Introduction
Social and emotional development in early childhood has been defined as the evolving ability to “form close and secure adult and peer relationships; experience, regulate, and express emotions in socially and culturally appropriate ways; and explore the environment and learn — all in the context of family, community, and culture” (Yates et al., 2008, p. 2). It is increasingly recognised that social and emotional development in early childhood plays an important role in the successful transition to school and is also related to later academic achievement, mental health and wellbeing [
1]. Most Aboriginal children have good mental health [
2]. However, the social and health disadvantage [
3,
4] that Aboriginal Australians experience from the perinatal period is well documented. Little is known about the early life characteristics of Aboriginal children and their families that are related to social and emotional development. This evidence is urgently needed to identify opportunities to promote social and emotional development in early childhood [
5], when supportive interventions have been shown to be particularly effective [
6,
7].
In recognition of the acute and long-term importance of early childhood development, the Australian Government has implemented a triannual census of children entering the first year of school since 2009 [
8]. Data for the census are collected via teacher-completion of the Australian Early Childhood Development Census (AEDC) (formerly the Australian Early Development Index) for each student. The AEDC covers five developmental domains, two of which are of particular relevance to social and emotional wellbeing: social competence (exemplified by the ability to get along with and respect peers and teachers, exert self-control, demonstrate curiosity and work independently) and emotional maturity (exemplified by recognising and responding to others’ moods appropriately and inviting other children to play). Data emerging from the AEDC has revealed inequalities in social and emotional development between Aboriginal and non-Aboriginal children throughout Australia [
9,
10]. While two studies have used the AEDC to examine early childhood social and emotional development in the general population of children [
10,
11], to our knowledge, there have been no studies focused specifically on Aboriginal children and the early life child, family and community characteristics associated with their increased risk of social and emotional vulnerability.
In this paper, we extend on previous work in this field by drawing on the Seeding Success data resource [
12] which allows a detailed examination of the factors associated with social and emotional development amongst Aboriginal school entrants in New South Wales, Australia. The resource includes linkage of 2009 and 2012 AEDC data with routinely collected data from perinatal, birth and Public School Enrolment records. First, we explored the association of a range of child, family and residential area-level characteristics (such as socio-economic indices for areas and level of remoteness) associated with developmental vulnerability, with a view to gaining insights to improve outcomes for Aboriginal children, including who might benefit most from enhanced support to improve social and emotional development. Second, we quantified the magnitude of the social and emotional developmental inequalities between Aboriginal and non-Aboriginal children and examined the extent to which differences in socioeconomic disadvantage and perinatal characteristics explained this inequality.
Discussion
In this population-based cohort study of more than 100,000 Australian children, we found that 84–88% of Aboriginal children were developing favourably, scoring above the developmental vulnerability threshold for social and emotional development on the AEDC measure. However, Aboriginal children were twice as likely to be vulnerable on measures of social and emotional development than their non-Aboriginal classmates. To our knowledge, this is the first study to identify child, family and area characteristics associated with social and emotional developmental vulnerability amongst Australian Aboriginal children at school entry. Importantly, a large proportion of the inequality in social and emotional development between Aboriginal and non-Aboriginal children was explained by differences in observed socioeconomic disadvantage and perinatal characteristics.
The child, family and area characteristics associated with a higher risk of vulnerability in relation to social competence and emotional maturity were largely similar amongst Aboriginal and non-Aboriginal children in our study population. Apart from the commonly noted elevated risk for social and emotional vulnerability among boys [
2,
10,
29,
30], family-based measures of socioeconomic advantage and disadvantage, such as maternal education and parental occupation, were also associated with social and emotional development in Aboriginal and non-Aboriginal children. While there is no comparable data on Aboriginal social and emotional development from other studies, these findings accord with a small number of cohort studies examining social and emotional wellbeing amongst Aboriginal children of a similar age [
2,
29], and with a large body of evidence describing the social determinants of physical and mental health and development across a range of populations [
9‐
11,
31,
32].
For both Aboriginal and non-Aboriginal children, perinatal characteristics associated with an increased risk of social and emotional developmental vulnerability included: younger motherhood, higher parity, smoking in pregnancy, no antenatal care in the first 20 weeks of pregnancy, and younger gestational age at birth. While not previously documented amongst Aboriginal children, the association of this set of perinatal factors with social and emotional development is broadly consistent with those noted in other populations [
32‐
34]. A more detailed exploration of the relationship between the whole distribution of gestational and maternal ages at birth, and physical, social, emotional, language, cognitive and communication development, has previously been documented in this study population [
28,
33]. Our finding that Aboriginal children who lived in more disadvantaged or more geographically remote areas were at greater risk of being assessed as vulnerable in terms of social competence and emotional maturity also aligns with research in other populations [
7]. Area-based characteristics such as social cohesion and access to resources such as parks, preschools and health and social services [
31] have been hypothesised to impact on early childhood development, however, the mechanisms underpinning their impact have not been established [
34].
An important finding of this study is that most, if not all, of the inequalities in social and emotional developmental vulnerability between Aboriginal and non-Aboriginal school entrants was attributable to the disproportionate burden of socioeconomic disadvantage that Aboriginal children experience from early life. This accords with a growing body of evidence documenting the major role that socioeconomic disadvantage plays in a range of outcomes for Aboriginal people [
35,
36]. The multigenerational disadvantage many Aboriginal Australians experience is an ongoing legacy of colonisation and is known to underpin much of the mental and physical health disparity experienced by Aboriginal people of all ages [
37]. The central role that disadvantage plays in vulnerable social and emotional development amongst Aboriginal children in early childhood underscores the need for targeted, culturally safe programs and support for disadvantaged children and families, to complement universal prevention efforts.
A key strength of the current study is the high population coverage of the source data and the large sample size afforded by examining two cohorts of school entrants in New South Wales, which made visible the social and emotional development experience of more than 7,000 Aboriginal children in early childhood. The use of linked, cross-sectoral population level data sources allowed us to examine, for the first time at a population-level, a wide range of early life characteristics of the child, their family and the area where they live that are related to social and emotional developmental vulnerability in Aboriginal children, and the factors that underlie inequalities in social and emotional development between Aboriginal and non-Aboriginal children. The use of multiple linked datasets, as in the current study, has been shown to increase enumeration of Aboriginal people [
38]. Further, recall errors are minimised due to teacher (as opposed to parent) rating of development and midwives’ recording of data. On the other hand, teacher assessment, particularly cross-culturally, of the social competence and emotional maturity of Aboriginal children may introduce bias. Other studies using the AEDC, however, have demonstrated that the scores for Aboriginal children do not seem appreciably different when a cultural consultant is on hand to assist with the assessment [
10,
20] and the AEDC has been validated within Australia and internationally, including an extensive evaluation for Australian Aboriginal children [
20].
Three key limitations in the source data should be noted. First, the main result presented here pertains to the 65% of school entrants in New South Wales in the relevant years who attended public schools only, as school enrolment data (including parental employment and education information) was not available for non-Public School students. However, our sensitivity analysis showed a similar proportion of children were socially and emotionally vulnerable in our study population compared with all NSW Kindergarten children with available outcome data. Second, while the measures of socioeconomic advantage and disadvantage used in this study provided powerful insights into the factors underpinning emotional and social development amongst Aboriginal children, they were limited to those available in routinely collected data. Thus, we were unable to capture important aspects of intergenerational disadvantage such as forced removal of children and racism and discrimination [
39,
40] or other important influences on child social and emotional development, such as the child’s physical health and parental mental and physical health and parenting style. A further minor limitation relates to the dichotomisation of the social competence and emotional maturity outcomes. Although it is standard practice to dichotomise the AEDC development outcomes for population-level research because of the skewed distribution of the raw scores, and this is standard practice in national reports [
8] this results in a loss of information and over-simplifies the experience of social and emotional challenges to a binary presence or absence of vulnerability.
The results of the current study suggest that service providers might usefully seek to engage with Aboriginal communities around these data and work in partnership with them to develop culturally appropriate strategies for supporting Aboriginal families. Children from families which are identified in the antenatal period as experiencing factors associated with early childhood developmental vulnerability (such as parents not being in the paid workforce, preterm birth and living in a disadvantaged area) may be particularly likely to benefit from culturally appropriate support commensurate to need throughout early childhood. Our findings also highlight a vulnerability gap between children living in more and less advantaged or remote areas. Increasing access to services, recreational facilities and support in these areas have been suggested as potentially promising avenues for reducing developmental inequalities [
41,
42]. It appears that the types of services required to improve the social and emotional development of Aboriginal children are not just those which focus directly on the child or on parenting but may also include those that improve the social and economic conditions that children grow up with. For example, support for parents to access further education and employment support, and improving access to the social determinants of health for Aboriginal children and their families including housing [
37]. The Australian government’s recognition of the central importance of the social determinants of health is acknowledged by the inclusion of targets such as halving the gap between Aboriginal and non-Aboriginal Australians completing secondary school by 2020 (this target is on track) and halving the gap in employment by 2018 in the Close the Gap campaign (this target is on track). Over and above the aforementioned factors, efforts to address issues such as racism and discrimination to improve equality of access to opportunities for Aboriginal children and families are also important.
The current study is the largest and most comprehensive of social and emotional development among Australian Aboriginal children to date. It finds that while the substantial majority of Aboriginal children have social and emotional development above the developmental vulnerability threshold on the AEDC, Aboriginal children were twice as likely to be assessed as vulnerable. It demonstrates that almost all of the gap in early childhood social and emotional development between Aboriginal and non-Aboriginal children can be attributed to the disproportionate burden of socioeconomic and early life health disadvantage Aboriginal children and families experience. In addition, it provides important insights for policy and practice regarding the child, family and area-level characteristics of children most likely to benefit from enhanced, culturally appropriate, support. More broadly, our findings support the need for health and social policies and programs that aim to reduce the socioeconomic and health inequalities experienced by Aboriginal Australians from early life. The AEDC provides a unique opportunity to monitor the impact of policies on closing the gap in early childhood development between Aboriginal and non-Aboriginal children at a population-level.
Acknowledgements
The Seeding Success Study Investigator team comprises Louisa Jorm, Kathleen Falster, Sandra Eades, John Lynch, Emily Banks, Marni Brownell, Rhonda Craven, Kristjana Einarsdóttir, Deborah Randall, Sharon Goldfeld, Alastair Leyland, Elizabeth Best and Marilyn Chilvers. The authors would like to thank the Australian Government Department of Education, the NSW Ministry of Health, the NSW Register of Births, Deaths and Marriages, the NSW Department of Education, and the NSW Department of Family and Community Services, for allowing access to the data included in the study data resource. The authors thank the NSW Centre for Health Record Linkage for conducting the linkage of data sources detailed in this paper. The authors thank Elizabeth Best (NSW Health) for commenting on the draft manuscript and staff in MH-Children and Young People Unit from the Mental Health Branch of the NSW Ministry of Health for discussing the policy and practice implications of the findings. We also acknowledge the Centre for Big Data Research in Health’s Aboriginal and Torres Strait Islander Maternal and Child Reference Group for their contributions to discussions about the design, findings and translation of this research from the project outset.
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