Risk for maltreatment also increases for children with physical and developmental disabilities. One explanation for this increased likelihood is that parents who have some degree of risk for abuse may become overtly abusive or neglectful in response to the stress of caring for a child with significant difficulties (Maclean et al., 2017; U.S. Department of Health and Human Services, 2008).
Secure Attachment as a Protective Factor Against Biological Risk
Research on children with biological conditions suggests that secure attachment and responsive caregiving, over time, have more impact on developmental outcome than the particular biological deficit. Biological conditions obviously impact development, but responsive parenting ameliorates the risks and helps the child develop adaptive coping mechanisms (Leve & Cicchetti, 2016).
Summarizing research on this issue, Lyons-Ruth and colleagues (2003) note: “Most parents may be able to compensate even for severe deviations in the infant's behavior and development, although infants are not similarly able to compensate for parental disturbance” (p. 613).
Temperament
Variations in temperamental factors constitute another child-based vulnerability. Temperament refers to biologically based personality traits that affect the child's orientation to the world.
Thomas and Chess (1977), studying infants beginning at 3 months of age, identified three patterns of temperament: "easy," "difficult," and "behaviorally inhibited" or "slow to warm up."
Temperamentally easy children have a positive mood, moderate activity level, adaptability to change, regular biological patterns, good attention span and persistence, mild-to-moderate intensity and sensitivity, and positive responses to new situations. Resilience research has identified this type of temperament as a protective factor.
The other two patterns—"difficult" and "behaviorally inhibited"—have been implicated as potential risk factors.
Children with difficult temperaments tended to have negative moods, and they were very active, "negatively" persistent, overly sensitive, intensely reactive, and resistant to change. Their biological rhythms were irregular, and they tended to withdraw in new situations. Behaviorally, these traits translate into a restless, irritable, hard-to-soothe baby who wakes up many times at night. Children with difficult temperaments are less rewarding for parents. Parents may quickly feel inadequate when they are unable to comfort an infant who is constantly fussy or, later, a preschooler who is negative and demanding (Wachs & Kohnstamm, 2001).
Compared with both the easy and difficult temperaments, children described as "slow to warm up" tend to be less reactive, less overtly emotional or intense, and less active. They are inhibited in novel situations, although they may participate actively if they have had enough time to size up a new experience. Behaviorally inhibited children seem cautious and shy and respond to stress, especially in unfamiliar situations, by withdrawing emotionally (Hirshfield-Becker et al., 2008).
Temperament, Parental Factors, and Goodness of Fit
Difficult temperament has the potential to interfere with the development of adequate self-regulation. These children have more difficulty soothing themselves and responding to parents' attempts to soothe them. Because they are so reactive and hard to comfort, they may have frequent experiences when parents cannot help them calm down. Consequently, they are less able to generalize from the experience of mutual regulation to self-regulation. Such interferences may contribute to later difficulties in sustaining attention and maintaining selective attention (Rothbart & Bates, 2006).
Strong behavioral inhibition has also been associated with potential psychiatric risk. Very inhibited children are much more reactive to new situations, as documented by physiological measures, including increased bodily tension, blood pressure, and heart rate (Kagan, Resnick, Clark, Snidman, & García Coll, 1984). These physiological responses are characteristic of anxiety disorders, and later studies of children with high behavioral inhibition indicated that they had higher rates of anxiety disorders in middle childhood (Rubin, Burgess, Kennedy, & Stewart, 2003).
These general associations notwithstanding, it is important to recognize that temperament is a risk factor primarily in combination with parentally based risk factors. Parenting and relationship quality can either reduce or exacerbate the effects of genetically based temperamental tendencies. Difficult temperament, for example, is a risk factor for abuse and maladjustment in the context of harsh and punitive parenting, but not positive, supportive parenting (Fox et al., 2005; Rothbart & Bates, 2006). Similarly, the developmental effects of behavioral inhibition tend to be most extreme when parents are highly anxious themselves (Fox et al., 2005). Although a few studies make links between irritable temperament in infancy and the development of avoidant attachment, overall research has not implicated temperament as a direct causal factor in insecure attachment. Infant irritability is primarily a risk factor when parents are subject to stress from other risk factors (Vaughn, Bost, & van IJzendoorn, 2008).
Thomas and Chess (1977; Chess & Thomas, 1984) proposed the bidirectional model of "goodness of fit" to explain the interaction between child temperament and parenting behavior. For example, a parent who tends toward self-reliance and prefers a "cool" interactional tone may feel frustrated and overwhelmed by an infant or toddler whose temperament inclines him toward high activity, intense emotions, and strong need for interaction. The fit here would not be a good one, whereas a parent with a more active, involved, and "warm" style would more easily adapt to the child's temperament and create a better interpersonal fit. The impact of temperament on development is best understood from a transactional perspective. When the parent of a "difficult" child is able to provide consistent empathy and limit setting, while avoiding natural tendencies to overreact, withdraw from, or take personally the child's behavior, the parent provides a "holding environment" for the child that encourages adaptive development (Ghera, Hane, & Malesa, 2006).
Temperament as a Transactional Process
Identifying temperamental characteristics is a useful way to understand how a child responds internally to his experience.
Shiner (2015) defines temperament as follows: "Temperament traits are early-emerging basic dispositions in the domains of activity, affectivity, attention, and self-regulation, and these dispositions are the product of complex interactions among genetic, biological, and environmental factors across time" (p. 86).
Temperament, however, does not exist in isolation from the parents' styles of responding to the child; it is only one piece of the puzzle in clinical evaluation. Given that temperament is assumed to be inherent, the expectation was that it would be stable over time. However, research findings offer only modest support for the stability of difficult temperament and somewhat stronger support for the persistence of behavioral inhibition (Rothbart & Bates, 2006).
In the original research of Thomas, Chess, and Birch (1968), difficult temperament in infancy did not increase risk for behavior problems, but difficult temperament at age 3 did predict later behavior problems. This finding suggests that there is a strong association between caregiving and temperament, since the link between difficult temperament and behavior problems was only evident after the child had been in a caregiving relationship for 3 years.
Many studies have found correlations between the way parents describe themselves and the way they characterize their infants' temperaments. Highly emotional parents describe their infants as being like themselves, and parents who view themselves negatively or who have significant depression or anxiety are likely to see their children as "difficult" (Rothbart & Bates, 2006).
Parents' working models of attachment also shape their perceptions of temperament. Several studies using the Adult Attachment Interview found that the mother's adult attachment classification during pregnancy predicted the child's attachment classification at 1 year of age in 70% of cases (Lyons-Ruth et al., 2003); that is, infants' behaviors were consistent with their mothers' expectations before birth. Similarly, Austin, Hadzi-Pavolvic, Leader, Saint, and Parker (2005) found that mothers who had experienced high levels of anxiety during pregnancy perceived their infants as "difficult" at 4-6 months.
These studies raise questions about the utility of thinking about temperament in isolation from the transactional context of the attachment relationship. What is perceived solely as temperament is influenced by the parent's working models or the degree of stress a parent experiences. Research matching infant temperament characteristics and parent personality style has shown that irritable or "distress-prone" infants develop insecure attachments and poorer self-regulation when their mothers are either rigid in personality or slow to respond to distress (Crockenberg & Leerkes, 2000). Parents under stress may have difficulty helping a child feel secure. The child may react with fussiness or aggression, which increases parents' stress and leads them to perceive the child as "difficult."
In clinical evaluation, however, it is very useful to explore the parent's perceptions of the child's temperament and to assess goodness of fit (Chess & Thomas, 1986). Parents often need help understanding why their regular styles of comforting do not work as well with a child who has a difficult temperament, and they need support for the exhausting work of parenting such a child. Whatever the "origins" of temperamental qualities, extremes of temperament, such as strong negative reactivity or intense inhibition, which require greater skill and patience on the part of caregivers, may increase risk for developmental, social, and behavioral problems (Rothbart & Bates, 2006).
Parental Risk Factors
Parents' functions:
Protecting the child.
Promoting adaptive development and self-esteem.
Modeling/supporting self-regulation.
Encouraging growth and opportunity.
Conveying cultural values.
These functions start in attachment and persist throughout development via parental influence and internalized working models.
Winnicott (1965) stated parents don't need to be perfect, just "good enough" – making mistakes but fulfilling normal parenting functions.
"Good enough" parents:
See children realistically.
Have developmentally appropriate expectations.
Empathize with children's perspectives.
Parenting becomes risky when demands exceed parents' skills and coping abilities.
Parental risk factors stem from:
Direct behavior (e.g., maltreatment).
Parental difficulties (e.g., substance abuse, psychopathology).
Familial/parental demands: teenage parenthood, single parenthood, father absence, paternal unemployment, family disruption/divorce, large family size, low maternal education (Coley & Chase-Lansdale, 1998; Garfield et al., 2016).
Multiple factors increase disorganized family structure and "household chaos," linked to children's problem behavior (Coldwell, Pike, & Dunn, 2006).
Parental risk factors reduce ability to buffer stressors, making child more vulnerable.
Without parental support, children cope alone. Younger children are less capable and develop maladaptive coping patterns.
For instance, a 3-4 year old traumatized by witnessing domestic violence faces an impossible task without support, leading to emergency-based coping strategies like hyperaggression and emotional numbing that become maladaptive (Davies, 1991; Peh et al., 2017).
Parents helping children cope with stress augment their coping ability. When parents can't buffer stress, children don't learn adaptive coping and are vulnerable to future stressors/psychopathology.
Parental risk factors often cluster (e.g., substance abuse, neglect, conflict, violence).
High Parental Conflict, Family Disruption, and Divorce
Ongoing parental conflict increases developmental risk. Anger/conflict/distancing creates insecure environments.
Chronic conflict spills over into parenting: parents become less available and invested (Sturge-Apple, Davies, & Cummings, 2006).
Children's emotional security diminishes, causing emotional reactivity, dysregulation, negativity, and aggression due to hyperarousal (heightened cortisol secretion) (Davies, Sturge-Apple, Cicchetti, & Cummings, 2008; Davies, Sturge-Apple, Winter, Cummings, & Farrell, 2006).
Triangulation into conflict worsen symptoms, leading to behavior problems, shame, and guilt (Kelly, 2000).
Conflicted couples have differing childrearing values enacted with the child in the middle (Katz & Woodin, 2002).
These parents have more mental health problems, adding to risk.
High-conflict marriage + depressed father intensifies children's symptoms (Keller, Cummings, Peterson, & Davies, 2008).
Adequately functioning single-parent/stepfamilies are better than high-conflict two-parent families (Amato, 2001).
Children distressed by divorce often appreciate the cessation of fighting.
Symptomatic behavior often precedes separation in high-conflict marriages, but divorce can exacerbate risk factors like parental addiction/psychopathology when that parent becomes the primary caretaker (Pruett, Williams, Insabella, & Little, 2003).
Separation/divorce stressors:
Disruption before/after separation.
Loss of one parent and extended family relationships.
Changes in residence/school, losing friends/support systems.
Economic mobility that goes downward.
The mother's return/increase in work.
Parental depression/self-absorption.
Parental dating, remarriage, and stepfamily relationships.
Children's reactions interfere with development, causing anxiety, depression, aggressive behavior, and poor school performance.
Many children cope and resume normal development within two years (Dunn, 2007).
Several years post-divorce:
About 10% have more psychological difficulties.
Many report painful memories and emotional disruption (Lansford, 2009).
Divorce risk buffers:
Ongoing emotional availability, consistent parenting (joint-custody).
Ongoing relationship with non-custodial parent via visits/participation.
Supportive relationships with grandparents/relatives.
Minimizing disruption of home/school.
Parents' healthy post-divorce adjustment.
Parents' ability to cooperate and prioritize the child's needs (Bridges, Roe, Dunn, & O'Connor, 2007).
Joint custody benefits children when parental conflict is low, communication is good, and parents accept joint custody (Bauserman, 2002). Nearly all children want to stay close to both parents.
Divorce mediation helps parents negotiate arrangements to stay active in children's lives (Kelly, 2006).
Joint custody where parents continue to fight keeps children in the middle, causing psychiatric symptoms and enmeshment (Dunn, O'Connor, & Cheng, 2005). Sole custody may be better.
Post-divorce risk factors:
Parent with whom the child lives declines in parental functioning due to stress/depression (Kelly, 2000).
Ongoing hostility, fighting, recriminations, court battles expose the child to fighting, put-downs, and pressure to ally with one parent (Bing, Nelson, & Wesolowski, 2009).
Father's withdrawal after divorce with the mother's sole custody is problematic, especially for boys (Amato, 2001).
Relocation by custodial parent making contact with the other parent impossible also holds risk (Kelly & Lamb, 2003).
Harsh Parenting, Corporal Punishment, and Coercive Family Process
Harsh, punitive, and inconsistent parenting negatively shapes working models, leading to negative interaction expectations.
Corporal punishment and ineffective parenting behavior, often based on parent's working models, contribute to negative interactions and coercive/aggressive behavior (Grogan-Kaylor & Otis, 2007; Rothbart & Bates, 2006).
Harsh parents view children negatively from infancy and unrealistically expect self-control at a young age.
Okay, imagine your environment like your house, your school, and your neighborhood. Environmental risk factors are like things in those places that could make it harder for you to grow up healthy and happy. For example:
If your house is always messy and noisy, it can be hard to concentrate on homework or feel calm.
If you don't have enough healthy food to eat, your body might not grow strong, and it can be hard to pay attention in school.
If there's a lot of pollution in the air where
Here's a list of risk factors and a brief explanation for each, based on the provided document:
Child-Based Vulnerabilities
Genetic Syndromes: Inherited conditions that can impact development.
In Utero Exposure to Teratogens: Exposure to harmful substances during pregnancy can harm the developing baby.
Prematurity and Low Birth Weight: Being born too early or too small can create developmental challenges.
Birth Injury or Anoxia: Injuries or lack of oxygen during birth can lead to developmental issues.
Exposure to Environmental Poisons: Exposure to toxins like lead can negatively affect development.
Chronic Illnesses: Ongoing health problems can hinder development.
Difficult Temperament: A disposition characterized by negative moods and resistance to change can pose challenges.
Behaviorally Inhibited Temperament: A tendency to be shy and withdrawn can be a risk factor.
Parental Risk Factors
Direct Behavior (e.g., Maltreatment): Abuse or neglect directly harms a child's development.
Parental Difficulties (e.g., Substance Abuse, Psychopathology): Parents' struggles with addiction or mental illness can negatively impact their children.
Familial/Parental Demands: Factors like teenage parenthood or single parenthood can create added stress.
High Parental Conflict: Ongoing conflict between parents creates an insecure environment for children.
Harsh Parenting: Punitive and inconsistent parenting can lead to negative outcomes.
Corporal Punishment: Physical punishment can have detrimental effects on children's behavior and development.
Environmental Risk Factors
Messy enviroment: It can be hard to concentrate on homework or feel calm.
Lack of healthy food: Your body might not grow strong, and it can be hard to pay attention in school.
Pollution: Can be harmful for your help.