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INTRODUCTION

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Resiliency is the ability to rebound from real, experienced adversity. It refers to an individual’s use of inner strengths and outer resources to overcome seriously adverse, even traumatic, circumstances and still continue to pursue and succeed in one’s endeavors. Resiliency varies according to personal hardiness and social supports, as well as the nature and degree of the imposed hardship or impediment.

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It is well established in the literature that adversity and prolonged exposure to stress are associated with poor health outcomes. In 1967, the original Whitehall study of British civil servants showed an inverse association between social class and mortality from a wide range of diseases. The Whitehall II study, conducted from 1985 to 1988, documented a similar social gradient in health in which those of lesser social classes had worse health and premature mortality compared to those who were more advantaged. The Adverse Childhood Experiences (ACE) Study of the Centers for Disease Control and Prevention (CDC)/Kaiser Permanente revealed that abuse, neglect, and family dysfunction, also known as toxic stressors, experienced during childhood contribute to lifetime chronic, mental, economic, and social health issues. The study found a dose response between the number of adverse childhood experiences and negative health behaviors and health conditions in adulthood such as alcoholism, drug abuse, depression, ischemic heart disease, stroke, cancer, diabetes, unintended pregnancy, obesity, and suicide attempts. The American Academy of Pediatrics (AAP) has affirmed the “new morbidities of childhood,” recognizing that the child’s health is influenced by family dysfunction, the environment, and socioeconomic status. The AAP presented the ecobiodevelopmental framework that explains the impact of toxic stress in early childhood (“new morbidities of childhood”) on epigenetics, brain development, and long-term health and development (Fig. 29-1). If left unaddressed, toxic stress can affect the development of brain architecture and fundamental biological functioning in a child’s growing body.

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Figure 29-1

The ecobiodevelopmental framework. Reproduced with permission from Shonkoff JP et al. The lifelong effects of early childhood adversity and toxic stress, Pediatrics. 2012 Jan;129(1):e232-e246..

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There is cause for optimism, however. Research studies over the last three decades have shown that, even without therapeutic interventions, most at-risk children do remarkably well over the course of their lives. Contrary to absolutist opinions, a proportion of children who suffer early oppressive circumstances grow up to be productive, law-abiding, fulfilled, and generative adults. In a large population of children followed over 4 decades, it has been discovered that one-third of the most at-risk children, defined by having at least 4 early risk factors, such as poverty, family conflict, perinatal stress, and abuse, developed well personally, socially, and educationally. In another longitudinal study of 300 mother–infant dyads in which the mother was exposed to partner violence, it was found that the intergenerational impact of violence on the child’s functioning was lessened by maternal self-efficacy and social support. Additional ...

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