NYT October 21, 2003 Rise in Income Improves Children's Behavior By ANAHAD
O'CONNOR

The notion that poverty and mental illness are intertwined is nothing new,
as past research has demonstrated time and time again. But finding
evidence that one begets the other has often proved difficult.

Now new research that coincided with the opening of an Indian casino may
have come a step closer to identifying a link by suggesting that lifting
children out of poverty can diminish some psychiatric symptoms, though
others seem unaffected.

A study published in last week's issue of The Journal of the American
Medical Association looked at children before and after their families
rose above the poverty level. Rates of deviant and aggressive behaviors,
the study noted, declined as incomes rose.

"This comes closer to pointing to a causal relationship than we can
usually get," said Dr. E. Jane Costello, a psychiatric epidemiologist at
Duke who was the lead author. "Moving families out of poverty led to a
reduction in children's behavioral symptoms."

The study took place over eight years in rural North Carolina and tracked
1,420 children ages 9 to 13, 25 percent of them from a Cherokee
reservation. Tests for psychiatric symptoms were given at the start of the
study and repeated each year.

When the study began, 68 percent of the children were from families living
below the federally defined poverty line. On average, the poorer children
exhibited more behaviors associated with psychiatric problems than those
who did not live in poverty. But midway through the study, the opening of
a local casino offered researchers a chance to analyze the effects of
quick rises in income.

Just over 14 percent of the American Indian children rose above the
poverty level when the casino started distributing a percentage of its
profits to tribal families. The payment, given to people over age 18 and
put into a trust fund for those younger, has increased slightly each year,
reaching about $6,000 per person by 2001.

"This is unique because it's a situation where everybody got the extra
money," Dr. Costello said. "You can't take a bunch of babies and randomly
assign them to grow up in comfort or poverty. So this is about as close to
a natural experiment as you can get."

When the researchers conducted their tests soon after, they noticed that
the rate of psychiatric symptoms among the children who had risen from
poverty was dropping. As time went on, the children were less inclined to
stubbornness, temper tantrums, stealing, bullying and vandalism -- all
symptoms of conduct and oppositional defiant disorders.

After four years, the rate of such behaviors had dropped to the same
levels found among children whose families had never been poor. Children
whose families broke the poverty threshold had a 40 percent decrease in
behavioral symptoms. But the payments had no effect on children whose
families had been unable to rise from poverty or on the children whose
families had not been poor to begin with.

The researchers also found that symptoms of anxiety and depression,
although more common in poor children, remained the same despite moving
out of poverty.

The deciding factor appeared to be the amount of time parents had to
supervise their children. Parents who moved out of poverty reported having
more time to spend with their children. In the other groups, the amount of
time the parents had on their hands was not much different.

"What this shows very nicely is that an economic shift can allow for more
time and better parenting," said Dr. Nancy Adler, professor of medical
psychology at the University of California at San Francisco.

In children, acting out is often a result of frustration that can stem
from feeling ignored or not getting enough validation from the parents,
said Dr. Arline Geronimus, a professor of public health at the University
of Michigan.

As a result, behaviors associated with frustration would be the first to
change when parents had more attention to devote to their children.
"Anxiety and depression, on the other hand, are a little more extreme and
might not be as susceptible to change," Dr. Geronimus added.

Recent research suggests that anxiety disorders and depression run in
families and probably reflect a mix of genetic and environmental causes.

The study highlights the role that adult supervision may have on mental
health in children, but another factor, Dr. Geronimus said, may be the
psychological benefits that the casino payments produce.

The Indian families were much more likely to be poor than their non-Indian
neighbors at the start of the study. After the payments, though, a higher
proportion of Indian families moved out of poverty.

"There's the possibility that this improved the general outlook of the
families -- that the whole community has more than before," Dr. Geronimus
said. "In addition to the material resources, there might have been some
psychological benefits."

Those psychological benefits may also be a byproduct of the jobs that the
casino has generated, said James Sanders, director of an adolescent drug
and alcohol treatment center on the reservation.

"The jobs give people the chance to pull themselves up by their bootstraps
and get out of poverty," said Mr. Sanders, whose son took part in the
study. "That carries over into less juvenile crime, less domestic violence
and an overall better living experience for the families."

But one question that lingers is why the economic change had a significant
effect on only a small proportion of the children. All of the families
that received the payment were given the same amount of money, but only 14
percent moved out of poverty while 53 percent remained poor.

The answer could be related to the number of siblings in each family. A
$6,000 payment could be a huge help to a poor family with one child, for
example, "but that money might not go as far for a family with multiple
children," Dr. Adler said.

In 2002, the average poverty threshold for a family of three was $14,348.

Though some questions remain, the study ultimately suggests that poverty
puts stress on families, which can increase the likelihood that children
will develop behavioral problems. That, said Dr. Geronimus, speaks to the
notion that welfare policy is heading in the wrong direction.

"Parents on welfare are increasingly required to work more and more hours
while spending less time with their families," she said. "These findings
suggest the opposite: parents value having more time to spend with their
kids, not less, and their kids respond favorably to that."

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