Can we detect mental health risk at school entry?
Melissa J Green, Australia, March 2019
Detecting the earliest signs of risk for mental health conditions in childhood is crucial to the delivery of preventative interventions to reduce the emergence of mental health problems in later life. Two recent studies using population data from the longitudinal ‘NSW Child Development Study’ have shown that patterns of early childhood developmental vulnerability, as indexed with the Australian Early Development Census (AEDC), can be used to detect groups of children who are at risk of developing mental health problems in later childhood. Approximately 10% of the child population showed signs of developmental risk at age five years, and were found to be more likely to develop a diagnosed mental health condition in middle childhood or early adolescence (i.e. age 6-13 years). Early intervention strategies at school entry for children identified as at-risk for mental health problems may help to reduce poor mental health outcomes in adulthood.
In a study by researchers at the University of New South Wales (NSW), de-identified records from Australian government departments of health, education, and child protection were linked with the Australian Early Development Census (AEDC) for a state population cohort of 87,037 children aged 5-6 years*. The AEDC is Australia’s national measure of early childhood developmental competency and is completed by school teachers every three years for children starting their first year of formal schooling. The AEDC assesses five broad domains of development:
- ‘emotional maturity’
- ‘social competence’
- ‘physical health and wellbeing’
- ‘language and cognitive skills’
- ‘communication skills and general knowledge’
Children who are rated among the lowest 10% of the Australian population are regarded as developmentally vulnerable in that domain (Brinkman, et al., 2014).
Patterns of early childhood developmental vulnerability in the general population
Analyses of the population patterns of AEDC vulnerability among 82,891 children with valid AEDC subdomain data revealed four subgroups of children with different profiles of developmental vulnerability at age five years. Children within each group were alike in their patterns of developmental vulnerability across sixteen AEDC subdomains.
One group of children (representing 6.5% of the general population) showed high tendency toward engaging in disrespectful and aggressive/hyperactive behaviours. Another group (representing 4% of the general population) showed a high chance of vulnerability across all of the AEDC domains. Together these two groups of children (representing 10-11% of the general population) showed the greatest likelihood of being diagnosed with a mental disorder between the ages of 6 -13 years. A third group of children showed only mild generalised probabilities of vulnerability across all of the AEDC domains (representing 11.5% of the general population). A final group of children, representing the majority (77%) of the general population, showed virtually no developmental vulnerabilities.
Compared to children showing no developmental vulnerabilities, children who were identified in the two highest risk groups at age five years were more likely to:
- be male
- have a background of socioeconomic disadvantage
- have been exposed to child maltreatment
- have parents with a history of mental illness
- have parents with a history of criminal offending
- have been exposed to various perinatal adversities (e.g. smoking during pregnancy).
Children in these two highest risk groups were also 5-8 times more likely to be later diagnosed with mental disorders (including developmental disorders, conduct disorders and hyperkinetic disorders). These findings persisted even after adjusting for the contribution of parental mental disorders, child protection involvement, and socioeconomic disadvantage.
While there are many advantages to using linked administrative population data to investigate life-course developmental psychopathology, the current research findings were limited to mental disorder diagnoses appearing in public-sector health records. Consequently, the current study may underestimate the extent of less-severe mental health difficulties in the population of Australian children.
Earliest detection of risk is crucial for prevention
School teachers, parents and population data analysts are all in a position to detect the early signs of children at risk of mental health difficulties and drive the delivery of preventative interventions. Routine screening of school-age children for patterns of social, emotional and cognitive vulnerabilities could assist in targeting interventions to help prevent poor mental health in later years. School administrators might also draw on these findings to select the most appropriate social and emotional learning programs for their school, based on knowledge of the distribution of AEDC risk profiles among their students. These findings provide a framework for the early detection of mental health problems that could prevent a cascade of poor health and social outcomes in later life, and thus deserve the attention of policy makers.
Brinkman, S. A., Gregory, T. A., Goldfeld, S., Lynch, J. W., & Hardy, M. (2014). Data Resource Profile: The Australian Early Development Index (AEDI). International Journal of Epidemiology, 43(4), 1089-1096.
*The views expressed here are those of the author and cannot be considered as either endorsed by Emerging Minds or the government departments involved in this research, or an expression of the policies or views of Emerging Minds or those departments. Any errors of omission or commission are the responsibility of the author.The authors would like to acknowledge the work of the Centre for Health and Record Linkage, the Commonwealth Department of Education, NSW Ministry of Health, and NSW Family and Community Services, and all other data custodians, academic collaborators, as well as representatives from the NSW population who contributed to this project.
This article presents a summary of the findings reported in: Green, M.J., Tzoumakis, S., Laurens, K.R., Dean, K., Kariuki, M., Harris, F., O’Reilly, N., Chilvers, M., Brinkman, S., Carr, V.J. (2018) Latent profiles of early developmental vulnerabilities in a NSW child cohort at age 5 years. Australian and New Zealand Journal of Psychiatry, 52 (6), 530-541 [DOI: 10.1177/0004867417740208], and;Green, M.J., Tzoumakis, S., Laurens, K.R., Dean, K., Kariuki, M., Harris, F., Brinkman, S., Carr, V.J. (2019). Early developmental risk for subsequent childhood mental disorders in an Australian population cohort. Australian and New Zealand Journal of Psychiatry, Accepted 30th October, 2018 [doi:10.1177/0004867418814943].