Chapter 5 CONCLUSION
Most children entering primary school in Scotland do not display any particular difficulties in their social, emotional and behavioural development. Amongst the difficulty scales, between 73% and 90% of children return scores within the 'normal' classification. However, it is clear that a small proportion of children do have quite severe difficulties at this point; between 5% and 12% of children are reported by their parents to have behaviour which places them in the abnormal classification on any scale. Furthermore, a significant minority (around 21%) display difficulties simultaneously across a range of behavioural domains. Whilst the largest behavioural groupings were those in which the children had no, or only singular difficulties (clusters 2 and 5) two groups of children with multiple concerning difficulties emerged. These were cluster 3 - where children had significantly higher than average hyperactivity/inattention scores along with conduct problems, peer and pro-social difficulties - and cluster 4 - where children had severe emotional difficulties alongside issues with conduct, peers and hyperactivity. Results of the cluster analysis are similar to those found elsewhere with children of this age group. Sonunga-Barke and colleagues (1997), on conducting cluster analysis of pre-school children's scores on an instrument similar to the SDQ, also found that two similarly problematic groups emerged - one with hyperactivity as the core problem, and the other with emotional problems.
The socio-economic and demographic characteristics of children with higher difficulties in each domain varied from those with lower or no difficulties. However, on the whole these characteristics were not independently associated with behavioural outcomes at school entry. Level of household income was the measure most consistently and independently associated with behavioural development with children in lower income households at higher risk of difficulties with conduct, emotional development and hyperactivity than those in higher income households.
Whilst socio-economic and demographic characteristics had limited direct impact they may yet be influential but in an indirect manner affecting the parenting, health and development factors which are shown, in section 3.3, to be more directly associated with outcomes in these domains.
Health and development factors also affected different behavioural domains in different ways: the condition of the child's general health over the period from age 2 to age 5 was consistently and strongly associated with a number of difficulties at age of school entry; delays in motor development at age 2 were associated with emotional difficulties; and delays in language development at age 2 were associated with difficulties in hyperactivity and peer problems as well as a high score on the total difficulties scale. The significance of early health problems and developmental delays to behavioural outcomes is notable. These findings show that children with identifiable health and developmental issues at age 2 are at an increased risk of displaying behavioural difficulties at age of school entry.
There is a key link, in particular, between poor health and motor delay in the early years and a higher incidence of emotional problems at school entry.
Parenting approaches are also shown to impact on behavioural outcomes at school entry, particularly in relation to hyperactivity and conduct problems. Those children who experienced no harsh discipline, higher levels of parent-child social interaction, and a higher frequency of social visits were less likely to score in the borderline or abnormal ranges of the conduct and hyperactivity scales. The direction of the relationship is not clear here. Increased use of harsh discipline among parents whose children display higher conduct problems and hyperactivity/inattention may be an attempt to control already difficult behaviour rather than a pre-cursor of it. In addition, lower levels of parent-child social interaction could be due to difficulties sustaining the child's attention to engage in these interactions or simply because these types of interaction are difficult to manage and thus pursued less often. Relatedly, visits to other children may be curtailed because of issues around controlling behaviour away from the home. However, lack of early peer contact may contribute to children having later problems interacting with peers and thus a higher incidence of peer-related difficulties at school entry.
Differences in the average difficulty scores of children who started school at different ages were not statistically significant. Neither were these children more or less likely to have scores classified into each of the normal, borderline and abnormal ranges. Thus the difference in age within a typical school year group does not appear to significantly explain variations in social, emotional and behavioural development at school entry. However, it is possible that variations in behavioural development by age at school entry will develop in later years.
In general, there is a decrease in difficult behaviour between pre-school and entry to primary school but this is not the case for all children; some children experience no change in behaviour and others experience an increase in difficulties. Emotional problems, in particular, show an increase in this period. More detailed analysis of movement between normal, borderline and abnormal classifications indicated that 65% of children with an emotional symptoms score in the abnormal range at school entry had scored in the normal range at age 3. As emotional development is perhaps quite closely related to maturity levels, such an increase in difficulties in this domain is perhaps expected throughout this period and it may be likely that the prevalence of such issues will continue to grow as the children age. Despite this increase, emotional problems are the difficulty least prevalent across all of the domains at school entry. The data indicate, in fact, that scores in each sub-scale at age 3 are quite closely related to corresponding scores at school entry. Thus children with higher scores at age 3 tend to also have higher scores at school entry. This suggests, therefore, that children displaying more difficult behaviour at age 3 continue to do so at school entry. Forty-seven percent of children with a total difficulties score in the abnormal range at age 3 also had a score in the abnormal range at school entry. This finding is supported by the results of the regression analysis which show that a previous score in the borderline or abnormal range is strongly associated with a similar score at age of school entry. So for some children, difficult behaviour at school entry is persistent through their early years and observable at age 3, possibly before.
These results should be considered in light of two methodological weaknesses to the data. First, the children in the cohort actually span two school year groups. Thus to obtain a measure of development at school entry, data was merged from two sweeps of data collection each corresponding with the child's first year at primary school. As the spread of age at entry when the two groups are combined is similar to that of any single school year group, this is not considered to be too problematic but is nonetheless not ideal. Secondly is that all SDQ data obtained is from the child's main carer interview. As such, the data does not reflect observations of school-based behaviour as recorded by the teacher, but parent-report data of the child's behaviour and interactions in a largely out-of-school context.
The findings have a number of important implications. The first is that, whilst the majority of children display no problematic behaviour at school entry, a small proportion showed severe difficulties. Those who displayed the most problematic behaviour often had higher than average difficulties in several domains although their core difficulty was different - one being hyperactivity, the other emotional symptoms. Each of these core difficulties was shown to have a different developmental pathway. Difficulties with hyperactivity/inattention were considerably more likely to have been present at age 3 and persist through to school entry. Emotional difficulties, in contrast, had a greater likelihood of developing between pre-school and entry to primary school. These children are likely to respond to the transition to school, and the early and continuing school experience in different ways. Children with hyperactivity and conduct difficulties in particular, may find it difficult to adapt to the educational and social constraints of the classroom impacting on their adjustment, further behaviour and later attainment (Sonunga-Barke et al., 1994 ). Given the often long-term nature of these difficulties, it appears there would be benefit to early screening, in the preliminary pre-school period for example, of these behaviours and their patterns of co-occurrence. Those children displaying difficulties matching the most problematic groupings could, along with their parents, be provided with the necessary support to manage and improve such difficulties. Furthermore, a more tailored transition process to ensure that moving into the school environment does not encourage deterioration of behaviour may be advisable.
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