Healthy and ready for school?Findings from the

Growing Up in Scotland study

Presentation to East & Midlothian

Equally Well Test Site

28th October 2010

Today’s presentation

• Background to the study

• Health inequalities in the early years

• ‘School readiness’

• Formal and informal support for parents

• Discussion

Discussion questions

1.Are these findings useful, or not?

2.Do they confirm your experience, or not?

3.Do the findings have any implications for the way that services are resourced and/or delivered?

4.Who else needs to know about these findings and how should we communicate them?

What is the Growing Up in Scotland study?

GUS: The A to Z of the Early Years

Accidents and injuries

Attachment

Behaviour

Child health

Diet

Childcare

Education

Family

Lone parents

Mental health

Neighbourhood

Obesity

Parental support

Parenting styles

Resilience

Social networksZoo visits!

Physical activity

Research Objectives• To provide data and information

– Characteristics, circumstances and experiences of children in Scotland aged between 0 and 5

– Longer-term outcomes across a range of key domains– Levels of awareness and use of key services– Nature and extent of informal sources of help, advice

and support for parents• To document differences

– Characteristics, circumstances and experiences of children from different backgrounds

– Longer-term outcomes for children from different backgrounds

• To identify key predictors– E.g. of adverse longer-term outcomes – With particular reference to the role of early years

Study design: ages and stagesAge at interview

Year 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8

2005 BC1(5217)

CC1(2858)

2006 BC1(4512)

CC1(2500)

2007 BC1(4191)

CC1(2331)

2008 BC1(3994)

CC1(2200)

2009 BC1 -

2010 BC1 -

2011 BC2 -

2012 - BC1

School records

School records

Health records

Cognitive assessmts

Main carer

(2009/10)

BC only

GUS5

Health records

Child height & weight

Main carer

(2010/11)

BC only

GUS6

Child height & weight

Child height & weight

Cognitive assessmts

Health records

Main carer

(2008/9)

GUS4

Health

records

Main carer

(2007/8)

GUS3

Health records

Partner

Main carer

(2006/7)

GUS2(2005/6)

Main carer

Health

records

GUS1

School records

School records

Health records

Cognitive assessmts

Main carer

(2009/10)

BC only

GUS5

Health records

Child height & weight

Main carer

(2010/11)

BC only

GUS6

Child height & weight

Child height & weight

Cognitive assessmts

Health records

Main carer

(2008/9)

GUS4

Health

records

Main carer

(2007/8)

GUS3

Health records

Partner

Main carer

(2006/7)

GUS2(2005/6)

Main carer

Health

records

GUS1

Sources of information

Study content:

Core topics of the main interview • Household composition and family

demographics• Non-resident parents• Parental support• Parenting styles• Childcare• Child health and development• Activities with others• Education and employment • Accommodation and transport• Income and benefits

Study content: Other topics covered in the interview

• Parental health and well-being

• Early experiences of pre-school

• Early experiences of primary school

• Pregnancy and birth

• Involvement of grandparents

• Material deprivation

• Food and nutrition

• Physical and sedentary activity

• Housing and neighbourhood

• Social networks and social capital

Research questions

• What is the extent and character of health inequalities in the early years?

• What factors, if any, correlate with the avoidance of negative early health outcomes, among families from disadvantaged backgrounds? (Resilience)

Health inequalities in the early years

GUS shows that children living in households in areas of high deprivation and/or in low income households were more likely to have:

• A mother who smoked (including during pregnancy)

• Never been breastfed• A mother with a long-term health problem or

disability• Poor diet and low levels of physical activity at

age 3

‘Risk factors’ for poor health

Area deprivation

Inequalities in pregnancy

0

10

20

30

40

50

60

70

Highest 20% Lowest 20%

Pregnancy unplanned

Mother smoked in pregnancy

Never breastfed

• Birth weight

• General health (rated by parents)

• Experience of long-term health problems

• Accidents

• Reported behaviour difficulties

• Problems with cognitive or language development

Child health outcomes

0

10

20

30

40

0 1 2 3 4+

Scotland

Most deprived 20%

Total number of negative outcomes

• Child factors– Being a girl

• Maternal factors– Not experiencing a long-term condition in child’s early years– Older age at birth– Having a positive attitude towards seeking help and advice

early on• Household factors

– An enriched home learning environment– At least one adult in full-time work

• Neighbourhood factors– Having higher satisfaction with facilities in local area

What might help disadvantaged children avoid negative outcomes?

‘Children’s social, emotional and behavioural characteristics at entry to primary school’Key research questions

What is the extent and nature of social, emotional and

behavioural difficulties among Scottish children

around the time they enter primary 1?

Which children are most likely to have such

difficulties at school entry?

What is the relationship between early behaviour (at pre-school) and later

behaviour?

Methods

• Analysis restricted to child cohort, all started school in Aug 2007 or 2008.

• Social, emotional and behavioural development measured via Strengths and Difficulties Questionnaire (SDQ)

% of children with moderate or severe difficulties

10

27

17

15

7

11

0 10 20 30

Pro-social

Total difficulties

Emotional symptoms

Conduct problems

Hyperactivity

Peer problems

%

Patterns of shared difficulties

Cluster 1 – 17%:

Low pro-social scores, but average scores for

difficulty scales

Cluster 2 – 37%:

High pro-social scores, low scores on difficulty

scalesCluster 3 – 11%:

Low pro-social scores, high scores on all difficulty

scales esp. hyperactivity

Cluster 4 – 10%:

Average pro-social scores, but high scores for difficulty scales esp.

emotional symptoms

Cluster 5 – 25%:

High pro-social scores, generally low scores for difficulty slightly higher hyperactivity

Factors associated with behavioural difficulties

Emotionalsymptoms

Conduct problems

Hyper-activity

Peer problems

Lone parent

Lower income

Poorer health

Harsh discipline

Low parent interaction

Fewer social visits

Less than 2 siblings

Lower income

Poorer health

Develop-mentaldelay

Male

Lower income

Poorer health

Younger mother

Low parent interaction

Fewer social visits

Speech probs age 2

Non-white mother

Speech probs age 2

Classification at pre-school by classification at primary school entry

Row percentages Classification of score at entry to primary school

Classification of score at pre-school (age 46 months) Normal Borderline Abnormal

Conduct problems

Normal (%) 85 11 4

Borderline (%) 57 25 19

Abnormal (%) 31 27 42

Emotional symptoms

Normal (%) 91 5 4

Borderline (%) 65 18 17

Abnormal (%) 46 15 39

• Most children entering primary school in Scotland do not display any particular difficulties in their social, emotional and behavioural development.

• A small proportion do have quite severe difficulties including around one-fifth who display higher than average difficulties across several developmental domains.

• Health, development and parenting factors were more closely related to behavioural development than economic or demographic characteristics

• There is a general decrease in difficulties between pre-school and primary school. But many who have difficulties at age 3 still have them at school entry other develop difficulties in the pre-school period.

Summary of findings

• Maternal mental health was associated with socio-economic disadvantage, poorer relationships and poor social support

• Poor maternal mental health at 10 months was a predictor of poor mental health beyond the first year

• Children’s emotional, social and behavioural development at 46 months was associated with their mothers’ emotional well-being

• When controlling for other factors, maternal mental health did not have a significant impact on child cognitive development at 34 months

• Should mothers’ mental health be monitored beyond the first year ?

Conclusions from maternal mental health report

Support for parents – formal and informal

‘If you ask for help or advice on parenting from professionals like doctors or social workers, they start interfering or trying to take over’

‘Professionals like health visitors and social workers do not offer parents enough advice and support’

‘If other people knew you were getting professional advice or support with parenting they would probably think you were a bad parent’

Attitudes towards seeking help or advice from professionals

24.4

11.6

5.88.3

29.9

25.8

19.421.4

22.9

15.9 14.8 13.6

0

5

10

15

20

25

30

35

40

Under 20 20 to 29 30 to 39 40 or older

%

Start interfering Think you're a bad parent Don't offer enough advice

Agreement with statements by maternal age at child’s birth(Source: GUS Sweep 1 birth cohort, babies aged 10 months)

Attitudes towards professional support

Informal support and social networks

Extensive use of informal support amongst parents with young children:

• Information and advice from family and friends during pregnancy and in relation to child health.

• Younger mothers less likely to attend classes or groups, more likely to say they feel shy or awkward and don’t like groups (including antenatal)

• Grandparents a key source of support – many providing informal childcare, particularly for younger mothers and those living low-income households.

• Strength of social networks – stronger networks associated with more advantaged circumstances – impacts on parents and children.

• Mental health - mothers reporting low levels of support from family and/or the local community were more likely to have experienced mental health difficulties during the first four years of their child’s life.

Parents who feel supported:

Support for parents – the story from GUS

Do more ‘home learning’ activities with their children

positive impact on child cognitive development

Are more open to seeking help and advice when required

Are less likely to experience mental health difficulties

positive impact on child social, emotional & behavioural development

contributes to ‘school readiness’

‘resilience’ (avoiding early negative health outcomes)

GUS is funded by the Scottish Government and is being carried out by the Scottish Centre for Social Research (ScotCen) in collaboration with the Centre for Research on Families and Relationships (CRFR) at the University of Edinburgh and the MRC Social & Public Health Sciences Unit at the University of Glasgow.

For more information about GUS and to download research findings, please visit: www.growingupinscotland.org.uk

Or contact:Lesley Kelly, GUS Dissemination OfficerCRFR, University of Edinburghlesley.kelly@ed.ac.uk