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Bio-behavioral Resilience: Examining Protective Factors for
Child Psychopathology
Angela Zamora1, Donna Hockey1, Kathryn Lemery-Chalfant1, & H. Hill Goldsmith2
1Department
of Psychology, Arizona State University, Tempe
Method
The present study examined the relationship among internalizing
and externalizing behaviors with established resilience factors,
(e.g., IQ, positive affect, and emotion regulation) with eight year old
children.
Additionally, we attempted to identify new resilient factors such as
adaptability, options thinking, creativity, expression of feelings, and
decisiveness (see Table 1), which have been infrequently
investigated in the resilience literature.
Our sample consisted of 120 monozygotic and dizygotic twin
pairs who were between the ages of 5 and 11 (M = 8.1 years) and
participated in the Wisconsin Twin Project.
The present study included twin pairs where at least one twin
was diagnosed with an internalizing or externalizing disorder using
DSM-IV criteria.
Some children develop psychopathologies such as depression
(1-2%, Costellow et al., 1996), anxiety (10%, Shafer et al., 1996),
conduct disorder, and attention deficit hyperactivity disorder
(ADHD; 2-9%, AACAP, 1997) that decrease their ability to
accomplish their goals and lead productive lives.
Many of these children may develop clinical depression, anxiety,
or other psychopathology in adulthood that may result in a lower
quality of life for them and their families (Harrington, Fudge, Rutter,
Pickles, & Hill, 1990).
Procedure
A novel coding system of resilient measures was created by
observing children’s behavior while participating in various tasks
during a videotaped four hour home visit.
Two research assistants were trained on the observational
coding system, and reached high inter-coder reliability (Kappa >
.70).
Using principal component analysis with varimax rotation, 5
factors summarized the observational data and reduced the overall
number of variables (see Table 1 for description of measures).
Table 1: Resilience Factors Coded From Observed Behavior
Resilience
Factors
Definition
Task
Measure
Creativity
Ability to
Imagine
beyond what
is there
1. Playdoh (Twins must share playdoh and
playdoh machine)
2. Snacktime (Twins must choose one
cookie and one juice to share)
3. Freethrow (Child given 3 balls to throw in
cups for a prize, but task is impossible)
While waiting, child’s creativity is measured.
Ability to see
other
possible
solutions
1. Picture Ripping
(Child shown experimenter’s favorite photo
and asked to rip it up)
Does child rip photo immediately or think of
other options.
e.g., child is asked to rip experimenter’s
favorite photo, instead of complying with
request fully, child makes a very small tear at
corner of photo
Ability to
change with
circumstances
1. Wrong Prize
(Child receives the wrong prize from his
previously rated choice)
Does child play with the wrong prize, and if
so, does he/she enjoy it.
e.g., child may be disappointed about getting
a prize that he/she did not pick, but the child
adjusts to the situation and plays with toy
Ability to
express one's
feelings to
another person
1. Candy
(Experimenter divides candy evenly, but
then gives herself all the candy in the end)
2. Wrong Prize
3. Picture Ripping
Child expresses his/her emotions
Ability to make
decisions easily
when no risk is
involved
1. Free Throw
2. Rated Prize
(After receiving a wrong prize, the child gets
to pick a prize again)
Latency measure: number of seconds to
choose a prize
Options
Thinking
Emotional and behavioral problems can be classified in two
categories:
Internalizing = over-controlled behaviors such as anxiety and
depression.
Externalizing = overt behaviors such as aggression and
delinquency (Achenbach & Edelbrock, 1978).
Much research has been conducted on identifying risk factors
that predict child problem behaviors or psychopathology, but less
research has investigated and defined resilience factors. Masten
and colleagues (1990) defined resilience as:
“the process of, the capacity for, or outcome of successful
adaptation
despite
challenging
or
threatening
circumstances.” (p. 426).
Adaptability
Expression
of Feelings
Decisiveness
Assessments
Hypothesis
Children with higher resilience (e.g., creativity, options thinking,
emotion regulation, positive affect) will be less likely to have
symptoms and diagnosis of internalizing and externalizing
disorders.
Analysis Plan
2 hierarchical regressions were performed to explore which
resilience variables uniquely predict psychopathology symptoms
while controlling for risk variables.
1 multinomial logistic regression was performed to test whether
the resilience variables predict psychopathology diagnosis.
Variables that were significantly correlated or approached
significance with internalizing or externalizing symptoms were
included in the regression models.
e.g., after seeing the experimenter take her
candy, child tells the experimenter that it is
‘not fair’ and explains why
Description of Measure
Table 4
Summary of Multinomial Logistic Regression Analysis Predicting Child Psychopathology
Diagnosis in 8 Year Olds (N = 240)
________________________________________________________________________________________
Likelihood of Diagnosis Relative to No Diagnosis
Internalizing
Externalizing
Comorbid
________________
________________
_________________
Predictors
Odds ratio 95% CI
Odds ratio 95% CI
Odds ratio 95% CI
________________________________________________________________________________________
Intelligence
1.04
0.69-1.57
0.68
0.41-1.16
0.43**
0.24-0.79
Positive affect
1.10
0.74-1.62
1.49†
0.91-2.44
1.36
0.77-2.37
Emotion regulation
0.75
0.43-1.30
0.11*** 0.05-0.22
0.09***
0.04-0.20
_____________________________________________________________________________________________________________________________ ____________________________________________________________
Creativity
0.59** 0.41-0.85
0.84
0.56-1.23
0.83
0.52-1.31
Internalizing symptoms
Externalizing symptoms
_____________________
____________________
Predictors
B
SE B
β
B
SE B
β
____________________________________________________________________________________________
Step 1: Risk variables
SES
-2.04
0.84
-0.16*
-0.31
0.74
-0.03
Family conflict
2.47
1.20
0.13*
2.18
1.04
0.14*
Controlling mother
0.98
1.05
0.06
1.55
0.93
0.11†
Warm father
-3.07
1.57
-0.12†
-3.05
1.37
-0.14*
R2 for Step 1
0.07**
0.05*
Options Thinking
0.73†
0.94
0.63-1.41
0.85
0.53-1.37
Table 3
Summary of Hierarchical Regression Analyses Predicting Child Internalizing and Externalizing
Symptoms in 8 Year Olds (N = 240)
Step 2: Established resilience variables
Intelligence
Positive affect
Emotion regulation
ΔR2 for Step 2
-0.36
-1.51
-4.10
0.76
0.74
0.85
-0.03
-0.13*
-0.30***
0.11***
-0.54
-0.13
-8.12
0.51
0.49
0.57
-0.05
-0.01
-0.69***
0.47***
Step 3: Hypothesized resilience factor
Creativity
ΔR2 for Step 3
-1.77
0.60
-0.17**
0.03**
0.16
0.41
0.02
0.00
FModel
7.66***
31.10***
____________________________________________________________________________________________
†p < .10. *p < .05. **p < .01. ***p < .001.
Our hypothesis was partially confirmed such that children with
higher levels of emotion regulation were less likely to have
internalizing and externalizing symptoms, and children with higher
levels of positive affect were less likely to have internalizing
symptoms after controlling for risk variables. The proportion of the
variance (11% and 46%) explained uniquely by the established
resilience predictors was significant.
Furthermore, children who were more creative were less likely
to have internalizing symptoms after controlling for all risk and
resilience variables. The proportion of the variance (3%) explained
uniquely by the predictor, creativity, was significant.
Contrary to our hypothesis, none of the hypothesized observed
resilience variables predicted externalizing symptoms.
0.52-1.01
Subsample N
81
57
35
________________________________________________________________________________________
†p < .10. *p < .05. **p < .01. ***p < .001.
Note: Reference group is children with no disorders. The risk variables did not significantly predict psychopathology diagnosis, so
they were removed from the final model.
The overall multinomial logistic regression model for the full
sample was significant, c2 (15, N = 240) = 106.36, p < .001.
The likelihood ratio tests on the individual variables revealed that
creativity, emotion regulation, and intelligence were significant
predictors of childhood psychopathology diagnosis.
The odds ratio (OR) is the ratio of the odds that an outcome will be
a diagnosis to the odds of no diagnosis meaning an OR less than
1.00 indicates reduced odds for diagnosis, and an OR greater than
1.00 indicates increase odds of having diagnosis.
The odds for having internalizing diagnosis was reduced when
children were more creative and displayed greater ability to think of
other options during at home tasks.
The odds of having an externalizing diagnosis was reduced when
children had greater ability to regulate their emotions.
The odds of having comorbid diagnoses was reduced when
children had higher intelligence and when they were able to regulate
their emotions.
A composite of family income, mother’s and father’s education.
SES
In order to gain a deeper understanding of the developmental
process of child psychopathology, protective factors and resilience
need to be examined as possible contributors to etiology.
Results
e.g., child pretends the playdoh is a snake
Table 2: Risk and Resilience Measures
Variables
of Psychology, University of Wisconsin-Madison
Results
Purpose of Study
Introduction
2Department
Family conflict
Family Conflict
Scale
A 10 item measure was used to assess how often marital hostility was expressed in
front of the child (Porter & O’Leary, 1980).
Controlling mother
Warm father
Child-rearing
Practices Report
(CRPR)
A 91 item measure was used to assess mother and father’s report on which parenting
methods and ideals are most important to them (Block, 1965). This report was used
to assess maternal and paternal warmth and control. For example, “I believe that
children should be seen and not heard” were rated on a scale ranging from 1-6.
Intelligence
PPVT
Block Design
The Peabody Picture Vocabulary Test (PPVT-R; Dunn & Dunn, 1997), a short test of
vocabulary, was administered as a measure of receptive language maturity. The
dependent measure used was an age-based standard score. The Block Design, a
subtest of the Weschler Intelligence Scale for Children, version three (WISC-III;
Weschler, 1991), was administered as a measure of spatial ability and correlated
strongly with the performance IQ component of the WISC. Each child was tested
separately in the home. The dependent measure used was the final sum score. A
composite of the PPVT-R and Block Design was formed.
Positive affect
Child Behavior
Questionnaire
(CBQ)
The CBQ is a parent-report measure of temperament for children from three to eight
years of age (Rothbart et al., 2001). Parents rated the child’s behavior over the past
six months on a 7-point Likert scale ranging from “extremely untrue of your child” to
“extremely true of your child”. Both mothers and fathers completed the CBQ. For the
purpose of this study, a composite of mother and father report on child’s Smiling and
Laughter was formed.
Emotion regulation
Bayley Rating
Scale- revised
(BRS) and CBQ
A composite of BRS observed regulation, CBQ mother and father reports on child’s
Attentional Focusing and Inhibitory Control was formed. The revised BRS (Bayley,
1993) provided an observer report measure of state regulation reported by two
trained experimenters who conducted the home visit.
Internalizing and
Externalizing Disorder
(dependent variables)
Diagnositc Interview
Schedule for
Children Version IV
(DISC-IV)
Primary caregivers completed the computerized version of the NIMH DISC-IV (add
reference), that is a structured psychiatric interview for children six and older. For the
purpose of the study, internalizing and externalizing symptom composites were
created, as well as presence of a diagnosis.
Discussion & Conclusion
Resilience factors may protect at risk children, especially from anxiety-related symptoms and disorders.
Our analyses replicated previous findings that emotion regulation and intelligence protected children from externalizing or comorbid behaviors. However, both emotion regulation and
intelligence were not associated with internalizing behaviors, suggesting that there are different processes going on for children with externalizing vs. internalizing.
Exploration of hypothesized observed resilience factors showed that creativity was a strong and consistent predictor for internalizing disorder, and a trend appeared for options thinking.
By teaching children resilience thinking (e.g., how to find alternative solutions to a problem), how to play in a creative way, and how to manage and cope with undesirable events may
lower symptoms and diagnosis of internalizing disorders.
Notably, findings indicate the behaviorally coded resilience factors (e.g., creativity, options thinking, see Table 1) were not associated with externalizing disorders, which could be attributed
to the fact that they were tapping internal thought processes. Creativity is imagining outside of reality, and options thinking is the process of assessing different outcomes when given one
choice.
By better understanding resilience factors, parents, teachers, and practitioners may be able to teach children strategies that may help them live up to their potential and protect them from
developing psychopathology.
Limitations of Study
The assumption of subject independence is a limitation of the study due to the sample including twins.
Direction of effects could not be assessed given the correlational nature of the study.
The bio-behavioral observed resilience measures had low variability given coder responses were typically yes / no. Low measurement variability could partly explain why effects were not
found for the other three resilient measures (i.e., adaptability, expression of feelings, and decisiveness).