Psychosocial risks may impair child’s development

Adverse childhood experiences (ACEs), financial needs, and other maternal psychosocial hardships can negatively affect the development of children from vulnerable families in Singapore, according to a study.

“The findings highlight the psychosocial risk profile of the low-income families in Singapore and its impact on child development outcomes,” said lead author Dr Kevin Wei Hao Liang, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore.

“Early targeted interventions such as home visitation are important to reach families who may have difficulties accessing healthcare services due to psychosocial constraints,” he added.

Liang and colleagues performed a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. They then obtained and analysed data on family demographics, maternal psychosocial risks, and outcomes of child development.

The Family and Adult Support Tool (FAST), a multipurpose communicative tool for understanding family needs, was used to assess psychosocial risks. FAST measures the domains of safety concerns, risk behaviours, individual functioning, family functioning, and family strengths, according to the researchers.

Each domain is scored from a level of 0 to 3, where 3 indicates the highest risk. Families in the home visitation programme were rated as “low risk” if risk factors were scored at 0 or 1 only, “moderate risk” for a score of 2, and “high risk” if at least one level-3 risk was found.

A total of 312 families (67 percent) had a moderate or high risk based on FAST. Children from these families achieved poorer Bayley cognitive (mean 95.88 vs 98.44; p=0.014) and language scores (87.38 vs 90.43; p=0.016) at 24 months of age than those from low-risk families. [Ann Acad Med Singap 2024;53:132-141]

Similarly, children of teenage mothers showed lower Bayley cognitive scores (mean 95.16 vs 97.76; p=0.037), while children of mothers with a history of sexual abuse had poorer scores in the Bayley cognitive (mean 93.1 vs 99.7; p=0.013) and language scales (mean 82.3 vs 91.3; p=0.021).

Notably, antenatal enrolment resulted in better child language (mean 90.1 vs 87.13; p=0.04) and motor outcomes (mean 99.62 vs 94.72; p=0.001) compared with postnatal enrolment.

Child abuse

Mothers from this cohort also had a significantly higher proportion of ACEs, particularly for violence, sexual abuse, substance abuse, incarceration, and divorce or separation, when compared with the adult population in Singapore. [Child Abuse Negl 2020;103:104447]

Additionally, previous studies reported the significant association of low income with ACEs and children’s long-term health, developmental, educational, and social outcomes. [Pediatrics 2012;129:e232-246]

“It is the responsibility of every child health worker to advocate for and achieve health equity in the vulnerable population,” Liang said. “As Singapore’s attention shifts from ‘survive to thrive’, and from ‘healthcare to health’, it is pertinent that these families are not left behind.” [Lancet 2021;398:1091-1104]

A 2007 study by Ho and colleagues stressed the need for perseverance in improving the developmental trajectory of children growing up in a difficult environment. [Ann Acad Med Singap 2007;36:898-910]

“A holistic population health approach with inter-professional collaboration within the community is crucial,” Liang said. “We must emphasize positive parenting and strengthen the capacity of parents to fulfil their roles effectively—this will give children a better start in life.” [Ann Acad Med Singap 2009;38:158-162]