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

eric.emerson@lancaster.ac.uk