When it comes to children under five, there’s a frustratingly large evidence gap in young children’s mental health. The last dedicated early years mental health survey was in 2017, and we don’t have population-level data for under-5s.
But what we do have is patterns. Research on older children reveals common risk factors among those experiencing mental health difficulties – and many of these risks are identifiable in early years.
In this blog, we’ll share six evidence-based risk factors that help nursery teams spot which children would statistically benefit most from targeted mental health and wellbeing support.
The 6 risk factors for children’s mental health difficulties
The 6 risk factors covered in this blog are those with the most supporting evidence.
While these aren’t a guaranteed outcome, they offer an evidence-based starting point for reviewing how you identify your EYFS groups vulnerable to learning and wellbeing.
We’ve also mentioned ACEs (adverse childhood experiences like trauma, abuse, or household instability) and family history of mental health difficulties as contributing factors.
While harder to quantify, building strong home – nursery relationships helps you track these risks and ensure smooth transitions to school.
Let’s look at the 6 risk factors that often predict mental health difficulties.
1. Poverty
If there’s one thing to take away from this article, it’s this: lower attainment creates mental health difficulties, which further impact learning – a vicious cycle.
Poverty is toxic to children’s mental health, development and achievement. It’s the common and most impactful predictor of all risk factors when it comes to children’s mental health. When other risk factors are paired with poverty, the impact it has on children’s outcomes is significant.
And when children start to stack risk factors: Free School Meal (FSM) eligible, SEND, summer-born boy. The likelihood of achieving expected developmental standards reduce, whilst the likelihood of experiencing mental health difficulties increase.
What we know about poverty and children’s mental health:
- Children from the poorest 20% of families are four times more likely to have serious mental health difficulties.
- At age 2-2.5, children in the most deprived areas are 8% less likely to meet expected development than those in the least deprived areas (ASQ-3).
- By age 5, children eligible for FSM are 29% less likely than their non-FSM peers to achieve GLD.
- Achievement levels at the end of EYFS significantly predicts NEET status (not in employment, education or training) at ages 16-17.
- By age 11, the gap remains wide with a non-FSM child being 48% more likely to achieve expected standard than a child from deprivation, that’s almost 50%!
2. Gender
Boys start behind and stay behind. At age 2-2.5, girls are 11% more likely to meet expected development. By age 5, that gap has widened to 22%. Girls outperform boys in every subject at Key Stage 2 except maths, where boys edge ahead by just one percentage point.
Lower attainment correlates directly with mental health difficulties, so you’d expect boys to have more challenges. But by ages 17-25, young women are twice as likely to have mental health disorders, yet male suicide rates are three times higher. Either boys’ difficulties aren’t being identified, or they’re manifesting differently.
What we know about gender and risks to children’s mental health:
- Boys are 11% less likely to meet expected development at age 2-2.5, widening to 22% less likely to achieve GLD by age 5.
- Boys’ early struggles concentrate in communication and language, fine motor skills, and self-regulation (all crucial for school readiness and emotional wellbeing).
- Among disadvantaged children at age 11, girls are 15% more likely to reach expected standard than boys.
- The educational gender gap that begins at age 2 persists throughout primary education, creating the attainment-mental health link for boys from the very start.
3. Special Educational Needs and Disabilities (SEND)
SEND creates the largest attainment gap of any characteristic, with a powerful connected relationship between SEND, low attainment, and mental health difficulties.
At age 5, children without SEND are 73% more likely to achieve GLD than children with SEND. For children with Education, Health and Care Plans (EHCPs), only 4% achieve GLD.
The relationship is bidirectional (works both ways): children with mental health difficulties at ages 11-14 are 3 times more likely not to achieve expected GCSEs, while educational struggles worsen mental health.
The average age for SEND diagnosis is 9, making it difficult for early years practitioners and families to access support when it’s needed most.
During the early years, the question often sits uncomfortably: is this SEND, or delayed development?
What we know about SEND and risks to children’s mental health:
- SEND creates a 56%-point attainment gap at age 5.
- Social, emotional and mental health (SEMH) needs are the second most common type of SEND, affecting 229,700 children in England.
- SEND prevalence is rising rapidly: from 1.3 million children (2020) to 1.67 million (2024), with EHC plans more than doubling from 2015 to 2024.
4. Speech, Language and Communication Needs (SLCN)
SLCN is a SEND need, but it deserves its own risk factor. SLCN has perhaps the clearest documented trajectory from early years through to adult mental health problems (and it’s deeply intertwined with poverty).
At age 5, 20% of children are not at expected level for communication and language.
The trajectory for achievement and mental health difficulties is strong. Children behind in communication and language at age 5 are six times more likely to be behind in English at age 11, and 11 times more likely to be behind in maths.
But the mental health link is what makes SLCN truly critical. 81% of children with emotional and behavioural disorders have unidentified speech and language needs.
What we know about SLCN and risks to children’s mental health:
- In deprived areas, over 50% of children start school with SLCN, disadvantaged children are twice as likely to have these difficulties.
- Only 15% with SLCN diagnosis go on to achieve grades 9-5 in English and maths at GCSE.
- 81% of children with emotional and behavioural disorders have unidentified SLCN, and 45% of young people in mental health services have significant communication needs.
- The trajectory extends to adulthood: 60% of young offenders and 88% of unemployed young men have speech and language difficulties.
- 80% of health visitors report increases in SLCN post-pandemic.
5. Summer-born children
Being born in August rather than September can seem to create a disadvantage that when combined with other risk factors, impacts achievement.
The gap appears at age 5 and remains virtually unchanged through primary school.
For example, a non-FSM girl born in September has roughly an 88% chance of achieving GLD. Whereas, statistically, a FSM boy born in August? Around 30%.
That means the boy is 66% less likely to achieve GLD due to the risk stack of disadvantage, gender, and birth month.
Mental health difficulties are seen in summer-born boys far more than other birth months, continuing the pattern we have already seen, where the relationship between being summer-born and lower attainment strengthens as children progress through school.
What we know about summer-born children and risks to mental health:
- At age 5, autumn-born children are 24% more likely to achieve GLD than summer-born children (76% vs 61%).
- By age 11, the gap continues: children born in September or October have a 67% estimated chance of meeting expected standard compared to 54% for those born in August.
- Summer-born boys from disadvantaged backgrounds face stacked risk.
6. Ethnicity
Ethnicity doesn’t follow the same clear pattern as other risk factors when it comes to children’s mental health. For most ethnic groups, poverty matters more than ethnicity itself. But when ethnicity combines with deprivation and low attainment, it creates additional barriers to learning and wellbeing.
At age 5, a child in the highest-achieving ethnic group is 228% more likely to achieve GLD than a child in the lowest-achieving ethnic group.
Cultural factors can work both ways. Some communities have strong protective factors – extended family support networks, high educational aspirations, or community values that buffer against poverty’s impact on achievement.
For others, systemic barriers like discrimination, or language barriers compound the effects of deprivation.
Since lower attainment correlates with mental health difficulties, these patterns matter.
What we know about ethnicity and risks to children’s mental health:
- For most ethnic groups, deprivation is the stronger predictor: white children in the most deprived areas achieve 58% GLD compared to 77% in the least deprived.
- FSM-eligible Chinese children at age 11 achieve 71% expected standard, this is higher than the 68% national average for non-FSM children, showing cultural factors can protect against poverty.
- Gypsy, Roma and Irish Traveller children face the most persistent gaps: only 14% of Gypsy and Roma children meet expected standard at age 11 (compared to 62% nationally).
What nurseries can do to support vulnerable children
These patterns aren’t guarantees. A FSM, summer-born boy won’t automatically develop mental health difficulties. But he’s at greater statistical risk, which matters for how you support him.
Ofsted case-samples vulnerable groups as a key inspection activity. What you deem as vulnerable to learning or wellbeing will fit your setting’s context.
Your EYFS vulnerable groups will likely include children with SEND, those eligible for pupil premium, summer-born children, and those with identified PSED or SLCN difficulties.
Regular monitoring of group-specific achievement reports shows whether gaps are closing or widening. If they’re widening, your provision needs to adapt quickly.
There are protective factors your nursery can implement that increase achievement for all children while creating the safe, secure environment vulnerable children particularly need to thrive:
Key protective factors that make a real difference:
- Secure key person relationships– for children experiencing difficult home circumstances, a warm, consistent relationship with their key worker can be the consistency and nurture they need.
- High-quality PSED provision– daily, planned PSED activities to develop self-regulation, manage feelings, and build relationships.
- Early SEND identification– high-quality observation and assessment of PSED, SLCN and Communication and Language, including using external agencies to support.
- Staff CPD training on risk factors– your team needs to understand how the risk factors interact.
- Trauma-informed practice– create a calm, predictable trauma-informed environment with clear routines. Positive behaviour management strategies support the needs whilst unpicking the communication behind the behaviour.
- Family support– signpost families to food banks, benefits advice, speech therapy, and mental health services when needed.
- Robust transitions– share mental health concerns, PSED difficulties, family circumstances and successful strategies when managing EYFS transitions.
- Strong team communication– keep all observations and concerns in one accessible place so everyone working with a child understands their vulnerabilities and the support in place.
The data doesn’t give us certainty, but it does show clear patterns. These risk factors are indicators that help to identify which children are likely to benefit from targeted support.
Early intervention changes trajectories. The relationships your nursery team build, the quality of your PSED provision, and early identification of SEND all impact children’s long-term outcomes.
It’s likely you naturally have protective factors underpinning your EYFS curriculum and provision, your next steps as a nursery leader is to use the ‘why’ shared in this article and be strategic about who needs the support most.
Found this information interesting? Share this article with your nursery practitioners to further explain the important work they do with the children in their care.
Want practical activities to support development across all EYFS areas? We have a bank of EYFS activities to try in your EYFS setting. Pedagogy-backed ideas for Communication and Language, PSED, and building school readiness, helping you support every child, especially those who need it most.
