A recent article by Dr. Jack Shonkoff in the Proceedings of the National Academy of Sciences, entitled Leveraging the Biology of Adversity to Address the Roots of Disparities in Health and Development stresses the importance of parenting and the use of assessments in combating chronic medical and developmental challenges for children at risk.
In the article, Shonkoff, from the Harvard Center for the Developing Child, reviews the literature on the life-long consequences of early toxic stress on both health and development. "Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support" (Center on the Developing Child at Harvard University).
Though some stressors can actually be positive, and some stress is tolerable, toxic stress results from strong, frequent or prolonged stimulation of the body’s defenses. The care of supportive adults, especially parents, can buffer the impact of toxic stress. In fact, parents can take tolerable stress and turn it to positive stress, resulting in learning and growth. In addition, through their effective responses, parents can reduce potentially toxic stress to tolerable levels.
Shonkoff's Proposed Strategies for Addressing Disparities
Shonkoff continues to propose three intervention approaches for combating disparities in Health & Development:
1) Protecting Children from the Impacts of Toxic Stress Requires Selective SkillBuilding—Not Simply the Provision of Information and Support for the Adults Who Care for Them.
2) Interventions That Improve the Caregiving Environment by Strengthening the Executive Function and Self-Regulation Skills of Vulnerable Parents Will Also Enhance Their Employability, Thereby Providing an Opportunity to Augment Child Outcomes by Strengthening the Economic and Social Stability of the Family.
3) Community-Based Initiatives and Broad-Based Systems Approaches Are Likely to be More Effective in Promoting Healthy Development and Reducing Intergenerational Disparities If They Focus Explicitly on Strengthening Neighborhood-Level Resources That Buffer Young Children from the Adverse Impacts of Toxic Stress.
The Central Role of Parents
These approaches don’t appear to be mutually exclusive; in fact to me they seem complementary. Important in each of the intervention approaches is the role of parents. In the first approach, parents provide buffering protection. However, to be successful, the underdeveloped skills of parents with little or no prior exposure to models of effective parenting need to be developed. Writes Shonkoff,
“The likelihood is, therefore, relatively low that these skills will be sufficiently strengthened by the simple provision of information about child development. In contrast, training or coaching strategies focused explicitly on adult capacity building in these domains offer a promising new direction that is worthy of investigation, especially for parents and early childhood program staff whose needs are not sufficiently addressed by existing supports.”
It is important to emphasize that parenting information alone is woefully insufficient. Effective interventions need to change parenting behavior.
In the second approach, the parents again are important. For parents who lacked opportunities during their own early years, working to improve their executive functioning makes them more employable, which in turn reduces family stressors. But as in the first approach, increasing executive functioning is likely to result in more nurturing parenting as well. In the third, community focused approach, the impact is at least partially imparted through parents or primary caregivers. If the parents experience less toxic stress in the neighborhood, then they can be more available to nurture their children.
The Role of Parenting Assessment
Shonkoff’s paper recognizes the challenge of assessment. “Among the many challenges that confound early childhood policy and practice, the assessment of developmental skills and the measurement of change over time are among the most complex.” Promoting high quality parenting is extremely important to all children, but even more so to the health and development for children at risk, who are much more likely to encounter potentially toxic stressors. By assessing parenting progress, using a tool like the Keys to Interactive Parenting Scale (KIPS), we are able to match intervention to the strengths and needs of each parent. Furthermore, we can evaluate the impact of our interventions, which funders have come to expect.
Shonkoff concludes, “Stated simply, building brain circuitry correctly from the beginning is easier and generally leads to better outcomes, but it is never too late to invest in remediation. The proposed emphasis on explicit capacity building in parents with limited education, described earlier in this paper, draws on these concepts….”
If, as Shonkoff suggests, quality Parenting is our central weapon in Combating Disparities in Health & Development, then measuring parenting is the scope we need to target our efforts. We can use parenting assessment in targeting parents’ love to effectively nurture their children.
The KIPS Cradle will settle down for a long winter’s nap, but will wake up in January. Wishing All a Joyful New Year!
Assess What Matters Most to Children, Their Parent’s Behavior.
KIPS was validated with support from the National Institute of Child Health and Human Development. Download a summary of the research showing that KIPS is valid, reliable and practical for use in programs serving diverse families.
KIPS shows how parents grow.