Can early social-emotional functioning predict later mental health issues?

Many mental health conditions are first diagnosed in early adolescence, yet many people report experiencing symptoms before their teenage years. To better identify and provide help early, more understanding is needed about how early childhood social-emotional functioning varies and how it may be associated with emerging mental health conditions.

Research Summary

  • Six functioning profiles based on kindergarten children’s social-emotional strengths and vulnerabilities were associated with later mental health conditions between ages 6 and 14 years.

What is the research about?

One of the main issues with the early detection and prevention of mental health problems is the lack of systems capable of identifying signs of problems before they reach a clinical stage.

Accordingly, the goal of the researchers from the University of British Columbia was to:

  • identify profiles of kindergarten children’s social-emotional functioning
  • learn how these relate to early-onset mental health conditions

What did the researchers do?

Researchers examined a population cohort of 34,552 children from birth to age 14.

Scores from eight subdomains of the Early Development Instrument (EDI) were used as indicators of children’s early social-emotional functioning:

  • overall social competence
  • responsibility and respect
  • approaches to learning
  • readiness to explore
  • prosocial and helping behavior
  • anxious and fearful behavior
  • aggressive behavior
  • hyperactive and inattentive behavior

In addition to early markers of social-emotional functioning, the researchers accounted for a variety of child and family factors that could explain differences in observed child behaviors, health service use, and mental health diagnoses. These included:

  • child age
  • sex
  • first language
  • family sociodemographic factors
    • family income
    • marital status at childbirth
    • maternal age at childbirth

These variables were used to create social-emotional functioning profiles. These profiles were then linked to mental health conditions obtained from physician claim files for anxiety, depression, conduct disorder, and ADHD. An additional category was created for children who received two or more diagnoses.

What did the researchers find?

Children with worse social-emotional functioning in kindergarten had higher odds of a later mental health condition by age 14 years.

Nearly 42% of children had some pattern of social-emotional vulnerability.

Overall, early internalizing symptoms led to later internalizing and externalizing conditions; and early externalizing symptoms led to later externalizing and internalizing conditions. For example, children showing high inhibition and anxious behavior in kindergarten had higher odds of conduct disorder and ADHD by early adolescence in addition to higher internalizing conditions. Children showing higher aggression and hyperactivity in kindergarten had higher odds of depression and anxiety in addition to externalizing conditions.

Surprisingly, internalizing symptoms for inhibited-disengaged children were not associated with higher odds of a later anxiety diagnosis. Rather, it was children characterized by anxious behavior combined with low social competence, high aggression, and hyperactivity that were most highly associated with later anxiety. 

Inhibited-disengaged children had higher odds of depression by early adolescence, and children with higher externalizing symptoms had higher odds of conduct disorder and ADHD.

However, not all inhibited children had their internalizing symptoms persist. Those with high social competence and low aggression and hyperactivity were less likely to have later internalizing problems.

What does this research mean?

This study shows how routinely collected early childhood data can help monitor population patterns in childhood mental health. This data can be used to develop interventions that target key factors before mental health conditions become fully developed.

The large number of children with early social-emotional vulnerability show that addressing childhood mental health requires population-level interventions that start early. Schools are a key point of prevention.

Addressing early social-emotional symptoms, such as aggression or low social competence, may help reduce future externalizing disorders as well as internalizing disorders.