Preventing adverse childhood conditions does not guarantee wellbeing in adulthood

Everyone working with the wellbeing of children and young people seems to agree that early intervention and support should be prioritised. This helps prevent problems from deepening and accumulating later in life.

The aim is to enhance the wellbeing of children and young people in its own right and to prevent the effects of risk factors at a later age. However, this perspective on the lifelong construction of wellbeing is incomplete.

According to life course research, investing in early life stages is not sufficient

The idea of investing in the early stages of life appears very sensible and has also received support from many studies. As a classic example, reference is often made to the research of James Heckman, which emphasises the importance of early investments.

Heckman’s conclusions have also attracted criticism, but among those who cite him there is often, at least implicitly, an idea that if we simply “vaccinate” children against wellbeing problems at a young age, we can achieve a society in which everyone thrives.

However, evidence based on longitudinal studies that follow the same individuals from one life stage to another does not support this view, and Heckman himself has highlighted the importance of continuity in investments.

Childhood conditions are linked to adult wellbeing through complex pathways

Childhood conditions are strongly associated with wellbeing in adulthood, but this does not mean that the elimination of childhood problems would guarantee wellbeing in later life. In other words, there is not necessarily a cause–effect relationship, or causality, between childhood adversity and adult wellbeing.

Life course research examines the mechanisms that explain the links between conditions in childhood and adulthood. We still do not know enough about these mechanisms, but research has shown that adverse childhood conditions do not automatically lead to problems in adulthood. Instead, these associations are often explained by complex pathways involving various factors that operate across different stages of life.

For example, the association between maternal smoking during pregnancy and a child’s increased risk of smoking later in life has been explained through physiological, genetic, behavioral and environmental factors, as well as their interactions. This is good news: chains of risk can be broken – at any stage of life.

There is therefore much that can and should be done to promote wellbeing even after childhood and adolescence.

In search of root causes

Many research projects state that they aim to identify the root causes of wellbeing problems. Once the root causes have been found, it is easy to propose remedies.

The use of the term “root cause” implies an assumption of causality. In practice, however, the relationship between research and causality is often unclear. This ambiguity arises from a tension between, on the one hand, the stringent requirements for research designs that allow causal inference and, on the other hand, the ability of observational studies to measure exposure to risks across the life course.

Randomised controlled trials provide high quality evidence on cause–effect relationships, but they are often poorly suited to studying the role of social factors over the life course. Instead of traditional individual focused longitudinal studies, greater attention should be paid to family based studies, which make it possible to examine both biological factors (genes and their interaction with the environment) and the accumulation of physical and psychological strain within families.

Life course theoretical research at the core of promoting wellbeing

If research on the links between childhood conditions and adult wellbeing ignores the importance of the factors that explain these associations, there is a risk that all resources will be directed towards interventions during pregnancy and early childhood, thereby missing opportunities to support people’s wellbeing later in life as well.

The development of wellbeing is a continuous process in which genetic, environmental and behavioral factors interact, and whose changing nature over time should be taken into account more effectively than at present. Life course theories and research are central when designing policy measures to promote wellbeing.