Family connection associated with adolescent ‘flourishing,’ study finds

Data from more than two dozen countries showed that higher levels of family connection may contribute to adolescent “flourishing,” according to a study published in Pediatrics.

Robert C. Whitaker, MD, MPH director of research at the Columbia-Bassett Program at Bassett Medical Center in Cooperstown, New York, and colleagues defined flourishing as “eudaimonic well-being” measured by “self-acceptance, environmental mastery, positive relations with others, autonomy, personal growth, and purpose in life.”

“Defined this way, flourishing is a developmental aspiration for children that neither requires nor excludes the hedonic aspects of well-being, such as happiness, positive affect, or satisfaction,” they wrote. “In addition, flourishing indicates thriving, even with adversity. This is different from resilience, which often means recovery from or avoidance of poor outcomes and harms in the context of adversity.”

The researchers analyzed data from International Survey of Children’s Well-Being on more than 37,000 adolescents from 26 countries who were aged 11 to 13 years between 2016 and 2019.

“Although there is evidence that relational health in families, or family connection, protects children from the negative outcomes that result from adversity, less is known about whether family connection is associated with children’s flourishing,” they wrote.

The researchers based family connection on a mean score of five items that asked about care, support, safety, respect and participation using a Likert-type scale ranging from 0 to 4.

In the analysis of 37,025 adolescents, at a mean age of 11.9 years, the authors found the prevalence of flourishing was 65.8% (95% CI, 65.3%-66.3%). The prevalence of flourishing increased along with an increase in the level of reported family connection, ranging from 34.9% among respondents who scored their level of family connection at less than a 2.5 on the scale, to 84.3% among respondents who scored their level of family connection as a 4 — the highest score.

The study was accompanied by an editorial by Tracy M. King, MD, MPH, a medical officer at the National Institute of Child Health and Human Development’s Intellectual and Developmental Disabilities Branch; and Rosalind B. King, PhD, the institute’s associate director for prevention.

They noted that much of modern research has been “oriented toward reducing the incidence and impact of negative health outcomes, such as illness, injury, death, or disability.”

“The reasons for this are many,” they wrote. “Negative health outcomes are generally easier than positive health outcomes to define and measure. Certain measurement tools reinforce such framing by explicitly defining health in terms of the absence of disease or other negative attributes. Global initiatives to frame ‘functioning’ as a positive outcome have not been broadly adopted beyond the disability and rehabilitation communities.”

They said pediatrics has often been “at the forefront” of efforts for measures of positive health.

“Moving from a deficit model to a strengths-based model is especially important for children and adolescents,” they wrote. “The goal of child development is not merely to avoid negative outcomes such as illness and injury but to reach positive outcomes such as high levels of self-regulation, skills in interpersonal communication, and experiences of school engagement. Childhood is a time for setting down the building blocks for decades of subsequent positive health, such as food preferences, exercise, sleep habits, patterns of risk-taking behaviors, and approaches to relationships.”

Still, the authors noted, capturing positive health outcomes “poses many challenges, particularly in children,” including measurements like quality of life and discrepancies between children’s self-reports and proxy reports from parents, and as such, a broader array of measures are needed to capture those constructs.

References:

King, et al. Pediatrics. 2021;doi:10.1542/peds.2021-056040.

Whitaker R, et al. Pediatrics. 2021;doi:10.1542/peds.2021-055263.