Chapter 3: Risk and Protection for Children

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3.1 Introduction

Frameworks for understanding children and childhood have developed in line with increasing clinical and academic knowledge of this area. Traditional conceptualisations, which viewed childhood transitions in terms of "a ladder-like progression through predictable stages, each of which has its set of tasks" (Rutter, 1989, p.45) are misleading. Childhood is not, as previously thought, a progression of certainty towards adulthood. Multiple pathways through childhood are available and a definitive set of needs do not exist (Hill & Tisdall, 1997). Economic and family background factors are important, as are educational experiences, but children's life prospects are not totally dependent on adults. Children actively shape their own environments and are capable of negotiating change and adversity within families and elsewhere (Gilligan, 1993; Hogan, Halpenny & Greene, 2002). Although a link has been claimed between family transformation and the rise in conduct disorders over the last half century (Rutter, Giller & Hagill, 1998) this association is not conclusive (Furstenburg, 1991). Conclusions regarding mental health trends among children remain tentative (McArdle, Prosser, Dickinson and Kolvin, 2003), and the exact mechanism by which broad socio-cultural changes may have led to increased rates of psychosocial problems in children and young people is unclear. In studies of children in Ireland and elsewhere, the majority remain well adjusted and without behavioural or psychological problems (Leader et al 1985; Fitzgerald & Jeffers, 1994). Socio-cultural change may bring about either positive or negative alterations to children's lives, and claims that childhood was a safer and happier period in former times are not supported by empirical findings (Lynch, 1998; O'Sullivan, 2001). It is also evident that children are resilient when faced with adverse conditions (Gilligan, 1993; Garmezy, 1993). Yet, while children may be, in general, adaptable and resilient some do emerge from childhood with negative attributes and the possible risk factors associated with this are considered below.

3.2 Risk and Resilience

Children exposed to a variety of adverse experiences can suffer long-term damage or negative psychological outcomes (Brooks, 1994). Yet, studies have demonstrated a diversity of responses to events, even within similar environments and conditions (Rutter, 1989; Masten, Best & Garmezy, 1990; Hogan, Halpenny & Greene, 2002). Outcomes vary because individuals differ in terms of their susceptibility to risk and because there may be protective mechanisms which reduce risk (Rutter, 1985; Kolvin, Miller, Scott, Gatzanie & Fleeting, 1990). Data from a large U.S. study of high-risk children found that a secure attachment in infancy, along with good quality parent-child relationships in early childhood, serve as major protective factors (Grotberg, 1995). Problems are not irreversible and negative outcomes are dependent on whether risk experiences are intensified or ameliorated by subsequent experiences. Improvements in the child's economic situation can have a significant impact across a number of intellectual indicators, including IQ (Kolvin et al, 1990). Similarly, negative childhood experiences may be ameliorated by economic security and a supportive relationship in adulthood (Quinton & Rutter, 1985).

The occurrence of multiple difficulties is an important factor related to outcomes as is the meaning of events or situations for the individual (Brown & Harris, 1978; Lazarus & Folkman, 1984; Turner & Lloyd, 1995). A single stress generally has little effect on a child but an accumulation of adversity greatly increases the likely negative impact (Rutter & Quinton, 1977; Kolvin et al 1990) In Rutter's (1979) study, the presence of two or three risk factors resulted in a fourfold increase in the rate of psychiatric disorder and exposure to more than four stressors produced a tenfold increase in distress (Rutter, 1979; Turner & Lloyd, 1995).

Children are generally resilient even when faced with major stressful life events and difficulties (Garmezy, 1993) and the majority emerge from childhood as psychologically healthy and socially competent (Grotberg 1995; Kolvin et al., 1990). Even with the most severe stresses and adversities, it is unusual for more than half of all affected children to succumb to a maladaptive outcome (Rutter, 1979). Children's responses to stress varies over time and circumstances. In fact, children are capable of repeatedly altering their reactions to tension (Rutter, 1989). Resilience is influenced by protective features within the child's environment which ameliorate the impact of difficulties and/or help the child to develop a strong self-concept and thus resist stress (Rutter, 1987). Protective elements might also include positive events or turning points in people's lives such as educational success (Garmezy 1987).

Certain personality attributes, such as self-confidence and a sense of control over one's life, can also protect an individual from risk factors (Holahan & Moos, 1987). Children with adverse temperamental features are more likely to be the target of parental criticism and hostility (Rutter, 1987). Resilient youngsters have a strong belief in their ability to control their environment and this might involve seeking affirmation outside the family (Werner & Smith 1982). External locus of control, in combination with poor social support, increases the risk of developing psychological disorder (Dalgard & Haheim, 1998) and the use of avoidant coping strategies has also been shown to be a significant risk factor (Vaillant, 1977; Moos & Schaefer, 1984).

Social support is perhaps the best-documented factor associated with stress resistance and this may come from a variety of sources (Holahan & Moos, 1987; Dalgard & Haheim, 1998). DeWilde, Kienhorst, Diekstra and Wolters (1994) found that at-risk adolescents reported a low level of support from their families. Support from teachers and peers is associated with high self-esteem (Cauce, Felner & Primavera 1982; Stone, Fitzgerald and Kinsella 1990). However low academic achievement does not in itself result in a negative self-concept (Hayes & Kernan, 2001). The neighbourhood one lives in can provide protection, or increase risk (Aneshensel & Sucoff, 1996). In Kolvin et al's (1990) study the surrounding environment was almost as important in predicting delinquency as was family deprivation.

Trying to identify specific risk features for research purposes can be problematic because similar outcomes often arise from diverse risk factors and, conversely, comparable risk factors can lead to different outcomes (Magnusson, Stattin & Allen, 1985). The measurement of resilience is similarly challenging. Children may display competence in many areas of their lives yet still be vulnerable in less obvious, psychological terms (Luthar & Zigler, 1991). Resilience is also likely to fluctuate over time as it is not a stable attribute of the individual but rather a function of the interaction between the individual and environmental influences (Herronkohl, Herronkohl & Egolf, 1994).

3.3 Factors influencing the Child's Development

As the above discussion indicates, the reasons why some individuals overcome adversity, while others succumb to maladaptive, less positive, outcomes lie partly in the study of the relevant environments (home, school, etc.) and of changes within those environments over time (Garmezy, 1988). The following sections consider some of these factors and sites of potential risk (or resilience) for the child.

3.3.1 Age and Gender

The responses of children to stress and adversity will obviously be modified by their age and thus their capacity to understand the experience (Garmezy, 1985). Gender is also significant and males are vulnerable in terms of developing conduct and behavioural difficulties and for offending (Kolvin et al., 1990) Educational outcomes are clearly less positive for men in Ireland and elsewhere (Hearn, 1998; Cleary, Corbett et al., 2004). Males appear to be more vulnerable in certain situations (such as family discord) and boys are more likely than girls to develop emotional and behavioural difficulties in these circumstances (Rutter, 1987). This may be due to a number of factors. Hetherington, Cox and Cox (1982) found that parents were more likely to argue in front of their sons than their daughters. Maccoby and Jacklin's (1974) work indicates that boys are more likely to react to difficulties in a disruptive, aggressive way and that this is likely to elicit negative reactions from parents and others. There are also varying cultural expectations for males and females in society and similar behaviour by boys and girls can have different consequences (Stevenson-Hinde & Hinde, 1986). Males and females have different ways of channelling emotional difficulties, which is, according to Chodorow (1978), a product of their differential emotional development in childhood. Young boys, she says, learn early in life to restrict the expression of emotion and this tendency is socially reinforced as they develop. The result is that males often experience difficulties expressing problems as they grow older. Females on the other hand are more likely to express feelings and to have channels in place to do so (Duncombe & Marsden, 1993).

3.3.2 Psychological Health & Well-being in Childhood

Early behavioural disturbance has been cited as one of the strongest predictors of later problems, including psychological difficulties, involvement in crime and antisocial behaviour (Rutter, 1989; Kolvin et al. 1990). Behavioural or conduct disorder is common in childhood and adolescence (Kolvin et al. 1990; Lawlor & James, 2000) and higher male than female rates are consistently found (Murphy, Fitzgerald, Kinsella & Cullen 1989; Martin 1997). Fitzgerald and Jeffers (1994) categorised almost a fifth of the Irish children they studied as behaviourally disordered with twice as many boys as girls classified in this way.

The fact that a child displays psychopathology in the early years makes it more likely that he/she will continue to experience difficulties into adulthood, although these difficulties may manifest themselves in various ways (Visser, Van der Ende, Koot & Verhulst, 1999). Disruptive behaviour makes it more likely that there will be an early exit from school and hence the individual is less likely to attain a stable occupational status (Fergusson & Horwood, 1998; Cleary, Corbett et al., 2004). Behavioural and other difficulties in childhood can be persistent (Fitzgerald, Jeffers & Kinsella, 1994). Children with conduct disorders at a young age are more likely to have higher rates of juvenile offending, substance use and mental health problems in later adolescence (Fergusson & Lynskey, 1998). Some children are vulnerable in this way and more generally exposed to risk (Nixon 2001; Halpenny, Keogh and Gilligan 2002).

Yet despite evidence of continuity between childhood and adult disorder only about a third persists into adulthood (Rutter, 1989). Teachers' assessments of deviant behaviour have been found to be reasonably reliable predictors of psychological outcome (Olin et al, 1998; Fergusson & Lynskey, 1998) but they can also be untrustworthy (Kolvin et al. 1990; Boyle et al. 1993). Such ratings are probably most accurate in relation to markedly deviant behaviour.

Longitudinal data indicates that the risk of continuity is greatest for males who show a combination of aggression, hyperactivity and poor peer relationships (Magnusson, 1988; Farrington, Loeber & Van Kammen, 1990). In Visser et al's (1999) study, the greatest predictive strength was found for aggressive and delinquent behaviour, attention difficulties and social problems. Continuity is likely for these individuals, according to Rutter (1989), because behavioural disturbance predisposes an individual to an increased likelihood of adverse environmental and psychosocial experiences in later life. In Fergusson and Horwood's (1998) study there were linkages between early conduct problems and later educational under-attainment and unemployment and this, they propose, is mediated by patterns of peer affiliations, substance use and problems with school authority. It also appears that conduct disorders are less amenable to treatment than internalising disorders such as depression (Visser et al 1999; Sheerin, Maguire & Robinson, 1999).

3.3.3 Family background and experiences Changing Family structures

For most children the family is the context within which initial relationships and understandings are developed. The structure and dynamic of families and family life has altered considerably in recent decades and, although the extent of this change has been questioned, there is now a diversity of family types (Trost, 1990; Fahey and Russell, 2001). Children are increasingly reared in lone parent family units or in reconstituted families, although the majority of children still grow up in two-parent households (McKeown, Ferguson & Rooney, 2000). Existing evidence in relation to the effects of differing family type on children suggests that the nature of the household is not the most significant factor, but rather the quality of the relationships and the economic resources available to the family (Hobcraft & Kiernan, 2001).

Studies have shown that a higher proportion of children in lone-parent households have scholastic or emotional problems, compared to those living with both parents, but this is more likely to be due to economic circumstances than to parental marital status (McMunn, Nazroo, Marmot, Boreham & Goodman, 2001; Flanagan, 2001). McMunn et al.'s (2001) research indicated that the high prevalence of psychological and conduct problems among children of lone mothers was a consequence of socio-economic disadvantage, but this effect disappeared when receipt of state benefits, housing tenure and maternal education were taken into account. Early lone motherhood, in particular, is a risk factor for children as it is associated with educational and thus economic disadvantage in the mother.

The increased levels of participation in the labour force by mothers probably marks the most important change in the lives of Irish children over the last two decades. This transformation in women's roles has affected the balance of power within families, which in turn, has influenced childcare practices. Fathers are becoming more involved in child rearing (Kiely, 2001) and family size has also decreased considerably. There is no evidence that having a mother working outside the home results in negative outcomes for the child. In fact, there is some evidence to the contrary. Hennessy's (2001) research shows that for the majority of children temporary non-parental care is a positive and enjoyable experience, and a Danish longitudinal study of children found that mothers' long term lack of employment was a risk factor for neglect and abuse of children (Christoffersen, 2000).

According to Kolvin et al. (1990), poor quality parental care makes a significant contribution to the prediction of offending in adolescence and adult life. Parenting skills undoubtedly impact on a child's life, but there is a good deal of flexibility in the type and form of parenting (Hill & Tisdall, 1997). The ability to engage in warm and loving relationships with children has been cited as a key factor (Fahlberg, 1994), and parental approval is predictive of higher levels of self-esteem in the child (Eccles, Wigfield & Schiefele, 1998). Yet, children are capable of negotiating difficult home environments and finding alternative sources of affirmation (Gilligan, 1993; Emond, 2002). In Horwitz, Widom, McLaughlin and White's (2001) follow-up study of children who were taken into care following abuse and neglect, this specific experience had little direct impact on lifetime mental health outcome. According to Kessler and Magee (1993), only some stressors such as family mental illness, discord, violence and divorce are significant predictors of adult psychological health for children.

Structural and family background features contribute to the prolongation of conduct disorders. Kolvin et al's (1990) work underlined the link between conduct disorder and economic disadvantage and this association is well established in the research literature (Kohlberg, LaCrosse & Ricke, 1972; Sroufe & Rutter, 1984). Behavioural disorder in childhood frequently results in poor educational attainment and this is connected to aspects of economic disadvantage and not simply impaired intelligence (Miech, Caspi, Entner & Silva, 1999). Other mediating factors are family discord and inadequate parenting (McArdle, O'Brien & Kolvin, 2002). Parental Mental Illness

The association between parental mental disorder and negative outcomes in the child is well documented (Weissman, et al., 1984; Beardslee, Keller & Klerman, 1985; Fitzgerald and Kinsella, 1989; Day-Cody and Fitzgerald, 1989; Mohan, Fitzgerald & Collins 1998). According to Fitzgerald and Jeffers (1994), the link between maternal and child psychological health in their study resulted from the fact that maternal depression undermined parenting ability and made it more likely that the child would become disturbed. However, this relationship is not simple or straightforward and the impact of parental illness can be lessened when other resources are available to the child. Maternal psychiatric disorder, as identified in the baseline study for this research project (Fitzgerald and Jeffers 1994), can be detrimental to the child's health and behaviour but this is usually associated with economic disadvantage.

There is widespread evidence of successful coping amongst children with parents who are mentally ill. The main risk factor when a parent suffers from psychological disorder appears to stem from the associated family discord, especially when the hostility directly involves the child (Quinton & Rutter, 1985; Rutter et al., 1998). For the child, this difficulty can be offset by a mentally healthy parent and the maintenance of a good relationship with that parent. This is true also when a child loses a parent due to death or separation. These potentially damaging situations, if successfully negotiated, can even benefit the child in the long-term (Beardslee & Poderefsky, 1988).

Despite empirical support linking parental mental disorder to negative outcomes in the child, this finding is contested. There are methodological problems about agreed definitions of mental disorder and the way in which this is measured in research studies. Greater emphasis has been placed on mothers' psychological health, which is usually measured objectively, while fathers' health status is often based on spouses' accounts. But perhaps more importantly, the causal pathway could be in either direction, a fact increasingly acknowledged by researchers (Mohan et al., 1998). Although the majority of research effort has focused on the direction of influence from the mother to the child, there is some evidence to support the opposite route (Hopkins, Campbell & Marcus, 1987; Sheeber & Johnson 1992). Naerde, Tambs and Mathiesen (2002) have presented evidence that the child's temperament and behaviour impacts on the mother's mental health from a very early age, especially in the absence of spousal support. The authors question the frequently documented belief that depressed mothers have distorted perceptions of their children's problems. These mothers may, in fact, be providing realistic accounts of their situations. In sum, it may be that parental disorder has a lasting impact on children or that parents' psychological status results from difficulties in the child or that both child and parental psychological problems originate from other stressful circumstances within families (Rodgers, 1990). Parental Substance Abuse and Involvement in Crime

Another area of research has sought to identify intergenerational links between parents and children in relation to crime and substance abuse. A longitudinal study of males in the U.K found that a convicted father or sibling was highly predictive of a boys' later offending (Farrington, Barnes & Lambert, 1996) and Kolvin et al's (1990) work produced similar findings. There is some evidence that drug taking is cross generational and that similar processes operate when crime and substance abuse is evident in the home (Cleary, Corbett et al., 2004). However, the resilience of the child is a factor that must be considered in assessing this risk, as are the social and economic resources available to the family. Risk is also dependent on the attitude and practices of the parent or parents and there is evidence that drug-taking parents often take great care to protect their children in these situations (Hogan & Higgins, 2001). Marital Discord

Marital disharmony has been associated with behavioural deviancy in children (Lucey & Fitzgerald 1989; McNestry, Fitzgerald & Kinsella, 1988). Dooley and Fitzgerald (1984) found that an increase in marital discord in the home was associated with an increased likelihood of referral to child psychiatric services and this is apparent in very young children (Mulhall, Fitzgerald & Kinsella, 1988). Yet, as with other adverse circumstances, marital disharmony does not in itself necessarily result in psychological difficulties in the child. If he or she can draw on supportive relationships outside the home this can often ameliorate the effects (Rutter, 1989). There are also links between parental separation and adverse psychological and social outcomes for children (Chase-Lansdale, Cherlin & Kiernan, 1995), but again these are predicated on events surrounding the separation and the availability of parent or substitute support to the child (Hogan, Halpenny & Greene 2002). As Rutter (1989) has said, it is not the single event or factor that is important but rather the possible chain of negative events and features this sets in motion. Yet, although long-term adverse outcomes typically only apply to a minority of children experiencing parental separation, these children are more likely to experience long-term ill effects than children of two-parent families (Emery, 1999; Amato, Loomis & Booth, 1995). Separation has been linked with conduct problems and delinquency and with less positive educational outcomes (Kiernan, 1992; Kiernan 1997).

3.3.4 Economic Factors

Economic factors play a key role in determining the overall health and social status of individuals throughout their life-span and there is a well-established correlation between adverse socio-economic circumstances and the probability of behavioural and school-related problems in children (Kolvin et al., 1990; Nolan, 2001). Relatively high rates of psychological distress have been found in a number of Irish studies based on lower socio-economic groups (Barton & Fitzgerald, 1986; Fitzgerald, Pritchard & Kinsella, 1988; Fitzgerald et al., 1994).

In Kolvin et al's (1990) longitudinal study there was a clear relationship, especially for males, between offending and lower occupational status,and the likelihood of offending increased with the severity of deprivation in the family of origin. A number of studies have tried to pinpoint the risk elements in low-income families (Luthar & Zigler, 1991). These factors include low status parental occupation, lone parenthood, large family size, and low level of maternal education (West & Farrington, 1977; Rutter & Quinton, 1977; Kolvin et al 1990). Economic factors are likely to explain the link between adverse outcomes for children and lone parenthood, as these families are more likely to be economically disadvantaged (Allan, 1999). Nolan (2001) cites parental unemployment and lone parenthood as reasons for the worsening financial position of households with children in Ireland despite improved levels of economic growth. Long-term unemployment and low income levels in the family were identified as a particular source of poverty for children. Nolan's research has charted growing levels of inequality amongst Irish children from the 1970s, a finding supported by Hayes and Kernan's (2001) recent analysis of educational outcome and Halpenny et al's (2002) study of children whose families are homeless. According to Fitzgerald and Jeffers (1994) unemployment and financial difficulties cause stress in families because they reduce the ability not just to obtain goods but also resources which may offer respite from a difficult environment. This kind of situation increases the mother's vulnerability to depression, which in turn may undermine her parenting ability, making it more likely that her children will develop difficulties.

3.3.5 Educational success or failure

School may act as an important risk or protective feature in the child's life (Garmezy, 1993; Hayes & Kernan, 2001). School offers the possibility of academic and social success and factors that will influence outcome include socio-economic and family background, IQ, the ability to learn and the school environment. It is recognised that attitudes to learning are shaped early and that academic success rests predominantly on a child's early knowledge of how to learn, as well as what is learned (Brazelton, 1992).

In Ireland all children have benefited from increased access to education but some groups have gained more than others (Clancy & Wall 2000; Clancy, 2001). Increasing retention levels are evident at second level from 1980 (from 60% to 81% in 1998) but socio-economic and gender differentials have emerged. Females are now outperforming males at most educational levels (Clancy & Wall, 2000; Cleary, Corbett et al., 2004), while males are much more likely to drop out of the school system (ESRI 1998).

Socio-economic factors appear to have a significant effect on educational participation and achievement and Clancy has described socio-economic background as a "powerful determinant of progress through the educational system" (Clancy 2001, p.58; Clancy & Wall, 2000; Hayes & Kernan, 2001). Hayes and Kernan (2001) found clear differences in academic achievement between disadvantaged and non-disadvantaged primary schools. At second level the increased participation rate of children from unskilled and semi-skilled groups (from 14% in 1992 to 23% in 1998) is relatively small in comparison to other socio-economic groupings (Clancy & Wall, 2000). The majority of early school leavers come from lower socio-economic groupings and fewer than a quarter of entrants to higher education come from unskilled and semi-skilled backgrounds (compared to 75% for the highest social groupings). And it appears that less able middle class students have higher retention levels than working class students, a fact Clancy and Wall (2000) attribute to differential resources and parental expectations. The employment implications of a lack of educational attainment are demonstrated by the ESRI (1998) School Leavers' survey. Young people leaving school with no qualifications are six times more likely to be unemployed than those with a Leaving Certificate. There are links also between unemployment and mental and social adjustment (Fergusson, Horwood & Woodward, 2001).

Early childhood appears to be a crucial period for developing learning and intellectual abilities, therefore poverty at this stage has a substantial influence on educational achievement (Rutter, 1989; Guo, 1998). Hayes and Kernan's (2001) study of Irish primary school children has shown how children from poor backgrounds are disadvantaged from the pre-school stage despite the acknowledged importance of this period for cognitive development. Based on their study of Irish primary schoolchildren, Hayes and Kernan (2001) conclude that the cumulative effect of family disadvantages make it more likely that poor children will have a less positive educational outcome than other children. The early origins of scholastic difficulties are clear also from Kolvin et al.'s (1990) research in that pre-school deprivation was shown to have a powerful effect on later intellectual performance. At primary level, children from disadvantaged backgrounds scored lower on linguistic and other key measures (with IQ controlled) and the gap widened between these children and their classmates as they progressed through the school system.

Disadvantage can impact in various ways on school performance. Extreme disadvantage can have a significant negative impact on IQ, and conversely IQ as well as general scholastic functioning can improve with better economic conditions in the family (Cronbach, 1969; Garbarino,1992; Kolvin et al 1991). Yet children do overcome economic obstacles and become successful in the educational system (Clarke & Clarke 1984; Kolvin et al. 1990). This appears to be strongly related to gender, peer group affiliation and the availability of successful role models (Jessor, Turbin & Costa, 1998).

There is a substantial body of literature evidence mapping the reasons why children from lower-economic groups may be disadvantaged in relation to other socio-economic groupings (Bernstein 1971; Bourdieu & Passeron, 1977; Lynch 1999). It is claimed that the Western educational system is dominated by middle-class frames of language and thinking and that children from this background have an automatic advantage in these settings. It does appear that school and out-of-school life is more similar for middle-class children (Lareau 2000). School can engender feelings of marginalisation for children from different background environments (Keogh & Whyte, 2003). Parental expectations are also important, as is the ability to redress learning deficits (Hanafin, 2000). That school-based factors are not the only elements involved is underlined by Hayes and Kernan's (2001) finding that disadvantaged schools had better pupil-teacher ratios than other schools, similar equipment resources and that there were no obvious curriculum disparities. The clear differences in academic achievement between the two school categories reflect, as Hayes and Kernan (2001) note, established evidence regarding the lower academic achievements of children who are disadvantaged (Garbarino 1992; Kellaghan, Weir, O hUallachan & Morgan, 1995).

3.4 Summary

Contemporary perspectives on child development favour flexibility and individuality rather than a definitive set of needs and outcomes. Economic and family background factors are important and there is an association between adverse social circumstances and the probability of behavioural and school-related problems in children. A higher proportion of children in lone parent households may experience difficulties compared to those living with both parents, but this may be related to economic circumstances rather than to family structure per se. Other family changes, such as mothers working outside the home, do not appear to have had adverse consequences for children, and the impact of parental separation is again dependent on the circumstances surrounding the separation. What is important for children is the quality of parenting they receive. Deficient parenting is more likely if one or both parents suffer from a mental disorder. Yet, children's life prospects are not totally dependent on adults and the majority of young people emerge from childhood well-adjusted and without behavioural or psychological problems. Outcomes vary for children because individuals differ in terms of their susceptibility to risk factors and also because of various protective mechanisms which reduce the impact of those factors. An accumulation of risks is more likely to adversely affect the child than a single event. The effects of such risks are likely to be mediated by age and gender. Education can be an important protective feature in a child's life, although there is considerable evidence suggesting that educational outcome itself is strongly associated with socio-economic factors, especially in the pre-school and early primary stage.


Note re Authorship
Executive Summary
Chapter 1: Introduction
Chapter 2: Methodology
Chapter 3: Risk and Protection for children
Chapter 4: Social and Psychological development
Chapter 5: Health and Behaviour in Childhoods
Chapter 6: Educational Attainment
Chapter 7: Discussion and Conclusions
Appendix 1

- Structured Clinical Interview for DSM-IV Axis I Diagnoses (SCID)
- Beck Scale for Suicide Ideation (BSSI)
- Rosenberg's Self-esteem Scale
- Arizona Social Support Interview Schedule (ASSIS)
- Locus of Control

Appendix 2

- Frequency of SCID Diagnostic Categories

Last modified:04/05/2010

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