Understanding development in the middle years

The following section provides a detailed overview of the major developmental milestones and events taking place throughout middle childhood across each of the five domains of development—cognitive, emotional, social, physical, and communication.

Together, these domains help to paint a picture about what is happening developmentally in the life of a child. It is important to note that each domain describes development under optimal circumstances.

Cognitive development

The cognitive development of children in the middle years can be organized into three different areas:

1. brain development and processing
2. learning and reasoning skills
3. behavioural learning.

Each of these is outlined below.

Brain development and processing

How the brain is changing

A child’s brain develops significantly very early in their lives, and then another burst of development occurs in middle childhood, between the ages of five and nine.^{footnote 18[18]} This launches a period of time when a child’s brain is primed for learning — they have greater adaptability or "plasticity," and are open to change.

Various types of development are taking place during this time. First, the various processing parts of the brain are developing and maturing, starting with those regions that affect vision, hearing, touch and movement. This is followed by the areas related to memory and language, and then by the frontal regions and systems that integrate and process information and support executive functioning.

During these middle years, children’s brains are going through actual physical changes. The outer layer of the brain, the cerebral cortex (often called "grey matter") is thickening and then thinning in specific regions as the brain continues to mature. There are also notable changes in growth patterns at the start of puberty.

While all of this is going on, there is also a great deal of "rewiring" occurring as different areas of the brain become increasingly interconnected and efficient and develop greater processing speed. During puberty, there are also significant changes in brain chemistry. Together, these processes of growth, maturation and change are associated with the development of intelligence, language, memory, visual-spatial, numeracy, literacy, social information processing, response and inhibition skills.^{footnote 19[19]}

Sensory and perceptual abilities

There are differences in the way the brains of adults and children receive and process visual information and the ways in which they understand spatial relationships. There is a transition during the middle years in the sensory and perceptual abilities of children, which is to say how they think and feel about the world. While children younger than six years prefer looking and thinking about things in a detailed, specific way, after the age of six they prefer focusing on the broader, or global, information they see.^{footnote 24[24]}

The ability to organize visual information into meaningful patterns and understand where things are in space improves in middle childhood,^{footnote 25[25]} and two-dimensional visual-spatial functioning becomes fully developed.^{footnote 26[26]} As noted above, there is a thickening in the area of the brain that supports these abilities that occurs sometime between the ages of 10-12 (and generally earlier for girls than boys). By age 12-14, a child’s ability to respond to complex visual tasks is close to that of adults, while the perception of complex visual scenes is still developing.^{footnote 27[27]}

Memory

Significant improvements occur in the memory capacities of children during the middle years. Episodic memory, which is the ability to recall specific events, improves, as does procedural memory, which is the part of long-term memory that stores information on how to perform certain actions and activities, such as walking, talking and riding a bike. Finally, what is referred to as working memory also improves. This is the ability to keep relevant information readily available and apply it to the tasks at hand.^{footnote 28[28]}, ^{footnote 29[29]}

Higher levels of brain functioning

During the middle years, there is a gradual increase in inquiry, investigating, logical thinking and problem-solving. Children are asking more questions, and doing a better job of analyzing the answers. They are occasionally able to think, "what if?" based on concrete life examples.

The thickening of the part of the brain that supports planning, organizing, strategizing, and paying attention peaks at ages 11-12 (earlier for girls). As a result, there is frequently improved behaviour and self-regulation among children in their later middle years.

Learning and reasoning skills

Developing learning strategies

Children in their middle years are gradually becoming better at learning. They develop a number of traits that are useful in the learning process, such as curiosity, creativity, imagination, cooperation, confidence, commitment, enthusiasm, and persistence.^{footnote 30[30] footnote 31[31]} They begin to understand cause and effect. ^{footnote 32[32]} While their ability to pay attention and concentrate on tasks will vary, ^{footnote 33[33]} this is a time when children are becoming more aware of strategies to improve their memory and learning.^{footnote 34[34]} Essentially, they are learning how to learn.

Drawing conclusions and critical thinking

Throughout the middle years, children are increasingly able to collect, organize and integrate information and ideas from various sources. In addition, they are learning to question and predict, examine and analyze opinions, identify values and issues, detect bias and distinguish between alternatives. In fact, they are learning how to think critically about things. The development of these early critical literacy skills means children at this age are able to start to look beyond what is literally said or written, and determine what it actually means.

Behavioural learning

Self-monitoring, behaviour and impulse control

The areas of the brain that regulate impulses are among the last to develop. This stage of brain development during the middle years results in children beginning to experience an increase in self-control. They are better able to pay attention, better able to regulate their emotions, and better able to inhibit impulsive behaviour.

Developing greater self-control tends to provide many benefits to children, including being more successful, getting into less trouble, doing better at school and having an easier time developing friendships. Some children are more susceptible to challenging emotions such as anger or sadness. In some cases, these children will have a harder time developing self-regulation skills. A number of strategies have been identified for helping children learn self-control. Music lessons, learning a second language, aerobic exercise, martial arts and yoga are some of the most popular and effective, as they involve repeated practice and are progressively more challenging. For children that are experiencing significant challenges with self-regulation, a children’s mental health program that focuses on self regulation and the development of social competencies may be helpful. Research has found that children in the middle years are good candidates for learning self-regulation strategies.^{footnote 35[35]}

Please note: Social learning, which is also impacted by changes in the brain, is covered in the section on Social Development.

Decision making and impulse control

In the early middle years, prior to puberty, taking risks is mainly related to a lower understanding of risk and less general impulse control. The ability to make good decisions depends on many factors, including the ability to stay focused and avoid distractions and this improves with maturity. As well, impulse control, anticipation of future consequences, strategic planning and resistance to peer influence all increase with age.

Later in the middle years, children learn how to assess risk, respond to threatening situations and protect themselves from a variety of social issues, such as bullying, violence, substance abuse and technology-related threats.^{footnote 36[36]} They also develop the decision making and communication skills needed to resist pressures to engage in behaviours that can lead to injury or harm. In this period, children may take risks due to a desire for immediate reward and a need to seek out thrills.^{footnote 37[37]} This behaviour is linked to the hormonal changes and resulting brain changes that occur in puberty. This type of behaviour is thought to be more strongly related to puberty than to age.^{footnote 38[38]}, ^{footnote 39[39]}, ^{footnote 40[40]}

The middle years are a key time to reinforce prevention supports. While early adolescents are generally not inclined to participate in risky behaviour, peer pressure can activate and increase activity in the reward regions of the brain and encourage risk-taking.^{footnote 41[41]}, ^{footnote 42[42]} However, children will make fewer risky decisions when a low-risk or cautious peer is present. As well, they tend to make safer decisions when they are with a parent/caregiver or other responsible adult, compared to when they are alone. As children near puberty and adolescence, discussions about wellbeing should begin to include ways that children can protect themselves from potential threats such as cigarette smoking, alcohol and drug consumption and unsafe sexual activity.^{footnote 43[43]}, ^{footnote 44[44]}

Importantly, when children engage in positive social behaviour, such as volunteering, it changes the way their brain reacts in threatening contexts and may reduce risk-taking behaviour. Creating more opportunities for children to engage in positive activities may reduce the feeling of reward they experience in potentially dangerous situations.^{footnote 45[45]}

Risk-taking and safety

Not all risk-taking behaviour is a problem. In many cases, it can help children engage in new behaviours and thereby learn new skills. This type of risk-taking is best undertaken when emotions are not involved, using deliberate, analytical decision making.^{footnote 46[46]} Ensuring children’s safety can be a balancing act for parents and caregivers.

Unsupervised travel and outdoor play benefit children through physical activity and can help them acquire confidence and independence. However, the benefits have to be weighed against concerns about strangers, bullies and traffic. Research has revealed that hyper-parenting—a parenting style in which parents or caregivers are very involved in managing every aspect of their child’s life—can limit physical activity, and when children are closely supervised outside, they are less active.^{footnote 47[47]}

Physical development

Children in the middle years are steadily growing. It is important to remember, however, that physical changes occur at different ages and rates, and can differ greatly among children. This is particularly true between ages 9-12.^{footnote 53[53]}, ^{footnote 54[54]}, ^{footnote 55[55] footnote 56[56]} There is a clear link between good physical health and good physical development during these years, and good nutrition and exercise are critical to children’s overall development.

Growth

During the middle years, most children experience a rapid growth spurt, both in height and weight. For girls, the growth spurt tends to occur between ages 9-13 typically starting at 10 and peaking at 12 years of age. For boys, it generally happens between ages 11-15 with a peak at age 14. During this time, children can grow between five and eight centimetres and gain as much as 2.75 kilograms in a year.^{footnote 56[56]} In general, girls gain more weight and height during this time period than do boys. This growth marks the beginning of adolescence, and sex-related differences start to become more evident.^{footnote 57[57]}

Strength and endurance

In the early middle years, children tend to have limited muscular endurance, and there is no significant difference in the physical abilities of boys and girls. Starting at age seven, children’s muscular strength increases slowly and steadily until age 13 to 14 in boys, and age 12 in girls. Boys, however, also experience an acceleration in strength development during the growth spurt stage that does not occur in girls.^{footnote 58[58]}

It is important to remember that any strength building activities should take into account the readiness of the child’s bones, muscles, nervous system and joints to handle load-bearing exercises.^{footnote 59[59]}

Puberty

Around age seven, the physical precursor to puberty occurs, when genes associated with reproductive behaviour and sexual differentiation are activated and changes to bodily hair, skin and sweat glands begin to occur.^{footnote 60[60]}

In puberty, children undergo a growth spurt, develop gender characteristics, become fertile and experience increased curiosity about human development, including changes in the body. There are changes in both physical appearance and behaviour,^{footnote 62[62]} with increased interest in romantic relationships^{footnote 63[63]} and exploratory behaviour.^{footnote 64[64]} As well, children’s notions of gender and their own gender identity become more solidified.^{footnote 65[65]}

Movement skills

The middle years are a critical phase in the development of motor (movement) skills. These skills are required for more than sports and recreation, and are critical for nearly all physical activities. They should be learned sequentially, based on the characteristics of the child. Skill development is less related to age than it is to growth and physical maturity, and is also associated with the environment in which a child is being raised.^{footnote 66[66]}

Early in the middle years, fundamental movement skills typically improve significantly. These skills include running, jumping, bending, twisting, throwing and kicking, and they should be mastered before children are able to develop more specialized skills. At this stage, children are typically able to perform these skills one at a time, but might have difficulty combining them. Gradually, they learn to combine various motor skills in sequence, and they can adapt them to various physical activities.^{footnote 67[67]} Children with developmental disabilities may develop these skills in a different manner.

Fine motor skills are also developing during this time period.^{footnote 68[68]} Fine motor skills involve the use of the small muscles in the fingers, hand and arm to effectively manipulate tools and materials. Hand-eye coordination is an important component of this development and requires a child to use their vision to control the movements and actions of their small muscles. As children enter the middle years, they continue to enhance their fine motor skills and their drawing, writing, colouring and scissoring skills become more fluid and adept.^{footnote 69[69]}

During the middle years, there is a need for children to become more independent in self-care tasks, productivity and leisure. All of these tasks require the development and application of skilled hand-eye coordination and the ability to use two hands when each hand is doing something different than the other. Examples of self-care skills that are developing during the middle years include:

• dressing independently (doing up zippers, buttons and snaps)
• using forks and knives
• completing morning and evening routines (e.g., tooth brushing)
• tying shoelaces
• managing backpacks and lunch containers
• using scissors
• keyboarding and using a computer mouse
• learning to play a musical instrument
• making art/crafts

Health knowledge and behaviour

Understanding and taking responsibility for good health

It is important for children in their middle years to begin understanding the factors that contribute to healthy growth and development. They also need to start taking responsibility for and playing a role in their own health and wellbeing.

Health literacy

It is important that children have the skills and knowledge that are essential for maintaining and improving their own health. These skills and knowledge are referred to as “health literacy”.^{footnote 70[70]}, ^{footnote 71[71]} As children develop and gain health literacy, they begin making better choices when it comes to food and drink, lifestyle, and safety.

Health literacy includes mental health. Increasing mental health literacy promotes wellness and knowing the signs and symptoms of mental illness. Those with high levels of mental health literacy are better able to identify the strengths and needs in themselves and others and are more equipped and empowered to seek help. In addition, those with high levels of mental health literacy report lower levels of mental health stigma.^{footnote 72[72]}

For children in their middle years, developing health literacy requires support from family, at school and in the community.^{footnote 76[76]} Parents and caregivers, in particular, can support children by modelling healthy choices related to eating, substance use, relationships, personal care, mental health and injury prevention. Families that select foods and prepare healthy meals together help children develop food literacy skills and reinforce healthy eating habits. Likewise, parents and caregivers that acknowledge and care for their own mental health help children to develop positive habits related to their mental wellness.

For Indigenous children, the use of traditional medicine can be a mechanism for wellbeing, and may be used to maintain good health.^{footnote 77[77]} Indigenous ways of knowing include a recognition that achieving balance across spiritual, emotional, physical and social spheres of life is essential to safeguarding health and wellbeing. Indigenous spiritual wellness is grounded in cultural connections, and so for Indigenous children in the middle years, participation in cultural learning and activities can inspire healthy choices and healthier living.

Canada’s Food Guide for First Nations, Inuit and Métis reflects the values, traditions and food choices of Indigenous people. For Indigenous families and communities, sharing food together is an important part of cultural learning and connection. For Inuit children and families, promoting opportunities to access and share country food has been identified as a fundamental component of healthy community development.^{footnote 78[78]}

Participation in physical activity

Children in their middle years need to maintain a healthy, active lifestyle. Most Ontario children in their middle years are not getting the recommended daily physical activity of 60 minutes of moderate to vigorous exercise, as well as vigorous muscle and bone strengthening activities at least three times a week. The need for more physical activity is even more essential for children with physical challenges, illness or disabilities, who may not reach the recommended levels because of their different abilities. It is important that parents, caregivers and other caring adults find ways of making physical activity meaningful and enjoyable for all children in the middle years, as this will increase the chances that they stick with these activities, develop good physical fitness, and remain physically active throughout their life.

Successful efforts to increase physical activity emphasize lifelong physical activity, the benefits of the outdoors and nature, and the importance of relaxation and having fun with family and friends. Ideally, such efforts should emphasize being physically active at various times throughout the day. They should also mix organized and unorganized activities, and address barriers to physical activity, such as the challenges faced by children with special needs.^{footnote 82[82]}

Experience and connection with the natural world provides children with dynamic developmental, social and cultural opportunities. Connection to nature has an impact not only on physical development, but also on social and emotional development. The value of going on the land and having a connection with the natural world and wild spaces has long been recognized by Indigenous cultures, but is equally relevant and beneficial for all children. Studies have shown that spending time in nature helps with recall and memory, problem-solving, and creativity, in addition to the benefits to physical health.^{footnote 83[83]}

For Indigenous children, spending time in the living world, including time with plants and animals and thinking about Creation stories allows the children to emotionally connect with their culture.^{footnote 84[84]}

Parents/caregivers and play

Parents and caregivers have an important role to play in supporting their children’s healthy physical development. Parents and caregivers can increase children’s activity levels by reducing the family’s sedentary time, promoting active play and time outdoors as an alternative to screen time, and planning for and spending time with children in physical activities. Acting as a role model for children is important; children who perceive at least one of their parents or caregivers to be physically active are more likely to meet physical fitness guidelines. The children who are physically active with their families are more likely to continue to be active as adults.^{footnote 85[85]}

Organized play

It has long been recognized that participation in organized sport, recreation and physical fitness yields tremendous benefits. For example, involvement in physical fitness is associated with reduced body fat and a lifetime of exercise and good health.^{footnote 86[86]} Many children in Canada participate in organized sports, with higher participation rates among boys, children with parents/caregivers involved in sports, children in smaller cities or towns, and children of Canadian-born parents and caregivers.^{footnote 87[87]}, ^{footnote 88[88]} Research shows a troubling trend that girls tend to drop out of organized sports and fitness as they get older,^{footnote 89[89]} demonstrating that more work is needed to create and support gender inclusive opportunities for participation.

Nutrition and healthy weights

In addition to physical activity and exercise, good nutrition and a healthy body weight are critical to healthy physical development. Nutrition and healthy weight is supported by access to adequate, affordable, fresh, nutritious food. The effects of unhealthy weights, such as high blood pressure and insulin resistance, can affect children’s cognitive skills, including memory, brain processing speed and verbal skills. There are a number of factors in the physical and social environments of children that can contribute to weight gain. These include poor eating habits and overeating, high-calorie drinks, lack of physical activity, toxic stress, inadequate or poor quality sleep, mental health challenges, too much screen time, and eating away from home.^{footnote 90[90]}

Sleep

There is increasing recognition that the quantity and quality of sleep that middle years children are getting has a great impact on their physical and mental health.^{footnote 91[91]} Ideally, children in the middle years should get nine to 11 hours of uninterrupted sleep per night.

Research indicates, however, that one-third of children have trouble falling asleep and staying asleep at least some of the time, and one-third are classified as sleep deprived.^{footnote 92[92]} Children with histories of stressful or traumatic experiences may have neurologic differences in sensory processing and self-regulation that may cause disturbances in sleep. Also, children with perceptual sensitivities to sound, light, or touch are more likely to have difficulty filtering these out at night. It is also thought that screen time and the presence of screens (e.g., phones) in bed, especially just before bedtime, have contributed to sleep problems. Bedtime access to and use of media devices is associated with an inadequate amount of sleep, poor sleep quality and excessive daytime sleepiness. Children who sleep less also tend to be less active. Conversely, exercise has been found to improve sleep quality.^{footnote 93[93] footnote 94[94] footnote 95[95]}

Body Image

Concern about body image can emerge early in some children. Starting at age six, some children report dissatisfaction with their bodies, and those feelings increase with age. The physical changes in the later part of the middle years have a significant effect on children’s sense of identity and body image.

Children at this age are becoming very aware of what others may be thinking, and as a result, some become more self-conscious about their bodies and how they compare to others. This increases through exposure to age inappropriate sexualized media content which is becoming more available and accessible to children online.^{footnote 96[96]} All of this is happening at a time when children are experiencing a greater need for social acceptance, and some children develop anxiety about being accepted or rejected based on appearance. For girls in particular, interactions with their peers focus more often on appearance and physical comparisons,^{footnote 97[97]}, ^{footnote 98[98]} and girls tend to become more dissatisfied with their bodies than boys.

Unfortunately, teasing about appearance is more common during this period and can have a significant influence on body image. ^{footnote 99[99]}, ^{footnote 100[100]} Poor body image can contribute to depression, low self-esteem, eating disorders, risky sexual behaviour and children representing themselves in age inappropriate sexualized ways to others.^{footnote 101[101]} However, friendships can protect against poor body image,^{footnote 102[102]} and increased physical activity can also help to improve body satisfaction.^{footnote 103[103]}

Emotional development

Over the course of the middle years, children undergo extremely complex emotional development. Their concept of self evolves dramatically, and they develop more complex images of who they are. In addition, their sense of competence—what they believe they are able to achieve—changes significantly. All of this is coupled with their growing understanding of moral behaviour and fairness, and an increased capacity for emotional understanding and expression. It is important to note that how children develop emotionally varies by a child’s circumstances and other influences.

Developing a sense of self and identity

As they progress through the middle years, children gain a greater awareness of how they appear and relate to others, and see themselves with greater complexity — as sons or daughters, friends, students, members of a community, in relation to their culture or areas of personal interest (e.g., arts, athletics). Middle years children also gain greater understanding of their personal attributes and abilities with respect to appearance, behaviour, academics, athletics and social competence. At this stage, the way they see and think about themselves is mainly influenced by parents, caregivers, mentors and cultural role models, although experience at school and with peers can also have an impact.^{footnote 104[104]}, ^{footnote 105[105]} Children at this age are exploring their concept of self and often intersecting identities, including their social identities (e.g., cultural, racial, ethnicity, gender expression) and their personal identities (e.g., preferences, values, beliefs, abilities). Children at this age can be supported to develop respectful and inclusive attitudes about diversity.

In the middle years, children begin to develop the identities and form the behaviours, moral beliefs and values that will come to define them as adults. They are increasingly able to examine themselves inwardly and in the abstract, and have a growing sense of themselves as an independent individual.^{footnote 106[106]}, ^{footnote 107[107]}

Their friendships are increasingly based on compatibility of personal characteristics,^{footnote 108[108]} and interaction with their peers can influence identity formation.^{footnote 109[109]} By age 12, they assess themselves with increasing understanding of the various areas of self-concept (physical appearance, behavioural conduct, academic competence, athletic competence and social competence), and the importance of those areas in their lives.

As they mature into adolescence, children who are racialized, Black, Indigenous, newcomer, from diverse ethnic, religious and varying socio-economic backgrounds and those living with disabilities or special needs, or questioning their gender or sexual orientation, may tend to engage with friends who they relate to, based on a shared sense of identity. It is beneficial for parents to support children’s identity exploration, while supporting a sense of shared belonging in the broader society. Engaged, responsive and supportive families can act as buffers or help children overcome challenges. Supportive families can also nurture children’s self-worth and belief in an inclusive society.^{footnote 110[110]}

Children from equity seeking groups may experience challenges in their identity formation, particularly where their community, school, social or family environment conveys a sense of "other" or being an "outsider," or lack of acceptance regarding that aspect of their identity. Connecting with adults and peers with shared social identities (e.g., LGBTQ2S, Deaf culture, racialized and/or cultural communities) can support children to develop a positive, and more stable sense of identity and community/group belonging.

It is also important that parents, caregivers and other caring adults help middle years children to broaden their identity horizons by having them explore a wide variety of potential future opportunities in the educational, employment and recreational spheres.^{footnote 111[111]}

Cultural identity

For many children, developing a connection to their ethnicity, culture, spirituality or faith supports positive identity development, which continues to evolve over time. Early in the middle years, for example, a child’s feelings and understandings about their culture tend to be oriented to ceremonial practices and food norms. Later in the middle years, these feelings may start to become more abstract and ethically oriented, involving issues associated with cultural beliefs and shared values.

Research has shown that children who feel they belong to a cultural community and understand what membership in that group means to them tend to experience more optimal development.

Children who form strong connections to their cultural groups tend to have better self-esteem, develop better social and behaviour patterns, and experience greater peer acceptance. They also tend to have higher academic motivation and achievement, fewer mental health problems, and take fewer health risks.^{footnote 112[112]} This is particularly important for newcomer children who may be navigating across different cultural contexts. For Indigenous children, immersing in their culture and participating in traditional cultural activities and practices supports the development of pride, identity and spirit, which have far-reaching lifelong impacts.

Families, teachers, school staff, communities, cultural leaders, traditional knowledge keepers and service providers have a role to play to support children who are exploring, building and sharing all aspects of their cultural identities.

Developing a sense of competence

Competence is defined as the ability to do something successfully or efficiently. When we talk about children developing a sense of competence, it is important to understand that we are not talking about them simply "getting good at something." Instead, a sense of competence is children feeling that they are being successful. This is an important distinction, because children develop competencies at their own pace, and according to their own abilities. What is a success for one child may not be a success for another, and that is perfectly acceptable. Competence can be understood subjectively based on culture, context and personal experience. For example, children with disabilities or special needs, children who are newcomers, and children from various cultural communities may have different perspectives on what competence means. These differences should be understood and supported accordingly.

Self-esteem

Children generally enter middle childhood with confidence in their ability to master various tasks, so they have relatively high self-esteem. In fact, at this stage, they are less able to distinguish between their desire to be good at something and their actual competence. This can lead to overestimations of their abilities.

Later in the middle years, children have increasing self-awareness and more ability to view their own qualities relative to others. Due to this, there is a stronger relationship between their sense of what they are able to do, and their actual performance. Their self-assessment and descriptions of themselves begin to reflect these changes.

Self-efficacy

There is growing evidence that it is better for children’s development to raise their sense of competence in specific areas — referred to as "self-efficacy"— than to simply raise their self-esteem. Research suggests that the importance given to self-esteem alone may be overestimated and high levels of self-esteem could have negative effects if it is based on unrealistic feedback. On the other hand, developing self-efficacy involves developing social, physical, educational and other competencies, along with confidence and pride in those abilities.^{footnote 113[113]} Self-efficacy, and not self-esteem, often predicts academic achievement.

Sense of industry

The middle years are a time when children develop greater motivation and readiness to take on new challenges, which is often referred to as a sense of "industry".^{footnote 114[114]}

Supporting children to develop this sense of industry is important. If they believe their efforts influence their own success, it affects their willingness to strive to succeed. Once their efforts contribute to a successful result, it motivates them to try to achieve even more. But children need to believe in their own ability and how they can influence results. If children believe they have failed because they lack ability, they will be less engaged than if they believe they just need more knowledge or practice.^{footnote 115[115]}

Parents/caregivers and others involved in children’s lives can help them build a sense of industry by helping them to focus on setting goals and learning from failure — seeing failure as motivating rather than demoralizing.^{footnote 116[116]}

Parents and caregivers who set high but realistic challenges, and help children through these challenges, can encourage higher levels of industry and self-efficacy. As well, adult endorsement of their abilities can reduce child frustration with failure and promote the expectation of future success.

Moral behaviour and fairness

Moral reasoning and a sense of right and wrong

Moral and ethical development characterizes the middle years,^{footnote 119[119]} Children are developing a greater sense of right and wrong and fairness.^{footnote 120[120]}, ^{footnote 121[121]}

In the early part of the middle years, the moral behaviour of children is shaped by the standards set by adults and the consequences of following or breaking adult rules. Later, children begin to recognize that individuals can have different viewpoints about right and wrong, but they still have difficulty separating their perspective from that of others. For children experiencing developmental delays or who do not have a "neurotypical" brain, such as those on the autism spectrum, moral reasoning can be delayed and/or may not develop along this trajectory.

As they age, children begin to act based on what they perceive will gain them a reward for doing the right thing or will gain them social approval. They begin to understand and adopt the moral standards of adult role models, and their perspectives on social conventions, law, justice and duty all deepen.^{footnote 127[127]}, ^{footnote 128[128]} This is a prime time to engage children in discussions about racism, discrimination, injustice and inequity and empower them to be advocates for themselves, for their peers, and for a more inclusive and equitable society.

Emotional regulation

Emotional understanding and expression

During the middle years, children are learning how to identify, express and regulate their emotions, and they are also developing a greater awareness of the emotions of others. They begin noticing when others are upset. During this stage, children begin developing strategies to manage their own emotions, and also to help others.

Around age seven, children generally become aware that how they think can affect the way they feel. This is the first stage in regulating emotions. Suddenly, they begin to realize that there is a crucial difference between experiencing an emotion and expressing it, and that not all emotions should be expressed externally. By age eight or nine, most children are able to competently regulate their emotions. They are better able to adapt to situations, problem solve and behave appropriately.^{footnote 132[132]}

The onset of puberty brings with it increased emotions and reactions, as well as mood fluctuations and sensitivity to stress that can influence a child’s response to their emotions.^{footnote 133[133]} This is where an ability to control emotions can dramatically affect a child’s future. Greater emotional regulation is related to many critical factors, including better academic performance and learning, increased literacy, more creativity, higher self-esteem, increased ability to cope with stress, and better moral reasoning. In addition, it is related to better social competence, including peer group acceptance, social skills, friendship quality, less loneliness and less bullying.

Supporting children to build skills to manage emotions early can help to support them later on as they navigate the complex world of adolescence and adulthood, and will help them to more effectively navigate the effects of hormonal changes brought on by puberty.

Dealing with stress

High levels of stress, and particularly sustained, chronic stress, can threaten the emotional development of children in the middle years and affect their resilience later in life.^{footnote 137[137]} This kind of stress can negatively affect how the brain is wired, and how it develops in terms of memory, concentration, the filtering of information, processing of emotions and regulation of behaviour. For children who have faced high levels of stress due to factors such as poverty, racism, family conflict, abuse, and trauma, chronic stress can compound other problems. For example, children who experience chronic stress may experience challenges such as hypersensitivity and trouble with paying attention and self-regulation.

Helping children cope with stress can improve their health, mental functioning and academic performance, and also reduce sleeplessness, fatigue, memory and concentration problems, irritability and anxiety. Interventions at an early age are particularly important for children who are highly sensitive to stress and at greater risk for developing mental health challenges. The earlier the intervention takes place, the more positive the outcomes. Techniques such as mindfulness-based approaches, teaching children to build awareness of their thoughts, feelings or perceptions in the present moment, are producing successful outcomes.^{footnote 138[138]}

Key supports for families and children could include safe and affordable housing, basic income supports and affordable and accessible transportation, especially for those in rural and remote communities, to buffer the stresses associated with living in isolated communities.

Social development

During the middle years, children begin taking steps into new social worlds where different types of relationships and influences outside the family home become increasingly important. They enter elementary school and make new friends. They may also join after-school and community-based programs.

This is an important stage for children, and it brings with it increased individual freedoms. There is tension as well, because increased freedom brings new challenges, responsibilities and greater expectations. There are new rules to understand and follow. Children are expected to regulate their behaviour, follow personal conduct guidelines, develop good work habits, sit quietly for longer periods of time, show respect for adults and cooperate with their peers.^{footnote 139[139]}

While children are building new relationships outside the home, they still continue to need the stability and familiarity of caring parents/caregivers at home. They also need dependable other adults, strong attachment to quality schools, access to quality health and mental health services, and safe participation in neighbourhood, school and community activities.^{footnote 140[140]}, ^{footnote 141[141]}

Social competencies

Ability to recognize faces and facial expressions

Throughout the middle years, children become better at remembering unfamiliar faces. They also become very good at differentiating facial features. Although children can identify many intense expressions of emotion by age five (particularly happy faces), they are still prone to misidentifying certain emotions and their ability to identify subtle expressions of emotion is still quite immature. Between the ages of five and 10, their sensitivity to subtle expressions of surprise, disgust and fear improves. After age 10, they become more sensitive to expressions of anger and sadness. Importantly, children who have experienced significant stress or abuse are more likely to misinterpret ambiguous faces as angry, and can experience greater brain responses to angry faces than children who have not had these experiences.^{footnote 142[142]}

Empathy and perspective-taking

Empathy is the ability to understand, at an emotional level, what others are feeling. "Perspective-taking" involves the ability, at a cognitive level, to see situations and events from the point of view of others.^{footnote 143[143]} One of the most significant social developments in middle years children occurs when changes in the brain result in the strengthening of both empathy and perspective-taking.

Children in the early middle years tend to be focused on their immediate reality. As they age, they progressively become less so. In the early middle years, children’s empathetic responses tend to be very emotional. What is lacking, but develops during the middle years, is the kind of cognitive processing that allows them to understand what others are thinking, feeling or intending. This more mature empathic understanding, or "cognitive empathy," involves perspective-taking. Puberty plays an important role in the development of perspective-taking, as the social network of the brain and the way it functions matures. Increased perspective-taking helps to strengthen the networks in the brain that support prosocial (positive, empathic, helpful) behaviour and safe decision-making.^{footnote 145[145]} Children begin to understand that others have different points of view and different knowledge, and that these differences have consequences for their interactions. There is also an emerging ability to engage with others in making agreements and compromises.^{footnote 146[146]}, ^{footnote 147[147]}, ^{footnote 148[148]}

Social connectedness

During the middle years, children develop a sense of belonging — a connectedness to people and places of importance. This begins with parents/caregivers and family, and extends to friends and then out into the community.

Studies show that children who feel disconnected from parents/caregivers, friends or other caring adults in the community have lower optimism, self-efficacy, self-esteem and empathy.^{footnote 149[149]}, ^{footnote 150[150]} On the other hand, children who are socially connected tend to have better relationships with their family and peers. They also have better social skills, better behaviour, higher self-confidence, and they generally develop better academic and leadership skills.^{footnote 151[151]}, ^{footnote 152[152]}, ^{footnote 153[153]}, ^{footnote 154[154]}

Social wellbeing for Indigenous peoples is directly linked to family and extended family and includes the wellbeing of communities.^{footnote 164[164]} Consequently, for Indigenous children, social connectedness is central. For example, relationships among the Inuit are based on mutual interdependence, including collaborative partnerships, extended family kinship patterns and relationships within the immediate family.^{footnote 165[165]}

It is important to note that while the Inuit do not have a clan system and do not come from a "tribe," kinship and community ties are the common form of self-identification.^{footnote 166[166]} There is an interdependence between family and kinship that involves activities such as going on the land together, sharing food together, hunting, camping, spending time with traditional knowledge keepers, making traditional tools, making skin clothing, building igloos, and other Inuit beliefs and customs.^{footnote 167[167]} To the Inuit, "wellbeing is family"^{footnote 168[168]} and families are trusted to determine and shape their own paths forward. There is also the belief that children learn by seeing and doing and this is reflected strongly in Inuit child rearing.

Social responsibility

Middle childhood is also a time when children start to develop a sense of social responsibility. They are learning to contribute and share responsibility in their social and physical environment. They are also learning to treat others fairly, and better understand rights and responsibilities.^{footnote 169[169]}

Indigenous children who experience a sense of belonging and connection with their families (including extended families) and community (including Elders, Senators and traditional knowledge keepers) can develop greater confidence, self-esteem, self-respect, resilience, social relationships and aspirations for the future. This engagement also promotes a sense of collective responsibility and action related to people in their community and the land.

Relationships with family and friends

Parents, caregivers and families

Parents, caregivers and families have an enormous effect on their children’s social, emotional, behavioural and learning development. Children who are more engaged with their families tend to have higher self-worth and social competence, and exhibit fewer antisocial behaviours such as arguing, bullying and conduct problems.^{footnote 170[170]}, ^{footnote 171[171]} Parents and caregivers play an important role in bonding, social buffering and easing stress.^{footnote 172[172]} Regular family dinners have been found to play an important role, and are associated with greater life satisfaction, strong sense of self, a greater willingness to help others and fewer feelings of sadness, anxiousness and loneliness.^{footnote 173[173]}, ^{footnote 174[174]} Experts suggest that dinnertime discussions about personal shortcomings, such as poor grades, should be avoided in favour of more encouraging topics, such as the child’s activities and interests and current events.^{footnote 175[175]} In general, children should be encouraged to interact with the family and to spend limited time alone in their bedroom—and not to have electronics in their bedroom.^{footnote 176[176]}, ^{footnote 177[177]}

It is important that parents and caregivers set high expectations for their children and provide a warm, supporting environment in which children can develop. Parents/caregivers should support their children by taking an interest in their school work and social life, and by encouraging and helping them to develop confidence. Engaging children in activities, such as sports, culture, arts and music, promotes the development of skills and motivation that contribute to the successful transitions from childhood to adulthood.^{footnote 181[181]}

Parents/caregivers can also help children explore their options for the future, and the middle years are a crucial time for that to happen. Canadian studies show that an optimal time for parents and caregivers to begin having career discussions with their children is when they are in Grade five and six. During these discussions, it is important to emphasize the importance of connecting with other people, and making a contribution to society.^{footnote 182[182]}

Developing greater autonomy and independence from the family

As noted earlier, the middle years are a time when children start taking tentative steps toward independence and autonomy. The process of identity building that is occurring during this time involves developing an identity independent from their parents/caregivers, and with that a desire for greater autonomy. By later in the middle years, children increasingly want and are ready for greater independence and responsibilities. This process may be unsettling for parents and caregivers, but is a natural part of the puberty/adolescence evolution that begins to develop in the middle years.^{footnote 183[183] footnote 184[184]} While research shows having greater autonomy supports children’s growth, it also indicates that the amount of autonomy given should align with the child’s level of development.^{footnote 185[185]}

How parents and caregivers respond to this transition is important. The fact that their children are asserting some independence is not an indicator that they should stop being involved, or that their guidance is no longer needed. In fact, children are in a period of identity formation that can lead to conflict and questioning of family rules and roles, and strong guidance is still needed from parents, caregivers and caring adults.^{footnote 186[186]}, ^{footnote 187[187]}, ^{footnote 188[188]} This balance is particularly important for parents and caregivers of children with disabilities. There are many opportunities to promote resiliency and opportunities for autonomy and independence for children with disabilities, and the active exchange between the home and schools and other services is critical.^{footnote 189[189]}

Parent/caregiver involvement remains extremely important and research reveals that parenting style is also critical. Being over- or under-controlling, being too permissive, demanding unquestioning obedience, and giving negative or ambiguous feedback, weak communication and weak affectionate bonding can all threaten healthy identity exploration.^{footnote 190[190]} Parenting style also has an impact on self-consciousness and self-confidence, and behaviour in children.^{footnote 191[191]footnote 192[192]}, ^{footnote 193[193]}, ^{footnote 194[194]}

Experts point to the benefits of "authoritative parenting" that is sensitive to children’s needs and allows for independent problem-solving, critical thinking and proactive exploration of ideas. This parenting style means providing consistent rules and high expectations for behaviour. Research has shown that this will result in better conduct and behaviour, social competence and academic achievement.^{footnote 195[195]}

Other caring adults

As children begin to develop a certain amount of autonomy from their parents/caregivers, they may benefit from the input of other caring adults, which is an important alternative to turning to their peers for guidance.^{footnote 196[196]}< Out-of-school activities and programs play an important role, allowing for greater interaction with other adults in the community.

Friends

Friends play an increasingly important role in the development of a sense of belonging, connectedness and self-worth during the middle years. During this time, children often develop one deep friendship with someone who, in addition to being a playmate, becomes someone of trust and confidence.^{footnote 199[199]} Children who have supportive friends have higher self-esteem, and sharing feelings and experiences with friends can provide emotional support and protection from loneliness and social exclusion.^{footnote 200[200]} Friends also can help to ease stress, which in the middle years is often caused by difficulties with other peers or family members. Strong friendships and peer acceptance are associated with better mental health, social competence, academic performance and physical activity.^{footnote 201[201]}, ^{footnote 202[202]}, ^{footnote 203[203]}

In the early part of the middle years, children have more interactions with their peers, through which they learn to cooperate and develop greater social self-confidence. As children get older, greater priority is given to social activities with their peers. Friendships become increasingly important, and early forms of dating relationships sometimes emerge.^{footnote 204[204]}

Parents and caregivers should be aware that during this time, children are becoming increasingly aware of gender role expectations and stereotypes, and it is important to discuss issues related to the harmful effects of bias, discrimination and stereotypes based on gender, gender identity and power relationships.^{footnote 205[205]}

In early adolescence, peer conformity peaks. The acceptance and approval of peers becomes extremely important to children, and is associated with their sense of self and self-worth. The self-esteem of children at this stage is more closely tied to social acceptance and how they feel about their physical appearance than how confident they are in their cognitive and academic abilities.

For children with disabilities, close peer relationships can be an important source of support. However, children with disabilities may experience greater challenges forming friendships, consequently may have fewer friends, and may experience challenges sustaining friendships.^{footnote 206[206]} Parents, caregivers and other caring adults should look for ways of supporting children with disabilities overcome the barriers to friendship that sometimes exist, such as travel distance to friends, problems with accessibility, or promoting an inclusive, accepting social environment. Parents, caregivers and other caring adults should also be aware that children with disabilities can also be targets of bullying, with an occurrence rate ranging from 25% in elementary school to 34% in middle school (about 1.5 times the national average).^{footnote 207[207]}

Bullying and cyberbullying

On average, it is estimated that 25% of students are involved in bullying as a victim, perpetrator or both.^{footnote 208[208]} As the use of technology increases (up to 97% of children ages 6-17 access the Internet regularly), online harassment and cyberbullying are also becoming more common. Distinct features of cyberbullying believed to increase its risk for harm include the vast potential audience of online content, difficulties with parental supervision of online activity, as well as the "long reach" of technology and nearly unlimited access to victims.^{footnote 209[209]}

Romantic relationships

As children develop through the middle years, they start to understand the difference between friendships and romantic relationships. By age nine, there is increased awareness and thinking about romantic relationships, and between ages 11-14, children become more interested in romance. These interests are often explored during activities such as sports, movies and dances, which allow children the opportunity to explore their emerging romantic feelings in a less awkward manner.

Helping children build healthy and positive, inclusive friendships can support their development of healthy positive romantic relationships later on in life. Research shows that secure, trusting relationships with peers in the middle years are associated with later stability and deeper connection with romantic partners. Children who have positive peer experiences during the middle years are more likely to participate in long-term committed relationships in adulthood.^{footnote 211[211]}

Parents and caregivers have a role to play in helping children develop positive romantic experiences. They should attempt to balance supervision with encouragement of their children’s growing interest in relationships outside the family. It is recommended that parents and caregivers of children in their middle years know about and monitor their social lives and romantic interests, but try to avoid completely restricting romantic activities or prescribing overly strict codes of conduct. However, it is important for parents and caregivers whose children start romantic relationships too early to promote alternatives, such as hobbies and other activities.^{footnote 212[212]} Children with special needs are also developing romantic interests and just like their peers, need help to navigate this new terrain.

Parents, caregivers and other caring adults should be aware that they may face challenges shaped by the nature of their individual abilities and limitations. For example, children with Autism Spectrum Disorder can experience challenges related to understanding social cues and having the interpersonal skills for appropriately expressing romantic interest, initiating dating, and establishing committed and healthy partnerships.^{footnote 213[213]}

Gender identity

Gender identity refers to one’s lived experience of gender, which may be different from their sex assigned at birth. Gender identity can be fluid, and can also shift throughout one’s life. A child may express their gender identity through ways that they act, dress and talk about themselves. Children in the middle years are beginning to explore who they are, and this includes their gender identity. Parents, caregivers and other caring adults can provide support during this period by talking to their middle years children about assumptions regarding gender roles and expectations, and helping them to identify and think critically about gender bias, stereotypes and discrimination. It is important that parents and caregivers let their children determine their own gender identity and expression and that middle years children feel supported in their identities and comfortable expressing who they are and what they feel.

Sexual orientation

Sexual orientation refers to a person’s sense of attraction to people of the same sex, the opposite sex or both sexes. Many suggest that sexuality should be understood as a spectrum rather than categorized with specific labels, especially during identity formation in middle childhood.^{footnote 214[214]}, ^{footnote 215[215]} Indigenous peoples use the term two-spirited to refer to a person having both the feminine and masculine spirits. It includes a broad range of gender and sexual identities. Traditional Indigenous approaches support children’s right to self-determine their gender, dress and define the language around their gender and sexual identities.^{footnote 216[216]} Parents, caregivers and other caring adults can provide support during this period by talking to their middle years children about healthy relationships and more specifically, about homophobia and assumptions with respect to sexual orientation.

Communication development

Language and communication skills increase gradually but significantly during the middle years. This is because children’s comprehension skills are improving, as is their ability to interact effectively in social conversations.

Expression and comprehension

In the early middle years, most children are able to start conversations, listen to others and respond appropriately. They can express ideas and opinions, and use language to ask clarifying questions and persuade others. Importantly, they are learning how to adjust a conversation based on their perception of someone else’s point of view.

By the later middle years, children have improved conversational skills and can participate in a range of social situations. They can start conversations with adults and children they don’t know. They are more able to keep conversations going by giving reasons and explaining choices, and to persuade others by presenting well-formed, convincing arguments for or against an issue. They are also becoming aware of the nuances or shades of meaning that can exist in some conversations, and can analyze information while listening and comparing what they hear to their own knowledge and opinions. They are also better able to use their listening and comprehension skills to decide what is true and what isn’t true.^{footnote 217[217]}

The way children express themselves changes dramatically during the middle years. Hearing children learn to vary volume and intonation patterns to add emphasis and use specific words to signal the beginning and ending of a thought or story. By the end of the middle years, most can speak fluently, using appropriate pitch, volume and pauses for emphasis.

As they get older, children also come to understand how language can change depending on the nature of the relationship between the people talking, and how tone and body language support words that are spoken. They also begin learning how to read social cues, understand social practices related to being polite, and use their language skills to negotiate in situations where there is conflict.^{footnote 220[220]}

Middle years children with hearing, visual or processing differences develop language and communication skills in ways that are tailored to their specific needs, strengths and abilities.

By the beginning of middle childhood, most children have a basic grasp of sentence structure. As they get older, they gain a greater understanding of the complexity and nuance of language. They learn to use comparative words, words expressing certainty such as could and should, and they begin using the passive voice. Between ages 8-10, children generally develop an appreciation for figures of speech, wordplay and jokes that depend on double meanings. By the time they reach 10 years of age, most children can derive the meaning of words they are unfamiliar with by analyzing their component parts.

The middle years is a time when the world of reading and writing becomes clearer to children. They learn how the same word can mean two things and how different words can mean the same thing. They learn how to understand feeling and descriptive words. Their ability to write fluently and express themselves through writing also improves, from better spelling and grammar to writing a short text that expresses what they are thinking.

During this time, the best support for children is to encourage and challenge them. Children’s language skills improve faster if their parents/caregivers engage them in conversation often, use an extensive vocabulary, read to them, and encourage them to express their feelings and ideas. When children share their ideas with their peers, their language skills improve even further.^{footnote 221[221]}

For children with Autism Spectrum Disorder (ASD), communication and social situations present daily challenges. Individuals with ASD experience different degrees of challenges with language and verbal communication. For children on the less severe end of the spectrum, speech skills may not be significantly delayed, and they may be very well spoken in some situations. Children on the more severe end of the autism spectrum, however, may have limited or no development of speech or they may have abnormalities in speech (such as pitch, stress, rate or rhythm).

While children with ASD often understand the words people use, they tend to miss social cues and nonverbal aspects of a conversation—things like facial expressions, voice tones, speed of speech, and gestures that communicate emotion and meaning. Also, some children with ASD may have trouble imagining another person’s point of view.

Expressing feelings and self-regulation

While middle years children are making great strides in acquiring language and learning to communicate, they have not yet fully learned how to express their feelings or talk about things they find upsetting. As such, play and other types of symbolic representation continue to be essential forms of communication in the middle years. For multilingual children, expressing complex thoughts or emotions in a second or subsequent language poses an additional challenge.

Learning how to express feelings has a tremendous impact on a child’s ability to self-regulate. As children become more able to express their feelings and assert themselves, they are less likely to act out their feelings through physical aggression. By encouraging verbal expression, parents and caregivers and others can help children better understand their world and better explain their world to others. This in turn will help children learn to resolve conflicts and regulate impulsive behaviour.

Language and Indigenous children

Language connects children to their culture. As a result, supporting Indigenous language learning is a core goal for many Indigenous communities and families. Indigenous language revitalization is a response to colonial policies which repressed and punished Indigenous language learning in an effort to strip Indigenous children of their cultural, family and community ties.

Some Indigenous language speakers do not speak fluent English or French. This is the experience of some Inuit children and families, who speak Inuktitut and have encountered language barriers when migrating from the north to live in southern communities where English or French are the dominant languages spoken.

Acquiring language and cultural knowledge can give Indigenous children a strong sense of who they are, which can help them to develop resiliency for when they interact outside their communities and attend formal schooling.^{footnote 223[223]} The acquiring of language skills and cultural understanding not only builds self-esteem, it can help Indigenous children in their middle years learn to move across different Indigenous and non-Indigenous cultural contexts.

Historically, many Indigenous cultures were predominantly oral-based, and they have retained this strong tradition of oral storytelling. Indigenous languages also embody core cultural beliefs, Indigenous knowledge and worldviews, and serve as a powerful way to transmit culture. Communitywide activities involving storytelling and dramatic enactments of stories can help children acquire language, as can dramatic play based on Indigenous culture. Where Indigenous knowledge has been integrated into the classroom, student achievement has been shown to improve.^{footnote 224[224]}

Language is not the only method of communication for Indigenous children. Knowledge and cultural expression are also transmitted through mentorship, songs, drumming, dance, and ceremonial activities.^{footnote 225[225]} For Inuit children, body language and gestures are also important and are used to convey meaning.

Language and newcomer children

Newcomer children face specific challenges when it comes to English or French acquisition. Very often, the language they are using in school is a new language, and they are trying to learn this at the same time as they are adapting to a new culture. These children may also be called upon to be a translator for family members. It is important for educators to remember that it may take additional time or be more challenging for newcomer children to master academic concepts while learning these in a new language.

Middle years children experience challenges in expressing complex thoughts and feelings verbally. These challenges are intensified when children attempt to do so in a second or subsequent language. In these cases, it may help to provide opportunities for newcomer children to express complex or challenging thoughts and emotions in their mother tongue, or explore expression through art, play or other types of symbolic representation.

Mental health in the middle years

Maintaining positive mental health and emotional wellbeing is critical to healthy living and involves physical, intellectual, social, emotional, and spiritual wellbeing. Good mental health in children supports their enjoyment of and satisfaction with life and their ability to cope effectively with its challenges, as well as to realize their full potential and be productive.^{footnote 227[227]}, ^{footnote 228[228]} Mental health challenges, on the other hand, can affect children’s productivity and functioning, including their learning, social interactions and lifelong health.

Young people experiencing mental health concerns (from stress to severe mental health problems) or aggressive behaviour are at greater risk for substance abuse, violence and interaction with the justice system.^{footnote 230[230]}Mental health challenges can impact social, behaviour, educational and family functioning. Between 50% and 74% of mental health issues first emerge during the middle childhood years.

Given their prevalence and long-term impact, mental health challenges are one of the leading health problems children face from infancy onwards. Thus, where possible, mental health concerns should be addressed early, rather than when they become more serious later in life. Treatment and services to support children’s mental health include services provided through community- and hospital-based programs, as well as through the child protection, education and youth criminal justice sectors.

Contextual influences

Parenting and mental health

Parenting behaviours and relationships have a significant impact on children’s mental health. Low levels of parental warmth and high parent-child conflict have been associated with risk for bipolar disorder in adolescents. Physical punishment increases the risk for child and adolescent mental health concerns. Inconsistent or ineffective discipline practices have been found to be associated with poor outcomes. A good relationship with parents and caregivers is protective to mental health and wellbeing.

Schools and mental health

School plays a critical role in the mental health and wellbeing of children in their middle years. It is an important environment for children to develop social skills and a sense of belonging. It is also an important place to develop mental health literacy skills, including an understanding of the factors supporting healthy development and the effects of stigmatization and bullying.

Culture

Culture has a major influence on a child’s psychological, emotional, social and cognitive development. Culture can influence how mental health functioning is understood and communicated, and the way that psychological symptoms are expressed.^{footnote 232[232]}

Culture and race may also interact with other factors that impact mental health. For example, racism and poverty increases stress which impacts mental health. Some communities experience lower levels of mental health and wellness, and this is linked to a history of socio-economic disparities, racism and discrimination. Refugee groups overall have been noted to have higher rates of common mental health challenges and post-traumatic stress disorder (PTSD), and immigrant children may be at risk of culture shock. In addition, racialized and newcomer children are less likely to receive the mental health services they need, possibly due to access barriers (e.g., language, proximity, cost and cultural safety), cultural differences in problem recognition, and beliefs about care and stigma related to mental health and treatment.

LGBTQ2S children

Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirited (LGBTQ2S) children and youth often encounter distinct challenges, including bias, discrimination, potential loss of family support, social exclusion, body image issues and harassment. These challenges can contribute to emotional distress, and eventually mental health concerns such as depression and anxiety. LGBTQ2S children and youth experience higher levels of depression and anxiety, have higher levels of suicidal thoughts, are more likely to report self-harm, make more suicide attempts and have significantly higher rates of substance use. It should be noted that these outcomes are less likely in those with supportive and accepting families.^{footnote 233[233]} LGBTQ2S children and youth who face other forms of marginalization, including newcomer and racialized LGBTQ2S children, can experience additional challenges navigating intersecting identities and multiple communities of belonging.