Coping with Adversity 287Family size and birth order
Family size and birth order can be measured so easily and reliably that
they are included as possible predictor variables in most studies of child
and adolescent psychiatric problems. Researchers who find an association
between psychiatric problems and family composition are likely to report
that finding, whereas researchers who find no such association may
concentrate on other positive findings and not even report the negative
findings. The predictable result is a profusion of reported associations, most
of which are not replicated by subsequent studies.
One of the few consistent findings to emerge from this muddled field
is that children and adolescents from large families are at greater risk
of disruptive behavioural problems and juvenile delinquency. Though
this may partly reflect an association between large families and social
disadvantage, family size probably has a direct effect too – with the number
of brothers being a stronger predictor of externalising problems than the
number of sisters.
Contrary to popular mythology, only children are not psychiatrically
distinctive; children from small families are at relatively low psychiatric
risk whether or not the family has one or two children. One important
implication for our overcrowded planet is that parents who choose to have
just one child need not feel that they are selfishly endangering their child’s
mental health.
Whereas most ‘oldest’ and ‘youngest’ children come from two-child
families, ‘middle’ children must come from families with at least three
children. Consequently, the link between larger family size and disruptive
behaviour will inevitably make it seem as though middle children have
more of these problems than oldest or youngest children if no account
is taken of family size. It is not clear whether birth order has an effect
on psychiatric problems once the effect of family size has been allowed
for, although there may be a link between school refusal and being the
youngest in the family.
Coping and resilience
Cumulative risk
Are some adverse experiences especially damaging, whereas others do
little lasting harm? Several longitudinal studies now indicate that it is
the dose rather than the type of stress or risk factor that is particularly
relevant. Exposure to one or even two moderate stresses or risk factors
only slightly raises the rate of psychiatric disorder, and may even have
long-term advantages. Children who have encountered and coped with
moderate stresses may be more resistant to stresses in later life than if
they had been spared all stresses. (This is not a reason for deliberately
stressing children, though it is a reason for encouraging them to take on
challenges that they can successfully master.) Though exposure to one
or two moderate stresses or risk factors may do little harm and perhaps
some good, children are far more likely to be adversely affected when they