Contextual Factors of Child Behavioral Health across Developmental Stages

Background and Purpose: Behavioral health issues in children are major public health concerns that have long-term negative consequences for development and health outcomes across the lifetime. Although a large body of evidence suggests that various socio-ecological contexts, such as families, neighborhoods, and schools, impact children's health and wellbeing, little is known about how these contextual factors affect child behavior problems differently at different stages of development. Addressing this knowledge gap is critical for identifying time periods and contexts for optimal intervention to create environments that promote healthy behaviors across different life stages of childhood and adolescence. The study aimed to examine the effects of family (i.e., Adverse Childhood Experiences [ACEs]), neighborhood (i.e., social cohesion, social control, neighborhood poverty), and school (i.e., school connectedness, peer bullying) contexts on child behavior problems across four developmental stages: early childhood (age 3), young school age (age 5), middle childhood (age 9), and adolescence (age 15). .

Methods: The study sample included 4,898 children from the Fragile Families and Child Wellbeing Study data. Dependent variables included child internalizing and externalizing behavior problems, assessed at child ages 3, 5, 9, and 15, using the Child Behavior Checklist. Independent variables included family context (i.e., ACEs) assessed at ages 3, 5, 9, and 15, neighborhood contexts (i.e., social cohesion, social control, neighborhood poverty) assessed at ages 3, 5, 9, and 15, and school contexts (i.e., school connectedness, peer bullying) assessed at ages 9 and 15. Control variables included child sex and race, maternal education and age, and economic hardship at age 3. Path analysis was conducted using Mplus v.8.6.

Results: The path model had an acceptable fit to the data: CFI = .987, TLI = .952, RMSEA = .021, 90% CI [.017, .024], SRMR = .015. At all four developmental stages, ACEs were concurrently associated with internalizing and externalizing behavior problems. Social cohesion, neighborhood poverty, school connectivity, and peer bullying were all significant contextual factors for child behavior problems, although their impact varied depending on the child's developmental stage. Multiple lagged effects were also discovered, with early neighborhood contexts (i.e., ages 3 and 5) and middle childhood school contexts (i.e., age 9) having long-term effects on later behavioral outcomes.

Conclusions and Implications: The findings of this study highlight the importance of multi-level contexts across the social ecology (i.e., family, neighborhood, and school) in blocking the adverse pathways that might lead to externalizing and internalizing behavior problems in children. Our ACEs findings point to the need for the early detection of ACEs and application of a trauma-informed lens to prevent and address child behavior problems. The results of the study also offer practical applications for targeting specific populations, developmental timing, and settings. For example, as our results indicate that both peer bullying and school connectedness during middle childhood have lasting effects on youth behavior problems, targeting this age group via school-based interventions (e.g., bullying prevention programs) may serve as a preventive method to promote positive behavioral functioning in adolescence.