Internalising problems and engagement among preschool children: trajectories of several functional outcomes in a Swedish longitudinal study

Internalising problems and engagement issues are prevalent among preschool children but often go undetected and untreated. There is a notable lack of longitudinal studies examining their long-term impact on functional outcomes and disability. Further knowledge in this area could support the identification of children at risk and inform the development of targeted interventions. This study aimed to investigate the longitudinal associations between emotional problems and low engagement on functional outcomes, while controlling for potential confounding variables. Preschool teachers assessed a representative cohort of 617 Swedish preschool children (317 boys and 300 girls, aged 24–71 months). The study consisted of three assessment waves. At baseline (Wave 1), teachers provided ratings of children’s emotional problems, engagement levels, and functional outcomes. Functional outcomes were then reassessed at Waves 2 and 3. Baseline emotional problems and low engagement were used to define risk groups. Associations between these baseline risk groups and functional outcomes across waves were analysed using Generalised Linear Mixed Models (GLMMs). In an interaction model, children with both emotional problems and low engagement exhibited the greatest functional outcome improvement over time (b = 0.063; 95% CI [0.038, 0.088] p < 0.001), suggesting potential for developmental catch-up. In a model excluding interaction terms, both emotional problems and low engagement were associated with lower ratings on functional outcomes. Additionally, increasing age, being female, and being a native speaker were associated with higher functional outcomes.