Failure to thrive

the road from adversity to disadvantage

Dr Dave Pearson

What is adversity and failure to thrive?

Why is it important to us?

Can anything be done about it?

Child adversity causes failure to thrive which damages child development and

mental health

•Child adversity includes:

• Malnutrition

•Child adversity includes:

• Malnutrition

• Abuse – physical, sexual, emotional

•Child adversity includes:

• Malnutrition

• Abuse – physical, sexual, emotional

• Poverty

•Child adversity includes:

• Malnutrition

• Abuse – physical, sexual, emotional

• Poverty

• Institutional care

•Child adversity includes:

• Malnutrition

• Abuse – physical, sexual, emotional

• Poverty

• Institutional care

• Living in war zones

•Child adversity includes:

• Malnutrition

• Abuse – physical, sexual, emotional

• Poverty

• Institutional care

• Living in war zones

• Ineffective/poor parenting

Some established links with later mental health problems

CHILDREN WHO ARE ABUSED ARE 9X MORE LIKELY TO

EXPERIENCE PSYCHOSIS IN LATER LIFE

From: Read & Bentall, (2013), see Dissociation. Kennedy, Kennerley & Pearson. Routledge (2013)

Using 27,390 self selected participants

earlier traumatic or abusive life experiences predicted later high levels of anxiety

and depression

From: Kinderman, Schwann & Pontin (2013)

From: Dissociation. Kennedy, Kennerley & Pearson - Routledge 2013

Examples of studies linking child adversity with later mental health problems

Clinical area examples Country of origin examples

Personality Hetzel and McCanne

Disorder (2005)

Berger et al. Japan

(1994)

Pseudo-seizures Ozcetin et al.

(2009)

Dalenberg and Russia

Palish (2004)

Post Traumatic Stovall-McClough

Stress Disorder and Cloitre (2006)

Hartt and Waller UK

(2002)

Dysfunctional Johnston et al.

schema modes (2009)

Putman USA

(1997)

Being a psychiatric Waldinger, Swett,

patient Arlene and Kristen

(1994)

Ozcetin et al. Turkey

(2009)

Borderline Korzekwa, Dell and

Personality Pain (2009)

Disorder

Hirakata Canada

(2009)

Murderers with Lewis, Yeager, Swica,

Dissociative Pincus and Lewis (1997)

Identity Disorder

Kessler et al. 21 countries

(2010)

Kessler et al. All major mental

(2010) disorders, using

WHO WMHS data

The links between child adversity and later mental

health problems are irrefutable.

Studies show that this is across disorders and cultures

Now to move on to failure to thrive

Failure to thrive is also known as ‘stunting’

Failure to thrive comes from adversity

Failure to thrive

Organic

(e.g., malnutrition)

Non-organic

(e.g., experiences of adversity, like institutional care)

From Pearson & Kennedy - The Dream Mentoring Manuals

• UNICEF (2009) - 160 million children live below the poverty line

• HUNGaMa Survey (2009) - estimated up to 59% stunted, 42% underweight (<5yrs) *

• MOSPI (2012) - 48% stunted, 20% wasted, 42% underweight (<5yrs)**

• NFHS-3 (2007-) - 45% stunted, 23% wasted, 40% underweight (<3yrs)***

(stunted – height for age, wasted – weight for height, underweight – weight for age)

* Naandi Foundation

** Ministry of Statistics and Program Implementation – Govt of India

***National Ministry of Health and Family Welfare – Govt of India

from - Kennedy, Pearson, Brett-Taylor & Talreja, (2014)

from Pearson & Kennedy, The Dream Mentoring Manual (2011)

from: Pearson & Kennedy - The Dream Mentoring Manual (2011)

Why does it matter if these children are tall or short?

When growth slows –development also slows

When growths slows

1. development slows

2. together with failure to thrive or stunting there is an associated package of problems that are known as attachment disorder

3. there are also associated cognitive problems

If we look at these three areas

(in real life these three areas interact with each other and cannot be clearly separated)

1. Development slows • Development happens in the same sequence for all children

• There is a need for one skill to be built on top of another

• At certain times children develop much more quickly – this is known as sensitive periods – they only happen at a certain time

• This means that development has to happen at the right time, otherwise this can cause long term damage

• For example if 7 year old development has not happened for a year, then at 8 years old it cannot happen because:

a) the foundations are not in place

b) the child is geared up neurologically, psychologically and socially to develop 8 year old skills (not 7 year old skills)

This can cause developmental collapse

• Development can be seen as similar to a building with weak walls –

When the wind blows the building may fall down

• A child’s development may fall down when challenged by demands, panic emotion etc

• This means that a child’s behaviour may appear much younger than its age

• This may be known as confused maturity or confused development

2. Attachment Disorder• All children need human contact to develop – often referred to as

attachment and / or bonding

• Children who fail to thrive often have attachment and relationship problems, e.g., holding hands in a shelter, inappropriate relationships, weak relationships

• Confused emotions, e.g., attaching wrong emotions, not controlling emotions, emotions based on exploitation or abuse

3. Cognitive Problems• It has been established that children who fail to thrive:

• Have poorer cognitive abilities (e.g., Mackner et al. 1997)

• Poor information processing (e.g., Kennedy, Kennerley & Pearson, 2013)

• Higher brain pathology (e.g., Korzekwa et al. 2009)

• Poor brain development (e.g., DeBellis et al. 2011)

• High anxiety levels (e.g., Essex et al. 2002; Van der Vegt et al. 2010)

see Kennedy, Kennerley & Pearson, Dissociaton, Routledge 2013

If we put all of these problems together they would appear as

life skills problems

To summarise:• Adversity and failure to thrive damages development and mental health

• This situation affects at least half of children in India

• It is a daily problem for disadvantaged children

• The damage can be long term or even life long

• The position can be reversible

• There is a need for an adult to be alongside the child

• There is a need for the adult to understand the effects of adversity

Are these problems recoverable from?

There is evidence that these problems can be minimised or

recovered from

Evidence for recovery:

• Cognitive deficits are recoverable (e.g., Corbett, 2004)

• Cognitive deficits decreased over time with improved nutrition and care (e.g., Boddy, 2003)

• Using international adoption studies the Rutter et al. research indicated long term improvements

• Growth can increase and return to expected levels

The most effective way to recover from these deficits are

1. better nutrition

2. good contact

3. life skills improvement

Nearly always children need a person to help them out of this

situation – often known as a mentor

This person may be:

A teacher

A program leader

An adult who stands by the child

A relative

A volunteer

If you see a group of disadvantaged children on a scrap of

land and as you go by, you throw them a football and continue to drive past

They will kick the ball around – this does not repair the damage of adversity and failure to thrive

Actually they were probably kicking something around before you drove past

These children need a team leader, a role model, belonging to a team, learning rules, etc. the football itself does not change lives

These children need a skilled mentor (whoever that person may be)

this mentor needs to understand the damaging effects of adversity, stand by that young person unconditionally to be able to

minimise the effects or help the young person to recover from them