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Many children may start school with social-emotional vulnerabilities

Findings from a prospective cohort study of more than 30,000 children showed that more than 40% started school with vulnerabilities in social-emotional functioning tied to emerging mental health conditions.

Prior longitudinal studies have demonstrated that early symptoms of internalizing and externalizing conditions, especially depression and conduct problems, are linked to earlier onset and greater severity of the same conditions later, according to Kimberly C. Thomson, PhD, of the University of British Columbia School of Population and Public Health, and colleagues.

“In the context of childhood social-emotional functioning, key knowledge gaps remain, including how internalizing and externalizing symptoms co-occur in the context of positive behaviors, such as social skills, and the extent to which patterns of early social-emotional symptoms are associated with mental health conditions,” they wrote in JAMA Network Open.

Researchers examined 34,552 Canadian children from birth to age 14 years to determine profiles of early childhood social-emotional functioning at age 5 years when they began kindergarten. Social-emotional functioning was defined as teacher-rated social competence, internalizing and externalizing symptoms. They also assessed whether these profiles were linked to early-onset mental health conditions — including depression, anxiety, conduct disorder and ADHD — from ages 6 to 14 years.

Analysis yielded six social-emotional functioning profiles at school entry, according to the results. Most children had high scores across all subscales on the Early Development Instrument; however, 14,262 children (41.6%) demonstrated comparative vulnerabilities in internalizing or externalizing behaviors. Thomson and colleagues found that the prevalence of mental health conditions from childhood to adolescence was 4% for depression, 7% for anxiety, 5.5% for conduct disorder, 7.1% for ADHD and 5.4% for multiple conditions.

In addition, the results showed that social-emotional functioning profiles when children entered kindergarten were linked to mental health conditions by age 14 years. After adjusting for demographic characteristics, analyses indicated that children classified in successively more vulnerable social-emotional functioning profiles in kindergarten usually were at higher risk for being diagnosed with depression, anxiety, conduct disorder and ADHD as well as multiple conditions from childhood to adolescence.

Furthermore, youth with higher teacher-rated symptoms of aggression and hyperactivity also had more consultations with a physician for conduct disorder, ADHD and multiple mental health conditions, according to study findings.

“Our results further support the notion that addressing early social-emotional symptoms, such as aggression or low social competence, may have overlapping benefits for reducing future externalizing disorders as well as internalizing disorders, and future studies should assess the extent to which this is effective,” Thomson and colleagues wrote. – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.