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J Pediatr. 2015 Aug;167(2):442-8.e1. doi: 10.1016/j.jpeds.2015.04.054. Epub 2015 May 26.

The Influence of Social Disadvantage on Children's Emotional and Behavioral Difficulties at Age 4-7 Years.

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School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Early Childhood and School Education Group, Victorian Department of Education and Training, Melbourne, Victoria, Australia.
School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia.
Dental Health Services Victoria, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.



To examine associations between indicators of social disadvantage and emotional and behavioral difficulties in children aged 4-7 years.


This cross-sectional study was based on data collected in a questionnaire completed by parents of children enrolled in their first year of school in Victoria, Australia, in 2010. Just over 57000 children participated (86% of children enrolled), of whom complete data were available for 38955 (68% of the dataset); these children formed the analysis sample. The outcome measure was emotional and behavioral difficulties, assessed by the Strengths and Difficulties Questionnaire Total Difficulties score. Logistic regression analyses were undertaken.


Having a concession card (a government-issued card enabling access to subsidized goods and services, particularly in relation to medical care, primarily for economically vulnerable households) was the strongest predictor of emotional and behavioral difficulties (OR, 2.71; 95% CI, 2.39-3.07), followed by living with 1 parent and the parent's partner or not living with either parent (OR, 1.93; 95% CI, 1.58-2.37) and having a mother who did not complete high school (OR, 1.27; 95% CI, 1.11-1.45).


These findings may assist schools and early childhood practitioners in identifying young children who are at increased risk of emotional and behavioral difficulties, to provide these children, together with their parents and families, with support from appropriate preventive interventions.

[Indexed for MEDLINE]

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