Resilience offers the promise of a paradigm shift in many fields of research, clinical practice, and policy. A lens on resilience shifts the focus of attention – from efforts to appraise risk or vulnerability, towards concerted efforts to enhance strength or capability. It also shifts the focus of analysis – from asking relatively limited questions regarding health outcomes, such as what are the linkages between risk exposures and functional deficits, to asking more complex questions regarding wellbeing, such as when, how, why and for whom do resources truly matter. Thus we might ask when interventions are most effective, within the time frame of human development and evolutionary life history; and how do we best measure pathways of human experience, to uncover ways in which individuals and communities withstand adversity.
To many, resilience is an intuitive, albeit opaque, concept – akin to fortitude in the face of adversity. We may have an intuitive grasp of what resilience means, but fall short of measuring it comprehensively and meaningfully (the same is true of risk). This Annual Research Review issue features ten articles from leaders in the field on how resilience can transform the field of child development. Each articulates important lessons on resilience some of which we wish to summarize at the outset. First, resilience is best understood as a process that unfolds over the course of development; consequently, we seek to understand human experience of adversity as pathways of risk and resilience. Second, research on resilience focuses attention on the biological and social trade-offs in human experience: issues of timing, process, and context to understand change or adaptability. For example, when are the most significant biological and social ‘tipping points’ for flexing health trajectories away from adverse outcomes? How do we move away from deterministic frameworks to modelling time- and context-sensitive interactions relevant to children's wellbeing (Goldstein & Brooks, 2012)? And how does a closer look at ‘context’ lead to an appreciation of normative dimensions of resilience, rather than just functional dimensions, in defining ‘better-than-expected’ outcomes?
We also lay some old debates to rest: (a) whether resilience is a trait, a process, or an outcome; (b) whether resilience should be regarded as exceptional, or normal, in conditions of severe adversity; and (c) whether resilience is new wine, or much the same wine as risk, but packaged in a new bottle. Such questions have practical importance for programmatic intervention: we need to know how to identify, measure, and enhance resilience. In moving such debates forward, we address other important questions: (i) how might we connect the dots from genomics to culture, with respect to domains of wellbeing; (ii) how we might translate scientific knowledge into a set of best practices for prevention and effective interventions; and (iii) what body of evidence now exists as proof-of-concept or resilience-focused exemplars, in child development and global health.
Our first two papers anchor the concept of resilience in neurobiology and social ecology, respectively. Ilia Karatsoreos and Bruce McEwen (2013) focus on the brain as ‘a key player’ in the process of human adaptation – specifically, the brain-body interactions that alter neurological, physiological, and behavioural systems at key stages of human development – to ask ‘how early life events shape the brain and whether adverse early life events can be reversed?’ It is now well-known that ‘toxic stress sculpts the brain’ – through a process of biological embedding during critical windows of development (as evidenced in the remarkable longitudinal work on foetal development during the Dutch famine). Although our understanding of mind–brain–body connections remains rudimentary, technological advances in genomics and neuroscience pave the way for an unprecedented opportunity to examine resilience at multiple levels of analysis within biological and psychological systems. This brings a renewed appreciation for ‘biological sensitivity to context,’ including the developmental trade-offs between fragility and toughness that can durably alter levels of gene expression. This article thus situates resilience in the context of brain activity and epigenetic processes, namely the architecture of neurobiological and physiological plasticity.
By contrast, Michael Ungar, Mehdi Ghazinour and Jörg Richter (2013) focus squarely on the social environment – charting a ‘systemic theory’ of resilience that calls for changing the social and physical odds stacked against the individual, rather than changing an individual's capacity to cope. This establishes an imperative to provide the necessary resources, at the right time, to children, families, and communities. In positioning the discourse of resilience on resource provision, Ungar et al. ask us to be attentive to both policy and cultural relevance: namely, establish which communal and institutional resources improve developmental outcomes, and which are meaningful in different cultural contexts. In their paper, the arrow of change is firmly pointed from society to developmental outcomes, with significant implications for designing interventions relevant to child wellbeing.
Resilience in child development is closely tied to physical and cognitive outcomes. Aisha Yousafzai, Muneera Rasheed and Zulfiqar Bhutta (2013) review the case for designing more comprehensive ‘pathways to care’ – examining the evidence for synergies of health outcomes, whereby cognitive stimulation and social learning are promoted concurrently with nutrition. A key point is that the social context of how children are fed is just as important as the nutritional content of what they are fed. Thus policies promoting exclusive breastfeeding facilitate responsive maternal care, not just optimal nutrition to infants; policies enhancing caregiver–child interactions improve not just feeding practices, but also responsive care, cognitive stimulation, educational attainment, and long-term wellbeing. Yousafzai et al. envisage early child interventions as resilience-building pathways of care that mitigate the nutritional and cognitive deficiencies known to impact brain architecture, learning ability, social behaviour, and health. They emphasize a critical insight from academic research: the timing of interventions must target the first thousand days of a child's life (from conception onwards, when the brain develops most rapidly). They add an important message for policy: interventions with broader scope, targeting responsive parenting and family dynamics as well as nutrition, will have greater impact. One can see that broader packages for early child interventions hold much promise, yet present many challenges, and require careful evaluation of synergistic impact.
The next few papers provide valuable reviews on pathways of resilience in the context of trauma, maltreatment, HIV/AIDS, and war. George Bonanno and Erica Diminich (2013) sharply disaggregate acute-onset traumatic life events – unexpected bereavement, natural disasters, and terrorist attacks – from chronic exposures, and advocate latent growth modelling to characterize the shape and frequencies of diverse ‘adjustment trajectories’ over time. Such work is methodologically sophisticated, and raises many difficult conceptual and practical issues: for example, to what extent is resilience equated with the absence of self-reported psychopathology, and what policy implications arise from differentiating ‘resilience’ from frank resistance or gradual recovery?
Dante Cicchetti (2013) offers a masterful interdisciplinary review of pathways of resilient functioning among children who experience ‘the greatest failure of the caregiving environment’ in the form of abuse and neglect. Research on resilient functioning among maltreated children is certainly complex, but provides crucial insight into neurobiological and psychological pathways of development, and into mechanisms of change or ‘turning points’ for intervention in the lifecycle. Cicchetti has long advocated the need to conceptualize resilience as a multidimensional construct: this requires longitudinal investigation, multiple-level analysis, and greater specificity regarding experiences of care or maltreatment across developmental domains. He also reminds us of the amazing complexity through which our bodies and brains interact across diverse environments. For example, some genetic variants have negligible effect in predicting resilience in maltreated children, yet contribute to better functioning in non-maltreated groups (Cicchetti & Rogosch, 2012).
In their systematic review pertaining to resilience and mental health in families and children living with HIV/AIDS, Theresa Betancourt, Sara Meyers-Ohki, Alexandra Charrow and Nathan Hansen (2013) also call for analysis at multiple levels, to identify individual, family, community and cultural ‘factors of resilience.’ Moreover, they highlight a handful of resilience-focused interventions available to-date, which exemplify platforms of change. The authors note deep limitations in the current literature, but also promising trends regarding key leverage points for both prevention and intervention – such as targeting family dynamics, peer-group support, and social equity, to promote strengths and reduce exclusion.
Wietse Tol, Suzan Song and Mark Jordans (2013) present a systematic review of children and adolescents affected by armed conflict, showing how we operationalize resilience in the academic literature through qualitative, quantitative, and mixed-methods work. Their work encompasses both protective processes that minimize undesired functional health outcomes such as poor mental health, and promotive processes that enhance desired developmental outcomes such as self-esteem. They also edge closer to an appreciation of what resilience means for people on the ground: most local understandings of resilience involve a combination of personal strengths and supportive social and political contexts. However, given the brutality and inequity of war, we do well to remember that not all expressions of resilience are at the positive pole of social, spiritual, and political activity. We find discrepancies across cultures (what is supportive in one context is not necessarily helpful in another), developmental stages, and conflict phases. The authors show strong interest in moving research into practice – and highlight that, globally, the most consistent and strongest evidence of impact converges on family-level variables (parenting and support) for promoting developmental and mental health outcomes for war-affected youth.
Brian Barber's (2013) article challenges us to think through the contextual and normative dimensions of resilience. He vigorously debates the overlap of resilience with other constructs, such as adaptation and different realms of competent functioning. Specifically, he asks us to pay attention to the political dimension of wellbeing and quality of life. In politics and culture, what do values and ‘meaning’ have to do with child development? They certainly structure the ways in which youth engage with political conflict and social inequity: personal and civic resilience is at the heart of efforts to secure dignity, hope, security, self-determination, and human rights amidst the chaos and violence of war. If we are to take seriously the notion that resilience pathways are complex and context-specific, then we need to appraise the normative, as well as the functional, dimensions of adaptation, health, and wellbeing. In our estimation, there is no longer much room for conceptual laziness and methodological naïveté in cross-cultural research on resilience. While a resilience framework usefully pulls us away from risk and deficits, it is not useful if we remain conceptually hazy, empirically light, and methodologically lame.
We close with two excellent chapters on clinical and policy implications. Sir Michael Rutter's reflections on resilience come from a lifetime of leadership in this area (Rutter, 2013). Although resilience findings do not translate into a clear program of prevention and treatment, they do provide numerous leads with regard to assessment. For example, his review is a powerful demonstration of the importance of asking ‘why’ and ‘how’ trajectories lurch towards, or flex away, from poor health outcomes. We know, for example, that divorce matters to child development, but also that the quality of parenting, the timing of divorce, and the support of a peer group are crucial to mediate linkages between ‘divorce’ and ‘maladjustment.’ This implies that resilience-focused interventions are those that foster family support and caregiver warmth, rather than family structure per se. Rutter also takes the long view in reminding us of turning point effects in adult life: these build upon individual strengths and social involvement beyond the window of childhood and adolescence, to help those burdened by a painful past to ‘knife off’ their disadvantages and pursue better opportunities.
Lastly, Alastair Ager (2013) presents us with a succinct review of the engagement and implications of work on child well-being and resilience within the world of public policy. The term resilience shows an eight-fold increase in literature usage over the last two decades: it is a powerful narrative, embraced by the political discourse of the left, which endorses civil society, and by the politics of the right, which holds individuals responsible for their own actions. Ager argues that we must now move from intuitive conceptual frameworks to proof-of-concept, and identifies six main categories of resilience-based interventions for which there is a growing evidence-base. However, rather than conceive individual, family, school, civic, spiritual, and societal domains as hierarchical concentric spheres of influence, Ager encourages us to see them as interconnected adaptive systems. The notion of connectedness across levels and systems is important: again, we are to look for synergistic effects of intervention. This is a another strong message in this Annual Research Review: synergistic impact is a key feature of resilience models, and a major departure from mechanistic, additive models linking functional outcomes to risk and protective factors.
Contributions in this issue also articulate the ‘next steps’ in resilience research. First, we need more careful definitions of what resilience means: our contributors conceive of resilience as both process and outcome, a tension that no doubt will continue to permeate academic work. Second, we need to operationalize multiple pathways of resilience, and appraise their time-sensitive and context-sensitive dimensions with careful longitudinal and comparative work. As Masten (2011) powerfully argued, the next phase of resilience research must integrate multiple systems of analysis. Much more interdisciplinary work can be done to connect, into a coherent framework, the neurobiology of resilience with the with the culture of resilience, the functional with the normative dimensions of human experience. A focus on child development helps to bridge together these very different levels of analysis: resilience is the process of harnessing biological, psychosocial, structural and cultural resources to sustain wellbeing. It specifically helps us to identify critical turning points for developmental trajectories to flex away from adversity: rather than interventions predicated on ‘saving one child’ at a time, we advocate broader-based interventions to render caregiving environments less fraught, less irksome, less violent, and more enabling for children. These include targeting family-level parenting behaviours as well as working ‘upstream’ on policies and structures to foster opportunities for education, marriage, housing, employment, and crime reduction. We now have key evidence for the lifetime effects and multi-level benefits generated by family-based programs and social policies that holistically promote child development (Kağıtçıbaşı, Sunar, Bekman, Baydar & Cemalcilar, 2009; Schweinhart et al., 2005). These findings should spur global strategic action (Britto, Engle & Super, 2012). In our view, attention to interventions with synergistic effects across multiple systems, given careful research on context-specific and time-sensitive resilience pathways, is one of the most exciting foci of research and practice in child development.