Time to ACE the way we measure the bad things that happen to children

Adverse Childhood Experiences (ACEs) have been a hot topic for policy work in child health and development in recent months. The Select Committee for Science and Technology announced an inquiry into evidence-based early-years interventions, with a particular focus on ACEs. Also a new All Party Parliamentary Group for the Prevention of Childhood Adversities was set up. Essential to the success of these policy initiatives is a fit for purpose method of measuring the negative things that happen to people when they are young, something Rebecca Lacey from the ESRC International Centre for Lifecourse Studies at University College London argues is often overlooked. As part of a new research project, she is hoping to change that.

When Norman Lamb MP launched the early-years intervention inquiryin late 2017, he expressed concern that research in this area was “not being effectively used” in the creation of health policy and other support arrangements. Part of the problem with effective evidence in this area is that the system used to ‘score’ the number of bad things that have happened to a child and assess their risk of poor outcomes later in life is often poorly thought through and rarely questioned.

In 1998 a landmark piece of research by Vincent Felitti and colleagues showed that adults who reported being abused as children, witnessing violence against their mother, living with a substance misuser, or someone who had been in prison or had a mental illness had an increased risk of numerous health problems, such as depression and drug misuse, when they grew up.

It also showed that the number of adversities that someone reported having experienced as a child was really important; the more adversities reported, the higher the risk of health problems in adulthood. This number of adversities is often known as an ‘ACE score’ and Felitti’s paper was the first to use this approach for childhood adversities. It’s an approach that has since been employed in hundreds of academic studies.

Advantages and disadvantages

ACE scores have several advantages. They’re easy to calculate by simply adding up the number of adversities each person has experienced. In a clinical setting, a simple screening tool can be used to identify people at particularly high risk of health problems. These are generally people who have experienced four or more adversities, regardless of which ones.

This approach also acknowledges that people reporting one adversity are much more likely to have experienced at least one other. In Felitti’s study more than half of the people reporting that they’d been psychologically abused as a child had also been physically abused. Similarly, 3 out of every 5 people who had a family member in prison also reported that someone in the household had substance misuse problems. This clustering of adversities is crucially important to recognise both in research and in policymaking.

However, there are many reasons why ACE scores aren’t helpful for policy use. In fact they were never ‘designed’ with policy use in mind. Because they lump together adversities which are often very different (for example, experiencing abuse is likely to be a different experience to having a parent in prison), it’s difficult to tell which adversities have the potential to have the most harmful effects on health. We also don’t always know a lot about howthose adversities affect health. Knowing this information would help us to better inform where to target policies. The problem is further confused by different studies including different adversities in their ACE score. So when looking at the findings of different studies you can be comparing apples and pears.

Policy relevance

The heightened interest in ACEs combined with the recognition that early life is important for how a person’s life will pan out is really good news. But we do need to think more carefully about how we measure adversities in research and in particular how we can make our research more policy relevant.

For instance, if there’s a limited budget, which adversities would you try to tackle first? Are there particular childhood adversities which increase the risk of a child experiencing many other adversities? How do different types of adversities affect health? Is it appropriate to lump together very different types of adversities into an ACE score or is there a more appropriate way of treating the clustering of adversities in a less crude way? These are just some of the questions that need to be addressed quickly.

 Whilst the research is underway, there are a few things that researchers and policymakers can think about. As a starting point researchers and policy makers and practitioners interested in this area need to think more critically about how adversities are measured, with an aim of being more meaningful and policy relevant. What do we and don’t we know by using ACE scores? What other approaches to adversity measurement could we explore?

Longitudinal studies are key

Longitudinal studies, such as the British Birth Cohorts, which collect information on children and their family circumstances over their lives, are key to improving the evidence base on ACEs and health. Many of the existing studies on ACEs and health have relied on people recalling information on what they experienced as a child. This is prone to error and bias, and can be affected by what people are experiencing at the time they are asked, such as depression or stress at work.

These studies can also help us better understand whether and how timing matters. Not only can we ask which adversities appear to be particularly harmful for health, but also, when exposure to specific adversities are particularly harmful. By doing this/taking this kind of approach, we can also identify the most fruitful times to intervene to help people flourish across their lives.

Finally, the communication of risk is really important. There are many advocates of ACEs who directly translate findings from observational, population-level research into their work with individuals. For instance, if a research study shows that children who experience 4 or more adversities are on average 6 times more likely to be depressed in adulthood, this doesn’t mean that every individual who experienced 4 adversities will be 6 times more likely to have depression in adulthood. This approach of directly translating population risk is not appropriate and if done means that research often gets miscommunicated in a way that’s too deterministic. The health (or other) consequences of ACEs are not inevitable.

The recent increase in policy interest gives us an opportunity to achieve a step-change in the way we look at adverse childhood experiences.  If we seize this opportunity, the research community can play a key role in supporting the desire of policy makers and politicians to be effective in achieving their aim of helping at-risk children, adults affected by earlier bad experiences, the NHS, all those working in this area and UK taxpayers.

Wheezing: Can breastfeeding for longer make a difference?

Public health bodies put a lot of effort into encouraging mothers to breastfeed, and for good reasons. Successive studies have shown breastfeeding has a range of health benefits, including a lower risk of wheezing illnesses, which can be linked to asthma. But which of these illnesses are most likely to respond? Is a breastfed child less likely to develop wheezing after age five, or age seven, for instance? Or is the protective effect mainly measurable only in younger children? Professor Maria Quigley from the National Perinatal Epidemiology Unit at the University of Oxford, along with colleagues at Oxford and UCL, has been looking at how and when breastfeeding is associated with wheezing.

Asthma is the most common chronic condition affecting children and young people in the UK. It’s the most common reason why children are admitted to hospital, and sadly each year a few still die from the condition. According to the British Lung Foundation three children in every hundred under the age of five have been diagnosed with asthma at some point; and by age 10 that figure rises to one in 10.

There’s no cure, and so the priority for public health bodies has been to understand the disease better, to manage it better and to learn more about the factors that can protect us from it. One such protective factor is breastfeeding: two recent pieces of research have shown there is a lower risk among breastfed children, but that the effect is stronger among the very young – both for asthma and for wheezing, which has many causes and which does not necessarily develop into asthma.

Childhood wheezing can follow a variety of patterns – it can set in early but clear up before adulthood, for instance, or it can start later but continue into later life. Some wheezing will start in childhood and will continue.

Millennium Cohort Study

We wanted to look at how breastfeeding might affect these different types, so we used data from the Millennium Cohort Study, which has followed the lives of almost 19,000 children born in the UK between September 2000 and January 2002. Their parents were interviewed when they were 9 months old, and again when they were 3, 5, 7 and 11 years.

Our study focused on just over 10,000 children who were seen at all of those points and who were the product of single as opposed to multiple birth. Mothers were asked whether they had tried to breastfeed, and for how long their children had been breastfed.

Among our sample, seven out of 10 children had been breastfed: a little more than one in ten of the study sample for less than a week; a fifth for between one and three weeks, just over one in six for three to six months and around a quarter for six to nine months.

We found that at age 9 months, 6.5 per cent of children had a history of wheezing. At age 3 years, 19.5 per cent had such a history in the past year. As the children got older, though, this proportion decreased – 16 per cent at age five, 11.8 per cent at age seven and 11.4 per cent at age 11.

Overall, 37 per cent of children had suffered from wheezing at least once between 9 months and 11 years. A little under a fifth (18.8 per cent) had wheezing at younger age which cleared up when they got older, while 6.2 per cent had wheezing which started later and 11.8 per cent had persistent wheezing.

Feeding and wheezing

When we looked at the association between breastfeeding and wheezing, we found the children who had been breastfed for longest were less likely to suffer from wheezing.

But this effect lessened with time. For example, those breastfed for six to nine months were less likely to wheeze between the ages of nine months and five years, but by the age of 11 this group had no significant advantage over those who were breastfed for less time.

What does our study tell us about the relationship between breastfeeding and wheezing? The picture is a complex one. There are many causes of wheezing and of asthma, and those causes change over time. So in order to draw firm conclusions about cause and effect, we would need a much more complex dataset. It would be interesting, for instance, to look at clinical information on children’s allergies or their lung function.

But what we can say is that age matters – in order to understand how breastfeeding affects the development of wheezing during childhood, we must take a longer and more nuanced view.

Breastfeeding And Childhood Wheeze: Age-Specific Analyses and Longitudinal Wheezing Phenotypes as Complementary Approaches To The Analysis Of Cohort Data is research by Maria Quigley (University of Oxford), Claire Carson (University of Oxford) and Yvonne Kelly (UCL). It is published in the American Journal of Epidemiology.

Calling time on a life of likes could be key to girls’ happiness

There have been increasing calls in recent months for more to be done to prepare children for the emotional demands of social media. Just a few weeks ago, the Government’s Science and Technology Committee announced an inquiry into the impact of social media on the health of young people. But do girls and boys use social media as much as each other and is all this time spent Facebooking, Whatsapping and Snapchatting having a detrimental effect on their happiness and well-being? Cara Booker from the University of Essex, in collaboration with collleagues from UCL, has been looking at trends in social media interaction and well-being in nearly 10,000 10-15 year-olds in the UK over a 5 year period. Their findings indicate that girls may be at greater risk and therefore a focus for those looking to intervene to protect and promote children’s happiness.

The Government’s inquiry into the impact of social media on the health of young people comes hard on the heels of a report from the Children’s Commissioner for England, which says that children between the ages of 8 and 12 find it hard to manage the impact of online life and become anxious about their identity as they crave ‘likes’ and comments for validation. 

An explosion in digital and social media platforms has revolutionised the way we all consume media with a recent report showing that young people aged 12-15 spending more time online than they do watching TV. Indeed, it seems a long time ago that parents’ prime concern around media was how much or what kind of TV their child was watching.

All these major developments have taken place at a time when we also know that young people are becoming less and less happy. In the most recent United Nations Children’s Fund report, UK adolescents are ranked in the bottom third on overall well-being, below Slovenia, the Czech Republic and Portugal.

Of course, it’s important to remember that the internet has done a great deal of good for children: connecting them with friends and family who may be far away, providing great opportunities to widen horizons and learn new things. These things have been shown in other studies to be linked with increased levels of happiness and well-being in children

On the negative side, social media use has been linked with obesity, cyberbullying, low self-esteem and lack of physical activity, all things that can affect the lives of children as they move through school and into adulthood and work.

Social media experiences

Young people who took part in the Understanding Society survey, were asked if they belonged to a social web-site and then how many hours they spent ‘chatting’ or ‘interacting with friends’ on a normal school day. They could select a range of responses from none to more than 7 hours.

At age 10, 50 per cent of girls and 55 per cent of boys said they had no internet access or spent no time on social media. At 15 years, this dropped to 8 and 10 per cent respectively.

Ten per cent of ten year old girls reported spending one to three hours a day (compared with 7 per cent of boys) and this increased to 43 per cent of girls at age 15 (and 31 per cent of boys).

At age 10 only a very small percent of girls/boys were spending 4 hours plus a day on social media. But by the age of 15, that rose to 16 per cent of girls and 10 percent of boys.

Levels of happiness 🙂 🙁

Young people who took part in the survey were asked about satisfaction with schoolwork, friends, family, appearance, school and life as a whole and this was used to create an overall happiness score for them.

They were also asked about any social and emotional difficulties they might be facing using the well-established Strengths and Difficulties Questionnaire (SDQ) with a higher score indicating more problems.

For both boys and girls, levels of happiness decreased between the ages of 10 and 15, however the decrease was greater for girls than for boys. Additionally, whilst SDQ scores increased for girls between the ages of 10 and 15, they decreased for boys.

10 year-old girls who spent an hour or more on a school day chatting online had higher SDQ scores (more social and emotional problems) than girls of the same age who spent less or no time on social media. In addition, the score (number of problems) increased as they got older.

Why the gender difference?

So why the gender difference? This is hard to unpick and not something we were able to look at specifically in our research. It may say something about the different ways that girls and boys interact with social media. For example, girls may be more likely than boys to compare their lives with those of friends and peers – whether those are ‘filtered’ selfies or positive posts about friendships, relationships or material possessions – these could lead to feelings of inadequacy, lower levels of satisfaction and poorer wellbeing.

The pressures associated with having peers like or ‘approve’ status updates and a perceived fall in or lack of popularity could add further pressure at, what for many teenagers is a tricky time in their lives.

Boys are more likely to be gaming than interacting online in the way just described and that wasn’t covered in this research, so it’s possible that changes in well-being may be more related to gaming success or skill.

What needs to change?

It’s clear that social media is no short-lived phenomenon and our research indicates that girls, possibly because of the way in which they interact online and the amount of time they spend doing so could be at greater risk.

In her report, A Life of Likes, the Children’s Commissioner Anne Longfield has called for more to be done to check and stop underage use and to prevent children becoming over dependent on likes and comments and “adapting their offline lives to fit an online image”, something she believes can lead to an anxiety about ‘keeping up appearances ‘ as they get older.

Our research really adds weight to recent calls for the technology industry to look at in-built time limits. Young people need access to the internet for homework, for watching TV and to keep in touch with their friends of course, but a body of evidence is emerging to show that substantial amounts of time spent chatting, sharing, liking and comparing on social media on school days is far from beneficial especially for girls.

Gender differences in the association between age trends of social media interaction and wellbeing among 10-15 year olds in the UK, is research by Cara Booker (University of Essex), Yvonne Kelly (University College London) and Amanda Sacker (University College London) and is published in BMC Public Health.

Off the scales: time to act on childhood obesity

By 2050, it is said that obesity could cost the NHS almost £10 billion a year, with the full economic cost rising from around £27 billion today to £50 billion by then. Today, the Centre for Social Justice (CSJ) publishes its report, Off the scales: time to act on childhood obesity. It calls on the Government to put prevention, health, inequality and cross-departmental collaboration at the heart of its efforts to tackle childhood obesity, drawing particular attention to the need to address the question of why poorer children are at ever greater risk of being obese. It’s a question researchers at the ESRC International Centre for Lifecourse Studies at UCL, including our editor Yvonne Kelly, have been among the first to address.

There have been numerous major studies on childhood obesity over the past 10 years, many of which have shown the links with poverty. But our research looks specifically at why children from disadvantaged families are significantly more likely to be obese than their better off peers.

To examine this as robustly and rigorously as we could, we used data from the Millennium Cohort Study (MCS) which has tracked the lives of nearly 20,000 children from across the UK since the turn of the century. Using a range of measurements taken when the children were aged 5 and 11 together with detailed information about their backgrounds and family circumstances, we were able to demonstrate just how key poverty was in respect of their obesity.

At age 5, poor children were almost twice as likely to be obese compared with their better off peers. By the age of 11, the gap had nearly tripled.

Knowing as we do that obese children are less likely than their peers to grow into economically successful adults and that obesity is clearly linked with a range of chronic diseases, it’s reasonable to say that for these children, the future is far from bright. From a policy perspective it is also clear that unless the gap between rich and poor children can be closed the chances of reducing the overall obesity trend, as the Government states it is committed to doing, are pretty slim.

How is poverty linked to obesity?

The MCS collects a broad range of data, allowing us to dig beneath these headline numbers to tease out some of the specific ways in which relative poverty in childhood leads to an increased risk of obesity.

To examine this question of whether a parent’s own lifestyle might have a role, we looked at factors previously shown to be linked to the increased risk of obesity, such as whether the mother smoked during pregnancy, how long she breastfed for and whether the child was introduced to solid food before the age of four months.

We could also factor in the degree to which a mother was herself overweight or obese and assess children’s physical behaviour, such as how often they exercised, played and how many hours they spent watching TV or playing on a computer, and the time that they went to bed. We looked at whether the child skipped breakfast, how much fruit they ate and how often they had sweet drinks.

A lot of these factors were relevant. A mother’s behaviour when her child was very young was certainly important. Markers of an ‘unhealthy’ lifestyle here could mean as much as a 20 per cent additional risk of obesity for a child.

Obese and overweight children living in poor families were more likely to have mothers who did not breastfeed or breastfed for a shorter duration, who introduced solid foods early in infancy, who smoked during pregnancy, and who were overweight or obese. The poorest children were also more likely to spend more time watching TV and using a PC (and so have greater exposure to food and drink advertising), experience later and more irregular bedtimes, do less sports and be more physically inactive, engage less in active play with their parent, live in an area without a playground, and not have breakfast every day.

5-year-olds from poorer families were also much more likely to gain excess weight up to age 11 than richer children, leading us to conclude that the earlier certain risk factors can be challenged and the appropriate support provided for the least well off families, the greater the chance of positive impact on the risk of obesity and in a reduction in inequality.

Pathways to obesity

More recently we have identified four BMI trajectories for children. The good news is that 80 per cent of them are on a stable path where, on average, from when they’re born through to age 11, they are not overweight.

There is a small group of children who are obese at age 3 but then join the stable group by age 7. We call them the ‘decreasing’ group. There is a ‘moderate increasing group’ (13.1 per cent) where children are not overweight at age 3 but whose BMIs increase throughout childhood into the overweight (but not obese) range. Finally we have a ‘high increasing’ group of children (2.5 per cent) who are obese at age 3 and whose BMI continues to increase.

From an inequality perspective, what’s most striking here is that the wealthiest children are least likely to be in the ‘moderate increasing’ BMI group whilst the poorest children are more than twice as likely to be on the high increasing path.

Today’s CSJ report agrees with our analysis that early intervention is key and, in line with it, proposes three key early years intervention opportunities to ensure children get the healthiest start possible before they reach primary school age.

The report acknowledges that the Government is already trying to persuade families to eat more healthily and take more exercise. But it has joined a body of voices critical of the Childhood Obesity Plan, which, it believes, “fails to put reducing inequality as a goal … despite acknowledging that the childhood obesity burden falls hardest on the poorest children.”

Certainly our body of evidence indicates that policy makers need to acknowledge and address inequality as a root cause of obesity. Doing something about the structural factors in people’s lives is what is needed rather than ‘tinkering around the edges’ of the problem.

Today the CSJ asks why there are disproportionately high levels of obesity, particularly childhood obesity, in our most deprived communities. Our research has gone some way to answering that question, and makes it clear that there is no simple one-stop shop solution.

Obesity is caused by a combination of environmental, biological, cultural and psychological factors, where one factor does not dominate and yet our obsessional search for the ‘one thing’ that can tackle obesity continues. If the Government is going to reduce obesity rates, it will indeed, need to introduce multiple bold measures in tandem across the entire ecosystem and recognise that success may only be measurable after a few years.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study is research by Alice Goisis, Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health

BMI Development and Early Adolescent Psychosocial Well-Being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery and Amanda Sacker and is published in Pediatrics

An equal start: longitudinal evidence to support children’s healthy development

Using longitudinal evidence to support children’s healthy development and give them an equal start in life is the subject of our editor Yvonne Kelly’s keynote address at the Growing up in Ireland Annual Conference in Dublin today.

Her talk discusses findings from the most recent of the British ‘birth ‘ cohort studies – the Millennium Cohort Study that have so far informed policy development. They include work by researchers at the ESRC Centre for Lifecourse Studies where Yvonne is based on alcohol consumption during pregnancy, breastfeeding and the introduction of solid foods, the physical punishment of children , childhood obesity, reading to children in the early years, and sleep patterns throughout childhood.

She will also share work with the potential to inform future policy challenges such as young people’s drinking, social media use and mental health.

Ahead of her talk, she said:

“It is well established that what happens in the early years of life has long-lasting consequences for health and social success across the lifespan. Stark social inequalities in children’s health and development exist and emerge early in life. It is therefore crucial to identify potential tipping points and opportunities for intervention   during childhood with the potential to affect change and improve life chances.”

 

 

Don’t let the kids get jet-lag: why regular bedtimes are key to a happy healthy childhood

The very best of sleep medicine and research is being presented at the World Sleep Congress in Prague this week. Among that research are findings from work by Child of our Time Editor, Professor Yvonne Kelly and colleagues at the ESRC International Centre for Lifecourse Studies. They have been trying to find out what it is about sleep that matters most when it comes to giving children the best possible start in life. Here Yvonne explains what they have found to date and why regular bedtimes are key to a healthy happy childhood.

What happens in the early years has profound implications for what happens later on in life. Thousands of research papers, many of them using the wonderful rich data in the British Birth Cohort studies, have documented the enduring impacts of the way we live our lives as children on how we fare later on. Children who get a poor start in life are much more likely to experience poor outcomes as adults, whether that’s to do with poor health or their ability to enjoy work and family life later on.

So what has all that got to do with getting enough sleep as a toddler you might ask? Well our research shows it is one of a number of important factors related to getting children off to the best possible start in life and here’s why.

Recommended sleep

The National Sleep Foundation recommends that toddlers should get around 11 to 14 hours sleep every day. For 3-5 year-olds, the recommendation is 10-13 hours and it suggests 9-11 hours for children once they’re at primary school. But is it all about the number of hours sleep children get, or is there more to it than that? Those are the questions we have been addressing in our research into children’s sleep and how it ties in with how they get on at home and at school across the first decade of their life.

Digging into one of those studies mentioned earlier, the Millennium Cohort Study, which has followed the lives of some 20,000 children since the turn of the century, we found that it’s not just the number of hours a child sleeps that matters, but also having consistent or regular bedtimes.

First we looked at the relationship between regular and irregular bedtimes and how the children got on in a range of cognitive tests. The results were striking. Children with irregular bedtimes had lower scores on maths, reading and spatial awareness tests.

Parents who took part in the MCS were asked whether their children went to bed at a regular time on weekdays. Those who answered “always” or “usually” were put in the regular bedtime group, while those who answered “sometimes” or “never” were put in the irregular bedtime group.

Interestingly, the time that children went to bed had little or no effect on their basic number skills, and ability to work with shapes. But having no set bedtime often led to lower scores, with effects particularly pronounced at age three and the greatest dip in test results seen in girls who had no set bedtime throughout their early life.

The key to understanding all this is circadian rhythms. If I travel from London to New York, when I get to there I’m likely to be slightly ragged because jet lag is not only going to harm my cognitive abilities, but also my appetite and emotions. That’s for me, an adult. If I bring one of my children with me and I want them to do well at a maths test having just jumped across time zones, they will struggle even more than I will. The body is an instrument, and a child’s is especially prone to getting out of tune.

The same thing happens when children go to bed at 8 p.m. one night, 10 p.m. the next and 7 p.m. another — we sometimes call this a “social jet lag effect.” Without ever getting on a plane, a child’s bodily systems get shuffled through time zones and their circadian rhythms and hormonal systems take a hit as a result.

Bedtimes and behaviour

Having established the importance of sleep to a child’s intellectual development, we turned our attention to the relationship between regular bedtimes and their behaviour.

At age 7, according to parents and teachers, children in the MCS who had irregular bedtimes were considerably more likely to have behaviour problems than their peers who had a regular bedtime. In addition, the longer a child had been able to go to bed at different times each night, the worse his or her behaviour problems were. In other words the problems accumulated through childhood.

One really important piece of good news was that we found that those negative effects appeared to be reversible, so children who changed from not having to having regular bedtimes showed improvements in their behaviour. There seems to be a clear message here that it’s never too late to help children back onto a positive path and a small change could make a big difference to how well they get on. Of course, the reverse was also true so the behaviour of children with a regular bedtime who switched to an irregular one, worsened.

Bedtimes and obesity

In a follow up study, which looked at the impact of routines including bedtimes on obesity, we reported that children with irregular bedtimes were more likely to be overweight and have lower self-esteem and satisfaction with their bodies.

In fact, of all the routines we studied, an inconsistent bedtime was most strongly associated with the risk of obesity, supporting other recent findings which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

So we have a body of robust evidence now that shows very clearly that regular bedtimes really matter when it comes to a child’s health and development over that important first decade of their life.

Providing that evidence in the form of advice to parents and all those caring for young children alongside recommended hours of sleep could make a real difference, helping protect our children from ‘social jet-lag’ and getting them off to a flying start instead.

Equally protected children: one step closer

In 2015 UCL researchers Anja Heilmann, Yvonne Kelly and Richard Watt produced a report, which showed that there was ample evidence that physical punishment can damage children and escalate into physical abuse. Together with the children’s charities that commissioned the report, they called for urgent action to provide children with the same legal protection against violence that British adults enjoy. The report was at the heart of Scottish MSP John Finnie’s proposed Children (Equal Protection from Assault) Bill which the Scottish Government have just announced that they will support in their programme for the coming year. The Bill would make Scotland the first UK country to outlaw all physical punishment by removing the defence of “justifiable assault” of children, and giving them the same protection as adults. Lead researcher, Anja Heilmann, reflects on the news and what she hopes it might mean for the human rights of children in Scotland and elsewhere.

On 11 May 2017, John Finnie MSP proposed a Bill to the Scottish Parliament to “give children equal protection from assault by prohibiting the physical punishment of children by parents and others caring for or in charge of children”.

After a three month consultation, which received more than 650 responses, the majority positive (75 per cent), that Bill became part of the Scottish Government’s plans for the next year, as Nicola Sturgeon announced she would not oppose it.

If passed, the Bill will prohibit the physical punishment of children by ending the existing common-law position that physical punishment by parents can be defended as reasonable chastisement and therefore be lawful. The Bill will not create a new criminal offence, as the common law offence of assault will apply (with a modification removing the reasonable chastisement defence).

It’s a far cry from similar efforts made in Scotland in 2002 to prohibit the physical punishment of children under the age of three. Back then, not only did a majority of MSPs reject the idea, but it was branded as “ridiculous” and an unwelcome intrusion into family life by many parents and the media.

15 years on it seems attitudes may have changed significantly. In the foreword to the Bill, John Finnie himself said:

“We would no longer consider it acceptable…. to allow our children to roam freely in the back of the car when going on a journey. Neither would we dream of taking them to a cinema if they had to watch a film through a fug of cigarette smoke … Attitudes towards these and many other fundamental societal issues have dramatically changed.”

Those attitudes changed as the result of a clear presentation of the evidence – the hard facts about the damage that those behaviours could cause.

We believe that, in this case, our evidence has made it clear for all to see that hitting children can not only damage them, but it carries the risk of escalation into physical abuse. It is a clear violation of international human rights law and children should and must be afforded the same rights as adults in this respect.

Overwhelming evidence

The evidence for the detrimental effects of physical punishment is vast and consistent. In short, our summary of the available evidence showed that physical punishment was related to increased aggression, delinquency and other anti-social behaviour over time. It also showed the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

There was also a clear link between physical punishment and more serious child maltreatment and negative effects continued into adulthood, including problems of drug and alcohol dependency.

Half-hearted responses to recent human rights rulings condemning the physical punishment of children need to become wholehearted changes to the law, not tinkering that does just enough to meet the minimum requirements of those judgments rather than properly respect the rights of children.

The UN Committee on the Rights of the Child is unequivocal – all forms of corporal punishment of children are unacceptable. Let’s hope the Scottish Parliament can find the courage to make that statement a reality and show the rest of the UK the way.

As Martin Crewe of Barnardo’s Scotland stated:

“This is a huge step forward and sends a very clear message about the kind of Scotland we want to see for our children.”

Personally, I am hoping it’s a kind of Scotland and indeed UK, we WILL see in the not too distant future and I appeal to all MSPs to listen to the evidence and support the Bill.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Why reading is key to giving our kids a great start in life

A growing body of research is pointing to how important and valuable reading is in giving children the best possible start in life, not just for academic success but more broadly including for a child’s mental health and happiness.

In this special episode of the Child of our Time Podcast, Professor Yvonne Kelly is joined by Jonathan Douglas, CEO of the National Literacy Trust and researcher Christina Clark, also from the  Trust. They discuss important new evidence about the benefits of reading for individual children and in addressing social inequalities.

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Do mental health problems have their roots in the primary school years?

Recent reports have shown worrying rises in young people suffering from mental health problems. A study for the Department of Education showed more than a third of teenage girls reporting depression, anxiety and low self-esteem. To try to understand this growing problem, Dr Afshin Zilanawala and fellow researchers from the ESRC International Centre for Lifecourse Studies at UCL have investigated how certain aspects of learning in the primary school years and success affect the behaviour and wellbeing of early adolescents.

Young people who drink, smoke and have behavioural problems are known to be at risk of suffering poor health as adults.

Understanding what causes this risky behaviour, and the anxiety and low self-esteem associated with it, can help professionals to target those most likely to drop out of school, become pregnant as a teenager, become obese or to suffer other long-term health issues.

By planning support and prevention programmes during childhood, they can improve the likelihood of a successful and healthy adulthood for our most vulnerable young people, and reduce the pressure on health and social services.

Mental health

A recent YouGov survey of Britain’s university students revealed that more than a quarter of them report depression and poor mental health.

But could the roots of these problems be found by looking more closely at how children develop and learn throughout the primary school years?

Information on more than 11,000 children collected by the UK Millennium Cohort Study (MCS) was used in our research, which explores the links between children’s verbal abilities and their behaviour and well-being as they make the move to secondary school.

Using information collected at ages three, five, seven and 11, we were able to see how well they could read, the range of their vocabulary and their verbal reasoning skills.

Then, at age 11, the children were asked about their school work and life, their family and friends and their appearance. There were questions about how happy they were, whether they felt good about themselves. They were also asked if they had tried cigarettes or alcohol, and if they had stolen anything or damaged property.

Verbal performance

In terms of how well they were getting on, the children were divided into three groups (low, average and high verbal achievers).

This in itself produced a startling and worrying view of the diverging paths these different children follow over time, particularly between the ages of seven and 11. One in five of the children (the high achievers) did better and better at the verbal tests, stretching away from their peers as they prepared to head to secondary school. The majority (around three quarters) of children were on the middle path, making steady progress but then plateauing off. But, most striking of all was what happened to the low achieving group (around one in 17 of the children), whose verbal abilities declined steeply.

Verbal ability

Millennium Cohort Study

Having established these pathways, we went on to look at which children at age 11 were involved in risky behaviours and then to dig deeper to see how these behaviours related to their progress to date. We also looked at what other factors, especially those related to their family circumstances, might be at play.

Boys were more likely than girls to be smoking and drinking or getting involved in anti-social behaviour. Girls were more likely to suffer from low self-esteem. First-born children were happier and had higher self-esteem, and were less likely to smoke, drink and have problem behaviours than second or later birth-order children. Children with younger mums were also more likely to engage in risky behaviour.

Those from disadvantaged backgrounds and those with more unsupervised time were more likely to suffer from poor mental health. We also found those whose mothers suffered from depression were more at risk of mental health problems.

Looking at the raw data, the low achieving children were three times more likely to smoke than their high achieving peers and twice as likely as the average group. Low achieving and average achieving children were also more likely to drink.

One in three of the low achieving children compared with one in five of the high achievers had been involved in anti-social behaviour and were more than four times more likely to have behaviour problems as reported by their parent. They also had much lower levels of self esteem.

Family factors

When we took a range of family factors into account including the child’s age and gender, mother’s age and mental health and socioeconomic circumstances, many or all of the differences between the groups disappeared or became smaller, confirming the overriding importance of the family and social environment.

However, we can say, for the first time, and with considerable confidence, that how well children are reading, talking and reasoning, can and does influence their health and well-being as they become adolescents. Indeed, we found clear evidence that children who were performing below average in this area across childhood were more at risk of poor mental health and risky behaviour than their consistently above-average performing peers.

If we want those children to stand a better chance of a healthy and happy life, we need to focus a great deal of attention on what is happening at home and at school in those early years, particularly, our research would seem to show, between the ages of 7 and 11.

Our results are consistent with other research, which demonstrates the huge challenge for young people with poor verbal skills, who arrive at the doorstep of adolescence with mental health, self-esteem and behavioural issues, which are likely to continue into adult life.

Recent reports that child poverty figures in the UK are continuing to rise, despite successive Governments’ promises to reduce them, does not bode well in this context. Indeed, it would seem to indicate that it will be some time before the yawning gaps in inequality that we see at primary school and their knock-on effects on children’s wellbeing in adolescence can be closed.

Longitudinal Latent Cognitive Profiles and Psychosocial Well-being in Early Adolescence is research by Afshin Zilanawala, Amanda Sacker and Yvonne Kelly and is published in the Journal of Adolescent Health

Photo credit: Creative curriculum  US.Army

 

Why mental health is not your average problem

There have been numerous reports in recent months of a growing crisis in children and young people’s mental health. From increased suicide attempts and incidents of self-harm to reports of a complete lack of appropriate services, it’s said that young people are facing unprecedented social pressures and that society’s response has been inadequate. When it comes to trends over time in the mental wellbeing of young people, the evidence to date is conflicting. Meanwhile, new research by Andy Ross and colleagues at the ESRC International Centre for Lifecourse Studies at UCL shows that the way we look at those trends may be masking an important story that could help those trying to tackle the problem to identify those most at risk of serious mental health problems.

There are few more high profile health issues at the moment than the mental health crisis among young people. The younger Royals may have helped raise public awareness about the need for more open conversations, but they agree the job is far from done. From a policy perspective, there are pledges of mental health legislation reform in the Queen’s Speech promises from Teresa May that her Government will “ensure that mental health is prioritised in the NHS in England”. But a recent report from NHS Providers says the government’s commitment to parity of esteem between mental and physical health services is being undermined by a failure to ensure funding increases reach the frontline.

Having a full and clear grasp of the scale of the problem and how young people’s mental wellbeing is changing over time will be key to any policies that may be developed to tackle it.

One of the main problems facing those trying to better understand the extent of the problem and whether the situation is getting better or worse, is that the evidence presented to date has been somewhat conflicting and, in some cases, doesn’t give the whole picture.

Some research has shown young people’s mental health deteriorating in the nineties and then stabilising and slightly improving in the early 2000s, whilst other work has evidenced a steady decline. Findings have also been different depending on whether it is teachers, parents or the young person themselves who are asked to report the symptoms.

Trends over time

We wanted to see whether we could add to and improve on the available evidence and show a more nuanced picture of mental health problems among young people by looking at trends over time, not just in respect of average levels of mental health, but also across the spectrum in levels of mental health. In simple terms, we were looking to see whether there were increases in the number of young people with unusually low levels of mental distress at the same time as increases in the numbers of those with very high levels of distress over an 18-year period.

Making use of information collected between 1991-2008 from more than 6,000 young people who took part in the British Household Panel Survey, we looked closely at their self-reported psychological distress. Once a year, young people between the ages of 16-24, were asked whether and how often, for example, they had experienced the loss of sleep through worry, a loss of confidence, felt constantly under strain, unhappy or depressed. They were also asked about positive symptoms such as their ability to concentrate and face up to their problems.

All this information was then combined to create an overall psychological distress score on a scale of 0-36, with high scores indicating high levels of psychological distress.

When we looked at the average psychological distress scores for young women in the study, we saw a small but significant increase over the 18-year period, indicating that, for this group, the situation worsened – in other words, their mental health deteriorated.

No increase was detected in the average scores for young men, which could be interpreted as a sign that levels of mental health among this group remained fairly stable.

At every time point, scores for women were worse than they were for men and this gap increased over time.

A story of polarisation

When we drilled deeper into the scores, however, the story changed a little. For young women there was a very clear and consistent increase in high and very high scores, following the overall increase in average scores mentioned above. The prevalence of those with high scores (17 and higher) increased from 12.8 per cent in 1991 to 18.8 per cent in 2008, and the prevalence of those with very high scores (20 and higher) from 6.6 per cent to 11.9 per cent. At the same time, however, there was also a small increase in the prevalence of those with scores much lower than average (5 and lower) from 10.6 per cent to 13.0 per cent.

It seems that when we move beyond looking only at average mental health scores over time, we identify two very different yet concurrent pictures of young women’s mental health. An increase in the number of young women presenting very poor levels of psychological distress, whilst at the same time an increase in young women with far better levels of mental health than average. In other words, over time, the mental wellbeing of young women appears to have become polarised.

Previously, our findings suggested that levels of mental health among young men had remained stable. However, when we look at both low and high scores over time, we find a very clear and consistent increase in low and very low scores, suggesting an overall improvement in levels of mental health among young men.

The prevalence of those with low and very low scores increased from 8.1 per cent to 15.6 per cent and from 2.1 per cent to 5.9 per cent respectively. At the other end of the scale however, whilst there was an increase in prevalence of those with high and very high scores, this increase was too small for us to consider it statistically significant[1]. Nevertheless, by considering trends at both ends of the spectrum we identified an improvement in young men’s mental health, which was otherwise ‘hidden’ when we only looked at average scores over time.

Although our study did not delve deeply into the backgrounds and circumstances of the young people with low and high scores, we did look at income levels to see if increasing levels of inequality might explain what we were seeing. It doesn’t appear to.

What we did find was evidence to support earlier research, which suggests that girls might feel increased pressure to achieve academically, which could contribute to increased levels of psychological distress.

Doing it for themselves

We are yet to explore causes for these trends, however one area that remains significantly under researched is the idea that we are becoming a more individualistic society, in which there are increased expectations placed on young people and an emphasis on them “doing it for themselves”. This includes increased pressure to take responsibility not just for one’s successes, but also for one’s failures, previously thought of as misfortunes, such as unemployment, illness and addiction. It is easy to imagine how the personalising of one’s failings could contribute to a young person’s poor mental health, or how they might develop a fear of failure even.

On the other hand, taking more responsibility for their own destiny could be empowering when things go well, boosting their self-esteem and confidence.

Evidence of polarising trends in young women’s mental health could be the first step in linking time trends to the sort of cultural and societal individualization that is being increasingly talked about amongst those concerned with the health and wellbeing of the UK’s young people.

For young women, continuing gender inequalities (some legislative, some cultural), which serve to frustrate women’s dreams of self-realisation, might also help to explain the differences in poor levels of mental health in particular that we see between them and young men.

By 2020, the NHS has promised that 70,000 more young people will be able to access services for their mental health problems. Robust evidence on trends and how the story of young people’s mental health is changing over time will be key to ensuring those services are provided effectively and efficiently.

Time trends in mental well-being: the polarisation of young people’s psychological distress is research by Andy Ross, Amanda Sacker and Yvonne Kelly and is published in the Journal of Social Psychiatry and Psychiatric Epidemiology

Photo credit: Allan Bergman