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Understanding the Costs of Adoption
An important goal of many health professionals is the betterment of lives within the community. One group given particular attention by health professionals is children, particularly those who face adversities (i.e., young people living in poverty; those suffering deprivation, neglect, and/or abuse; and orphans, regardless of their socio-economic bracket). One reason for the focus on vulnerable children is that many behaviors and routines established in childhood are sustained into and through adulthood. This tendency holds true for adaptive and maladaptive behaviors, routines, and beliefs.
Among children, those who are vulnerable—including those subject to parental abandonment, neglect, abuse, and other deprivations—have higher rates of maladaptive behavior than their non-vulnerable peers. Indeed, studies find higher rates of risk behaviors (e.g., substance abuse, unprotected sex, truancy, self-mutilation, criminal behavior) among this group. For example, in studies comparing adolescents in foster care to those not in foster care, Donald Thompson and Wendy Auslander found higher rates of unprotected sex, Bessel van der Kolk and colleagues found higher rates of self-mutilation, and Sara Carpenter and colleagues found first pregnancies occurred at a younger age and more sexual partners among the adolescents in foster care.
In addition to these risk behaviors, studies also find higher rates of psychological issues among vulnerable children. For example, in an examination of midwestern foster youth, Sunny Shin found higher rates of conduct disorder, depressive disorder, and anxiety among foster youth when referenced to the norm. In another study, Stine Lehmann and colleagues discovered that more than half the foster children in their sample satisfied criteria for one or more DSM disorders. In a study of adoptees, Margaret Keyes and colleagues noted suicide attempts at 4 times the rate of non-adoptees. Without proper intervention, these behaviors and issues can continue through adolescence and into adulthood.
In the field of psychology, the concept of resilience was originally associated with the movement of positive psychology. According to Michael Rutter, whose name in many circles is synonymous with resilience, resilience is not the same as positive psychology. It also differs from competence, and it is not a theory per se. Rather, according to Rutter and other experts in the field (e.g., Norman Garmezy, Ann Masten, Michael Unger, Froma Walsh, and co-author Maria Yunes), resilience is a set of life processes. More specifically, resilience is a set of life processes that enable an individual or a group to overcome situations of suffering and adversity with personal or collective strengthening, empowerment, and transformation. These unexpectedly positive outcomes, in the face of extreme adversity, are referred to by Rutter as steeling effects, one of the defining characteristics of resilience research.
With regard to vulnerable children, situations of suffering and adversity may be manifold. They may include parental absence, emotional abuse, sexual abuse, physical abuse, scarcity of resources (poverty), and bullying. Within these contexts, resilience building may take the form of promoting positive relationships; interpersonal support; meaningful interactions; order, supervision, and discipline; and task completion. All of these factors are associated with the positive capacity to cope with stress and adversity.
It is important, however, to remember that although resilience was once considered a trait (i.e., the equivalent of heartiness), it is now considered a process, and one unique to different contexts and environments. Some scientists, such as Xiao Ying Zhang and colleagues, stress the importance of social capital within this process. Others, such as Urie Bronfenbrenner, stress the notion of nested, interactive environments, all of which affect and are affected by each other.
In response to the health threat disproportionately affecting vulnerable children, community activists have designed and implemented various resilience-building interventions with mixed results. For example, Big Brothers Big Sisters is a mentoring program that provides children with adult role models. In an impact study of the program, Joseph Tierney and colleagues noted improved academic performance and reduced truancy and violence among children enrolled in the program. In a separate evaluation, David De Wit and colleagues noted reduced social anxiety and improved social skills.
Another program that seeks to support vulnerable children is Head Start. In the United States, Head Start has been providing comprehensive services to low-income preschool children and their families since 1965. The first major evaluation of the program was conducted by the Westinghouse Learning Corporation in 1969. Although the Westinghouse investigators acknowledged that children in the program experienced cognitive and language gains at the first grade level, they lamented that the gains had faded by the second or third grade. In hindsight, critics of the Westinghouse study have called into question the methodology employed, which they claim biased the results.
The next major evaluation of the program was conducted in 1985 by the Administration for Children, Youth, and Families. In a meta-analysis of 210 reports, Ruth Hubbell McKey and colleagues concluded that children enrolled in Head Start experienced significant immediate gains in cognitive test scores and socioemotional test scores, but similar to the Westinghouse evaluation, these gains did not sustain over time. McKey and colleagues did acknowledge, however, that Head Start was “very successful in improving the general health of the children it serves, providing needed health care, and improving existing health care within communities.”
Both Big Brothers/Big Sisters and Head Start are programs designed to foster develop- ment of competencies, including life and social skills and coping strategies to compensate for adversities suffered during childhood. Other programs share the same goals. Among at-risk girls, for example, sexual education programs have shown success in terms of increasing condom use, reducing number of sexual partners, and delaying second pregnancies among teen mothers. For pediatric cancer patients, an as- of-yet unevaluated program has used comic superheroes (CSH) in an attempt to bolster children’s hope and fuel their will to fight the cancer.
Implemented among pediatric cancer patients at the A.C. Camargo Cancer Center in São Paulo, Brazil, this program has shown promise in bolstering resilience. It does so via special comics, animated videos, and superhero plastic covers for IV bags. The patient’s chemo drip is “Superformula.” The goal of this effort is to draw parallels between the CSH’s battle against evil and the child’s own battle against cancer. This approach uses invincibility suggestion, in that it inspires children to believe that, like the superhero, they, too, have powers on which they can draw. These powers can help them battle against their illness. Untapped, however, is the wellspring of the superhero’s life before they donned their cloak or costume. In fact, there are no studies that we know of that have considered the pre-cloak, pre-costumed stage of the CSH’s life as a potential resilience-building tool for at-risk children.
The lack of studies on this topic is somewhat surprising given that CSHs have been providing entertainment, adventure, and excitement to children and adults across the globe since the early 1930s. Originally appearing in comic book format, characters such as DC Comics’ Superman (1938), Captain Marvel (1940), and Batman (1939), along with Marvel Comics’ The Hulk (1962), Spiderman (1962), and Iron Man (1963) have been supplying supernatu- ral adventure to generations of young children as they grow to adolescents and then into adulthood. With the advent of film, CSHs filled the silver screen with their larger- than-life presence and their abilities to leap large buildings in a single bound (Superman) and move objects through telekinesis (Green Lantern). Although the entertainment world (comic books, film) holds spotlight on the superheroes when they are wielding powers, it is in the pre-super-powered phase that we begin.
The focus of this article is on the CSH’s pre- cloak stage as a potential tool for resilience building and empowerment. For that purpose, the pre-cloak stage refers to the developmental stage prior to the fully costumed debut of the fully powered CSH (see Fig. 1). Using the example of Spiderman, the pre-cloak stage refers to the period from birth through age 16—the age at which Peter Parker made his cape-and-costumed debut as the super-powered Spiderman. This moment of empowerment is critical in development. Joseph Campbell, chronicler of the hero’s journey in mythology, refers to this event as the moment of initiation. Rutter makes reference to a turning point. Regardless of the name, this moment is monumental for the CSH and also for the vulnerable child. In this sense, it is a developmental milestone.
Although scientists have employed CSH as a resilience-building tool, it has primarily been used for invincibility suggestion (e.g., telling children they have superhero powers). To the best of our knowledge, there has been no research conducted that has examined parallels between the real-life adversities experienced by vulnerable children and the fictional adversities experienced by pre-cloak childhood CSHs. The lack of research leaves open several questions: (a) Are there parallels between the real-life adversities experienced by vulnerable children and the fictional adversities experienced by pre- cloak childhood CSHs?; (b) Is there overlap between the real-life adversities experienced by vulnerable children and the fictional adversities experienced by pre-cloak childhood comic superheroes?; and (c) If there are parallels or overlaps in the adversities experienced by these two groups, what implications might there be for clinicians, social workers, and public policy designers?
To address these questions, we began by developing a detailed indexing of superheroes to create a sample of the most influential CSHs. (Demographics of the CSH sample are presented in Table 1.)1 Next, prevalences of adversities (hardships suffered in the CSH’s pre-cloak, developmental stage) were calculated.2 The results were then compared to those among subgroups of vulnerable children, to ascertain if the adversities were related.
Among the adversities identified were: growing up as an orphan (Spiderman, Super- man, Batman), abandonment by family (Hulk, Superman, Black Widow), murder of relatives (Spiderman, Ironman), economic limitations (Captain America, Spiderman), and bullying (Spiderman, Captain America). Of the 20 film CSHs, 86% were either orphaned or aban- doned; 49% had at least one parent murdered; 15% were kidnapped; 29% were bullied; and 29% endured economic limitation (see Fig. 2). There were also isolated adversities including: being blinded (1%), being used in deviant experiments (6%), having mother raped by step-father (2%), and activity in crime (<1%).
1 Inclusion in the sample was based on pop culture vis- ibility, popularity, and endurance over time. Based on these criteria, a working sample of the 20 most influen- tial CSHs was assembled, using film earnings as a proxy for influence. For CSHs from ensemble films (e.g., X- Men, Avengers, Captain America: The Winter Soldier), film earnings were pro-rated as per cast size.2 As there was a wide range of variability in influence among the sample (as proxied by gross film earnings), weighting was employed for calculations.
In addition to these isolated adversities is the stress-compounding aspect of multiple adversities, which occurred frequently among the 20 film CSHs examined (e.g., Spiderman, Batman, Ironman).
Regarding parallels between adversities experienced by vulnerable children (e.g., aban- donment, abuse) and the fictional adversities experienced by pre-cloak CSHs (e.g., abandonment, violence, abuse), our findings suggest that, indeed, there is a parallel. However, the parallel may apply most strongly to the sub- group of vulnerable children who are orphaned or abandoned by their families.
Findings further suggest there is overlap between adversities experienced by vulnerable children and the fictional adversities experienced by pre-cloak CSHs, but it is conditional in that the most pronounced overlap in adversities occurs among the subgroup of vulnerable children who are orphaned or abandoned by their families. In other words, the overlap we see goes well beyond the lifestyle of the lower- income child. The key term here is absent parents, which is a broad term encompassing children in foster care, institutional settings, and those made vulnerable by the AIDS epidemic in sub-Saharan Africa.
Our analyses revealed orphaned as the most commonly occurring adversity among our CSH sample, but there are other adversities of note. Although these adversities are secondary, in terms of frequency of occurrence, they have potential in terms of intervention. One such adversity is being bullied. Among our CSH sample, 29% of the CSHs were bullied. Members who were bullied included: Spiderman, Captain America, and Rorschach. For the bullied child—both orphaned and non-orphaned—knowing they share history with a CSH can inform the child that they are not alone. In light of the statistics reported on the news concerning bullying and suicide in children, this common history shared with a CSH may have the potential to literally save lives.
Another secondary adversity unearthed in our findings is economic limitations, which occurred among 29% of our CSHs, in their pre-cloak, pre-super-powered stage. CSHs subjected to economic limitation included Spiderman and Captain America. As children of economic limitations have higher rates of illness—both physical and psychosocial—and neglect, for this group, our findings may be helpful. As with the other groups described (orphaned, bullied), children of economic limitations may find comfort—and find strength—in knowing that they are not alone in their plight. Once again, there is a message of shared history and overcoming difficulties.
For the clinician, resilience-building efforts could draw on the moment of empowerment—the turning point in the CSH’s life. This moment marks the end of the pre- cloak stage. For Superman, this is the moment at which Clark Kent dons his costume and his mask and emerges from the phone booth super-powered. Thus, for counselors and therapists, sharing the stories of pre-cloak CSHs may help children to feel hopeful and less alone. Indeed, the knowledge that Spiderman struggled with abandonment and bullying holds potential to reduce the isolation, and replace it with a sense of common ground and the possibility that better things lie ahead. It may also help in gaining trust and establishing rapport with children who have experienced adversities. Having common frames of reference, such as pre-cloak CSHs, can help in this process of trust and relationship building.
For educators, knowledge of the shared history that exists between pre-cloak CSHs and groups of vulnerable children can be woven into school lessons. These lessons can be used not only to reassure children facing adversity but also to spark dialog about diversity, tol- erance, and respect. For the non-vulnerable student, being reminded about the adversities endured by CSHs could plant the seeds of empathy and tolerance. It could even reduce bullying.
Helping children who have experienced adversity such as abandonment and bullying to fly for the first time is a goal to which we aspire. Indeed, we strive to give all children a fair chance. In the real world, however, resources are not always given fairly. Some children grow up in stable, loving households, and others experience disruption and disconnection. For the clinician and the educator, highly vulnerable children present challenges that can overwhelm. Interventions need to be designed and empirically tested to discern whether utilizing pre-cloak CSHs in settings such as therapy and schools works.
There are, however, logistical and instrumental challenges inherent in such an under- taking. For examples, using videos and pictures of the CSHs would require gaining permission from the corporations (DC and Marvel Comics) and might entail a fee. The CSH program at the A.C. Camargo Cancer Center in São Paulo provides a variation on this theme. Their program—or, campaign—was the brainstorm of J. Walter Thompson (JWT), the advertising agency for the cancer center and Warner Bros./DC Comics. In essence, JWT brokered a partnership between Warner/DC and the cancer center, which included licensing of Warner/DC CSHs for usage on the children’s cancer ward. Thus, the insignias of Superman, Batman, Wonder Woman, and Green Lantern could be used on chemo-drip IVs in the cancer center’s pediatric ward. It is possible that DC, Marvel, and their entertainment partners may be reluctant to grant licenses, regardless of the promise our work shows. Thus, the best course of action may be this route of using an established partnership with licensing pre-granted.
Another issue that needs to be thought through in implementing a pre-cloak CSH pro- gram is race/ethnicity. In our sample of the most influential CSHs, 18 of the 20 CSHs are White. The exceptions are Catwoman (ranked 16th) and Falcon (ranked 19th), both of whom are Black. Research must determine if this racial/ethnic bias might impair effectiveness of future interventions. In other words, do non-Hispanic White children have a stronger innate bond with these White CSHs than their non-White counterparts? Like- wise, there is the issue of gender. Again, 18 of the 20 CSHs are male. The exceptions are Black Widow (ranked 10th) and Cat- woman (ranked 16th). This imbalance begs the question: Do males have a stronger innate bond with these CSHs than their female counterparts? Studies are needed to bring answers to these questions.
Despite these challenges, the untapped resource of shared adversities of the pre- cloak CSH as a tool for resilience-building holds potential for helping children experiencing adversity. It is our hope that this article will spark the development of interventions that incorporate a strong evaluation component.
keywords: resilience; empowerment; comic superhero; children; adolescents; invincibility
Suggestions for Further Reading
Lehmann, S., Havik, O. E., Havik, T., & Heiervang, E. R. (2013). Mental disorders in foster children: A study of prevalence, comorbidity, and risk factors. Child and Adolescent Psychiatry and Mental Health, 7, 39.
aWathier, J. L., & Dell’Aglio, D. D. (2007). Depressive symptoms and stressful events in children and adolescents in the institutionalized context. Revista de Psiquiatria do Rio Grande do Sul, 29, 305–314.
aWeschenfelder, G. V. (2013). Os super-heróis e essa tal de filosofia. REI: Revista de Educac ?ão do IDEAU, 7, 2–13.
Zhang, X. Y., DeBlois, L., Deniger, M. A., & Kamanzi, C. (2008). A theory of success for disadvantaged children: Reconceptualization of social capital in the light of resilience. Alberta Journal of Educational Research, 54, 97–111.
Chris Fradkin is an American psychologist who recently completed a pós-doc at Centro Universitário La Salle, in Canoas, Brazil. His research has appeared in Health Psychology, Academic Pediatrics, Asian American Journal of Psychology, Psicologia: Reflexão e Crítica, and Child Abuse & Neglect.
Gelson Weschenfelder, known throughout Brazil as o Filósofo dos Quadrinhos—the philosopher of comics—writes and speaks extensively on the cultural relevance of comic superheroes within an Aristotelian framework.
Maria Angela Mattar Yunes is a Brazilian psychologist with a focus on family resilience, community resilience and parental support programs. Her research has appeared in Psicologia em Estudo, Psicologia: Reflexão e Crítica, and Paidéia (Ribeirão Preto).
03 Mar 2016
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