By Rebecca Ruiz
Drew McWilliams, a clinician and the Chief Operating Officer at Morrison Child and Family Services in Portland, Ore., suggests that amid the underwater mortgages, chronic unemployment and other fallout of the recent recession, a less obvious but equally worrying phenomenon has emerged: the troubled minds of children.
Since the financial collapse of 2008, McWilliams said his clinic has seen an increasing number of children suffering anxiety, depression and post-traumatic stress disorder. Of the 6,000 children that the center treats through in- and out-patient programs, McWilliams said many are trying to cope with the stress borne of persistent financial insecurity.
"Parents are struggling with their own issues and that spills over to their kids," he said.
Most parents don't think children are affected by financial burdens. In a 2010 survey, the American Psychological Association found that 69 percent of parents said their stress had little or no impact on their kids, while 91 percent of children said they saw the effects in their parents' behavior, which included yelling and arguing. The young respondents who noticed their parents' tension reported feeling sad, worried and frustrated.
The developing brain is also more vulnerable to chronic stress than most parents may realize. New and emerging research hints at how the constant barrage of stress hormones can change the way the brain develops, causing behavioral and psychological disorders and putting children at risk for mental illness later in life. While the brain's malleability may be worrisome, it also means positive changes can occur with the right interventions.
"Kids who face adversity have highs and lows, strengths and weaknesses," said Christopher Sarampote, a program officer at the National Institute of Mental Health who focuses on trauma and anxiety disorders. "Parents can really be strong agents of change."
It may not always feel that way to the millions of parents who have struggled since the recession. In addition to the middle-class families that have experienced unemployment, the number of children living in high-poverty areas increased by 25 percent to nearly 8 million in the last decade, according to a recent report. Last month, the child advocacy group First Focus reported that the foreclosure crisis has affected 8 million children, 2.3 million of whom have lost their homes.
Money remains a top stressor, according to an APA survey published in January. Forty-four percent of respondents also felt their stress had increased over the past five years.
McWilliams said parents may be more vulnerable than they realize: "So many of the parents also struggle with their own anxiety or depression. It gets exacerbated when folks are worrying about job prospects or when unemployment might run out."
Susan Lowery O'Connell is a psychologist who manages an early-childhood mental health program in Stark County, Ohio, which includes the city of Canton. The program works with parents, teaching them about child and brain development and how to model self-control and resilience to their children. She understands why it's difficult for some adults to make the connection between their financial struggles and the mental health of their kids.
"When you don't have a roof over your head, you're not really worried about emotional literacy," she said. "However, if that happens during your children's development, it's really making a mark."
This mark goes much deeper than most might expect. Increasingly, research shows that experiences and the environment in which we live can alter the way genes behave. Chemical switches that regulate gene expression can be influenced by experience through a process called epigenetics.
Stress, neglect and abuse, for example, is thought to trigger a cascade of signals that cause chemical markers to attach to a gene. The DNA remains unchanged, but almost like a light switch, the markers can turn a gene on or off. In particular, scientists have studied what happens when markers attach to a gene that regulates stress hormones.
In a small study published in PLoS ONE in January, researchers found that childhood adversity in the form of maltreatment, parental loss or abandonment altered a control mechanism for a key gene that regulates the brain's ability to handle stress hormones. The subjects weren't aware of the change; it happened silently as their environment influenced their genes.
The effects of early-life stress and hormone disruption, said the researchers, are a risk factor for major depression and post-traumatic stress disorder.
The aftermath of adversity can also reach beyond genes. Researchers have found that the hippocampus, a portion of the brain critical to learning and memory, is vulnerable to stress.
Last year, researchers studied brain images of 317 children from varying socioeconomic backgrounds and found that the hippocampus tended to be smaller in participants with lower family incomes and bigger in more affluent subjects. A smaller hippocampus has been linked to several psychiatric disorders, including schizophrenia, anti-social personality disorder, major depression and PTSD.
In a study published in February, researchers found, among the 193 participants, reduced hippocampal volume in individuals who had experienced childhood maltreatment, which most commonly included physical abuse and parental verbal abuse. They also found a significant relationship between maltreatment and parental education and perceived financial stability.
These studies illuminate the relationship between childhood adversity and mental health, but Christopher Sarampote, of the NIMH, cautions that the research is emerging and much remains unknown.
"We know there's a great degree of variability in the types of outcomes," he said. "You see everything from anxiety disorders to depression to behavior disorders -- even no disorder. You can have children where you don't see an impact for several years."
No agency has tracked youth mental health as tied to the economy, but according to the Centers for Disease Control and Prevention, 5 percent of children aged 4 to 17 were characterized by their parents as having "serious emotional or behavioral difficulties" between 2004 and 2009. In each age group, that number was much higher among low-income children than among their wealthier peers.
Researchers and social workers have a hard time untangling why financial insecurity is a risk factor for mental illness, but those on the front lines see the dynamic play out daily.
"Poverty works against resilience," said Lowery O'Connell, noting that research has shown that low-income kids face developmental setbacks of up to 18 months, compared to their well-off peers. Teachers and parents often see behavioral problems when a child cries excessively, has difficulty playing with others or is disengaged in class. What they're really trying to express, said Lowery O'Connell, is "I'm missing pieces, I'm not managing well."
Children dealing with high-stress situations won't just "get over" stress, she said. Instead, they have to decrease their stress response by performing a cognitive task, like attaching a word to how they feel or focusing their attention elsewhere. These are skills that don't come intuitively, but must be taught by attentive parents and teachers.
Morrison Child and Family Services in Portland focuses on identifying at least one advocate or ally in a child's life; research has shown that the consistent presence of a single nurturing adult can greatly improve a child's resilience to traumatic events. "If there is no one," said McWilliams, "those are the kids that are most at risk."
Dr. Liliana Lengua, director of the Center for Child and Family Well-being at the University of Washington, is examining the development of low-income kids by studying 306 families. She and her fellow researchers have shown that harsh and critical parenting can contribute to disruptions in children's stress hormones. Kids who grow up in poverty tend to have less self-control, according to the team's research.
"[Parents] are such a major funnel or filter of the broader stressful experiences in kids' lives," Lengua said. The warmer and more instructive a parent can be, her research has shown, the more likely a child will exercise better self-control and have a consistent stress hormone response.
Lengua has seen parents and children improve in tandem, but knows it's hard to achieve during times of economic hardship. "What's humbling is that there are really major life events in these families' lives," she said. "This is the fabric of life, how strong families are, how resilient families are."
Rebecca Ruiz is a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow.