SMAD, Rev. Eletrônica Saúde Mental Álcool Drog.

Review Article
2017 July-Sept.;13(3):156-166
DOI: 10.11606/issn.1806-6976.v13i3p156-166
www.eerp.usp.br/resmad

Resilience in children and adolescents victims of early life stress and

maltreatment in childhood

Isabela Masucci de Lima Camargo1

Maria Neyrian de Fátima Fernandes2
Marina Sayuri Yakuwa3
Ana Maria Pimenta Carvalho4
Patricia Leila dos Santos5
Edilaine Cristina Silva Gherardi-Donato4
Débora Falleiros de Mello4

This study aimed to characterize resilience in children and adolescents who were abused in
childhood. 17 articles were found, between 2011 and 2015. According to the analyzed scientific
literature, it found that childhood abuse have negative relationship with the development of
resilience and positive with the emergence of depressive and anxiety symptoms, as well as,
positive factors such as social and family support has positive relationship with resilience. It
is concluded that the development of resilience in children and adolescents victims of abuse
can act as a protective factor for these individuals.

Descriptors: Psychological Resilience; Psychological Stress; Child Abuse.

1
Master’s student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre
for Nursing Research Development, Ribeirão Preto, SP, Brazil.
2
Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre
for Nursing Research Development, Ribeirão Preto, SP, Brazil. Assistant Professor, Universidade Federal do Maranhão,
Imperatriz, MA, Brazil.
3
Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre
for Nursing Research Development, Ribeirão Preto, SP, Brazil.
4
PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating
Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.
5
PhD, Professor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Corresponding Author:
Maria Neyrian de Fátima Fernandes
Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto
Av. dos Bandeirantes, 3900
Bairro: Monte Alegre
CEP: 14040-902
Ribeirão Preto, SP, Brasil
E-mail: [email protected]
 Camargo IML, et al. 157

Resiliência em crianças e adolescentes vítimas de estresse precoce e

maus-tratos na infância

Este estudo teve como objetivo caracterizar a resiliência em crianças e adolescentes que
sofreram abusos na infância a partir de revisão da literatura científica. Revisão integrativa com
evidências da literatura, nas bases de dados Web of Science, PubMed/Medline e PsycInfo,
com os descritores resilience, psychological e child abuse. Foram encontrados 17 artigos,
no período de 2011 e 2015. De acordo com a produção científica analisada, encontrou-se
que os abusos na infância têm relação negativa com o desenvolvimento da resiliência e
favorável ao surgimento de sintomatologia depressiva e ansiosa. Fatores como o apoio social
e familiar apresentam relação positiva com a resiliência. Conclui-se que o desenvolvimento
da resiliência em crianças e adolescentes vítimas de abuso pode atuar como fator protetor
para estes indivíduos.

Descritores: Resiliência Psicológica; Estresse Psicológico; Maus-tratos Infantis.

La resiliencia en niños y adolescentes víctimas de estrés temprano y

maltrato en la infancia

Este estudio tuvo como objetivo caracterizar la resiliencia en niños y adolescentes abusados
en la infancia. Se encontraron 17 artículos, entre 2011 y 2015. De acuerdo con la literatura
científica analizada, se encontró que el abuso infantil tiene relación negativa con el desarrollo
de la capacidad de recuperación y positiva con la aparición de los síntomas depresivos y de
ansiedad, así como, factores positivos tales como el apoyo social y familiar tiene relación
positiva con la capacidad de recuperación. Se llegó a la conclusión de que el desarrollo de
la resiliencia en niños y adolescentes víctimas de abuso puede actuar como un factor de
protección para estas personas.

Descriptores: Resiliencia Psicológica; Estrés Psicológico; Maltrato a Los Niños.

Introduction Thus, it is possible to affirm that life is an ongoing

process of losses and gains and a kind of healing
From the earliest age to the end of life, the human is necessary to learn how to deal with losses. This
being experiences the most varied types of stressors healing process can be compared to the development
and must continually learn to adapt to the different of resilience in individuals, since it arises from a wound
realities shaped by these adversities. We can say open by trauma(1).
In this sense, we can define resilience as an
that individuals spend their entire lives looking for
interactive and subjective process that occurs in some
mechanisms and strategies to overcome and deal with
individuals who have a relatively good evolution despite
grief, change and constant attempts to turn negative
the experience of strong stresses or adversities. These
experiences into something positive, whether to individuals present a better response than others who
avoid contact with stressors or ease their reactions undergo the same experiences, consolidating some
before them. type of development(1-2).

www.eerp.usp.br/resmad
158 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2017 July-Sept.;13(3):156-166.

As adversities can be present since the conception favoring the development of pathologies, or could act
of human beings, their impact on child development is as a catalyst for the development of a greater capacity
a reason of concern, due to the consequent increased to respond to future adversities, giving the subjects a
chance of triggering physical and mental difficulties higher level of resilience before stressful events.
throughout life. Any adverse event occurred during In view of the exposed problem and the scientific
childhood is considered an abuse(3), and it is called early production on the subject, the following guiding
stress. Stress is a reaction of individuals to adversity question was formulated: What are the characteristics
that impels them to seek an adjustment or response to of resilience in children and adolescents victims of
the conditions that aroused the anxiety or fear, aiming childhood abuse? In this sense, the objective of the
to stabilize internal biological processes and preserve present study is to characterize resilience in children
self-esteem(4). and adolescents who suffered childhood abuse, based
According to the World Health Organization on a review of the scientific literature.
(WHO), child abuse corresponds to any type of abuse
and neglect that occurs in children under 18 years Method
of age. It includes all types of physical or emotional
abuse, sexual abuse, abandonment, neglect or This is an Integrative Literature Review, a method
exploitation of any nature that may result in damage, that proposes to incorporate the applicability of study
potentiate immediate or long-term harm to health, results, establishment of data collection criteria, and
survival and development of dignity in the context of a synthesis of knowledge, allowing the inclusion of
social interactions(5). experimental and non-experimental studies(8-9).
Child abuse leads to suffering of children and In this study, the integrative review focused first
their relatives, generating stress that is associated on the identification of the theme and selection of the
with disrupted brain development. In extreme cases, guiding question of the study; then, establishment
it may compromise the development of the nervous of inclusion and exclusion criteria; categorization
and immune systems(5). of studies; evaluation of the studies included in
Studies(3,6-7) show that adults with a history of the integrative review; interpretation of results and
childhood abuse are at higher risk for development synthesis of knowledge(10-11).
of mental disorders, including depression and anxiety. The topic addressed in this study was the
Indices of use of drugs and other substances and risk development of resilience in children and adolescents
behaviors are also more prevalent in these adults. who experience childhood abuse. The guiding question
The greater chance of compromised health in adult of the research was: how does the development of
life is related to changes in the response to stress resilience take place in children and adolescents who
triggered by traumatic experiences, that is, the effect have suffered childhood abuse?
of stress as a risk factor for several pathologies can The survey of articles in the literature was carried
be increased in individuals with a history of childhood out in the months of March to April 2016 in the following
abuse because these individuals tend to have an databases: Web of Science, PubMed/Medline (Medical
increased response to stress in adult life. Literature and Retrivial System on Line), PsycInfo.
In this context, it is evident that facing sorrow The DecS (Descriptors in Health Sciences) and MeSH
during childhood can indefinitely cause deep marks in (Medical Subject Headings) descriptors used were:
individuals. Thus, adverse events, such as childhood resilience, psychological and child abuse.
abuse, are generators of early stress and factors The inclusion criteria adopted were: articles
capable of catalyzing and leading to the development published in the period from 2011 to 2015 to include
of clinical pathologies and mental disorders in adult life. the most up-to-date evidence on the subject, original
Although the relationship between early stress articles available in full length and published in
and development of pathologies in the adult life of Portuguese, English or Spanish. Articles that did not
people who experienced child abuse is clear, not address abuse in children and adolescents (abuse
all individuals who have this e kind of traumatic suffered up to age 19), research conducted with adults,
experience develop pathologies. Among the factors or with people over 19 years of age, and theoretical
underlying this relationship, the literature cites genetic, or review studies were excluded.
psychological and social availability. Figure 1 shows the results of the search for articles
Thus, the same stressing event occurred early in per database. The initial result refers to the total number
life could weaken the response to stress in adult life, of articles found according to the descriptors used,

www.eerp.usp.br/resmad
 Camargo IML, et al. 159

and then the inclusion criteria (filter) were applied to The overall classification of articles was based
refine the search. Of these studies listed, 287 met the on scientific evidence currently available in the
inclusion criteria. After applying the exclusion criteria literature, including levels of evidence and degrees
and after the reading of the articles in full length, the of recommendation as a way of obtaining the best
corpus of this study was composed of 17 articles. results. The level of evidence was classified according
Then, relevant data for this review were extracted to the type of study as set by the Oxford Centre for
and the information organized in groups. Evidence-based Medicine(12).

Web of Science
Without filter With filter
“resilience, Psychological” and “child abuse” “resilience, Psychological” and “child abuse”
124 articles 54 articles
Pubmed
Without filter With filter
“resilience, Psychological” and “child abuse” “resilience, Psychological” and “child abuse”
85 articles 67 articles
Psycinfo
Without filter With filter
“resilience, Psychological” and “child abuse” “resilience, Psychological” and “child abuse”
531 articles 166 articles
Overall total
Without filter With filter
740 articles 287 articles
Figure 1 - Databases according to results with and without filter.

At Level 1, evidence comes from randomized of the articles. Data were organized according to
controlled clinical trials with narrow-confidence similarities of content that emerged in the corpus
intervals or systematic reviews or meta-analyses investigated and were descriptively analyzed. The
of all relevant randomized controlled trials or from articles were distributed into three categories: family
clinical guidelines based on systematic reviews of and institutional abuse and resilience; sexual abuse
randomized controlled trials. At level 2, evidence and resilience; and resilience and factors intrinsic to
comes from historical cohort studies or with segments the individuals.
of committed cases (at least one well-delineated,
but lower quality, randomized controlled trials) and
Results
ecological studies. At level 3, evidence is obtained
from well-designed clinical trials without randomization
The articles that make up the corpus of this study
(case-control studies), systematic reviews of case-
were mostly written in the English language. Figure 2
control studies. At level 4, evidence comes from case
summarizes the general data of the selected articles.
reports (cohort or lower quality case-control studies).
The majority (88%) had a quantitative delineation.
At level 5, evidence originates from the opinion of
As for the place of origin, eight were researches
authorities and/or expert committee reports. Studies
developed in the United States but there was variability
with evidence up to level three were considered in
the present study(12). among the countries, with results from Canada, United
In order to analyze and interpret data, the Kingdom, Serbia, Argentina, New Zealand, Israel,
information was organized in a previously prepared Korea, among others. Regarding the level of evidence,
identification form(10) containing the identification of the all articles we classified as level 1.
study, year of publication, authors, type of study, place, The 16 articles were divided into three categories:
and population studied. This information was collected family and institutional abuse and resilience (10);
for each article of the sample to catalog the data. substance use and abuse and resilience (3); and
This allowed a better visualization and comparison resilience and factors intrinsic to the individuals (3).

www.eerp.usp.br/resmad
160 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2017 July-Sept.;13(3):156-166.

Type of study Target-

Authors Title year Objective Country
and evidence audience
Collin-Vézina, Trauma experiences, 2011 To promote a description of Quantitative. Canada 53
D; Coleman, K; maltreatment-related the traumatic experiences, Evidence adolescents
Milne, L; Sell, J; impairments, and trauma-related sequelae, Level 1
Daigneaut, I. resilience among and resilience characteristics
child welfare youth in of a sample of Canadian
residential care. adolescents in therapeutic
residences, as well as
explore the impact of gender
and number of different
traumas suffered in these
aspects.
Oshri A, Developmental 2011 To examine whether Longitudinal. USA 415 children
Rogosch FA, pathways to individual personality Evidence
Burnette ML, adolescent differences are associated Level 1
Cicchetti D. cannabis abuse with the severity of
and dependence: maltreatment and to explain
Child maltreatment, the association between
emerging early childhood maltreatment
personality, and and symptoms of cannabis
internalizing versus abuse and addiction in early
externalizing adolescence by increased
psychopathology. risk of psychopathology.
Bada HS, Bann Protective factors 2012 To determine the role of risk Longitudinal USA 1388 children
CM, Whitaker can mitigate and protective factors in cohort.
TM, Bauer CR, behavior the trajectory of behavioral Evidence
Shankaran S, problems after problems associated with Level 1
LaGasse L, et al prenatal cocaine and high cocaine exposure and
other drug use of multiple drugs during
exposures prenatal period.
Williams, J; Predicting resilience 2012 To examine factors that Cross-sectional USA 237
Nelson-Gardell, in sexually abused predict resilience in Quantitative. adolescents
D. adolescents adolescent victims of sexual Evidence
abuse. Level 1
Cicchetti D, Gene× Environment 2012 To find out whether there are Longitudinal. USA 595 children
Rogosch FA interaction and genetic variants of specific Evidence
resilience: Effects of genes that, when interacting Level 1
child maltreatment with the experience of child
and serotonin, abuse, are associated with
corticotropin higher levels of resilient
releasing hormone, functioning in low-income
dopamine, and abused and non-abused
oxytocin genes. children.
Sapouna, M; Resilience to bullying 2013 To clarify the process of Longitudinal UK 3136
Wolke, D. victimization: The resilience before bullying short-term. adolescents
role of individual, by identifying individual, Evidence
family and peer family and peer factors that Level 1
characteristics. predict lower than expected
levels of depression and
delinquency subsequent to
bullying.
Oshri A. et al. Child maltreatment 2013 To investigate the process of Longitudinal. USA 400 children
and mediating longitudinal study related to Evidence
influences child abuse, organization of Level 1
of childhood child personality and juvenile
personality types maladaptation.
on the development
of adolescent
psychopathology
(the Figure 2 continue in the next page...)

www.eerp.usp.br/resmad
 Camargo IML, et al. 161

Type of study Target-

Authors Title year Objective Country
and evidence audience
Milovančević Psychopathology 2014 To investigate clinical Exploratory Serbia 84
et al. and resilience in symptoms, family quantitative. adolescents
relation to abuse in functioning and resilient Evidence
childhood among characteristics in Level 1
youth first referred adolescents with experience
to the psychiatrist. of abuse who were referred
to psychiatrists for the first
time.

Morelato GS Evaluation of 2014 To explore the self- Descriptive Argentina 103 children
factors perception, family transverse.
of resilience in relationships, cognitive skills Evidence
Argentine children for solving interpersonal Level 1
in conditions of problems, and indicators
family vulnerability of creativity in the children
evaluated.

Cruz Fuentes, BDNF Met66 2014 To know how BDNF Met66 Experimental. Mexico 3005
C. S et al modulates The modulates the cumulative Evidence adolescents
cumulative effect effects of psychosocial Level 1
of psychosocial adversities
childhood of childhood in major
adversities on depression in adolescents.
major depression in
adolescents

Cicchetti D, Maternal 2014 To examine the trajectories Longitudinal. USA and 100 American
Natsuaki MN, caregiving and of depressive symptoms Evidence England adolescents
Harold GT, Leve girls’ depressive and antisocial behaviors Level 1 145 England
LD, Kim HK, symptom and in two risk groups of adolescents
Mahedy L, et al antisocial behavior adolescent girls;
trajectories: An To examine the role of
examination among maternal involvement as
high-risk youth a promoter of trajectory
based on the resilience
of psychopathologies as
symptoms of depression
and antisocial behavior in
adolescent girls.
Arslan, G Psychological 2015 To examine the mediating Quantitative. Turkey 937
maltreatment, role of resilience and self- Evidence adolescents
emotional and esteem in the relationships Level 1
behavioral problems between problems of
in adolescents: The psychological and emotional
mediating role of abuse and problems of
resilience and self- psychological-behavioral
esteem abuse in adolescents.

Kim J, Seok J, The protective role 2015 To investigate the Descriptive- Korea 461
Choi K, Jon DI, of resilience relationship between Early exploratory, adolescents
Hong H, Hong in attenuating Stress and resilience, quantitative
N, et al emotional distress depression, anxiety and approach.
and aggression aggression in young adults. Evidence
associated with Level 1
early-life
stress in young
enlisted military
service candidates

(the Figure 2 continue in the next page...)

www.eerp.usp.br/resmad
162 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2017 July-Sept.;13(3):156-166.

Type of study Target-

Authors Title year Objective Country
and evidence audience
Miller-Graff; Posttraumatic stress 2015 To conduct an exploratory Exploratory USA 1354 children
Howell. symptom trajectories analysis of trajectories longitudinal.
among children of posttraumatic stress Evidence
exposed to violence symptoms over time in a risk Level 1
group of children with proven
or probable experiences of
abuse;
To examine the common or
single factors associated with
such trajectories.
Davidson-Arad, Resilience among 2015 To compare the resilience of Experimental Israel 286
B; Navaro- adolescents in foster adolescent victims of abuse Evidence adolescents
Bitton, I. care in an orphanage with those of Level 1
adolescent victims of abuse
in the home and community
environment.
Sanders, J; The Role of positive 2015 To examine whether services Cross- New 605
Munford, R; youth development using the “positive youth sectional. Zealand adolescents
Thimasarn- practices in building development” approach relate Evidence
Anwar, T; resilience and to better outcomes in at-risk Level 1
Libenberg,L; enhancing wellbeing youth.
Ungar, M. for at-risk youth
Galinowsky, Resilience and 2015 To explore the projection Experimental France, 2224
A; Miranda, R; corpus callosum of the white matter of cohort study. USA, adolescents
Lemaitre, H; microstructure in the cerebral cortex of Finland,
et al. adolescence. perceived differences in the England,
corpus callosum through Canada,
tractography. Germany
Figure 2 - Overview of articles according to authors, title, year of publication, purpose, type of study, country of
origin, and study population.

Resilience: family and institutional abuse and uncles or grandparents to avoid abuse or neglect(15)
early stress were described.
A study also found(17) that greater involvement of
The studies included in this category deal with maternal care and its benefits leads to a decrease in
resilience in children and adolescents victims of family depressive symptoms, but does not prevent their onset.
and institutional abuse; ten articles were obtained for Family factors such as exposure to violence may have
this analysis. Five studies(13-17) investigated exclusively a negative effect on the development of resilience(14)
the abuse that occurred in the family environment, and children and adolescents with higher resilience
and the other five(18-22) addressed institutional abuse. indexes, when compared to those with lower indices,
Among the ten studies included in this category, two(13, had a greater capacity to identify the existence of
22)
investigated both family and institutional abuse. family problems(15).
It was found that the occurrence of childhood abuse With regard to abuse in institutions, studies reported
is closely related to higher rates of onset of symptoms that children or adolescents who had suffered abuse had
of psychiatric disorders(13-15, 19), lower rates of resilience, experienced effects of such abuse on their development.
learning difficulties in children(15), and greater occurrence It was also found(20) that bullying in adolescence is
of delinquency and depressive and anxious behavior associated with higher levels of depressive symptoms
in girls who were victims of abuse when compared to and delinquent behavior. There was also association
girls without such a history(13). with lower self-esteem and greater conflict with parents.
With respect to family abuse, factors that positively However, the majority of male adolescents presented
influence the development of resilience by children lower indexes of these symptoms, thus showing to be
and adolescents, such as parental acceptance and more resilient. On the other hand, despite the traumatic
self-perception of adolescents as being resilient(16) and experience, female adolescents presented higher self-
the intervention of secondary family member such as esteem and a lower rate of family conflicts. The highest

www.eerp.usp.br/resmad
 Camargo IML, et al. 163

level of resilience was also associated with less use of and the severity of early childhood abuse with the
alcohol and other drugs. symptoms of cannabis abuse and dependence in
As for the relationship between resilience and early adolescence. In this study, it was observed that
early stress, median levels of early stress may suggest children who had experienced severe levels of abuse
higher levels of resilience(14), as well as, exposure to were less predisposed to develop resilience and
violence within the family and community may be a presented more externalizing symptoms (egocentrism
risk factor for the development of post-traumatic stress and aggressiveness). Child abuse, personality
symptomatology in children and adolescents(14). disorder and internalizing or externalizing symptoms
In addition, it was identified that adolescents with predispose to regular use of cannabis and development
two or more types of negative experiences achieved of cannabis dependence. There is therefore a positive
lower resilience results; those with four or five different relationship between exposure to trauma and substance
traumatic experiences had the lowest scores when use disorder(24).
compared with those with only one type(18). The age at Similar results were also found in another study(25) in
which the traumatic experience had been experienced which child abuse was perceived as an environmental
also influenced the development of resilience. It was stressor that potentiate the impairment of personality
observed that older and younger adolescents reached development, resulting in increased psychopathology
similar levels of resilience; however, older subjects in adolescence and a higher tendency to use cannabis.
had made a better use of the services in which they
were inserted(21). Other factors that influence behavioral Resilience and factors intrinsic to the
development are personal variables such as sense of individual
hope or expectation and intelligence, also influencing
the development of resilience. Adolescents with lower Four articles were included in this category,
levels of school engagement, social support, hope and two related to the genotype/phenotype interaction,
expectation, as well as previous history of sexual abuse, other addressing the neurological characteristics of
had greater behavioral problems and were less likely adolescents exposed to early stress, and a last one
to be resilient(22). that addressed the relationship between self-esteem
and resilience.
Drug use and abuse and resilience According to the studies(26-27), there is a close
relationship between genotype and stressful events
This category included one article(23) that analyzed experienced by children and adolescents, who are in
the effects of a prenatal environment exposed to drugs a crucial phase of human development. For example,
and its influence on the development and the resilient stressful events can cause changes in brain-derived
capacity of the child; and two articles(24-25) that related neurotrophic factor (BDNF), a component of the family
use and abuse of drugs and childhood abuse. of homologous proteins known as neurotrophins that
Abuse of psychoactive substances still during the plays a central role in the development, physiology,
prenatal phase leaves marks on children that can last for and pathology of the nervous system, as well as in
a lifetime. As for the role of risk and protective factors on processes related to brain plasticity such as memory
the development of behavioral problems associated with and learning(27).
high exposure to cocaine and use of several different In the research findings (27), it was found that
drugs during pregnancy, it was found that children of homozygous subjects for BDNF were statistically
mothers with high exposure to drugs were more likely associated with the resilient phenotype. Moreover, there
to develop an aggressive and problematic behavior was evidence that the BDNF genotype associated with
during life, especially in the case of boys(23). The other the number of adversities experienced in childhood,
article included in this category showed that individuals such as abuses, neglect and family dysfunction, poor
with aggressive characteristics had a greater tendency family adjustment, parental death and experience of
to engage in drug abuse and chemical dependency(24). serious diseases, had a protective effect against the
Children of mothers who were strongly exposed to risk of lifelong depression. However, these results were
drugs had low rates of verbal IQ and attention deficit. evident only in women.
However, research showed that children with high levels Another research(26) attempted to find out whether
of resilience were protected against behavioral problems there were specific gene variants that interacted with
in childhood and adolescence(23). the experience of child abuse and were associated
There was an association between increased risk with higher levels of resilient functioning in low-income
of psychopathology, individual personality differences malnourished children; the study found low resilient

www.eerp.usp.br/resmad
164 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2017 July-Sept.;13(3):156-166.

functions in abused children. The study also found mechanisms of change and points of reflection for
that individual personality traits such as resilient intervention in the human life cycle(30). Therefore,
ego and moderate super-ego, self-esteem process, promoting resilience is a critical factor for children
and relationship factors were differentially predictive experiencing early abuse and neglect.
of resilient functioning in children who had or not The results of this review are consistent with another
been abused. study(31) that considers the variations in resilience to
The results of this research showed that some be associated with various influences such as the age
genetic variants exert an insignificant effect on the at which the stressful situation is experienced, temper
prediction of resilience in the group of abused children. and personality of the child, availability of social capital
On the other hand, genotype contributes to the high in the home and in the community, and family poverty.
functioning of resilience in non-abused children when Moreover, the development of resilience has
compared to abused children who have the same been also seen in children and adolescents who use
genotype. Abuse experiences may also influence drugs. The study showed that frequent use of drugs
genetic processes, including epigenetic processes is detrimental, especially in dysfunctional families.
and the degree to which genes are expressed(26). That Furthermore, drug abuse can generate other forms
is, childhood abuse can cancel out the effects of a of harm such as sexually transmitted diseases and
genotype favorable to the development of resilience. cardiorespiratory problems and injuries resulting
Another path taken to understand the development
from violence(32).
of resilience is the neurobiological one. The projection
Studies(31, 33) of human development show the
of the white matter of the cerebral cortex of perceived
influence of the quality of parenting on individuals.
differences in the corpus callosum was investigated to
Effective parenting has been associated with positive
evaluate the relationship between negative events of
outcomes in children exposed to a range of adverse
life and fractional anisotropy (FA) values in a sample of
conditions, such as poverty, divorce, and parental
adolescents. The results showed that FA is increased
death. Thus, parenting can be considered an important
after exposure to stressful events and that high levels
resource for promoting resilience.
of FA are associated with high resilience capacity(28).
The presence of depression in the caregiver is also
The results showed an increase in FA in certain
an important factor in child development. Depressive
segments of the corpus callosum in the resilient
symptoms were associated with children who were
group (adolescents with low risk of mental disorder,
unlikely to develop competence criteria in the social,
despite exposure to stressful events). In this way, a
behavioral and resilient domains(30). Besides the
solid corpus callosum should protect against mental
quality of parenting, having healthy parents is also
disorders by increasing resilience. It is, thus, possible
another important factor that promotes resilience in
to state that the nature of the response of the corpus
young children.
callosum to early stress can play an important role in
the determination of psychiatric resilience(28). The study of resilience must constantly consider
Another factor analyzed was the mediating role how impressive is the complexity in which the body
of self-esteem and resilience in psychological and and the brain interact through different environments(26).
emotional abuse, indicating that these are negatively Currently, the field of genetics is rapidly turning
correlated with resilience and self-esteem, and positively attention towards studies on global genomic expression
correlated with behavioral and emotional problems in profile in large populations to examine the complex
adolescents(29). Thus, high levels of resilience and self- genetic contributions to resilience. Additional
esteem protect adolescents from behavioral problems, genetic polymorphisms, and gene-gene and gene-
even when they are experiencing psychological abuse, environment interactions have currently been identified.
thus playing an important role in protecting the well- As the genetic basis of resilience becomes more
being of adolescents facing adversity(29). evident, it is expected that genes and therapeutic
drugs be specifically developed for low resilience
Discussion genetic profiles(34).
Although social support and the influence of social
Research on the development of resilience among relationships are essential to help children overcome
individuals who are victims of child abuse is complex difficulties experienced in early age, the evidence
and requires a multidisciplinary approach. Such study suggests that intrinsic characteristics and external
runs through the fundamental vision of neurobiology factors do not exert an isolated but rather a joint
and the psychological paths of development to promote influence to promote and help maintaining resilience(35).

www.eerp.usp.br/resmad
 Camargo IML, et al. 165

Conclusion Support in the Study of Child Abuse and Adult Physical and
Mental Health. Am J Orthopsychiatry. 2016.
The analyzed aspects show that children and 4. Townsend MC. Psychiatric Mental Health Nursing:
adolescents who experience adversity can develop concepts of care in evidence-based practice. 8th ed.
resilience according to several factors ranging from Philadelphia: F. A. Davis Company; 2014.
genetic characteristics to the quality of the relationship 5. World Health Organization (WHO). Child maltreatment.
with social institutions. Knowing these factors makes In: Organization WHO, editor. Geneva: World Health
it possible to know and understand how individuals Organization; 2014.
are able to adapt to new forms, seek resources in 6. Hebert M, Lavoie F, Blais M. Post Traumatic Stress
themselves and in the environment that surround them, Disorder/PTSD in adolescent victims of sexual abuse:
solve the problems that they meet in the course of their resilience and social support as protection factors. Cien
lives, through the development of resilience. Saude Colet. 2014;19(3):685-94.
Scientific evidence from the analyzed studies made 7. Konradt CE, Jansen K, Magalhães PVdS, Pinheiro RT,
it clear that the identification of stressors in childhood Kapczinski FP, Silva RAd, et al. Early trauma and mood
and adolescence is essential for prevention and health disorders in youngsters. Archives of Clinical Psychiatry
promotion actions in order to increase the possibilities (São Paulo). 2013;40:93-6.
for the development of resilience in these individuals. As 8. Lanzoni GMM, Meirelles BHS. Liderança do enfermeiro:
for the practice of health professionals, it is fundamental uma revisão integrativa da literatura. Revista Latino-
to include this theme in the training, in the continuing Americana de Enfermagem. 2011;19(3):651-8.
education and in the planning of health care, seeking 9. Souza MT, Silva MD, Carvalho R. Revisão integrativa:
the instrumentation of the professional action to detect o que é e como fazer? Einstein. 2010; 8(1): 102-6.
and intervene in cases of children and adolescents in 10. Broome ME. Integrative literature reviews for the
situation of abuse. development of concepts. In: Rodgers BL, Knafl KA,
However, further studies are still needed to editors. Concept development in nursing: foundations,
understand how to intervene so as to facilitate the techniques and applications. Philadelphia (USA): W.B
promotion of resilience since childhood, through the Saunders Company; 2000. p.231-50.
social and family support network that children or 11. Ganong LH. Integrative reviews of nursing research.
adolescents may have, so that they may grow and Res Nurs Health. 1987 Mar; 10(1):1-12. Oxford. Oxford
develop in a healthy and safe manner, having their Centre for Evidence-based Medicine – Levels of Evidence:
rights guaranteed. Oxford University; 2009 [cited 2016 15 mai]. Disponível
It is noteworthy that although there is a large em: http://www.cebm.net/oxford-centre-evidence-based-
scientific production on issues related to resilience, the medicine-levels-evidence-march-2009/.
research of this topic specifically related to children and 13. Milovancević MP, Tenjović L, Ispanović V, Mitković M,
adolescents victims of abuse, the literature produced is Kirćanski JR, Mincić T, et al. Psychopathology and resilience
still insufficient. Bearing in mind that, for the described in relation to abuse in childhood among youth first referred
age group, the development of resilience is a key to the psychiatrist. Vojnosanit Pregl. 2014;71(6):565-70.
protective factor in favor of healthy development, the 14. Miller-Graff LE, Howell KH. Posttraumatic stress
need for investment in intervention studies to contribute symptom trajectories among children exposed to violence.
to the construction of scientific evidence focused on the J Trauma Stress. 2015;28(1):17-24.
development of resilience for improvement of assistance 15. Morelato GS. Evaluación de factores de resiliencia en
to children and adolescents who experience situations niños argentinos en condiciones de vulnerabilidad familiar.
of early stress is clear. Universitas psychologica. 2014;13(4):1473-88.
16. Davidson-Arad B, Navaro-Bitton I. Resilience
References among adolescents in foster care. Children And Youth
Services Review. 2015;59:63-70. doi: 10.1016/j.
1. Coimbra RM, Morais NA. A resiliência em questão: childyouth.2015.09.023.
perspectivas teóricas, pesquisa e intervenção. Porto Alegre: 17. Cicchetti D, Natsuaki MN, Harold GT, Leve LD, Kim HK,
Artmed; 2015. 232p. Mahedy L, et al. Maternal caregiving and girls’ depressive
2. Rutter M. Annual Research Review: Resilience – clinical symptom and antisocial behavior trajectories: An examination
implications. Journal of Child Psychology and Psychiatry. among high- risk youth. 2014;26(4pt2):1461-75.
2013;54(4):474-87. doi: 10.1111/j.1469-7610.2012.02615.x. 18. Collin-Vezina D, Coleman K, Milne L, Sell J, Daigneault
3. Herrenkohl TI, Jung H, Klika JB, Mason WA, Brown EC, I. Trauma Experiences, Maltreatment-Related Impairments,
Leeb RT, et al. Mediating and Moderating Effects of Social and Resilience among Child Welfare Youth in Residential

www.eerp.usp.br/resmad
166 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2017 July-Sept.;13(3):156-166.

Care. International Journal of Mental Health and Addiction. Resilience in Young Children. Academic pediatrics. 2016
2011(5):577-89. Apr 30;16(3):233-9.
19. Kim J, Seok J, Choi K, Jon DI, Hong H, Hong N, et al. 32. Claro HG, Oliveira MAF, Ribeiro APR, Fernandes CC,
The Protective Role of Resilience in Attenuating Emotional Cruz AS, Santos EGM. Perfil e padrão de uso de crack de
Distress and Aggression Associated with Early- life Stress crianças e adolescentes em situação de rua: uma revisão
in Young Enlisted Military Service Candidates. Journal Of integrativa. SMAD, Ver. Eletrônica Saúde Mental Álcool
Korean Medical Science. 2015;30(11):1667-74. Drog. 2014 Apr; 10(1): 35-41.
20. Sapouna M, Wolke D. Resilience to bullying victimization: 33. Sandler I, Schoenfelder E, Wolchik S, MacKinnon
The role of individual, family and peer characteristics. Child D. Long-term impact of prevention programs to promote
Abuse & Neglect. 2013;37(11):997-1006. effective parenting: Lasting effects but uncertain processes.
21. Sanders J, Munford R, Thimasarn-Anwar T, Liebenberg Annual review of psychology. 2011;62:299.
L, Ungar M. The role of positive youth development practices 34. Wu G, Feder A, Cohen H, Kim JJ, Calderon S, Charney
in building resilience and enhancing wellbeing for at- risk DS, et al. Understanding resilience. Frontiers in behavioral
youth. Child Abuse & Neglect. 2015;42:40-53. neuroscience. 2013 Feb 15;7:10.
22. Williams J, Nelson-Gardell D. Predicting Resilience in 35. Herrenkohl TI, Jung H, Klika JB, Mason WA, Brown EC,
Sexually Abused Adolescents. Child Abuse & Neglect: The Leeb RT, et al. Mediating and Moderating Effects of Social
International Journal. 2012;36(1):53-63. Support in the Study of Child Abuse and Adult Physical and
23. Bada HS, Bann CM, Whitaker TM, Bauer CR, Shankaran Mental Health. Am J Orthopsychiatry. 2016.
S, LaGasse L, et al. Protective factors can mitigate behavior
problems after prenatal cocaine and other drug exposures.
(Report). Pediatrics. 2012;130(6):E1479.
24. Oshri A, Rogosch FA, Cicchetti D. Child maltreatment
and mediating influences of childhood personality types
on the development of adolescent psychopathology. J Clin
Child Adolesc Psychol. 2013;42(3):287-301.
25. Oshri A, Rogosch FA, Burnette ML, Cicchetti D.
Developmental Pathways to Adolescent Cannabis Abuse
and Dependence: Child Maltreatment, Emerging Personality,
and Internalizing Versus Externalizing Psychopathology.
Psychology of Addictive Behaviors. 2011;25(4):634-44.
26. Cicchetti D, Rogosch FA. Gene × Environment
interaction and resilience: Effects of child maltreatment
and serotonin, corticotropin releasing hormone, dopamine,
and oxytocin genes. Development and Psychopathology.
2012;24(2):411-27.
27. Cruz-fuentes CS, Benjet C, Martínez-levy GA,
Pérez-molina A, Briones-velasco M, Suárez-gonzález
J. BDNF Met66 modulates the cumulative effect of
psychosocial childhood adversities on major depression
in adolescents. Brain and Behavior. 2014;4(2):290-7.
28. Galinowski A, Miranda R, Lemaitre H, Paillère Martinot
ML, Artiges E, Vulser H, et al. Resilience and corpus callosum
microstructure in adolescence. 2015;45(11):2285-94.
29. Arslan G. Psychological maltreatment, emotional
and behavioral problems in adolescents: The mediating
role of resilience and self-esteem. Child Abuse Negl.
2015;52:200-9.
30. Panter-Brick C, Leckman JF. Editorial commentary:
resilience in child development–interconnected pathways
to wellbeing. Journal of Child Psychology and Psychiatry.
2013 Apr 1;54(4):333-6.
31. Dubowitz H, Thompson R, Proctor L, Metzger R, Received: Oct. 12th 2016
Black MM, English D, et al. Adversity, Maltreatment, and Accepted: Jul. 30th 2017

www.eerp.usp.br/resmad