According to the National Academies of Sciences, Engineering, and Medicine, the well-being of a child’s primary caregiver is one of the most important factors associated with fixing and preventing health disparities among children.
Children from low-income or ethnic minority homes are more likely to have poorer physical health, suffer from behavioral and/or mental health problems and have substance abuse disorders. But decades of work by developmental psychologists, including researchers at Arizona State University, shows that being strongly connected to their primary caregiver can protect children from the effects of poverty, discrimination, trauma and chronic stress. Based on this work, the recently released National Academies report Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity prioritizes supporting primary caregivers.
“We know that a child’s primary caregiver — who is most often the mother — is a good buffer against the adversity a child might experience, and a strong relationship between caregiver and child can begin to level the playing field in terms of health disparities,” said ASU’s Suniya Luthar, who was part of the interdisciplinary 14-member committee responsible for writing the report.
The importance of the primary caregiver
The emphasis on the well-being of caregivers is a new target for improving children’s lives. A 2000 report on children’s health, From Neurons to Neighborhoods: The Science of Early Childhood Development, focused on promoting self-regulation in children. The ability to adjust behavior based on circumstances — for example whether one responds to a verbal insult with a witty reply versus aggression — can predict success in school and healthy social relationships.
What influences how, and how well, children self-regulate?
According to ASU’s Nancy Eisenberg, an expert on self-regulation in children, the answer includes biological factors, like genetics, the child’s environment and the primary caregiver. The quality of the relationship between caregiver and child affects how well children self-regulate.
Luthar, who is a Foundation Professor of Psychology at ASU, was one of just two psychologists on the National Academies committee. Along with other developmental psychologists, she keeps finding that if the primary caregiver is unwell or under stress, the bond between caregiver and child can become dysfunctional and children can suffer. This idea, recently highlighted in a special issue of Child Development, forms the core of Luthar’s research on motherhood and her work on developing ways to help mothers under stress.
The National Academies report includes a roadmap of recommendations for how to address health disparities in children. The first item on the roadmap is the usefulness of intervening early; the second is the importance of supporting a child’s primary caregiver.
“But it is never too late to intervene,” Luthar said.
Luthar added that a strong and healthy attachment between children and caregivers — one capable of buffering against challenges like growing up in poverty or experiencing chronic stress — is possible in all kinds of families and living situations. She has developed two of the scientifically validated supportive group interventions cited in the National Academies report. The Relational Psychotherapy Mothers Group is used with women who are living in poverty, and the Authentic Connections Group is used with mothers who are white collar professionals.
Fathers need support too
In 2018, fathers were the primary caregiver in 7% of American households, and the National Academies report emphasizes that understanding how best to ensure their well-being is also important.
“What mothers need and what fathers need can be very different, and what has been shown to work for supporting mothers might not work for fathers,” Luthar said. “Instead of telling parents to do this or do that, we need to start asking how we can best equip mothers and fathers, individually, for success.”
There are few evidence-based support programs designed specifically for male caregivers, but the report did mention one evidence-based program as a promising model for how to support fathers: The Family Check-Up.
Started by the late Thomas Dishion, the Family Check-Up teaches fathers and mothers parenting skills, like effective discipline methods, to help address problem behaviors in children. The Family Check-Up is one of the evidence-based interventions being implemented throughout the US and internationally by ASU’s REACH Institute.
The program takes a holistic, wide angle perspective to problem behaviors in children, and involves all caregivers, whether they are mothers, fathers, grandparents, or guardians.
“What is happening with the child is not just about the child: it is about the family, the school, and even the neighborhood,” said Anne Mauricio, who is an associate research professor of psychology at ASU who is currently working on scaling up the program.
Mauricio said support for the caregiver is a critical part of both the program’s framework and its success.
Evidence-based interventions that provide support to primary caregivers — like the Relational Psychotherapy Mothers Group, Authentic Connections and the Family Check-Up — are a feasible and scalable way to leverage the caregiver-child relationship as a buffer against adversity like poverty, discrimination, trauma and chronic stress.
“The interventions just need to have the right ingredients, which are the same for low-income moms with addiction or mental health problems as they are for well-educated moms. Caregivers, just like their children, need ongoing, authentic love and support,” Luthar said.
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