This chapter analyses the key determinants of children's social and emotional well-being and highlights the data required to develop better policies for meeting children’s social and emotional needs. It considers key social and emotional outcomes, such as emotional security, sense of safety, social and cultural identity, mental health, and life satisfaction. It examines how children’s activities, behaviours and relationships shape well-being as well as the effects of children’s family situation and school and neighbourhood environments. It also summarises key areas of public policy for promoting children’s social and emotional well-being. The chapter considers the cross-national data available on child social and emotional well-being and discusses the way forward, highlighting key data gaps and setting out priorities for data development.
Measuring What Matters for Child Well-being and Policies
5. Do children feel safe and secure, respected, included and happy?
Abstract
5.1. Introduction and main findings
The purpose of this chapter is to analyse the key determinants of children's social and emotional well-being and identify the main data gaps and priorities for data collection. The chapter reviews the available evidence on children’s social and emotional well-being and discusses different approaches to measurement to better capture social and emotional well-being across different stages of childhood.
The quality of children’s early caregiving relationships is fundamental to healthy social-emotional development. From the very first months of life, children learn to recognise and manage their emotions, with the support of parents and other caregivers. Throughout the course of childhood, children develop the ability to form positive relationships with peers and adults and to cope with adversities or set-backs they might encounter, thanks to the resources available in the family, at school, in friendships networks or in the community environment. Missing out on opportunities to develop strong social-emotional skills serves children a disadvantage as young adults in terms of various well-being outcomes.
Social and emotional skills have persistent and cumulative effects on various child and later life outcomes. For example, good social skills can help children adapt better to the school environment and consequently perform better in school. This, in turn, is related to better occupational status, health, and life satisfaction in adulthood. Likewise, being curious and having an active approach towards learning is an important pre-requisite for developing and improving innate cognitive capacities (Kautz et al., 2014[1]; OECD, 2021[2]). Social and emotional skills are also fundamentally dependent on cognitive skills such as perception, memory, and reasoning (Schoon et al., 2015[3]). Cognitive, and social and emotional skills are dynamically interconnected in such a way that a person’s higher skills in one area may be able to better influence the development of skills in other areas. There is also evidence that socio-emotional and cognitive skills in early childhood have independent effect on later outcomes, and that knowing more about children's socio-emotional well-being is therefore key to designing policies with lifelong impact (Schoon, Nasim and Cook, 2021[4]).
All stages of childhood shape children's social-emotional development, in their own important way. Early childhood is a crucial period of development as children learn to self-regulate and have their first informative experiences with their physical and relational environments. The things that children learn and experience in the first years of life lay the foundations for later social-emotional and cognitive development, and continue to have their own effect on various dimensions of adult-well-being. For example, early self‑regulation skills benefit language development, as well as the development of reading and numerical literacy (Schoon et al., 2015[3]; Shuey and Kankaras, 2018[5]). Conversely, experiencing adverse circumstances in early childhood can have an effect on the development of later difficulties. For instance, exposure to domestic violence in the early years is associated with an increased likelihood of academic problems, experiencing anxiety, and developing aggressive behaviours (Kitzmann, 2012[6]; Berger, 2019[7]).
During middle childhood and adolescence, children develop social relationships and friendships, and spend an increasing amount of time away from the family and caregivers, making the quality of resources found in school, the community and the neighbourhood very critical. How successfully children navigate school life and manage interpersonal relationships are predicative of aspects of adult well-being. For instance, the reporting of self-isolation and lack of school or social connectedness in middle- to late- childhood is associated with higher prevalence of mental health difficulties and anxiety symptoms, as well as lower global life satisfaction and adult well-being (Ann and Vincent Bowles, 2013[8]; Shochet et al., 2006[9]; Olsson et al., 2013[10]) On the other hand, social competence (i.e. the successful use of social behaviours to achieve goals) in middle- to late-childhood was found to have a persistent effect on adult employment and social outcomes. For instance, Masten et al. (2010[11]) found that social competence in middle-childhood and early adolescence, as captured by peer acceptance, the formation of friendships, and the maintenance of those relationships, was associated with better work competence (i.e. a record of holding down a job successfully and carrying out responsibilities well) at around age 20.
The changing nature of work and the labour market is another key reason to pay close attention to nurturing the development of children’s of social-emotional skills (OECD, 2019[12]). Younger generations are expected to have longer working lives than their predecessors, changing jobs more often and retiring much later. Moreover, the job tasks attached to most occupations is being altered by technological advances and associated changes in work organisation, which brings about a rising demand for high-level cognitive and complex social-interaction skills (OECD, 2019[12]). Low-skilled adults working in jobs that are very intensive in simple and repetitive tasks are likely to be most exposed to these changes. Therefore, to navigate the working world well as adults, children will be required to have the capabilities to keep their skills up-to-date and in line with the needs of the job market, and to transition between job sectors (OECD, 2019[13]). Social-emotional skills such as curiosity, openness, and persistence will become all the more important, as well as the ability to adapt to new workplaces and challenges. Education systems and parents need to prepare children to become life-long learners and to develop the capacity to adapt to the many changes that may lie ahead (Lippman, 2015[14]; John and De Fruyt, 2015[15]).
The following main findings stem from the literature review carried out in the rest of the chapter:
Self-regulation, defined as the ability to control or modulate the intensity of one's emotional state and behaviours to an adaptive end, starts to develop in the first few years of life and is critical for children’s learning and development of relationship skills.
Interpersonal relationships are crucial to building the emotional security needed by children to develop fully and thrive. In the first few years of life, the bonding relationships with parents and caregivers are critical. As children get older, the quality of relationships with peers and other adults gain importance.
Children’s conscientiousness, which refers to their commitment in regards to performing well in the activities they undertake, is fundamental for succeeding at school and performing well later in the workplace.
Children’s propensity to cooperate, empathise and take others’ perspectives into account is key to developing social capital and dealing constructively with collective issues. These kind of pro-social behaviours develop early, with many different forms observable in everyday contexts from the early years of life – through, for example, helping, sharing, comforting and cooperating with others.
The home, school, community and neighbourhood environments provide important resources to help foster children social and emotional well-being. At home, parental active involvement in childcare and joint activities with children promote child-parent attachment. The adoption of a parenting style that combines warmth and responsiveness, while also establishing expected rules of conduct and clear limits, is conducive to children’s perception of being protected and safe, listened to, and well supported. The school climate and interactions with teachers and school-mates are also key for children’s feelings of self-confidence and social connectedness. The neighbourhood is also important, particularly with regards to ensuring that children can move around freely and safely without coming into harm’s way, and by providing opportunities for leisure, cultural activities, sports and other group-based activities.
Conversely, children’s social and emotional well-being can be compromised by risk factors present in these different environments. For example, the presence of conflict between family members or domestic violence deeply affect the emotional and affective well-being of children. School can be a place where bullying occurs, or where children struggle to fit in. Deprived neighbourhoods where poverty and crime are more common expose children to higher risks and reduce their sense of safety. The absence of recreational facilities and green spaces leave children without adequate places to play safely and hang around with friends.
The literature review provides a basis for identifying a set of priorities to improve data collection of children’s social and emotional well-being:
At the international level, data collection should aim to measure children’s social and emotional well-being through outcomes that are relevant to the different stages of childhood and that have also been shown to have a proven link to present or future well-being. At present, internationally comparable information comes from surveys with different focuses and is not based on a common understanding of social-emotional development across childhood. As a consequence, there is a lack of alignment in the social-emotional dimensions explored at different ages.
When it comes to social and emotional well-being, it is especially important to consider what matters to children. Basically, this involves asking children about issues that are important to them, such as family and school life, and their feeling of safety in the neighbourhood or the availability of green and outdoor leisure spaces. It also entails focusing on children’s perceptions with regards to whether they feel listened to or not, and if they feel supported in their different life domains (Rees, 2017[16]). However, while there is some information on these areas in respects to middle-childhood in the Children’s Worlds data, for example, there is no equivalent international information available on adolescents’ views.
The evidence available for a few countries shows that new risks to the social and emotional well-being of children are surfacing. For example, while historically common risky behaviours such as smoking are becoming less frequent, there is evidence of adolescents making use of alternative substances for recreational purposes, including prescription pharmaceuticals (e.g. painkillers, tranquillisers, sedatives). The internet and social networks are also creating new risks at the same time as new opportunities for children. The nature of these risks and opportunities are changing rapidly, requiring the strengthening of efforts to not only understand these changes but also to make data on the relevant issues available for a wider range of countries.
Finally, the chapter identifies important gaps in knowledge about the social and emotional well-being of children, including:
The social and emotional well-being of the most vulnerable children and adolescents, in particular, children with disabilities, children in care institutions, homeless children, or children experiencing maltreatment. These children are generally not well covered by general population surveys and other sources of information on children’s social and emotional well-being.
The social and emotional well-being of children in early- and middle-childhood. Thanks to HBSC and PISA, the information on adolescents' social-emotional status is larger than that of younger children. It is imperative that the data gaps for younger children are filled.
The very limited information available on children's and adolescents' personal, social and cultural identities. Identities play an important role in well-being, including by helping foster a sense of purpose and belonging and by shaping the ways children interact with others. More information about children's identity formation, their participation in group activities, their trust in institutions, and their knowledge of and interest in global and societal issues is valuable for strengthening future social cohesion.
The links between children’s mental health and socio-emotional well-being and their educational and physical health outcomes. Many studies point to evidence of “developmental cascades”, which refers to the cumulative consequences of interactions across domains of child development (Masten and Cicchetti, 2010[17]). Social-emotional difficulties or mental health problems can have negative consequences for physical health and academic achievement. Breaking this cycle requires effective interventions and joined-up policies, which, ultimately, rely on joined-up data.
This chapter begins with a deep review of the literature on the key dimensions of children’s social and emotional well-being with reference to the different stages of social-emotional development and their determinants. The chapter moves on to provide an overview of the available cross-national data on children’s social and emotional well-being. The chapter concludes by identifying the priority areas for data development moving forward.
5.2. Key aspects of social and emotional well-being
Children’s social and emotional well-being cuts across several research disciplines. In a general sense, social and emotional well-being refers to the ways children behave and think and feel about themselves and others. It includes being able to form adaptive coping strategies and resilience in the face of life’s many challenges, and being able to achieve interpersonal goals and positive social outcomes. It also covers the types and strength of children’s affective states – for example, feelings of happiness and joy, sadness and insecurity – and broader subjective well-being, as well as children’s mental health more generally. Children’s social and emotional well-being relies to a large extent on the quality of interpersonal relationships with parents, teachers, peers, and the experiences these afford children. At the same time, it is very much shaped by culture, temperament and individual differences.
Each research discipline tend to favour a means of intervention to enhance social and-emotional well-being. The medical sciences and clinical psychology focus on pathology (i.e. the cause, development and outcomes of a mental disorder) and providing diagnoses of disorders that can be either treated or medically managed. Developmental psychology understands children’s development as occurring along an expected trajectory (i.e. milestone competencies) and supported by a responsive and loving caregiving relationship, and influenced through the interactions between the environment and biology. Economic research focusses on the acquisition of human capital during childhood (i.e. the various skills that the child develops through parental and/or state investment) which contributes to adult socio-economic success and self-sufficiency (Conti and Heckman, 2014[18]). More broadly, economic research has also demonstrated the value of subjective well-being measures such as "life satisfaction” as a means for understanding social and emotional well-being (Kahneman and Deaton, 2010[19]; Diener et al., 2009[20]; Proctor, Linley and Maltby, 2009[21]).
Children are continuously developing social and emotional skills during childhood and into adulthood. As with other areas of child well-being, many aspects or components of social and emotional well-being follow a developmental trajectory (Box 5.1), making age appropriateness a key factor in measurement. Children learn to master different set of social-emotional skills that enable them to gain self-control, and to form and sustain close, stable and nurturing relationships. These sets of skills help children feel safe and secure enough to explore their environment, go into their imaginations, and to learn from experience and from doing (OECD, 2020[22]; Chernyshenko, Kankaraš and Drasgow, 2018[23]). Children’s social-emotional development also depends on the interaction of a large number of factors. These include individual endowments, the quality of care a child receives, relationships with parents, caregivers, teachers and peers, and the quality of the physical environment, among others.
Box 5.1. Children’s social-emotional development in a nutshell
During the first year of life, infants begin to recognise emotions and develop bonding relationships with parents and other caregivers. If infants’ physical and emotional needs are well met on a consistent basis, infants learn to develop a basic sense of trust in their caregivers and, by effect in the world (Kuther, 2019[24]; Belsky et al., 2020[25]). Through supportive caregiving Infants develop the capacity to regulate their own emotional reactions, learning that arousal in the presence of a caregiver does not lead to feeling overwhelmed (Howe, 2005[26]). The mental health of parents during the perinatal period is critical for bonding and the quality of caregiving relationships (Schoon, 2015[27]; McDaid, Hewlett and Park, 2017[28]).
Early childhood is defined by marked increases in social-emotional development. The family remains to be the primary social tie to children but relationships with other children become important (Belsky et al., 2020[25]; Zaouche-Gaudron, 2015[29]). Young children get better at emotional regulation, and are more aware of own feelings and characteristics. They internalise expectations of behaviours for themselves and others, and can feel guilt when they do not uphold the rules or miss objectives. They also become better at perspective-taking, and showing empathy and other pro-social behaviour. These skills represent the basic building blocks for the later development of complex of social and emotional skills that form throughout childhood and whose influence remains detectable on a wide range of later outcomes, including educational and socio-economic attainment, health and life satisfaction (Schoon, 2015[27]; Shuey and Kankaras, 2018[5]; Belsky et al., 2020[25]). Much of this development takes place through play, where young children experiment and learn to cooperate to achieve common goals, thus learning about themselves and the social world (Kuther, 2019[24]).
During middle childhood, children make important gains in refining the rudimentary social-emotional skills developed during the preschool years. The transition to primary school represent an increasing involvement with peers and adults outside of the family (Carr, 2011[30]). From ages six to 12 years, children develop multiple strategies for autonomously self-regulating and managing interpersonal relationships in increasingly sophisticated ways. They start learning about how the world operates, and about their different roles and responsibilities (Yücelyiğit, 2020[31]).
During adolescence interpersonal relationships become more sophisticated (Kuther, 2020[32]). Particularly during transitions (e.g. starting secondary school and undergoing puberty), adolescents are highly sensitive to peer influences and feel under pressure to conform, from aspects of their personal appearance to engaging in pro-social behaviour, but also in risky behaviours too. Adolescents can develop strong feelings of empathy, solidarity and trust, yet also be defiant and rejecting of certain behaviours or values.
Adolescents’ self-concept becomes more complex, differentiated and organised. They become more introspective and start to consider what matters to them more, who they really are, and how they fit into the world. This process involves trying out new things like different clothing styles, music, art or hanging around in new friendship groups. Many adolescents also search for new experiences and to push the boundaries, with a few engaging in risky behaviours, such as substance misuse or non-protected sex. Forming a sexual identity is a key developmental task, which requires adolescents to have an awareness and comfort of personal sexual attitudes, behaviours and interests (Kuther, 2020[32]).
Adolescents seek more independence regarding how they live and lead their lives and prefer to spend more time with friends and peers and less with family. They often start to develop a stronger individual sense of values and morals, and begin questioning things more. While adolescents are required to learn how to become fully responsible, they still need guidance and support from adults along the way. Becoming more independent sees family routines changing and relationships maturing.
Table 5.1 provides a summary of key aspects of children’s social and emotional well-being, as well as related aspects tied to children’s social and cultural identities. The table is divided into four panels, structured in a similar way to the child well-being measurement framework outlined in Chapter 2:
Panel A covers key child social and emotional outcomes, as well as related cultural outcomes. These outcomes include children’s basic emotional needs like attachment to caregivers, emotional security and the need to be loved and cared for; children’s basic social needs such as being listened to, respected, fairly treated and socially recognised; children’s sense of identity and belonging (including ethnic and/or cultural identities); and pro-social behaviours. Also included here are a range of socio-emotional skills or competences that children develop during childhood to help them self-regulate, engage with others, and engage in learning processes (e.g. emotional regulation, conscientiousness, open-mindedness; see Box 5.2), key aspects of mental health (including disorders), and children’s life satisfaction, both in general and in key domains, such as with home and family life and with school life.
Panel B highlights important child-level drivers, influences and determinants of children’s social and emotional outcomes. These include time, activities and relationships with parents and the family as a whole, as well as their participation in social, leisure and civic activities, their friendships and relationships with peers, and their digital activities and behaviours, including internet and social media use. Aspects of children’s brain development are also included here; healthy brain development overlaps with elements of physical well-being, but is also a foundational component of social and emotional well‑being.
Panel C focuses on key environment-level drivers and influences of children’s social and emotional outcomes. This includes in particular aspects of the family and household environment, especially factors relating to the safety, security and stability of the family environment (e.g. living and custody arrangements, parental conflict, and family violence), but also family financial resources and family physical and mental health. Several aspects of children’s community and physical environment are also covered here – including crime rates and access to local resources such as parks and museums – as well as the environments children face at school or in early childhood education and care (ECEC).
Lastly, Panel D highlights policies that can influence children’s social and emotional outcomes. There are a wide variety of policies relevant here. These include several types of family policy, especially family and parenting support services but also family financial supports and family employment-related policies such parental leave; housing and built-environment policies and regulations, such as public housing supports and “child-friendly city” policies; health policies, including physical and mental health supports available to mothers/parents during pregnancy and in the period after childbirth, as well as child mental health supports; and education policies, including both ECEC policies and regulations and school and wider education policies and regulations.
More detail on the various aspects covered and their empirical basis is given in this and the following sections of this chapter.
Table 5.1. Key aspects of children’s social and emotional well-being throughout childhood
Box 5.2. What are social-emotional skills?
It is not at all surprising that social-emotional skills are the subject of interest across many different disciplines when one considers their link with many types of child outcomes, and contributions to the prosperity of the economy and societies. The domain of social-emotional skills covers individual capacities manifested in consistent patterns of thoughts, feelings and behaviours. These capacities are developed and mastered through relationships and formal and informal learning experiences.
Social-emotional skills are often called non-cognitive skills or soft skills. Over the years, the term “skills” has gained a preference over the term "traits", in recognition of their malleability as opposed to them being fixed and immutable. They develop gradually throughout childhood and early adulthood and there is the potential to affect improvements through policy interventions.
Social and emotional skills are instrumental in increasing the returns on cognitive skills. Social and emotional skills differ from cognitive skills, in as far as they mainly concern how people manage their emotions and feelings, perceive themselves and engage with others, rather than indicating the raw ability to process information. But, similar to cognitive skills, they are dependent on situational factors and are responsive to change and development through formal and informal learning experiences. Like every aspect of mental functioning, they involve some form of information processing and cognition, such as individual perception, memory and reasoning abilities. In other words, while useful to identify social-emotional and cognitive skills separately, their interaction has an effect on a large range of individual personal and social outcomes. Much research underlines how this interaction can have a large influence on educational and employment outcomes (Cunha and Heckman, 2007[33]; Heckman, Stixrud and Urzua, 2006[34]). For example, evidence from the Dunedin study suggests that children who are classified as inhibited at age three (i.e. showing signs of social withdrawal and shyness) are more likely to leave school early and experience unemployment between the ages of 15 and 21 (Caspi, 2000[35]).
Social and emotional skills have powerful consequences for many important personal and social life outcomes, including physical and mental health (Strickhouser, Zell and Krizan, 2017[36]), job and life satisfaction (Judge, Heller and Mount, 2002[37]), adolescent and young adult conduct problems (OECD, 2015[38]), civic engagement (Omoto, Snyder and Hackett, 2010[39]), and the involvement in criminality. For a comprehensive overview see: (Kautz et al., 2014[1]; OECD, 2015[38]; Chernyshenko, Kankaraš and Drasgow, 2018[23]).
A challenge in measuring social-emotional skills is that surveys use heterogeneous measures to assess social-emotional skills, with little agreement about how different skill sets should be defined and measured, while the terms and concepts are not always consistently applied (Pirus and Léridon, 2010[40]; Schoon, 2015[27]).
A well-known framework of social-emotional skills is the Big Five model. This model compromises of five broad categories which encompass of a grouping of mutually-related skills. They are openness to experience, conscientiousness, emotional stability, extraversion and agreeableness. They are grouped together in such way as to ensure a systematic, comprehensive and balanced consideration of individuals’ social and emotional skills. The Big Five dimensions and its facets are clearly present in most cultures and languages, although some cultural-specific constructs do exist. The OECD's Study on Social and Emotional Skills (SSES) draws on this framework (Annex 5.A).
The processes behind the development of social-emotional skills are interdependent and reinforcing of another. In particular, the literature on child social-emotional development strongly highlights the importance of the quality of the relationships children have with parents, caregivers, teachers and peers for social-emotional development. Interpersonal relationships are the drivers behind helping children develop strong socio- emotional skills, to gain self-confidence as well as being able to trust others. Critically, the literature shows that the single most common protective factor shared by resilient children is the support of one stable and committed relationship with an adult, be it a parent, caregiver or other adult (Center on the Developing Child at Harvard University, 2016[41]).
Attachment, emotional security, and the fundamental role of relationships for social-emotional development
Throughout childhood, the relationships children develop with others are a central component of their social and emotional well-being. Overall, parents have a great influence on child development through the parent-child relationship, and this goes well beyond meeting a child’s physical needs. The early caregiving relationship between parent and child is thought to help lay the foundations for future healthy relationships, and is considered as a prototype for future relationships (Malekpour, 2007[42]).
Infants come into the world vulnerable and dependent on others’ for care and protection. They born with a set of inbuilt behaviours (i.e. attachment behaviours) to increase their survival. Attachment behaviours have the goal of protection and get activated when infants perceive a threat or danger. Once this goal has been achieved – through reunion or proximity to a caregiver – the attachment behaviour is deactivated. Infants form attachments to their caregiver(s) through repeated caregiving interactions and growing familiarity. Children’s attachment patterns are typically classified under two main categories: secure and insecure (ambivalent, avoidant and disorganised). Children develop secure attachments when the caregiving experience is adequately sensitive, loving, responsive and consistent, whereas they form a variant of insecure attachments when caregivers are unwilling or unable to respond to their needs, or if the caregiving experience is inconsistent or a source of distress (Howe, 2005[26]).
Infants usually have a number of attachment figures, who provide a secure base from which they feel confident to explore their environment and have a safe haven to return to when in need of support or protection. The attachment figures help him or her make sense of and manage their own feelings (i.e. emotional regulation). Most infants form clear-cut attachments to more than one attachment figure from the ages of six to nine months. Attachment figures are hierarchically organised, with the person who is the most regularly involved in the care and the protection of the child the primary attachment figure, which often is the mother (Howe, 2005[26]). Research highlights the benefits of father’s involvement in the early years, with the attachment formed between father and child having a long-lasting influence on child outcomes and life chances (Chung, 2021[43]).
Children’s patterns of attachment form early on and are expected to be stable yet open to revision in light of experiences throughout childhood, adolescence and adulthood (Mcconnell and Moss, 2011[44]). Much research underlines the far-reaching effects of children’s attachment patterns on the development of emotional, social and cognitive skills (Ranson and Urichuk, 2008[45]; Widom et al., 2018[46]; Alhusen, Hayat and Gross, 2013[47]). The early caregiving experiences lead to children forming internal working models, representing beliefs and expectations they hold about themselves, the social world and relationships. Securely attached children enjoy higher self-esteem and self-confidence, and are able to self-regulate and be resilient. Insecurely attached children have difficulties self-regulating and managing stress, and are more likely to experience relationship difficulties in adulthood and encounter difficulties in rearing their own children (Howe, 2005[26]). Early attachment security is found to influence measures of emotional health, self-esteem, agency and self-confidence, positive affect, ego resiliency, and social competence in interactions with peers, teachers, romantic partners, and others (Sroufe et al., 2005[48]). Attachment security is also an important consideration in numerous childhood health and behavioural difficulties and neurodevelopmental disorders (Rees, 2005[49]).
During infancy, numerous factors can inhibit the ability of caregivers to form a bonding attachment and respond sensitively to infant’s needs. These include poor maternal mental and physical health, parents’ difficult adaption to their new roles as mother and father, parents’ own attachment history, and the quality of parents’ own couple relationship. The bonding process is also influenced by socio-cultural factors, which include gender roles, level of education, and support networks (Karakaş and Dağlı, 2019[50]).
Pregnancy and childbirth are times of critical psychological adjustment for women. Some changes to women’s mental states and functioning are to be expected as part of normal adaption to parenthood. However, many women experience high levels of mental distress around pregnancy and childbirth, as reflected in the prevalence (one in eight new mothers) of mental health difficulties such as anxiety and depression in the ante-natal and post-natal period (Woody et al., 2017[51]; Dennis, Falah-Hassani and Shiri, 2017[52]). These difficulties have consequences for mothers’ well-being and that for their children.. For example, maternal depression or anxiety during pregnancy is associated with internalising and externalising behavioural problems in middle childhood (Leis et al., 2014[53]), with potential long run effects into adolescence and adulthood. Overall, prenatal depression and anxiety may account for 10-15% of the attributable risk of childhood behavioural problems (Glover, 2014[54]). Persistent post-natal depression of a severe nature beyond the baby’s first six months also increases the risk of behavioural issues. All of these issues underscore the importance of ensuring women have access to adequate social and emotional support during pregnancy and following childbirth. How much support women receive from their partners can make a critical difference; greater partner support during pregnancy is associated with lower maternal emotional distress postpartum and less infant distress to novelty (Tanner Stapleton et al., 2012[55]). Moreover, parenting interventions starting during the pregnancy can have long-term benefits for children’s behaviours (Glover, 2014[54]).
In early childhood, parent-child interactions influence the development of empathy and pro-social behaviours. Other caregivers and early childhood teachers also play similar roles, helping children learn how to understand their own and others’ emotions, express their emotions appropriately and help others (Kuther, 2019[24]). In Early Childhood Care and Education (ECEC) settings, the teacher-child relationship is centred on proximal processes, which promote children’s self-regulation. For example, intimate caregiving tasks like feeding and soothing the child provide teachers with plenty of opportunities to engage in sensitive and responsive caregiving (Mortensen and Barnett, 2015[56]). A few studies have found a positive effect of ECEC participation on children’s social-emotional skills but the evidence is not as robust as it is for academic outcomes (Phillips et al., 2017[57]). One English study found better scores for self-regulation and pro-social behaviour and lower scores for hyperactivity at age 16 years among those who had attended high-quality pre-school. The quality of pre-school was especially important for children whose parents have a lower level of education (Brief et al., 2014[58]). Young children are eager to develop peer relationships. These relationships are based in play, and have implications for all areas of development. Play encourages children to see that everyone does not perceive things in the same way and to take the perspectives of others on board (Kuther, 2019[24]).
In middle childhood, the parent-child relationship becomes less close as children become more interested in forming and nurturing peer relationships. Parent and children spend time together engaging in task-orientated activities, for example, doing homework and shopping. Older children look for more independence and can be more disregarding of parental authority. Compared to early childhood, peer relationships become complex and reciprocal in nature as children become increasingly able to take on the perspectives of others and consider their needs. Social acceptance by peers becomes very important and is informed by children’s social skills. Children find it easier to maintain peer relationships when they can self-regulate and have the capacity to provide emotional support (Kuther, 2019[24]).
Beginning in early adolescence, the time spent with parents declines as time spent with friends increases. Friendships offer adolescence a source of belonging and support and a medium to develop relationships skills. When parent-child relationships are poor, adolescents often turn to friends for emotional support which can alleviate some of the associated negative effects (Kuther, 2019[24]). Moreover, the presence of supportive adults in a young person’s life who are not the parent is associated with higher levels of self-esteem, lower levels of conduct problems, substance abuse, and sexual activity. Supportive adults serve a purpose that a parent or a peer cannot or may not be able to fulfil; they can provide advice based on experience and discuss with adolescences situations that they may be too embarrassed to do with their parents (Sterrett et al., 2011[59]).
Children in out-of-home care are an example of one group who experiences difficulties in forming secure attachments to their caregivers. Prior to their reception into care, in families where neglect, abuse or addiction were issues, children are likely to have experienced a difficult caregiving environment (Howe, 2005[26]). Coming into care often implies changing schools and neighbourhoods and being a distance from family and friends, which disrupts children’s relationships; the same can be said for placement breakdowns. What children need from the care system is stability and certainty to help them acquire safety, progress developmentally, and have good outcomes. However, placement breakdowns are not uncommon, with research indicating that many children experience a high rate of (multiple) placement moves, for instance, upwards to half of all children in out-of-home care in the United States (Jedwab et al., 2019[60]) . Children with the more extensive involvement with child protection services prior to coming into care are more likely to face repeat placement breakdowns.
Self-regulation
Self-regulation is a complex, multi-component construct that operates across several levels of functioning (including motor, physiological and socio-emotional, as well as cognitive functions; see Chapter 6 on the latter). Broadly, it is the ability to control or modulate the intensity of one's emotional state and behaviours to an adaptive end (Montroy et al., 2016[61]). Children’s ability to draw on, integrate, and manage these multiple processes increases as they get older. Children who can self-regulate have learnt to keep their emotions in check and temper under control. When upset, they are capable of calming themselves. They can adjust to changes in expectations, and handle frustration without an outburst. When children begin to quickly recognise how emotions affect their own behaviour and that of others, they understand the social world and become socially competent. They are at low risk of developing behavioural and mental health difficulties. Whereas when children struggle with understanding their own and others’ emotions, they are poor at managing their feelings of arousal and are not competent in dealing with interpersonal relationships (Howe, 2005[26]). Many of the core capabilities possessed by resilient children which allows them to thrive in the face of adversity fall under self-regulation (Center on the Developing Child at Harvard University, 2016[41]).
In the family context, the early development of self-regulating behaviours concerns children modelling the responses and reactions of parents, which takes on a larger verbal component as children grow. Parenting practices have a role, for example parental conditional regard in its positive and negative sense (i.e. how parents vary the level of attention and affection towards a child, depending on the desirability of the child’s behaviour). Another aspect is the emotional climate of the family measured by the child-parent attachments and parents’ own couple relationship, for example the presence of marital discord (Rutherford et al., 2015[62]).
Promoting self-regulation in children during the pre-school years is found to help improve school readiness and has a positive effect on academic performance in primary school (Ursache, Blair and Raver, 2012[63]; McClelland and Cameron, 2011[64]). The research on early childhood focuses on the mental processes that develop in the first years of life when children are learning how to self-regulate: for instance, the ability to store and manipulate or use information, in order to complete a task; being able focus attention and control impulsive behaviours: and being able to shift between rules, adapt to changing circumstances and juggle multiple tasks successfully (Shuey and Kankaras, 2018[5]; OECD, 2020[22]; McClelland et al., 2017[65]).
The ways in which self-regulation can be measured vary with the age of children. At young ages, children cannot reliably be asked directly about their emotions and feelings, but it is possible to collect information through play-based assessments (OECD, 2020[22]), through observations of children’s behaviours in different situations, or through parental and/or caregiver reports. As children grow older, it becomes possible to ask more direct questions on how they manage their emotions and the feelings that different situations evoke.
Though encompassing certain aspects of emotion regulation, self-control as a standalone concept describes a child’s ability to regulate emotions, desires and behaviours in the service of later rewards. Within child psychology self-control has been studied with reference to delayed gratification. In other disciplines it is described similarly and is understood as a vital component of strong executive functioning and good self-discipline, and allows individuals to be act conscientiously and without impulsivity. The capability of young children to exercise self-control have been shown to have lasting impacts on many facets of adult well-being, including health, wealth accumulation, parenting, drug misuse and involvement in criminality (Poulton, 2011[66]; Moffitt et al., 2011[67]).
Conscientiousness
Conscientiousness (or task performance) relates to the commitment children display in regards to performing well in the activities they undertake. It appears to be a significant predictor of educational attainment, health and labour market outcomes, coming up as strong as measures of cognitive ability (Heckman and Kautz, 2012[68]; Noftle and Robins, 2007[69]; Rosander and Bäckström, 2014[70]; Chernyshenko, Kankaraš and Drasgow, 2018[23]). Individuals who show traits of conscientiousness have a lower likelihood of engaging in risky health behaviours and are more likely to enjoy a higher degree of financial security (Bogg and Roberts, 2004[71]; Moffitt et al., 2011[67]).
Conscientiousness involves a combination of different facets of the personality working together, but each can be measured separately. These include achievement motivation, persistence in effort, self-control, the ability to follow norms and rules, and the ability to take responsibility and be held accountable. For instance, achievement motivation means accomplishing something difficult, as quickly and as independently as possible. It implies working hard to meet one’s own high standards and putting in a consistent effort to be productive and achieve good results. It requires self-discipline and self-control (Hulleman et al., 2010[72]). Persistence in efforts capture individuals attitudes towards completing work and finishing a task, and for students it is found to be related in a positive way to school performance at age 10 and 15 (OECD, 2021[2]).
Middle childhood is a critical period in the forming and evolution of children’s achievement motivations (Wigfield, Muenks and Rosenzweig, 2015[73]; Eccles et al., 1999[74]). During the early stage of middle childhood, the first few years of primary school are often associated with a decline in children’s achievement motivation and school attachment. This effect is particularly marked among children with low self-esteem and less well-developed self-control, and those who have poorer self-organisational strategies, and more problematic behaviours (Wigfield et al., 2007[75]; Eccles, 2007[76]). These types of children are vulnerable as they are also more likely to report symptoms of internalised distress such as depression and social isolation, as well as greater signs of externalising behaviours such as anger or aggression. As children get older, experiencing this kinds of difficulties contributes to disengagement from school work (Wigfield, Muenks and Rosenzweig, 2015[73]; Eccles et al., 1999[74]).
Self and social identity
Children’s sense of identity and understanding of their “self” plays a central role in their development, behaviour and overall well-being. Just as adults do, children need an idea of self to guide their behaviours and responses to the world. This idea of self starts to develop early (Cimpian et al., 2017[77]): even in infancy, many children are able to demonstrate at least a basic understanding of who they are and what makes them unique through, for example, a grasp of personal ownership (Davoodi, Nelson and Blake, 2020[78]; Ross, Friedman and Field, 2015[79]). These understandings become increasingly detailed and organised over time, especially during adolescence, during which children begin to form a fuller sense of “identity” (Kuther, 2019[24]).
There are two main components to individuals’ sense of self (Campbell et al., 1996[80]; Kuther, 2019[24]). The first is a knowledge component, sometimes called “self-concept”, which refers to peoples’ understandings and descriptions of the type of person they are. It addresses the question “Who am I?” The second is self‑esteem, which is evaluative and reflects feelings of self-worth, either globally or in specific areas. It answers ‘‘How do I feel about myself?’’ A key developmental challenge for children, particularly during adolescence, is the exploration and organisation of these components and the formation of a balanced and coherent sense of self (Crocetti and Van Dijk, 2016[81]). Arriving at this stable sense of self is sometimes called “identity achievement” (Schwartz et al., 2013[82]).
Both self-concept and self-esteem have been shown to be important for children’s (and adults) well-being outcomes. For self-concept, it is not always the content of the concept that matters for outcomes, as much as the structure.1 Self-concept clarity – the extent to which an individual has a stable and consistent perception of the self, whatever that perception is2 – has been linked to various aspects of adolescents’ and young people’s mental health and well-being (Van Dijk et al., 2014[83]; Crocetti and Van Dijk, 2016[81]). One explanation is that uncertainty around who and what you are contributes to anxiety and internalising problems, possibly through lower self-esteem (Van Dijk et al., 2014[83]). Self-esteem itself, meanwhile, has strong and clear links with a range of outcomes. Among adolescents, low self-esteem and a negative view of the self has been linked to depression and education drop-out, as well as a range of outcomes later in life, including depression and anxiety, criminality, employment and finances, and self-esteem itself (Swann, Chang-Schneider and McClarty, 2007[84]; Orth and Robins, 2014[85]; Steiger et al., 2014[86]). Identity achievement more generally is associated with adolescents’ and young people’s life satisfaction and sense of purpose (Waterman, 2007[87]; Schwartz et al., 2011[88]; Schwartz et al., 2013[82]), as well as several other aspects of self-evaluation and socio-emotional well-being, including pro-social behaviour (Kuther, 2019[24]) and a stronger sense of control over one’s own life – sometimes referred to as an “internal locus of control” – which itself has been linked to a range of educational, health and socio-emotional outcomes (OECD, 2019[89]; Lillevoll, Kroger and Martinussen, 2013[90]; Nowicki et al., 2018[91]).
Social identity
Social identity – a person’s sense of who they are based on membership and affiliation to social groups – plays an important role in shaping children’s over-arching self-image. Children, like adults, have a fundamental need to “belong” and to feel connected to others (Baumeister and Leary, 1995[92]). Indeed, from an early age, children display an eagerness to both join and conform to the behaviours of peer groups (Bennett, 2011[93]). Social identities help people form these connections. By attaching themselves to and adopting the norms and behaviours associated with social groups, children can feel part of something bigger and wider than themselves. These identities influence the ways children perceive their self and their place in society; they provide a sense of belonging, and a means with which children can categorise people’s behaviour, identify to groups and take part in collective action (Tajfel and Turner, 2004[94]; Bennett, 2011[93]).
Children’s social identities take many forms. They can range from identities based on small groups such as the family, a group of friends, or the classroom, to wider collective identities rooted in, for example, gender, sexuality, ethnicity, culture and religion. Importantly, identifying with a social group is not the same or as simple as being a member of a social group (Brewer, 1991[95]). Group membership itself may be chosen (e.g. sports team affiliations) or imposed (e.g. gender or ethnicity); social identities, on the other hand, become meaningful only when membership of the group is important (at some level) to children themselves (Cruwys et al., 2014[96]). The effects of strong social and group identification are not always positive: they can lead to in-group bias and prejudice towards others, for instance (Bennett, 2011[93]). At the same time, however, clear social identities have been linked to clearer personal identities, an improved sense of belonging, and better subjective well-being outcomes, including among young people (Baumeister and Leary, 1995[92]; Bennett, 2011[93]; Taylor and Usborne, 2010[97]; Usborne and Taylor, 2010[98]; Gardner and Garr-Schultz, 2018[99]; Kayama and Yamakawa, 2020[100]).
While social identity can be studied globally through aggregate measures (Nario-Redmond et al., 2004[101]; Cheek and Cheek, 2018[102]), measurement and investigation usually concentrates on specific identities considered important for children’s outcomes. One example is children’s gender identity. Often operationalised through multi-dimensional instruments (Egan and Perry, 2001[103]), studies have found links between various sub-aspects of gender identity – including gender typicality (feeling one is a typical member of the assigned gender), gender contentment (satisfaction with the assigned gender), and “felt pressure” to conform to gender stereotypes – and children’s psychological well-being (Egan and Perry, 2001[103]; Carver, Yunger and Perry, 2003[104]).
A second example is ethnic or cultural identity – that is, an individual’s sense of membership of and attachment to their ethnic or cultural group(s). Particularly important here is the strength, clarity and positivity of ethnic/cultural identities, which are associated with a range of outcomes, among both adults (Taylor and Usborne, 2010[97]; Usborne and Taylor, 2010[98]) and children (Carlson, Uppal and Prosser, 2000[105]; Umaña-Taylor, Gonzales-Backen and Guimond, 2009[106]; Rivas-Drake et al., 2014[107]). While research on ethnic/cultural identity often uses group-specific measures (Phinney and Ong, 2007[108]), instruments that are more widely applicable are also available. Examples include the Multigroup Ethnic Identity Measure – a multi-item measure of the clarity and positivity of ethnic identities and practices (Phinney, 1992[109]) – and Usborne and Taylor’s Cultural Identity Clarity Scale – also a multi-item scale, aimed at capturing the clarity of cultural identities (Usborne and Taylor, 2010[98]).
Supporting the development of ethnic and/or cultural identity is likely to be particularly important for children from minority groups, such as those with migrant backgrounds, children in out-of-home care placed with a family from a different background, and those from historically oppressed groups, such as Aboriginal peoples (Taylor and Usborne, 2010[97]; Usborne and Taylor, 2010[98]). These children may have to navigate multiple and at times conflicting cultural identities, or face a situation where their heritage culture has been suppressed. Added to this, both parental opposition to integration and discrimination and hostility from wider society can make it difficult for these children to construct clear and coherent identities (Kuther, 2019[24]). This can lead to identity confusion, feelings of being “lost”, and a lack of belonging (Kayama and Yamakawa, 2020[100]). At the same time, however, a strong and positive sense of ethnic and cultural identity can help build child resilience (Kuther, 2019[24]). For example, a strong ethnic identity can help children and young people reject negative views of their culture (Rivas-Drake et al., 2014[107]), and may help mitigate the impact of discrimination (Seaton, 2009[110]; Galliher, Jones and Dahl, 2011[111]; Romero et al., 2014[112]).
Which exact social identities matter most to and for children is not easy to pin down. The importance of different identities seems to vary from person to person (Kiang, Yip and Fuligni, 2008[113]), often in ways that reflect their circumstances and background. For instance, comparing the relative importance of gender and ethnicity identities among 5- to 12-year-old children in the United States, Turner and Brown (2007[114]) found that ethnic majority children place greater importance on gender than ethnicity, while ethnic minority children value them equally. Others (Onnie Rogers and Meltzoff, 2017[115]) find that gender identities are consistently ranked as more important than ethnic identities, but to different extents across ethnic groups.
Pro-social behaviour
Pro-social behaviour comprises actions that are beneficial to others, such as cooperating, helping others at some sacrifice to oneself, intervening to prevent harm, and volunteering, among other things. Pro-social behaviour is driven by a broad range of biological, motivational, cognitive, and social processes, with the idea that they are not reflexive actions but rather are preceded by a physiologically-based affective or motivational state. Empathy and perspective-taking play an important role in motivating pro-social behaviours. For instance, altruistic actions aimed at improving the situation of a person in need can be aroused by feelings of sympathy and compassion at another’s distress. Sometimes the underlying goal of these actions may be more egotistically motivated and aimed at relieving one’s own negative emotional state. Overall, due to a sense of group belonging, people are inclined towards helping others who belong to their ‘’own group’’ – those with whom their share social identities – as opposed to “other groups’’ (Tajfel and Turner, 2004[94]; Penner et al., 2005[116]).
Pro-social behaviour develop early in life, with many different forms observable before children turn two years old, for example helping, sharing, comforting and cooperating with others, especially in everyday contexts when a caregiver is nearby to provide affective and behavioural support. Young children are not indiscriminately pro-social and may have a preference for one form of pro-social behaviour over another (Brownell, 2013[117]). There is evidence to suggest that at age two children are also autonomously pro-social (Brownell et al., 2013[118]). The individual differences in pro-social behaviours that emerge in the preschool years are predictive of later pro-social tendencies and overall social adjustment. For instance, sharing in the preschool years is associated with pro-social behaviour in adolescence, while cooperation at age four is associated with compliance and low levels of disruptive behaviours at age 11 (Hay and Cook, 2007[119]).
During adolescence, pro-social behaviour is expected to either increase or temporarily decrease due to a range and combination of physical, cognitive and relational changes. For instance, advances in perspective-taking should translate into greater ability for moral reasoning, which in turn promotes pro-social actions. At the same time, however, brain maturation might challenge self-regulation, among other changes, and diminish adolescents’ ability to attune to others’ emotions. Moreover, gender-specific socialisation pressures can lead to increasingly adherence to gender stereotypes, for example girls displaying nurturing and caring behaviours while boys inhibiting these (Van der Graaff et al., 2018[120]).
Social capital
The development of pro-social behaviours is key to enhancing the formation of social capital, which Putnam defines as “features of social organisation such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, 1995[121]). Put differently, social capital describes the benefits that are derived from personal social relationships (within families and communities) and social affiliations (Runyan et al., 1998[122]). For children, social capital is primarily viewed as a resource within family relationships which enables children and adolescents to gain access to good quality services, schools, or leisure opportunities (Leonard, 2005[123]; Morrow, 1999[124]). However, children’s social capital is also drawn outside the family, increasing so with age i.e., at school, with the network of friends, or through their participation in leisure and other group activities (Leonard, 2005[123]; Harpham, 2002[125]).
The expectation that current generations of children will have to deal with global issues in an interconnected and culturally diverse world during their adult lives explains why strengthening children’s and adolescent social capital is seen as a critical issue (Huber et al., 2014[126]; Suárez-Orozco, 2007[127]; OECD, 2018[128]). In this perspective, the key challenge is to help children and young people to develop their capacity to examine issues and situations of local, global and cultural significance (e.g. poverty, economic interdependence, migration, inequality, environmental risks, conflicts, cultural differences and stereotypes), as well as their capacity to understand and appreciate different perspectives and world views, and their ability to establish positive interactions with people of different national, ethnic, religious, social or cultural backgrounds or gender (OECD, 2018[128]).
Capturing children's social capital is challenging because it refers to a heterogeneous set of relational resources that shape children's opportunities and mind-sets. For example, in order to measure the effect of children's social capital on health, Klocke and Stadtmüller (2019[129]) construct a social capital index that includes information on the quality of relationships with parents ("is it easy to communicate with parents"), the quality of the school climate ("are other students caring and accepting of me?"), and the quality of relationships in the neighbourhood ("do people like to talk to each other and do they trust each other?"). Yet, measuring what matters in terms of social capital requires a more complete theory of the origins, maintenance, transformation, and effects of social capital (Morrow, 1999[124]; Levi, 1996[130]).
Key aspects of children and adolescents' social relationships are argued to be measurable and important for future adult social capital (Runyan et al., 1998[122]; Furstenberg and Hughes, 1995[131]; Harpham, 2002[125]). These include: the extent of networks (often proxied through, for instance, children’s and adolescent’s participation in leisure, sport, cultural activities); perceived support received from family, peers, and community networks; perceived trust in society and trust in institutions; and the perception of shared norms and shared responsibility (that for instance can be measured by adolescents civic engagement, participation in volunteering activities, but also by collecting information on children’s knowledge of and interest in society-level developments, challenges and trends).
Mental health, mental health conditions, and substance use
Recognition of the critical importance of supporting child and adolescent mental health has been gaining in prominence over recent years, and deservingly so; on average in the OECD around 1 in 8 children report a low level of life satisfaction; and, worldwide between 10 to 20% of children and adolescents experience clinical-level mental health difficulties, such as depression and anxiety, with the reported prevalence of psychiatric disorders growing over the last few decades (Kieling et al., 2011[132]; Collishaw, 2015[133]; Choi, 2018[134]). Moreover, available evidence suggests that the mental health gap between children in relatively advantaged and disadvantaged socioeconomic circumstances is growing (Elgar et al., 2015[135]; Collishaw et al., 2019[136]).
Mental health is about much more than the simple absence or presence of mental distress or a mental health condition. As illustrated by a definition offered by the World Health Organisation, it is “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively, and is able to contribute to their community” (WHO, 2018[137]). Just like physical health, staying in good mental health requires effort, care and attention.
Despite growing efforts to understand and prevent the emergence of child and adolescent mental ill-health, parents, teachers and other professionals are concerned that that the current generation suffer from worse mental health than previous generations (Collishaw, 2015[138]). Mental health conditions and substance disorders represent a growing share of the burden of disease amongst adolescents (Patton et al., 2016[139]). However, the extent to which increases in reported prevalence represents real growth in mental health conditions – as opposed to changes in awareness, help-seeking behaviour, and diagnosing – is subject to ongoing debates among experts (Choi, 2018[134]).
Given the varied nature and development of mental health conditions, identifying which children and young people are vulnerable and in need of support is challenging. Recent estimates developed by the Institute for Health Metrics and Evaluation (IHME) indicate that in 2017, the average prevalence of mental health conditions among the under-twenties population in the OECD was 12% (IHME, 2019[140]). Worldwide estimates are higher, at between 10-20% of children and adolescents (Kieling et al., 2011[132]; WHO, 2018[137]). For successful management, early identification of mental health difficulties is key, particularly among children as the propensity to develop mental ill-health often has its roots in childhood; an analysis of World Health Surveys based on 17 countries in the early 2000s suggested that around half of severe mental health conditions begin by age 14, and three-quarters by the time a person is in their mid-twenties 20s (Kessler et al., 2007[141]; Kessler et al., 2007[142]) .
Children’s states of mental health determine how well they can manage the different kinds of emotions, affects and feelings that life events arouse, which at times can be intense and varied in nature. One way to measure mental health is to ask about subjective life evaluations, i.e. how happy one thinks he or she is, and how one feels about him or herself and life in general. This is usually possible from middle childhood onwards. Then it is common to ask children how they are feeling at a particular point in time i.e. core affect. This type of feeling varies over time and does not have a beginning nor an end, and may not necessarily be directed at anything. Often it can be feeling happy, or relaxed, or satisfied, or in a calm state or full of energy. These are among the feelings referred to as "core affects" (Barrett and Russell, 1999[143]; Rees, 2017[16]).
Life satisfaction assessments rely on a more fundamental judgement about children's satisfaction with their life taken as a whole, or by just focusing on separate areas of life such as family, school or social relationships. There is a strong argument for measuring child and adult satisfaction separately. In general, there has been little correlation found between the average national level of children’s life satisfaction, on one hand, and respectively adults’ satisfaction and country gross national income, on the other (Rees, 2017[16]).
The assessment of mental health conditions among adolescents is made easier by virtue of the fact that adolescents can more easily respond to questions about their mental states and subjective well-being, both in surveys and as part of medical examinations. A number of studies indicate that an increasing number of adolescents report symptoms of depression and anxiety (including anxiety about school work) and higher rates of teenagers reporting psychological complaints, including sleep disorders, low mood, etc. (Choi, 2018[134]; Hewlett, 2020[144]; OECD, 2017[145]). In the transition to adulthood (up to 30 years of age), mental health conditions such as psychosis, bipolar disorder, eating disorders, and substance abuse disorders become more prevalent, while disruptive behaviour orders, social anxiety disorder, and generalised anxiety disorder become less common (Costello, Copeland and Angold, 2011[146]). These difficulties can spell severe consequences for youth engagement in education and employment, and social outcomes.
Mental health conditions
A well-known distinction made in the field of child psychology and psychiatry is between “externalising” and “internalising” disorders. Though this dichotomy is far from perfect, it does provides a good framing for discussing children’s mental health difficulties and the respective implications for different age-groups. The two concepts are closely linked to how effectively a child self-regulates their emotions i.e. express and manage emotions and behaviours in an adaptive and healthy manner. As explained earlier, a child’s ability to self-regulate is very much informed by their sense of safety and security in their environment.
When children have difficulty coping with negative emotions or stressful situations, they may sometimes lock their feelings inside (i.e. internalising behaviour). For example, a child may respond to being bullied by a peer by using self-blame or withdrawing from social activities and peer relationships. As internalising behaviours are not outward and do not cause the same level of disruption in the classroom or at home as externalising behaviours would, they are sometimes not visible to others. Internalising of difficult emotions gives rise to negative psychological states such as depressed behaviours, extreme withdrawal, low mood, anxiety, irritability as well as feelings of inferiority, self-consciousness, shyness, or hypersensitivity or subjective health complaints. Broadly speaking, internalising disorders are categorised as either taking the form of a depressive disorder (e.g. major depressive disorder) or an anxiety disorder (e.g. generalised anxiety disorder and social anxiety disorder), but the distinction in young children is not very clear cut. These disorders can also co-occur. Overall, the understanding of internalising disorders in early childhood has lagged behind advances in the assessment of externalising disorders (Tandon, Cardeli and Luby, 2009[147]).
Internalising disorders are more difficult to detect in the very young as they have less developed verbal skills and a more limited capacity to describe how they are feeling inside. Among this age group, internalising disorders can take the form of quiet, internal distress, meaning that there is a tendency for parents, teachers, and other caregivers to view these type of states as less problematic and therefore less of a priority for seeking help over. However, advances in research methodologies have facilitated the ability to screen better how young children may be feeling inside and to identify early symptoms of depression, anxiety and other forms of negative emotional states (Schoon, 2015[27]; Jamnik and DiLalla, 2019[148]). For instance, Wichstrøm et al. (2012[149]) found that in the city of Trondheim in Norway during the regular community health check‐ups for four‐year‐olds, symptoms of anxiety were detected in nearly 9% and symptoms of depression in 2% of children. However, much work remains yet to be done to come up with some kind of gold standard measurement of internalising disorders in young children.
Children’s feelings can take the form of negative behaviours directed outwards at other people or at things in their environment (i.e. externalising behaviours). Externalising behaviours includes strong disobedience of rules, hyperactivity, being disruptive or aggressive, and using threatening behaviours, and using threatening behaviours, with common examples of externalising disorders in children including conduct disorder (CD) and oppositional defiant disorder (ODD) (Huberty, 2004[150]). For school-age children, repeated involvement in physical scuffles or bullying classmates are common measures of externalising disorders.
Eating disorders
Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and related syndromes. Eating disorders are on the rise in many countries, including high-income countries (Schmidt et al., 2016[151]; Treasure, Duarte and Schmidt, 2020[152]; Galmiche et al., 2019[153]). While much of the scientific literature on eating disorders has focused largely on prevalence and treatment among young women, increasing attention is now also being paid to the ways in which eating disorders occur among young men (Limbers, Cohen and Gray, 2018[154]). In addition to the psychological and social implications of eating disorders, there can be strong physical implications too. Eating disorders are also difficult to treat, and many sufferers go without help, or do not recover or only partially so. Mortality rates among people with eating disorders are almost twice as high as in the general population, and nearly six times higher for people with anorexia nervosa. To put into context, the mortality risk from anorexia nervosa in individuals aged 15-24 years is higher than for any other serious disease, such as asthma or type 1 diabetes (Schmidt et al., 2016[151]; Zipfel et al., 2015[155]).
Self-harm and suicide
Self‐harm is another expression of mental distress. Self-harm is often hidden, and frequently under-reported (Madge et al., 2011[156]; Borschmann et al., 2017[157]; Muehlenkamp et al., 2012[158]). One study from the United Kingdom, for example, matched survey-based self-report self-harm data to medical records, finding that approximately 20% of self-harm hospital admissions were not disclosed by survey respondents (Mars et al., 2016[159]). Nonetheless, evidence from both hospital presentations and survey data suggest that the frequency of self-harm may be increasing among adolescents, especially girls (McManus et al., 2019[160]). Self-harm takes on different degrees of severity, with a history of more severe self-harming associated with greater rates of depression, anxiety and impulsivity and lower self-esteem. Self-harm is more prevalent among adolescents with experiences of traumatic life events, and those who have problems with schoolwork and/or peers, or struggles with their individual or sexual identity (Madge et al., 2011[156]).
Experiencing heightened mental distress can lead children and adolescents to make an attempt to end their own lives. Suicide is the third leading cause of death among adolescents worldwide (WHO, 2014[161]). Between 2000 and 2015, the average number of deaths by suicide recorded amongst young people aged 15 to 25 years old in the OECD fell by 31%, but rose by 10% or more in a small number of countries (Australia, Luxembourg, Mexico, Netherlands, New Zealand, Sweden, and the United States). Comparing suicide statistics across countries is not straightforward. There are differences between countries in how the cause of death by suicide is determined. Moreover, the varying levels of stigma attached to suicide may influence the rates of suicides that are officially recorded (OECD, 2020[162]). Caution is therefore required in interpreting variations across countries.
Similar to the adult population, death by suicide amongst children and young people is correlated with access to a lethal means, poor mental health, and a history of prior suicide attempts. The latter two findings point to the need for overall strengthening of access and the provision of mental health services and to school-based interventions as a meaningful means of reducing incidences of attempted suicide, and suicidal ideations and behaviours (Hewlett, 2020[144]).
Substance abuse
The occasional use of alcohol and drugs is not necessarily harmful for mental health and may not be indicative of a young person having a need for help. A young person’s use of alcohol and drugs is considered as substance abuse when an ongoing pattern of usage develops that generates negative consequences for individuals and for those around them. Young people have a substance dependence problem when they develop psychological and physiological dependency on alcohol and/or drugs. This is a more serious issue than substance abuse as it implies addictive and dependent patterns of use and often the consequences for individuals are much greater (Cannon et al., 2013[163]). The younger the age of initiation, the higher the risk of adverse consequences for physical and mental health and for lifelong substance use disorders (Belcher and Shinitzky, 1998[164]). In particular, early drug use (i.e. before 14 years of age) is associated with the highest risk (Jordan and Andersen, 2017[165]).
Risk taking during the teenage years can be seen as part and parcel of growing up but it leaves young people at risk of developing a vulnerability to alcohol and drugs abuse, even if relatively few go onto develop substance use disorders. In many OECD countries, the use of traditionally common drugs such as nicotine and alcohol by adolescents has declined steadily in recent years. For example, according to data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) – a Europe-wide survey that includes 22 OECD countries – between 1995 and 2019, on average across 30 European countries, the share of 15-and 16‑year-old students reporting ever having used cigarettes fell from 68% to 42%, and the share reporting daily use of cigarettes halved, from 20% to 10%. Over the same period, the share of 15-and 16‑year-olds reporting ever having used alcohol fell from 88% to 80%, although the share reporting “heavy episodic drinking” (binge drinking) has remained relatively stable (ESPAD Group, 2020[166]). Lifetime use of cannabis is less common than cigarettes and alcohol (16% in 2019), and has declined slightly in recent years since peaking at 18% in 2011 (ESPAD Group, 2020[166]).
One issue that has received increasing attention in recent years is harmful substances that adolescents can access in their homes. These substances include inhalants (e.g. glues), and prescription pharmaceuticals such as painkillers, tranquillisers, sedatives and anabolic steroids taken for non-medical use. In the 2019 wave of the ESPAD survey, on average across 30 European countries, about 7% of 15-and 16‑year-olds reported ever having used tranquillisers or sedatives without a prescription – down very slightly on 1995 (7.4%) (ESPAD Group, 2020[166]). 8% reported ever having used inhalants – a slight increase on 1995 (7.4%), but down from a peak of 10% in 2011. New psychoactive substances (sometimes called “legal highs”) such as synthetic cannabinoids are a more recent development. In 2019, about 3% of 15-and 16‑year-olds reported ever having tried at least one new psychoactive substances (ESPAD Group, 2020[166]).
Substance use during adolescence is problematic given the significant changes occurring to the body and brain, not to mention to the environment and in socialisation. It is associated with alterations in brain structure and functioning, and in neuro-cognition (Squeglia and Gray, 2016[167]; Squeglia, Jacobus and Tapert, 2009[168]). Adolescence is a unique period of neurodevelopment, where the brain undergoes substantial physiological changes. The evidence suggests that the impact of substance use on brain development differs by substance use pattern. For example, heavy drinking during adolescence, particularly heavy binge drinking, can lead to decreased performance on cognitive tasks and changes in the brain structures.
The co-occurrence of mental health difficulties and substance abuse is common. However, there is variance in the temporal sequencing i.e. which problem pre-dates the other. For example, among late-teens social anxiety disorders are found to be a precursor to alcohol abuse, while post-traumatic stress disorder are found to predict all types of substance use disorders. The use of substances to alleviate mental distress is thought to be a factor (Wolitzky-Taylor et al., 2012[169]). On the other hand, cannabis use is associated with an earlier mean age of the onset of psychotic illness such as schizophrenia and other psychotic disorders, perhaps because of an interaction between genetic and environmental factors or by disrupting brain development (Large et al., 2011[170]). There is mixed evidence on alcohol and drug abuse being a precursor for the development of anxiety and mood disorders (Barker and Kay-Lambkin, 2016[171]). Better understanding of comorbidity patterns and their temporal relationship would help improve timing and targeting of prevention and treatment.
5.3. Key influences on children’s social and emotional outcomes
Children’s social and emotional well-being is determined by a variety of different factors operating at the individual and environmental levels. Individual dimensions stem from cognitive, emotional, and physical capabilities or personal circumstances, such as having a serious health issue or a disability, or a neurodevelopmental disorder. Environmental factors include the family and home environment, especially the safety, security and stability of the family environment, to the school and care service environment, and to the neighbourhood and built environment. These "environmental" factors can be modified by public policies and are therefore important levers for promoting children's social and emotional well-being.
Serious health issues, developmental delays and disabilities
Children with chronic health conditions or disabilities can face a whole host of extra challenges when it comes enjoying good social and emotional well-being. For young children, chronic ill health can impact on school readiness. For example an Australia-based study found that having an early childhood chronic illness increases the risk of a child being classified delayed in social, emotional and language developmental domains by the time he or she starts school, even after controlling for socio-demographic characteristics (Bell et al., 2016[172]). Compared to healthy peers, children and adolescences suffering from a chronic illness experience, on average, higher levels of depressive symptoms. Of note, depressive symptoms were highest for highest in children reporting chronic fatigue syndrome, diseases characterised by chronic pain (fibromyalgia, migraine/tension-type headache), cleft lip and palate, and epilepsy diseases (Pinquart and Shen, 2011[173]). Moreover, children and adolescents living with chronic pain are found to have fewer friends, report more peer victimisation, and are viewed as more isolated and less likeable than healthy peers (Compas et al., 2012[174]).
Children with disabilities sometimes face specific difficulties in social communication and interactions and therefore require extra support in developing emotional and social skills (McCollow and Hoffman, 2019[175]). Typically children with disabilities participate in significantly fewer social and recreational activities and report not having fewer friends (Solish, Perry and Minnes, 2010[176]; Hunt, 2019[177]; Bult et al., 2011[178]).
Neurodevelopmental disorders
Neurodevelopmental disorders, for example, Autism Spectrum disorders (ASD) and Attention Deficit and Hyperactivity Disorders (ADHD), are the result of impairments in the growth and development of the brain and/or central nervous system. These impairments typically appear during childhood and directly impact a child’s ability to learn or to understand the social world (Carpenter Rich et al., 2009[179]; Şahin et al., 2018[180]). Given the close connection between neurodevelopmental disorders and social and emotional well-being, greater awareness, and better methods for making an early clinical diagnosis are fundamental. This would also include providing better early intervention to neurodiverse children (Cosci and Fava, 2013[181]).
Neurodevelopmental disorders appear to becoming more prevalent The few national data available for a small number of countries suggest that the prevalence of ADHD diagnoses is on the rise (Hinshaw et al., 2011[182]; Visser et al., 2014[183]; Danielson et al., 2018[184]), and the same seems to be also the case for Autism Spectrum Disorders (Van Naarden Braun et al., 2015[185]). However, part of the reported increases in ADHD and ASD prevalence may reflect the increased attention and improved methods to diagnose and provide support for children.
Improvements in the diagnosis of neurodevelopmental disorders among young children may help alleviate the obstacles these disorders present for children’s development if it is accompanied by appropriate support (Daley and Birchwood, 2010[186]; Vivanti et al., 2017[187]). Therefore, tracking neurodevelopmental disorders with sound data from the early years of life appear to be particularly useful to encourage early diagnosis and make visible the need to offer appropriate support to children to manage these differences (Ewald et al., 2018[188]).
Family and home environment
The vulnerability of some families to big stressors such as financial hardship, intra-familial conflict, or social exclusion can have an adverse impact on children’s social and emotional well-being (Golombok and Tasker, 2015[189]). These stressors influence children’s social-emotional development through their effect on parenting behaviours, parental mental well-being, and parents’ couple relationships (Labella and Masten, 2018[190]; Golombok and Tasker, 2015[189]). Higher conflict and discord in the family is associated with behavioural problems and child maladjustment, while an increase in supportiveness between parents is associated with a reduction in behavioural problems (Goldberg and Carlson, 2014[191]).
It is not uncommon for children to have lived through a parental separation and the disruption it causes. In the OECD, on average 1 in 6 children live in a single-parent family while 1 in 10 in a step-family (i.e. with a step-parent and potentially step-siblings) (Miho and Thévenon, 2020[192]). Parental separation contributes to socio-economic disadvantage, increased parental distress, and child exposure to parental conflict. Often parental separation is preceded by conflict, and in families where the intensity of conflict is high across the different stages of the separation, there is a stronger negative effect on child behavioural difficulties. In part, this reflects the cumulative effect of parental conflict on children (Xerxa et al., 2020[193]; Golombok and Tasker, 2015[189]).
The type of child custody arrangements agreed upon by parents after they go their separate ways can be a source of ongoing tension. Joint parental custody arrangements are becoming more common place. They can benefit children in terms of being able to maintain close relationships with both parents. Though the evidence is scarce, children in joint custody arrangements may experience lower stress and have higher self-esteem compared to children subject of sole custody arrangements (Steinbach, 2019[194]). This may partly reflect that shared custody allows contact with both parents to be maintained within with a predictable regularity. However, rather than reflecting a causal effect, this may be due to the fact that shared custody arrangements are more likely to occur when parents' relationships are not highly conflictual.
The social-emotional climate in the home as expressed through parenting practices is critical to children’s social-emotional development. Broadly, parenting that is based fundamentally on dismissive, overbearing and punitive practices appear to be associated with low degree of child happiness and feeling of being supported. Perceived parental rejection by the child is associated with declines in pro-social behaviour and school performance, and with increases in internalizing and externalizing disorders (Putnick et al., 2015[195]). Corporal punishments are recognised as a denial of children's fundamental rights, and for this reason prohibited by United Nations Convention on the Rights of the Child. By contrast, parenting that is based on warmth, acceptance, and where children can exercise a say in the decision affecting them has a positive effect on children’s social-emotional adjustment and well-being: they are more likely to feel listened to and supported by their family (Rodrigo, Byrne and Rodríguez, 2014[196]; Ulferts, 2020[197]; NIPH, 2019[198]). Acceptance involves parents and caregivers treating children with warmth and being responsive to their needs. (MacDonald, 1992[199]). This, however, does not mean that child does what he or she wants to do. Instead, children thrive on having a routine and knowing what rules to follow and where the boundaries lie. Routine and predictability promote good behaviour in children and provide a sense of stability and security in their environment (Bornstein and Putnick, 2018[200]). On the contrary, the absence of discipline and rules may be neglectful or seen by the child as a lack of parental interest in their well-being (Lansford, 2019[201]).
As children grow older, they desire to become more autonomous, yet nonetheless the need to feel well supported and guided by parents remains as they manage a heavy schedule of school work and examinations and considering decisions about their future. The degree of pressure parents place children under to succeed along the lines of a particular path in life and the level of control they exert have consequences. If excessive, it is associated with higher levels of anxiety, lower school engagement, externalising behaviours, and overweight (Ulferts, 2020[197]).
School and ECEC environment
For many children across the OECD, early childhood education and care (ECEC) can be their first experience of interacting with other adults and children on a regular basis away from the family setting. These interactions provide children with important opportunities to develop social skills, emotional skills and to foster resilience. For example, participation in (high-quality) ECEC can help promote children’s self-regulation skills. One mechanism for this comes through intimate caregiving tasks such as feeding and soothing: these tasks provide staff with opportunities to engage in sensitive and responsive caregiving, which is critical for children’s development of adaptive self-regulation (Mortensen and Barnett, 2015[56]).
However, the quality of ECEC matters. Important here is both the “structural” quality of ECEC (for example, child-staff ratios, staff pre-service qualifications, and staff participation in in-service training) and what is known as “process quality”, that is, the quality of the processes and interactions that affect children’s everyday experiences in ECEC (OECD, 2018[202]). The latter includes factors such as the sensitivity of teachers to children's emotions and behaviours, as well as individual needs, collaboration between staff members, and collaboration between staff and parents (OECD, 2015[203]).
Schools and the school environment can directly affect the social and emotional well-being of school-age children. In addition to the overall role schools play in supporting students (OECD, 2019[204]; OECD, 2020[205]), including through programmes and interventions (see later in this section), the school environment can impact on social and emotional well-being through its effects on children’s interactions and relationships. One specific example is classroom climate (e.g. classroom disciplinary climate). Classroom climate can impact the perceived quality of peer relationships, and also affects teachers' abilities to provide individualised support to each student (Collie, Shapka and Perry, 2012[206]; Rucinski, Brown and Downer, 2018[207]). Perceived support from teachers appears to be positively valued by students and is associated with better social-emotional well-being outcomes of primary school age children and adolescents (Tennant et al., 2015[208]; Danielsen et al., 2009[209]). Among children with behavioural problems, close relationships with teachers are associated with improved academic and social-emotional functioning, while for children with either externalising and internalising problems, relationships with teachers that are conflictual in nature are associated with exacerbated negative outcomes (Sabol and Pianta, 2012[210]; Curby, Brock and Hamre, 2013[211]). For older children, feeling respected at school and supported by teachers are key to their well-being at school as well as to their life satisfaction in general (OECD, 2017[145]; Rees, 2017[16]).
A related issue for many children is the institutions in which they spend time outside of (pre-) school hours. As touched on in Chapter 3, in some OECD countries, it is common for children to attend out-of-school-hours (OSH) services before and/or after (pre-) school, and also during school holidays (OECD, 2019[212]). Often provided on school premises, OSH services typically offer a mixture of schoolwork-focused activities (e.g. homework help) and extra-curricular activities, such as sports training and arts education – themselves important for children’s well-being (Box 5.4) – depending on child age. These kinds of OSH services can help promote well-being in several ways. One report from the U.S., for example, highlights a range of benefits from OSH service participation, especially for children from low-income families, including better learning motivation and cognitive outcomes, as well as potentially improved social, emotional and behavioural outcomes (Bartko et al., 2020[213]). However, in many countries, the (structural) quality and quality standards of OSH services can differ sharply (Plantenga and Remery, 2017[214]).
Neighbourhood and the built environment
Neighbourhood quality matters for children's social-emotional well-being at all stages of childhood. For children who have not yet started school, there is evidence that growing up in a safe neighbourhood, with strong social ties, and high quality childcare institutions, green spaces and playgrounds at a walkable distance have a positive effect on language, emotional, and behavioural outcomes (Minh et al., 2017[215]; Christian et al., 2015[216]). Neighbourhood quality tends to be an even more crucial determinant of older children’s social-emotional well-being, as this age group spend a larger amount of their time outside the family home and are nearing the transition from compulsory education. Adolescents growing up in a disadvantaged neighbourhood (i.e. a neighbourhood with high levels of poverty, crime rates and a lack of recreational facilities) are also more likely to exhibit mental health problems, commit delinquency, have unprotected sex, and use drugs (Choi, 2018[134]; Leventhal, Dupéré and Brooks-Gunn, 2009[217]). Adolescent often secure their first job in the local community, meaning that the opportunities in the local labour market are fundamental for helping acquire early work experience (Deutscher, 2018[218]).
Perceived neighbourhood security is a very important dimension of neighbourhood quality. A neighbourhood environment that is characterised by a high crime rates and where delinquency or violence are problems erodes a child’s sense of predictability and trust in the environment, increasing the risk of child misconduct problems (Leventhal and Brooks-Gunn, 2000[219]). By contrast, a neighbourhood where children and families feel safe and where three are good physical facilities provides children with invaluable opportunities to develop relationships with people outside of the family extra-familial and to pursue social activities and personal interests (McKendrick, 2014[220]). A growing body of research argues that neighbourhoods have a causal effect on child and later adult outcomes, distinct from family factors (Chetty and Hendren, 2018[221]; Chetty, Hendren and Katz, 2016[222]; Deutscher, 2018[218]; OECD, 2019[223]).
The built environment is another important aspect of neighbourhood quality for children’s social-emotional well-being. In designing neighbourhoods, both the needs of children and factors that hinder or promote child well-being should be kept mind. Built environment features such as walk/bicycle paths, recreational facilities, low street traffic are positively associated with children’s levels of physical activity and social-emotional competence (Binns et al., 2009[224]; Pellegrini, 2009[225]; Ferguson et al., 2013[226]). So too is children’s access to “green space”, such as parks, gardens and playing fields. One review of the evidence finds that children’s green space access is positively associated with a range of mental and socio-emotional outcomes – including self-discipline, stress moderation, and symptoms of disorders like attention deficit hyperactivity disorder (ADHD) – as well as indicators of physical health and cognitive development (McCormick, 2017[227]).
Reports on children’s views on the impact of neighbourhood quality on child well-being affirm what is found in the research. When asked about the dimensions of the neighbourhood environment that matter most, children identify having places where they can meet up with friends safely, and open green spaces and play areas. Among the factors listed by children as compromising their well-being are high levels of unsafety and insecurity – due for instance to violence in the neighbourhood – dense car traffic and unsafe outdoor equipment), pollution and lack of green space, and poor sanitation (Christensen and O’Brien, 2003[228]; Bartlett, 2002[229]; Nordström, 2010[230]; Ergler, Kearns and Witten, 2017[231]). However, as one report from the United Kingdom notes, children’s thoughts, views and needs are not always well integrated into planning policies and decision-making mechanisms (Wood, Bornat and Bicquelet-Lock, 2019[232]).
Public policies
Policies supporting families with children, care service and school policies, and policies and regulations impacting neighbourhood quality provide a set of resources that ultimately can affect children’s social-emotional outcomes.
Interventions during pregnancy and infancy can be effective ways to support children’ development in all its aspects, including social-emotional development. Supporting maternal mental health can be effective in reducing the mother’s risk of developing perinatal depression, and in turn increases the chances of developing a bonding relationship with their new-born. A Cochrane review found that women who received any psychological or psychosocial intervention had a 22% reduction in their risk of developing perinatal depression compared with those who received standard care (Dennis and Dowswell, 2013[233]). Subgroup analysis found that the most effective types of intervention for the perinatal and postpartum period were intensive, individualised postpartum home visits, lay (peer)-based telephone support, and interpersonal psychotherapy. Home visit programmes following the birth of a child are also particularly effective to reach families who would otherwise lack the information or social capital to use the services to which they are entitled. Home visits provide information, resources, and support to expecting parents and families with young children, typically infants and toddlers, in their home (Michalopoulos et al., 2017[234]; Duggan et al., 2018[235]).
Parental leave policies are another way of providing opportunities for parents to spend time bonding with and caring for their children, while giving economic assurance. Parental leave is also associated with better mental health outcomes for mothers (Van Niel et al., 2020[236]; Galtry and Callister, 2005[237]). However, the evidence for the impact of leave on child outcomes is mixed. Some evidence suggests that parental leave is associated with higher quality mother-child interactions and the forming of a secure attachment. Positive impacts on early child health and nutrition have also been found (Plotka and Busch-Rossnagel, 2018[238]; Clark et al., 1997[239]). There is also evidence to suggest that greater paternal involvement in caregiving – which may be facilitated by parental leaves targeted at fathers – is associated with better child cognitive development (Huerta et al., 2013[240]). However, others studies suggests little or no impact of leave on child developmental outcomes, including cognitive development and academic achievement (Huebener, Kuehnle and Spiess, 2018[241]; Baker and Milligan, 2008[242]).
Policies aimed at fostering the quality of early childhood education and care can also help promote young children’s social-emotional development. As discussed above, there is extensive evidence that high-quality staff‑child interactions can impact children’s behavioural outcomes, for instance, and that children’s skills can develop more effectively when staff engage in quality developmental activities with children (OECD, 2018[202]). There are a range of policy factors associated with quality in ECEC. These include minimum standards regulations (e.g. staff-child ratios, group sizes), minimum qualification requirements, staff in-service training and professional development, and aspects of staff working conditions, such as staff salaries and well-being (OECD, 2018[202]).
School-based interventions can improve child well-being (OECD, 2019[204]; OECD, 2020[205]). A range of interventions delivered in school are found to have beneficial effects on children’s mental health, social, emotional and educational outcomes (Weare and Nind, 2011[243]; Durlak et al., 2011[244]). In addition to longer term benefits associated with better mental health, there may be more immediate impacts including better school attachment (or the sense of belonging that children have about the school that they attend), as well as having less risky behaviours. The characteristics of more effective school interventions include teaching skills, focusing on positive mental health, starting early with the youngest children and continuing with older ones; operating for a lengthy period of time, embedding this work within the school curriculum and better liaison with parents.
More generally, family support services can be helpful at preventing and addressing problems in children's social-emotional development (Riding et al., 2021[245]). Mental health supports can be tailored for families through counselling, psychiatric assessments and medication support as well as health interventions such as assessments, prescriptions, and referrals to specialists. Services may also aim to support family functioning by providing family counselling services, access to specialised social services agencies, respite services (short term family support with care for children during times of family crisis), in-home supports (individualized planning and service coordination provided within the family home) or additional assistance, services and resources for families coping with chronic stress.
5.4. Overview of data availability
In recent years, the development of data on children's social and emotional well-being and mental health has earnt a growing amount of attention. Different types of data have been developed but they do not cover all stages of childhood with the same level of depth.
To date, there exists no large-scale cross-national datasets to provide comparable information on the social and emotional well-being of children under school-going age (current initiatives to fill this gap are discussed in the next section). Middle childhood and adolescence are better covered by the available international data, particularly adolescence. Closing these data gaps is important to ensure that policy responses to the problems affecting younger children are adequately tailored to age and need. Given the awareness of the need to intervene early, before problems emerge or have the time to become more complex, data on younger children would aid the development of more effective preventative policies. Table 5.2 summarizes the data available for the different age groups, while a more detailed inventory is provided in Annex 5.B.
The main source of data available on middle childhood are from the Children’s Worlds surveys, which covers the subjective well-being of children aged 8, 10 and 12 years. On average, data are collected on children living in 40 countries, including about 20 OECD countries (which provides a fair geographical coverage compared to country coverage of surveys for adolescents). An important strength of these data is that they provide information on children’s satisfaction and emotional affects with regards to different life domains, including family life, school life, peer relationships, the neighbourhood and child’s personal possessions. They also provides information on the quality of interpersonal communication, support and time spent with parents, friends, teachers and adults in general, as well as basic information on identity and self-esteem. The surveys do not provide any information on children's attitudes towards schoolwork, or their self-confidence and self-awareness, or how opened-minded they are; these dimensions are fairly well covered in surveys for adolescents. Furthermore, children are not asked about their use of the internet and digital tools, and of any associated positive or negative experiences. This is in spite of middle childhood often being the time when children first start using digital technologies (see next section).
Table 5.2. Overview of available data sources
Note: The Children’s Worlds surveys include: Belgium, Chile, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Ireland, Italy, Norway, Poland, Portugal, Spain, Switzerland, South Korea, Turkey, the United Kingdom and the United States. “Disaggregation” means that the publicly available data allows for disaggregation by at least basic socio-economic and demographic groups, such as by sex, age, family status, and family income.
Thanks to two major surveys conducted in a large number of OECD countries, the data available for adolescents cover a wider range of social-emotional dimensions. The Health Behaviours of School-aged Children data cover adolescents aged 11, 13 and 15 years living in Canada and European OECD countries. It uses the same harmonised questionnaire for all participating countries, which is advantageous for comparability. The OECD Programme for International Student Assessment (PISA) surveys provide data on 15-year-olds students. PISA first began in the early 2000s and over time its content has gradually expanded to include a growing number of items to capture students’ social and emotional well-being. Taken together, these two surveys include information on a broad spectrum of mental health and social-emotional outcomes. Moreover, the access to individual data make it possible to disaggregate information according to a range of socio-demographic characteristics, within the limits of constraints imposed by sample sizes.
The data collated through these two surveys provide information on mental health outcomes, including subjective health complaints (including physical complaints), substance use and conduct disorders (understood as involvement in physical fight, bullying or cyberbullying perpetration or victimisation). The PISA surveys also gather information on conscientiousness towards schoolwork, ability to deal with stressful situations, self-confidence, sense of belonging, and beliefs towards the value attached to efforts (with the distinction between students with “growth” versus a “fixed” mind-set). For the 2018 wave, PISA added questions on the global skills needed by adolescents to solve problems and cooperate with others, as well as on pro-social intercultural knowledge, attitudes and skills and attitudes towards change (OECD, 2019[246]).
A few other data sources in addition to PISA and HBSC provide some information on adolescents' participation in domestic chores and volunteer work, but their scope is restricted to adolescents aged 15 years and older. More generally, there is a lack of data on children's participation in sport, leisure, social and cultural activities, in and outside of school. Similarly, there is no systematic collection of data on children's perceptions of their physical environment, including aspects of safety, and the appropriateness of local facilities and amenities for children to partake in leisure and social activities, and to meet up with friends. There is also a lack of cross-national data on adolescents' sense of belonging outside of school and their personal, social and cultural identities more generally.
Last but not least, both PISA and HBSC collect data on the use of the internet and social media by adolescents, but as will be discussed in the following section, the information collected does not sufficiently capture nor pre-empt all of the potential risks to children's social and emotional well-being.
The Global Burden of Disease study by the IHME provide a comprehensive worldwide observational epidemiological dataset, which includes population-level estimates on mental health and neurodevelopmental disorders experienced by children, from birth all the way up to becoming young adults. These data are made available by age group, which allows for instance information on pre-school children to be separated from that on older children. Though the data can be disaggregated by gender, the same cannot be done for other socio-demographic characteristics. As already mentioned in the Chapter 4, these data collections are not without problems; lack of transparency is an issue as the documentation for the estimates contain a few discrepancies to those found in national official statistics (Shiffman and Shawar, 2020[247]; Mahajan, 2019[248]). A stronger commitment by national statistical offices to produce these data could lead to a greater consensus on data validity. Alternatively, though, greater obligations for transparency with respects to the estimates published by the IHME could improve the quality of the data and their comparability, and provide the confidence on the data critical to policy making.
Important steps on gathering data on the most vulnerable groups of children that would cover all stages of childhood remain outstanding. It is first desirable to have data that make visible those groups of children whose social or family circumstances put their social and emotional well-being particularly at risk. The big issue of the rise of children’s usage of digital tools, starting in early childhood, also requires better assessment, as well as of the associated opportunities and risks.
5.5. The way forward
Designing and steering policies to support children's social and emotional well-being is of crucial importance and requires sound data to monitor trends in mental well-being and map of the risks affecting children who are particularly vulnerable for whatever reason. Tracking trends in child mental health and their wider social and emotional well-being is invaluable for the planning of investments in services to address present and future needs, and in determining whether these efforts are successful or not. Good data are also required on risk factors and the new challenges that put certain groups of children in very vulnerable situations and that are driving the observed rise in mental health inequalities. Understanding which groups of children are the most affected is critical to raise children’s social-emotional well-being at the population level (Collishaw and Sellers, 2020[249]).
It is of fundamental importance for policy makers to ascertain whether children’s outcomes are changing, especially for those who suffer from poor mental health and/or social-emotional problems. Policy monitoring in this area requires good quality data on the levers and resources that countries have at their disposal to support the social-emotional development of all groups of children, to promote good mental health, and to provide assistance to children experiencing psychological or emotional disorders.
Improve the tracking of vulnerable children
The evidence presented in this chapter illustrates the many ways in which children's social and emotional well-being is put at risk due to different individual, family or social circumstances. The key risk factors for social and emotional well-being are largely the same as those for physical health.
There is a dearth of comparable data on the vulnerable groups of children (e.g. children in out-of-home care), the prevalence of child maltreatment (see Chapter 3), and the effects of experiencing adversity on well-being outcomes. One of the main reasons behind this lack of data is often these groups of vulnerable children are not living in stable "private" housing, or are living in institutions, or have disabilities, and therefore are not covered by general standard household surveys. These children remain invisible in official statistics when special surveys are not carried out. Given the higher likelihood of poor outcomes, data on vulnerable children is crucial to improve policy design and monitoring.
Addressing the data gaps for these groups of vulnerable children is critical to ensure that they are visible and receive the political attention needed to develop better policies to address their particular needs. To this end, the Conference of European Statisticians has set up a Task Force mandated to review data gaps, sources, standards and definition and collection mechanisms used in UNECE countries and to develop a set of recommendations for a harmonized improvement of the availability of data in these areas.
Bridge data gaps for preschool-age children and children in middle childhood
Developing policies to enhance children's well-being requires reliable indicators of social-emotional outcomes that have the potential of being positively influenced during childhood. However, as the data availability section highlights, there is a real lack of comparative data for preschool-age and primary school-age children. Filling these data gaps is challenging, not least because collecting cross-national comparable data will require the building of a broad consensus on which dimensions of social and emotional well-being should be assessed at particular age, along with how these should be measured. This has yet to be reached.
The scientific literature on the influence of the first few years of life on well-being outcomes across the life course has raised awareness in many countries of the need to collect data on children from birth (and even from the point of a child’s conception). Several countries have started the process of collecting data on young children, and have done so via experimental surveys or longitudinal surveys that follow a sample of children throughout childhood from birth at a local or national level. However, such surveys are costly and few countries have the opportunity to repeat them at regular intervals to measure progress and changes in the risk factors and challenges (Reiska et al., 2019[250]).
To address the lack of comparable data, several strategies are currently being pursued. At the European level, a few research networks aim to disseminate harmonised child cohort data or to promote the adoption of common data collection methodologies. Another strategy targets the development of international surveys at well-defined ages of children. This has the advantage of reducing the scope of the survey, which can reduce costs and encourage the repetition of surveys at regular time intervals. This is, for example, the approach of the OECD-led surveys with the PISA surveys focusing on 15-year-olds, the Early Learning and Child Well-Being Study for the 5-year-olds carried out in three countries (OECD, 2020[22]), and the Study on Social and Emotional Skills targeted at 10-year-olds and 15-year-olds (Box 5.3). In Europe, the birth cohort survey GUIDE (Growing Up In Digital Europe: EuroCohort (2020[251])) also aims at providing longitudinal statistical evidence on very young and school-age children for years to come.
A particularly pressing challenge for early childhood data development comes from the fact that care and education practices and policies are not only very diverse across countries but also within countries, making it not always possible to define standards and measurement procedures that can be used homogeneously within and across countries (Diaz-Diaz, Semenec and Moss, 2019[252]; Moss and Urban, 2020[253]; Nóvoa, 2018[254]).
For middle-childhood, the data challenges are fairly comparable, despite one example of a comparable cross-sectional survey infrastructure on child well-being already existing in the form of the Children's Worlds Surveys. As discussed in data availability section, these surveys provide information mainly on children's affects, satisfaction with various life areas, and on interpersonal relationships. Many important aspects of this age-group’s social and emotional well-being are not covered such as for instance children’s experience with the digital world, and social-emotional skills important for school-work. By contrast, these areas are one of the main focuses of PISA data on adolescents’ well-being. The different focus of child surveys is an advantage because it sheds light on different facets of child well-being; its limitation is that some dimensions of social and emotional well-being are measured at one age and not at another, which implies that one may miss when in childhood certain problems may emerge.
The OECD's Study on Social and Emotional Skills is an important endeavour encouraging countries to fill in this data gap. This survey, in its first phase, covers 10 and 15-year-old children in 10 municipalities around the world, and aims primarily to demonstrate that valid, reliable, comparable information on social and emotional skills of children in middle childhood can be collected across diverse populations and settings. This survey will progress the building of a common understanding of issues, which is needed before countries commit to large-scale data collection on social and emotional well-being in middle childhood.
Box 5.3. Ongoing OECD studies on Early learning and Social and Emotional Skills
The International Early Learning and Child Well-being Study (IELS) is a survey that assesses five-year-old children, to enable countries to benchmark, compare and monitor children’s early learning outcomes over time. The survey has a balanced focus across children’s cognitive skills, self-regulation, and social-emotional skills such as trust, empathy and pro-social behaviours. The study also collects information from children on what they enjoy and what they want to do or be when they grow up. In addition, it looks at the relationship between children’s early development, their home learning environment, childcare settings and parental background. A total of about 7 000 five-year-olds in England, Estonia and the United States were surveyed in 2018. The first results show that children from low socio-economic backgrounds were more likely to be reported as having learning or behavioural difficulties, especially boys. However, children from low socio-economic backgrounds who had participated in ECEC, had children’s books at home, and whose parents read to them every day, achieved significantly higher outcomes (OECD, 2020[22]).
The OECD's Study on Social and Emotional Skills (SSES) aims to assist cities and countries to better support the development of social and emotional skills of their students. In order to assess these skills, the Study draws on a well-known framework in the field of social and emotional skills – the Big Five model. Out of the 19 skills that were assessed during the Study’s Field Trial in 2018, a broad and balanced set of 15 skills were chosen for the main study based on their policy relevance, validity and reliability. Two indices, a compound skill (self-efficacy) and achievement motivation, were also included, created from items that are used to evaluate other skills in the assessment. The first round of the survey covers students aged 10 and 15 years old in 10 cities: Ottawa (Canada), Houston (USA), Manizales (Colombia), Bogota (Colombia), Sintra (Portugal), Helsinki (Finland), Istanbul (Turkey), Moscow (Russia), Daegu (South Korea), and Suzhou (China). Three findings from this survey can be highlighted:
In general, social and emotional skills are more strongly related to school performance for 15-year-olds than 10-year-olds.
Intellectual curiosity and persistence in efforts are the skills most strongly related to higher school performance for both 10- and 15-year-olds.
Optimism is the skill that is most strongly related to both life satisfaction and current psychological well-being, followed by trust. Stress resistance and optimism are most strongly related to students’ test anxiety.
Improve the scope of data on adolescents
The PISA and HBSC surveys provide a much broader set of data on the social and emotional well-being of adolescents than for other age groups. Nevertheless, the environment in which adolescents live is changing rapidly, and one of the challenges is to collect data that reflect changes in risks, practices and behaviours. For example, the evidence reviewed earlier for European countries showed that the use of new psychoactive substances such as painkillers, tranquillizers, sedatives and anabolic steroids has emerged as a new form of substance abuse among adolescents that requires close monitoring beyond the patchy evidence pulled together so far.
Another limitation of the data on adolescent well-being is that there is very little information on the activities and the physical environments where adolescents spend their time outside of school and the home. There is a wealth of evidence confirming that extra-curricular activities – including sports, arts education or musical training – can play an important role in the development of a range of cognitive, emotional and social skills (Box 5.4). One option for collecting better data on this could be to extend and expand Time Use Surveys (TUSs) – a rich source of information on how people spend their time – to better cover children and adolescents. Currently, children are covered only inconsistently in national TUSs: while in some countries TUSs cover all household members from a young age (e.g. Italy from age 3 (Istat, 2018[255]) and the United Kingdom from age 8 (Gershuny and Sullivan, 2017[256])), in others, coverage often starts from age 15 or older. Even where children and adolescents are already covered, it may be beneficial to expand and revise time use data collections to better capture modern activities, such as the use of digital tools, as well as to better measure children and adolescents affective states (e.g. enjoyment, happiness, anxiety) when engaging in different activities.
The quality of the built neighbourhood environment is very important for facilitating the engagement of adolescents (and children too) in extra-curricular activities, such as accessible and well-equipped outdoor spaces, leisure or sport facilities, that are in the case of an urban context within walking or cycling distance and where children feel safe. Making cities and local areas child-friendly, therefore, is an important driver to promote children's well-being (UNICEF, 2004[257]; 2018[258]; Woolcock, Gleeson and Randolph, 2010[259]; Nam and Nam, 2018[260]). Data on how adolescents (and younger children) perceive their environment would be particularly useful to inform decisions at the local or national level to be taken in order to ensure that adolescents all get good opportunities to develop positive social contacts and activities that are key to their social-emotional well-being. This information is particularly useful for adolescents whose social life outside the family setting becomes more intense, but similar information for children in middle childhood would also be useful to ensure that their perspectives are taken into account at a time in their lives when extracurricular and/or outdoor activities start to develop.
The lack of information on children's satisfaction and perceptions of their family situation and practical family living arrangements is also a limitation of the existing data, given that about 1 in 6 children live in a single-parent family in the OECD, and 1 in 10 in a step family (Miho and Thévenon, 2020[192]). In countries such as Sweden and Norway, more than 1 in 6 teenage girls also live between the two homes of their separated parents. These situations may not necessarily lead to financial hardship, poverty, family conflict or stress, and it is important to look at these issues from a child perspective. Children raised by same-sex couples may also face discrimination or exclusion that needs to be measured in order to combat it (Golombok and Tasker, 2015[189]).
Last, although international surveys provide highly comparable data for a large number of countries, a few countries are not covered by the available data. To fill this gap, some countries may have national surveys that could be used to extract equivalent information. However, it is likely that differences in sampling, question wording, metrics and measurement scales may not cause major comparability issues. In such case, an alternative is that a few questions taken from PISA or HBSC surveys are added to national surveys and make sure that the sampling used in national and international surveys are consistent.
Box 5.4. Sport training and arts education: the benefits for children
Research on the effects of participation in sports and music lessons and training on children's development is relatively rare and recent, but the available evidence suggests that they both contribute and foster physical, emotional, and social skills. These are not just fun activities; they play a role in helping children develop fine motor skills, such as coordination and balance, and contribute to learning teamwork, discipline, and how to focus on achieving a goal (Bidzan-Bluma and Lipowska, 2018[261]). Children also benefit from the experience of merely taking part in something fun (Eime et al., 2013[262]).
The role played by sport in improving physical health is one obvious one, but there is also evidence showing that it increases self-esteem among adolescents, fosters mutual understanding and helps children to learn how to resolve conflict (UNICEF, 2019[263]). Engaging in sport is also found to improve children’s school performance and peer relations (Felfe, Lechner and Steinmayr, 2016[264]). Music training and other types of arts education are found to stimulate creative thinking; they teach children how to express their feelings and emotions and improve their language and reasoning skills (CBNCCAS, 2012[265]). There is also evidence to suggest that learning to play a musical instrument affects the brain networks that enable executive functioning, thereby enhancing cognitive abilities (Sachs et al., 2017[266]; Habibi et al., 2018[267]).
Organised sporting activities can foster positive outcomes in vulnerable children through developmentally appropriate tasks and positive child-adult relationships. There is evidence that participation in sport is a protective factor against delinquency. Moreover, research shows that opportunities to develop musical and artistic abilities benefit vulnerable children’s school performance and social-emotional skills (OECD, 2019[223]).
Collect data on children’s self and social identity, and social capital
Childhood is the period of life when, through their experiences, encounters and contacts with peers and adults, children build up an image of themselves and their connection to groups that contributes to the development of their personal, social and cultural identity. Scattered data exist on some dimensions of children's perceptions of their identity, but more systematic information in this area can help to understand the challenges that may exist for children to have a fulfilling personal and social life. Children's sense of self, perceived locus of control and, for adolescents, their perceived autonomy are among the important dimensions of personal identity that the literature show to be connected with children's sense of well-being.
Group identities also develop throughout childhood and over time children may feel some proximity, sense of belonging to and acceptance by various “social” groups. Children's perception of their gender identity, and their possible attachment to certain cultural traditions and values, are two dimensions that can impact on their contacts with people who belong or not to the same groups. A positive image of belonging to a social, ethnic or cultural group can be a resource in a period of life when children and adolescents are questioning the meaning of life and their place in the world. More negatively, group belongingness, perceived or real, can be associated with subjective feeling of discrimination or exclusion, undermining social cohesion.
Measuring the social capital of adolescents is also important to understand whether the erosion of social cohesion that is often highlighted in public opinions surveys has its roots in childhood. Specifically, understanding how social capital develops requires attention being paid to children and adolescents’ participation in group activities (e.g., participation in leisure, sport, cultural activities, as well as in volunteering activities), but also data being collected on their perception of the support they receive from family, peers, and community networks, the trust they have in the institutions that govern their life and on their knowledge and degree of concerns with regards to global and societal issues.
Improve the tracking of the risks and opportunities provided by the digital environment
Using digital technologies has become a major staple of everyday life, and for children it is no different. The current generation of children have been exposed to digital technology for their entire lives and are the most frequent users of emerging online and digital services. The digital environment has an influence on children’s social and emotional well-being, with the development of internet-connected devices, social networks and digital tools are changing the ways in which children learn, spend their leisure time and interact with peers. While digital technologies create new opportunities for children’s learning and social relationships, they also bring new challenges and risks (Burns and Gottschalk, 2019[268]; OECD, 2018[269]).
The age of children’s first use of digital devices is dropping, with many pre-schoolers now familiar with digital tools before they are even exposed to books (Hooft Graafland, 2018[270]). In 2015, 61% of 15-years old students across the OECD reported that they accessed the Internet for the first time when they were younger than 10 years of age, and 18% reported that they did so at or before the age of six. Recent data from the 2018 OECD Early learning and Child Well-Being Study on five-year-olds children in England (United Kingdom), Estonia and the United States, indicates even earlier use with the vast majority (83%) of preschool children using a digital device at least once a week and 42% doing so on a daily basis. Very little is still known about how early use of digital tools impacts children's development, with the results of this study suggesting that the relationship between regular use of electronic devices and children’s skills development is mixed. For example, a positive relationship between the frequency of device use and the mental flexibility skills of children was found in Estonia and the United States but this was not the case in England. There were also some positive associations between device use and emergent literacy in England and the United States, but not in Estonia (OECD, 2020[22]).
One concern around children’s use of digital tools is that it could potentially displace physical activity or other activities considered important for child development. Some evidence suggests that screen exposure during the first three years is linked to negative health outcomes, including increased Body Mass Index, decreased cognitive and language development and reduced academic success (Duch et al., 2013[271]). In light of these observations, the World Health Organization recommends that children under the age of five should not be exposed to sedentary screen time for more than one hour a day, recommending, if possible, a shorter duration supported by parental interactions (WHO, 2019[272]).
The number of children with access to the internet at home and to a range of digital devices has been steadily increasing in OECD countries; in 2015, the proportion of 15-year-olds with access to internet at home was 95% across the OECD on average (OECD, 2017[273]). On average across OECD countries, in 2015 about 7 in 10 students reported that they use the internet for at least two hours outside of school on a typical weekday (OECD, 2020[274]). Also, a typical 15-year-old student had been using the internet since the age of 10, spending an average 29 hours per week on the Internet. However, the international development of data on the digital environment of children has mainly concentrated on adolescents, and there is a lack of comparable data on the amount of time children spend before they reach adolescence, the type of use and their learning of the Internet and digital tools.
Evidence on the effect of internet use and digital devices on school-age children is still limited. What is available suggests that moderate use can bring benefits, whilst both too much use or no activity in the digital environment can have a negative impact on children’s mental well-being, including life satisfaction (Burns and Gottschalk, 2019[268]; Kardefelt-Winther, 2017[275]; Przybylski and Weinstein, 2017[276]; Inchley, 2016[277]; OECD, 2018[278]). A large-scale study of adolescents in England looked at moderate use of digital devices and suggested that the impact depended in part on whether it was a week-day or the weekend, with some digital activities better suited to week-days than others, for example switching between tasks on a computer versus playing a video game. Furthermore, whether digital activities actually interfered with other structured activities was relevant. Overall, moderate use was found not to present a material risk to social and emotional well-being, although high levels of engagement may have a measurable, albeit small, negative influence (Przybylski and Weinstein, 2017[276]).
PISA data points to a negative association between time spent on the internet and life satisfaction, with extreme internet users (more than 6 hours a day) showing lower life satisfaction than any other student, while moderate internet users (1-2 hours a day) had the highest life satisfaction (OECD, 2017[273]). In addition, both “extreme” and “high internet users” (i.e. more than 6 hours a week, and between 2 and 6 hours per week day respectively) are at greater risk of school disengagement school. One in four “extreme internet users” reported that they had arrived late for school in the two weeks prior to the PISA test – a share of 11 percentage points larger than the share of “moderate Internet users”. Moreover, the share of student expecting not to continue in education after secondary education was much higher among extreme internet users than in other groups.
The research shows an association between social media use and poor physical and mental health outcomes. For example, excessive social media use is associated with poorer sleeping patterns, and body image concerns and associated disordered eating among young women and men (with possibly the association strengthening over time) (OECD, 2018[278]). Moreover, recent research on the effects of social media on clinically diagnosed depressed children underlines that social media can exacerbate depressive symptoms, with girls being more adversely affected than boys (Rich, 2019[279]) (Royal College of Psychiatrists, 2020[280]). Yet, the evidence base is still emerging and therefore it remains quite problematic to establish clear causality. One issue is that those children who already suffer from anxiety or depression appear to be also more prone to digital overdependence (OECD, 2019[281]; Burns and Gottschalk, 2019[268])
Beyond measuring whether the intensity of Internet or social media use is problematic, it is important for policy makers to understand the different types of risks children can encounter online. Children face a variety of online risks, which are classified under the OECD revised Typology of Risk as content risks, conduct risks, contact risks and consumer risks (Box 5.5). The Typology also identifies risks that cut across these four risk categories, for instance privacy risks, and can have wide ranging effects on children’s lives. The different categories of risks requires countries to engage different sorts of protective measures, which is no mean feat given how rapidly the digital environment is evolving (OECD, 2020[282])
In order to help countries develop measures that adequately safeguard and protect children, more robust research is needed on the associated risks and opportunities, including the types of activities engaged in and of children’s experiences. This would help ascertain in a fuller sense the impact on children’s well-being. To this aim, PISA data provide information on the time spent by 15-years-old students on the Internet and it also gives some information on whether students use internet to play online games, participate in social networks, or online chat. The PISA survey also asks students whether they have been victims of cyberbullying. Data from the 2017/18 wave of the HBSC survey contained information on whether teenagers had any kind of negative experience with social media, encompassing cyberbullying and addiction like symptoms such as loss of control over one’s use of social media at the expense of other important life domains, including relationships with peers and parents, and hobbies (Van Den Eijnden, Lemmens and Valkenburg, 2016[283]). On average, about 7% of 11, 13 and 15 year-old adolescents classified as problematic social media users (but the rate can be as high as 16% of 15 year-old adolescents in Spain, for example).
Further development of data in this area is important to better identify the positive benefits associated with certain type of digital use, Children should be taught about the positives and negatives outcomes of using digital devices and empowered to build on their digital literacy skills. The development of data on the type of support received by children at home or at school is necessary to assess unmet needs in this area and to monitor the effectiveness of measures taken by countries to develop school-based learning in this area. To this aim, PISA 2018 asks students whether they have received any teaching at school on how to decide whether to trust information they read on the internet, how to detect phishing emails, or how well they understand the consequences of making personal information public on the internet. Though some children may not receive any teaching at school, their parents or other family members may be able to guide them well in this regard, but in some cases the opposite may be true. It seems desirable to collect information on children receiving guidance, either at school or at home, and on the quality of the guidance to children and parents.
Box 5.5. Children in the Digital Environment: Revised Typology of Risks
The OECD recently published a Revised Typology of Risks to provide an update to the 2011 Typology of Risks. The original Typology was adopted by Council and informed the 2012 OECD Recommendation on the Protection of Children Online. Such an update was regarded as necessary given the significant changes in nature of existing risks in the digital environment and the emergence of a number of new risks.
The Revised Typology of Risk contains four risk categories, which are: i) Content Risks; ii) Conduct Risks; iii) Contact Risks; and iv) Consumer Risks. Though the Revised Typology recognises some of the broad categories identified in 2011 (such as content and contact risks) as still relevant for today’s children, it highlights that the substantive acts underlying these risks have changed and evolved over time. In particular, pre-existing risks, such as cyberbullying or exposure to harmful content have changed in nature, while different types of exploitation may pose as risks (e.g. sextortion). Among the new concerns that have emerged are the spread of mis- or dis-information (“fake news”) or children acting in peer-to-peer exchanges where their own conduct can make them vulnerable (conduct risks).
The Revised Typology of Risk further identifies risks that cut across the four risk categories and that have the potential for wide ranging impacts on children’s lives. These are: i) privacy risks; ii) advanced technology risks; and iii) health and wellbeing risks. For example, with the abundance of personal information collected, processed and shared through advanced technologies such as artificial intelligence and predictive analytics, children’s data may also be used for the purpose of profiling, potentially affecting their fundamental legal rights and freedoms. There is are also emerging concerns about the health and wellbeing effects of the digital technologies, for example, the consequences of screen time on cognitive and social-emotional development, and the effect of social media on mental health.
Source: Children in the Digital Environment: Revised Typology of Risks, (OECD, 2021[284]).
Monitor progress on social inclusion of children with disabilities
Children with disabilities face higher social and environmental barriers to their full participation in society. Given the central role that school plays in children’s lives, the Convention on the Rights of Persons with Disabilities affirms children’s right to access inclusive, quality and free primary education and secondary education on an equal basis with others in the communities in which they live. Access to a local school helps children with disabilities integrate in the community and can also facilitate children remaining living at home with their families. Often children with disabilities need individual assistance to fully participate in a regular classroom. Therefore, to assess how countries' practices are evolving with regards to children with disabilities inclusion in mainstream schools, indicators are needed on the numbers enrolled in mainstream schools and if they are receiving all of the appropriate support.
But at schools and in education are not the only areas in which children with disabilities may face obstacles. Section 5.3 above emphasised the importance of the neighbourhood and the built environment for children’s social and emotional well-being, including access to green space, while earlier chapters stressed the importance of local learning, cultural and leisure facilities (e.g. play parks, recreation centres). Having access to these resources is no less important for children with disabilities than for other children, but they can be excluded due, for example, to the way these facilities and the broader built environment are constructed. Better data on the availability, accessibility and broader inclusiveness of these types of facilities/services – as well as on the accessibility of homes, shops, and community services, more generally – are important for understanding the additional barriers that children with disabilities may face to full participation in society.
Connect the dots: mental health issues, child outcomes and policies
While meeting the needs of children with mental health issues requires the provision of appropriate therapeutic supports, it also requires addressing needs arising in other areas of life, such as in education and physical health. For instance, children with mental health problems often experience difficulties at school. They have on average poorer educational outcomes and are over-represented among early school leavers. Later in life, poor mental health is a barrier to full participation in the labour market (OECD, 2015[285]; OECD, 2018[286]). From a data perspective, breaking this cycle requires the development of indicators comparing educational outcomes such as school drop-out rates, school performance, rates of transition to secondary education or the workforce between children with and without mental health issues.
Some children’s level of mental health difficulties reach the threshold of requiring support from specialised mental health services. However, some children are unable access appropriate services for a variety of reasons: the family may not be aware of existing services, cost is prohibitive, services are inaccessible at a reasonable distance from the family home, or demand for services outstrips supply. In order to develop these services on an appropriate scale, it is necessary to develop information on the coverage of health care services and the different reasons for children in need not being able to access an adequate level of care.
Last but not least, addressing children's mental health problems requires significant public investment to provide supports that are age-appropriate and able to address the different sorts of mental health needs. For policy monitoring purposes, it is then important to measure public expenditure and how it evolves in response to mental health trends. There remain significant methodological challenges in collecting and comparing mental health spending, in particular scope of what services are included, and whether government expenditure or all expenditure is included (Hewlett, 2020[144]).
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Annex 5.A. The Big Five domains of social-emotional development
The Big Five framework is a well-established taxonomy to which essentially all social and emotional skills can be cross-referenced (John, Naumann and Soto, 2008[287]; John and De Fruyt, 2015[15]). This taxonomy provides a simple, parsimonious and organized categorisation of social-emotional development. It is used at the OECD for developing surveys on social-emotional skill development of children, based on the evidence that these domains are predictive of a wide range of later life outcomes including educational success, well-being, health, work performance and social interactions (Chernyshenko, Kankaraš and Drasgow, 2018[23]; John and De Fruyt, 2015[15]; Lippman, 2015[14]; OECD, 2019[288]).
As such, it offers an integrative function, outlining a common, empirically-based framework to a myriad of social and emotional measurable personality characteristics (John, Naumann and Soto, 2008[287]; John and De Fruyt, 2015[15]). The Big Five domains account for personality characteristics which are organised hierarchically, with broad, higher-order characteristics that can be split into narrower, lower-order ones. The Big Five characteristics are widely regarded as providing an optimal balance between conceptual breadth, descriptive specificity, and generalisability across cultures, samples and measures (Chernyshenko, Kankaraš and Drasgow, 2018[23]).
As shown in Annex Figure 5.A.1, each of the five dimensions encompasses a cluster of mutually related social and emotional skills. For example, task performance (conscientiousness) includes self-control, responsibility and persistence, which are all qualities that contribute to performing well. Each skill refers to different behavioural expressions that need to be taken into account in order to have a fair and accurate view on the social-emotional skills that matter.
As illustrated by Annex Figure 5.A.1, the Big Five domains of personality traits are:
Emotional regulation represents the degree to which individuals are able to control their emotional responses as well as the quality of their emotional states in general. Persons with high degrees of emotional stability will show more resilience in stressful situations, will be less likely to experience anger, irritation or sudden changes of mood, and will tend to have a more optimistic view of the world and outlook of the future.
Conscientiousness (task performance) refers to the tendency of individuals for self-controlled, organised, and cautiously planned behaviour, as well as of making persistent and dedicated efforts to achieve personal goals.
Openness to experience (open-mindedness) involves the degree to which people are open to intellectual stimulation in general, as reflected in their intellectual curiosity, imagination, creativity, preference for novelty, and also to self-reflection and self-exploration.
Extraversion (engaging with others) represents the tendency to seek the company of others, to initiate and maintain connections, and to feel comfortable and respected in the presence of others. Extraverted individuals are also more likely to show assertiveness in social situations and provide leadership.
Agreeableness (collaboration) refers individuals tendency to cooperate, maintain positive relations with others, minimise interpersonal conflict and show empathy towards others.
Annex Figure 5.A.1. The Big Five Domains of social-emotional development
Note: Classification of social and emotional skills as operationalised in the OECD Study on Social and Emotional Skills (SSES). The SSES examines 15 skills spread across the “Big Five” domains. Two additional skills (achievement motivation and self-efficacy) are also measured using indices calculated from a selection of items that belong to scales of related skills.
Source: (Kankaraš and Suarez-Alvarez, 2019[289]), “Assessment framework of the OECD Study on Social and Emotional Skills”, OECD Education Working Papers, No. 207, OECD Publishing, Paris, https://dx.doi.org/10.1787/5007adef-en.
Each personality dimension is made up of traits or skills that have a specific role and can be assessed independently. The assessment framework used by the OECD includes 15 social-emotional competencies to measure these five dimensions of personality (Chernyshenko, Kankaraš and Drasgow, 2018[23]; Kankaraš and Suarez-Alvarez, 2019[289]).
Not all personality traits with proven effects on child outcomes fall strictly in this categorisation, however. This is notably the case of individuals’ capacity to question their emotions, attitudes and motivations, an ability that children acquire as they grow up and which involves reflective thinking. Several emotional constructs refer to such human capacity, including the concepts of locus of control, self-confidence, self-esteem, and self-efficacy or having a “growth mind-set”.
Annex 5.B. Overview of data on children’s social and emotional well-being
Data availability for adolescence
Annex Table 5.B.1 provides a mapping of the broad spectrum of the social and emotional outcomes covered by internationally available data for adolescents. The data include information on global satisfaction with life as well as satisfaction by life domains such as health, school life, relationships with parents and teachers, and with what children possess or satisfaction with their physical appearance. The information is supplemented by the affects and feelings that adolescents report experiencing more or less frequently under normal circumstances. Another set of data concerns mental health disorders experienced by adolescents. The first subset includes data on neurodevelopmental and psychological disorders that are part of the data collected in the IHME Global Burden of Diseases on the prevalence of each type of disorder, including those identified as particularly relevant to adolescents (e.g. depression & anxiety, eating disorders, self-harm). The other subset consists of data on subjective health complaints available in the HBSC or PISA surveys, both of which allowing a comparison of the prevalence of these disorders according to different socio-demographic characteristics (see Annex Box 5.B.1 for an overview of social-emotional skills in PISA).
Two data sources relate to substance abuse. HBSC provides information on alcohol abuse, and the use of drugs such as cannabis, while the European School Survey Project on Alcohol and Other Drugs (ESPAD) provides more detailed information on drug use among 15- and 16-year-olds, including use of new psychoactive substances (i.e. painkillers, tranquillisers, sedatives and anabolic steroids). Only European countries are covered by this survey, which has been repeated every four years since 2003.
Finally, the HBSC and PISA data allow us to track important conduct problems through data on bullying, cyberbullying and the involvement of teenagers in physical fights.
Data on adolescents also cover a wide range of social-emotional skills. The PISA data first provide some information on students' emotional reactions to different school-related situations, including:
the anxiety or nervousness felt by a student who has to take an exam or to solve a problem;
students’ sense of efficacy, or competence particularly in the face of adversity;
the feeling a student has when failing to do something;
students’ belief in a growth mind-set, i.e. that someone’s ability and intelligence can develop over time.
School-work conscientiousness is the topic of a block of questions in PISA 2018 surveys to assess students' achievement motivation, perseverance and aptitude to work hard to achieve his or her goal, and his or her perception and attitudes towards competition and cooperation.
The quality of interpersonal relationships established at school, in the family and with peers is the subject of a series of data that look at them from different angles. A first set of data from PISA surveys indicates whether students make friends easily, develop a sense of belonging to the school and are liked by other students, or if, instead, they perceive themselves as outsiders or feel lonely; the HBSC asks adolescents about their perception of the support provided by classmates. HBSC data also provide information on whether young adolescents perceive that their friends really try to help them, that they can count on them when things go wrong, if they had friends with whom they can share their sorrows and joys, and if they can talk to them about their problems.
Another set of questions concern perceived teacher support: PISA data ask students whether they feel listened to, and understood by their teachers, and whether their teacher help them gain confidence; HBSC data provide information on the global perceived level of teacher support.
The quality of the relationship between adolescents and their parents is addressed through various questions. PISA surveys ask students about their perception of their parents' support in school and in gaining self-confidence. In addition, in PISA 2018 parents are asked about whether they are spending time to discuss with their children, and if they are talking about how children do at school, about school work or having discussion about general political and social issues. On the other hand, the HBSC data include information on how easy it is for young adolescents to talk to their mother and father separately about things that really bother them. Young people are also asked also about whether if they perceive that their family really tries to help them, that they can get emotional support from them when they need it, they can talk to their family about problems, and if the family is prepared to help them make decisions.
A novelty of the 2018 wave of PISA surveys in the context of the assessment of global competences was to include some information on adolescents' attitudes towards people having views that they disagree with, as well as their interest in or tolerance of other cultures, and their contact with people from other countries. Students are also asked about their knowledge of major world issues (including climate change, global health (e.g. epidemics), international conflicts, migration, hunger and malnutrition, causes of poverty, and gender equality).
Finally, data from different sources focus on "social" activities which adolescents participate in outside of school. It includes information on whether adolescents participate in domestic work or if they do some kind of paid work such as babysitting or summer jobs. European surveys on living conditions (EU-SILC) also include, in their ad-hoc modules on children, data on whether or not school-aged children can invite friends to play or eat at home, and on their participation in regular leisure activities outside the home.
A few data also exist on adolescents’ participation people in voluntary work and their memberships to group organisations, including sports and recreational organisation; art, music or educational organisations; trade unions, political parties; humanitarian or charitable organisations; environmental organisations. Data on voter turnout can also be used, for example, to compare their participation in elections with that of older generations.
International surveys also look at the use of the internet and social media. PISA 2015 includes questions on current internet use, time spent, and age of first use. The HBSC survey asks teenagers about the use of social media, and in its latest wave about any negative experiences related to social media.
Annex Box 5.B.1. Social-emotional skills in PISA surveys
The Programme for International Student Assessment (PISA) is a triennial survey – since 2000 – that emphasises the functional skills that 15-year-old students have acquired in reading, mathematics and science literacy as they near the end of compulsory schooling. PISA also includes measures of general or cross-curricular competencies, such as collaborative problem-solving.
In recent years, PISA has broadened its scope by assessing a growing set of social and emotional skills. In particular, the latest PISA cycles include scales on various types of academic self-efficacy (belief in one’s ability to successfully complete the task at hand), persistence, intellectual curiosity, meta-cognition, and achievement motivation. In 2015, PISA gathered international evidence on the importance of social and emotional skills, publishing a volume detailing key positive and negative well-being indicators, such as life satisfaction, bullying and anxiety (OECD, 2017[273]). In PISA 2015 Results (Volume III): Students’ Well-Being, the positive characteristics that promote healthy development such as interest, engagement, and motivation to achieve were explored. Moreover, for the first time in 2018, PISA assessed students’ global competence, providing information on their abilities to examine local, global and intercultural issues, understand and appreciate different perspectives and world views, interact successfully and respectfully with others, and take responsible action towards sustainability and collective well-being (OECD, 2019[246]).
Annex Table 5.B.1. International data on adolescents’ social and emotional well-being
Note: “Disaggregation” means that the publicly available data allows for disaggregation by at least basic socio-economic and demographic groups, such as by sex, age, family status, and family income.
Data availability for middle childhood
A much smaller pool of international data exists for children in middle childhood compared to what is available on adolescents (Annex Table 5.B.2). The epidemiological data collected by the Global Burden of Diseases allows, as it does for older children, the prevalence of mental health disorders to be monitored. However, data on the social-emotional well-being of children are less rich than those for adolescents and cover a smaller number of countries. The Children's Words Surveys ask children aged 8, 10 and 12 about their satisfaction with life in general and with particular areas of life. The categorization of life domains considered here is different and more detailed than in the PISA surveys for adolescents. It includes:
Satisfaction with life as a whole, and with time use and free time, health, the way a child looks and body image, and self-confidence.
Satisfaction with family life, the home and the things children have
Satisfaction with the area where children live (including the outdoor environment)
Satisfaction with people who children are living with, in the local area, and with people in general
Satisfaction with what may happen later in life and about children’s preparation for the future
A few other questions aim to capture emotional well-being, including the sense of safety and security in the main places where children live (in the family, school and neighbourhood), as well as questions about emotions experienced in a recent period. Finally, a final set of questions relates to the quality of interpersonal relationships: first, by asking children whether they feel they are listened to and treated fairly by parents, teachers and adults in general. Children are also asked whether they are treated kindly by their friends or whether they sometimes feel left out. Finally, the subjective quality of interpersonal relationships is assessed by asking the child about the time spent talking, learning or having fun with family and friends respectively.
Annex Table 5.B.2. International data on middle-aged children’s social and emotional well-being
Note: “Disaggregation” means that the publicly available data allows for disaggregation by at least basic socio-economic and demographic groups, such as by sex, age, family status, and family income.
Notes
← 1. However, there is evidence linking self-concept content to outcomes, such as in cases where adolescents’ actual self-concepts do not match up to their ideal or desired images of the self (Kuther, 2019[24]).
← 2. Self-concept clarity is often captured through responses to multi-item scales. Examples of items include “My beliefs about myself often conflict with one another” and “In general, I have a clear sense of who I am and what I am” (Campbell et al., 1996[80]).