Childhood family environment,social competence,and health across the lifespan

Abstract

Childhood family adversity increases the risk of a wide range of psychological and physical health problems later in life, prompting research into developmental pathways linking childhood experiences to adult health. The current paper discusses a social-biological pathway by which childhood family relationships influence the development of the social and emotional skills necessary for adaptive behavioral and biological responses to stress. Failures in the development of social and emotional competence during childhood may lead to dysregulated responses to stress and difficulties in social relationships across the lifespan. Over time, the cumulative impact of dysregulated stress responses and low social support may increase the risk of mental and physical health problems later in life.

Keywords

Childhood adversity stress social support cortisol health

In countless conscious and unconscious ways, experiences from childhood are carried into adulthood. Supportive, cohesive childhood family environments are important protective factors promoting positive mental and physical health, while highly stressful or otherwise toxic childhood experiences can have damaging influences on health across the lifespan. Family-related adversities, including conflict, abuse, neglect, parental psychopathology, and parental separation or death, exert particularly profound effects on developmental trajectories and health outcomes. Estimates suggest that almost two-thirds of children experience at least one form of significant adversity (Anda et al., 2006).

Understanding the pathways by which childhood experiences are carried into adulthood is critical for efforts to promote positive health among at-risk children. Numerous pathways have been proposed, involving health behaviors, cognitive functioning, emotion regulation, social functioning, and biological stress-response systems (Luecken, Appelhans, Kraft, & Brown, 2006; Luecken & Lemery, 2004; Miller, Chen, & Parker, 2011; Repetti, Taylor, & Seeman, 2002). Many of these pathways assume that childhood adversity impairs the ability to respond to future challenges in an adaptive manner; over time, the cumulative impact of maladaptive responses leads to mental and physical disorder. The identification of modifiable factors along these pathways will greatly enhance efforts to minimize the negative impact of childhood adversity.

The focus of the current paper is on a social-biological pathway in which exposure to family adversity may lay the foundation for poor mental and physical health in adulthood by undermining the development of social and emotional competence, critical tasks of childhood. Two processes linking socioemotional competence to health are discussed. Problematic socioemotional competence may 1) interfere with the ability to adaptively appraise and respond to stress, and 2) set the stage for continuing relationship problems in adulthood. We begin by reviewing the development of social and emotional competence in childhood and the implications for adult relationships. Next, we discuss how social and emotional competencies may impact stress-related regulatory processes. Relations between social support, stress regulation, and health in adulthood are presented. We conclude with methodological considerations and directions for future research.

The development of social and emotional competence

In a biopsychosocial model of social development, external factors (e.g. family environment, Socioeconomic Status (SES) and culture) and internal factors (e.g. temperament, personality and physical factors) interact with brain development to influence the acquisition of social skills and functioning (Beauchamp & Anderson, 2010). Basic social interactions between infants and caregivers are observable during the first few months of life. By early childhood, toddlers learn to navigate simple play interactions. Relationships become increasingly intimate and complex in middle childhood. By adolescence, peer relationships become an integral part of identity development, influencing adolescent behavior and sense of self. The social skills developed in childhood and adolescence exert strong influences on the onset and maintenance of social relationships throughout the lifespan. Poorly developed social skills and social rejection increase the risk of problem behavior and psychological problems in childhood and beyond (Parker, Rubin, Erath, Wojslawowicz & Buskirk, 2006).

Although many factors influence the development of social competencies, the role of the parent-child relationship is particularly powerful. Parental monitoring of play interactions is integral to the development of adaptive social skills, as parents correct socially unacceptable behaviors and help children navigate conflicts. Parents also model social skills in their own relationships. Warm and expressive parent-child relationships are important factors in children’s development of empathy, and longitudinally predict children’s social functioning (Zhou et al., 2002). Parent-child attachment bonds impact the acquisition of social competencies and guide the development of relationship schema that children generalize into adult relationships. Secure parent-child attachment is associated with better social skills and higher quality childhood friendships, while poor attachment can negatively impact children’s social competence (Youngblade & Belsky, 1992). The impact of attachment on social functioning is long-lasting. Insecure attachment in infancy leads to more conflict, poor emotional recovery from negative interactions, and less commitment in romantic relationships in adulthood (Simpson, Collins, & Salvatore, 2011).

Adverse childhood family environments and negative parent–child relationships can impede the development of social competence. For example, children exposed to marital conflict and aggression have lower peer competence in kindergarten, an effect that is mediated by negative parenting behavior (Finger, Eiden, Edwards, Leonard, & Kachadourian, 2010). In a longitudinal study, Kim and Cicchetti (2004) report that the impact of child maltreatment on internalizing and externalizing disorder is partially mediated by impairments in social competence. Abusive or problematic parent–child relationships can also influence social development by disrupting attachment bonds (Scaramella & Leve, 2004).

The ability to express and regulate emotions in a socially and contextually appropriate manner is critical in promoting positive social functioning and psychological adjustment in childhood and beyond (Eisenberg, Hofer, & Vaughan, 2007). Parental coaching, modeling, validation, and healthy displays of emotion are powerful influences on the development of emotion regulation. Considerable evidence documents the negative impact of adverse childhood family environments on the development of emotion regulation, and the consequences for social functioning. For example, maltreated children exhibit more difficulty regulating emotions and are more likely to respond to social interactions in inappropriate ways (e.g., with aggression; Maughan & Cicchetti, 2002). Emotion dysregulation in maltreated children partially explains their higher risk of peer rejection and behavior problems (Rogosch, Cicchetti, & Aber, 1995).

Socioemotional competence and stress-related regulatory processes

In line with “cascades” models common in developmental psychopathology research, impairments in social and emotional functioning in childhood can have diffuse influences across time and on other domains of functioning. Impaired social competence can have lasting effects on social relationships, and may compromise functioning in other health-relevant domains. Of particular relevance to the current paper is the impact of adversity and social functioning on characteristic cognitive, behavioral, and biological regulatory responses to stress.

Social information processing models propose that children encode, interpret, and make inferences about social cues within the context of a “database” of social schemas and stored memories. These processes culminate to determine children’s behavioral responses in a socially stressful situation (Crick & Dodge, 1994). Experiences of adversity and deficiencies in socioemotional competence may contribute to biases in how children perceive and process social information, impairing their ability to accurately appraise threat in the external environment, which may then lead to inappropriate or dysregulated responses. Chaotic, conflictual, or unpredictable family environments can lead children to develop a heightened sense of potential danger, selectively attend to negative aspects of their environment, or mistakenly perceive ambiguous or benign situations as threatening. For example, higher levels of conflict or abuse in the childhood family environment predicted greater vigilance towards social threat cues in young adulthood (Luecken & Appelhans, 2005). The inability to respond in a socially and emotionally appropriate manner with peers may result in or exacerbate negative social interactions that children generalize into a broader lens through which they appraise their social world (Crick & Dodge, 1994). Lansford, Malone, Dodge, Pettit, and Bates (2010) observed that children’s aggressive behavior increased rejection from peers, contributing to subsequent threat perception and hostile attribution biases.

Well-regulated biological stress responses support adaptive cognitive, emotional, and behavioral responses to challenging situations. Biological stress response systems include processes regulated by the sympathetic-adrenomedullary (SAM) axis, influencing cardiovascular activation and the release of epinephrine and norepinephrine into the bloodstream, and the hypothalamic-pituitary-adrenal (HPA) axis, resulting in the secretion of the stress hormone cortisol. Experiences of chronic or acute stress early in life can disrupt regulatory processes involved in mounting an adaptive physiological response to stress. For example, young adults reared in high conflict/low affection family environments exhibit dysregulated cortisol and cardiovascular responses to a simulated social conflict interaction relative to youth from lower conflict homes (Luecken, Kraft, & Hagan, 2009; Luecken & Roubinov, 2012). Over time, the cumulative impact of biological dysregulation increases vulnerability to a wide variety of physical and mental problems later in life (McEwen & Wingfield, 2003).

In the context of negative family environments, deficiencies in socioemotional skills may further impair children’s ability to effectively regulate biological responses to perceived threat. Experiences of social isolation and peer rejection may be commonplace for at-risk children, and are linked to dysregulated cortisol (Gunnar, Sebanc, Tout, Donzella, & van Dulmen, 2003) and cardiovascular (Gazelle & Druhen, 2009) activity. Children reared in adverse environments struggle to respond flexibly to situational demands, manage emotional arousal, and use other adaptive strategies required by dynamic social environments (Ramani, Brownell, & Campbell, 2010). Lacking in socioemotional competence, these children may experience everyday peer interactions as stressful or respond in a manner that exacerbates a stressful interaction, chronically activating the physiological response systems, contributing to the development of biological dysregulation. For example, lower levels of prosocial behavior and higher levels of disruptive behavior mediate the association between childhood maltreatment and dysregulated cortisol activity (Alink, Cicchetti, Kim, & Rogosch, 2012). In our research, aggressive behavioral responses during a simulated social interaction mediate the impact of a high conflict/low affection childhood family on heart rate reactivity in young adulthood (Luecken & Roubinov, 2012). Failure to behave in a well-regulated, socially appropriate manner may elicit negative peer feedback, “confirming” biased appraisals of the environment, and contributing to further social rejection and physiological dysregulation (Alink et al., 2012).

Adult social support and health

Childhood experiences that interfere with the successful development of social and emotional competence may negatively impact health through their effects on social relationships across the lifespan. Exposure to childhood adversity is associated with smaller social support networks, more negative social interactions in adulthood, and greater conflict in romantic relationships (Doucet & Aseltine, 2003; Ford, Clark, & Stansfeld, 2011). Several decades of research provide convincing evidence that structural and functional aspects of social relationships exert significant influences on physical and emotional health. While strong social support is a well-documented health protective resource in adulthood, social isolation is linked to dysregulated physiological stress responses, poor physical health, and premature mortality. In a recent meta-analytic review, Holt-Lunstad, Smith, and Layton (2010) confirm that poor social relationships significantly increase mortality risk, even after accounting for initial health status, age, and health behavior. The effect size for the impact of social relationships on mortality is comparable to or greater than risk factors such as smoking, obesity, or sedentary behavior.

Considerable research identifies both direct and indirect mechanisms behind the beneficial impact of social support on adult health. Social support may directly impact health by promoting healthy behaviors or increased utilization of health care. Strong social support may indirectly impact health by its association with improved cardiovascular regulation, immune function, inflammatory processes, and cardiovascular and neuroendocrine responses to stress (Uchino, 2006; Uchino, Cacioppo, & Kiecolt-Glaser, 1996). For example, the provision of social support buffers the impact of negative life experiences on cortisol activity (Adams, Santo, & Bukowski, 2011). The relations between stress, social support, and health are multidirectional. To illustrate, low social support can increase the impact of a current stressor or serve as a source of stress in itself. High stress levels or poor mental or physical health can lead to deterioration in social support as individuals withdraw from potentially supportive relationships or as sources of support become overwhelmed by demands (Bolger, Foster, Vinokur, & Ng, 1996).

Methodological considerations and future directions

Limitations in current research on childhood adversity and lifespan health suggest several directions for future studies. Perhaps most significant is the need for longitudinal investigations. Individual, family, and social processes that link childhood experiences, social functioning, and health may be strongly impacted by developmental stage. Especially within the context of childhood adversity, social, emotional, and cognitive regulatory processes may develop in a nonlinear fashion, such that change is most appropriately modeled by a longitudinal design (Beauchamp & Anderson, 2010). Limited research focuses on developmental periods when peer relationships increase in salience and significance, such as adolescence. In addition, stability in brain development, new social and occupational challenges imposed by increasing autonomy, and increased initial onset of mental and physical health problems make the transitional period of late adolescence/early adulthood critical for study.

The current paper attempts to briefly link research across developmental, social, cognitive, and biological domains to provide a comprehensive approach to understanding the long-term impact of childhood adversity on health. Each of these domains bears unique complexities that challenge the development of a comprehensive model, the full extent of which is beyond the scope of this article. For example, within the social domain, there is disagreement regarding the definition and operationalization of many social constructs, which can make comparisons across studies difficult. The childhood adversity construct also encompasses an array of markedly different stressors, each of which may differ in its effects on social development and regulatory functioning. Inherent within social processes are dynamic interactions among individual, familial, and environmental factors. Existing studies test discrete social and biological pathways that relate early life adversity to long-term health; future research will be challenged to model the full extent of direct, indirect, and reciprocal relations in a social-biological pathway linking adversity to health.

Growing evidence of the profound impact of childhood adversity on lifespan health places a high priority on the development and implementation of interventions to reduce early life adversity or decrease the long-term impact of adverse experiences. From a public health perspective, the consistent evidence for social support as a powerful stress-buffering resource calls for wide dissemination of interventions to help at-risk individuals build social competency and support. A wide variety of interventions targeted at children, adolescents, and adults aim to improve social support. Although the potential impact on physical health is rarely considered, evidence linking social support to physiological functioning and physical health suggests that support-enhancing interventions may also benefit lifespan physical health.

Concluding comments

Considerable research identifies the potential long-term consequences of childhood family adversity; it will be important for future research to focus on the mechanisms that link early experiences to later mental and physical health, with an eye towards potentially modifiable factors. Given the relation between early adversity and social and physiological functioning in childhood and adulthood, a developmental social-biological pathway is proposed which focuses on disruptions in the development of adaptive socioemotional and physiological regulatory skills. The negative effects of such disruptions may accumulate over the lifespan, resulting in significant deficits in both psychosocial and physiological functioning in adulthood. The longitudinal study of social-biological pathways is highly complex due to bidirectional and interacting internal and external influences across the course of development. Nevertheless, findings from such studies may advance prevention and intervention programs that operate on socioemotional mechanisms to limit the negative long-term physical health outcomes associated with exposure to childhood family adversity.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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