Journal of Child Psychology and Psychiatry 56:1 (2015), pp 4–17 doi:10.1111/jcpp.

12306

Practitioner Review: Diagnosing childhood resilience –

a systemic approach to the diagnosis of adaptation in
adverse social and physical ecologies
Michael Ungar
Resilience Research Centre, Dalhousie University, Halifax, NS, Canada

Background: With growing interest in resilience among mental health care providers globally, there is a need for a
simple way to consider the complex interactions that predict adaptive coping when there is exposure to high levels of
adversity such as family violence, mental illness of a child or caregiver, natural disasters, social marginalization, or
political conflict. Methods: This article presents diagnostic criteria for assessing childhood resilience in a way that is
sensitive to the systemic factors that influence a child’s wellbeing. The most important characteristics of children who
cope well under adversity and avoid problems like depression, PTSD, and delinquency are highlighted. Results:
A multidimensional assessment of resilience is presented that examines, first, the severity, chronicity, ecological
level, children’s attributions of causality, and cultural and contextual relevance of experiences of adversity. Second,
promotive and protective factors related to resilience are assessed with sensitivity to the differential impact these
have on outcomes depending on a child’s level of exposure to adversity. These factors include individual qualities like
temperament, personality, and cognitions, as well as contextual dimensions of positive functioning related to the
available and accessibility of resources, their strategic use, positive reinforcement by a child’s significant others, and
the adaptive capacity of the environment itself. Third, an assessment of resilience includes temporal and cultural
factors that increase or decrease the influence of protective factors. A decision tree for the diagnosis of resilience is
presented, followed by a case study and diagnosis of a 15-year-old boy who required treatment for a number of
mental health challenges. Conclusions: The diagnostic criteria for assessing resilience and its application to clinical
practice demonstrate the potential usefulness of a systemic approach to understanding resilience among child
populations. Keywords: Resilience, vulnerable child populations, diagnostic criteria, adversity, social ecologies,
social capital, differential diagnosis, differential impact.

facilitate their coping in culturally meaningful ways

Introduction
(Ungar, 2011).
There is general agreement that resilience is a
While studies of resilience have shown that indi-
process of adaptation when there is exposure to
vidual characteristics like temperament (Derauf
adversity (Masten, 2011; Rutter, 2012; Ungar,
et al., 2011; Rettew, 2008), personality type (Ase-
2011). Resilience is most commonly understood to
ndorpf & van Aken, 1999; Coifman, Bonanno, Ray, &
be present if no disorder is diagnosed (exposure has
Gross, 2007), neurophysiology (Karatoreos & McE-
had minimal impact), if disorder was previously
wen, 2013; Kent, 2012), genetic predispositions
present and the individual is recovering, or the
(Kaufman, 2008), cognitive skills (Brown, Barbarin,
individual exceeds expectations and is functioning
& Scott, 2013), and intelligence (Friborg, Barlaug,
better than before exposure to a potentially trauma-
Martinussen, Rosenvinge, & Hjemdal, 2005) are
tizing event (PTE) (Bonanno & Mancini, 2012). These
predictive of positive child development, the cumu-
processes of successful adaptation in situations
lative impact of individual traits typically accounts
where there is abnormally high environmental load
for less of the variance in children’s outcomes than
(the quality and quantity of the adversity that is
systemic factors like the quality of a child’s family,
experienced) have been attributed to a range of
school, or community (Abramson, Park, Stehling-Ari-
biological, psychological, relational, and sociocul-
za, & Redlener, 2010; Ungar, 2013). This is especially
tural factors, some more likely to respond to clinical
the case when children’s social and physical ecolo-
interventions than others (Cicchetti, 2013; Hobfoll,
gies fail to facilitate the expression of strengths for
2011). Given the multidimensionality of the pro-
children living in conditions that are suboptimal for
cesses associated with resilience, the likelihood of
their development (Cicchetti, 2013; Masten, 2014;
individual children withstanding the impact of
Rutter, 2000; Ungar, Ghazinour, & Richter, 2013).
cumulative stressors is not a measure of their
Though these social and physical ecologies can
personal invulnerability. Instead, resilience is pre-
threaten children’s development, they can also be
dicted by both the capacity of individuals, and the
the source of five types of capital (resources) children
capacity of their social and physical ecologies to
need to buffer the impact of stress or help them
recover when their mental health has deteriorated
(Obrist, Pfeiffer, & Henley, 2010; Ungar, 2011).
Conflict of interest statement: No conflicts declared. These are the child’s social capital (relationships

© 2014 Association for Child and Adolescent Mental Health.

Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA
doi:10.1111/jcpp.12306
with caregivers, feelings of trust, and cultural em-
beddedness), human capital (the ability to learn,
play, and work), financial/institutional capital
(social welfare programs, health care, specialized
supports at school, mentoring programs), natural
capital (land, water, biological diversity), and built
capital (safe streets, public transit, recreational
facilities, housing and schools). A systemic theory
of resilience avoids reifying resilience as a static trait
of the individual (Ungar et al., 2013a). It instead
emphasizes the processes children engage in to
access these different types of capital. In this regard,
a systemic understanding of positive child develop-
ment under stress is informed by what we already
know about the social determinants of health
(Raphael, 2004), the need to prevent adverse child-
hood experiences (Anda et al., 2006) and other
factors that contribute to wellbeing attributable to
social policy, family functioning, and a community’s
capacity to respond to children in crisis (see, for
example, Flynn, Dudding, & Barber, 2006).
This Review explores the process of diagnosing
childhood resilience in a way that is sensitive to the
systemic factors that make resilience more or less
likely to occur. It addresses key considerations such
as the severity and chronicity of a child’s risk
exposure, the individual and contextual dimensions
of resilience, and the temporal and cultural rele-
vance of promotive and protective factors.
Though the term ‘diagnosis’ usually refers to the
identification of disorder, it is used here to provide
structure for the assessment of wellbeing under
stress in a way that mirrors conventional diagnostic
procedures already familiar to mental health profes-
sionals. Though certainly an unconventional use of
the term, its use is intended to position the diagnosis
of resilience as one part of a thorough mental health
assessment.
Diagnostic criteria for resilience
There are many excellent reviews of the resilience
literature, though their conclusions tend to be com-
promised by the diversity of definitions of resilience
that are used, the broad scope of factors studied,
and the range of psychological problems that resil-
ience has been shown to influence (Cicchetti, 2013;
Masten, 2014). The purpose here is not to wade into
these definitional debates but instead to highlight
dimensions of resilience that appear repeatedly in
the literature, in particular qualities of a child’s
social and physical ecologies that are known to
interact with individual factors to nurture and
sustain resilience. Accordingly, the diagnosis of
resilience should account for several domains
that are well-supported by the research. As detailed
in Table 1, these include (a) the presence and
experience of adversity, (b) individual and contextual
dimensions of resilience, and (c) temporal and cul-
tural influences on the promotive and protective
© 2014 Association for Child and Adolescent Mental Health.
Diagnosing childhood resilience 5
factors children need to do well. Given the complex-
ity of the interactions between these factors, diag-
nosing resilience requires a multidimensional
approach (Lerner, 2006). Without an assessment of
the environmental load, for example, it is not possi-
ble to properly account for the function of protective
processes (Luthar, 2006).
Table 1 describes the diagnostic criteria required
for resilience. Similar to the assessment of disor-
der, a differential diagnosis is necessary to deter-
mine whether there is enough evidence for a
finding of resilience, or if patterns of coping are
unrelated to exposure to adversity. In instances
where there are normal levels of developmental
stress (e.g. transition to a new school or the death
of a grandparent who is not a child’s legal guard-
ian) and a child is well-resourced, successful
coping should not be an indication of resilience.
In such instances, there is no pile-up of stressors
and no necessity for the promotive or protective
function of resilience-related processes. Children
do well but it is not because they are resilient.
Without stressors to challenge them, their success
is simply normal development in circumstances
where the environmental load is as expected for a
particular context.
The first domain: adversity
Diagnosing resilience begins with an assessment of
exposure to adversity and the impact risk factors
have on children’s experience of wellbeing. Large
cohort studies have shown that adverse childhood
events such as neglect and exposure to family
violence exert long-term deleterious effects on men-
tal and physical health (Felitti et al., 1998). Risk
factors are cumulative with the risk for poor out-
comes increasing in direct proportion to the quantity
of risk factors to which a child is exposed (Chartier,
Walker, & Naimark, 2010). This has been well
documented in diverse contexts. Children exposed
to war in Bosnia, for example, were at significantly
higher risk of PTSD, anxiety, depression and prob-
lems learning the more they witnessed violent death
caused by gunfire or landmines, experienced ethnic
cleansing, genocide, rape, forced displacement,
physical diseases, or been orphaned (Layne et al.,
2008).
Though exposure to adversity is the first criteria
for resilience described in Table 1, the quality of that
exposure will influence which promotive and protec-
tive factors contribute most to children’s positive
developmental outcomes. To diagnosis resilience,
there is a need to assess five dimensions of adversity:
the severity, chronicity, ecological complexity, attri-
butions of causality, and the cultural and contextual
relevance of the factors that influence children’s
experience of their exposure to risk.
Exposure to more severe and chronic forms
of adversity increases the vulnerability of a child
6 Michael Ungar
to stress. For example, Hobfoll (2011) found that
among Israeli Jews and Arabs, the chronicity
and severity of their exposure to war-related
violence produces ‘resource loss cycles’ (p.133)
Table 1 Diagnostic criteria for resilience
Domain
Adversity
A detailed description
of adversity is required
that takes into
accounts all five
dimensions of
adversity. Resilience
may be present if at
least one dimension
poses a significant
barrier to wellbeing.
Resilience
In relation to the level of
exposure to adversity,
there is evidence of
individual and
contextual promotive
and protective
processes that
contribute to wellbeing
Multidimensional
Considerations
that make people vulnerable to future loss.
Even when social supports remain strong, and
coping strategies include post-traumatic growth,
the more burdensome the individual’s risk
Dimension
(1) Severity
(2) Chronicity
(3) Ecological level (psychological/biological,
microsystemic, mesosystemic, exosystemic,
macrosystemic, chrono-systemic)
(4) Attribution of causality
(5) Cultural and contextual relevance
(1) Individual dimensions: In contexts of above
normal, but less severe and chronic, adversity,
both (a) and (b), or just (a), or just (b), should be
present; in contexts of more severe or chronic
adversity (a) and (b) are optional
(a) Individual temperament, personality
(b) Cognitions, including locus of control,
self-regulation, empowerment
(2) Contextual dimensions: At all levels of exposure
to adversity, the following have been at least
minimally present in the last six months. Greater
frequency predicts increased likelihood of
resilience, especially as exposure to adversity
increases.
(a) Availability of individual, family, community,
and political resources
(b) Accessibility of individual, family,
community, and political resources
(c) Strategic use of biological, emotional,
psychological, spiritual, social and political
resources
(d) Positive reinforcement of individual coping
strategies by family and community
(e) Adaptive capacity of the environment to
change in order to better meet the needs of an
individual, family or community
(1) Temporal
(2) Cultural
© 2014 Association for Child and Adolescent Mental Health.
J Child Psychol Psychiatr 2015; 56(1): 4–17
Explanation
Exposure to adversity poses a significant threat to
wellbeing, with the most extreme single episode
being the basis for an assessment of severity
The duration of exposure to at least one adverse
experience is significant
Adversity is experienced at one or more systemic
levels; there are interactions between factors at
different levels
Cause of adversity is attributed by the individual to
self or others, or cause of adversity is attributed
by others to factors the individual controls or
factors beyond the control of the individual (Both
attribution patterns can be indicators of
successful coping in different contexts)
The experience of adversity is perceived
individually and/or collectively as a threat to
wellbeing
Often shows individual characteristics associated
with wellbeing
Often perceives a personal ability to engage and
control self and environment
The resources necessary to nurture and maintain
wellbeing are present in the environment
The resources that are available are also
accessible; barriers to access have been
addressed
There is evidence of purposeful strategies by
individuals, families, or communities to navigate
towards, and make use of, resources; these
patterns of navigation may be episodic or
enduring from one developmental period to the
next
There is social recognition (positive) for how the
individual copes with adversity; individuals or
groups successfully negotiate with significant
others to be seen as resilient and given the
resources they need to sustain wellbeing
The environment actively demonstrates capacity to
change and integrate new ways of meeting the
needs of those who depend on it for support
Coping strategies are developmentally appropriate,
sustainable as the individual ages, and
historically responsive/contextually appropriate
Coping strategies fit with the community’s
perception of successful coping; the individual or
individual’s significant others negotiate with the
community for recognition of the individual as
resilient
doi:10.1111/jcpp.12306
exposure, the more likely he or she is to experience
PTSD.
Likewise, stressors that occur at multiple ecolog-
ical levels (e.g. a child experiences a biological
disorder like FASD, family violence, and a poorly
resourced school) may burden a child more than less
complex adversity that affects a single system (e.g. a
child who shows signs of PTSD following a sexual
assault is likely to recover more quickly when she is
well-supported psychologically and physically). Both
risk and resilience may be thought of as involving
multiple biological, psychological, and social sys-
tems and their interactions (Supkoff, Puig, & Sroufe,
2012; Ungar et al., 2013a).
An individual’s biosystem, for example, includes
interactions that either inhibit or enhance neuro-
logical functioning and gene expression (Bronfen-
brenner & Ceci, 1994). The human body is itself a
bio-ecological microsystem in which physical sub-
systems are influenced by cognitive and emotional
processes. Microsystemic interactions also refer to
those between children and their social groups like
caregivers, school classmates, or congregation.
Mesosystemic processes are those in which mi-
crosystems interact. For example, effective interac-
tions between a foster child’s social service
workers, educators, and mental health care pro-
viders (each of which form their own microsystems)
can help a child cope better with an out-of-home
placement (Cheung, Goodman, Leckie, & Jenkins,
2011).
Exosystemic social processes are the distal inter-
actions that have the potential to shape micro- and
mesosystems. A simple illustration is how a care-
giver’s employment, educational attainment, or
access to welfare (financial assistance) can all pos-
itively influence the caregiver’s ability to parent a
child who is developmentally at risk because of low
birth weight (Klebanov & Brooks-Gunn, 2006).
Macrosystems are the part of the social ecology
that create favorable contexts, values and beliefs
about children’s development which promote or
sustain resilience. For example, a mixed meth-
ods-longitudinal study of former child soldiers in
Sierra Leone showed that community acceptance of
these children as victims of the war, rather than
stigmatizing them for their participation as com-
batants, was related to better re-integration and
lower incidence of mental disorders (Betancourt,
2012).
Finally, chrono-systems introduce into this sys-
temic model temporal dimensions, like the socio-
historical period in which adaptations to stress
take place (Is the economy doing well, and will
there be job opportunities for children who grow up
with learning disorders?) and the developmental
age and stage of children which determines the
coping strategies they are empowered to use (At
what age can a child be encouraged to advocate for
himself when needing extra services at school?).
© 2014 Association for Child and Adolescent Mental Health.
Diagnosing childhood resilience 7
In addition to severity, chronicity, and ecological
complexity of risk, there are also two cognitive
dimensions to risk exposure that determine the
impact stressors have on children’s resilience. Build-
ing on Bandura’s (1977) attribution theory, chil-
dren’s attributions of causality may mitigate or
accentuate the negative impact of exposure to a
PTE. Scales to measure resilience, like the Resilience
Scale for Adolescents (Hjemdal, Friborg, Stiles, Mar-
tinussen, & Rosenvinge, 2006) and the Child and
Youth Resilience Measure (Ungar & Liebenberg,
2011), among others, have included questions relat-
ing to self-efficacy, with an internal locus of control
in low and moderate risk environments being asso-
ciated with a lower than expected rate of depression,
delinquency, and other socially undesirable out-
comes. Qualitative studies, such as that with fami-
lies affected by the 9/11 attack in New York City,
show a similar emphasis on self-efficacy as an
important protective factor related to recovery (Saul,
2014).
Finally, cultural and contextual relevance also
shape the way risk factors influence children’s
developmental outcomes and the impact of promo-
tive and protective factors. Indeed, once culture is
accounted for, the complexity of models of resilience
increases. A particularly intriguing example of this is
found in results from the Western Australian Aborig-
inal Child Health Survey, a representative sample of
5,289 Aboriginal children aged 0–17 drawn from
households with at least one child of Aboriginal or
Torres Strait Islander background (Hopkins, Taylor,
D’Antoine, & Zubrick, 2012). While the results
showed that in general, risk factors such as harsh
parenting, family violence, and caregiver unemploy-
ment were cumulative, resilience was predicted by
just three factors. As expected, a prosocial peer
group created the social capital to protect young
people from delinquency and substance abuse.
However, living in a less economically disadvantaged
neighborhood (higher SES) actually decreased the
likelihood that children showed resilience. Likewise,
children who demonstrated more knowledge of their
culture were less resilient.
Both results are culturally specific anomalies that
are explained by processes of exclusion. In a context
where 90% of Aboriginal peoples live in lower SES
neighborhoods, being from a more economically
advantaged community may separate a child from
social supports and expose the child to more
prejudice. Likewise, knowledge of one’s culture in
such a context may create heightened sensitivity to
oppression and lead to higher levels of depression
and delinquency. Results such as this demonstrate
the heterogeneity in patterns of resilience among
children from different ethnoracial backgrounds
exposed to similar types of stressors.
For all these reasons, a thorough assessment of
resilience requires an assessment of risk first, spe-
cifically the five dimensions of severity, chronicity,
8 Michael Ungar
ecological complexity, attributions of causality, and
understanding of the cultural and contextual con-
structions of experience that put children at risk.
Psychological and behavioral processes associated
with resilience are those that respond optimally to
risk factors.
The second domain: resilience
Diagnosing the presence of resilience (the second
domain in Table 1) starts with an examination of
individual dimensions of coping such as tempera-
ment, personality, cognitions, locus of control,
self-regulation and empowerment, these being
among the most commonly discussed dimensions
of individual resilience found in the literature. Where
risk exposure is less severe and chronic, these
individual factors are more likely to influence resil-
ience. Where risk exposure is more severe and
chronic, these individual characteristics may have
much less influence on a child’s experience of
resilience until risk exposure is mitigated.
More than anything else, it is this need to account
for the level of risk exposure when assessing the
impact of a protective process that distinguishes the
study of resilience from broader understandings of
general coping, positive development, and wellbeing.
Studies of resilience have shown that at different
levels of exposure to adversity, different promotive
and protective processes exert a differential impact
on mental health outcomes (Ungar, 2011, 2013). For
example, Kassis and his colleagues (Kassis, Artz,
Scambor, Scambor, & Moldenhauer, 2013) studied
resilience and depression among a random sample of
5,149 middle school students from four European
countries, 30% of who reported experiences of family
violence. Factors associated with resilience such as
emotional self-control, talking with parents about
violence and attitudes toward violence that suppress
aggression were only correlated with better outcomes
for children at medium and low levels of exposure to
violence. At higher rates of exposure, aspects of a
child’s environment, like the amount of violence that
had been experienced, predicted whether a child
experienced resilience.
These findings are similar to those in other areas of
research as diverse as conduct disorder (Nix, Pin-
derhughes, Bierman, & Maples, 2005), PTSD (Bet-
ancourt, 2012) and heterosexism (Bos & Gartrell,
2010). In each case, studies show that in highly
adverse contexts a child’s resilience is accounted for
more by the quality of the child’s environment than
personality, temperament, or psychological coping
mechanisms. In less adverse contexts, where there
are more resources to support wellbeing, individ-
ual-level factors and coping strategies are more likely
to predict positive psychological and behavioral
outcomes. It is for this reason that a comprehensive
diagnosis of resilience requires an assessment of risk
to understand the differential impact of promotive
J Child Psychol Psychiatr 2015; 56(1): 4–17
and protective factors in contexts of low, medium
and high adversity.
There has been no consistent modeling, however,
to explain which processes associated with resilience
best protect which populations of children against
which risks. Instead, studies tend to choose their
independent and dependent variables based on
studies of psychopathology. They hypothesize an
absence of problems as an indication of resilience, or
that the factors that mitigate problem behaviors
when stress is low will be the same ones that are
protective in contexts where stress is high. Neither
hypothesis can lead to an accurate account of the
way processes that make children more resilient
actually function.
If, for example, we look at why children from ‘bad
neighborhoods’ avoid delinquency, we would need to
assess both the level of children’s exposure to risk
factors, like street violence, and children’s access to
resources for positive development. If we did this, we
would likely see that just because a child does not
show signs of trauma in a community where exposure
to violence is high does not mean the child is resilient.
The child could be socially isolated, lack motivation,
and show poor engagement and academic perfor-
mance at school. None of these symptoms, however,
would be significant to an assessment of mental
disorder as long as the child scores below the clinical
cutoffs, but these behaviors would be significant when
diagnosing resilience (or in this case, a lack thereof).
Likewise, a child’s resilience relies heavily on the
capacity of the child’s community to help the child
cope with the violence found there. We know, for
example, that parents who provide more authoritar-
ian parenting in a context like this and keep their
children away from dangerous peers and under close
supervision are more likely to have children who do
well when compared to parents who are less directive
(Burton, Allison, & Obeidallah, 1995). Likewise, a
community’s sense of social cohesion (Elliott et al.,
2006), even when there is the threat of violence, can
have a positive impact on children’s sense of wellbe-
ing and prosocial behavior.
The factors associated with resilience are, there-
fore, contextual (the second dimension of resilience
that is considered when making a diagnosis). The
study of resilience is, by necessity, complicated by
the availability and accessibility of the resources
individuals require to do well. Preferred outcomes
may be unattainable when structural barriers pre-
vent children from succeeding. In such contexts,
children are forced to take advantage of antisocial
alternatives that serve a protective function. For
example, working children may resist attending
school if they feel they will lose social status or
economic rewards (Liborio & Ungar, 2013). And
children who experience trouble learning, or are
racially marginalized in the classroom, may choose
to drop out early to preserve their sense of self--
esteem (Dei, Massuca, McIsaac, & Zine, 1997).
© 2014 Association for Child and Adolescent Mental Health.
doi:10.1111/jcpp.12306
The availability and accessibility of the resources
associated with resilience result in a cumulative
effect on outcomes (Ungar, Liebenberg, Armstrong,
Dudding, & van de Vijver, 2013b). Researchers like
Laub and Sampson (2003) view person-environment
interactions as emergent and contingent. With
results from a follow-up study of a large cohort of
delinquent and nondelinquent boys from the 1930s,
they have shown that chance encounters and turn-
ing points are important to how and when a child or
adult accesses protective factors that are associated
with resilience (e.g. a healthy relationship with an
intimate partner or a meaningful role in one’s
community). These factors accumulate over time,
reinforcing positive trajectories through life.
The availability and accessibility of the resources
necessary to support resilience also vary in their
influence depending on how well individuals make
strategic use of them, and how well their use is
reinforced by others. It is at this juncture that the
assessment of resilience must necessarily become
phenomenological. A number of qualitative studies
show that even though individuals may show the
capacity to navigate to the resources they need, and
their environments are able and willing to provide
resources well-matched to the risks children face,
processes that support resilience are still negotiated
(France, Bottrell, & Armstrong, 2012; Munford &
Sanders, 2007; Ungar et al., 2007). These negotia-
tions take place at two levels. First, a child’s choice of
coping strategy (when there is choice) will be encour-
aged or discouraged based on the coping strategy’s
social desirability. Second, negotiation may also take
place with institutional gatekeepers who make
resources available depending on their perception of
what makes a child resilient. Social policies, for
example, have an indirect impact on the types of
social and physical capital available to children
(Leadbeater & Way, 2007). Are children in vulnerable
families provided with subsidized daycare to enhance
their psychosocial development and school readi-
ness? Is mental health care available in close prox-
imity to where a child lives? Do institutional policies
worsen a child’s social exclusion because the child
self-identifies as Lesbian, Gay, Bisexual, or Trans-
gendered, or when a child is unable to function in a
regular classroom because of a physical disability?
This process of community reinforcement also
extends to the labels assigned to specific coping
strategies. In many instances, in adverse contexts,
children are forced to resort to maladaptive coping
that threatens their wellbeing (e.g. substance abuse
and other self-harming behaviors to cope with emo-
tional issues), or contextually specific patterns of
coping that are not recognized as such by those who
do not share the patient’s culture or context (e.g.
what has been termed ‘hidden resilience’, Ungar,
2004). For example, the adultification of a child who
assumes the role of caregiver can compensate for
parents who are mentally ill or economically
© 2014 Association for Child and Adolescent Mental Health.
Diagnosing childhood resilience 9
stressed. In both instances, these patterns of resil-
ience may be overlooked even though they are
adaptive in contexts where socially desirable coping
strategies remain blocked.
Finally, when diagnosing resilience, we need to
consider to what extent the environment around the
child has the capacity to adapt. The more capacity that
caregivers, schools, communities, and service provid-
ers have to provide children with the resources they
need, the more likely children are to take advantage of
opportunities to enhance their wellbeing (see, for
example, work with child soldiers and the prevention
of PTSD [Betancourt et al., 2010;] and interventions to
address conduct disorder that rely on communication
between schools and parents [Nix et al., 2005]).
The third domain: multidimensional
considerations
Resilience also has temporal and cultural dimen-
sions. The first temporal dimension is a child’s
physical and cognitive development that makes
certain coping strategies more or less viable (e.g. a
4-year-old’s temper tantrum may get the child
attention from both caregivers and a child psychia-
trist but a 14-year-old’s violent outburst puts the
child at risk for incarceration if he or she causes an
assault). The second temporal dimension is socio-
historical. Research has shown that the period
during which a child lives influences opportunities
for children to access resources and the social
construction of their behaviors as either problems
or solutions (Bottrel, 2009; Schoon, 2006). For
example, a large qualitative study of 11 to 18-year--
olds from poor neighborhoods in the United Kingdom
examined pathways into delinquency and factors
that made children resilient (France et al., 2012).
Looking at the problem of delinquency from the
perspective of political ecology, researchers searched
for ways that children’s everyday worlds are pro-
duced by the external political forces at play in
microsystems, mesosystems, exosystems and mac-
rosystems. While children’s patterns of play, associ-
ation with peers, and time spent in social spaces in
their communities increase their exposure to the risk
factors associated with criminality, children also
experience these aspects of their lives as helping
them to manage everyday stressors, maintain social
cohesion, and provide a sense of safety, cultural
learning and identity. Research in the United States
has shown much the same: under conditions of
adversity, neighborhoods contribute to both delin-
quency and survival far more than an individual’s
personal characteristics (Elliott et al., 2006;
S!anchez-Jankowski, 2008).
This means that context and culture influence a
child’s expression of resilience by shaping the child’s
access to different types of capital. Results from an
11-country mixed methods study of resilience with
youth identified by their communities as having been
10 Michael Ungar
exposed to significant levels of adversity, but thought
by members of local advisory committees to be ‘doing
well,’ (Ungar & Liebenberg, 2011, p.135) showed both
homogeneity and heterogeneity in how young people
cope. For example, the research identified seven ‘ten-
sions’ in the data that accounted for young people’s
experiences across cultures. These included pro-
cesses such as how children formed relationships,
the identities they constructed through those relation-
ships, their personal and social efficacy, their experi-
ence of social justice, how they accessed material
resources like food and education, how they main-
tained a sense of cohesion and life purpose, and their
experience of cultural continuity (different cultures
emphasized one or more of these tensions). Results
also showed that the 58 items used to assess resilience
(later reduced to form the Child and Youth Resilience
Measure-28) did not maintain a stable factor structure
across minority and majority world contexts. Minority
world youth (those from economically developed
nations) responded to questions about resilience in a
fairly homogeneous way, with no significant differ-
ences between boys and girls. Majority world youth
(those from economically disadvantaged countries
and Aboriginal peoples in minority world countries)
required a different sorting of the items to create a
coherent factor structure. Girls and boys, for example,
were separated, with girls from countries as different
as Colombia, China, and South Africa demonstrating
homogeneity in their response patterns, while for the
majority world boys, no such consistency was found.
Instead, boys’ responses differed by the level of social
cohesion reported in their communities (the degree to
which their community shared a common purpose and
worked well together).
Similar patterns of cultural variation are found in
numerous other studies (Stevenson-Hinde, 2011).
Chen and his colleagues (Chen, Cen, Li, & He, 2005),
for example, found in the mid-1990s that shyness
has been a historically valued trait of children in
urban China, contrary to its association with anxiety
in American studies. When Chen went back to China,
however, a decade after his initial research, he was
able to document changing social and economic
patterns associated with an emerging capitalist sys-
tem that was influencing people’s values. The shy
child was no longer seen positively, and instead was
thought to be less likely to succeed and more
vulnerable to peer rejection and school problems.
Intersections of risk and resilience in complex
ecologies
To illustrate these multiple and intersecting dimen-
sions when diagnosing childhood resilience, we can
review the results from a follow-up study of 11-year-
olds who had been adopted from Romanian orphan-
ages before 6 months, between 6 and 23 months,
and from 24 to 42 months. Children’s abilities and
intelligence were predicted by both the severity of the
J Child Psychol Psychiatr 2015; 56(1): 4–17
children’s experience of deprivation and the quality of
the environments into which they were placed (Beck-
ett et al., 2006). Children who had been adopted
before 6 months of age resembled other UK children
who had been adopted within 6 months of their birth,
with cognitive impairments increasing with the
length of time children were exposed to deprivation.
However, the most severely disabled children at age
six, those with IQ scores in the bottom 15%, also
showed the greatest gains in cognitive development
at age 11. These results could not be explained as
simply the regression to the mean, but instead were
accounted for by the extra formal supports provided
at school to children who were most at risk. School--
based supports for developmentally challenged chil-
dren in the United Kingdom appear to favor the most
disadvantaged children but may not be sufficiently
available for children with less serious delays who
could still benefit from extra support.
There are, then, several principles that should be
accounted for when diagnosing resilience. First, the
severity and chronicity of risk matter. Second, there is
a cumulative effect of protective factors with dose–
response being dependent upon the availability and
accessibility of resources. Third, while individual
factors such as head circumference and neurological
functioning are important to predictions of resilience,
for children who are more severely affected by risk,
environmental factors like the level of violence in a
child’s home exert a differentially large impact on
development.
In summary, when thinking about resilience sys-
temically we misspeak when we say, ‘This child is
resilient.’ In fact, the etiology of both disorder and
successful coping is often found in the cumulative
effect of interactional patterns between the child and
the child’s social and physical ecologies. To further
illustrate, a longitudinal cohort study of Black boys in
the United States (one group particularly vulnerable to
oppression and social exclusion) during their elemen-
tary school years showed that higher scores on cogni-
tive skills in kindergarten predicted lower initial levels
of internalizing problems, though changes in the
severity of internalizing problems were influenced
most by maternal distress and the SES of the child’s
family (Brown et al., 2013). In fact, SES was strongly
correlated with maternal distress, early cognitive skills
and environmental risk, making it among the most
important factors to explain children’s behavior.
Examples such as this show that, first, children
travel different developmental trajectories through
adversity depending on the interaction between their
individual strengths and environmental resources
(Hobfoll, 2011), and second, environmental risk and
protective factors pile-up. Race and lower SES can
produce a cascade of negative consequences for
parents and children while the cumulative effect of
supportive homes and well-resourced schools can
affect positive outcomes for vulnerable children (Nix
et al., 2005). For these reasons, in contexts of
© 2014 Association for Child and Adolescent Mental Health.
doi:10.1111/jcpp.12306
greater adversity such as resettlement after a natural
disaster, war, domestic violence, neglect, and pov-
erty, remediation of a child’s environment is more
likely than individually oriented interventions to
decrease the incidence of disorder (Abramson et al.,
2010; Cicchetti, 2010; Kassis et al., 2013; Tol et al.,
2011; Ungar, 2013). Diagnosing childhood resilience
requires sensitivity to the complexity of these risk
factors, the protective processes that mitigate their
impact, and the temporal and cultural factors that
influence which aspects of resilience will have the
greatest impact on a child’s development.
Diagnostic features
A finding of resilience is possible if there is signifi-
cant chronic or acute exposure to risk and if there is
evidence of protective processes that the individual
is engaged in to mitigate risk exposure in socially
desirable ways (e.g. in most, but not all, cultures, the
child who delays first episode of sexual intercourse
despite earlier exposure to trauma or caregiver
neglect is more likely to be perceived as coping well
and avoiding the cascade of risks associated with
early sexual activity). Diagnosis should be multidi-
mensional and include a description of the adversity
the individual faces and its contextual relevance.
Regardless of the rate of exposure to adversity,
meta-analyses of studies of resilience have shown that
the capacity to adapt and function well is more
common than expected (Tol, Song, & Jordans,
2013). Furthermore, the pattern of risk exposure,
the quality of the resources available, their protective
function, and individual and collective coping strate-
gies are known to combine to produce a number of
different resilience processes, or subtypes. These
include: avoidant, unaffected, minimal impact, recov-
ery sustaining, maladaptive (or hidden), and growth
(Bonanno & Mancini, 2012; Masten, 2011). Each
subtype describes a different pattern of adaption to
adversity (e.g. large or small changes in mental health
over time), a different level of functional outcomes (e.g.
staying in school, avoiding substance abuse, or
maintaining attachments to significant others), and
differences in the social desirability of the coping
strategies that are used (e.g. a neglected child’s
emotionally avoidant strategy may be protective in
contexts where there is no possibility of engaging with
a caring adult). Though the research on these sub-
types is nascent, they demonstrate a growing under-
standing of the multifinality of resilience processes.
Specific gender, genetic, age, family/systems,
and cultural features
There are a number of factors that differentiate
children’s successful use of coping strategies. Males
and females, for example, show differences in their
capacity to cope with environmental load. In higher
risk neighborhoods, girls are more likely than boys to
© 2014 Association for Child and Adolescent Mental Health.
Diagnosing childhood resilience 11
show resilience through relational coping strategies
such as maintaining a peer group and attachments
to caring adults (Caughy et al., 2012). Genetic pre-
disposition to coping well may be distinguished by
neurological functioning under stress, with children
who have the capacity to self-regulate doing better
than those who do not (Buckner, Mezzacappa, &
Beardslee, 2003).
A number of contextual factors have also been
found to influence resilience, including the sociohis-
torical period in which children were born (Schoon,
2006), ethnoracial or cultural background (Claus-
s-Ehlers, 2008; Ungar & Liebenberg, 2011), and
family context (Erdem & Slesnick, 2010; Walsh,
2006). The child who is successful at one point in
time is seldom resilient in all contexts and through-
out all subsequent developmental periods, with
environmental load predicting periods of decline in
functioning (Werner & Smith, 2001).
Differential diagnosis
The research to support a description of a child as
resilient is still evolving as clinical cutoffs have not
been defined for how many resources, at what level
of adversity, in which culture or context is likely to
produce the highest measure of wellbeing. While
numerous studies propose the absence of clinical
disorder as evidence for resilience when exposure to
stressors predicts psychopathology, a more positive
and developmental orientation to the diagnosis of
resilience is preferred. Studies have shown that the
more an individual is engaged in processes that
either protect against risk exposure, prevent nega-
tive chain reactions after exposure, open opportuni-
ties for new coping strategies, or prevent exposure in
the first instance (promote access to the factors
associated with wellbeing), the more likely that
person is to show positive developmental patterns
of coping (e.g. engagement with a nondelinquent
peer group despite the criminal behavior of a parent)
(Rutter, 1987). Recent research supports a dosage
effect (the greater the number of individual, family
and community resources that are available and
accessible, the less disordered individual behavior
will be) as well as the cumulative impact of resil-
ience-related processes (engagement in one protec-
tive process, like maintaining a positive orientation
toward life or a healthy intimate relationship, will
increase the presence and quality of other resources
over time) (Laub & Sampson, 2003).
A diagnostic decision tree for resilience
Using the criteria in Table 1, we can diagnosis resil-
ience using a five-phase approach: (a) assess exposure
to adversity; (b) assess the differential impact of
promotive and protective factors/processes; (c) assess
the capacity of the environment to provide resources;
(d) assess whether coping strategies are experienced,
12 Michael Ungar J Child Psychol Psychiatr 2015; 56(1): 4–17

and/or perceived, as adaptive or maladaptive; and (e)
assess contextual and cultural considerations regard-
ing promotive and protective processes. Table 2 pre-
sents a Decision Tree for Diagnosing Resilience using
these five phases.
As discussed earlier, diagnosis of resilience
includes an assessment of adversity. An experience
of significant exposure to adversity (above that which
would normally be present at a community level, or
in particularly toxic environments like war, adverse
experiences that outsiders assess as potentially
traumatizing) is required. While there are no mini-
mum exposure criteria, assessment of risk exposure
using the five criteria listed under the domain
Adversity in Table 1 should show the child’s expo-
sure to be non-normative and reasonably predictive
of psychopathology or disordered behavior.
The second phase of diagnosis is to assess the
relevance and function of the promotive and protective
processes. To what extent are promotive and protective
processes responsive to specific risks? Depending on
the level of risk exposure, is it reasonable to expect
individual capacities to buffer the impact of these risks
or will contextual changes be necessary first? In
contexts of higher risk exposure, individual and envi-
ronmental resources will have a differential impact on
outcomes. It may, then, not be necessary to assess
individual characteristics associated with resilience
when these have little likelihood of exerting a positive
influence on child development until after a change in a
child’s social and physical ecology occurs and the child
is made safe. Where risk exposure is above average,
and there is evidence of the presence of individual or
environmental resources that are promotive or protec-
tive, a finding of resilience is predicted.
The third diagnostic phase is the assessment of the
child’s environment and the capacity it has to provide
resources. When the environment has sufficient social

Table 2 Decision tree for diagnosing resilience

Phase Description Status

(1) Assess exposure Is there evidence of above normal, or atypical, exposure to adversity, ☐ Yes
to adversity or that the individual has experienced events in his or her life that Continue assessment (Phase Two)
threaten wellbeing, regardless of whether the individual shows ☐ No
mental health or behavioral problems? The answer to this question Modify focus of assessment.
must be yes to proceed with the assessment. If the answer is no,
the assessment becomes an investigation of the individual’s
strengths, but not resilience.
(2) Assess the Is the individual’s abnormal exposure to risk excessively severe or ☐ Yes
differential impact of chronic? If yes, assessment of individual capacities may not be Proceed directly with assessment of
promotive and sufficient to determine resilience. Ecological factors should also be environmental resources (Phase
protective factors/ assessed. If exposure to risk is normal or mild, then more Three), then assess individual
processes emphasis should be placed on assessment of individual capacities. capacities.
Ecological factors may still be important, but their influence is ☐ No
expected to be lower than at higher levels of exposure to risk. Proceed with assessment of
Sufficient individual capacities may be enough to make individuals individual capacities, then conduct
resilient in contexts of less severe and less chronic exposure to an assessment of environmental
adversity. resources (Phase Three).
(3) Assess the In all contexts where there are abnormal levels of adversity (high, ☐ Yes
capacity of the medium and low), does the environment have the capacity to Environment has capacity to
environment to mitigate the impact of risk exposure? To assess, review the sustain resilience. Resilience is
provide resources availability and accessibility of resources, their strategic use, and Predicted.
whether the individual’s coping strategies are reinforced by others. ☐ No
An environment with sufficient resources to mitigate risk predicts When environmental resources are
resilience when resources are used and coping strategies judged few, resilience is only predicted if
favorably. abnormal levels of adversity are low
or medium, and there are individual
capacities to cope.
(4) Assess whether Are the promotive and protective processes used by the individual ☐ Yes
coping strategies are seen as adaptive by the individual? Depending on the social Coping strategies are either
experienced, and/or desirability of these coping strategies, and the individual’s ability experienced and/or perceived as
perceived, as to influence the perception of others (help them to understand why adaptive. Resilience is Predicted.
adaptive or a behavior is an appropriate response to adversity), individuals ☐ No
maladaptive may be assessed as resilient or maladapted. Coping strategies are experienced
and/or perceived as maladaptive.
Proceed with the assessment (Phase
Five).
(5) Assess contextual Do the individual’s coping strategies meet their own, and/or others’, ☐ Yes
and cultural expectations for how to behave under conditions of adversity? If (a) Resilience is predicted.
considerations maladaptive behaviors are reasonable given the environmental ☐ No
regarding promotive load and the availability and accessibility of resources, or (b) Coping strategies may be
and protective coping strategies reflect culturally relevant forms of adaptation temporarily functional, but
processes. that are reinforced by others, then a finding of (hidden, or resilience is not predicted.
culturally specific) resilience is appropriate.

© 2014 Association for Child and Adolescent Mental Health.

doi:10.1111/jcpp.12306
and physical capital to nurture and sustain resilience,
a child’s wellbeing is predicted.
This is more likely to occur, however, when, during
the fourth phase of diagnosis the child’s coping strat-
egies are shown to be personally helpful and perceived
by others as adaptive. A child who is doing whatever he
or she can do to survive (e.g. in the absence of a
therapeutic intervention, using self-harming behav-
iors to cope with trauma), but thought by others to be
doing poorly, will typically be diagnosed as mal-
adapted rather than resilient.
Finally, the fifth diagnostic phase invites a critical
analysis of the child’s coping strategies relative to
other possible patterns of adaptation. Culture deter-
mines what a socially desirable expression of resil-
ience will be. A critical stance helps us to understand
how factors like family values, life circumstance, age,
gender, sexual orientation and ability influence the
adaptive capacity of both individuals and the systems
with which they interact. When maladaptive coping
strategies are reasonable accommodations in chal-
lenging contexts, or coping strategies reflect nuanced
cultural norms, then resilience can be predicted even
though it may be overlooked by those living outside the
child’s culture and context.
Case example: diagnosing resilience in an
adverse context
The following is a brief description of an assessment
conducted by a community-based mental health ther-
apist employed at a government-funded clinic that
illustrates the application of the diagnostic criteria for
resilience to a child with complex needs. The patient,
Matthew, was a 15-year-old Native Canadian boy with
problems that were psychological (impulsivity, a threa-
tened cultural identification, and possible signs of
depression), behavioral (street fighting, truancy) and
contextual (the lack of a stable place to live or attachment
to a caregiver, exposure to racism and bullying). The
referral came from the boy’s probation officer who was
concerned with Matthew’s peer-on-peer violence.
Matthew had been mostly absent from school for the
past year after moving from one of the poorer suburbs
of a midsize city into a downtown basement apartment
with his 21-year-old sister, an older cousin and his
4-year-old nephew. Matthew had not wanted to move
from his mother’s home but, when he prevented his
uncle’s gas station from being robbed by a group of
white youth, several of them attacked Matthew. With a
gun pointed at Matthew’s head, they threatened worse
if he didn’t leave the community.
Matthew is a tall muscular boy with tattoos on both
arms. He said his father taught him to stand up for
himself, something Matthew had taken to heart even
though he seldom saw his father while growing up.
Matthew’s parents separated when Matthew was a
baby. He and his mother have lived in one subsidized
housing unit after another since then, often moving
once or twice a year. Matthew described his new living
© 2014 Association for Child and Adolescent Mental Health.
Diagnosing childhood resilience 13
arrangements as ‘a big house of stress,’ especially
since his mother moved in with them temporarily a few
weeks earlier, fleeing another abusive relationship.
Matthew’s sister and cousin were completing their
high school leaving certificates. To contribute to the
functioning of the household, Matthew volunteered to
look after his nephew most afternoons, picking him up
from his daycare at noon. Matthew did not mind
providing child care and explained that he did not see
the point to attending school all day since his goal was
to become a house painter like his father.
Since moving to his sister’s home, Matthew had been
harassed by other youth at his school. To help him
remain safe and avoid fights that would lead to a school
expulsion (a breach of his probation order), Matthew
was allowed to come to school 15 min late, and leave
early to avoid confrontations on school grounds or
when walking home. When not at school or providing
child care, he attended a local Native Friendship
Centre where he was relied upon as a volunteer.
Clinical assessment
While a clinical assessment identified evidence of
disorder, appreciation for Matthew’s resilience was
clinically useful when designing interventions. Not
only was his treatment team able to suppress his
disordered behavior, they also engaged Matthew in
several protective processes that positively influenced
his mental health. Based on the criteria set out in
Table 1, and following the steps described in Table 2,
an assessment of risk was done first (Phase One of the
Diagnostic Decision Tree). Matthew’s self-report
showed he met the criteria for severe and chronic
exposure to adversity. Stressors appeared at multiple
ecological levels with evidence of individual, family,
community and sociopolitical (e.g. racism, commu-
nity violence) factors contributing to cumulative risk
exposure. Matthew’s attribution was that he himself
could do little to change his situation though he was
willing to accept help from others when they inter-
vened to modify his environment. The changes that
were made appear to have been meaningful to Mat-
thew as demonstrated by his compliance with his
school schedule and change in living situation.
An assessment of the impact of protective processes
(Phase Two) showed that despite some serious limita-
tions with regard to learning and cognition, Matthew
had individual qualities that were associated with resil-
ience such as persistence and an ability to attach to
others. To the extent that his family, school and commu-
nity created opportunities for Matthew to successfully
express these personal qualities, his potential for resil-
ience was increased. Furthermore, Matthew attributed
the cause of his problems to himself or others (depending
on the problem), demonstrating an ability to realistically
appraise his individual influence over others.
Broadening the focus, Matthew’s environment
showed the capacity to provide resources and make
them accessible (Phase Three). He demonstrated strate-
14 Michael Ungar
gic use of many of these resources, such as his sister’s
home, the Native Friendship Centre, and an adapted
educational program. There was a strong latent capacity
of the environment to meet Matthew’s needs in adaptive
ways (e.g. modifying his school day to match his learning
needs and exposure to community risks).
Matthew’s coping strategies and use of the envi-
ronmental resources he had available provided an
atypical, but adaptive, pathway to resilience (Phase
Four). Furthermore, Matthew’s family perceived his
coping strategies as developmentally and culturally
appropriate (e.g. attending school half days) though
his educators and probation officer had to show
considerable flexibility in how they provided services
to Matthew (Phase Five).
Based on these patterns of both risk exposure and
adaptive coping, Matthew could be diagnosed with
resilience at multiple psychological and systemic
levels. The interactions between Matthew’s individual
capacities and an environment that had been responsive
in ways that were contextually and culturally relevant
provided a complex network of resources for Matthew.
We may conclude that Matthew’s resistance to more
serious mental disorder was mitigated by his access to
many individual and social determinants of wellbeing.
As the example illustrates, we can diagnose resil-
ience. Further development of a nosology is, how-
ever, required if we are going to consistently describe
diagnostic features of different protective processes
in very different contexts of adversity. Indeed, we
need greater specificity in the subtypes of resilience
and their specifiers, more studies with populations
that are coping well with stressors following inter-
vention, and research with nonclinical populations
that have avoided contact with service providers
altogether. We also need to account for culturally
diverse definitions of wellbeing.
Implications for practice
The study of resilience has added support to the adage
that ‘problem free is not fully able’. Research has
shown that mental health can be understood as a
two-factor phenomenon (Keyes, 2002; Reich & Zautra,
1988). The first factor is the presence or absence of
mental disorder. The second, the individual’s measure
of mental health which can also refer to a general sense
of wellbeing or resilience. Even when disorder is
present, individuals can still report experiences of
self-worth, a sense of coherence, relationships,
empowerment, cultural identification, and many other
qualities related to positive development under stress.
Though the two factors (mental disorder and mental
health) are related [e.g. a child that shows signs of early
psychosis may cope better with the disorder if she has a
supportive network of peers and adults, (Lal, Ungar,
Malla, Frankish, & Suto, 2014)], each factor can be
influenced independent of the other.
When we diagnosis resilience, we are focused on the
second factor and the biopsychosocial resources that
J Child Psychol Psychiatr 2015; 56(1): 4–17
predict mental health (Ungar, 2011). In this regard, the
process of diagnosing resilience informs more com-
plete treatment plans. Not only is the goal to decrease
the incidence of disorder (something that may not be
possible when mental disorders are chronic and
severe), but also to enhance the capacity of individuals
to cope with their adversity. The addition of resilience
to a comprehensive assessment of mental health and
mental disorder adds a broader spectrum of arenas in
which interventions may be effective.
While many persistent psychological problems
can be difficult to change, positive aspects of child
development can be impacted through changes to
children individually as well as their social and
physical ecologies. In conditions where exposure to
adversity is more extreme, shaping the child’s
environment is likely to be the better clinical inter-
vention. For example, better engagement at school
can decrease suicidal ideation among physically
and sexually abused children (McCreary Centre
Society, 2009); parenting courses indirectly help
children who have been exposed to mass trauma
learn to self-regulate (Gewirtz, Forgatch, & Wieling,
2008); and creating more cohesive, culturally rich
communities may mediate the negative impact of
racial and social marginalization that contribute to
suicide and violence (Chandler & Lalonde, 1998).
A more balanced assessment of mental health
status, one that focuses on both disorder and the
processes that support resistance to mental disor-
der and recovery, increases the range of interven-
tions that might be useful to a child.
By codifying the assessment of resilience, we may
also be able to better justify the time clinicians spend
enhancing the conditions for children’s mental health.
While mental health systems tend to provide financial
compensation for the treatment of disorders, changes
in children’s resilience should also be valued as a
worthwhile use of the clinician’s time. Case confer-
ences to help create a more engaging school environ-
ment free of bullying, family therapy that improves the
ability of parents and children to problem-solve,
intensive in-home support services, and commu-
nity-based efforts to increase wellbeing are all inter-
ventions that have shown potential to improve a
child’s resilience. They deserve to be funded. Diag-
nosing resilience, though, is only a first step toward
the validation of interventions that focus on the
promotion of wellbeing. Our next step must be to
create a larger evidence base for these interventions.
Acknowledgements
The author wishes to thank the Networks of
Centres of Excellence, Canada, and the Social
Sciences and Humanities Research Council of
Canada for their support of research and knowl-
edge mobilization activities that helped advance the
ideas discussed in this paper. The author also
wishes to acknowledge the financial support of the
© 2014 Association for Child and Adolescent Mental Health.
doi:10.1111/jcpp.12306 Diagnosing childhood resilience 15

Killam Trust who provided ongoing support of the Correspondence

author’s work at Dalhousie University. A special
thanks as well to the many readers who graciously
reviewed earlier drafts of this paper and provided
helpful critiques. The author has declared that he
has no financial or any potential or competing
conflicts of interest
Michael Ungar, Resilience Research Centre, Dalhou-
sie University, 6420 Coburg Road, PO Box 15000,
Halifax, B3H 4R2 Canada; Email: michael.ungar@
dal.ca

Key points

Key practitioner message

• A systemic approach to the diagnosis of resilience avoids viewing resilience as a static trait of an individual
child.
• Diagnosis should be multidimensional and include a description of the adversity the child faces and its
contextual relevance.
• Factors such as gender, genetics, age, family/systems, and culture influence a child’s coping strategies.
• A differential diagnosis can be used to determine whether there is enough evidence for a finding of resilience.
• In contexts of higher exposure to adversity, environmental factors may be more important to resilience than
individual factors.
• Even maladaptive patterns of coping may be signs of resilience in challenging contexts.
Areas for future research
• Are there clinical cutoffs or specific dosages of protective factors (individual and environmental) that mitigate
the impact of stressors and prevent psychological and behavioral problems?
• How do different levels of exposure to adversity, different contexts, and different cultures, affect these
cutoffs?
• In which contexts and under what conditions are children likely to develop maladaptive coping strategies as a
pathway to resilience?
• What is the relationship between higher levels of resilience and a child’s recovery from a mental disorder?
• Which resilience-promoting interventions are the most effective with which specific populations of children?

A handbook of theory and practice (pp. 347–356). New

References
Abramson, D.M., Park, Y.S., Stehling-Ariza, T., & Redlener, I.
(2010). Children as bellwethers of recovery: Dysfunctional
systems and the effects of parents, households, and
neighborhoods on serious emotional disturbance in
children after Hurricane Katrina. Disaster Medicine and
Public Health Preparedness, 4(Supp. 1), S17–S27.
Anda, R.F., Felitti, V.J., Bremner, J.D., Walker, J.D., Whitfield,
C., Perry, B.D., . . . & Giles, W.H. (2006). The enduring effects
of abuse and related adverse experiences in childhood:
A convergence of evidence from neurobiology and epide-
miology. European Archives of Psychiatry and Clinical
Neuroscience, 256, 174–186.
Asendorpf, J.B., & van Aken, M.A.G. (1999). Resilient,
overcontrolled, and undercontrolled personality prototypes
in childhood: Replicability, predictive power, and the
trait-type issue. Journal of Personality and Social
Psychology, 77, 815–832.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of
behavioral change. Psychological Review, 84, 191–215.
Beckett, C., Maughan, B., Rutter, M., Castle, J., Colvert, E.,
Groothues, C., . . . & Sonuga-Barke, E.J.S. (2006). Do the
effects of early severe deprivation on cognition persist into
early adolescence? Findings from the English and Romanian
Adoptees Study. Child Development, 77, 696–711.
Betancourt, T.S. (2012). The social ecology of resilience in
war-affected youth: A longitudinal study from Sierra Leone.
In M. Ungar (Ed.), The social ecology of resilience:
York: Springer.
Betancourt, T., Borisova, I., Williams, T., Brennan, R.,
Whitfield, T., De La Soudiere, M., . . . & Gilman, S.E. (2010).
Sierra Leone’s former child soldiers: A follow-up study of
psychosocial adjustment and community reintegration.
Child Development, 81, 1077–1095.
Bonanno, G.A., & Mancini, A.D. (2012). Beyond resilience and
PTSD: Mapping the heterogeneity of responses to potential
trauma. Psychological Trauma, 4, 74–83.
Bos, H., & Gartrell, N. (2010). Adolescents of the USA National
Longitudinal Lesbian Family Study: Can family characteristics
counteract the negative effects of stigmatization? Family
Process, 49, 559–572.
Bottrel, D. (2009). Understanding ‘Marginal’ perspectives:
towards a social theory of resilience. Qualitative Social
Work, 8, 321–339.
Bronfenbrenner, U., & Ceci, S.J. (1994). Nature-nurture
reconceptualised in developmental perspective: A Bioeco-
logical Model. Psychological Review, 101, 568–586.
Brown, J., Barbarin, O., & Scott, K. (2013). Socioemotional
trajectories in Black boys between Kindergraten and the fifth
grade: The role of cognitive skills and family in promoting
resiliency. American Journal of Orthopsychiatry, 83, 176–184.
Buckner, J., Mezzacappa, E., & Beardslee, W. (2003).
Characteristics of resilient youths living in poverty: The role
of self-regulatory processes. Development and Psycho-
pathology, 15, 139–162.
Burton, L.M., Allison, K.W., & Obeidallah, D. (1995). Social
context and adolescence: Perspectives on development
among inner-city African-American teens. In L. Crockett &

© 2014 Association for Child and Adolescent Mental Health.

16 Michael Ungar
A.C. Crouter (Eds.), Pathways through adolescence:
Individual development in relation to social context
(pp. 119–138). Hillsdale, NJ: Erlbaum.
Caughy, M.O., Franzini, L., Windle, M., Dittus, P., Cuccaro, P.,
Elliotte, M.N., . . . & Schuster, M.A. (2012). Social
competence in late elementary school: Relationships to
parenting and neighborhood context. Journal of Youth and
Adolescence, 41, 1613–1627.
Chandler, M.J., & Lalonde, C. (1998). Cultural continuity as a
hedge against suicide in Canada’s First Nations.
Transcultural Psychiatry, 35, 191–219.
Chartier, M.J., Walker, J.R., & Naimark, B. (2010). Separate
and cumulative effects of adverse childhood experiences in
predicting adult health and health care utilization. Child
Abuse & Neglect, 34, 454–464.
Chen, X., Cen, G., Li, D., & He, Y. (2005). Social functioning
and adjustment in Chinese children: The imprint of
historical time. Child Development, 76, 182–195.
Cheung, C., Goodman, D., Leckie, G., & Jenkins, J.M. (2011).
Understanding contextual effects on externalizing behaviors
in children in out-of-home care: Influence of workers and
foster families. Children and Youth Services Review, 33,
2050–2060.
Cicchetti, D. (2010). A developmental psychopathology
perspective on bipolar disorder. In D. Miklowitz &
D. Cicchetti (Eds.), Understanding bipolar disorder:
A developmental psychopathology perspective. New York:
Guilford.
Cicchetti, D. (2013). Annual research review: Resilient
functioning in maltreated children—past, present, and
future perspectives. Journal of Child Psychology and
Psychiatry, 54, 402–422.
Clauss-Ehlers, C.S. (2008). Sociocultural factors, resilience,
and coping: Support for a culturally sensitive measure of
resilience. Journal of Applied Developmental Psychology, 29,
197–212.
Coifman, K.G., Bonanno, G.A., Ray, R., & Gross, J.J. (2007).
Does repressive coping promote resilience? Affective-
autonomic response discrepancy during bereavement.
Journal of Personality and Social Psychology, 92, 745–758.
Dei, G., Massuca, J., McIsaac, E., & Zine, J. (1997).
Reconstructing “drop-out”: A critical ethnography of the
dynamics of Black students’ disengagement from school.
Toronto: University of Toronto Press.
Derauf, C., LaGasse, L., Smith, L., Newman, E., Shah, R.,
Arria, A., . . . & Lester, B. (2011). Infant temperament and
high-risk environment relate to behavior problems and
language in toddlers. Journal of Developmental and
Behavioral Pediatrics, 32, 125–135.
Elliott, D.S., Menard, S., Rankin, B., Elliott, A., Wilson, W.J., &
Huizinga, D. (2006). Good kids from bad neighborhoods:
Successful development in social context. New York:
Cambridge University Press.
Erdem, G., & Slesnick, N. (2010). That which does not kill you
makes you stronger: Runaway youth’s resilience to
depression in the family context. American Journal of
Orthopsychiatry, 80, 195–203.
Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F.,
Spitz, A.M., Edwards, V., & Marks, J.S. (1998). Relationship
of childhood abuse and household dysfunction to many of
the leading causes of death in adults. American Journal of
Preventive Medicine, 14, 245–258.
Flynn, R.J., Dudding, P.M., & Barber, J.G. (Eds.) (2006).
Promoting resilience in child welfare. Ottawa, ON: University
of Ottawa Press.
France, A., Bottrell, D., & Armstrong, D. (2012). A political
ecology of youth and crime. London: Palgrave Macmillan.
Friborg, O., Barlaug, D., Martinussen, M., Rosenvinge, J.H., &
Hjemdal, O. (2005). Resilience in relation to personality and
intelligence. International Journal of Methods in Psychiatric
Research, 14, 29–42.
J Child Psychol Psychiatr 2015; 56(1): 4–17
Gewirtz, A., Forgatch, M., & Wieling, E. (2008). Parenting
practices as potential mechanisms for child adjustment
following mass trauma. Journal of Marital and Family
Therapy, 34, 177–192.
Hjemdal, O., Friborg, O., Stiles, T.C., Martinussen, M., &
Rosenvinge, J.H. (2006). A new scale for adolescent
resilience: Grasping the central protective resources
behind healthy development. Measurement and Evaluation
in Counseling and Development, 39, 84–96.
Hobfoll, S. (2011). Conservation of Resources Theory: Its
implication for stress, health, and resilience. In S.
Folkman (Ed.), The Oxford handbook of stress, health,
and coping (pp. 127–147). New York: Oxford University
Press.
Hopkins, K.D., Taylor, C.L., D’Antoine, H., & Zubrick, S.R.
(2012). Predictors of resilient psychosocial functioning in
Western Australian Aboriginal young people exposed to figh
family-level risk. In M. Ungar (Ed.), The social ecology of
resilience: A handbook of theory and practice (pp. 425–440).
New York: Springer.
Karatoreos, I.N., & McEwen, B.S. (2013). Annual research
review: The neurobiology and physiology of resilience and
adaptation across the life course. Journal of Child
Psychology and Psychiatry, 54, 337–347.
Kassis, W., Artz, S., Scambor, C., Scambor, E., &
Moldenhauer, S. (2013). Finding the way out:
A non-dichotomous understanding of violence and
depression resilence of adolescents who are exposed to
family violence. Child Abuse & Neglect, 37, 181–199.
Kaufman, J. (2008). Genetic and environmental modifiers of
risk and resiliency in maltreated children. In J.J. Hudziak
(Ed.), Developmental psychopathology and wellness: Genetic
and environmental influences (pp. 141–160). Washington,
DC: American Psychiatric Publishing.
Kent, M. (2012). From neuron to social context: Restoring
resilience as a capacity for good survival. In M. Ungar (Ed.),
The social ecology of resilience: A handbook of theory and
practice (pp. 111–126). New York: Springer.
Keyes, C.L.M. (2002). The mental health continuum: From
languishing to flourishing in life. Journal of Health and
Social Research, 43, 207–222.
Klebanov, P., & Brooks-Gunn, J. (2006). Cumulative, human
capital, and psychological risk in the context of early
intervention: Links with IQ at ages 3,5, and 8. In B.M.
Lester, A.S. Masten & B. McEwen (Eds.), Resilience in
children (pp. 63–82). Boston: Blackwell.
Lal, S., Ungar, M., Malla, A.K., Frankish, J., & Suto, M.J.
(2014). Meanings of well-being from the perspectives of
youth recently diagnosed with psychosis. Journal of Mental
Health, 23(1), 25–30.
Laub, J.H., & Sampson, R.J. (2003). Shared beginnings,
divergent lives: Delinquent boys to age 70. Cambridge, MA:
Harvard University Press.
Layne, C., Saltzman, W., Poppleton, L., Burlingame, G.,
Pasalic, A., Durakovic, E., . . . & Pynoos, R.S. (2008).
Effectiveness of a school-based group psychotherapy
program for war-exposed adolescents: A randomized
controlled trial. Journal of American Academy of Child
Adolescent Psychiatry, 47, 1048–1062.
Leadbeater, B.J.R., & Way, N. (Eds.) (2007). Urban girls
revisited: Building strengths. New York: New York
University Press.
Lerner, R.M. (2006). Resilience as an attribute of the
developmental system: Comments on the papers of
Professors Masten & Wachs. In B.M. Lester, A.S. Masten &
B. McEwen (Eds.), Resilience in children (pp. 40–51). Boston:
Blackwell.
Liborio, R., & Ungar, M. (2013). Resilience as protagonism:
Interpersonal relationships, cultural practices and personal
agency among working adolescents in Brazil. Journal of
Youth Studies, 17, 682–696.
© 2014 Association for Child and Adolescent Mental Health.
doi:10.1111/jcpp.12306
Luthar, S.S. (2006). Resilience in development: A synthesis
of research across five decades. In D. Cicchetti, & D.J.
Cohen (Eds.), Developmental psychopathology: Vol.3.
Risk, disorder and adaptation (2nd ed., pp. 739–795).
New York: Wiley.
Masten, A. (2011). Resilience in children threatened by
extreme adversity: Frameworks for research, practice, and
translational synergy. Development and Psychopathology,
23, 493–506.
Masten, A.S. (2014). Global perspectives on resilience in
children and youth. Child Development, 85, 6–20.
McCreary Centre Society (2009). A picture of health: Highlights
from the 2008 BC adolescent health survey. Vancouver:
McCreary Centre Society.
Munford, R., & Sanders, J. (2007). Borders, margins
and bridges: Possibilities for change for marginalized young
women. Community Development Journal, 42, 317–329.
Nix, R.L., Pinderhughes, E.E., Bierman, K.L., & Maples, J.J.
(2005). Decoupling the relation between risk factors for
conduct problems and the receipt of intervention services:
Participation across multiple components of a prevention
program. American Journal of Community Psychology, 36,
307–325.
Obrist, B., Pfeiffer, C., & Henley, R. (2010). Multi-layered social
resilience: A new approach in mitigation research. Progress
in Development Studies, 10, 283–293.
Raphael, D. (2004). Introduction to the social determinants of
health. In D. Raphael (Ed.), Social determinants of health:
Canadian perspectives (pp. 1–18). Toronto, ON: Canadian
Scholars’ Press.
Reich, J.W., & Zautra, A.J. (1988). Direct and
stress-moderating effects of positive life experiences. In
L.H. Cohen (Ed.), Life events and psychological functioning:
Theoretical and methodological issues (pp. 149–180).
Newbury Park, CA: Sage.
Rettew, D.C. (2008). Temperament and child psychopathology:
Beyond associations. In J.J. Hudziak (Ed.), Developmental
psychopathology and wellness: Genetic and environmental
influences (pp. 67–84). Washington, DC: American
Psychiatric Publishing.
Rutter, M. (1987). Psychosocial resilience and protective
mechanisms. American Journal of Orthopsychiatry, 57,
316–331.
Rutter, M. (2000). Psychosocial influences: Critiques, findings
and research needs. Development & Psychopathology, 12,
375–405.
Rutter, M. (2012). Resilience: Causal pathways and social
ecology. In M. Ungar (Ed.), The social ecology of resilience: A
handbook of theory and practice (pp. 33–42). New York:
Springer.
S!
anchez-Jankowski, M. (2008). Cracks in the pavement: Social
change and resilience in poor neighborhoods. Los Angeles,
CA: University of California Press.
© 2014 Association for Child and Adolescent Mental Health.
Diagnosing childhood resilience 17
Saul, J. (2014). Collective trauma, collective healing. New York:
Routledge.
Schoon, I. (2006). Risk and resilience: Adaptations in changing
times. Cambridge, UK: Cambridge University Press.
Stevenson-Hinde, J. (2011). Culture and socioemotional
development, with a focus on fearfulness and attachment.
In X. Chen & K.H. Rubin (Eds.), Socioemotional development
in cultural context (pp. 11–28). New York: Guilford.
Supkoff, L.M., Puig, J., & Sroufe, L.A. (2012). Situating
resilence in developmental context. In M. Ungar (Ed.), The
social ecology of resilience: A handbook of theory and
practice (pp. 127–142). New York: Springer.
Tol, W.A., Barbui, C., Galappatti, A., Silove, D., Betancourt,
T.S., Souza, R., . . . & van Ommeren, M. (2011). Mental
health and psychosocial support in humanitarian settings:
Linking practice and research. Lancet, 378, 1581–1591.
Tol, W.A., Song, S., & Jordans, J.D. (2013). Annual research
review: Resilience and mental health in children and
adolescents living in areas of armed conflict—a systemic
review of findings in low- and middle-income countries.
Journal of Child Psychology and Psychiatry, 54, 445–460.
Ungar, M. (2004). Nurturing hidden resilience in troubled youth.
Toronto, ON: University of Toronto Press.
Ungar, M. (2011). Community resilience for youth and families:
Facilitative physical and social capital in contexts of adversity.
Children and Youth Social Services Review, 33, 1742–1748.
Ungar, M. (2013). Resilience, trauma, context and culture.
Trauma, Violence, & Abuse, 14, 253–264.
Ungar, M., Brown, M., Liebenberg, L., Othman, R., Kwong, W.M.,
Armstrong, M., & Gilgun, J. (2007). Unique pathways to
resilience across cultures. Adolescence, 42(166), 287–310.
Ungar, M., Ghazinour, M., & Richter, J. (2013a). What is
resilience within the ecology of human development?
Journal of Child Psychology and Psychiatry, 54, 348–366.
Ungar, M., & Liebenberg, L. (2011). Assessing resilience across
cultures using mixed-methods: Construction of the child
and youth resilience measure-28. Journal of Mixed-Methods
Research, 5, 126–149.
Ungar, M., Liebenberg, L., Armstrong, M., Dudding, P., & van
de Vijver, F.J.R. (2013b). Patterns of service use, individual
and contextual risk factors, and resilience among
adolescents using multiple psychosocial services. Child
Abuse & Neglect, 37, 150–159.
Walsh, F. (2006). Strengthening family resilience, 2nd ed. New
York, NY: Guilford.
Werner, E.E., & Smith, R.S. (2001). Journeys from childhood to
midlife: Risk, resilience, and recovery. Ithaca, NY: Cornell
University Press.
Accepted for publication: 28 March 2014
Published online: 1 August 2014