Journeys From Childhood to Midlife: Risk, Resilience, and Recovery

Abstract

The latest report from the Kauai Longitudinal Study addresses 2 fundamental questions of interest to pediatricians and health care professionals: 1) What are the long-term effects of adverse perinatal and early child-rearing conditions on individuals’ physical, cognitive, and psychosocial development at midlife? 2) Which protective factors allow most individuals who are exposed to multiple childhood risk factors to make a successful adaptation in adulthood?1The Kauai Longitudinal Study has monitored the impact of a wide array of biological, psychological, and social risk factors on the lives of a multiracial cohort of 698 individuals who were born in 1955 on the Hawaiian island of Kauai, from the perinatal period to ages 1, 2, 10, 18, 31/32, and 40. The follow-up at midlife was able to track ∼80% of the “high-risk” children who had been exposed to chronic poverty, birth complications, parental psychopathology, and family discord (approximately one third of the cohort) as well as comparison groups of men and women who had not experienced significant childhood adversities.With the exception of serious central nervous system damage, the impact of perinatal complications on adult adaptation diminished with time, whereas the outcomes of biological risk conditions depended, increasingly, on the quality of the child-rearing environment and the emotional support provided by family members, friends, teachers, and adult mentors. Most of the high-risk youths who had developed serious coping problems in adolescence (learning disabilities, mental health problems, teenage pregnancies, and/or a record of delinquencies) had staged a recovery by the time they reached the end of their fourth decade of life. Overall, such “troubled” teenagers had a slightly higher mortality rate by age 40 than did the cohort as a whole, but the majority of the survivors were in stable marriages and jobs, were satisfied with their relationships with their spouses and children, and were responsible citizens in their community.Poorest outcomes at age 40 were associated with prolonged exposure to parental alcoholism and/or mental illness—especially for the men. Individuals who had been born small for gestational age and those who received a diagnosis of mental retardation in childhood had a higher incidence of serious health problems in adulthood, including serious depression. They also had higher mortality rates than was the norm for men and women of their age. Men and women who had encountered more stressful life events in childhood reported more health problems at age 40 than those who had encountered fewer losses and less disruption in their family during the first decade of life.Health status in the first decade of life (based on a pediatric assessment of all organ systems at age 2 and number of health problems, including serious illnesses and accidents, between birth and age 10) correlated significantly with the quality of the individual’s adaptation at age 40—as did the mother’s caregiving competence and the emotional support provided by the family in childhood.This study demonstrates the need for early attention to the health status of our nation’s children—especially those who are exposed to poverty, serious perinatal complications, and parental psychopathology. The social policy implications are clear: early access to good preventive and ameliorative health services and proper attention to the quality of early child care can pay ample dividends in an improved quality of life in adulthood.2

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