Risk, protection and resilience

Transcript

RyanA young woman finds out she's six weeks pregnant. And her first feeling isn't joy. It's panic. Because two weeks ago, before she knew, she was at a friend's wedding, and she had a few glasses of wine.

SoheeShe asks her doctor, have I already ruined everything? And the answer from the Centers for Disease Control and Prevention, the CDC, is one we'll come back to. Because it captures the spirit of this whole topic.

RyanWelcome to EPPP Prep, the podcast. I'm Ryan.

SoheeI'm Sohee. Today's knowledge area is risk and protective factors that may shape a developmental course: things like nutrition, prenatal care, health care, social support, socioeconomic status, abuse, victimization, and resilience.

RyanDefinitions first, from the CDC, which uses them for harms like child abuse and other adverse childhood experiences. Risk factors are characteristics that may increase the likelihood of experiencing that harm. But they may or may not be direct causes. Protective factors are characteristics that may decrease that likelihood.

SoheeAnd the CDC stresses that adverse childhood experiences are not often caused by a single factor. It's a combination at the individual, relationship, community, and societal levels. Sound familiar? That's Bronfenbrenner's circles again.

RyanLet's start before birth. A teratogen is any disease, drug, or other environmental agent that can harm the embryo or fetus, or influence health or behavior after birth.

SoheeAnd two principles the exam loves. Timing: Lifespan Development says a teratogen's influence on a body part is strongest while that part is developing. After organs form, they're usually less vulnerable, except the nervous system, which is always susceptible.

RyanAnd dose: the longer the exposure, or the higher the dose, the greater the likelihood of harm. The impact also depends on genetic susceptibility and the quality of the prenatal environment. And embryos can even be harmed by teratogens their biological fathers were exposed to.

SoheeOne more principle. The long-term effects of some teratogens depend on the quality of the environment after birth. Risk isn't sealed at delivery.

RyanAlcohol is the big one. The psychology textbook calls alcohol use during pregnancy the leading preventable cause of intellectual disabilities in children in the United States.

SoheeAnd the CDC is very clear. There's no known safe amount of alcohol during pregnancy, and no safe time. Alcohol in the first three months can cause abnormal facial features. And because the brain develops throughout pregnancy, it can be affected by exposure at any time.

RyanSmoking is also a teratogen. The psychology textbook, citing the CDC, says smoking during pregnancy can lead to premature birth, low birth weight, stillbirth, and sudden infant death syndrome.

SoheeNow protective factors before birth. Routine prenatal care monitors the health of both the pregnant person and the fetus, and can reduce the risk of complications. But the textbook notes prenatal care isn't provided equitably across populations or locations.

RyanAnd folic acid. The CDC passes along the U.S. Public Health Service recommendation: anyone who could become pregnant should get four hundred micrograms of folic acid daily, to help prevent neural tube defects, serious birth defects of the brain and spine.

SoheeAnd here's the why. Neural tube defects happen in the first few weeks of pregnancy, often before a person knows they're pregnant. So the protection has to already be in place.

RyanOkay, back to our worried mom-to-be. What does the CDC tell her? It's never too late to stop alcohol use during pregnancy. Because brain growth happens throughout pregnancy, stopping will improve the baby's health and well-being. And get regular prenatal checkups.

SoheeThat's the spirit of this topic. Risk is real, but it's never the whole story. There's almost always a next protective step.

RyanAfter birth, the environment keeps mattering. Lead, for example. The CDC says no safe blood lead level in children has been identified. Even low levels are associated with developmental delays, difficulty learning, and behavioral issues.

SoheeChildren under six are more likely to be exposed because of their hand-to-mouth behavior. Sources include chipping paint in buildings from before 1978, and water from lead pipes.

RyanNutrition. Lifespan Development describes stunting, impaired growth in height from malnutrition, which cannot be reversed and can increase the risk of cognitive and physical damage. But the textbook also notes that nutrition supplementation in early childhood can help children catch up on physical growth.

SoheeNow the big framework of the last few decades: adverse childhood experiences, or ACEs. The CDC defines them as potentially traumatic events that occur in childhood, from birth to seventeen.

RyanExamples include experiencing violence, abuse, or neglect, witnessing violence at home or in the community, and having a family member attempt or die by suicide. Also growing up in a household with substance use problems, mental health problems, or instability from parental separation or a household member in jail or prison.

SoheeAnd here's the developmental mechanism. The CDC says ACEs and community factors can cause toxic stress, extended or prolonged stress. Toxic stress can negatively affect children's brain development, immune system, and stress-response systems, which can affect attention, decision-making, and learning.

RyanLifespan Development connects this to epigenetics. Trauma experienced in childhood could make someone sensitized and highly reactive to signs of conflict later in life.

SoheeAnd the CDC says something every clinician should say out loud. Although some risk and protective factors are at the individual and family level, no child is at fault for the ACEs they experience.

RyanNow abuse and neglect specifically. The CDC lists risk factors for victimization, like being younger than four years old, or having special needs that may increase caregiver burden. And again, children are not responsible for the harm done to them.

SoheeRisk factors for perpetration include caregivers with drug or alcohol issues, mental health issues including depression, high parenting or economic stress, and the use of spanking and other corporal punishment. Community risks include high rates of violence and poverty, and neighbors who don't look out for each other.

RyanPause and think. Sort these into risk or protective, and name the level. A family isolated from friends and extended family. A caring adult mentor outside the family. Community access to high-quality preschool.

SoheeIsolation from other people is a family-level risk factor on the CDC's list. A caring adult mentor outside the family is protective. And access to high-quality preschool is a community-level protective factor.

RyanThe CDC's protective factors are the hopeful half of the picture. Caregivers who create safe, positive relationships, and who use nurturing parenting skills. Families with strong social support networks. Caregivers who can meet basic needs for food, shelter, education, and health care. And communities with access to medical and mental health care and safe after-school programs.

SoheeAnd the CDC's prevention message ties it together. Creating safe, stable, nurturing relationships and environments for all children prevents ACEs and helps children reach their full potential.

RyanWhich brings us to resilience. Lifespan Development quotes the American Psychological Association's definition: the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress.

SoheeAnd the textbook says resilience is common. It takes extreme deprivation to severely restrict a developing human's potential.

RyanThere's also a strengths-based framework called developmental assets, from the Search Institute. Forty qualities to nurture in youth. Twenty internal, like commitment to learning and a positive identity. Twenty external, like support, boundaries, and constructive use of time.

SoheeAnd the more assets a young person has, the more likely they are to succeed in school, help others, value diversity, resist danger, and overcome adversity.

RyanPause and think, last one. A nine-year-old has had several adverse experiences, including a parent's incarceration. An answer choice says her outcome is now largely fixed. Based on the sources, what's wrong with that?

SoheeRisk factors raise likelihood, they don't determine destiny. Protective factors like a caring mentor, a supportive caregiver, and good after-school programs can lower risk, and resilience is common. The tempting wrong answer treats risk as fate.

RyanRecap. Risk factors raise the likelihood of harm, protective factors lower it, and neither is a guaranteed cause. They work at individual, relationship, community, and societal levels.

SoheeTeratogens act by timing and dose, and the nervous system stays vulnerable. No safe amount or time for alcohol in pregnancy, but it's never too late to stop. Prenatal care and folic acid protect. No safe level of lead in children.

RyanACEs can cause toxic stress that affects the developing brain and stress systems. Safe, stable, nurturing relationships prevent them. And resilience is common, especially with developmental assets.

SoheeHere's the thing to carry with you. A setback, like a hard exam result, is a risk factor, not a verdict. Your protective factors count: your support, your plan, and your persistence.

RyanAnd you're building them right now. Thanks for listening to EPPP Prep.

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