Chapter 5: Health and Behaviour in Childhood
The aim in this chapter is to examine two factors, diagnosis and/or categorisation of deviance, which emerged as important in Phase One of the study, and to relate these features to the present lives of the interviewees. A high degree of overlap was evident between the two variables in that over two-thirds (n = 20) of those with a diagnosis were also categorised as behaviourally deviant. Over sixty percent (63%) of the behaviourally deviant group also had a psychiatric diagnosis at age eleven in contrast to 14% of the other respondents ( = 24.21, df = 1, p < 0.01).
5.2 Psychiatric Diagnosis
Almost 30% of respondents in the present study had received a formal psychiatric diagnosis in Phase One
18. To examine the impact of having a diagnosis at age ten, participants with a diagnosis (twenty-nine) were compared with non-diagnosed participants (sixty-eight). Although there was a slight preponderance of males in the diagnosed group (65% of the diagnosed group vs. 54% of the others), these differences were not significant. The groups were similar in age and they were also comparable in terms of marital status, parental status, and living arrangements.
18 The main diagnostic categories were conduct-related disorder and enuresis
5.2.1 Education, Employment & Socio-economic Status
22.214.171.124 Education & Employment
There were differences between the groupings in relation to educational attainment. A greater percentage of those without a diagnosis sat the Leaving Certificate examination, (74% in contrast to 48% in the diagnosed group), but this difference was not statistically significant. The groups differed significantly in terms of the age they completed full-time education (t =- 2.327, df = 75, p < 0.01). For those with a diagnosis, the mean age was 16.7 years (standard deviation = 1.6), while for those without a diagnosis, the mean age for completing the educational cycle was 17.8 (standard deviation = 1.9). Most importantly perhaps, almost half (49%) of those without a diagnosis in Phase One had gone on to third level education in contrast to 17% of those with a diagnosis, and this difference was significant ( = 8.352 df = 1, p < 0.01). This is illustrated in Figure 5.1 below. The relationship between diagnosis and educational attainment will be examined in greater detail in the next chapter (Chapter 6).
Figure 5.1: Percentage of Respondents who went on to Third Level Education, by Diagnostic Categorisation
On subjective reports of school behaviour, 55% of respondents without a diagnosis reported being rarely or never in trouble in school in contrast to 35% of the diagnosed participants. There was a significant difference between diagnosed (45%) and non-diagnosed (7%) groups on reports of frequent trouble in school ( = 18.949, df = 2, p < 0.01). This is illustrated in Figure 5.2.
Figure 5.2: Percentage of Respondents who reported Frequency of Trouble in School, by Diagnostic Categorisation
There were no important differences in relation to employment. This is not unexpected in the context of the respondents' ages and the buoyant economic situation in the period between the two study phases. Three-quarters of both groups were in full-time employment at the time of the study. Similar proportions (13%) in both groups were in receipt of social welfare benefits.
In terms of socio-economic status, more from within the diagnosed group (35% in contrast to 15% of the non-diagnosed group) were in semi-skilled and unskilled categories while the non-diagnosed grouping tended to predominate in the lower professional and non-manual categories (51% in contrast to 24%).
5.2.2 Social Supports & Networks
Respondents with a past diagnosis had a smaller social network (mean = 7.24, standard deviation = 2.32) than those without a diagnosis (mean = 8.79, standard deviation = 2.53), and this difference was significant (t = 2.930, df = 95, p < 0.01).
More individuals with a diagnosis reported not believing in God (31% vs. 12%) and attended Church services less frequently. Over half said that religion was unimportant to them (58%) in comparison to those without a diagnosis (41%).
5.2.3 Psychological Health
There was little difference between those with and without a psychiatric diagnosis in childhood in terms of present psychological status. There were no differences between the groups on the number of likely diagnoses obtained on the SCID. There were no significant differences in relation to suicidal ideation/behaviour nor in respect to consumption of alcohol. Only 10% of those with a past diagnosis (n = 3) and 13% of the others (n = 9) had experienced recent (i.e. in the past year) psychological problems. More respondents with a past diagnosis (28% in contrast to 15% of the non-diagnosed group) had previously received treatment for psychological problems but this difference was not statistically significant and, in fact, slightly more of the non-diagnosed (three in comparison to one) were receiving treatment at the time of the study.
As indicated in the introduction to this Chapter, the diagnosed group was more likely to be categorised as behaviourally deviant. Over two-thirds (69%) of those with a diagnosis in contrast to 18% without a diagnosis were categorised as behaviourally deviant
19. Analysis of the symptom profiles of all respondents revealed an interesting and significant difference between the groups in the number of hyperactive and conduct symptoms displayed at that age (U = 572.0, N1 = 29, N2 = 68, p < 0.01; U = 358.0, N1 = 29, N2 = 68, p < 0.01
20 ), with the diagnosed group showing higher levels of both symptoms.
19 Measured by Rutter B2
20 Mann-Whitney Test
5.2.4 Self-Esteem & Locus of Control
There were no significant differences between those with a diagnosis and those without on the measures of Self-Esteem and Locus of Control.
5.2.5 Family Background & Experiences
There were few differences between the two groups of families in terms of socio-economic status but economic disadvantage was more common in the diagnosed group. The Index of Poverty
21 used in Phase One did not reveal any difference between diagnosed and non-diagnosed groups. Nor did fathers' unemployment history. However, there was a significant difference in relation to an important indicator of childhood economic disadvantage, i.e. whether the family had been in receipt of state benefits. Almost 60% of families of those with a diagnosis had been in receipt of benefits in contrast to just over a quarter (28%) of the other families and this difference was significant ( = 6.851, df = 1, p < 0.01). This is illustrated in Figure 5.3.
Figure 5.3: Percentage of Families in receipt of State Benefits, by Diagnostic Categorisation of Key Respondent.
A significant difference emerged in relation to one measure of psychological health (The Malaise Inventory (Rutter et al 1970)), the mothers of diagnosed children having higher scores than the other mothers (U = 575.5, N1 = 28, N2 = 67, p < 0.01). However, the more comprehensive psychiatric assessment (Clinical Psychiatric Interview, Goldberg et al., 1970) revealed no differences between the two groups, which might imply that symptoms were minor and transitory rather than long-term in nature.
In relation to current psychological health, 41% of mothers of diagnosed respondents and 22% of mothers of non-diagnosed respondents had experienced emotional problems in the year prior to interview but this difference was not significant. A similar percentage of mothers in both groups had attended for therapy while their children were growing up, and the same number (three) in each group had been hospitalised for psychiatric reasons. Neither were there differences between the mothers in relation to alcohol problems. Two mothers in the diagnosed group and four mothers in the comparison group reported a problem with alcohol at some time.
A similar number of fathers (19% in both groups) had had psychological difficulties in the past and eight fathers (one father of a child with and seven fathers of children without a diagnosis) had received treatment while their children were growing up. There were no differences between the two groups in relation to paternal alcohol use but three of the fathers of diagnosed respondents had misused drugs in contrast to the undiagnosed group where no father had abused drugs.
Almost the same proportion of mothers in both groups (six in the diagnosed group and eleven in the non-diagnosed group) reported problems with their children when they were growing up. A high percentage in both categories (96% of mothers of diagnosed children and 86% of the others) reported parental role satisfaction.
21 Computed on the basis of presence or absence of specific material goods (Telephone, car etc)
5.2.6 Contact with the Law
Almost 40% of those with a diagnosis and 19% without a diagnosis reported contact with the Law for minor offences (Figure 5.4). Although this did not reach statistical significance, a definitive trend is evident.
Figure 5.4: Percentage of Respondents who reported Contact with the Law, by Diagnostic Categorisation
5.3 Behavioural Deviancy
In Phase One of the study, behaviour was assessed using Rutter's B2 Instrument (Rutter, 1967). To measure the impact of an assessment of behavioural deviancy at age eleven, respondents who were categorised in this way (n=30) were compared with the non-deviant group (n=65). There were more males than females (69% in contrast to 31%) in the deviant group. Although this difference was non-significant there was clear trend which reflects other research findings. Background factors such as marital and parental status in the two groupings were similar.
5.3.1 Education, Employment & Socio-economic Status
126.96.36.199 Education and Employment
There were important differences between the two groups in relation to educational attainment. Sixty-six percent of the behaviourally deviant group left secondary school before completing the Leaving Certificate compared with only 19% in the non-deviant group and this difference was significant ( = 21.25, df= 1, p < 0.01). This is illustrated in Figure 5.5. A related variable, age at leaving school, provided another significant differential between the groups (t = -5.108, df = 75, p < 0.01). For the behaviourally deviant group, the mean age for completing school was 16.14 years (standard deviation = 1.38), while for the others the mean age was 18.12 (standard deviation = 1.76). Participation in third level also varied considerably. Approximately fifty percent (51%) of the non-deviant group went to third level education in contrast to 16% of the group classified as behaviourally deviant and this was also statistically significant ( = 11.115, df= 1, p < 0.01). The relationship between diagnosis, behavioural deviancy and educational attainment will be explored further in the next chapter (Chapter 6).
Figure 5.5: Percentage of Respondents who left secondary school before their Leaving Certificate, by Categorisation of Behavioural Deviance.
Subjective school experiences also varied between the deviant and non-deviant groups but here the differences were not significant. Over one-third (34%) of the behaviourally deviant group reported frequent problems in school in contrast to 11% of the remaining respondents.
There were no important differences in relation to employment status of the two groups. Almost 80% of the behaviourally deviant group and 71% of the comparison group were in full-time employment at the time of the study. Similarly there were no important differences between the groups in relation to socio-economic status. A higher percentage of the non-deviant group (54% in comparison to 34%) were in non-manual and higher groupings but this difference did not reach statistical significance. Conversely, more of the behaviourally deviant group than the others (28% in contrast to 17%) were in the semi-skilled and unskilled category, but, again, these differences were non-significant.
5.3.2 Social Supports & Networks
There were no significant differences between the behaviourally deviant and comparison groups in relation to social support and networks.
Religious adherence was also similar for both groups. Somewhat fewer in the behaviourally deviant group believed in God (75% in contrast to 86%); they attended church services less often (3% attended at least monthly in contrast to 15% of the comparison group), and more (57% in contrast to 40%) declared that religion was unimportant.
5.3.3 Psychological Health
Similar numbers in both groups (12%) had had psychological difficulties in the past year and although more from the behaviourally deviant group had received treatment (25%, in contrast to 15% of the non-deviant group) this difference was not significant. There were no differences between the two groups on the number of likely diagnoses obtained on the SCID or in relation to substance (including alcohol) misuse. Suicidal behaviour and ideation was similarly absent in both groups.
5.3.4 Self-esteem & Locus of Control
There were no significant differences between the groups in relation to Self-esteem or Locus of Control.
5.3.5 Family Background & Experiences
Family background was similar. The marital status of mothers in both groups was similar and a comparable percentage of fathers (45% of fathers of the behaviourally deviant children and 40% of other fathers) had been unemployed during the key respondent's childhood. However, in line with the analysis of the diagnosed group, a significant difference emerged in relation to receipt of benefits by the family. Almost sixty percent (58%) of the deviant groups' families (in contrast to 27% of the others) had been in receipt of benefits while the child was growing up ( = 7.235, df = 1, p < 0.01). This is illustrated in Figure 5.6.
Figure 5.6: Percentage of Families in receipt of State Benefits, by Categorisation of Behavioural Deviance of Key Respondent.
Not unexpectedly (and in line with the analysis of diagnosis) the re-examination of mothers' mental health in Phase One, based on the Malaise Inventory (Rutter et al 1970), revealed a significant difference between the behaviourally deviant and non-deviant groups (U = 629.5, N1 = 32, N2 = 65, p < 0.01
22). However, there was no important difference between the groups in relation to mothers' subsequent psychological health i.e. during the key respondent's late childhood and adolescence. One-third of mothers of behaviourally deviant respondents (in comparison to 25% of the others) had experienced psychological problems in the year prior to interview. A similar percentage of mothers in both groups (25% in the behaviourally deviant group and 21% in the other group) had received psychiatric treatment while their children were growing up and slightly more of the mothers of non-deviant than of deviant respondents (four and two respectively) had been hospitalised for this. There were no differences in relation to alcohol abuse.
A comparable number of fathers in both groups (ten in comparison to five) had psychological difficulties in the past and figures for alcohol misuse were also similar (20% and 27% respectively).
Approximately the same percentage of mothers in each group expressed satisfaction with their parental role.
22 The mothers of those in the behaviourally deviant group had a mean Malaise score of 7.03 (standard deviation = 4.44) in contrast to a mean score of 4.48 (standard deviation = 4.63) amongst other mothers.
5.3.6 Contact with the Law
There were important differences between the groups in relation to contact with the law. Fifteen (47%) of the deviant group, in contrast to nine (14%) of the non-deviant group had been in trouble with the police and this difference was statistically significant ( = 12.563, df = 1, p < 0.01). This is illustrated in Figure 5.7.
Figure 5.7: Percentage of Respondents who reported Contact with the Law, by Categorisation of Behavioural Deviance
This section examined the impact of two childhood difficulties - psychiatric diagnosis and categorisation of behavioural deviancy. There was considerable overlap between the two categories in that over two-thirds of those with a diagnosis were also classified as behaviourally deviant. Educational attainment emerged as important in relation to both indicators. Almost half of those without a diagnosis in Phase One had gone onto third level education in contrast to less than one fifth of those with a diagnosis. Furthermore, over half of those with a diagnosis did not sit their Leaving Certificate examination, in contrast to just over a quarter of individuals without a diagnosis. There was also a significant difference in the age at which the two-groups completed full-time education and whether they had frequently been in trouble at school. There was evidence of economic disadvantage in the families of the diagnosed group in that they were more likely to have been in receipt of state benefits when they were growing up.
Education also emerged as significant in relation to those classified as behaviourally deviant at age eleven. Again, this group was less likely to sit their Leaving Certificate or to go on to Third Level education, and they were more likely to finish their education at an earlier age. Families of these children were more likely to be in receipt of benefits from the state. Finally, those classified as behaviourally deviant at age eleven were more likely to be in trouble with the law at a later stage. To assess the comparative strengths of these factors in relation to educational outcome they were subjected to more detailed analysis. The findings are presented in Chapter 6.
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
Frequency of SCID Diagnostic Categories