3  Child development and well-being

It is important to have a broad idea of the main causal factors implicated in good and bad outcomes over time in order to be able to design policies and specific interventions which stand a reasonable chance of influencing outcomes positively. A development approach to intervention design involves understanding the stages of child development, what underlies behaviour at each stage and creating age-appropriate interventions.

A number of developmental models try to explain how the way that children develop affects their well-being later in life. An understanding of how children develop is important in identifying how and why individuals differ in terms of well-being and in developing effective interventions. Yet causal pathways are complex and often not well-understood, so that it can be difficult both to identify the causes of adverse outcomes and to devise interventions that address underlying causes. A pragmatic approach to interventions involves identifying those factors that increase or decrease the risk of poor outcomes later in life. This section explores the way child development can affect later well-being and reviews how risk and resilience can be used to identify individuals at risk of adverse outcomes and to target interventions.

3.1  Developmental stages

A developmental or life course approach focuses on the impact of early experiences in childhood on later life and the following generation. It recognises that improving the well-being of children not only helps them immediately, but can also assist them to attain better outcomes later on. A number of adverse outcomes for children and young people have particular importance for later outcomes in adulthood (see Table 5).

Different negative outcomes become apparent at different ages, as the child develops, although they are usually strongly influenced by prior experiences. Interventions to remedy causes of specific adverse outcomes should target behaviours and influences that occur at particular ages. For example, interventions designed to counter negative peer influences are ineffective before adolescence (US Surgeon General 2001).

Recent biological and medical research on brain development and antenatal health confirms the importance of the early years for future outcomes (Tremblay 1999). Cognition, language, literacy, emotional regulation, curiosity, the ability to care for others, creativity, motor skills and so on all derive from the early interaction between a child’s experience, particularly of nurturing and stimulation, and its developing brain (Zuckerman and Kahn 2000). An early history of responsive care-taking and secure relationships with parents reduces the individual’s vulnerability to subsequent environmental threats. Early negative events can cause physiological changes with lasting consequences due to sensitive periods in development when particular skills and abilities are acquired. Adverse health outcomes in infancy and early life (such as low birth weight or developmental delay) are also risk factors for later ill-health (Currie and Hyson 1999). While early childhood is important for human development, subsequent experiences are also important for adult outcomes.

During middle childhood (ages 5 to 11) children move from home into wider social contexts. At the same time they to begin to reason and develop key thinking and conceptual skills and self-awareness. The transition to school plays a critical role in the incubation of pre-existing risk and protective factors in the child, as well as in the development of new ones (Huffman, Mehlinger, Kerivan, Cavanaugh, Lippitt and Moyo 2000b). Children’s competency at school depends on having basic neuro-developmental functions, social skills and emotion regulation capacities. Thus, “school-readiness” (involving the establishment of early literacy foundations, an internal locus of control, self-regulation of one’s own attention, emotions and behaviour, and appropriate social behaviour) is important for enabling a smooth transition into, and success at, school.

The transitions from childhood to adolescence and adulthood are difficult to navigate (CSR Incorporated 1997). Adolescence involves significant biological changes, educational transitions, and psychological shifts that accompany the emergence of sexuality. Most teenagers have newly-granted independence and a desire to test limits, yet they lack information and decision-making skills. Key spheres of influence change as teenagers spend much more unsupervised time with peers and less time interacting with parents. Even more important is the effect of peers on the decisions of young people. Susceptibility to peer influences is highest at around 14 years, and then declines. Adults outside the family, such as teachers, also play an increasingly significant role in young people’s lives. Adolescent cognition transforms from concrete to formal-logical thought that has implications for almost all areas of functioning, including problem-solving, negotiation, performance in academic tests, establishment of identity, and relationships with parents (CSR Incorporated 1997).

While late adolescence and early adulthood are not characterised by the physical changes of childhood and early adolescence, they involve continuing, more subtle, cognitive and social development. For example, young drivers are at greater risk of accidents in part because they still do not have fully developed perceptual and cognitive skills (eg, young drivers are slower to detect hazards while driving and over-estimate their driving skills).

Most individuals seem to engage temporarily in some antisocial or risky behaviour in the transition to adulthood (Fischoff 1992). Risky and antisocial behaviours may be seen as a means of attaining adult status (Moffit 1993). Or it may be that the neurological, hormonal, and cognitive characteristics of adolescence foster both sensation-seeking behaviours and a reduced perception of potential negative consequences of actions, resulting in a temporary increase in risk-taking behaviours (Arnett 1992). Young people also have volatile moods that they find hard to control and which may allow transient emotions to resolve uncertain situations.

Regardless of the causal explanations, a certain amount of experimentation with risky behaviours may be an essential component healthy adolescent experience and development. However, a key issue is to differentiate between temporary, normal antisocial behaviours, and those that may result in a pattern of maladaptive functioning continuing into adulthood (CSR Incorporated 1997, Gruber 2000).