Better to know where we’re going than only where we are

Enough evidence has accumulated in recent years for it to be widely accepted that the condition of children living in the northern European nations is better in health and development terms than that of children in the UK and across other parts of the continent. [See, for example, Wealth over well-being: UNICEF survey highlights challenges? [1]].

But are things continuing to get better for North Europeans? In the UK where the signs of a deterioration in children’s emotional health and behavior over a 25 year period have been given wide coverage, is there evidence of a continuing slide? [See, for example, UK childhood inquiry highlights the slide toward unhappiness [2]]

These underlying “secular trends” are more difficult to gauge, but the efforts to find out are gradually becoming more coherent.

In the US, for example, Tom Achenbach, the leading developmental scientist and deviser of the widely applied Child Behavior Check List (CBCL), has identified a fluctuating pattern. In Finland, Andre Sourander and colleagues found children’s mental health improved slightly over a decade.

Now two Netherlands studies by Nouchka Tick from the Erasmus MC–Sophia Hospital in Rotterdam have added interesting new pieces to the puzzle.

The first compared the mental health of two samples of Dutch two- and three-year-olds, one assessed in 1989, the other in 2003. The second considered populations of children between the ages of six and 16 assessed in 1983, 1993 and 2003.

Their strength lies in the fact that data were collected using the same measure – the Achenbach CBCL. As Noucha Tick points out in her reports, there are some methodological weaknesses but, with the exception of a significant caveat (given below), none is serious enough to invalidate the results.

She and her colleagues find that there has been no deterioration in the well-being of pre-schoolers. In fact, by one rubric – the assessment of parents – the functioning of very young children in the Netherlands improved between 1989 and 2003.

Among school-age children the results are not so rosy, but nor are they as depressing as the UK data. Between 1983 and 2003 there were small increases in symptoms of mental ill-health, particularly with regard to emotional well-being, but they were offset by an improvement in children’s competence.

The recent data on the younger children provide one of the few sources of good epidemiology on the mental health and behavior of the pre-school age group in wealthy countries. Five per cent of children are displaying sufficient emotional problems to warrant intervention; significant behavior difficulties run to about eight per cent. As might be expected, socio-economic circumstances are a strong predictor of many symptoms of mental ill-health.

So what explains the differences between trends in the UK, US, Netherlands and Finland? As Noucha Tick suggests, one plausible explanation is that the variation in the findings is an artifact of the methods. Since most governments, central or local, remain largely uninterested in trends in the health and development of children, researchers are left to piece together the evidence from less than ideal data.

Another possibility raised in the Dutch studies is that environmental risks are having a different effect on children at different developmental stages. In the Netherlands, the well-being of children pre-school has not greatly altered, but among school-age children there are negative trends.

It might also be the case that macro-environmental conditions are weighing on children’s health and development. Maybe some force at work in UK society is not present to the same extent in Dutch society. Or maybe the Fins have a secret ingredient that better protects their offspring. The need for more and better data on these questions is obvious.

And the caveat to the Dutch studies? The samples of pre-school and school-age children did not include those whose parents could not speak Dutch. At the time, these were mostly poor Turks and Moroccans, who made up over seven per cent of the six- to 16-year-old population.

How the well-being of such children, now such a significant part of most western societies, influences trends for Dutch children is an important question. As is the adjustment of the immigrant child to Western life.

References
Nouchka Tick, Jan van der Ende, Hans Koot and Frank Verhulst, “Fourteen-year changes in emotional and behavioral problems of very young Dutch children”, Journal of the American Academy of Child and Adolescent Psychiatry, 46, 10, 2007, pp 1333–1340.
Nouchka Tick, Jan van der Ende, Hans Koot and Frank Verhulst, “Twenty-year trends in emotional and behavioral problems in Dutch children in a changing society”, Acta Psychiatrica Scandinavia, 116, 2007, pp 473-482.