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Social-Emotional Functioning at School Entry Linked to Mental Health Diagnoses at 14

January 10, 2019

By Anne Harding

NEW YORK—Children who have internalizing and externalizing symptoms or low social competence when they start school are at increased risk of mental-health problems in adolescence, according to new findings from Canada.

"At a population-level, most children in British Columbia were entering school with overall very high social-emotional functioning. However, over 40% of children were entering school with some social-emotional vulnerabilities, and children with the most vulnerabilities had up to eight times the odds of a mental-health condition by age 14 relative to their peers," Dr. Kimberly C. Thomson of the University of British Columbia in Vancouver, the lead author of the new study, told Reuters Health by email.

"We also observed notable cross-over between early symptoms and later conditions - for example, children with high aggression at age 5 had higher odds of conduct problems by age 14 as one might expect, but also higher odds of anxiety and depression," she added. "This finding was consistent with other current research showing a high degree of comorbidity and progression between mental-health conditions."

Dr. Thomson and her team looked at the Developmental Trajectories cohort of more than 34,000 children born in British Columbia in 1996-1998, including 15,204 who completed follow-up at age 14. The cohort links child-development data assessed using the Early Development Instrument (EDI) to provincial health and school records.

Children with no externalizing or internalizing symptoms at school entry were classified as social-emotional functioning profile 1, and made up 58.4% of the cohort, the researchers report in JAMA Network Open, online January 4.

There were five more latent profiles among the 41.6% of children with internalizing/externalizing symptoms: 2, inhibited-adaptive (8.3%); 3, uninhibited-adaptive (16.4%); 4, inhibited-disengaged (6.2%); uninhibited-aggressive and hyperactive (7.8%); and overall low social-emotional functioning (2.8%).

Between age 6 and 14, 4.0% of the children were diagnosed with depression, 7.0% with anxiety, 7.1% with attention deficit hyperactivity disorder (ADHD), and 5.4% with multiple conditions.

Overall, children with internalizing symptoms at school entry were at increased risk of internalizing conditions, while those with early externalizing symptoms developed externalizing conditions. Children in the profile-4 group were more likely to develop depression, while those in profile 5 and 6 were more likely to be diagnosed with conduct disorder or ADHD.

"Recent research indicates that mental health conditions may have shared genetic and environmental causes and that the expressions of early emotional problems may operate more like a phenotype, with variations in outcomes influenced by children’s social, biological and physical environments," Dr. Thomson and her team write.

"Future research is need to better understand the mechanisms that contribute to shared mental health symptoms in childhood, with the goal of identifying where progressions from early symptoms to qualified mental health disorders can be interrupted or shifted to less severe conditions," they add.

"Because such a high proportion of children were observed to have social-emotional vulnerabilities by the time they started school, we've suggested that universal, school-based interventions may be a place to start," Dr. Thomson said. "That is, programs and services promoting social-emotional development that are provided to all children from an early age. There is also a large body of evidence suggesting we need to intervene even more upstream with policies and systems that create better conditions for families long before children reach school."


JAMA Netw Open 2019.

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