Much like the proverbial canary in a coal mine, our children’s wellbeing is an early warning system for the collective health of our society. If our children are struggling, the signal is clear that our current priorities are askew and our future prospects as a country are waning. Today, there are ample signs that our children, and the families who care for them, are struggling mightily. The question before us is no longer if our children are ill, but whether we will continue to treat a myriad of symptoms at the individual level or garner the courage needed to address the underlying, unifying cause at the societal level.
The symptoms are abundant. Social workers are seeing increasing rates of foster care placements, many in response to parental neglect or substance abuse. Preschools are reporting alarming levels of behavioral concerns and expulsions. Teachers of older children witness high rates of bullying, cyberbullying and physical violence. A recent study showed that between 2007 and 2015 the number of emergency room visits by youth with suicidal thoughts and attempts doubled to over 1 million per year, and more than 40% of those kids were under 11 years of age.
Although the social service, educational and healthcare sectors all recognize that far too many of our children are suffering, their urgent calls for social change are overwhelmed by deficits in foundational interpersonal and relational skills that have eroded our ability to see and treat each other as equals. These deficits are a societal disease that we might call relational deficit disorder, or RDD. Rather than treating the causes of RDD, social workers, teachers and physicians are frequently resigned to treating the symptoms by removing children from their families, expelling “difficult” children from school, and starting suicidal children on medications like selective serotonin re-uptake inhibitors (SSRIs).
The science of early childhood development offers an evidence-based way to not only minimize the individual symptoms of relational deficit disorder (e.g., substance abuse, school expulsions, violence, suicide, racism, xenophobia, inequity, social isolation) but to actually treat the underlying disease at the societal level by promoting policies, practices and conditions that encourage the formation of safe, stable, and nurturing relationships (SSNRs).
Pivoting towards the promotion of relational health and the development of SSNRs has the potential to be transformational. Parents who struggle with substance abuse, mental illness, or food insecurity could be a source of strength for their children if they were able to receive effective treatments and supports. But if the parents are left in “survival mode,” they are less available to form the SSNRs that buffer their children from further adversity.
Rather than punishing and isolating “difficult” children, social workers, teachers and school counselors can intervene on their behalf by first forming SSNRs with these children and then working with parents, social services, and community organizations to identify and address potential barriers to healthy relationships like delays in development, chaos at home or neighborhood violence. Similarly, schools could respond to children fighting by seizing the opportunity to teach kids the relational skills needed to resolve conflicts without violence.
Ironically, the medical system is not immune to treating the symptoms of RDD rather than the cause. While there is no doubt that psychotropic medications, like SSRIs, can be lifesaving for youth experiencing anxiety or depression, they often take a month or longer to work, and they are most effective in conjunction with other therapies that teach kids new, more adaptive coping skills. There is no substitute for helping kids learn to cope with distressing emotions in a healthy, adaptive manner. And kids learn these skills best within the context of a SSNR. SSRIs are simply no substitute for SSNRs.
Many of the conditions commonly termed “adult onset” diseases are more properly viewed as adult manifest diseases with their origins in childhood adversity. Seven of the ten leading causes of death in the United States are related in a dose-dependent manner to adversity in childhood. This means the more children experience adversities like abuse, neglect, domestic violence, and parental substance abuse, mental illness, separation, and divorce, the more likely those children will eventually deal with heart disease, cancer, lung disease, stroke, dementia, diabetes, and mental illness as adults.
Keen observers have long noted that what happens in childhood does not stay in childhood. Recent advances in developmental sciences begin to explain how early experiences are biologically embedded, changing who we are at the molecular, cellular and behavioral levels. That said, early adversity is not destiny, and not all stress is bad. Our goal should not be to place kids in a stress-free zone of protection, but to promote the SSNRs that teach youth how to cope with adversity in a healthy, adaptive manner.
The SSNRs that develop through interactions with engaged and responsive caregivers, developmentally appropriate play with peers, and access to quality home visiting, parenting and early education programs are known to buffer adversity and to build the foundational social, emotional, language and adaptive skills that kids need to thrive. Simply put, SSNRs are a biological necessity for all children.
Let’s address the underlying crisis of disconnection by reclaiming a culture that sees all children as our children, and by promoting policies and practices that support the formation and maintenance of safe, stable and nurturing relationships.
Andrew S. Garner, MD, PhD, FAAP; Clinical Professor of Pediatrics, Case Western Reserve University School of Medicine
Robert A. Saul, MD, FAAP, FACMG; Professor of Pediatrics, University of South Carolina School of Medicine-Greenville
Authors, THINKING DEVELOPMENTALLY: NURTURING WELLNESS IN CHILDHOOD TO PROMOTE LIFELONG HEALTH, American Academy of Pediatrics, 2018, 175 pages. (ISBN 978-1610021524)