Socio-demographic factors are also associated with variation in children’s social, emotional and behavioural difficulties, with the most disadvantaged children (in terms of income, resources and other adversities) generally being found to have the poorest outcomes e.g. (Bradshaw, Hall, Hill, Mabelis, & Philo, 2012a; Green et al., 2005; Brooks-Gunn & Duncan, 1997; McLoyd, 1998). This is particularly relevant in Glasgow City, where a large proportion of children grow up living in socio-economically disadvantaged circumstances, as evidenced in the previous section. Gershoff states that “several decades of research leave little doubt that family income matters for children” (Gershoff et al., 2007a). Whilst the
evidence clearly demonstrates that this is true in terms of cognitive
development (Dooley & Stewart, 2007; Lee, 2011; Graham & Power, 2004; Sameroff, 1998a), results are less straight-forward for social and emotional outcomes, with outcomes related to peer relationships and emotional regulation appearing substantially weaker than those for behaviour (Wilson et al., 2013).
64 The impact of disadvantage on social and emotional outcomes in the early years has been less well researched than impacts in middle childhood or adolescence and, where it has been investigated, impacts are arguably smaller than on these later outcomes. Correlations have been found between low income and both lower social competence and an increase in behavioural problems at age three (National Institute of Child Health, 2007).
A recent British study found that experiencing ‘adversity’ in the first year, including poverty, predicted parent-reported externalising problems at age three, with adversity at ages two and three predicting both parent-rated
internalising and externalising problems at age three (Flouri, Tzavidis, & Kallis, 2010). Data from the Longitudinal Study of Australian Children showed an association between income and child social, emotional and learning outcomes at age 2-3 (using a parent-rated abbreviated version of the Short Temperament Scale for Infants (Sanson, Prior, Garino, Oberklaid, & Sewell, 1987)). Children in the older cohort (social and emotional outcomes here measured using
Goodman’s Strengths and Difficulties Questionnaire) saw an improvement in socio-emotional scores at age 5-6. Effects of income were larger on learning outcomes, again suggesting that the relationship with income is stronger for learning outcomes than it is for social and emotional outcomes (Lee, 2011). Results for middle childhood through to adolescence have generally found a link between low income and poorer socio-emotional development, though effect sizes vary dramatically. Poverty was associated with greater psychological distress for children in Grades 3-4 (mean scores on the Rutter Children’s Behaviour Questionnaire were 11.73 in the low income group, compared with 6.86 in the middle income group) (Evans & English, 2002), and with parent-rated behavioural problems in middle childhood: an increase in income of one unit (which equates to a 2.7-fold increase in income, or an increase to $13,590 for a family starting with an income of $5,000) resulting in a decline in behaviour problems by 0.30 of a standard deviation (Votruba-Drzal, 2006). Prevalence of clinically measured mental disorders among 9 year old low income children living in Spanish slums was five times higher than the median derived from pooled published studies on the general population (Ezpeleta et al., 2007).
65 Longitudinal studies investigating within-child differences have demonstrated a relationship between family income and both internalising and externalising behaviours at age six, however the effect of a change in income was small, with a $10,000 rise in income resulting in a decrease of 0.13 in the externalising problems score on the Child Behaviour Check List (CBCL) (range 0-20) (Dearing, McCartney, & Taylor, 2006). The Canadian National Longitudinal Study of Children and Youth, which assessed children aged 6-12, concluded that a doubling of income reduces a child’s emotional and behavioural score by one- tenth of a standard deviation, as reported by the child’s parent (Dooley & Stewart, 2007).
Costello and colleagues followed slightly older children aged between 9 and 13 for eight years, who were part of a natural experiment which raised the income of every individual on an American Indian reserve and lifted many children out of poverty, named the Great Smokey Mountain Study. They found that children living in poverty were more likely to have DSM IV psychiatric diagnoses and symptoms than children who lived in never poor families. Those who were still in poverty four years after the change of income increased their total psychiatric symptoms by 21%, whilst children who moved out of poverty decreased their symptoms by 40% (Costello et al., 2003). Although the chronic poor group and the group who moved out of poverty, both started “in poverty”, it may be that the two groups had different baseline characteristics: those who remained in poverty may have started out in more extreme poverty than those who later moved out poverty. It could also be that other factors, such as substance misuse and pre-existing mental health problems, differed between the two groups. This raises the question as to whether it is the differential baseline that had the impact on outcomes, rather than the subsequent move out of poverty. Effects of income poverty are not necessarily linear, with variations near the bottom of the spectrum showing far stronger relationships to cognitive and socio-emotional development, than those in the upper ranges (Votruba-Drzal, 2006; National Institute of Child Health, 2007). It may be that downward changes in income for families towards the bottom of the spectrum may result in greater stress and changes in material hardship, than variation further up the income spectrum.
66
8.5.6.1 The timing and duration of poverty
The impact of disadvantage on socio-emotional outcomes may differ depending on the timing of poverty and the length of time spent in poverty, though results are inconsistent. The majority of studies which examined duration found that children who experienced persistent or chronic poverty have the poorest outcomes in terms of both internalising and externalising behaviours (National Institute of Child Health, 2007; Costello, Compton, Keeler, & Angold, 2003; Lee, 2011). In contrast, Brooks-Gunn and Duncan report that that current, but not persistent poverty, was associated with more externalising problems among 4-8 year olds in the National Longitudinal Study of Youth (NLSY) cohort (Brooks-Gunn & Duncan, 1997).
The Great Smokey Mountain study reported that a move out of poverty was associated with declining behavioural problems four years later, as opposed to remaining in poverty. However, internalising problems, such as depression, were not affected by a move out of poverty, but rather remained significantly higher for those who had experienced early poverty but moved out of poverty (Costello et al., 2003). It should be noted that the children in this study ranged in ages from 9 to 13 at the start of the study.
McLoyd’s review concluded that “neither internalising nor externalising symptoms have been linked to timing of poverty within the first four years of life” (McLoyd, 1998). Whilst evidence is weaker for the early years, research has recently been conducted on the impact of poverty on early outcomes. Social patterning of externalising problems has been found in children as young as three years old (National Institute of Child Health, 2007; Spencer & Coe, 2003), with differences in parental behavioural reports at 8 months and at 18 months (Spencer & Coe, 2003). In addition, there is increasing evidence for a degree of stability of social and emotional ill-health throughout childhood (Spencer & Coe, 2003); (Sameroff, 1998b), which may suggest that any early impact on child social and emotional development may have long-lasting consequences. It remains the case, however, that a greater proportion of the literature establishes a link between late poverty and externalising and internalising symptoms. In reports directly comparing early and later poverty, late poverty appears to have an effect on behavioural outcomes over and above any effects
67 of living in early poverty (Votruba-Drzal, Coley, Maldonado-Carreno, Li-Grining, & Chase-Lansdale, 2010; National Institute of Child Health, 2007). The NICH study reported that, although all mothers reported fewer behavioural problems over time, living in poverty between the ages of four and nine resulted in significantly more behavioural problems than being in poverty up to the age of three. Furthermore, mothers in the ‘late poor’ and ‘always poor’ groups
reported significantly more internalising problems than those in the never poor group. On the teacher-rated behavioural problems though, there was no
significant difference between the early poor and late poor groups. This
suggests the possibility of reporter bias, in that more recent poverty may affect parental mental health, which may in turn reflect in the parent’s view of the child’s behaviour (National Institute of Child Health, 2007). It may also be that teachers use the area where they work as a reference point when rating
children, which may minimise true differences between levels of socio-economic deprivation in different areas.
Whilst the evidence suggests a relationship between income and poverty, it is debatable whether there is a direct causal link, or whether this link is mediated by other factors such as parental stress, parenting, resources or diet. Gershoff, among others, found a small direct link once factors such as parental stress and material hardship were controlled for, though it is arguable whether this small ‘direct link’ is actually confounded by unmeasured variables (Gershoff, Aber, Raver, & Lennon, 2007b; Gershoff et al., 2007a).
Many mediating factors have been cited and investigated. A difficulty with this area of research is that studies often control for a small number of individual risks, but rarely control for a wide spectrum of potentially contributing factors. Factors are generally split into those related to the family stress model (Conger, Conger, & Martin, 2010) and those related to the Parent Investment Model (Becker & Becker, 2009).
The family stress model proposes that income poverty and material hardship (the latter being a lack of material goods, rather than a lack of money) have an impact on parental mental health and relationships with partners, which has an effect on parenting behaviour, which in turn impacts on child outcomes
68 poverty and socio-emotional outcomes at the age of four only where there was also a mother with mental health problems, who lacked social support and who had a lower level of education. Where this was not the case, the child was usually progressing as normal (Lee, 2011).
Three studies found an impact of poverty/material hardship on parental stress, which in turn impacted on the provision of family resources (National Institute of Child Health, 2007); (Gershoff et al., 2007a);(Black et al., 2007). The NICH found that poverty was highly related to enrichment of the home environment,
however once other family characteristics were taken into account, such as parental education, partner status and depressive symptoms in the mother, the effect was not statistically significant (National Institute of Child Health, 2007). The parent investment model proposes that parents’ abilities to provide material resources, such as books and other goods, as well as trips, e.g. to museums and libraries, may impact on child well-being. The mediating role of family resources has been highlighted in a substantial body of research. Though the effect of better family resources has been evidenced as being stronger for cognitive development, there is a body of research showing the benefits of providing a high quality, safe and stimulating home environment on social development (Evans & English, 2002; Nakao et al., 2000; Sameroff, 1998a). For example, Vortruba-Drzal looked at the middle childhood period and found that, whilst the home environment did appear to mediate some of the effects of income on behaviour, it rarely explained more than 30-40% of the variance, suggesting that other pathways must mediate these effects. Providing warm, responsive care- giving in the home environment helps children to develop secure attachments, regulate emotion and learn to successfully negotiate social situations (Votruba- Drzal et al., 2010).
There appears to be a stronger link between the home environment and socio- emotional outcomes in the pre-school period, where children are most reliant on their main carer, than it does once the child reaches school age (Bradley & Corwyn, 2002). Maternal sensitivity and warmth have also been viewed as a mediator between poverty and child socio-emotional outcomes. NICH found that mothers who were classed as ‘never poor’ showed the highest rates of maternal sensitivity, while those who were ‘always poor’ showed the lowest rates (with
69 those who moved into and out of poverty having sensitivity rates in between these) (National Institute of Child Health, 2007).
The amount of supervision through the presence of an adult in the home also appears to be a mediating factor in the link between poverty and behavioural outcomes. Costello found that this was the main factor responsible for the change in behavioural outcome when a family moved out of poverty (Costello et al., 2003). Dunifon et al. also demonstrated that where low income single
mothers had a long commute, and thus were absent from their children for longer periods, this had an impact on child behaviour outcomes, in comparison with those who were on low incomes but did not have a long commute (Dunifon, Kalil, & Bajracharya, 2005). Further support is lent to this through the success of some interventions focussing on parenting in order to improve social and
emotional outcomes in the early years. For a full review of this see Barlow’s Cochrane Collaboration Review (Barlow et al., 2010).
The impact of peers, particularly in terms of levels of peer victimisation, behavioural problems and aggression, has also been cited as a mediating factor for children already at risk of poorer outcomes through poverty (Hoglund & Leadbeater, 2004). Conversely, Sacker et al. found that school composition had little effect on psycho-social adjustment in middle childhood, though it did have an effect in adolescence (Sacker, Schoon, & Bartley, 2002). The latter may account for some of the differences seen between the impact of early and late poverty on children’s internalising and externalising behaviours, for example in the NICH’s work (National Institute of Child Health, 2007).
Genetic confounders did not frequently arise in the particular literature
examined. However, it is important to mention the few cases in which they have arisen. Biedermann reports that previous twin studies have shown that genes explain a substantial amount of environmental variation normally seen in terms of social support and life stress (Biederman, Faraone, & Monuteaux, 2002). Costello purports that a possible reason for the lack of effect on behavioural problems for children who move out of poverty is a genetic loading which predisposes these children to behaviour problems, rather than an effect of poverty per se (Costello et al., 2003). Flouri et al., however, found an effect for family contextual risk on externalising and internalising symptoms, even when
70 controlling for maternal characteristics, which they suggest therefore transcends genetic disposition (Flouri et al., 2010).
Whilst there is some evidence of a small direct link between disadvantage and child social and emotional outcomes, this section has demonstrated a wide range of factors, through which much of the impact of disadvantage may be mediated. These include parental stress and parenting more generally, resource
availability, peers, genetic confounders and cumulative risk. This is particularly interesting for the current research study as it raises the possibility of picking up children at risk of maladaptive development in these areas and introducing interventions to alleviate some of the mediating factors which may be
contributing to these outcomes, e.g., helping parents to manage their stress and promote positive and warm parenting. It is clear, however, that this is a highly complex area which needs to be explored in the context of these different environments in future research.