• By Dartington SRU
  • Posted on Saturday 26th May, 2012

The high cost of aggressive preschoolers

It is widely accepted that aggressive behavior in older children and adolescents has a financial impact. Aggressive young people’s delinquency, substance abuse, and unemployment all come at a cost to individuals, families, and society. But what about preschoolers? Raising an aggressive four-year-old might be tough on parents, but is it actually expensive?A recent Dutch study shows just how costly aggressive preschoolers can be, both in their use of services and in their financial impact on parents’ home lives and work lives.Children with high levels of aggression were more costly than children with low levels of aggression. They used health, social, and educational services more often and generated higher services costs. Also, parents of aggressive children in the former group – especially mothers – had more difficulties at work, a harder time with housework, and a harder time including their children in household chores. The Dutch results are based on a cross-sectional study of 317 preschool children who were divided into four groups with different levels of aggression: low, moderate, borderline, and clinical. The study, carried out by researchers at the University of Utrecht, The Netherlands, focused on service use rates, service costs, and family functioning for all four groups of children and their parents. The costs of service use and property damageThe findings are striking. Despite their very young age, aggressive children were already generating higher service costs than their less aggressive peers by the age of four, the researchers found.Children in the clinical group generated more service costs and, compared to the group with a low level of aggression, used services such as medical, mental health, youth services, and educational care more frequently. These trends were similar whether the researchers looked at the previous three months or the previous four years.Over the last three months, children with low levels of aggression cost an average of €167 ($238), due to the higher cost of services – while children with clinical levels of aggression cost €1,035 ($1,478), more than six times as much. Over their four-year lifetime, the difference was less dramatic, although still notable: €817 ($1,167) versus €1,433 ($2,047).Interestingly, although aggressive preschoolers used services more frequently, their parents did not. Parents of aggressive preschoolers “did not seek help or use services more often than parents of children with lower levels of aggression did,” despite the problems their children’s behavior posed in their daily lives. It may be that this is a result of the young age of the children, the researchers suggested, and parents may start to use services more if their children continue to be aggressive as they grow older.There were also costs of property damage. More children in the clinical group had damaged or destroyed objects such as toys, plates, furniture and vases compared to children with lower levels of aggression. However, there were no differences between the groups in terms of the monetary value of the damaged objects or the number of physical injuries caused by the child. Could it be the case that the costs of service use were actually the result of social deprivation, not antisocial behavior? After all, disadvantaged families are more likely to use services, whether or not their children are aggressive. The researchers used the parents’ education levels as a proxy for socio-economic status. They found that the costs did not depend on the educational level of the parents but were “truly costs of antisocial behavior.” They argue that the influence of social status on service costs was much smaller than the influence of aggressive behavior. Taking a toll on working lifeChildren’s behavior problems had other direct costs in the families’ day-to-day lives, both at work and at home. And, on several measures, the impact was greater on mothers than on fathers.Take, for example, the question of employment. The researchers looked at whether parents said they had to work part-time or miss work in order to deal with their children’s behavior problems. They found that the largest number of mothers who were unable to work full-time due to the child’s behavior problems was in the clinical group. But fathers carried on working: “Not one father reported that he was not able to work or had to work part-time due to the child’s aggressive behavior,” the authors reported.Similarly, mothers of children in the clinical group said they had to miss work more often to visit services with their child, compared to mothers of less aggressive children. However, some problems at work applied to fathers as well as mothers. Both mothers and fathers in the clinical and borderline groups were more often needed at home due to their child’s behavior compared to parents in the moderate and low groups. Parents in the clinical and borderline groups also reported “being hampered at work or functioning less optimally” because of their child’s aggression.The costs at homeFamilies with aggressive preschoolers generally got less done at home, took longer to do it, included their child in fewer tasks, and had to recruit more help to keep the household ticking over. Again, mothers bore the brunt.Mothers of children in the more aggressive groups spent more hours on household tasks such as cleaning and cooking than mothers of children in groups with lower levels of aggression. They tended to hire more paid help for household work. And they were much less likely to include their children in household tasks, grocery shopping, and other activities. Fathers of more aggressive children spent more time grocery shopping compared to fathers in the moderate group. They also received more help from relatives or neighbors than fathers of children with low levels of aggression. But there was no difference in the likelihood that they would include their children in household work. Unsurprisingly, a large percentage of both mothers and fathers in the clinical group reported that their child’s aggressive behavior hindered their ability to do the household work.Cost savings start earlyThese findings demonstrate that a high level of aggressive behavior results in high costs and impaired family functioning at an early age – perhaps earlier than previous research would suggest. What are the implications of this finding?The costs of aggressive behavior in young children are already high. If the aggressive behavior continues, the price will rise: educational and mental health services, and dealing with delinquency and crime, are all expensive. The authors suggest that prevention programs aimed at young children may have long-term benefits that result in large savings in the long run. Any caveats to the Dutch study? The researchers note that data on both child behavior and service use was collected from the main caregiver only, usually the mother, and that parents were reporting what they remembered about their service use and family patterns. The sample consisted mostly of boys. Also, parents in this study tended to be highly educated and had children at an older than average age. Further, the authors caution that the findings of this study are applicable to the Dutch health care system and cannot directly be applied to countries with other kind of systems. ReferenceRaaijmakers, Maartje A., Jocelyne A. Posthumus, Ben A. van Hout, Herman van Engeland, and Walter Matthys. 2011. “Cross-Sectional Study into the Costs and Impact on Family Functioning of 4-Year-Old Children with Aggressive Behavior.” Prevention Science. DOI: 10.1007/s11121-011-0204-y.

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