Bugental, Daphne B. (2003). Thriving In the Face of Childhood Adversity. Reviewed by Karen E. Petersen, Portland State University

Bugental, Daphne B. (2003). Thriving In the Face of Childhood Adversity. New York: Psychology Press Pp. v + 232 $49.95     ISBN 1-84169-058-9 Reviewed by Karen E. Petersen Portland State University February 4, 2005 Thriving in the Face of Childhood Adversity is a book that belongs on the bookshelf of every professional and every parent whose life includes a child with a disability. Daphne Blunt Bugental examines the lives of children with disabilities through a multidisciplinary lens. She uses current information from the fields of social development, developmental neuroscience, social cognition, and evolutionary psychology to examine how the life experiences of children with medical and physical disabilities (MPD) create high risk or resilient outcomes. She sprinkles the research findings with vignettes of children and their families and how they deal with the many challenges that MPD’s inject into the lives of the individuals with the MPD and everyone they interact with. The introduction to the book is also an introduction to the author, offering a glimpse at the motivation that drove her to write this book. She also uses the introduction to clearly outline the remainder of the book. Chapter one provides a historical overview of how MPD’s have been viewed over time and from different cultural perspectives, examining in particular the different religious and philosophical views of different cultures. This section of the book looks to what are the perceived nature and causes of MPD’s and how they vary by culture. She ends the introduction with an inquiry into what can be done about MPD’s. Chapter two delves into this question by exploring the medical model and the changing beliefs from the scientific world. It is here we are first introduced to the social developmental approach and the evolutionary psychology approach of MPD’s and what conditions create an environment in which the child will thrive or fail to thrive. Chapter three is the final chapter in the introduction and it lays a strong foundation outlining how some children with MPD’s seem to escape much of the negative aspects of disability and thrive while others suffer a much more dismal life outcome. She examines risk versus thriving from the response of the parents and the response of the child. She defines the long term effects of risk and the effects of unrelieved stress and the damage it creates through allostatic overload. Following the examination of risk, she defines the positive conditions that are most likely to create an environment where the child with an MPD will thrive. In both cases, it is the early experiences of these children that largely contribute to the long term outcome and whether or not they thrive in the face of adversity. She breaks the book into three categories of MPD’s interweaving the common underlying characteristics that all individuals with MPD’s face with the contextual differences and the unique obstacles individuals with different MPD’s face. The three categories of disabilities covered in this text are disabilities that constrain mobility, attention and response disabilities, and stigmatizing disabilities. Each section begins by creating understanding of the MPD and the type of experience commonly encountered by children with the particular MPD. It next discusses parental response and action to their child and the disability, and concludes by examining the social interactions of children with MPD’s and those they come in contact with. Each chapter is neatly summarized and then integrates the information of the experience of the child, the interaction of the parents and the child, and the social experience these children face out in the world. The first type of MPD covers disabilities that constrain mobility. Bugental chooses to focus on disabilities of visual and orthopedic impairment for this section. To introduce the challenges some of these individuals face, Bugental takes narrative snapshots from the lives of musician Andrea Bocelli, scientist Geerat Vermeil, and poet Kenny Fries. Both Bocelli and Vermeil were born with congenital glaucoma and lost their sight at an early age. Fries was born with malformations to both his feet and legs, surgery was able to do little to correct the condition and as an adult his legs are permanently crossed and visibly scarred. These three men do not deny their worlds are fraught with difficultly and obstacles, yet in their interviews there is a sense of optimism that comes with the reality that though they can not control becoming disabled, they can choose how to live life with their disability. Bugental also uses vignettes for the subsequent MPD categories she examines in the following sections of the book. How do individuals with MPD’s manage to thrive under such adverse conditions? This is the thematic question Bugental addresses in each section of the book. She also addresses the instances and conditions in which children fail to thrive. She first examines the relationship that develops between the parents and children with MPD’s and how that relationship is critical to the long term outcome for their children. Parental investment is crucial for human development, the first months of a parent child relationship sets the stage for how the child will interact in all future relationships. Parents react either by rejecting the child, physically or emotionally, or they invest as many of their resources as possible to compensate for the MPD. Approaching the parental willingness to invest question from an evolutionary perspective, Bugental gives evidence for the conditions when parents are most likely to invest or reject their offspring. Evolutionary psychology makes the claim that we are biologically predisposed to reject those who are deformed or look sickly; such differences indicated disease and danger during the era of evolutionary adaptation. It is imperative to note that this is evidence offered as to why parents may fail to invest in their children, it is not a judgment, nor is it meant to characterize the parents as bad parents. In fact, Bugental makes it quite clear that while there is a biophysiological response to aversion, we are humans and we have the capacity to override the initial reaction and become advocates and managers of the child’s social interactions in the world. The social developmental approach evaluates the characteristics of the child and the ways in which they interact with others and how others respond to those interactions. This approach also takes into account the attributions parents feel about their child with a MPD, if parents feel the child is somehow to blame, the risk of maltreatment increases dramatically. These characteristics seemed to hold across the three types of MPD’s that Bugental focused on through out the book. It is believed that long term effects of high risk children manifest from allostatic overload and an ambiguous environment in which they are never sure if their caretaking needs will be met. Conversely, children who thrive go through what could be considered an inoculation of early stressful experiences, quickly followed by a period where they are comforted and nurtured by their parents. These early experiences serve to buffer them to later life stresses setting up the opportunity to thrive. The social developmental and evolutionary approach are quite parallel for the mobility constraint disabilities and the stigmatizing disabilities, this may have much to do with the visibility of the disorders. There are different risks for children whose disabilities make them appear unresponsive to others around them. Bugental focuses on hearing impairments, ADHD, and briefly mentions Tourette’s syndrome in this class of MPD’s. If Children seem unresponsive to authority, it may elicit a negative response from the adult in charge. When a child fails to respond appropriately adults may perceive the non-response as a threat to their authority. It is when this type of dynamic defines the relationship between the adult and child that the child is at an increased risk for physical abuse or maltreatment. Children with this type of disability also are subject to lack of support or services from professionals who attribute the disability as something the child can control. Much like the biophysiological response to physical anomalies, this reaction may not be conscious, but a manifestation of the “just world” beliefs, that is the belief that people in this world get what they deserve. Bugental again reminds the reader that while this response may not be a conscious one, it is one that can be overridden so that the child can receive appropriate services in the medical and educational arenas. The last social issue Bugental address in conjunction with each category of MPD’s is that of social interactions with others. For all of the disabilities, a common theme emerged in social interactions with others. Parents who invest highly in their child become proactive and manage their child’s social interactions and set up situations that are most likely to produce positive outcomes. The next two strategies that are most commonly used, attempt to normalize the child, or normalize the reaction of others; in cases of physical deformities, particularly facial deformities, cosmetic surgery is a common path to normalizing the child. To normalize the reaction of others, education about the nature of the disability may reduce the natural level of discomfort people feel around others who are not like them. When done well, this can mitigate negative reactions and create an environment conducive to positive social interactions for all parties involved. What makes this book a worthy addition to one’s personal library is the prescriptive program Bugental offers as a way to increase the number of children that can thrive in the face of childhood adversity. After examining the existing programs, Bugental and her staff developed a protocol that identified at risk families and assigned them to one of three conditions. One group participated in a community referral group. They were given information where they could obtain medical services or other services offered in the community; during the study they received no home visitations. A second group received basic home visitation, this group received services based on the Healthy Start model. Parents were taught effective parenting skills, how to build successful social support and how to access services available to them in the community. The number of home visits this group received during the study averaged seventeen. The final group received cognitively enhanced home visitation which included all the same services as the other conditions as well as a two step problem solving strategy that focused on refocusing causal thinking, that is attributional retraining to remove the concept of blame from the environment. The second phase of the cognitive strategy was to encourage parents to think of problem solving strategies, deciding on the most appropriate approach to solve the problem and concludes with a follow up at the next home visitation. The follow up provided the opportunity for the parents to discuss what methods worked and why. This enhanced cognitive training helped parents become competent problem solvers which helped give them a sense of control and allowed them to develop a relationship in which their child had the best chance to thrive. Initial findings of this innovative program are encouraging; the group that received the advanced cognitive training was far less likely to physically abuse their children. While this research is yet to be replicated, it demonstrates the need for early intervention by preventing the problems before they occur. This book is important because it not only outlines the conditions that contribute to positive or negative outcomes of children with MPD’s, it offers a solution to reduce the number of negative outcomes for our children and offers a plan to create an environment where children can thrive in the face of childhood adversity. About the Reviewer Karen E. Petersen is a graduate student at Portland State University. She is currently completing work on her Master’s degree in Special Education. Her interests include psychology, human development, education, motivation and learning, and the interaction between nature and nurture.