Children may therefore go apparently unharmed through experiences that would produce grave results in people of another age. On the other hand, they may break down completely under strain which to the ordinary adult person seems negligible. The peculiarities of the psychological make-up of the child may account on the one hand for the astonishing robustness of children, on the other hand for most of the problems of behavior and symptoms to which all the war nurseries complain.
(p. 64â65)
While Freud and Burlingham were tending to childrenâs reactivity to war in England, Friedl Dicker-Brandeis artistically engaged children imprisoned in the TerezĂn ghetto in former Czechoslovakia. Despite her tragic death in Auschwitz, Dicker-Brandeisâ safely guarded collection of approximately 5,000 drawings created by children of the Holocaust survived and provide an example of legacy for vitality summoned in the face of annihilation (Makarova, Makarov, & Kuperman, 2004). In a letter in 1940, Dicker-Brandeis wrote, âToday only one thing seems importantâto rouse the desire towards creative work, to make it a habit, and to teach how to overcome difficulties that are insignificant in comparison with the goal to which you are striving,â (Dicker-Brandeis, as cited in Makarova, 2001, p. 151). Dicker-Brandeis, a teacher and mentor for art therapy pioneer Edith Kramer, demonstrated the undebatable therapeutic potential for art-making in the face of engulfing anguish. In reference to Dicker-Brandeisâ contributions, John-Steiner (2010) described:
They understood that for the minutes or hours during which they drew with a pencil on scraps of paper or performed or listened to music, they were alive in the deepest sense of what it is to be human. To create is to go beyond restrictions of habit, pain, terror and the known. It requires a continuity of concern, an absorption in shaping experience in a novel and moving manner.
(p. ix)
Kramer referenced and credited Dicker-Brandeis for her influences on her foundational theories of art as therapy (Makarova, 2001). Kramer (2010), commenting on the work of Dicker-Brandeis, wrote that she âallowed children to depict the sanity and beauty of their past lives while permitting comfort amid present nightmares. In this sense she formed a kind of therapeutic community that sustained the many children who endured unimaginable fear, loss and the threat of annihilationâ (p. 2).
In the presence of adversity, coping (and healing) through creative play and artistic exploration has paralleled the established, pathology-driven, âmedical modelâ of mainstream child psychiatry and laid the foundation for a more holistic understanding of the child in a resilience-oriented approach (Ludwig-Körner, 2017). Observation of the child engaged in their natural setting, while the clinician restrains preemptive judgment, will enable a more precise assessment of strengths. Freud and Burlinghamâs (1943) observations also highlight the increased resilience of children when caregivers maintained expected routines and positive interactions. These protective factors include active coping skills, self-efficacy, social support, and the maintenance of stable relationships with adults that encourage adaptive practices (Garbarino & Kostelny, 1993, p. 29).
Almost 80 years later, clinicians and community leaders continue to identify, systematize, and strengthen a framework of protective factors in pursuit of childhood resilience. To encapsulate the state of young people today, one is tasked with understanding complex experiences of identity and self. Bracketed by community norms, economic conditions, geographic location, family structure, and psychological idiosyncrasies, each young personâs voice carries with it a unique fingerprint of personal history; a snapshot of time and place; self-definition; and their particular, often non-linear, experiential perceptions. Understanding the global context and the experience of youth today would take many lifetimes of inquiry. Here, we provide only a brief snapshot of demographic information to ground readers with the trends and patterns exemplified in literature to date.
Young people today make up the largest youth population in history, and half of the global population is now under 30 years old (Sharma, 2017). By 2020, the under-18 population is expected to grow to 73.9 million (Vespa, Armstrong, & Medina, 2018). As a group, they face unprecedented technological, social, environmental, and economic challenges. The experience of being a young person varies drastically based on age, sex, religion, ethnicity, location, level of ability or disability, racial minority status, gender identity, and sexual orientation, among many other factors. As clinicians, therapeutic interventions designed at engaging young people have needed to adapt to technological advances, communication styles, and evolving relational dynamics as children and adolescents prepare themselves to manage an increasingly volatile world.
The International Youth Foundation, a cumulative source for global trends in youth welfare, defines well-being as a âmultidimensional concept that includes a personâs physical and mental health, educational status, economic position, physical safety, access to freedoms and ability to participate in civic life. It is, in a sense, the abundance or scarcity of opportunities available to an individualâ (Sharma, 2017, p. xiv). Under the domain of health, in 2017 The International Youth Foundation ranked the U.S. twelfth globally behind Saudi Arabia, Spain, the United Kingdom, China, Morocco, Germany, Colombia, Ghana, Vietnam, Sweden, and Jordan (Sharma, 2017). Several factors contribute to the low health ranking, including a high rate of adolescent fertility (21 per 1,000 births for women ages 15 to 19 versus an average of 9 per 1,000 births in European countries) and high rates of youth self-harm fatalities (23 deaths per 100,000 youth). Currently the U.S. ranks twenty-third globally in youth interpersonal violence, accounting for 20 deaths per 100,000 youth (Sharma, 2017).
Despite advances in the field, The National Institute of Mental Health reports an estimated 49.5% of adolescents live with a mental disorder; of those, an estimated 22.2% are severely impaired based on DSM-IV criteria (Merikangas et al., 2010). ADHD, behavior problems, anxiety, and depression are the most commonly diagnosed mental disorders in children, whereby 9.4% of children aged 2â17 years (approximately 6.1 million) have received an ADHD diagnosis (Danielson et al., 2018), and, of children aged 3â17, 7.4% (approximately 4.5 million) have a diagnosed behavior problem, 7.1% (approximately 4.4 million) have diagnosed anxiety, and 3.2% (approximately 1.9 million) have diagnosed depression (Ghandour et al., 2019). Depression and anxiety diagnostic rates have increased over time among youth (Bitsko et al., 2018). A multitude of factors impact access to care, treatment options, and outcomes. The Centers for Disease Control and Prevention (2019) acknowledged that age and poverty-level were strong predictors in the treatment of mood and behavioral problems.
In the U.S. 20% of all children ages 0â17 lived in poverty in 2015, down from 21% in 2014 (Federal Interagency Forum on Child & Family Studies, 2017). In 2015, approximately 13.1 million children (18% of all children in the U.S.) lived in households that were classified as food insecure (Federal Interagency Forum on Child & Family Studies, 2017). While socioeconomic class correlates with health, wellness, and educational markers of success, strongly held racism and other discriminatory ideologies have had devastating consequences, particularly on youth of color and LGBTQ (Lesbian, Gay, Bisexual, Transgender and/or Queer) individuals. For example, despite an overall decline in youth incarceration rates, as of 2015, African-American youth were five times as likely as white youth to be detained or committed to youth facilities (The Sentencing Project, 2017). Black students, who comprise 16% of students in U.S. public schools, make up over a quarter of students referred to law enforcement from schoo...