TACKLING INEQUALITIES IN THE EARLY YEARS: KEY MESSAGES FROM 10 YEARS OF THE GROWING UP IN SCOTLAND STUDY

PART THREE: REDUCING INEQUALITIES IN OUTCOMES IN THE EARLY YEARS

While it is difficult to counter the very powerful socio-economic influences on children's lives, GUS has highlighted that there are some factors that seem to promote positive outcomes or build resilience, in the face of socio-economic disadvantage.

• A rich home learning environment can improve cognitive development for all children, regardless of their socio-economic background.

The protective impact of the home learning environment is a recurring theme in the evidence from Growing Up in Scotland.

GUS has repeatedly demonstrated that better cognitive ability is linked to home learning activities: being read to frequently; playing educational games at home (those that involve recognising words, number or shapes); and visiting a range of places/events. GUS has also demonstrated that better cognitive scores are associated with socio-economic advantage. The first set of analysis from GUS that tried to disentangle the impact of socio-economic background and home learning activities used data collected at age three. Using multivariate analysis^[39], this revealed that being read to every day at 10 months, being actively involved in daily home learning activities at 22 months and visiting a wide range of places at 22 months were all significantly related to vocabulary ability even after taking account of socio-economic backgrounds. This means that what parents do with their children is important for developing cognitive ability. Furthermore, these last two activity measures were still significant even when the analysis focused only on children from disadvantaged backgrounds, suggesting that all children can benefit from home learning activities regardless of their socio-economic background^[40].

Later analysis from GUS focused on factors most strongly related to improvement in cognitive ability. GUS has shown that the biggest gap in cognitive ability in the pre-school years is between children whose parents have the highest and lowest education attainment. GUS therefore used regression analysis to identify which factors (over and above parental educational attainment) are most strongly related to improvement in cognitive development between the ages of 3 and 5. This analysis highlighted the significance of parent-child attachment and home learning activities for all children but particularly so for children whose parents had lower educational qualifications^[41].

These findings suggest that home learning activities have a significant impact on cognitive development that can moderate - though by no means eradicate - the effects of socio-economic disadvantage. It is also worth noting that most of these activities have few or no monetary costs. This suggests that policies that encourage active parenting can help promote children's cognitive development (including that of children from disadvantaged backgrounds).

• High quality early learning and childcare can help to reduce inequalities in cognitive development.

Changes in vocabulary ability in the pre-school years are more strongly related to aspects of the child's home learning environment than external influences such as early learning and childcare^[42]. That said, GUS has shown that early learning and childcare provided to children from the age of around three, does have an impact. High quality pre-school provision is significantly associated with cognitive development in the pre-school years. GUS has found that children who attended providers with a high 'care and support' grade as assessed by the Care Inspectorate were more likely to show improvement in vocabulary skills by age five, irrespective of their social background and other pre-school characteristics^[43].

GUS data shows that the vast majority of children (92% of four-year-olds in 2008/09) take up their statutory pre-school entitlement. More recent data from the Early Learning and Childcare Census, suggests that this is now even higher (98.5% for three and four year olds) in 2014^[44]. Importantly GUS has also shown that children from more and less deprived areas and from higher and lower income households are equally as likely to take up their entitlement and that children from disadvantaged backgrounds are no less likely, than those from advantaged backgrounds, to attend the highest quality pre-school provision. High quality pre-school provision therefore has the potential to reduce socio-economic inequalities in cognitive development by the start of primary school^[45].

GUS has also explored the relationship between various aspects of non-parental childcare, up to age three, and cognitive development in the pre-school years. Non-parental childcare (including informal as well as formal) of between 17 and 40 hours per week at age three was found to have a significant impact on vocabulary among girls, even after controlling for socio-economic characteristics. What is also reassuring is that the analysis found that the 'fragmentation' of childcare typical to many families (defined as exposure to multiple childcare providers, including formal as well as informal), does not have a detrimental impact on cognitive development in the early years^[46].

It is worth noting, however, that analysis from GUS has revealed that 40 hours or more of non-parental childcare per week at age three is detrimental to children's behavioural outcomes at age five, especially for girls^[47].

• Being born to an older mother makes children more resilient to a range of negative outcomes.

GUS has confirmed the significant socio-economic disadvantage faced by younger mothers. Mothers under the age of 24, and particularly under the age of 20, tend to have lower educational qualifications, lower employment levels, lower income, more unstable partner relationships, poorer health behaviours and health outcomes and lower levels of engagement with formal parenting support^[48].

GUS has also shown that being born to mothers aged 35 or over makes children living in disadvantaged circumstances more resilient to a range of negative outcomes. The analysis focused specifically on children who came from a deprived area, a low-income household or from a family classified as having a routine or semi-routine occupation, but who were not also from the most advantaged category of any other of these measures. The researchers added up the number of the negative outcomes experienced by these children in the first four years of their lives. This included a mixture of physical health measures as well as cognitive, and social, emotional and behavioural outcomes. Using logistic regression analysis they then explored the correlation between the number of negative outcomes that the children experienced and a range of potential resilience factors. They found that children were less likely to experience negative outcomes if their mother was aged 35 or older at the time of their birth^[49].

• Improving the physical and mental health of mothers is likely to have a positive effect on the health and development of their children.

GUS has found that children are less likely to experience negative health and development outcomes by age four if their mother has not experienced a long-term health problem or disability herself since the child's birth. As above, the analysis focused specifically on children who were born into the most disadvantaged backgrounds and used regression analysis to explore the correlation between the number of negative outcomes that the children experienced and a range of potential resilience factors. Having a physically healthy mother throughout a child's earliest years was found to be a significant resilience factor^[50].

The emotional health of mothers is also important to their children's development. GUS has shown that children whose mothers were emotionally well during their first four years had better social, emotional and behavioural development than those whose mothers had brief mental health problems, and they in turn, had better development than those whose mothers had repeated mental health problems. These relationships remained significant after taking account of family characteristics and socio-economic factors^[51]. This relationship between poor maternal physical health and children experiencing social, emotional and behavioural difficulties was also evident at age seven^[52].

Understanding the possible causal relationship between maternal mental health and the child's development is not straightforward. Problems with a child's social, emotional or behavioural development may be a factor in a parent's mental health (as well as vice versa). However there is consistent evidence from elsewhere that mothers experiencing depression are less responsive than mentally well mothers to their child's efforts to engage them and that this affects attachment.

GUS has also provided other clues about how to support parents and improve outcomes for children.

• Supporting parenting skills can help protect against the impact of adversity and disadvantage.

As we might expect, day-to-day parenting skills are important for health and health behaviours in the early years of children's lives. GUS data has shown that the risk of poor health and of health risk behaviours (e.g. low physical activity and poor diet) is greatest for children experiencing the lowest level of parenting skills. Low parenting skills are defined as low levels of parent-child connection, low levels of control of the child's behaviour and high levels of parent-child conflict.

However, GUS data has also shown that good parenting skills can help protect against the impact of adversity and disadvantage. GUS has shown that adversity and disadvantage increase the risk of poor health in childhood but has also demonstrated that good parenting skills can help to reduce this association - and do so quite substantially for: poor general health; social, emotional and behavioural difficulties; limiting long-term illness; and poor dental health^[53]. This suggests that, if the development of parenting skills can be supported, particularly among those in the most disadvantaged circumstances, child outcomes can be improved - even if material circumstances remain unchanged.

• The role of the health visitor, in providing one-to-one advice and support to parents, should be central in the efforts to tackle inequalities in the early years.

GUS has revealed that mothers experiencing disadvantage are less likely than their more advantaged peers to attend antenatal classes, parenting classes and parent and baby/toddler groups. GUS has also found that younger parents, lone parents and parents with lower levels of income and education are generally less comfortable engaging with formal support services, more likely to believe that there is a stigma attached to this^[54] and that parents in lower income groups are less likely to seek help from written sources (books, leaflet and the internet)^[55].

Unfortunately, the parents who are most reluctant to engage with formal services are also those in most need of support. GUS has found that 'reluctant' service users are not only those whose children have the most challenging experiences and outcomes in the early years^[56] but are also those who express less confidence in themselves as parents^[57].

With the exception of younger mothers, reluctant service users also tend to have lower levels of informal support from family and friends. Data collected from BC1 at age two revealed that mothers with no qualifications and with lower household incomes had weaker informal support networks^[58].

However, GUS does provide some insights about how engagement with formal support services might be strengthened. Parents who say they are uncomfortable engaging with formal support services are more likely to say that they dislike the group format in which some of these are delivered and that they would prefer to receive information, advice and support on a one-to-one basis. GUS has also revealed that satisfaction with health visitors is very high - 83% of mothers of children born in 2010/11 stated that their health visitor was very or fairly good at providing helpful advice and 91% stated that they are very or fairly good at listening to them. This is especially true of parents living in the most deprived areas. In the most deprived areas^[59], 67% of mothers thought their health visitor was very good at listening to them compared with 61% of those in the least deprived areas^[60].

With this expressed preference for one-to-one support and such a high level of satisfaction with health visitors, the enhanced health visitor service^[61] that is being introduced across Scotland in the near future has the potential to make an important contribution to tackling inequalities in the early years.

• It is important to ensure that messages about positive parenting practices are understood by grandparents as well as parents.

Grandparents play an important role in the lives of children. In the first few years of a child's life, almost all GUS families (around 95%) receive some type of help or support from the child's grandparents and many (around a third) were receiving a full range of support including regular childcare, taking the child on outings and providing financial and material support^[62].

GUS has also shown that grandparents play a particularly important role in the lives of lone parents and younger mothers - those who face particular challenges and who are less likely to seek advice from formal sources of support^[63]. Even up to the age of six, the proportion of grandparents with very frequent 'hands on' interaction is higher for children in lower income groups and those born to teenage mothers. For example, at age six, 64% of children whose mothers were under 20 at the time of their birth, stayed overnight with their maternal grandparents at least once a month, compared with 31% of other children^[64].

Comparison across the cohorts has also suggested that the use of grandparents for childcare is increasing - 42% of parents in BC2 were using the child's grandparents for regular childcare at age three, compared with 38% in BC1^[65].

GUS has suggested that grandparents are playing an increasingly important role in the lives of children, and a role that is particularly important among those for whom outcomes need to improve if we are to tackle inequalities in the early years. It might therefore be worth considering whether messages about positive parenting (such as those included in the 'Play Talk Read' and breastfeeding campaigns) should be targeted at grandparents, as well as parents, so that habits and behaviours can be supported and reinforced across the child's full care environment.