Epidemiologic studies to examine how childhood events or circumstances are associated with adult health have largely focused on the outcomes of chronic disease and risk behaviors rather than well-being. Recently, there has been a shift from studying the impacts of adverse childhood experiences to studying the impacts of positive childhood experiences.1 However, these studies often show that positive experiences are associated with fewer negative adult outcomes rather than with greater well-being.2

There are many dimensions of both positive childhood experiences and adult well-being. We recently reported in this journal on the association between childhood family connection and adult flourishing.3 We used the term flourishing to refer specifically to eudaimonic well-being, a construct that describes psychological functioning with an emphasis on having a sense of meaning and purpose that involves self-realization and self-actualization.4 We chose this framework of adult well-being, rather than the hedonic framework, because we felt the former was more compatible with the experience of managing adversity during growth and development. We focused on childhood emotional connection with parents, one dimension of positive childhood experiences, because it reflected a child’s exposure to adults with relational health, or those with the capacity to develop and maintain safe, stable, and nurturing relationships with children.5 Using survey data from 4,199 US adults in the Midlife in the United States Study (2004-2014), we showed that a 1 SD increase in a score of childhood family connection was associated with a 0.25 (95% CI, 0.20, 0.29) SD increase in a score of adult flourishing, after controlling for adult socioeconomic disadvantage and chronic disease. This association was also present across levels of childhood adversity.3 We describe studies, published since ours was submitted on October 20, 2020, that support and extend our findings, and we discuss future research directions in this area.

Using population-based samples outside the US, three new studies have supported our original findings.6, 7, 8 Although we have used the term flourishing to refer to eudaimonic well-being, the term has been used to describe both eudaimonic and hedonic dimensions of adult well-being, and these new studies assessed both dimensions. Using data from a cross-sectional survey administered in 2022 to 9,468 young adults from Mainland China, Yu and colleagues demonstrated significant, positive correlations (r = 0.19 to 0.28) between positive household experiences during childhood (e.g., felt safe and protected by an adult in your home) and current assessments of meaning and purpose as well as happiness and life satisfaction.8 Jakobsen and colleagues, in a prospective cohort study in Denmark, assessed approximately 1,800 individuals in 2004 during adolescence (age 14-15 years) and again in early adulthood (age 20-21 years). Paternal support in adolescence (e.g., he understands my problems and worries), but not maternal support, was significantly associated with meaningfulness in early adulthood. Both maternal and paternal support were significantly associated with a single question about life satisfaction (How do you feel about your life as a whole?).6 Finally, in prospective studies involving over 10,000 participants from two British birth cohorts (1946 and 1970), Wood and colleagues found that parental care in childhood (e.g., spoke to me in a warm and friendly voice) was significantly associated with a measure of adult well-being that combined eudaimonic and hedonic dimensions.7

Additionally, we have extended our original findings with two recent studies. Using data from the Midlife in the United States Study (2004-2014), we created a more specific measure of childhood parental connection by not reverse scoring the five items describing connection on the emotional neglect subscale of the Childhood Trauma Questionnaire.9 For each 1 SD increase in this childhood parental connection score, there was a 0.24 (95% CI, 0.20, 0.28) SD increase in the adult flourishing score and a -0.23 (95% CI, -0.27, -0.19) SD decrease in the adult depressive symptoms score. In a cross-sectional study of over 37,000 11- to 13-year-olds in 26 countries (2016-2019), the prevalence of flourishing, based on a six-item measure of eudaimonic well-being for youth, rose across five levels of increasing family connection from 34.9% (95% CI, 33.3%, 36.5%) to 84.3% (95% CI, 83.6%, 85.1%).10

These new studies support and extend our original findings using prospective designs, non-US samples, the hedonic dimension of flourishing, a more specific measure of connection, and assessment of eudaimonic well-being during adolescence. However, these observational studies do not prove a causal association. There is inherent subjectivity in the assessment of connection and flourishing, and the mechanisms linking childhood parental connection to adult well-being, though plausible, remain uncertain.

Existing clinical practices supporting relational health should continue,5 because they appear to foster the development of a healthy social nervous system. Furthermore, efforts to increase childhood parental connection are aligned with parental aspirations for their children and are actionable, associated with benefits in childhood and adulthood, and unlikely to do harm.

Future research might be best directed toward understanding what types of connection, at what ages, and with which adults are the most important for flourishing across the life course. Qualitative research might determine what makes parents and children feel most and least connected to one another. We have hypothesized that emotional connection, perhaps the very opposite of emotional neglect, is what gives children the sense of being safe and seen and that this is what matters most for later flourishing.9 “Being” with children in a way that affirms their inner experiences, from joy to frustration, may matter as much as the activities adults are “doing” with children.10What adults do with children matters, but so does how they do it. Children need the affordance of activities, including those that challenge them, but the emotional climate created around these experiences may be the most important part of childhood connection with adults. Furthermore, the adults who can provide children with emotional connection are not limited to parents or other primary caregivers in the household. Teachers, coaches, relatives, neighbors, and clinicians with relational health can all participate in building a web of safety, nurturance, and support that helps children develop the relational capacities they need to make meaning through relationships.