Understanding Failure to Thrive –We know that about half the population of children in India are stunted. This means they are very likely to mental health and developmental problems. We need to know what these problems are, if we are to design programmes to help these children out of this situation. Dr. David Pearson, Consultant Clinical Psychologist

1. Failure to thrive
the road from adversity to
disadvantage
Dr Dave Pearson

2. What is adversity and failure to thrive?
Why is it important to us?
Can anything be done about it?

3. Child adversity causes failure
to thrive which damages
child development and
mental health

4. •Child adversity includes:
• Malnutrition

5. •Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional

6. •Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty

7. •Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty
• Institutional care

8. •Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty
• Institutional care
• Living in war zones

9. •Child adversity includes:
• Malnutrition
• Abuse – physical, sexual, emotional
• Poverty
• Institutional care
• Living in war zones
• Ineffective/poor parenting

10. Some established links with
later mental health problems

11. CHILDREN WHO ARE ABUSED
ARE 9X MORE LIKELY TO
EXPERIENCE PSYCHOSIS IN
LATER LIFE
From: Read & Bentall, (2013), see Dissociation. Kennedy, Kennerley & Pearson. Routledge (2013)

12. Using 27,390 self selected
participants
earlier traumatic or abusive
life experiences predicted
later high levels of anxiety
and depression
From: Kinderman, Schwann & Pontin (2013)

13. From: Dissociation. Kennedy, Kennerley & Pearson - Routledge 2013
Examples of studies linking child adversity with later mental health problems
Clinical area examples Country of origin examples
Personality Hetzel and McCanne
Disorder (2005)
Berger et al. Japan
(1994)
Pseudo-seizures Ozcetin et al.
(2009)
Dalenberg and Russia
Palish (2004)
Post Traumatic Stovall-McClough
Stress Disorder and Cloitre (2006)
Hartt and Waller UK
(2002)
Dysfunctional Johnston et al.
schema modes (2009)
Putman USA
(1997)
Being a psychiatric Waldinger, Swett,
patient Arlene and Kristen
(1994)
Ozcetin et al. Turkey
(2009)
Borderline Korzekwa, Dell and
Personality Pain (2009)
Disorder
Hirakata Canada
(2009)
Murderers with Lewis, Yeager, Swica,
Dissociative Pincus and Lewis (1997)
Identity Disorder
Kessler et al. 21 countries
(2010)
Kessler et al. All major mental
(2010) disorders, using
WHO WMHS data

14. The links between child
adversity and later mental
health problems are irrefutable.
Studies show that this is across
disorders and cultures

15. Now to move on to failure to
thrive

16. Failure to thrive is also known as
‘stunting’
Failure to thrive comes from
adversity

17. Failure to thrive
Organic
(e.g., malnutrition)
Non-organic
(e.g., experiences of adversity, like institutional care)

20. From Pearson & Kennedy - The Dream Mentoring Manuals

21. • UNICEF (2009) - 160 million children live below the poverty line
• HUNGaMa Survey (2009) - estimated up to 59% stunted, 42% underweight
(<5yrs) *
• MOSPI (2012) - 48% stunted, 20% wasted, 42% underweight (<5yrs)**
• NFHS-3 (2007-) - 45% stunted, 23% wasted, 40% underweight (<3yrs)***
(stunted – height for age, wasted – weight for height, underweight – weight for age)
* Naandi Foundation
** Ministry of Statistics and Program Implementation – Govt of India
***National Ministry of Health and Family Welfare – Govt of India
from - Kennedy, Pearson, Brett-Taylor & Talreja, (2014)

22. from Pearson & Kennedy, The Dream Mentoring Manual (2011)

23. from: Pearson & Kennedy - The Dream Mentoring Manual (2011)

24. Why does it matter if these
children are tall or short?

25. When growth slows –
development also slows

26. When growths slows
1. development slows
2. together with failure to thrive or stunting there is an
associated package of problems that are known as
attachment disorder
3. there are also associated cognitive problems

27. If we look at these three
areas
(in real life these three areas interact with each other and cannot be
clearly separated)

28. 1. Development slows
• Development happens in the same sequence for all children
• There is a need for one skill to be built on top of another
• At certain times children develop much more quickly – this is known as sensitive
periods – they only happen at a certain time
• This means that development has to happen at the right time, otherwise this can cause
long term damage
• For example if 7 year old development has not happened for a year, then at 8 years old
it cannot happen because:
a) the foundations are not in place
b) the child is geared up neurologically, psychologically and socially to develop
8 year old skills (not 7 year old skills)

29. This can cause developmental
collapse
• Development can be seen as similar to a building with weak walls –
When the wind blows the building may fall down
• A child’s development may fall down when challenged by demands, panic
emotion etc
• This means that a child’s behaviour may appear much younger than its age
• This may be known as confused maturity or confused development

30. 2. Attachment Disorder
• All children need human contact to develop – often referred to as
attachment and / or bonding
• Children who fail to thrive often have attachment and relationship
problems, e.g., holding hands in a shelter, inappropriate
relationships, weak relationships
• Confused emotions, e.g., attaching wrong emotions, not controlling
emotions, emotions based on exploitation or abuse

31. 3. Cognitive Problems
• It has been established that children who fail to thrive:
• Have poorer cognitive abilities (e.g., Mackner et al. 1997)
• Poor information processing (e.g., Kennedy, Kennerley & Pearson, 2013)
• Higher brain pathology (e.g., Korzekwa et al. 2009)
• Poor brain development (e.g., DeBellis et al. 2011)
• High anxiety levels (e.g., Essex et al. 2002; Van der Vegt et al. 2010)
see Kennedy, Kennerley & Pearson, Dissociaton, Routledge 2013

32. If we put all of these problems
together they would appear as
life skills problems

33. To summarise:
• Adversity and failure to thrive damages development and mental health
• This situation affects at least half of children in India
• It is a daily problem for disadvantaged children
• The damage can be long term or even life long
• The position can be reversible
• There is a need for an adult to be alongside the child
• There is a need for the adult to understand the effects of adversity

34. Are these problems
recoverable from?

35. There is evidence that these
problems can be minimised or
recovered from

36. Evidence for recovery:
• Cognitive deficits are recoverable (e.g., Corbett, 2004)
• Cognitive deficits decreased over time with improved nutrition and care
(e.g., Boddy, 2003)
• Using international adoption studies the Rutter et al. research indicated
long term improvements
• Growth can increase and return to expected levels

37. The most effective way to
recover from these deficits are
1. better nutrition
2. good contact
3. life skills improvement

38. Nearly always children need a
person to help them out of this
situation – often known as a
mentor
This person may be:
A teacher
A program leader
An adult who stands by the child
A relative
A volunteer

39. If you see
a group of disadvantaged children on a scrap of
land and as you go by, you throw them a football
and continue to drive past
They will kick the ball around – this does not repair the damage of
adversity and failure to thrive
Actually they were probably kicking something around before you drove
past
These children need a team leader, a role model, belonging to a team,
learning rules, etc. the football itself does not change lives

40. These children need a skilled mentor
(whoever that person may be)
this mentor needs to understand the
damaging effects of adversity, stand by that
young person unconditionally to be able to
minimise the effects or help the young
person to recover from them