Children vulnerable in early development

Early childhood development (ages 0 to 5) is complex and multi-faceted. Delays in key developmental areas (such as the social, emotional, fine motor, gross motor and cognitive domains) can lead to challenges in learning, social integration, and long-term well-being. Such challenges can also arise from contextual factors, including family dynamics, caregiving environments, socioeconomic conditions, cultural context, and the availability of support services. The two sub-indicators below focus on socio-emotional and behavioural vulnerability. These measures were selected based on existing, nationally comparable data and validated screening tools intended to identify children in early development who may be delayed in the socio-emotional and behavioural domains. However, these sub-indicators do not capture the full complexity of early childhood development and should not be interpreted as comprehensive measures of developmental vulnerability.

• Proportion of children aged 2 to 3 with socio-emotional difficulties.
• Proportion of children aged 4 to 5 by frequency of attentional, emotional or behavioural difficulties.

Over time, additional indicators may be added to capture other aspects of developmental vulnerability, including context-based measures of early childhood development that reflect environmental, social, and structural factors.

This indicator is measured using separate validated tools for each age group.

Proportion of children aged 2 to 3 with socio-emotional difficulties.

This indicator is measured in the Canadian Health Survey on Children and Youth (CHSCY) using the Preschool Paediatric Symptom Checklist (PPSC). The PPSC is a screening tool designed to help identify and assess emotional and behavioural difficulties in children. It covers a broad range of emotional and behavioural difficulties and is meant to provide an assessment of psychosocial functioning.

The PPSC has 18 questions. The PPSC score is calculated by assigning a "0" for each "N=not at all" response, a "1" for each "somewhat" response, and a "2" for each "very much" response and then summing the results. A total score of 9 or greater indicates that a child is at risk and needs further evaluation.

Respondents (person most knowledgeable, typically a parent or guardian) are asked the questions below:

For the following questions, please think about [name of child]'s overall behaviour in general.

These questions are about your child's behaviour. Think about what you would expect of other children the same age and tell us how much each statement applies to your child.

1. Not at all
2. Somewhat
3. Very much

• Does your child seem nervous or afraid?
• Does your child seem sad or unhappy?
• Does your child get upset if things are not done in a certain way?
• Does your child have a hard time with change?
• Does your child have trouble playing with other children?
• Does your child break things on purpose?
• Does your child fight with other children?
• Does your child have trouble paying attention?
• Does your child have a hard time calming down?
• Does your child have trouble staying with one activity?
• Is your child aggressive?
• Is your child fidgety or unable to sit still?
• Is your child angry?
• Is it hard to take your child out in public?
• Is it hard to comfort your child?
• Is it hard to know what your child needs?
• Is it hard to keep your child on a schedule or routine?
• Is it hard to get your child to obey you?

Proportion of children aged 4 to 5 by frequency of attentional, emotional or behavioural difficulties.

This indicator is measured in the Canadian Health Survey on Children and Youth (CHSCY) using the Emotional Behavioural Scale (EBS). The EBS is a list of 25 statements that describe some of the feelings and behaviours of children and youth. A subset of 20 items from the EBS is collected on the CHSCY and used to measure attentional, behavioural, and emotional symptoms. Further research is needed to establish thresholds for the EBS.

Respondents (person most knowledgeable, typically a parent or guardian) are asked the questions below:

Below is a list of statements that describes some of the feelings and behaviours of children and youth. For each statement, please select the response that best describes [name of child] now or within the past 6 months. You may only select one response.

1. Never or not true
2. Sometimes or somewhat true
3. Often or very true

Attentional:

• Can't concentrate, can't pay attention for long/has trouble concentrating or paying attention
• Can't stay seated when required to do so
• Distractible, has trouble sticking to any activity/easily distracted, has difficulty sticking to any activity
• Fails to finish things they start
• Fidgets
• Has difficulty awaiting turn in games or groups
• Impulsive or acts without thinking

Emotional:

• Anxious or on edge
• Feels worthless or inferior
• Finds it hard to stop worrying
• Has trouble enjoying self
• Nervous, high-strung or tense
• Talks/thinks about killing self
• Too fearful or anxious
• Unhappy, sad or depressed

Behavioural:

• Angry and resentful
• Argues a lot with adults
• Blames others for own mistakes
• Easily annoyed by others
• Loses their temper

The first five years of life are foundational for later health, learning, and social outcomes. Early signs of socio-emotional and behavioural challenges may signal the need for additional support and early intervention.

At the same time, vulnerability in early childhood is shaped by structural and environmental conditions. Children in materially and socially deprived communities often face higher risk due to systemic inequities rather than individual deficits alone. Investments in early childhood development can improve health, education, and economic outcomes while reducing long-term inequalities.

Proportion of children aged 2 to 3 with socio-emotional difficulties

Canadian Health Survey on Children and Youth

• Data tables for this indicator will be released in Fall 2026.

Proportion of children aged 4 to 5 by frequency of attentional, emotional or behavioural difficulties

Canadian Health Survey on Children and Youth

• Data tables for this indicator will be released in Fall 2026.

For products related to children vulnerable in early development, including data tables, data visualizations, articles, and other product types, see Analytical releases: Children vulnerable in early development or view all analytical releases.

• Community Action for Prenatal and Child Health Program (Public Health Agency of Canada)
• Healthy Early Years program (Public Health Agency of Canada)
• How healthy are people in Canada (Public Health Agency of Canada)
• Protecting Our Children (Department of Justice Canada)
• The Preschool Pediatric Symptom Checklist (PPSC): Development and initial validation of a new social/emotional screening instrument (National Library of Medicine)