poverty, adversity and the wellbeing of people with developmental disabilites eric emerson
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Poverty, Adversity and the Wellbeing of people with Developmental Disabilites
Eric Emerson
Four Questions
› What is poverty?
› How should we measure it?
› Is it important for people with intellectual or developmental disabilities?
› What should we be doing about it?
What Is Poverty?
› ‘The inability, due to lack of [economic] resources, to participate in society and to enjoy a standard of living consistent with human dignity and social decency’
Fabian Commission on Life Chances and Child Poverty (2006)
How Should We Measure Poverty?
› Traditionally
- Current household income (adjusted for household composition)
› More recently
- Material & social hardship due to lack of resources (http://www.poverty.ac.uk/)
- Neighbourhood deprivation (but …..)
› Under consideration
- measures of ‘multidimensional’ poverty (DfE/DWP)
Emerson, E., Graham, H., & Hatton, C. (2006). The measurement of poverty and socio-economic position in research involving people with intellectual disabilities. In L.M. Glidden (Ed.) International Review of Research in Mental Retardation, New York: Academic Press.
Is Poverty Important?
› Centuries of research
- Living in poverty (especially in childhood) is associated with
- constrained life opportunities
- Increased risk of a range of adversities
- poorer cognitive, emotional, social and behavioural development
- poorer health
- premature mortality
Environmental Adversity & Well-Being
› Villermé (1826)
- Annual mortality rates (per 1,000) related to Arrondisement wealth in Paris (1817-21)
2 3 1 4 11 6 5 7 10 9 8 120
5
10
15
20
25
6
Is Poverty Important?
› Centuries of research
- Living in poverty (especially in childhood) is associated with constrained life opportunities, increased risk of a range of adversities, poorer cognitive, emotional, social and behavioural development, poorer health, premature mortality
- Many children in the UK are growing up in poverty (3.6 million; 27% ….. and growing)
- Children with severe intellectual disability or autism are at least as likely as other children to grow up in poverty
- Children with less severe intellectual disability are much more likely than other children to grow up in poverty
- Unless they are immune to the effects of poverty …….
Child Poverty and SEN
MLD SLD PMLD ASD No SEN0%
5%
10%
15%
20%
25%
30%
35%
40%
Percentage of 7-15 Year Old Children Eligible for Free School Meals , England 2011
Emerson, E. (2012). Deprivation, ethnicity and the prevalence of intellectual and developmental disabilities. Journal of Epidemiology & Community Health 66, 218-224.
Immunity?
› Is there an association between poverty and wellbeing among children with intellectual disabilities? Se-
ries1
0%
10%
20%
30%
40%
50%Emotional Disorder
IDNo ID
0 1 2 3 4 5+0%
10%
20%
30%
40%
50%Conduct Disorder
Emerson, E., & Hatton, C. (2007). The mental health of children and adolescents with intellectual disabilities in Britain. British Journal of Psychiatry 191, 493-499.
What Should We Be Doing?
1. Reduce exposure
- ‘Upstream’ interventions (poverty reduction)
o regulation of labour markets (e.g., minimum wage, salary/bonus caps, flexible employment)
o redistributive tax policies
- ‘Downstream’ interventions that aim to disrupt the pathways that mediate the link between poverty and child wellbeing
o biological pathways
- ‘allostatic load’ resulting from dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis
- inflammation responses
Social/Environmental Pathways
Poverty Parental Wellbeing Parenting Child
Wellbeing
Partner Conflict
Conger, R. D., & Donnellan, M. B. (2007). An interactionist perspective on the socioeconomic context of human development. Annual Review of Psychology, 58, 175-199.
Lack of investment in developmental activities
‘Downstream’ Risks Associated with Poverty
› 2,236 families in SW England supporting a child under 5 with developmental delay
Domestic violence
Alcohol abuse
Drug abuse
Mental health
Social isolation
Parenting problems
-25% 0% 25% 50% 75%
No PovertyPoverty
Parenting Interventions
› Extensive evidence of long-term efficacy among ‘at risk’ children in general
› Growing evidence in intellectual and developmental disabilities (e.g., SSTP)
- Tailoring interventions to
- Social context of parenting a child with intellectual or developmental disabilities
- Syndrome-specific issues
Tellegen, C. L., & Sanders, M. R. (2013). Stepping Stones Triple P-Positive Parenting Program for children with disability: a systematic review and meta-analysis. Research in Developmental Disabilities, 34, 1556-1571.
What Should We Be Doing?
1. Reduce exposure
2. Build resilience
› Supporting
- Children
- Families
- Communities
› Building and sustaining
- Behavioural health
- Problem solving
- Self-esteem
- Achievement and purpose
- Relationships
- Belonging
Many Unanswered Questions
› Strength of association (OR) between environmental risk at age 9 months and 3 years and the persistence of conduct difficulties from age 3 to ages 5 and 7 in UK children with/without intellectual and developmental disabilities
Poverty Low Mat WB
Low Mat Education
Irregular Activity
Harsh parenting
0.1
1
10
No ASD/IDID/no ASDASD
Four Questions
› What is poverty?
› How should we measure it?
› Is poverty important for people with intellectual or developmental disabilities?
› What should we be doing?
Emerson, E. (online early). Commentary: Childhood exposure to environmental adversity and the well-being of people with intellectual disabilities. Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2012.01577.x