Educational level, attention problems, and externalizing behaviour in adolescence – Social causation versus health-related selection

Abstract

Background Social causation and health-related selection may contribute to educational gradients in adolescents’ attention problems (AP) and externalizing behaviour (EB). From past studies it is unclear which of these mechanisms predominates, as AP and EB have the potential to interfere with educational performance, but may also be affected by differences in the educational context. Furthermore, gradients in AP and EB may reflect confounding by stable background characteristics, which are often unmeasured (e.g. genetics). We investigated social causation and health-related selection in the development of educational differences in EB and AP. Methods We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level, EB, and AP at ages around 14, 16, 19, 22, and 26 years. We employed cross-lagged panel models with fixed effects. This novel method allowed to evaluate the directionality in longitudinal associations between education, EB, and AP, whilst simultaneously controlling for time-stable individual differences. Results AP, but not EB, consistently predicted decreases in subsequent educational level throughout all of adolescence and young adulthood. Regarding social causation, only lower education around age 14 predicted increases in AP around age 16, though this effect was not robust in sensitivity analyses. Conclusions AP interfere with educational performance and have the potential to negatively affect adolescents’ educational attainment throughout all phases of adolescence and young adulthood. Key messages Interventions to address the impact of AP on education are necessary in all age groups. Hereby, it is important to take developmental differences into account.