Study Results: Child Development
Explore research on child and youth development from infancy through adolescence.
Featured Publication
How Do Children Develop Over time when They are Born Preterm?
- By 5 years of age, 11% of children were found to be at-risk of a delay in one or more areas of development.
- Children who may benefit from additional support are those who experienced delays either...
- In more than two areas of development
- Over a number of years
Risk and protective factors in early child development
Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modelling. Protective factors for child development in ‘at risk’ family environments were identified using bivariate analyses.
At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in ‘at risk’ environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction.
Conclusion: The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health, and through normalizing engagement with low cost, accessible community resources that can support parent-child interaction.
Risk factors for delayed social-emotional development and behavior problems at age two
Mothers completed five comprehensive questionnaires spanning mid-pregnancy to 2 years postpartum. At child age two, behavior and competence outcomes were measured using the Brief Infant‐Toddler Social and Emotional Assessment.
Risk factors for possible delayed social‐emotional development in children included maternal depression at 2 years postpartum (OR 2.46, 95% CI 1.63, 3.72), lower parenting self‐efficacy at 2 years postpartum (OR 2.76, 95% CI 1.51, 5.06), non‐daily play‐based interaction when child was 1 and 2 years old (OR 1.43, 95% CI 1.02, 1.99), child delayed sleep initiation at 2 years of age (OR 1.58, 95% CI 1.05, 2.37), and playgroup non‐attendance between 1 and 2 years postpartum (OR 1.43, 95% CI 1.03, 1.99). Risk factors for possible behavior problems included lower maternal optimism during pregnancy (OR 2.02, 95% CI 1.36, 2.99), maternal depression at 2 years postpartum (OR 2.19, 95% CI 1.46, 3.27), difficulty balancing responsibilities at 2 years postpartum (OR 2.32 95% CI 1.55, 3.47), child second language exposure at 2 years of age (OR 1.88, 95% CI 1.37, 2.58), child delayed sleep initiation at 2 years of age (OR 1.55 95% CI 1.06, 2.26), child frequent night wakings at 2 years of age (OR 2.95 95% CI 2.13, 4.10), and more screen time exposure at 2 years of age (OR 1.85 95% CI 1.34, 2.54).
Conclusions: This study suggests that addressing maternal mental health and promoting parenting strategies that encourage play‐based interaction, limiting screen time, preventing sleep problems, and engagement in informal playgroups would reduce the risk of behavior and social‐emotional problems.
Risk and protective factors for externalizing behavior at 3 years
Externalizing behavior was assessed using a short version of the Child Behavior Checklist. Risk and protective factors included the child's characteristics, maternal mental health and disposition, socioeconomic status, and community engagement and child care.
Poor maternal mental health and high levels of maternal neuroticism were associated with an increased risk for externalizing problems at 3 years (AOR, 1.66; 95% confidence interval [CI], 1.16–2.40 and AOR, 2.28; 95% CI, 1.58–3.30). Care by their mother, relative, or a nanny (compared with being in child care) also conferred an increased risk (AOR, 1.38; 95% CI, 1.01–1.90). Mothers' community engagement modified the risk for boys, such that boys whose mothers did not participate in community activities were 4 times more likely to have externalizing problems than boys whose mothers engaged in community activities.
Conclusion: Identification of mothers with mental health challenges or dispositional traits provides the opportunity to promote engagement with parenting supports to improve outcomes of child and family. Providing opportunities for children to practice their self-regulation skills through participation in child care and community activities promotes development and mitigates the risk of externalizing behavior.
Maternal adverse childhood experiences, mental health, and child behaviour at age 3
Links between adverse childhood experiences (ACEs) and threats to health and well-being later in life are well established. The current study extends those findings into younger populations of pregnant women and their children.
Approximately 62% of participants experienced at least one ACE; 25% experienced 3 or more ACEs. The presence of 3 or more ACEs was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms, lower optimism and higher neuroticism, and lower reported parenting morale. In children, 3 or more maternal ACEs was associated with higher levels of internalizing (e.g., anxiety) and externalizing difficulties (aggression and hyperactivity), as well as temperament (surgency and negative affectivity).
Conclusion: Cumulative maternal ACEs are associated with postpartum mental health and parenting morale, as well as maladaptive coping strategies. The downstream consequences of maternal ACEs for child outcomes suggests that early intervention strategies and community resources to improve life course outcomes for parents and children are critical for breaking intergenerational continuities of risk.
2024
Pavlova M, Noel M, Orr SL, Walker A, Madigan S, McDonald SW, Tough SC, Birnie KA. Early childhood risk factors for later onset of pediatric chronic pain: A multi-method longitudinal study. BMC Pediatrics. 2024 Aug 8;24(1):508.. DOI 10.1186/s12887-024-04951-4
Putnam SP, Sehic E, French BF, Gartstein MA, Luttges BL, Tough S, 485 additional partners. The Global Temperament Project: Parent-Reported Temperament in Infants, Toddlers and Children from 59 Nations. Developmental Psychology. 2024 May;60(5):916-941. doi: 10.1037/dev0001732 – International collaboration
2023
Stephenson N, Tough S, Williamson T, McDonald S, McMorris C, Metcalfe A. Early childhood trajectories of domain-specific developmental delay and gestational age at birth: An analysis of the All Our Families cohort. PLOS ONE. (Dec 2023). https://doi.org/10.1371/journal.pone.0294522
Plamondon A, McArthur, BA, Eirich R, Racine N, McDonald S, Tough S, Madigan S. Changes in Children’s Recreational Screen Time During the COVID-19 Pandemic. Jama Pediatrics. 177(6):635-637, April 2023. doi:10.1001/jamapediatrics.2023.0393
Stephenson N*, Metcalfe A, McDonald S, Williamson T, McMorris, Tough S. The association of gestational age at birth with trajectories of early childhood developmental delay among late preterm and early term born children: A longitudinal analysis of All Our Families pregnancy cohort. Paediatric and Perinatal Epidemiology. 23 March 2023. DOI: 10.1111/ppe.12965.
Vinther JL, Cadman T, Avraam D, Ekstrom CT, Sorensen TIA, Elhakeem A, Santos AC, Point de Moira A, Heude B, Iniguez C, Pizzi C, Simons E, Voerman E, Corpeleijn E, Zariouh F, Santorelli G, Inskip HM, Barros H, Carson J, Harris JR, Nader JL, Ronkainen J, Strandberg-Larsen K, Santa-Maria, L, Calas L, Cederkvist, L, Popovic M, Charles MA, Welten M, Vrijheid M, Azad M, Subbarao P, Burton P, Mandhane PJ, Huang RC, Wilson RC, Haakma S, Fernandez-Barres S, Turvey S, Santos S, Tough S, Sebert S, Moraes TJ, Salika T, Jaddoe, VWV, Lawlor DA, Andersen AMN. Gestational age at birth and body size from infancy through adolescence: An individual participant data meta-analysis on 253,810 singletons in 16 birth cohort studies. PLOS Medicine. 26 January, 2023, DOI: 10.1371/journal.pmed.1004036
2022
Ahmed Elhakeem, Taylor AE, Inskip HM, Tough S., et al. Association of Assisted Reproductive Technology With Offspring Growth and Adiposity From Infancy to Early Adulthood. JAMA Network Open. 26 Jul, 2022; 5(7):e2222106. doi:10.1001/jamanetworkopen.2022.22106 Publication attracted 4,037 views within 3 months of publication.
MacKinnon Al*, Sell H, Silang K, Xie EB, Jung JW, Tough S, Tomfohr-Madsen L. Neighbourhood characteristics, lifestyle factors, and child development: Secondary analysis of the All our Families cohort study. Frontiers in Epidemiology. 09Dec, 2022 doi: 10.3389/fepid.2022.1073666
Queenie KWL*, MacKinnon AL*, Tough S, Graham S, & Tomfohr-Madsen L. Does Where You Live Predict What You Say? Associations between Neighborhood Factors, Child Sleep, and Language Development. Brain Sciences. February 2022, 12, 223, DOI: 10.3390/brainsci12020223
McArthur B*, Browne D, Racine N, Tough S, & Madigan S. Screen time as a mechanism through which cumulative risk is related to child socioemotional and developmental outcomes in early childhood. Research on Child and Adolescent Psychopathology. 8 January 2022, DOI: 10.1007/s10802-021-00895-w Online ahead of Print
2021
Scime N*, Hetherington E*, Tomfohr-Madsen L, Nettel-Aguirre A, Chaput K, Tough S. Hypertensive disorders in pregnancy and child development at 36 months in the All Our Families prospective cohort study. PLOS One. Dec 2021, 16(12):e0260590. DOI: 10.1371/journal.pone.0260590
McArthur BA*, Hentges R*, Christakis D, McDonald S, Tough S, Madigan S. Cumulative social risk and child screen use: The role of child temperament. Journal of Pediatric Psychology. August 2021, DOI: 10.1093/jpepsy/jsab087
Hentges RF*, Madigan S, Tough S, McDonald SW, Graham SA. Maternal depressive symptoms and language development: The moderating role of child temperament. Developmental Psychology. 2021 Jun;57(6):863-875. DOI: 10.1037/dev0001184
McArthur B*, Racine N*, Browne D, McDonald S, Tough S, Madigan S. Recreational screen time before and during COVID-19 in school aged children. Acta Paediatrica. June 2021, DOI: 10.1111/apa.15966.
McArthur BA*, Browne D, McDonald S, Tough S, Madigan S Longitudinal Associations Between Screen Use and Reading in Preschool-Aged Children. Pediatrics. June 2021, 147 (6) e2020011429; DOI: 10.1542/peds.2020-011429. Video abstract: https://pediatrics.aappublications.org/content/147/6/e2020011429.
McArthur BA*, Tough S, Madigan S. Screen time and developmental and behavioral outcomes for preschool children. Pediatric Research. 19 May, 2021, 91: 1616–1621, DOI: 10.1038/s41390-021-01572-w
Morin-Lessard E, Hentges RF*, Tough S, Graham SA. Developmental pathways between infant gestures and symbolic actions, and children’s communicative skills at age 5: Findings from the All Our Families Pregnancy Cohort. Child Development. April 2021, 92(3), 799-810. DOI: 10.1111/cdev.13567.
McArthur BA*, Eirich R*, McDonald S, Tough S, Madigan S. Screen use relates to decreased offline enrichment activities. Acta Paediatrica. March 2021, 110(3):896-898. DOI: 10.1111/apa.15601.
2020
McArthur B*, Browne D, Tough S, Madigan S. Trajectories of screen use during early childhood: Predictors and associated behavior and learning outcomes. Computers in Human Behavior. December 2020, 113:106501. DOI: 10.1016/j.chb.2020.106501.
Hetherington E*, McDonald S, Racine N*, Tough S. Longitudinal predictors of self-regulation at school entry: findings from the All Our Families cohort. Children. June 2020, 7(10): 186. DOI: 10.3390/children7100186.
MacKinnon A*, Tough S, Tomfohr-Madsen L. Neighborhood socio-economic factors and associations with infant sleep health. Behavioral Sleep Medicine. May 2020. DOI: 10.1080/15402002.2020.1778478
Hentges RF*, Graham SA, Fearon P, Tough S, Madigan S. The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5. Depression and Anxiety. May 2020, 37(6):576-586. DOI: 10.1002/da.23039.
Shay M, Tomfohr-Madsen L, Tough S. Maternal psychological distress and child weight at 24 months: Investigating indirect effects through breastfeeding in the All Our Families cohort. Canadian Journal of Public Health. March 2020, 111:543-554. DOI: 10.17269/s41997-020-00312-7.
Madigan S, Racine N*, Tough S. Prevalence of preschoolers meeting versus exceeding screen time guidelines. JAMA Pediatrics. January 2020, 174(1): 93-95. DOI: 10.1001/jamapediatrics.2019.4495.
2019
Hentges RF*, Madigan S, Plamondon A, Racine N*, Collisson B, Tough S, Graham S. Heterogeneous trajectories of delayed communicative development from 12 to 36 months: Predictors and consequences. Journal of Developmental & Behavioral Pediatrics. June 2019, 40(5):335-343. DOI: 10.1097/DBP.0000000000000677.
Adhikari K*, Patten S, Williamson T, Patel A, Premji S, Tough S, Letourneau N, Giesbrecht G, Metcalfe A. Does neighbourhood socioeconomic status predict the risk of preterm birth? A community-based Canadian cohort study. BMJ Open. February 2019, 9(e025341): 1-10. DOI: 10.1136/bmjopen-2018-025341.
McNeil DA, Mueller M, MacDonald S*, McDonald S, Saini V, Kellner JD, Tough S. Maternal perceptions of childhood vaccination: Explanations of reasons for and against vaccination. BMC Public Health. January 2019, 19(49): 1-12. DOI: 10.1186/s12889-018-6338-0.
Madigan S, Browne D, Racine N*, Mori C, Tough S. Association between screen time and children’s performance on a developmental screening test. JAMA Pediatrics, January 2019. DOI: 10.1001/jamapediatrics.2018.5056.
2018
Golab BP, Santos S, Voerman E, Lawlor DA, Jaddoe VWV, Gaillard R, MOCO Study Group Authors. Influence of maternal obesity on the association between common pregnancy complications and risk of childhood obesity: an individual participant data meta-analysis. Lancet Child & Adolescent Health. November 2018, 2(1):812-821. DOI: 10.1016/S2352-4642(18)30273-6.
Racine N*, Madigan S, Plamondon A, Hetherington E*, McDonald S, Tough S. Maternal psychosocial risk profiles in pregnancy: Associations with postpartum maternal health and child outcomes. Clinical Psychological Science, August 2018, 6(6): 783-796. DOI: 10.1177/2167702618788863.
Rafferty E, Hetherington E*, Tough S, Aujla S*, McNeil D, Saini V, McDonald S, MacDonald S*. The impact of time since vaccination and study design on validity in parental recall of childhood vaccination status in the All Our Families cohort. Vaccine. May 2018, 36(21): 2953-2959. DOI: 10.1016/j.vaccine.2018.04.045.
Racine N*, Plamondon A, Madigan S, McDonald S, Tough S. Maternal adverse childhood experiences and infant development. Pediatrics. March 2018, 141(2): e20172495. DOI: 10.1542/peds.2017-2495.
Doktorchik C, Premji S, Slater D, Williamson T, Tough S, Patten S. Patterns of change in anxiety and depression during pregnancy predict preterm birth. Journal of Affective Disorders. February 2018, 227: 71-78. DOI: 10.1016/j.jad.2017.10.001.
2017
Tough SC, McDonald SW, Collisson BA, Graham SA, Kehler H, Kingston D, Benzies K. Cohort profile: the All Our Babies cohort (AOB). International Journal of Epidemiology. October 2017, 46(5): 1389-1390k. DOI: 10.1093/ije/dyw363.
Saini V, MacDonald SE*, McNeil DA, McDonald SW, Kellner JD. Edwards SA. Stagg V, Tough S. Timeliness and completeness of routine childhood vaccinations in children by two years of age in Alberta, Canada. Canadian Journal of Public Health. June 2017, 108(2): e124-e128. DOI: 10.17269/cjph.108.5885.
2016
Tomfohr-Madsen L, Bayrampour H*, Tough S. Maternal history of childhood abuse and risk of asthma and allergy in 2-year-old children. Psychosomatic Medicine. December 2016, 78(9): 1031-1042. DOI: 10.1097/PSY.0000000000000419.
McDonald S, Kehler H, Tough S. Protective factors for child development at age two in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort. BMJ Open. November 2016, 6:e012096. DOI: 10.1136/bmjopen-2016-012096.
McDonald S, Kehler H, Bayrampour H*, Fraser-Lee N, Tough S. Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort. Research in Developmental Disabilities. November 2016, 58: 20-30. DOI: 10.1016/j.ridd.2016.08.010.
Pujadas Botey A, Vinturache A*, Bayrampour H*, Breitkreuz R, Bukutu C, Gibbard WB, Tough S. Adults' knowledge of child development in Alberta, Canada: comparing the level of knowledge of adults in two samples in 2007 and 2013. Child Care in Practice. November 2016, 23(4): 404-416. DOI: 10.1080/13575279.2016.1215292.
McDonald S, Ginez H, Vinturache A*, Tough S. Maternal perceptions of underweight and overweight for 6-8 year olds from a Canadian cohort: reporting weights, concerns and conversations with healthcare providers. BMJ Open. October 2016, 6(e012094): 1-8. DOI: 10.1136/bmjopen-2016-012094.
Ballantyne M*, Benzies KM, McDonald S, Magill-Evans J, Tough S. Risk of developmental delay: Comparison of late preterm and full term Canadian infants at age 12 months. Early Human Development. October 2016, 101: 27-32. DOI: 10.1016/j.earlhumdev.2016.04.004.
Richards JL, Kramer MS, Deb-Rinker P, Rouleau J, Mortensen L, Gissler M, Morken NH, Skjaerven R, Cnattingius S, Johansson S, Delnord M, Dolan SM, Morisaki N, Tough S, Zeitlin J, Kramer MR. Temporal trends in late preterm and early term birth rates in six high-income countries in North America and Europe and association with clinician-initiated obstetric interventions. JAMA. July 2016, 316(4): 410-419. DOI: 10.1001/jama.2016.9635.
Pujadas Botey A, Bayrampour H*, Carson V, Vinturache A*, Tough S. Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age. Preventive Medicine Reports. June 2016, 3: 14-20. DOI: 10.1016/j.pmedr.2015.11.012.
Collisson BA*, Graham SA, Preston JL, Rose MS, McDonald S, Tough S. Risk and protective factors for late talking: An epidemiologic investigation. Journal of Pediatrics. May 2016, 172: 168-174.e1. DOI: 10.1016/j.jpeds.2016.02.020.
Vinturache AE*, Chaput KH, Tough SC. Pre-pregnancy body mass index (BMI) and macrosomia in a Canadian birth cohort. Journal Maternal-Fetal & Neonatal Medicine. April 2016, 1-8. DOI: 10.3109/14767058.2016.1163679.
2015
Vinturache AE*, McDonald S, Slater D, and Tough S. Perinatal outcomes of maternal overweight and obesity in term infants: a population-based cohort study in Canada. Scientific Reports. March 2015, 5(9334): 1-6. DOI: 10.1038/srep09334.
2014
McDonald SW*, Kingston D, Bayrampour H*, Dolan SM, Tough SC. Cumulative psychosocial stress, coping resources, and preterm birth. Archives of Women’s Mental Health. December 2014, 17(6):559-568. DOI: 10.1007/s00737-014-0436-5.
Benzies K*, Mychasiuk R, Tough S. What patterns of postpartum psychological distress are associated with maternal concerns about their children’s emotional and behavioral problems at age 3 years? Early Child Development and Care. March 31, 2014, 185(1):1-16. DOI: 10.1080/03004430.2014.899592.
2013
McDonald SW*, Lyon AW, Benzies KM, McNeil DA, Lye SJ, Dolan SJ, Pennell CE, Bocking AD, Tough SC. The All Our Babies pregnancy cohort: design, methods, and participant characteristics. BMC Pregnancy and Childbirth. January 2013, 13(Suppl 1):S2. DOI: 10.1186/1471-2393-13-S1-S2.