Data resource profile: the Edinburgh Child Protection Dataset - a new linked administrative data source of children referred to Child Protection paediatric services in Edinburgh, Scotland.

Introduction: Child maltreatment affects a substantial number of children. However current evidence relies on either longitudinal studies, which are complex and resource-intensive, or linked data studies based on social services data, which is arguably the tip of the iceberg in terms of children who are maltreated. Reliable, linked, population-level data on children referred to services due to suspected abuse or neglect will increase our ability to examine risk factors for, and outcomes following, abuse and neglect. Objective: The objective of this project was to create a linkable population level dataset, The Edinburgh Child Protection Dataset (ECPD), comprising all children referred to the Edinburgh Child Protection Paediatric healthcare team due to a concern about their welfare between 1995 and 2015. Methods: The paper presents the process for creating the dataset. The analyses provide examples of available data from the main referrals dataset between 1995 and 2011 (where data quality was highest). Results: 19,969 referrals were captured, relating to 11,653 children. Of the 19,969 referrals, a higher proportion were girls (54%), although boys were referred for physical abuse more often than girls (41% versus 30%). Younger children were more likely to be referred for physical abuse (35% of 0-4 year olds vs. 27% 15+): older children were more likely to be referred for sexual abuse (48% of 15+ years vs. 18% of 0-4 years). Most referrals came from social workers (46%) or police (31%). Conclusions: The ECPD offers a unique insight into the characteristics of referrals to child protection paediatric services over a key period in the history of child protection in Scotland. It is hoped that by making these data available to researchers, and able to be easily linked with both mother and child current and future health records, evidence will be created to better support maltreated children and monitor changes over time.

Short Report: Exploring the extent to which Intellectual Disability is undiagnosed within children attending developmental paediatric clinics.

Intellectual Disability is under-ascertained worldwide and is associated with greater physical and mental health difficulties. This research aimed to identify clinical features and characteristics of children with Intellectual Disability in a population of 126 6-18 year olds in mainstream school, attending paediatric developmental clinics. Intellectual Disability was defined according to the DSM-5 (deficits in intellectual and adaptive functioning, present during childhood). Measures used to assess this were WISC-IV IQ (score <70) and ABAS adaptive behaviour (score =<70). Clinical features were compared from a structured clinical records investigation and logistic regression explored which factors were associated with Intellectual Disability. Twenty-eight children (22%) met the criteria for Intellectual Disability. Five variables were associated with higher odds of having Intellectual Disability: no other neurodevelopmental diagnosis, multiple other health problems, prior genetic testing, maternal smoking during pregnancy, and parental unemployment. Routinely-collected paediatric data only predicted Intellectual Disability correctly in two out of five cases. Further research is needed to verify these findings and improve identification. WHAT THIS PAPER ADDS?: Many children with Intellectual Disability, particularly a milder version, still reach adulthood without a diagnosis, despite evidence indicating that diagnosis is generally well received by children and families, and that early intervention leads to improvements in outcomes. This short report, based on a small sample of 126 children aged 6-18 in mainstream school who attended a paediatric development clinic in South East Scotland, provides tentative data on the clinical features and characteristics which are associated with Intellectual Disability. This tentative evidence suggests that the combination of a) having multiple concerns and investigations, alongside b) one or both parents being out of work (which may be related to familial undiagnosed Intellectual Disability), should raise a flag for paediatricians to further investigate the possibility of an Intellectual Disability diagnosis among these children and young people. Further research with larger samples is needed to explore this more robustly, with the potential to create an algorithm to highlight to paediatricians cases requiring formal screening for Intellectual Disability.

Mapping Geographic Trends in Early Childhood Social, Emotional, and Behavioural Difficulties in Glasgow: 2010-2017.

Measuring variation in childhood mental health supports the development of local early intervention strategies. The methodological approach used to investigate mental health trends (often determined by the availability of individual level data) can affect decision making. We apply two approaches to identify geographic trends in childhood social, emotional, and behavioural difficulties using the Strengths and Difficulties Questionnaire (SDQ). SDQ forms were analysed for 35,171 children aged 4-6 years old across 180 preschools in Glasgow, UK, between 2010 and 2017 as part of routine monitoring. The number of children in each electoral ward and year with a high SDQ total difficulties score (≥15), indicating a high risk of psychopathology, was modelled using a disease mapping model. The total difficulties score for an individual child nested in their preschool and electoral ward was modelled using a multilevel model. For each approach, linear time trends and unstructured spatial random effects were estimated. The disease mapping model estimated a yearly rise in the relative rate (RR) of high scores of 1.5-5.0%. The multilevel model estimated an RR increase of 0.3-1.2% in average total scores across the years, with higher variation between preschools than between electoral wards. Rising temporal trends may indicate worsening social, emotional, and behavioural difficulties over time, with a faster rate for the proportion with high scores than for the average total scores. Preschool and ward variation, although minimal, highlight potential priority areas for local service provision. Both methodological approaches have utility in estimating and predicting children's difficulties and local areas requiring greater intervention.

Validity of Scottish predictors of child obesity (age 12) for risk screening in mid-childhood: a secondary analysis of prospective cohort study data-with sensitivity analyses for settings without various routinely collected predictor variables.

OBJECTIVE: To analyse the Growing Up in Scotland cohort for predictors of obesity at age 12, present at school entry (age 5-6). METHODS: The initial model included literature-based risk factors likely to be routinely collected in high-income countries (HICs), as well as "Adverse/Protective Childhood Experiences (ACEs/PCEs)". Missing data were handled by Multiple Chained Equations. Variable-reduction was performed using multivariable logistic regression with backwards and forwards stepwise elimination, followed by internal validation by bootstrapping. Optimal sensitivity/specificity cut-offs for the most parsimonious and accurate models in two situations (optimum available data, and routinely available data in Scotland) were examined for their referral burden, and Positive and Negative Predictive Values. RESULTS: Data for 2787 children with full outcome data (obesity prevalence 18.3% at age 12) were used to develop the models. The final "Optimum Data" model included six predictors of obesity: maternal body mass index, indoor smoking, equivalized income quintile, child's sex, child's BMI at age 5-6, and ACEs. After internal validation, the area under the receiver operating characteristic curve was 0.855 (95% CI 0.852-0.859). A cut-off based on Youden's J statistic for the Optimum Data model yielded a specificity of 77.6% and sensitivity of 76.3%. 37.0% of screened children were "Total Screen Positives" (and thus would constitute the "referral burden".) A "Scottish Data" model, without equivalized income quintile and ACEs as a predictor, and instead using Scottish Index of Multiple Deprivation quintile and "age at introduction of solid foods," was slightly less sensitive (76.2%) but slightly more specific (79.2%), leading to a smaller referral burden (30.8%). CONCLUSION: Universally collected, machine readable and linkable data at age 5-6 predict reasonably well children who will be obese by age 12. However, the Scottish treatment system is unable to cope with the resultant referral burden and other criteria for screening would have to be met.

The predictive value of universal preschool developmental assessment in identifying children with later educational difficulties: A systematic review.

BACKGROUND: Developmental delay affects substantial proportions of children. It can generally be identified in the pre-school years and can impact on children's educational outcomes, which in turn may affect outcomes across the life span. High income countries increasingly assess children for developmental delay in the early years, as part of universal child health programmes, however there is little evidence as to which measures best predict later educational outcomes. This systematic review aims to assess results from the current literature on which measures hold the best predictive value, in order to inform the developmental surveillance aspects of universal child health programmes. METHODS: Systematic review sources: Medline (2000 -current), Embase (2000 -current), PsycInfo (2000 -current) and ERIC (2000 -current). Additional searching of birth cohort studies was undertaken and experts consulted. Eligibility criteria: Included studies were in English from peer reviewed papers or books looking at developmental assessment of preschool children as part of universal child health surveillance programmes or birth cohort studies, with linked results of later educational success/difficulties. The study populations were limited to general populations of children aged 0-5 years in high income countries. Study selection, data extraction and risk of bias assessment were carried out by two independent authors and any disagreement discussed. PROSPERO registration number CRD42018103111. RESULTS: Thirteen studies were identified for inclusion in the review. The studies were highly heterogeneous: age of children at first assessment ranged from 1-5 years, and at follow-up from 4-26 years. Type of initial and follow-up assessment also varied. Results indicated that, with the exception of one study, the most highly predictive initial assessments comprised combined measures of children's developmental progress, such as a screening tool alongside teacher ratings and developmental histories. Other stand-alone measures also performed adequately, the best of these being the Ages and Stages Questionnaire (ASQ). Latency between measures, age of child at initial measurement, size of studies and quality of studies all impacted on the strength of results. CONCLUSIONS: This review was the first to systematically assess the predictive value of preschool developmental assessment at a population level on later educational outcomes. Results demonstrated consistent associations between relatively poor early child development and later educational difficulties. In general, specificity and Negative Predictive Value are high, suggesting that young children who perform well in developmental assessment are unlikely to go on to develop educational difficulties, however the sensitivity and Positive Predictive Values were generally low, indicating that these assessments would not meet the requirements for a screening test. For surveillance purposes, however, findings suggested that combined measures provided the best results, although these are resource intensive and thus difficult to implement in universal child health programmes. Health service providers may therefore wish to consider using stand-alone measures, which also were shown to provide adequate predictive value, such as the ASQ.

Study protocol: a mixed-methods realist evaluation of the Universal Health Visiting Pathway in Scotland.

INTRODUCTION: The growing political emphasis on the early years reflects the importance of these formative years of life. Health visitors in the UK are uniquely positioned to improve health outcomes for children and families and to reduce health inequalities. Recently, there has been a policy change in Scotland in an attempt to enhance the delivery of the universal health visiting service. This study aims to examine the extent to which the enhanced Universal Health Visiting Pathway is implemented and delivered across Scotland and to assess any associated impacts. METHODS AND ANALYSIS: A mixed-methods study incorporating four methodological components and uses realist evaluation as the overall conceptual framework. It comprises three phases (1) initial programme theory development; (2) programme theory validation and (3) programme theory refinement. The programme theory validation will use interview and focus group data of parents and health visitors, and conduct a case note review at five study sites. It also involves a national survey of parents and health visitors and routine data analysis of existing secondary data. The analyses of the ensuing qualitative and quantitative data will be carried out using a convergent mixed-methods approach to ensure continuous triangulation of multiple data. The findings of the evaluation will provide contextually relevant understanding of how the Universal Health Visiting Pathway works and evidence the impact of increased investments in health visiting in Scotland. ETHICS AND DISSEMINATION: This protocol has been approved by the School of Health in Social Science Research Ethics Committee, University of Edinburgh. Additional approvals have been granted/will be sought from the Public Benefit and Privacy Panel for health and social care in Scotland for the case note review,survey and routine data analysis elements of the evaluation. The findings will be prepared as reports to the funders and presented at conferences. It will be submitted for publication in peer-reviewed journals.

Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland.

OBJECTIVE: To examine the association between high maternal weight status and complications during pregnancy and delivery. SETTING: Scotland. PARTICIPANTS: Data from 132 899 first-time singleton deliveries in Scotland between 2008 and 2015 were used. Women with overweight and obesity were compared with women with normal weight. Associations between maternal body mass index and complications during pregnancy and delivery were evaluated. OUTCOME MEASURES: Gestational diabetes, gestational hypertension, pre-eclampsia, placenta praevia, placental abruption, induction of labour, elective and emergency caesarean sections, pre-term delivery, post-term delivery, low Apgar score, small for gestational age and large for gestational age. RESULTS: In the multivariable models controlling for potential confounders, we found that, compared with women with normal weight, the odds of the following outcomes were significantly increased for women with overweight and obesity (overweight adjusted ORs; 95% CI, followed by the same for women with obesity): gestational hypertension (1.61; 1.49 to 1.74), (2.48; 2.30 to 2.68); gestational diabetes (2.14; 1.86 to 2.46), (8.25; 7.33 to 9.30); pre-eclampsia (1.46; 1.32 to 1.63) (2.07; 1.87 to 2.29); labour induction (1.28; 1.23 to 1.33), (1.69; 1.62 to 1.76) and emergency caesarean section (1.82; 1.74 to 1.91), (3.14; 3.00 to 3.29). CONCLUSIONS: Women with overweight and obesity in Scotland are at greater odds of adverse pregnancy and delivery outcomes. The odds of these conditions increases with increasing body mass index. Health professionals should be empowered and trained to deliver promising dietary and lifestyle interventions to women at risk of overweight and obesity prior to conception, and control excessive weight gain in pregnancy.

Preschool developmental concerns and adjustment in the early school years: Evidence from a Scottish birth cohort.

BACKGROUND: Preschool language and behavioural difficulties impact on multiple domains of the child's early life and can endure into adulthood, predicting poor educational, social, and health outcomes. Highlighting risk factors associated with poor outcomes following language and behavioural difficulties raised in early childhood may facilitate early identification and intervention. METHODS: Data from the Growing Up in Scotland national birth cohort study were used. Language and behavioural difficulties were assessed at age 4 years using parent-reported language concerns and the Strengths and Difficulties Questionnaire. Measures of adjustment were collated into four key outcome domains: attitude to school life, language and general development, behaviour, and general health at age 6 years. Both univariate and multivariate logistic regression models were fitted in order to explore independent associations between language and behavioural difficulties at age 4 years and adjustment to life circumstances at age 6 years, whilst controlling for other risk factors. RESULTS: Language difficulties at age 4 years increased the odds of the child experiencing difficulty with language and general development, poorer health outcomes, and behavioural difficulties at age 6 years. Behavioural difficulties alone at age 4 years were associated with increased odds of the child experiencing all of the aforementioned outcomes and difficulties in early school life. Lone parent family, low income, and male gender were identified as risk factors for poorer outcomes in the domains measured. At age 4 years, there was no additive effect found with the presence of behaviour difficulties on the relationship between language difficulties and language and developmental outcomes at 6 years. CONCLUSIONS: This paper demonstrates language and behavioural difficulties are associated with poor social, educational, health, and behavioural outcomes. Taking seriously parent-reported concerns and identifying risk factors could limit negative outcomes for the child, their family, and society.

How community resources mitigate the association between household poverty and the incidence of adverse childhood experiences.

OBJECTIVES: To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks. METHODS: Using Growing Up in Scotland birth cohort data (N = 2816), an inverse probability-weighted regression-based mediation technique was applied to assess associations between low-income status (< £11,000 in 2004/5), resource access, and cumulative 8-year ACE incidence (≥ 1, ≥ 3 ACEs). Resource access was measured based on households' self-reported difficulties (yes/no) in accessing housing, transportation, childcare, and breastfeeding counselling, and park proximity (within 10 min from the residence). RESULTS: The protective effects of resources were heterogeneous. Only access to transportation was associated with lower ACE incidence in both low- and higher-income households. If all had access to transportation, 21% (95% CI 3%, 41%) of the income-based inequality in incidence of 3 or more ACEs could be eliminated. CONCLUSIONS: While second best to the elimination of child poverty, measures to improve families' access to community resources such as transportation may mitigate the effects of poverty on ACE incidence.

Factors associated with adverse childhood experiences in Scottish children: a prospective cohort study.

BACKGROUND AND OBJECTIVES: Adverse childhood experiences (ACEs) have been associated with a range of poorer health and social outcomes throughout the life course; however, to date they have primarily been conducted retrospectively in adulthood. This paper sets out to determine the prevalence of ACEs at age 8 in a recent prospective birth cohort and examine associations between risk factors in the first year and cumulative ACEs. DESIGN: This study uses the Growing Up in Scotland Birth Cohort 1, in which children born in Scotland in 2004/5 were identified using Child Benefit Records and followed up for 7 years (n.3119). ACE scores and sample characteristics were calculated and described. Logistic regression models were fitted to explore associations between risk factors (sex, mother's age and education, household income, area level deprivation and urban/rural indicator) and ACE scores. RESULTS: Seven ACEs (or proxies) were assessed: physical abuse, domestic violence, substance abuse, mental illness, parental separation, parental incarceration and emotional neglect. Instances of sexual abuse were too few to be reported. Emotional abuse and physical neglect could not be gathered. Around two-thirds of children had experienced one or more ACE, with 10% experiencing three or more in their lifetime. Higher ACE scores were associated with being male, having a young mother, low income and urban areas. CONCLUSIONS: Using prospective data, the majority of children born in 2004/2005 in Scotland experienced at least one ACE by age 8, although three ACEs could not be assessed in this cohort. ACEs were highly correlated with socioeconomic disadvantage in the first year of life.

Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review.

BACKGROUND: Preschool screening for developmental difficulties is increasingly becoming part of routine health service provision and yet the scope and validity of tools used within these screening assessments is variable. The aim of this review is to report on the predictive validity of preschool screening tools for language and behaviour difficulties used in a community setting. METHODS: Studies reporting the predictive validity of language or behaviour screening tools in the preschool years were identified through literature searches of Ovid Medline, Embase, EBSCO CINAHL, PsycInfo and ERIC. We selected peer-reviewed journal articles reporting the use of a screening tool for language or behaviour in a population-based sample of children aged 2-6 years of age, including a validated comparison diagnostic assessment and follow-up assessment for calculation of predictive validity. RESULTS: A total of eleven eligible studies was identified. Six studies reported language screening tools, two reported behaviour screening tools and three reported combined language & behaviour screening tools. The Language Development Survey (LDS) administered at age 2 years achieved the best predictive validity performance of the language screening tools (sens 67%, spec 94%, NPV 88% and PPV 80%). The Strengths and Difficulties Questionnaire (SDQ) administered at age 4 years achieved the best predictive validity compared to other behaviour screening tools (Sens 31%, spec 93%, NPV 84% and PPV 52%). The SDQ and Sure Start Language Measure (SSLM) administered at 2.5 years achieved the best predictive validity of the combined language & behaviour assessments (sens 87%, spec 64%, NPV 97% and PPV 31). Predictive validity data and diagnostic odds ratios identified language screening tools as more effective and achieving higher sensitivity and positive predictive value than either behaviour or combined screening tools. Screening tools with combined behaviour and language assessments were more specific and achieved higher negative predictive value than individual language or behaviour screening tools. Parent-report screening tools for language achieved higher sensitivity, specificity and negative predictive value than direct child assessment. CONCLUSIONS: Universal screening tools for language and behaviour concerns in preschool aged children used in a community setting can demonstrate excellent predictive validity, particularly when they utilise a parent-report assessment. Incorporating these tools into routine child health surveillance could improve the rate of early identification of language and behavioural difficulties, enabling more informed referrals to specialist services and facilitating access to early intervention.

Credibility of subgroup analyses by socioeconomic status in public health intervention evaluations: An underappreciated problem?

There is increasing interest amongst researchers and policy makers in identifying the effect of public health interventions on health inequalities by socioeconomic status (SES). This issue is typically addressed in evaluation studies through subgroup analyses, where researchers test whether the effect of an intervention differs according to the socioeconomic status of participants. The credibility of such analyses is therefore crucial when making judgements about how an intervention is likely to affect health inequalities, although this issue appears to be rarely considered within public health. The aim of this study was therefore to assess the credibility of subgroup analyses in published evaluations of public health interventions. An established set of 10 credibility criteria for subgroup analyses was applied to a purposively sampled set of 21 evaluation studies, the majority of which focussed on healthy eating interventions, which reported differential intervention effects by SES. While the majority of these studies were found to be otherwise of relatively high quality methodologically, only 8 of the 21 studies met at least 6 of the 10 credibility criteria for subgroup analysis. These findings suggest that the credibility of subgroup analyses conducted within evaluations of public health interventions' impact on health inequalities may be an underappreciated problem.

Primary schools and the amplification of social differences in child mental health: a population-based cohort study.

BACKGROUND: This paper examines socioeconomic inequalities in mental health at school entry and explores changes in these inequalities over the first 3 years of school. METHODS: The study utilises routinely collected mental health data from education records and demographic data at ages 4 and 7 years, along with administrative school-level data. The study was set in preschool establishments and schools in Glasgow City, Scotland. Data were available on 4011 children (59.4%)at age 4 years, and 3166 of these children were followed at age 7 years (46.9% of the population). The main outcome measure was the teacher-rated Goodman's Strengths and Difficulties Questionnaire (4-16 version) at age 7 years, which measures social, emotional and behavioural difficulties. RESULTS: Children living in the most deprived area had higher levels of mental health difficulties at age 4 years, compared with their most affluent counterparts (7.3%vs4.1% with abnormal range scores). There was a more than threefold widening of this disparity over time, so that by the age of 7 years, children from the most deprived area quintile had rates of difficulties 3.5 times higher than their more affluent peers. Children's demographic backgrounds strongly predicted their age 7 scores, although schools appeared to make a significant contribution to mental health trajectories. CONCLUSIONS: Additional support to help children from disadvantaged backgrounds at preschool and in early primary school may help narrow inequalities. Children from disadvantaged backgrounds started school with a higher prevalence of mental health difficulties, compared with their more advantaged peers, and this disparity widened markedly over the first 3 years of school.

No evidence of whole population mental health impact of the Triple P parenting programme: findings from a routine dataset.

BACKGROUND: The Triple P parenting programme has been reported to improve child mental health at population level, but it consumes substantial resources. Previous published work has suggested improvements in whole population scores in the Strengths and Difficulties Questionnaire (SDQ) Total Difficulties Scale among samples of children following introduction of the programme. This paper aims to explore whether Triple P had an impact on child mental health problems using routinely collected data over 6 years before and during the implementation of the multilevel Triple P programme in Glasgow City. METHODS: Annual monitoring of teacher-rated SDQ Total Difficulties Scale scores among children in their pre-school year in Glasgow City. RESULTS: No significant or consistent changes in SDQ Total Difficulties Scale scores were seen during or after the implementation of Triple P programme on a whole population level. CONCLUSION: Triple P in Glasgow City appears to have had no impact on early child mental health problems over a 6 year period. The Triple P programme, implemented on a whole population level, is unlikely to produce measurable benefits in terms of child mental health.

Fit to WHO weight standard of European infants over time.

OBJECTIVES: The 2006 WHO growth charts were created to provide an international standard for optimal growth, based on healthy, breastfed populations, but it has been suggested that Northern European children fit them poorly. This study uses infant weight data spanning 50 years to determine how well-nourished preschool children from different eras fit the WHO standard, and discuss the implications of deviations. DESIGN: Four longitudinal datasets from the UK and one from Finland were used comprising over 8000 children born between 1959 and 2003. Weights from birth to 2 years were converted to age-sex-adjusted Z scores using the WHO standard and summarised using Generalized Additive Models for Location, Scale and Shape. RESULTS: Weights showed a variable fit to the WHO standard. Mean weights for all cohorts were above the WHO median at birth, but dipped by up to 0.5 SD to a nadir at 8 weeks before rising again. Birth weights increased in successive cohorts and the initial dip became slightly shallower. By age 1 year, cohorts were up to 0.75 SD above the WHO median, but there was no consistent pattern by era. CONCLUSIONS: The WHO standard shows an acceptable, but variable fit for Northern European infants. While birth weights increased over time, there was, unexpectedly, no consistent variation by cohort beyond this initial period. Discrepancies in weight from the standard may reflect differences in measurement protocol and trends in infant feeding practice.

Exploring the social, emotional and behavioural development of preschool children: is Glasgow different?

BACKGROUND: Glasgow City has poorer adolescent and adult health outcomes in comparison to demographically similar cities in England and the rest of Scotland. Until now, little exploration of differences in child development between Glasgow and other areas has been made. The authors hypothesized that the poorer health outcomes and lifestyle behaviours of adults, coupled with relative economic deprivation, may impact on child social, emotional and behavioural development, compared with children from other parts of Scotland. METHODS: Data from the Growing Up in Scotland national birth cohort study were used. Differences between Strengths and Difficulties Questionnaire (SDQ) scores and child and family characteristics of children living in the Greater Glasgow and Clyde (GGC) Health board vs. other health boards were examined. Logistic regression and linear regression models were fitted in order to explore independent associations between health board and SDQ raw and banded scores, respectively, whilst controlling for other contributing factors. RESULTS: Children in GGC were demographically different from those in other areas of Scotland, being significantly more likely to live in the most deprived areas, yet no difference was found in relation to the mental health of preschool-aged children in GGC. Children in GGC had slightly better SDQ Conduct Problems scores once demographic factors were controlled for. CONCLUSIONS: At 46 months, there does not appear to be any difference in Glasgow with regards to social, emotional and behavioural development. Glaswegian children appear to have slightly fewer conduct problems at this age, once demographics are taken into account. A range of theories are put forward as to why no differences were found, including the inclusion of areas adjacent to Glasgow City in the analysis, sleeper effects, and rater bias.

Associations between social isolation, pro-social behaviour and emotional development in preschool aged children: a population based survey of kindergarten staff.

BACKGROUND: The impact of peer relationships has been extensively reported during adolescence, when peer influence is generally considered to be at its greatest. Research on social isolation during childhood has found associations with school achievement, future relationships and adult mental health. Much of the evidence is derived from either parent or child-rated assessment of peer relationships, each of which have their limitations. METHODS: We report findings from Goodman's Strengths and Difficulties Questionnaire (SDQ), completed by staff in preschool establishments for over 10,000 children in their preschool year (aged 4-5), linked with routine demographic data. Correlations between scores and demographics were explored. Regression models examined the independent relationships between three social isolation variables, taken from the SDQ Peer Relationship Problems, Pro-social Behaviour and Emotional Symptoms subscales, controlling for demographics. RESULTS: There were substantial overlaps between problem scores. Regression models found all social isolation variables to be significantly correlated with social and emotional functioning. Different types of social isolation appeared to relate to different psychological domains, with unpopularity having a stronger relationship with poor pro-social skills, whereas being solitary was more strongly linked to poorer emotional functioning. CONCLUSIONS: Social isolation does have a significant association with reported child social and emotional difficulties, independent of demographic characteristics. The analysis highlights the complexity of measuring social isolation in young children. Different types of social isolation were found to have relationships with specific areas of social and emotional functioning.