Scottish Study of Early Learning and Childcare: Phase 5 Report

Child health and development

This chapter focuses on data relating to children's development. Child outcomes explored are:

• social, emotional and behavioural development
• cognitive and language development, and
• physical and mental health and wellbeing.

The chapter examines parent-report information on the presence of developmental risk factors, such as sleep patterns and breastfeeding, and on the child's general health and long-term illnesses. Development outcomes are measured via ELC keyworker observations which utilised the Ages and Stages (ASQ) and Strengths and Difficulties (SDQ) Questionnaires^[18] along with additional parent-report data on speech and language specifically.

Child general health, development and long-term conditions

The questionnaire for parents included a question asking them to assess the health of their child in general. Seven in ten (69%) parents said their child's general health was "very good" and a further 26% described it as "good". Just 5% of parents stated their child's health was "fair", while less than 0.5% assessed it as "bad" or "very bad".

There were no noticeable differences in perceptions of the child's general health between boys and girls. However, single parents (56%) were significantly less likely than those in couple households (71%) to perceive their child's health as being "very good", as were those living in the most deprived areas (58%) compared with those living in other areas (58%).

When asked, one in eight (13%) parents described their child as having a physical or mental health condition or illness lasting or expected to last for 12 months or more. Of these children, 25% of parents said that the longstanding condition limited the child "a lot", 47% said it limited them "a little" and 28% stated it did not limit their child. This means that 9% of all four-and five-year olds attending an ELC setting had a limiting longstanding health condition.

Close to half (46%) of parents said their child's longstanding condition or illness affected their child socially or behaviourally (Table 4.1). A quarter (27%) said the illness or condition affected their child's stamina, breathing or fatigue, while a similar proportion (25%) reported that their child's learning, understanding or concentrating was affected.

Base: All children with a long-term condition (parent questionnaire, Phase 5, weighted)

Developmental risk factors

More than six in ten (63%) parents reported that their child had been breastfed.^[19] Parental reports of breastfeeding increased in line with decreasing levels of area deprivation and couple parents were more likely than single parents to report their child was breastfed (65% compared with 51%).

Parents were asked how many hours their child typically slept over a 24-hour period (including daytime naps) (Figure 4.1). Over half (57%) of children were reported as sleeping 11 hours or more in a typical 24-hour period. Boys were more likely than girls to sleep under 10 hours a day (14% and 9%, respectively) and children living in the most deprived areas were more likely than those living elsewhere to have under 10 hours sleep (22% compared with 10%).

Figure 4.1: Typical hours slept in a 24hr period by child's sex

Base: All respondents (parent questionnaire, Phase 5, weighted)

Speech and language development

Parents were asked whether they had any concerns about how their child talks or what they understand (Figure 4.2). Most parents had no concerns about either (84% and 91% respectively).

Parents of boys were more likely than parents of girls to report being concerned or a little concerned about their child's speech (20% compared with 11%) and how well their child understands what they, and others say (12% compared with 7%).

Parental concern about child speech and language development also varied by area deprivation. Those living in the most deprived areas were most likely to report worries about how their child talks with over a quarter (27%) stating they were concerned or a little concerned compared with 13% of parents living in other areas. A similar pattern was observed for concern about what their child understands.

Parents were also asked if their child received any specific support for speech and language development from their ELC setting. Most (88%) did not. Boys (15%) were more likely than girls (9%) to be in receipt of such support. Similarly, those living in the most deprived areas (18%) were more likely than those in other areas (10%) to receive support.

Figure 4.2: Parental concerns about how child speaks, by child's sex and area deprivation

Base: All respondents (parent questionnaire, Phase 5, weighted)

Where parents said they had worries or concerns about what their child understood, over three-quarters (78%) indicated that their child was receiving specific speech and language support at their ELC setting. However, a sizeable minority (22%) with concerns about their child's understanding did not report their child receiving such support. Similar figures were found where parents had concerns about how their child talked, with 75% receiving speech and language support and 25% not.

Assessments of development

The children's keyworkers were asked to complete child development observations using the Ages and Stages (ASQ) and Strengths and Difficulties (SDQ) questionnaires.

The ASQ is a structured assessment of a range of developmental domains to identify children at increased risk of developmental difficulties. The instrument includes 30 items split into five different domains: communication, gross motor, fine motor, problem solving and personal-social. Each domain produces a summary score which can be used to indicate whether the child's development is on schedule, needs monitoring or requires further assessment.

The SDQ is a commonly used behavioural screening questionnaire designed for use with children aged between two and 16. The questionnaire includes 25 questions about a child's behaviour. Responses can be combined to form five different measures of the child's development, namely emotional symptoms (e.g. excessive worrying), conduct problems (e.g. often fighting with other children), hyperactivity/inattention (e.g. constantly fidgeting), peer relationship problems (e.g. not having close friends) and prosocial behaviour (e.g. being kind to others). The first four measures can be combined into a "total difficulties" scale.

Further details of these measures are included in Appendix C.

Ages and Stages Questionnaire

Figure 4.3 shows the proportion of children deemed as having development on schedule, needing further monitoring or requiring further assessment for each of the five ASQ domains. The majority of children were considered to be on schedule on all five domains. The proportion of children on schedule was highest on the personal-social domain (89%) and children were least likely to be on schedule on fine motor development (77%).

Figure 4.3: ASQ score by domain

Base: All children (with keyworker observations, Phase 5, weighted)

Differences in ASQ scores by sex and area deprivation

As is commonly seen on a range of different measures throughout childhood^[20], girls were more likely than boys to be on schedule on all five domains (Figure 4.4 to Figure 4.8). There was also an association between ASQ score and area deprivation on each domain. Children living in the most deprived areas were less likely than those living elsewhere to be assessed as developmentally on schedule. When area deprivation and sex were examined together, differences were particularly pronounced for the fine motor and communication domains. On both these domains, boys living in the most deprived areas were least likely to be on schedule and most likely to be in need of further assessment (Figure 4.4 to 4.8).

ASQ communication domain

Scores on the ASQ communication domain are broken down by area deprivation and sex in Figure 4.4. Boys were less likely than girls to be on schedule for the communication development, with 12% of boys classified as "further assessment may be needed" compared with 8% of girls. Children living in the most deprived areas (77%) were less likely than children living elsewhere (84%) to be on schedule developmentally.

When broken down by area deprivation and sex together, the size of the gap between those in the most deprived areas who were on schedule with communication skills and those living in other areas was larger for boys than for girls. Seventy-one percent of boys in the most deprived areas appeared to be on schedule, compared with 80% of boys living in other areas and 87% of girls.

Figure 4.4: ASQ communication score by child's sex and area deprivation

Base: All children (with keyworker observations, Phase 5, weighted)

ASQ gross motor domain

The proportion of girls assessed as on schedule for gross motor development (86%) was 14 percentage points higher than the equivalent figure for boys (72%) (Figure 4.5). Children living in the most deprived areas were most likely to be assessed as requiring monitoring or further assessment for gross motor development.

Figure 4.5: ASQ gross motor score by child's sex and area deprivation

Base: All children (with keyworker observations, Phase 5, weighted)

ASQ fine motor domain

This domain is where boys and girls differ the most – 88% of girls were assessed as on schedule for fine motor skills compared with 67% of boys (Figure 4.6). Children living in the most deprived areas (18%) were more likely than those living elsewhere (10%) to be in need of further assessment. This differences by sex and area deprivation were most pronounced on the fine motor domain, with boys living in the most deprived areas most likely to be assessed as requiring monitoring or further assessment (39%).

Figure 4.6: ASQ fine motor score by child's sex and area deprivation

Base: All children (with keyworker observations, Phase 5, weighted)

ASQ problem-solving domain

Girls were more likely than boys to be on schedule (91% compared with 84%) (Figure 4.7) for problem-solving. The gap by area deprivation was widest for this domain, with children in the most deprived areas (79%) least likely to be on schedule (compared with 90% in other areas). Again, boys in the most deprived areas appeared to have the greatest developmental issues.

Figure 4.7: ASQ problem solving score by child's sex and area deprivation

Base: All children (with keyworker observations, Phase 5, weighted)

ASQ personal-social domain

Across the domains, the gap between the proportion of boys (85%) and girls (93%) on schedule was smallest for the personal-social development domain (Figure 4.8). As observed elsewhere, children in the most deprived areas were less likely than those living elsewhere to be on schedule for personal-social development. Although the size of the gap between the proportion on schedule in the most deprived areas, compared with elsewhere, was smallest on this domain.

Figure 4.8: ASQ personal domain score by child's sex and area deprivation

Base: All children (with keyworker observations, Phase 5, weighted)

Strengths and Difficulties Questionnaire

Figure 4.9 provides a breakdown for all five SDQ domains as well as for the total difficulties score (the sum of the scores for the four "problem" domains). The prosocial behaviour domain is presented in a different colour to highlight the different labelling, although the general meaning of the categories are similar. The scales are designed so that most children have a score in the 'close to average' range. Around 20% of the population are expected to have raised scores (lowered for prosocial behaviour)^[21] although some variation occurs according to the age of the children.

Keyworker observations data indicates that most children had a SDQ total difficulties score in the "close to average" (78%) or "slightly raised" (11%) range. One in ten (11%) had a total score in the "high" or "very high" range.

Figure 4.9: SDQ score by domain

Base: All children (with keyworker observations, Phase 5, weighted)

Rates varied across the individual domains, with the proportion scoring close to average largest on the prosocial behaviour domain (89%) and smallest (72%) on the hyperactivity domain. Very high scores were most common on the hyperactivity domain (9%).

Differences in SDQ scores by child's sex and area deprivation

Similar to ASQ scores, child sex was a significant factor in predicting child outcomes on the SDQ. Across all the SDQ domains, with the exception of emotional symptoms, girls tended to have fewer difficulties than boys (Figure 4.10). On the total difficulties score, 85% of girls were close to average compared with 72% of boys.

On the individual domains, the gap between boys and girls was largest for the hyperactivity domain (82% of girls close to average compared with 62% of boys), followed by the prosocial behaviour domain (95% of girls and 84% of boys were close to average).

Figure 4.10: SDQ domain scores by child's sex

Base: All children (with keyworker observations, Phase 5, weighted)

Area deprivation was significantly associated with SDQ total difficulties score, with children living in the most deprived areas less likely than those living elsewhere to be assessed as close to average (74% compared with 80%). Of the individual SDQ domains, hyperactivity was the only one where a significant difference by area deprivation was observed (Figure 4.11). Boys living in the most deprived areas were least likely to score close to average for hyperactivity (58% compared with 64% of boys living elsewhere and 82% of all girls). One in five (18%) boys in the most deprived areas had a 'very high' score on the hyperactivity domain.

Figure 4.11: SDQ hyperactivity domain scores by child's sex and area deprivation

Base: All children (with keyworker observations, Phase 5, weighted)