Preschool study on mental health and cognition

Source	Equal-Life Deliverable 1.3: In-depth studies (2024) Kerstin Persson Waye , Maria Klatte,  Natalia Vincens, Dirk Schreckenberg, Dick Botteldooren, Peter Lercher, Angel Dzhambov Jan Spilski,  Larissa Leist, Yun Chen, Sarah Benz and the Equal-Life scientific team.
Level of evidence	Direct
Where	Germany (2x) and Belgium (2x)
Who	111/60(42) 5-7 year old children
Approach	The preschool study aimed to analyse the effects of multiple physical and social risk and protective factors on cognition, academic achievement, well-being and mental health in preschoolers (cross sectional) and on the developmental trajectories during the transition from preschool to primary school (first graders, longitudinal). The aim is also to explore the potential of behavioural and physiological (EEG) measures of children´s hearing and speech processing as early indicators of exposure-related language and literacy problems. The in-depth preschool study is performed by three partner institutions from the Equal-Life consortium: (1) RPTU Kaiserslautern (formerly: TUK), (2) ZEUS, and (3) UGent. Children are recruited at each of two study sites:  Dortmund/ Hagen/ Bochum (Germany), and a wider region around Gent (Belgium). Developmental outcomes and environmental exposures are assessed at two measurement waves: Wave 1: end of final kindergarten year; Wave 2: end of first school year.
Findings	German sample: -        Parental stress was identified as the most important predictor of children´s well-being and mental health problems, followed by parental support. Parental stress turned out to mediate the impact of neighbourhood quality on children’s mental health and well-being both in preschool (cross-sectional) and one year later after the first grade in primary school (longitudinal). -        Lower neighborhood physical and social quality (noise and air pollution, disorder, aesthetics/greenery, social cohesion, safety) was associated with more parental stress and lower parental support. -        Neighborhood quality emerged as a significant predictor of children´s well-being. Total neighborhood quality and its components were significantly related to well-being (i.e., physical well-being, mental well-being, parents/family, peers, well-being in preschool).. -        The SDQ total difficulties score was unrelated to neighborhood quality. -        Language and cognitive outcomes (e.g., speech-in-noise perception, phonological awareness, selective attention) were unrelated to parental stress but were significantly associated with the children´s home literacy environment, maternal education, and child and language spoken at  home -        Neighborhood quality was unrelated to most measures of language/ cognition. -        Cumulative risk analyses consistently confirmed a significant decrease in children´s well-being and language outcomes with increasing number of risks. Modelled noise levels (SDI-3-6, Lnight, Lden) were highly interrelated (all rs > .92) but unrelated to any of the outcomes. Belgian sample: -        Cluster analysis identified three physical exposome clusters related to a combination of neighborhood quality and noise levels (high density, low noise, high density high noise, low density low noise?) and four  outcome clusters (mental health problems, well-being, and cognitive and language outcomes). -        Children grouped in the high density low noise cluster scored low on selective attention and average scores on auditory brainstem response (ABR) and frequency-following response (EFR) and lower scores on signal in noise detection. These patterns were not significant (due to low sample size). Total: -        EEG-data analysis (cross sectional) showed no significant association with the physical exposome components and patterns as expected in young children.
Recommendations	-        Hypothesis-driven longitudinal data analysis have been carried out and are recommended for future research addressing the life course perspective in exposome research and considering children’s varying vulnerability in different developmental stages. -        Larger samples are needed stratified by exposure levels and social economic status -        A broader and more diverse approach is needed which is not restricted by simple “causal” thinking in the exposome approach -        Next to actual exposure perceived exposure, both by parents and the child is highly relevant for children’s mental health. -        Given the many exposome indicators we need to reduce or combine the various indicators in a meaningful way to fully capture the whole picture from the physical, the social and the internal exposome in order to integrate findings for further policy use. -        Supporting children's mental health and lowering the burden of adverse environmental (physical and social) factors requires reducing the environmental stress for the whole family, including all family members (adults, adolescence, children). In other words: “A society that values its children should cherish their parents” (John Bowlby).